Unique Autonomic Profile of the Pulmonary Veins and Posterior Left Atrium

Rishi Arora, Jason Ng, Joseph Ulphani, Ilias Mylonas, Haris Subacius, Greg Shade, David Gordon, Alexander Morris, Xiang He, Yi Lu, Rashad Belin, Jeffrey Goldberger, Alan H. Kadish

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to investigate the electrophysiologic profile of the pulmonary veins (PVs) and left atrium (LA) in response to autonomic manipulation. Background: The parasympathetic innervation of the PVs and posterior left atrium (PLA) is thought to contribute to focal atrial fibrillation (AF). We hypothesized that autonomic effects would be more prominent in these regions. Methods: In 14 dogs, epicardial mapping was performed in the PVs, PLA, and left atrial appendage (LAA) under the following conditions: baseline, 20-Hz cervical vagal stimulation (VS), propranolol (P), P + VS, and P + atropine. Effective refractory periods (ERPs) were measured, and conduction vectors were computed at multiple sites. Western blotting and immunostaining were performed for IKAch (Kir3.1/3.4). Results: The VS and P + VS caused more ERP shortening in the PV and PLA than in the LAA. The P + atropine caused greatest ERP prolongation in the LAA. Cumulative ERP change (ERP difference between P + VS and P + atropine) was greatest in the LAA and corresponded with expression of Kir3.1/3.4 (LAA > PLA ≥ PV). The ERP change in response to vagal manipulation was most heterogeneous in the PLA; this corresponded with a pronounced heterogeneity of Kir3.1 distribution in the PLA. With VS and/or P, there was evidence of regional conduction delay in the PVs with a significant change in activation direction. Similar activation changes were not seen in the PLA and LAA. Conclusions: The PVs and PLA demonstrate unique activation and repolarization characteristics in response to autonomic manipulation. The heterogeneity of vagal responses correlates with the pattern of IKAch distribution in the LA. The peculiar autonomic characteristics of the PVs and PLA might create substrate for re-entry and AF.

Original languageEnglish (US)
Pages (from-to)1340-1348
Number of pages9
JournalJournal of the American College of Cardiology
Volume49
Issue number12
DOIs
StatePublished - Mar 27 2007
Externally publishedYes

Fingerprint

Pulmonary Veins
Heart Atria
Atrial Appendage
Atropine
Atrial Fibrillation
Epicardial Mapping
Autonomic Agents
Propranolol
Western Blotting
Dogs

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Arora, R., Ng, J., Ulphani, J., Mylonas, I., Subacius, H., Shade, G., ... Kadish, A. H. (2007). Unique Autonomic Profile of the Pulmonary Veins and Posterior Left Atrium. Journal of the American College of Cardiology, 49(12), 1340-1348. https://doi.org/10.1016/j.jacc.2006.10.075

Unique Autonomic Profile of the Pulmonary Veins and Posterior Left Atrium. / Arora, Rishi; Ng, Jason; Ulphani, Joseph; Mylonas, Ilias; Subacius, Haris; Shade, Greg; Gordon, David; Morris, Alexander; He, Xiang; Lu, Yi; Belin, Rashad; Goldberger, Jeffrey; Kadish, Alan H.

In: Journal of the American College of Cardiology, Vol. 49, No. 12, 27.03.2007, p. 1340-1348.

Research output: Contribution to journalArticle

Arora, R, Ng, J, Ulphani, J, Mylonas, I, Subacius, H, Shade, G, Gordon, D, Morris, A, He, X, Lu, Y, Belin, R, Goldberger, J & Kadish, AH 2007, 'Unique Autonomic Profile of the Pulmonary Veins and Posterior Left Atrium', Journal of the American College of Cardiology, vol. 49, no. 12, pp. 1340-1348. https://doi.org/10.1016/j.jacc.2006.10.075
Arora, Rishi ; Ng, Jason ; Ulphani, Joseph ; Mylonas, Ilias ; Subacius, Haris ; Shade, Greg ; Gordon, David ; Morris, Alexander ; He, Xiang ; Lu, Yi ; Belin, Rashad ; Goldberger, Jeffrey ; Kadish, Alan H. / Unique Autonomic Profile of the Pulmonary Veins and Posterior Left Atrium. In: Journal of the American College of Cardiology. 2007 ; Vol. 49, No. 12. pp. 1340-1348.
@article{006b09c174d94f109e0743504e9824d5,
title = "Unique Autonomic Profile of the Pulmonary Veins and Posterior Left Atrium",
abstract = "Objectives: The purpose of this study was to investigate the electrophysiologic profile of the pulmonary veins (PVs) and left atrium (LA) in response to autonomic manipulation. Background: The parasympathetic innervation of the PVs and posterior left atrium (PLA) is thought to contribute to focal atrial fibrillation (AF). We hypothesized that autonomic effects would be more prominent in these regions. Methods: In 14 dogs, epicardial mapping was performed in the PVs, PLA, and left atrial appendage (LAA) under the following conditions: baseline, 20-Hz cervical vagal stimulation (VS), propranolol (P), P + VS, and P + atropine. Effective refractory periods (ERPs) were measured, and conduction vectors were computed at multiple sites. Western blotting and immunostaining were performed for IKAch (Kir3.1/3.4). Results: The VS and P + VS caused more ERP shortening in the PV and PLA than in the LAA. The P + atropine caused greatest ERP prolongation in the LAA. Cumulative ERP change (ERP difference between P + VS and P + atropine) was greatest in the LAA and corresponded with expression of Kir3.1/3.4 (LAA > PLA ≥ PV). The ERP change in response to vagal manipulation was most heterogeneous in the PLA; this corresponded with a pronounced heterogeneity of Kir3.1 distribution in the PLA. With VS and/or P, there was evidence of regional conduction delay in the PVs with a significant change in activation direction. Similar activation changes were not seen in the PLA and LAA. Conclusions: The PVs and PLA demonstrate unique activation and repolarization characteristics in response to autonomic manipulation. The heterogeneity of vagal responses correlates with the pattern of IKAch distribution in the LA. The peculiar autonomic characteristics of the PVs and PLA might create substrate for re-entry and AF.",
author = "Rishi Arora and Jason Ng and Joseph Ulphani and Ilias Mylonas and Haris Subacius and Greg Shade and David Gordon and Alexander Morris and Xiang He and Yi Lu and Rashad Belin and Jeffrey Goldberger and Kadish, {Alan H.}",
year = "2007",
month = "3",
day = "27",
doi = "10.1016/j.jacc.2006.10.075",
language = "English (US)",
volume = "49",
pages = "1340--1348",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "12",

}

TY - JOUR

T1 - Unique Autonomic Profile of the Pulmonary Veins and Posterior Left Atrium

AU - Arora, Rishi

AU - Ng, Jason

AU - Ulphani, Joseph

AU - Mylonas, Ilias

AU - Subacius, Haris

AU - Shade, Greg

AU - Gordon, David

AU - Morris, Alexander

AU - He, Xiang

AU - Lu, Yi

AU - Belin, Rashad

AU - Goldberger, Jeffrey

AU - Kadish, Alan H.

PY - 2007/3/27

Y1 - 2007/3/27

N2 - Objectives: The purpose of this study was to investigate the electrophysiologic profile of the pulmonary veins (PVs) and left atrium (LA) in response to autonomic manipulation. Background: The parasympathetic innervation of the PVs and posterior left atrium (PLA) is thought to contribute to focal atrial fibrillation (AF). We hypothesized that autonomic effects would be more prominent in these regions. Methods: In 14 dogs, epicardial mapping was performed in the PVs, PLA, and left atrial appendage (LAA) under the following conditions: baseline, 20-Hz cervical vagal stimulation (VS), propranolol (P), P + VS, and P + atropine. Effective refractory periods (ERPs) were measured, and conduction vectors were computed at multiple sites. Western blotting and immunostaining were performed for IKAch (Kir3.1/3.4). Results: The VS and P + VS caused more ERP shortening in the PV and PLA than in the LAA. The P + atropine caused greatest ERP prolongation in the LAA. Cumulative ERP change (ERP difference between P + VS and P + atropine) was greatest in the LAA and corresponded with expression of Kir3.1/3.4 (LAA > PLA ≥ PV). The ERP change in response to vagal manipulation was most heterogeneous in the PLA; this corresponded with a pronounced heterogeneity of Kir3.1 distribution in the PLA. With VS and/or P, there was evidence of regional conduction delay in the PVs with a significant change in activation direction. Similar activation changes were not seen in the PLA and LAA. Conclusions: The PVs and PLA demonstrate unique activation and repolarization characteristics in response to autonomic manipulation. The heterogeneity of vagal responses correlates with the pattern of IKAch distribution in the LA. The peculiar autonomic characteristics of the PVs and PLA might create substrate for re-entry and AF.

AB - Objectives: The purpose of this study was to investigate the electrophysiologic profile of the pulmonary veins (PVs) and left atrium (LA) in response to autonomic manipulation. Background: The parasympathetic innervation of the PVs and posterior left atrium (PLA) is thought to contribute to focal atrial fibrillation (AF). We hypothesized that autonomic effects would be more prominent in these regions. Methods: In 14 dogs, epicardial mapping was performed in the PVs, PLA, and left atrial appendage (LAA) under the following conditions: baseline, 20-Hz cervical vagal stimulation (VS), propranolol (P), P + VS, and P + atropine. Effective refractory periods (ERPs) were measured, and conduction vectors were computed at multiple sites. Western blotting and immunostaining were performed for IKAch (Kir3.1/3.4). Results: The VS and P + VS caused more ERP shortening in the PV and PLA than in the LAA. The P + atropine caused greatest ERP prolongation in the LAA. Cumulative ERP change (ERP difference between P + VS and P + atropine) was greatest in the LAA and corresponded with expression of Kir3.1/3.4 (LAA > PLA ≥ PV). The ERP change in response to vagal manipulation was most heterogeneous in the PLA; this corresponded with a pronounced heterogeneity of Kir3.1 distribution in the PLA. With VS and/or P, there was evidence of regional conduction delay in the PVs with a significant change in activation direction. Similar activation changes were not seen in the PLA and LAA. Conclusions: The PVs and PLA demonstrate unique activation and repolarization characteristics in response to autonomic manipulation. The heterogeneity of vagal responses correlates with the pattern of IKAch distribution in the LA. The peculiar autonomic characteristics of the PVs and PLA might create substrate for re-entry and AF.

UR - http://www.scopus.com/inward/record.url?scp=33947505844&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33947505844&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2006.10.075

DO - 10.1016/j.jacc.2006.10.075

M3 - Article

C2 - 17394967

AN - SCOPUS:33947505844

VL - 49

SP - 1340

EP - 1348

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 12

ER -