Lin Jiaxiong, Scherlag Benjamin J, Niu Guodong, Lu Zhibing, Patterson Eugene, Liu Shaowen, Lazzara Ralph, Jackman Warren M, Po Sunny S
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
J Cardiovasc Electrophysiol. 2009 Mar;20(3):318-24. doi: 10.1111/j.1540-8167.2008.01315.x.
We sought to systematically investigate the role of the ligament of Marshall (LOM) and inferior left ganglionated plexi (ILGP) in modulating electrophysiological functions.
The following structures were exposed in 36 dogs: (1) LOM, (2) superior left GP (SLGP) near the junction of left superior pulmonary vein (LSPV) and left atrium, (3) ILGP near the left inferior pulmonary vein-atrial junction, (4) anterior right GP (ARGP) near the sino-atrial node, and (5) inferior right GP (IRGP) at the junction of inferior vena cava and atria. High frequency stimulation (HFS; 0.6-8.0 V, 20 Hz, 0.1 msec in duration) was applied to the LOM, SLGP, ILGP, ARGP, IRGP, or vagosympathetic trunk. Ventricular rate (VR) during atrial fibrillation (AF) was compared before and after ablation of GP in different sequences.
ARGP + ILGP ablation but not ARGP ablation alone eliminated the VR slowing response induced by LOM stimulation, suggesting that all the autonomic innervation from the LOM to AV node passes the ILGP. LOM ablation attenuated the VR slowing response caused by SLGP or left vagosympathetic stimulation, suggesting that LOM modulates the autonomic innervation between the AV node and the left vagosympathetic trunk or SLGP. ARGP attenuated while ARGP + ILGP ablation eliminated the VR slowing response induced by left vagosympathetic stimulation, suggesting that both ARGP and ILGP modulate the AV nodal innervation of the extrinsic and intrinsic cardiac autonomic nervous system (ANS).
The LOM and ILGP function as the "integration centers" that modulate the autonomic interactions between extrinsic and intrinsic cardiac ANS on AV nodal function.
我们试图系统地研究马歇尔韧带（LOM）和左下神经节丛（ILGP）在调节电生理功能中的作用。
在36只犬身上暴露以下结构：（1）LOM；（2）左上肺静脉（LSPV）与左心房交界处附近的左上神经节丛（SLGP）；（3）左下肺静脉-心房交界处附近的ILGP；（4）窦房结附近的右前神经节丛（ARGP）；（5）下腔静脉与心房交界处的右下神经节丛（IRGP）。对LOM、SLGP、ILGP、ARGP、IRGP或迷走交感干施加高频刺激（HFS；0.6 - 8.0V，20Hz，持续时间0.1毫秒）。比较不同顺序消融神经节丛前后心房颤动（AF）期间的心室率（VR）。
ARGP + ILGP消融而非单独的ARGP消融消除了LOM刺激诱导的VR减慢反应，表明从LOM到房室结的所有自主神经支配都经过ILGP。LOM消融减弱了SLGP或左迷走交感神经刺激引起的VR减慢反应，表明LOM调节房室结与左迷走交感干或SLGP之间的自主神经支配。ARGP减弱而ARGP + ILGP消融消除了左迷走交感神经刺激诱导的VR减慢反应，表明ARGP和ILGP都调节心脏自主神经系统（ANS）的外在和内在部分对房室结的神经支配。
LOM和ILGP作为“整合中心”，调节心脏自主神经系统外在和内在部分在房室结功能上的自主相互作用。
