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Review
. 2013 Oct 1;128(14):1566-75.
doi: 10.1161/CIRCULATIONAHA.113.001596.

Local innervation and atrial fibrillation

S Rasika Wickramasinghe  1 , Vickas V Patel
Affiliations
Review

Local innervation and atrial fibrillation

S Rasika Wickramasinghe et al. Circulation. .
No abstract available

Keywords: atrial fibrillation; ganglia, autonomic; models, animal.

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Figures

Figure 1
Figure 1. Ganglionated plexi in the human heart
Shown is an illustration of the posterior aspect of the human heart and major vessels that shows the locations of the posterior atrial and ventricular ganglionated plexi. Note that the mediastinal nerves run adjacent to the aortic root and join the two superior atrial ganglionated plexi. The positions of the superior vena cava (SVC), inferior vena cava (IVC), right ventricle (RV), left ventricle (LV), right superior pulmonary vein (LSPV) are shown. Adopted with permission from Armour et al, Anat. Rec. 1997;247:289-298.
Figure 2
Figure 2. Cyclical Promotion of Atrial Fibrillation through Autonomic Stimulation
Once the atrium begins to fibrillate (AF), rapid atrial rates promote increased sympathetic nerve sprouting which augments β–adrenergic tone leading to increased protein-kinase A (PKA) mediated hyperphosphorylation of atrial ryanodine receptors (RyR2). Increased RyR2 phosphorylation promotes sarcoplasmic reticular calcium release that induces calcium-mediated inhibition of voltage-dependent L-type calcium currents, leading to shortening of atrial myocyte action potential duration and effective refractory periods. This electrical remodeling promotes further AF and increased sympathetic nerve sprouting. In addition, increased atrial myocyte RyR2 calcium release induces myocyte apoptosis and fibrosis, which leads to atrial dilatation and structural remodeling that further increases the propensity for AF.
Figure 3
Figure 3. Dct-expressing Cells in the Atrium Co-express Autonomic Receptors and are Near Autonomic Nerve Terminals
Immunohistochemistry within the adult mouse atrium using an antibody to Dct demonstrates Dct-positive cells with characteristic morphology (A, D, G, J, and M). Sections were co-stained with antibodies to β1-adrenergic receptor (β1R; B), α1-adrenergic receptor (α1R; E), muscarinic receptor subtype 3 (M3R; H), tyrosine hydroxylase (T-OH; K), and choline acetyltransferase (ChAT; N). Merged images of Dct and each respective antibody are shown, demonstrating co-expression of Dct with β1R (C), α1R (F), and M3R (I) receptors (arrowheads). In addition, presumptive sympathetic nerve terminals that express tyrosine hydroxylase (L) and parasympathetic nerve terminals that express choline acetyltransferase (O) were seen in close proximity to Dct-expressing cells (arrows). Scale bars: 20 μm. Reproduced with permission from Levin et al. J Clin Invest. 119, 3420-3436 (2009).
See this image and copyright information in PMC

References

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