医学
传出的
刺激
迷走神经电刺激
心脏病学
内科学
神经调节
迷走神经
心率
自主神经系统
解剖
麻醉
血压
传入的
作者
Michael J. Dacey,Owais Salahudeen,Mohammed Amer Swid,Cameron Carlson,Kalyanam Shivkumar,Jeffrey L. Ardell
出处
期刊:Heart Rhythm
[Elsevier]
日期:2022-06-01
卷期号:19 (6): 975-983
被引量:9
标识
DOI:10.1016/j.hrthm.2022.01.033
摘要
Mapping the structure/function organization of the cardiac nervous system is foundational for implementation of targeted neuromodulation-based therapeutics for the treatment of cardiac disease.The purpose of this study was to define the spatial organization of intrathoracic parasympathetic and sympathetic efferent projections to the heart.Yucatan mini-pigs (N = 11) were anesthetized and the thoracic cavity exposed. Electrical stimulation of the cervical vagi and stellate ganglia was performed individually, and hemodynamic responses were assessed in the intact state and after progressive debranching of each thoracic vagosympathetic trunk (VST). Subsequently, residual cardiac efferent projections arising from paravertebral chain ganglia (T1-T4) were evaluated by stimulation before and after individual ganglionic debranching.Stimulation of the cervical vagi decreased heart rate and contractility while prolonging the activation-recovery interval (ARI). Stimulation of the stellate ganglia increased heart rate and contractility and decreased ARI. The majority of parasympathetic and sympathetic cardiac-evoked responses were mitigated after debranching of the right VST rostral to heart, whereas the left VST demonstrated a distribution with greater dispersion and caudal intrathoracic shift compared to the right. After complete thoracic VST debranching, stimulation of the T4 paravertebral chain ganglia demonstrated residual cardiac sympathetic efferent innervation to the heart in ∼50% of animals. That response was mitigated by transecting medial ganglionic branches.The nexus point for optimum neuromodulation engagement of parasympathetic efferent projections to the heart is the cervical vagus and the T1-T2 paravertebral chain ganglia for sympathetic control. Removal of principal sympathetic efferent projections to heart requires targeting the T1-T4 regions of the paravertebral chain.
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