Ganglionated plexi explained

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. 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. 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.

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]

Notes and References

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

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