Autonomic nerves in pulmonary veins

Abstract

Rapid repetitive activities arising from pulmonary veins may initiate atrial fibrillation. The basis of these rapid repetitive activities remains unclear, but recent evidence suggests that the autonomic nervous system plays an important role in their formation. Pulmonary veins and the adjoining left atrium are highly innervated structures. This review summarizes recent developments in the understanding of the anatomy of autonomic nerves in and around pulmonary veins and their implications for atrial fibrillation.

Figure 1

Distributions of adrenergic [tyrosine hydroxylase (TH)] and cholinergic [choline acetyltransferase [ChAT]) nerves along the longitudinal (A) and transmural (B) axes. (Reproduced with permission from Tan et al.4)

Figure 2

Circumferential distributions of adrenergic and cholinergic nerves around pulmonary vein orifices. AO = aorta; CS = coronary sinus; IVC = inferior vena cava; LA = left atrium; LI = left inferior pulmonary vein; LS = left superior pulmonary vein; PA = pulmonary artery; RI = right inferior pulmonary vein; RS = right superior pulmonary vein; SVC = superior vena cava; VOM = vein of marshall. (Reproduced with permission from Tan et al.4)