Ganglionated plexi interactions with atrio-ventricular node and right vagus nerve

What is it about?

There is a large interactive network among different GP; this network serves as an “integrated center” of the cardiac autonomic innervation. Vagus nerve exerts its influence on the AVN through the epicardial fat pads that are primarily located on the posterior wall of the left atrium. The inferior vena cava-left atrium fat pad (namely also right inferior GP) located around the coronary sinus provides mainly vagal innervations and selectively innervates the AVN in humans. It was shown that high frequency stimulation of the right anterior (or superior right atrial vagal GP) and left superior GP (or superior left atrial vagal GP) could also influence the AVN. In addition, the influence of the right anterior GP on the AVN appears to be more important than its influence on the left superior GP. A functional neural pathway between the right vagus nerve and the AVN was identified, and the integrity of the GP seems to represent a mandatory interconnected network. In this study, the absence of any alteration in the ventricular rate in response to high frequency stimulation of the right vagus nerve after the ablation of GP suggests that the right vagus nerve is not directly connected to the AVN and that the integrity of the GP is required to produce vagal effects on the AVN. Probably there is not a direct pathway between both the right and left vagus nerves and the AVN. At long-term it is not known the influence of GP ablation on the electrophysiology of the AVN. However, the incomplete ablation of the GP can increase the vulnerability of the atria to atrial fibrillation and denervation is likely transient. In addition, the ablation of the GP that led to parasympathetic denervation of the AVN could play a role in the high ventricular rate response of atrial tachycardia after atrial fibrillation ablation. Therefore, GP interaction with AVN and right vagus nerve could provide new insights on that particular mechanism. In conclusion, there are GP interactions with AVN and right vagus nerve with possible important consequences on vagal denervation in atrial fibrillation ablation.

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Why is it important?

In this study, the absence of any alteration in the ventricular rate in response to high frequency stimulation of the right vagus nerve after the ablation of GP suggests that the right vagus nerve is not directly connected to the AVN and that the integrity of the GP is required to produce vagal effects on the AVN. Probably there is not a direct pathway between both the right and left vagus nerves and the AVN.

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