人类左心房神经的定量研究。

Quantitative study of nerves of the human left atrium.

作者信息

Chevalier Philippe, Tabib Alain, Meyronnet David, Chalabreysse Lara, Restier Lioara, Ludman Valérie, Aliès Alexandre, Adeleine Patrice, Thivolet Françoise, Burri Haran, Loire Robert, François Laurent, Fanton Laurent

机构信息

Service de Rythmologie et de Soins Intensifs Cardiologiques, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France.

出版信息

Heart Rhythm. 2005 May;2(5):518-22. doi: 10.1016/j.hrthm.2005.01.022.

DOI:10.1016/j.hrthm.2005.01.022

PMID:15840477

Abstract

OBJECTIVES

To quantify and study the distribution of innervation of the left atrium and the pulmonary veins in humans.

BACKGROUND

Damage to cardiac nerves has been hypothesized as the explanation for successful radiofrequency ablation of atrial fibrillation.

METHODS

From January 2003 to September 2003, histologic and quantitative studies of innervation of the left atrium and the pulmonary veins was performed in 43 consecutive necropsied adult hearts (30 men and 3 women; mean age 45.5 +/- 12.4 years). The left atrium was sectioned in 1-cm slices from left to right, with the plane of section perpendicular to the long axis of the heart. Sections of the pulmonary veins at their ostia and sections 1 cm away of this structure also were obtained. Nerve fiber density was counted manually for each case and expressed as the mean number per slice.

RESULTS

Numerous epicardial nerve fibers and ganglia having distinct patterns of distribution in the left atrium were found. Nerve density was significantly higher at the ostia of the four pulmonary veins than in their distal part (7.1 +/- 2.1 vs 5.2 +/- 1.3 for left upper pulmonary vein; 6.3 +/- 1.5 vs 5.2 +/- 1.7 for right upper pulmonary vein; 7.4 +/- 2 vs 5.9 +/- 2 for left lower pulmonary vein; 6.7 +/- 1.8 vs 3.9 +/- 1.3 for right lower pulmonary vein). The left superior vein was significantly more innervated than the right inferior vein (12.3 +/- 3 vs 10.6 +/- 1.4). Gradients of innervation were found from right to left (9.8 +/- 4.6 vs 18.5 +/- 6.6, P < .05) and from the front to the rear of the atrium (17.2 +/- 6.4 vs 20.7 +/- 6.5, P < .05). The same heterogeneous distribution was observed at the myocardial level but with thinner nerve fibers, making quantification difficult. Only very thin nerve fibers were present in the endocardium.

CONCLUSIONS

The human left atrium exhibits several gradients of innervation at discrete sites. These findings may have clinical implications for radiofrequency ablation of atrial fibrillation.

摘要

目的

量化并研究人类左心房和肺静脉的神经分布情况。

背景

心脏神经损伤被认为是心房颤动射频消融成功的原因。

方法

2003年1月至2003年9月，对43例连续尸检的成人心脏（30例男性和3例女性；平均年龄45.5±12.4岁）进行左心房和肺静脉神经分布的组织学和定量研究。将左心房从左至右切成1厘米厚的切片，切片平面垂直于心脏长轴。还获取了肺静脉开口处及其开口处1厘米远的切片。对每个病例手动计数神经纤维密度，并表示为每片的平均数。

结果

发现左心房有许多心外膜神经纤维和神经节，其分布模式各异。四条肺静脉开口处的神经密度明显高于其远端部分（左上肺静脉：7.1±2.1对5.2±1.3；右上肺静脉：6.3±1.5对5.2±1.7；左下肺静脉：7.4±2对5.9±2；右下肺静脉：6.7±1.8对3.9±1.3）。左上肺静脉的神经支配明显多于右下肺静脉（12.3±3对10.6±1.4）。发现从右到左（9.8±4.6对18.5±6.6，P<.05）以及从心房前部到后部（17.2±6.4对20.7±6.5，P<.05）存在神经支配梯度。在心肌层面也观察到相同的异质性分布，但神经纤维较细，难以进行量化。心内膜中仅存在非常细的神经纤维。