Superior vena cava-aorta ganglionated plexus: an arbitrator of the heart or just a passer-by?

摘要

In the past, cardiac control was considered to depend on the neurons within the central nervous system. The intratho-racic pre- and para-vertebral ganglia (sympathetic postgan-glionic neurons) and the intrinsic cardiac ganglia (parasym-pathetic postganglionic neurons) were assumed to be the neuronal relay stations for the efferent autonomic nervous system. Therefore, the atrial cells are modulated differently by those sympathetic and parasympathetic inputs.Several publications demonstrated the autonomic imbalance in the atrium would predispose it to an instability of the atrial electrical activity and cause atrial fibrillation (AF). Coumel and colleagues characterized paroxysmal AF as vagotonic and adrenergic types according to the relation of the autonomic tone change and onset time.1-2 Vagal activation is thought to promote AF by shortening the refractory period, which accelerates and stabilizes the reentrant excitation. Adrenergic activation is related to the increasing atrial ectopies, which are caused by enhanced automaticity or triggered activity.