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Paradoxical Long-Term Proarrhythmic Effects after Ablating the "Head Station" Ganglionated Plexi of the Vagal Innervation to the Heart.
MedLine Citation:
PMID:  23357542     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The ganglionated plexi (GP) located at the junction of the superior vena cava, aorta and right pulmonary artery (SVC-Ao GP) was proposed to be the "head station" between the extrinsic and intrinsic cardiac autonomic nervous system (ECANS, ICANS). OBJECTIVE: We investigated the chronic effects after interrupting the ECANS-ICANS connections by ablating SVC-Ao GP. METHODS: A right thoracotomy in 10 dogs allowed stimulation at the right superior and inferior pulmonary veins (RSPV, RIPV), right atrial appendage (RAA) and SVC to determine effective refractory period (ERP) and AF inducibility in the first operation. Group 1 (N=5) received SVC-Ao GP ablation; Group 2 (N=5) received no ablation. A second operation and the same measurements were made 10 weeks later. A pacemaker with lead implanted at RSPV recorded atrial fibrillation or tachycardia (AF/AT). RESULTS: During the first operation in Group 1, ERPs increased significantly in SVC, but not at the RSPV, RIPV or RAA site immediately after ablation whereas the ERPs decreased significantly in RSPV, RIPV and RAA, but not SVC in the second operation performed 10 weeks later (compared to ERP in the first operation). ERPs decreased and AF/AT burden increased significantly from 4 and 5 weeks respectively after the first operation in Group 1 dogs. The ERP and AF/AT burden in Group 2 remained unchanged between operations. CONCLUSION: Ablation of the "head station" GP between ECANS and ICANS prolonged the ERP acutely, but shortened regional ERPs and increased AF/AT burden chronically, suggesting that ECANS may tonically inhibit the ICANS activity.
Authors:
Li-Wei Lo; Benjamin J Scherlag; Hung-Yu Chang; Yenn-Jiang Lin; Shih-Ann Chen; Sunny S Po
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-25
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013. Published by Elsevier Inc.
Affiliation:
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University.
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