Autonomic Innervation and Segmental Muscular Disconnections at the Human Pulmonary Vein-Atrial Junction. Implications for Catheter Ablation of Atrial-Pulmonary Vein Junction

Alex Y. Tan, Hongmei Li, Sebastian Wachsmann-Hogiu, Lan S. Chen, Peng Sheng Chen, Michael C. Fishbein

Research output: Contribution to journalArticle

237 Scopus citations

Abstract

Objectives: This study sought to examine the muscle connections and autonomic nerve distributions at the human pulmonary vein (PV)-left atrium (LA) junction. Background: One approach to catheter ablation of atrial fibrillation (AF) is to isolate PV muscle sleeves from the LA. Elimination of vagal response further improves success rates. Methods: We performed immunohistochemical staining on 192 circumferential venoatrial segments (32 veins) harvested from 8 autopsied human hearts using antibodies to tyrosine hydroxylase (TH) and choline acetyltransferase (ChAT). Results: Muscular discontinuities of widths 0.1 to 5.5 mm (1.1 ± 1.0 mm) and abrupt 90° changes in fiber orientation were found in 70 of 192 (36%) and 36 of 192 (19%) of PV-LA junctions, respectively. Although these anisotropic features were more common in the anterosuperior junction (p < 0.01), they were also present around the entire PV-LA junction. Autonomic nerve density was highest in the anterosuperior segments of both superior veins (p < 0.05 versus posteroinferior) and inferior segments of both inferior veins (p < 0.05 vs. superior), highest in the LA within 5 mm of the PV-LA junction (p < 0.01), and higher in the epicardium than endocardium (p < 0.01). Adrenergic and cholinergic nerves were highly co-located at tissue and cellular levels. A significant proportion (30%) of ganglion cells expressed dual adrenocholinergic phenotypes. Conclusions: Muscular discontinuities and abrupt fiber orientation changes are present in >50% of PV-LA segments, creating significant substrates for re-entry. Adrenergic and cholinergic nerves have highest densities within 5 mm of the PV-LA junction, but are highly co-located, indicating that it is impossible to selectively target either vagal or sympathetic nerves during ablation procedures.

Original languageEnglish (US)
Pages (from-to)132-143
Number of pages12
JournalJournal of the American College of Cardiology
Volume48
Issue number1
DOIs
StatePublished - Jul 4 2006

ASJC Scopus subject areas

  • Nursing(all)

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