Left-insular cortex lesions perturb cardiac autonomic tone in humans

Abstract

The insular cortex is involved in cardiac regulation. The left insula is predominantly responsible for parasympathetic cardiovascular effects. Damage to this area could shift cardiovascular balance towards increased basal sympathetic tone (a pro-arrhythmic condition) and contribute to the excess cardiac mortality following stroke. Acute left insular stroke increased basal cardiac sympathetic tone and was associated with a decrease in randomness of heart rate variability. In addition, phase relationships between heart rate and blood pressure were disturbed, implying a disruption of oscillators involved in cardiovascular control. The insula appears to be involved in human heart rate regulation and damage to it may encourage a pro-arrhythmic state.

A prominent role for amygdaloid complexes in the Variability in Heart Rate (VHR) during Rapid Eye Movement (REM) sleep relative to wakefulness

“…Moreover, the observations of brain damaged patients confirm the pivotal influence of the insular cortex in cardiovascular regulation (Oppenheimer, 1994;Oppenheimer et al, 1996;Tokgozoglu et al, 1999). The insular cortex is implicated in the generation of cardiac arrhythmias following hemispheric stroke (Oppenheimer, 1994).…”

“…We determined the brain areas where the regional blood flow (CBF) was more tightly related to the VHR during REMS than during wakefulness, during SWS than during wakefulness or during SWS than during REMS. We focused on a set of target areas identified as critical in autonomous regulation during wakefulness: the insula (Cechetto and Saper, 1987;Oppenheimer et al, 1992;Oppenheimer, 1994;Corfield et al, 1995;Oppenheimer et al, 1996;Williamson et al, 1997;Critchley et al, 2000), the amygdala (Orem and Keeling, 1980;Sei and Morita, 1996;Critchley et al, 2000), the hypothalamus (paraventricular nucleus) (Hopkins and Holstege, 1978;Coote, 1995;Xia and Krukoff, 2003) and the midbrain (Herbert et al, 1990;Chamberlin and Saper, 1992;Henderson et al, 2002). Other areas more occasionally implicated in heart rate regulation were also considered as potential regions of interest: the hippocampus (Rowe et al, 1999;Ribeiro et al, 2002;Pedemonte et al, 2003), the anterior cingulate cortex (Buchanan et al, 1985;Neafsey, 1990), the ventromedial prefrontal cortex (Buchanan et al, 1985;Neafsey, 1990), the motor cortex (Critchley et al, 2000), the neostriatum (Delgado, 1960;Bradley et al, 1987Bradley et al, , 1991Lin and Yang, 1994;Critchley et al, 2000), the cerebellum (Delgado, 1960;Bradley et al, 1987Bradley et al, , 1991Lin and Yang, 1994;Critchley et al, 2000) and the brainstem areas of the pons and medulla …”

Central periodic breathing during sleep in 74 patients with acute ischemic stroke – Neurogenic and cardiogenic factors

“…Severe cardiovascular and autonomic disturbances have been reported in human and animals in association with insular lesions including stroke, predominantly on the right side [29][30][31][32][33]. Otherwise, left-sided insular strokes lead rather to a disturbed cardioinhibitory/cardioregulatory function with an autonomic shift toward a proarrhythmic condition [29].…”

784. Structural Dysconnectivity of Key Cognitive and Emotional Hubs in Young People at High Genetic Risk for Bipolar Disorder

“…The presence of network disturbances involving both left and right fronto-insular circuits is of particular interest, given the putative left-right hemispheric asymmetry in control of the parasympathetic versus sympathetic system, respectively. [75][76][77] Indeed, disturbances in this left-right balance may yield the pattern of autonomic disturbances often seen in frontotemporal dementia. 78 In this light, bilateral disturbances speak to a 'balanced' interoceptive and autonomic dysregulation in those at HR of BD.…”