Hou Yinglong, Scherlag Benjamin J, Lin Jiaxiong, Zhang Ying, Lu Zhibing, Truong Kim, Patterson Eugene, Lazzara Ralph, Jackman Warren M, Po Sunny S
Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Clinical Medical College of Shandong University, Jinan City, Shandong, China.
J Am Coll Cardiol. 2007 Jul 3;50(1):61-8. doi: 10.1016/j.jacc.2007.02.066. Epub 2007 Jun 18.
This study sought to systematically investigate the interactions between the extrinsic and intrinsic cardiac autonomic nervous system (ANS) in modulating electrophysiological properties and atrial fibrillation (AF) initiation.
Systematic ganglionated plexi (GP) ablation to evaluate the extrinsic and intrinsic cardiac ANS relationship has not been detailed.
The following GP were exposed in 28 dogs: anterior right GP (ARGP) near the sinoatrial node, inferior right ganglionated plexi (IRGP) at the junction of the inferior vena cava and atria, and superior left ganglionated plexi (SLGP) near the junction of left superior pulmonary vein and left pulmonary artery. With unilateral vagosympathetic trunk stimulation (0.6 to 8.0 V, 20 Hz, 0.1 ms in duration), sinus rate (SR), and ventricular rate (VR) during AF were compared before and after sequential ablation of SLGP, ARGP, and IRGP.
The SLGP ablation significantly attenuated the SR and VR slowing responses with right or left vagosympathetic trunk stimulation. Subsequent ARGP ablation produced additional effects on SR slowing but not VR slowing. After SLGP + ARGP ablation, IRGP ablation eliminated VR slowing but did not further attenuate SR slowing with vagosympathetic trunk stimulation. Unilateral right and left vagosympathetic trunk stimulation shortened the effective refractory period and increased AF inducibility of atrium and pulmonary vein near the ARGP and SLGP, respectively. The ARGP ablation eliminated ERP shortening and AF inducibility with right vagosympathetic trunk stimulation, whereas SLGP ablation eliminated ERP shortening but not AF inducibility with left vagosympathetic trunk stimulation.
The GP function as the "integration centers" that modulate the autonomic interactions between the extrinsic and intrinsic cardiac ANS. This interaction is substantially more intricate than previously thought.
本研究旨在系统地探究心脏自主神经系统（ANS）的外在和内在部分在调节电生理特性及房颤（AF）起始过程中的相互作用。
尚未详细阐述通过系统性肺静脉前庭消融来评估心脏外在和内在自主神经系统关系的情况。
在28只犬中暴露以下肺静脉前庭：窦房结附近的右前肺静脉前庭（ARGP）、下腔静脉与心房交界处的右下肺静脉前庭（IRGP）以及左上肺静脉与左肺动脉交界处附近的左上肺静脉前庭（SLGP）。在依次消融SLGP、ARGP和IRGP之前及之后，通过单侧迷走交感干刺激（0.6至8.0V，20Hz，持续时间0.1ms），比较房颤期间的窦性心率（SR）和心室率（VR）。
消融SLGP显著减弱了右侧或左侧迷走交感干刺激时的SR和VR减慢反应。随后消融ARGP对SR减慢产生了额外影响，但对VR减慢无影响。在SLGP + ARGP消融后，消融IRGP消除了VR减慢，但在迷走交感干刺激时并未进一步减弱SR减慢。单侧右侧和左侧迷走交感干刺激分别缩短了ARGP和SLGP附近心房和肺静脉的有效不应期并增加了房颤诱导率。消融ARGP消除了右侧迷走交感干刺激时的ERP缩短和房颤诱导率，而消融SLGP消除了左侧迷走交感干刺激时的ERP缩短，但未消除房颤诱导率。
肺静脉前庭起到“整合中心”的作用，调节心脏外在和内在自主神经系统之间的自主神经相互作用。这种相互作用比之前认为的要复杂得多。
