Unique Autonomic Profile of the Pulmonary Veins and Posterior Left Atrium

Arora, Rishi; Ng, Jason; Ulphani, Joseph S.; Mylonas, Ilias; Subačius, Haris; Shade, Greg; Gordon, David; Morris, Alexander R.; He, Xiang; Lü, Yi; Belin, Rashad J.; Goldberger, Jeffrey J.; Kadish, Alan H.

doi:10.1016/j.jacc.2006.10.075

Cited by 61 publications

(60 citation statements)

References 17 publications

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Section: Relation To Neural Influences On the Atriamentioning

confidence: 94%

“…38 Interestingly, adrenergic and cholinergic epicardial nerve and muscarinic receptor densities as well as I K(ACh) heterogeneity are relatively higher in the canine posterolateral LA wall. 37,38 When the early tachyarrhythmias beats originated from (1) the posterolateral LA wall next to the left PVs or (2) Bachmann bundle insertion into the superior RA wall, repolarization changes were concentrated in the atrial regions in which the tachyarrhythmia sites of origin were identified. The tachyarrhythmia sites of origin identified in the posterolateral LA wall (most frequently associated with left dorsal mediastinal nerve stimulation) were adjacent to the ligament of Marshall (which includes predominantly cholinergic neural elements in the canine heart 39 as well as to the LA and dorsal atrial ganglionated plexuses.…”

Section: Relation To Neural Influences On the Atriamentioning

confidence: 94%

See 1 more Smart Citation

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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Section: Relation To Neural Influences On the Atriamentioning

confidence: 94%

Section: Relation To Neural Influences On the Atriamentioning

confidence: 94%

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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“…It is known that the pulmonary vein as well as the atrium is densely innervated by the autonomic nerves (19,20), and parasympathetic nerve activation usually encourages reentry via shortening of the effective refractory period, acting as a maintenance factor of atrial fibrillation. Indeed, in the canine model of vagally induced atrial fibrillation, ablation of the autonomic ganglia near the ostia of pulmonary vein prevented atrial fibrillation, showing the importance of cholinergic activation in the pulmonary veins for this type of atrial fibrillation (21).…”

Section: Discussionmentioning

confidence: 99%

Electrophysiological and Pharmacological Characteristics of Triggered Activity Elicited in Guinea-Pig Pulmonary Vein Myocardium

Takahara¹,

Sugimoto²,

Kitamura³

et al. 2011

J Pharmacol Sci

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Abstract. The pulmonary vein is known as an important source of ectopic beats, initiating frequent paroxysms of atrial fibrillation. We analyzed electrophysiological and pharmacological characteristics of triggered activity elicited in the isolated pulmonary vein from the guinea pig. Immediately after the termination of train stimulation (pacing cycle length of 100 ms), spontaneous activities accompanied with phase-4 depolarization were detected in 43 out of 45 pulmonary vein preparations. Such triggered activities were not observed in the isolated left atrium. The incidence of triggered activity was higher at a shorter pacing cycle length (100 -200 ms), and the coupling interval was shorter at a shorter pacing cycle length. Verapamil (1 μM), ryanodine (0.1 μM), and pilsicainide (10 μM) suppressed the occurrence of triggered activities. The resting membrane potential of the pulmonary vein myocardium was more positive than that of the left atrium. Carbachol (0.3 μM) hyperpolarized the resting membrane potential and completely inhibited the occurrence of triggered activities. These results suggest that the pulmonary veins have more arrhythmogenic features than the left atrium, possibly through lower resting membrane potential. The electrophysiological and pharmacological characteristics of triggered activity elicited in the pulmonary vein myocardium were similar to those previously reported using ventricular tissues.

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“…Parasympathetic innervation and activation can induce and maintain atrial fibrillation, whereas ablation can induce parasympathetic denervation and improve clinical outcome. 93,94 Due to the lack of sufficient experience and data, imaging of cardiac parasympathetic system has been limited. There is a low density of cholinergic neurons in the heart, as well as difficulty in tracer design because of rapid degradation of acetylcholine by esterase and a high specificity of the presynaptic receptor system for acetylcholine.…”

Section: Imaging Of the Cardiac Parasympathetic Systemmentioning

confidence: 99%

Radionuclide imaging of cardiac autonomic innervation

Travin

2010

Journal of Nuclear Cardiology

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Cardiac autonomic function plays a crucial role in health and disease, with abnormalities both reflecting the severity of the disease and contributing specifically to clinical deterioration and poor prognosis. Radiotracer analogs of the sympathetic mediator norepinephrine have been investigated extensively, and are at the brink of potential widespread clinical use. The most widely studied SPECT tracer, I-123 metaiodobenzylguanidine ((123)I-mIBG) has consistently shown a strong, independent ability to risk stratify patients with advanced congestive heart failure. Increased global cardiac uptake appears to have a high negative predictive value in terms of cardiac events, especially death and arrhythmias, and therefore and may have a role in guiding therapy, particularly by helping to better select patients unresponsive to conventional medical therapies who would benefit from device therapies such as an ICD (implantable cardioverter defibrillator), CRT (cardiac resynchronization therapy), LVAD (left ventricular assist device), or cardiac transplantation. Cardiac autonomic imaging with SPECT and PET tracers also shows potential to assess patients following cardiac transplant, those with primary arrhythmic condition, coronary artery disease, diabetes mellitus, and during cardiotoxic chemotherapy. Radiotracer imaging of cardiac autonomic function allows visualization and quantitative measurements of underlying molecular aspects of cardiac disease, and should therefore provide a perspective that other cardiac tests cannot.

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Unique Autonomic Profile of the Pulmonary Veins and Posterior Left Atrium

Cited by 61 publications

References 17 publications

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

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

Electrophysiological and Pharmacological Characteristics of Triggered Activity Elicited in Guinea-Pig Pulmonary Vein Myocardium

Radionuclide imaging of cardiac autonomic innervation

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