Ganglionated plexi

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Ganglionated plexi (GP) comprise the intrinsic cardiac autonomic nervous system composed of autonomic ganglia of the heart atrium and ventricles. [1] Cholinergic neurons throughout the GPs project to all areas of the heart, [2] The GP are embedded in the epicardial fat pads, consisting of only a few neurons or as many as 400 neurons. [1] Vagus nerve stimulation has been shown to inhibit the activity of the GP, possibly through Nav1.8. [3]

GP are spatially close to the pulmonary veins, so pulmonary vein isolation necessarily affects the GP. [4] [5] GP has been shown to be a contributor to atrial fibrillation (AFib), such that ablation of the GP has been a strategy for treatment of AFib. [1] Pulsed field ablation has shown to be an AFib ablation strategy which effectively destroys the GP. [6] GP ablation alone has been shown to eliminate AFib in approximately three-quarter of AFib patients. [1]

Ligation of the left atrial appendage may reduce AFib by alteration of the GP. [7]

There are intrinsic plexuses that form part of the autonomic nervous system (ANS), [8] the best known intrinsic plexus being the enteric nervous system. The GP are part of the cardiac intrinsic ANS. [9]

In animal models, cardiac overload leads to change in the electrophysiological properties of these neurons, leading to the suggestion that such changes might be relevant to the pathophysiology of heart failure. [10]

In humans, the ganglia are mostly associated with the posterior or superior aspect of the atria. [11] The ganglia mediate at least some of the effects of vagal nerve stimulation on the sinoatrial node, although don't seem to mediate atrioventricular node conduction. [12]

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<span class="mw-page-title-main">Autonomic nervous system</span> Division of the nervous system supplying internal organs, smooth muscle and glands

The autonomic nervous system (ANS), sometimes called the visceral nervous system and formerly the vegetative nervous system, is a division of the nervous system that operates internal organs, smooth muscle and glands. The autonomic nervous system is a control system that acts largely unconsciously and regulates bodily functions, such as the heart rate, its force of contraction, digestion, respiratory rate, pupillary response, urination, and sexual arousal. This system is the primary mechanism in control of the fight-or-flight response.

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References

  1. 1 2 3 4 Stavrakis S, Po S (2017). "Ganglionated Plexi Ablation: Physiology and Clinical Applications". Arrhythmia & Electrophysiology Review. 6 (4): 186–190. doi:10.15420/aer2017.26.1. PMC   5739885 . PMID   29326833.
  2. ↑ Ardell JL, Armour JA (2016). "Neurocardiology: Structure-Based Function". Comprehensive Physiology . 6 (4): 1635–1653. doi:10.1002/cphy.c150046. PMID   27783854.
  3. ↑ Capilupi MJ, Kerath SM, Becker LB (2020). "Vagus Nerve Stimulation and the Cardiovascular System". Cold Spring Harbor Perspectives in Medicine . 10 (2): a034173. doi: 10.1101/cshperspect.a034173 . PMC   6996447 . PMID   31109966.
  4. ↑ SHu F, Zheng L, Yao Y (2019). "Avoidance of Vagal Response During Circumferential Pulmonary Vein Isolation: Effect of Initiating Isolation From Right Anterior Ganglionated Plexi". Circulation: Arrhythmia and Electrophysiology. 12 (12): e007811. doi:10.1161/CIRCEP.119.007811. PMID   31760820.
  5. ↑ Zheng S, Zeng Y, Meng X (2014). "Active ganglionated plexi is a predictor of atrial fibrillation recurrence after minimally invasive surgical ablation". Journal of Cardiac Surgery . 29 (2): 279–285. doi: 10.1111/jocs.12299 . PMID   24517359.
  6. ↑ Bradley CJ, Haines DE (2020). "Pulsed field ablation for pulmonary vein isolation in the treatment of atrial fibrillation". Journal of Cardiovascular Electrophysiology . 31 (8): 2136–2147. doi:10.1111/jce.14414. PMID   32107812.
  7. ↑ AlTurki A, Huynh T, Essebag V (2018). "Left atrial appendage isolation in atrial fibrillation catheter ablation: A meta-analysis". Journal of Arrhythmia. 34 (5): 478–484. doi:10.1002/joa3.12095. PMC   6174377 . PMID   30327692.
  8. ↑ Wake, Emily; Brack, Kieran (August 2016). "Characterization of the intrinsic cardiac nervous system". Autonomic Neuroscience. 199: 3–16. doi:10.1016/j.autneu.2016.08.006.
  9. ↑ Calkins H, Hindricks G, Yamane T (2018). "2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation". Europace . 20 (1): e1–e160. doi:10.1093/europace/eux274. PMC   5834122 . PMID   29016840.
  10. ↑ Hardwick, Jean C.; Baran, Caitlin N.; Southerland, E. Marie; Ardell, Jeffrey L. (September 2009). "Remodeling of the guinea pig intrinsic cardiac plexus with chronic pressure overload". American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. 297 (3): R859–R866. doi:10.1152/ajpregu.00245.2009. PMC   2739792 .
  11. ↑ Smith, R. B. (January 1971). "The occurrence and location of intrinsic cardiac ganglia and nerve plexuses in the human neonate". The Anatomical Record. 169 (1): 33–40. doi:10.1002/ar.1091690104.
  12. ↑ Aksu, Tolga; Gopinathannair, Rakesh; Gupta, Dhiraj; Pauza, Dainius H. (June 2021). "Intrinsic cardiac autonomic nervous system: What do clinical electrophysiologists need to know about the "heart brain"?". Journal of Cardiovascular Electrophysiology. 32 (6): 1737–1747. doi:10.1111/jce.15058.
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