Characterization of Sinoatrial Parasympathetic Innervation in Humans

Quan, Kara J.; Lee, Jai H.; Geha, Alexander S.; Biblo, Lee A.; Hare, George F. Van; Mackall, Judith A.; Carlson, Mark D.

doi:10.1111/j.1540-8167.1999.tb00278.x

Cited by 49 publications

(31 citation statements)

References 10 publications

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“…Quan et al (16,17) previously identified and characterized the parasympathetic innervation of the two posterior FPs by applying direct nerve stimulation to both FPs. Nerve stimulation of the right pulmonary vein-atrial FP decreased atrial refractoriness and slowed sinus CL, demonstrating selective innervation to the SA node.…”

Section: Discussionmentioning

confidence: 99%

“…This is consistent with the current understanding of vagal stimulation shortening atrial refractoriness and increasing susceptibility to AF. Additionally, Quan et al (16,17) evaluated atrial refractoriness during nerve stimulation of the posterior epicardial FPs. It was demonstrated that atrial refractoriness decreased in areas of the atria that were densely innervated by parasympathetic nerves.…”

Section: Discussionmentioning

confidence: 99%

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Preservation of the anterior fat pad paradoxically decreases the incidence of postoperative atrial fibrillation in humans

Cummings

Gill

Akhrass

et al. 2004

Journal of the American College of Cardiology

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102

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Preservation of the anterior fat pad paradoxically decreases the incidence of postoperative atrial fibrillation in humans

Cummings

Gill

Akhrass

et al. 2004

Journal of the American College of Cardiology

Self Cite

102

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“…21 Numerous studies have observed multiple major and small GPs in the atria of mammalian hearts. 19,[22][23][24] These GPs modulate the interaction and balance between the extrinsic and intrinsic autonomic nervous system and contain efferent cholinergic and adrenergic neurons which influence the atrial myocardium, 25 in terms of action potential duration, AERP, and conduction velocity. In many animal studies, autonomic denervation exhibited short-term efficacy.…”

Section: Changes In the Electrophysiological Characteristics In The Tmentioning

confidence: 99%

Long-Term Effects of Ganglionated Plexi Ablation on Electrophysiological Characteristics and Neuron Remodeling in Target Atrial Tissues in a Canine Model

Wang

Zou

Zhang

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-The long-term effects of ganglionated plexi ablation on electrophysiological characteristics and neuron remodeling in target atrial tissues remain unclear. Methods and Results-Dogs in group 1 (control, n=8) were not subjected to ganglionated plexi ablation and observed for 1 month, and dogs in groups 2 to 4 (ablation groups, n=8 each) underwent ablation of the right-sided ganglionated plexi and observed for 1, 6, and 12 months, respectively. Atrial electrophysiological characteristics were examined before ablation, immediately and continuously after ablation. Target atrial tissues were subjected to immunohistochemical staining and Western blot analysis. Atrial effective refractory period was significantly prolonged immediately after ablation (P<0.001), and persisted for 1 month (P<0.05). Nerve densities decreased 1 month after ablation (P<0.001). These parameters reverted to preablation levels after 6 and 12 months. In the ablation groups, atrial fibrillation was induced in 5 of 8 dogs after 1 month and in all animals after 6 and 12 months. Atrial fibrillation was not observed in the control group and in the experimental groups immediately after ablation. Moreover, the expression of the growth-associated protein 43 was upregulated after ablation. Conclusions-Ganglionated plexi ablation effectively prolonged atrial effective refractory period for a short period, but the long-term effects on atrial effective refractory period and the suppression of atrial fibrillation induction were not persistent. Targeted atrial neuron remodeling may be an important mechanism underlying the observed electrophysiological changes.

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“…5 This observation is the rationale for implanting vagal nerve stimulator leads in proximity to the left vagus nerve 6 because stimulation of the right vagal nerve might lead to bradycardia. 7 In our patient, the preoperative HR DB and VR, markers of cardiovagal function, were normal. After a surgical procedure involving a tumor that was intimately associated with the right vagus nerve, he developed sinus tachycardia, loss of baroreflex control of heart rate, and right vocal cord paralysis.…”

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confidence: 50%

Reversible right vagal neuropathy

Muppidi¹,

Gupta²,

Vernino³

2011

Neurology

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REVERSIBLE RIGHT VAGAL NEUROPATHYVagus nerve efferent fibers carry the parasympathetic innervation to the heart. The right and left vagal nerve innervation to the heart is believed to be asymmetric, with the right vagal nerve providing most of the parasympathetic innervation to the atria and sinoatrial (SA) node. The left vagal nerve carries parasympathetic innervation to the ventricles. This anatomic and physiologic asymmetry has been studied in animals 1 but not as extensively in humans. Cardiovascular parasympathetic function can be assessed noninvasively by measuring the heart rate variability in response to deep breathing (heart rate deep breathing range [HR DB ]) or heart rate changes during the Valsalva maneuver (Valsalva ratio [VR]). 2 We describe a case of transient right vagal dysfunction and corresponding changes in the cardiovagal function in a patient with a right jugular foramen schwannoma. This report provides additional physiologic data to support the notion that cardiovagal innervation of the SA node comes from right vagus nerve.Case report. A 37-year-old man presented with a history of 3 episodes of syncope over the past 10 years. Results of an extensive cardiac workup were normal. He also noticed occasional difficulty swallowing liquids for the past 2-3 years. Neurologic examination revealed right gaze nystagmus and slight tongue deviation to the right. Results of the rest of the cranial nerve, motor, and sensory examinations were normal. A MRI brain scan revealed an irregularly enhancing mass in the right cerebellopontine and cerebellomedullary cisterns, causing mass effect on the brainstem and a 5-mm shift and distortion of the fourth ventricle without hydrocephalus (figure 1, A and B).As part of evaluation for unexplained syncope, an autonomic reflex screen 3 was performed. Cardiovagal heart rate responses to deep breathing and the Valsalva maneuver were normal ( figure 1, C and D). Beat-to-beat blood pressure changes during the Valsalva maneuver and head-up tilt were normal, indicating normal sympathetic vasomotor reflexes. Preoperative laryngoscopy revealed normal vocal cord movement. The patient went on to have a suboccipital craniotomy and resection of the jugular foramen tumor, which proved to be a schwannoma (figure e-1 on the Neurology ® Web site at www.neurology.org).Immediately after surgery, the patient frequently aspirated when swallowing thicker liquids and required a temporary gastrostomy. His voice became hypophonic and hoarse. Repeat laryngoscopy revealed complete paralysis of the right vocal cord. He also developed unexplained persistent tachycardia with a resting heart rate in the range of 110 -120 beats/min. Repeat autonomic testing revealed a profoundly impaired heart rate response to deep breathing and the Valsalva maneuver (figure 1, E and F) with normal sympathetic vasomotor function. Over the next 4 months, speech and swallowing function gradually improved and tachycardia resolved. Autonomic testing showed normalization of cardiovagal function (figure 1, G and H).Disc...

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Characterization of Sinoatrial Parasympathetic Innervation in Humans

Abstract: Stimulation of parasympathetic nerves that innervate the sinoatrial node shortened atrial refractoriness in humans.

Cited by 49 publications

References 10 publications

Preservation of the anterior fat pad paradoxically decreases the incidence of postoperative atrial fibrillation in humans

Preservation of the anterior fat pad paradoxically decreases the incidence of postoperative atrial fibrillation in humans

Long-Term Effects of Ganglionated Plexi Ablation on Electrophysiological Characteristics and Neuron Remodeling in Target Atrial Tissues in a Canine Model

Reversible right vagal neuropathy

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