Tags

Type your tag names separated by a space and hit enter

Human adult cardiac autonomic innervation: Controversies in anatomical knowledge and relevance for cardiac neuromodulation.
Auton Neurosci. 2020 09; 227:102674.AN

Abstract

BACKGROUND

Cardiac sympathetic blockade is a therapeutic approach for arrhythmias and heart failure and may be a beneficial effect of high thoracic epidural anesthesia. These treatments require detailed knowledge of the spatial location and distribution of cardiac autonomic nerves, however, there are controversies on this subject in humans.

OBJECTIVE

To provide a systematic overview of current knowledge on human anatomy of the cardiac autonomic nervous system.

RESULTS

In contrast to the often claimed assumption that human preganglionic sympathetic cardiac neurons originate mainly from thoracic spinal segments T1-T4 or T5, there is ample evidence indicating involvement of cervical spinal segment C8 and thoracic spinal segments below T5. Whether cervical ganglia besides the stellate ganglion play a role in transmission of cardiac sympathetic signals is unclear. Similarly, there is debate on the origin of cardiac nerves from different thoracic ganglia. Most human studies report thoracic cardiac nerves emerging from the first to fourth thoracic paravertebral ganglia; others report contributions from the fifth, sixth and even the seventh thoracic ganglia. There is no agreement on the precise composition of nerve plexuses at the cardiac level. After years of debate, it is generally accepted that the vagal nerve contributes to ventricular innervation. Vagal distribution appears higher in atria, whereas adrenergic fibers exceed the number of vagal fibers in the ventricles.

CONCLUSION

Anatomy of the human cardiac autonomic nervous system is highly variable and likely extends beyond generally assumed boundaries. This information is relevant for thoracic epidural anesthesia and procedures targeting neuronal modulation of cardiac sympathetic innervation.

Authors+Show Affiliations

Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: j.wink@lumc.nl.Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands.Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, the Netherlands.Department of Anesthesia, University Hospitals Ghent, Belgium.Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, the Netherlands.Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands.Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.

Pub Type(s)

Journal Article
Review
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32497872

Citation

Wink, J, et al. "Human Adult Cardiac Autonomic Innervation: Controversies in Anatomical Knowledge and Relevance for Cardiac Neuromodulation." Autonomic Neuroscience : Basic & Clinical, vol. 227, 2020, p. 102674.
Wink J, van Delft R, Notenboom RGE, et al. Human adult cardiac autonomic innervation: Controversies in anatomical knowledge and relevance for cardiac neuromodulation. Auton Neurosci. 2020;227:102674.
Wink, J., van Delft, R., Notenboom, R. G. E., Wouters, P. F., DeRuiter, M. C., Plevier, J. W. M., & Jongbloed, M. R. M. (2020). Human adult cardiac autonomic innervation: Controversies in anatomical knowledge and relevance for cardiac neuromodulation. Autonomic Neuroscience : Basic & Clinical, 227, 102674. https://doi.org/10.1016/j.autneu.2020.102674
Wink J, et al. Human Adult Cardiac Autonomic Innervation: Controversies in Anatomical Knowledge and Relevance for Cardiac Neuromodulation. Auton Neurosci. 2020;227:102674. PubMed PMID: 32497872.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Human adult cardiac autonomic innervation: Controversies in anatomical knowledge and relevance for cardiac neuromodulation. AU - Wink,J, AU - van Delft,R, AU - Notenboom,R G E, AU - Wouters,P F, AU - DeRuiter,M C, AU - Plevier,J W M, AU - Jongbloed,M R M, Y1 - 2020/05/16/ PY - 2019/09/19/received PY - 2020/03/13/revised PY - 2020/04/21/accepted PY - 2020/6/5/pubmed PY - 2020/6/5/medline PY - 2020/6/5/entrez KW - Cardiac autonomic nervous system KW - Cardiac ganglia KW - Cardiac sympathetic blockade KW - Epicardial plexus KW - Human anatomy KW - Vagal nerve SP - 102674 EP - 102674 JF - Autonomic neuroscience : basic & clinical JO - Auton Neurosci VL - 227 N2 - BACKGROUND: Cardiac sympathetic blockade is a therapeutic approach for arrhythmias and heart failure and may be a beneficial effect of high thoracic epidural anesthesia. These treatments require detailed knowledge of the spatial location and distribution of cardiac autonomic nerves, however, there are controversies on this subject in humans. OBJECTIVE: To provide a systematic overview of current knowledge on human anatomy of the cardiac autonomic nervous system. RESULTS: In contrast to the often claimed assumption that human preganglionic sympathetic cardiac neurons originate mainly from thoracic spinal segments T1-T4 or T5, there is ample evidence indicating involvement of cervical spinal segment C8 and thoracic spinal segments below T5. Whether cervical ganglia besides the stellate ganglion play a role in transmission of cardiac sympathetic signals is unclear. Similarly, there is debate on the origin of cardiac nerves from different thoracic ganglia. Most human studies report thoracic cardiac nerves emerging from the first to fourth thoracic paravertebral ganglia; others report contributions from the fifth, sixth and even the seventh thoracic ganglia. There is no agreement on the precise composition of nerve plexuses at the cardiac level. After years of debate, it is generally accepted that the vagal nerve contributes to ventricular innervation. Vagal distribution appears higher in atria, whereas adrenergic fibers exceed the number of vagal fibers in the ventricles. CONCLUSION: Anatomy of the human cardiac autonomic nervous system is highly variable and likely extends beyond generally assumed boundaries. This information is relevant for thoracic epidural anesthesia and procedures targeting neuronal modulation of cardiac sympathetic innervation. SN - 1872-7484 UR - https://www.unboundmedicine.com/medline/citation/32497872/Human_adult_cardiac_autonomic_innervation:_Controversies_in_anatomical_knowledge_and_relevance_for_cardiac_neuromodulation L2 - https://linkinghub.elsevier.com/retrieve/pii/S1566-0702(20)30108-9 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.