Ganglionated plexi (GP) comprise the intrinsic cardiac autonomic nervous system composed of autonomic ganglia of the heart atrium and ventricles.[1] The GP are embedded in the epicardial fat pads, consisting of only a few neurons or as many as 400 neurons.[1] GP are spatially close to the pulmonary veins, such that pulmonary vein isolation necessarily affects the GP.[2][3] 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] Addition of GP ablation to pulmonary vein isolation has not improved outcomes,[4] but possibly other methods of GP ablation would be more successful.[5] 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.[6]
There are intrinsic plexuses that form part of the autonomic nervous system (ANS),[7] the best known intrinsic plexus being the enteric nervous system. The GP are part of the cardiac intrinsic ANS.[5]
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.[8]
In humans, the ganglia are mostly associated with the posterior or superior aspect of the atria.[9] 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.[10]
References
edit- ^ a b c d 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.
- ^ 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.
- ^ 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.
- ^ Pearman CM, Poon SS, Gupta D (2017). "Minimally Invasive Epicardial Surgical Ablation Alone Versus Hybrid Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis". Arrhythmia & Electrophysiology Review. 6 (4): 202–209. doi:10.15420/aer/2017.29.2. PMC 5739900. PMID 29326836.
- ^ a b 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.