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Identification and characterization of atrioventricular parasympathetic innervation in humans.
- Source :
-
Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2002 Aug; Vol. 13 (8), pp. 735-9. - Publication Year :
- 2002
-
Abstract
- Introduction: We hypothesized that in humans there is an epicardial fat pad from which parasympathetic ganglia supply the AV node. We also hypothesized that the parasympathetic nerves innervating the AV node also innervate the right atrium, and the greatest density of innervation is near the AV nodal fat pad.<br />Methods and Results: An epicardial fat pad near the junction of the left atrium and right inferior pulmonary vein was identified during cardiac surgery in seven patients. A ring electrode was used to stimulate this fat pad intraoperatively during sinus rhythm to produce transient complete heart block. Subsequently, temporary epicardial wire electrodes were sutured in pairs on this epicardial fat pad, the high right atrium, and the right ventricle by direct visualization during coronary artery bypass surgery in seven patients. Experiments were performed in the electrophysiology laboratory 1 to 5 days after surgery. Programmed atrial stimulation was performed via an endocardial electrode catheter advanced to the right atrium. The catheter tip electrode was moved in 1-cm concentric zones around the epicardial wires by fluoroscopic guidance. Atrial refractoriness at each catheter site was determined in the presence and absence of parasympathetic nerve stimulation (via the epicardial wires). In all seven patients, an AV nodal fat pad was identified. Fat pad stimulation during and after surgery caused complete heart block but no change in sinus rate. Fat pad stimulation decreased the right atrial effective refractory period at 1 cm (280 +/- 42 msec to 242 +/- 39 msec) and 2 cm (235 +/- 21 msec to 201 +/- 11 msec) from the fat pad (P = 0.04, compared with baseline). No significant change in atrial refractoriness occurred at distances >2 cm. The response to stimulation decreased as the distance from the fat pad increased.<br />Conclusion: For the first time in humans, an epicardial fat pad was identified from which parasympathetic nerve fibers selectively innervate the AV node but not the sinoatrial node. Nerves in this fat pad also innervate the surrounding right atrium.
- Subjects :
- Adipose Tissue drug effects
Adipose Tissue innervation
Adult
Aged
Anti-Arrhythmia Agents administration & dosage
Atrioventricular Node drug effects
Atropine administration & dosage
Coronary Artery Bypass
Coronary Artery Disease surgery
Electric Stimulation
Electrodes, Implanted
Electrophysiologic Techniques, Cardiac
Female
Heart Atria drug effects
Heart Atria innervation
Heart Atria pathology
Humans
Injections, Intravenous
Male
Middle Aged
Ohio
Parasympathetic Nervous System drug effects
Pericardium drug effects
Pericardium innervation
Treatment Outcome
Atrioventricular Node innervation
Atrioventricular Node pathology
Parasympathetic Nervous System pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1045-3873
- Volume :
- 13
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Journal of cardiovascular electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 12212688
- Full Text :
- https://doi.org/10.1046/j.1540-8167.2002.00735.x