Quantitative study of nerves of the human left atrium

Chevalier, Philippe; Tabib, A.; Meyronnet, David; Chalabreysse, Lara; Restier, Lioara; Ludman, Valérie; Aliès, Alexandre; Adeleine, P.; Thivolet, Françoise; Burri, Haran; Loire, R; Laurent, François; Fanton, Laurent

doi:10.1016/j.hrthm.2005.01.022

Cited by 93 publications

(66 citation statements)

References 22 publications

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“…The nerve densities are much more pronounced within 5 mm of the PV–LA junction and are higher in the epicardial surface than in the endocardium. 107,108 These data reveal that the areas of LA endocardial surface most suitable for ANS modification are located in the immediate vicinity of the PV–LA junction. Due to close relationship of the sympathetic and parasympathetic ANS components, it is difficult to perform selective radiofrequency (RF) ablation of a particular part of the ANS, 109 and ablation of these sites can destroy both adrenergic and cholinergic nerves.…”

Section: Section 2: Definitions Mechanisms and Rationale For Af Ablmentioning

confidence: 77%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,769

1,468

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Section: Section 2: Definitions Mechanisms and Rationale For Af Ablmentioning

confidence: 77%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,769

1,468

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“…7,8 Such nerves, which can be identified in humans 9 -11 as well as in canines, 7,8 represent a major route of autonomic neural input to the intrinsic cardiac nervous system, together with nerves coursing along the superior vena cava and the PVs. 12,13 Using multielectrode atrial mapping in the canine heart-a standard model to study the cardiac nervous system that bears good correspondence to human 14,15 -we show that the initial beats of ATs induced when electric stimuli are applied to dorsal mediastinal nerves occur most frequently without any prior neurally induced sinus rate modification and originate from several distinct left atrial locations that include the PV region. We also investigate the proposition that the sites of origin of ATs thus induced are spatially concordant with waveform changes in the repolarization phase of local unipolar recordings.…”

Section: Clinical Perspective On P 520mentioning

confidence: 87%

Atrial Tachyarrhythmias and Repolarization Changes Induced by Discrete Activation of Dorsal Mediastinal Cardiac Nerves in Canines

Cardinal

Armour

Bouchard

et al. 2010

Circ: Arrhythmia and Electrophysiology

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Background-Chronotropic "vagal responses" elicited by high-frequency stimulation have been used to identify atrial targets for ablative treatment of atrial tachyarrhythmias (AT), whereas an anatomic approach consisting of extensive ablation of the ganglionated plexus areas has been proposed as an alternative. Therefore, there is a need for precise delineation of juxtacardiac nerves involved in AT initiation and clarification of their regional influences throughout the atria in relation to AT sites of origin, beyond chronotropic effects related to sinus node modulation. Methods and Results-Unipolar electrograms were recorded from 191 biatrial epicardial sites in 13 anesthetized canines, with concomitant left atrial endocardial recording from 63 sites in 5 of 13 animals. When electric stimuli were delivered to dorsal mediastinal nerves during the atrial refractory period, atrial premature depolarizations initiating AT were elicited in all animals, most frequently without prior sinus cycle length modification. Among 63 episodes, the sites of origin of early AT beats were localized to (1) the posterolateral left atrial wall in the pulmonary vein region (33%), (2) superior left atrial loci along the Bachmann bundle (55%), and (3) the region of Bachmann bundle insertion into the superior right atrial wall (11%). Moreover, the AT sites of origin were spatially concordant with regional waveform changes during the repolarization phase of unipolar recordings. AT induction and repolarization changes were abolished after atropine administration. Conclusions-Activation of individual dorsal mediastinal nerves induces AT arising from distinct sites of origin which are spatially concordant with regional atrial repolarization changes. (Circ Arrhythm Electrophysiol. 2010;3:511-520.)

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“…3,5) Although recent anatomic studies clarified the distribution of the autonomic nerve plexus in the LA and showed that there is a considerably high density of fibers in the left PV-LA junction, 13) Tan et al 8) reported the highest density of adrenergic fibers in the right superior PV and the highest density of cholinergic fiber in the left superior PV. Contrary to the marked decrease of nerve fibers in the posterior wall observed in the present study, Tan et al 8) showed a relatively large number of cholinergic fibers in the posterior wall, particularly in the left and right inferior PVs.…”

Section: Discussionmentioning

confidence: 99%

Arrangement of the Autonomic Nerves Around the Pulmonary Vein-Left Atrial Junctions —Histologic and Immunohistochemical Analyses—

et al. 2006

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Introduction: Imbalanced autonomic activity in the area of the pulmonary veins (PVs) can result in spontaneous atrial fibrillation (AF). Histologic characteristics of the PV sleeve musculature and associated autonomic nerve are not fully understood. We investigated the arrangement of autonomic nerve fibers around PV-left atrium (LA) junctional musculature.Methods: Thirteen autopsied adult hearts (9 men and 4 women; mean age at death, 66.2 years) were studied. The atria were removed from each heart, along with all PV stalks, and cut longitudinally to each PV myocardial sleeve. After treatment with azan-Mallory stain and immunohistochemical staining for S-100 and tyrosine hydroxylase (TH), autonomic nerve distribution was assessed by counting the numbers of TH-positive (adrenergic) and -negative (non-adrenergic) fibers within S-100-positive fibers (>50 mm in diameter) in the anterior, posterior, and septal junctions.Results: TH-positive adrenergic fibers, consisting of sympathetic nerves, were most predominant in the anterior and septal junctions. In the anterior junction, these fibers were packed tightly among myocardial sleeve fascicles. In the posterior junction, the numbers of adrenergic and non-adrenergic fibers were fewer. In the septal junction, the number of THnegative non-adrenergic fibers (predominantly parasympathetic nerves) was greater, concomitant diffuse ganglionic nodule distribution in the interatrial fat pad.Conclusions: In each PV-LA junction, autonomic nerves were localized on the anterior and septal walls. Heterogeneous distribution of TH-positive and TH-negative fibers and ganglion nodules around each PV opening appears to represent the major histologic characteristic in these areas. (J Arrhythmia 2006; 22: 234-241)

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Quantitative study of nerves of the human left atrium

Cited by 93 publications

References 22 publications

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Atrial Tachyarrhythmias and Repolarization Changes Induced by Discrete Activation of Dorsal Mediastinal Cardiac Nerves in Canines

Arrangement of the Autonomic Nerves Around the Pulmonary Vein-Left Atrial Junctions —Histologic and Immunohistochemical Analyses—

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