Morphology, distribution, and variability of the epicardiac neural ganglionated subplexuses in the human heart

Mapping of Atrial Repolarization Changes and Tachyarrhythmia Sites of Origin During Activation of Mediastinal Nerve Inputs to the Intrinsic Cardiac Nervous System

“…Chronotropic (sinus node), dromotropic (atrioventricular [AV] node) or hypotensive "vagal responses" elicited by high frequency stimulation have been employed to identify neural atrial targets for ablation [1,2,4,5]. Alternatively, extensive ablation of putative ganglionated plexus areas has been proposed as a purely anatomical approach [6,7] based on published anatomic data [8,9] and, recently, in combination with high frequency stimulation of selected nerve sites to confirm neural activity [10]. Therefore, there is a need for precise delineation of juxtacardiac nerves involved in the initiation of atrial tachyarrhythmias and clarification of their regional functional influences throughout the atria in relation to tachyarrhythmia sites of origin, beyond chronotropic and dromotropic effects related to sinus node and AV node modulation.…”

“…Regional patterns of efferent neural projections from individual ganglionated plexuses onto the atria have been proposed on the basis of histochemical determinations, e.g. acetylcholinesterase (AChE) staining [9]. However, efferent projection patterns determined on this basis carry uncertain functional significance since the ganglionated plexuses are interconnected [29,30] and, moreover, their cardiac influences are spatially divergent [24].…”

Recent Observations in Mapping of Complex Fractionated Atrial Electrograms in Atrial Fibrillation

“…The cardiac ganglionic plexi (GP) are a collection of autonomic nervous tissues with afferent and efferent sympathetic and parasympathetic fibers [18][19][20][21][22][23]. Six major GPs (Figure 26.2) that may exert influence on the atria are: (i) superior LA; (ii) posterolateral LA; (iii) posteromedial LA; (iv) anterior descending LA; (v) posterior right atrium (RA); (vi) superior RA.…”

“…Ongoing research has identified a close relationship between the location of CFAEs and the GP in animal models [18][19][20][21][22][23]. CFAE targeted ablation may provide a surrogate for modification of the GP if this relationship can be confirmed in humans.…”

Mapping of Atrial Fibrillation: Comparing Complex Fractionated Atrial Electrograms, Voltage Maps, Dominant Frequency Maps and Ganglionic Plexi

“…Six major GP exert influence on the atria. Specifically, these are located: (i) superior and posterior to the left superior pulmonary vein; (ii) posterior and lateral to the left inferior pulmonary vein; (iii) superior and anterior to the right superior pulmonary vein; (iv) posterior and inferior to the right inferior pulmonary vein; (v) between the superior vena cava and the aortic root; and (vi) at the junction between the inferior vena cava and both atria [41,42]. Of these, the four left-sided GP are often targeted for ablation.…”