Ganglionated Plexi Modulate Extrinsic Cardiac Autonomic Nerve InputEffects on Sinus Rate, Atrioventricular Conduction, Refractoriness, and Inducibility of Atrial Fibrillation
Yinglong Hou, MD*,
Benjamin J. Scherlag, PhD ,
Jiaxiong Lin, MD,
Ying Zhang, MD, PhD ,
Zhibing Lu, MD,
Kim Truong, DO,
Eugene Patterson, PhD,
Ralph Lazzara, MD,
Warren M. Jackman, MD and
Sunny S. Po, MD, PhD,*
* Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Clinical Medical College of Shandong University, Jinan City, Shandong, China
Cardiac Arrhythmia Research Institute, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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Figure 1 Schematic and Photographic Representation of the Right and Left Thoracotomy Approach
Schematic and photographic representation of the right (A, C) and left (B, D) atria and associated ganglionated plexi (GP). The labels RA, RSPV, LA, and LSPV indicate cardiac structures or multielectrode catheters positioned on the epicardial surface of the right atrium, right superior pulmonary veins, left atrium, and left superior pulmonary vein, respectively. For all catheters, the distal electrode pair (D,2) was positioned adjacent to the GP (hatched area) near the pulmonary vein–atrial junction. ARGP = anterior right ganglionated plexi; CS = coronary sinus; IRGP = inferior right ganglionated plexi; IVC = inferior vena cava; LAA = left atrial appendage; LIPV = left inferior plumonary vein; LOM = ligament of Marshall; LPA = left pulmonary artery; RAA = right atrial appendage; RIPV = right inferior pulmonary vein; SLGP = superior left ganglionated plexi; SVC = superior vena cava.
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Figure 2 Interactions Among Vagosympathetic Trunks, ARGP, IRGP, and SLGP on SAN and AVN Function
(A) Modulation of sinus rate by vagosympathetic stimulation. (B) Modulation of ventricular rate during atrial fibrillation by vagosympathetic stimulation. Thick lines and thin lines indicate strong and weak regulatory effects, respectively. See text for details. AVN = atrioventricular node; LVG = left vagosympathetic trunk; RVG = right vagosympathetic trunk; SAN = sinoatrial node; other abbreviations as in Figure 1.
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