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Ganglionated plexi and ligament of Marshall ablation reduces atrial vulnerability and causes stellate ganglion remodeling in ambulatory dogs

  • Ye Zhao
    Affiliations
    Krannert Institute of Cardiology, Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana

    Department of Cardiac Surgery, The First Affiliated Hospital of China Medical University, Sheng Yang, China
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  • Zhaolei Jiang
    Affiliations
    Krannert Institute of Cardiology, Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana

    Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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  • Wei-Chung Tsai
    Affiliations
    Krannert Institute of Cardiology, Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana

    Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Yuan Yuan
    Affiliations
    Krannert Institute of Cardiology, Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana

    Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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  • Kroekkiat Chinda
    Affiliations
    Krannert Institute of Cardiology, Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana

    Department of Physiology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
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  • Eue-Keun Choi
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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  • Michael C. Fishbein
    Affiliations
    Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, California
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  • Shien-Fong Lin
    Affiliations
    Krannert Institute of Cardiology, Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana

    Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan
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  • Peng-Sheng Chen
    Affiliations
    Krannert Institute of Cardiology, Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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  • Thomas H. Everett IV
    Correspondence
    Address reprint requests and correspondence: Dr. Thomas H. Everett, IV, 1800 N Capitol Ave, Indianapolis, IN 46202
    Affiliations
    Krannert Institute of Cardiology, Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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      Background

      Simultaneous activation of the stellate ganglion (SG), the ligament of Marshall (LOM), and the ganglionated plexi often precedes the onset of paroxysmal atrial tachyarrhythmia (PAT).

      Objective

      The purpose of this study was to test the hypothesis that ablation of the LOM and the superior left ganglionated plexi (SLGP) reduces atrial vulnerability and results in remodeling of the SG.

      Methods

      Nerve activity was correlated to PAT and ventricular rate (VR) at baseline, after ablation of the LOM and SLGP, and after atrial fibrillation. Neuronal cell death was assessed with tyrosine hydroxylase and terminal deoxynucleotidyl transferase dUTP nick end label (TUNEL) staining.

      Results

      There were 4 ± 2 PAT episodes per day in controls. None were observed in the ablation group, even though SG nerve activity and VR increased from 2.2 µV (95% confidence interval [CI] 1.2–3.3 µV) and 80 bpm (95% CI 68–92 bpm) at baseline, to 3.0 µV (95% CI 2.6–3.4 µV, P = .046) and 90 bpm (95% CI 75–108 bpm, P = .026) after ablation, and to 3.1 µV (95% CI 1.7–4.5 µV, P = .116) and 95 bpm (95% CI 79–110 bpm, P = .075) after atrial fibrillation. There was an increase in tyrosine hydroxylase–negative cells in the ablation group and 19.7% (95% CI 8.6%–30.8%) TUNEL-positive staining in both the left and right SG. None were observed in the control group.

      Conclusion

      LOM and SLGP ablation caused left SG remodeling and cell death. There was reduced correlation of the VR response and PAT to SG nerve activity. These findings support the importance of SLGP and LOM in atrial arrhythmogenesis.

      Keywords

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