title: Integrity of the Ganglionated Plexi Is Essential to Parasympathetic Innervation of the Atrioventricular Node by the Right Vagus Nerve.
abstract: BACKGROUND
  Radiofrequency isolation of pulmonary vein can be accompanied by transient sinus bradycardia or atrioventricular nodal (AVN) block, suggesting an influence on vagal cardiac innervation. However, the importance of the atrial fat pads in relation with the vagal innervation of AVN in humans remains largely unknown. The aim of this study was to evaluate the role of ganglionated plexi (GP) in the innervation of the AVN by the right vagus nerve.
  
  
  RESULTS
  Direct epicardial high-frequency stimulation (HFS) of the GP (20 patients) and the right vagus nerve (10 patients) was performed before and after fat pad exclusion or destruction in 20 patients undergoing thoracoscopic epicardial ablation for the treatment of persistent AF. Asystole longer than 3 seconds or acute R-R prolongation over 25% was considered as a positive response to HFS. Prior to the ablation, positive responses to HFS were detected in 3 GPs in 7 patients (35%), 2 GPs in 5 patients (25%), and one GP in 8 patients (40%). After exclusion of the fat pads, all patients had a negative response to HFS. All the patients who exhibited a positive response to right vagus nerve stimulation (n = 10) demonstrated negative responses after the ablation.
  
  
  CONCLUSIONS
  The integrity of the GP is essential for the right vagus nerve to exert physiological effects of on AVN in humans.
authors.affiliation: Université catholique de Louvain, CHU UCL Namur, Département de médecine, Service de cardiologie, Unité de rythmologie, Yvoir, Belgium.
authors.forename: Olivier
authors.initials: O
authors.lastname: Xhaet
authors.affiliation: Université catholique de Louvain, CHU UCL Namur, Département de médecine, Service de cardiologie, Unité de rythmologie, Yvoir, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: DE Roy
authors.affiliation: Université catholique de Louvain, CHU UCL Namur, Département de médecine, Service de cardiologie, Unité de rythmologie, Yvoir, Belgium.|Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.
authors.forename: Mariana
authors.initials: M
authors.lastname: Floria
authors.affiliation: Université catholique de Louvain, CHU UCL Namur, Département de médecine, Service de cardiologie, Unité de rythmologie, Yvoir, Belgium.
authors.forename: Olivier
authors.initials: O
authors.lastname: Deceuninck
authors.affiliation: Université catholique de Louvain, CHU UCL Namur, Département de médecine, Service de cardiologie, Unité de rythmologie, Yvoir, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Blommaert
authors.affiliation: Université catholique de Louvain, CHU UCL Namur, Département de médecine, Service de cardiologie, Unité de rythmologie, Yvoir, Belgium.
authors.forename: Fabien
authors.initials: F
authors.lastname: Dormal
authors.affiliation: Université catholique de Louvain, CHU UCL Namur, Département de médecine, Service de cardiologie, Unité de rythmologie, Yvoir, Belgium.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ballant
authors.affiliation: Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Centre for Cardiovascular Diseases, Brussels, Belgium.
authors.forename: Mark
authors.initials: M
authors.lastname: LA Meir
mesh_terms: D000200:Action Potentials; D000273:Adipose Tissue / Q000601:surgery; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D001283:Atrioventricular Node / Q000294:innervation*; D002304:Cardiac Pacing, Artificial; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005726:Ganglia, Parasympathetic / Q000503:physiopathology* / Q000601:surgery; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D013906:Thoracoscopy; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000503:physiopathology*
keywords: AV node fat pads; atrial fibrillation; autonomic nervous system; ganglionated plexi; parasympathetic system; vagus nerve