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Chen HS, van Roon L, Ge Y, van Gils JM, Schoones JW, DeRuiter MC, Zeppenfeld K, Jongbloed MRM. The relevance of the superior cervical ganglion for cardiac autonomic innervation in health and disease: a systematic review. Clin Auton Res 2024; 34:45-77. [PMID: 38393672 PMCID: PMC10944423 DOI: 10.1007/s10286-024-01019-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/22/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE The heart receives cervical and thoracic sympathetic contributions. Although the stellate ganglion is considered the main contributor to cardiac sympathetic innervation, the superior cervical ganglia (SCG) is used in many experimental studies. The clinical relevance of the SCG to cardiac innervation is controversial. We investigated current morphological and functional evidence as well as controversies on the contribution of the SCG to cardiac innervation. METHODS A systematic literature review was conducted in PubMed, Embase, Web of Science, and COCHRANE Library. Included studies received a full/text review and quality appraisal. RESULTS Seventy-six eligible studies performed between 1976 and 2023 were identified. In all species studied, morphological evidence of direct or indirect SCG contribution to cardiac innervation was found, but its contribution was limited. Morphologically, SCG sidedness may be relevant. There is indirect functional evidence that the SCG contributes to cardiac innervation as shown by its involvement in sympathetic overdrive reactions in cardiac disease states. A direct functional contribution was not found. Functional data on SCG sidedness was largely unavailable. Information about sex differences and pre- and postnatal differences was lacking. CONCLUSION Current literature mainly supports an indirect involvement of the SCG in cardiac innervation, via other structures and plexuses or via sympathetic overdrive in response to cardiac diseases. Morphological evidence of a direct involvement was found, but its contribution seems limited. The relevance of SCG sidedness, sex, and developmental stage in health and disease remains unclear and warrants further exploration.
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Affiliation(s)
- H Sophia Chen
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, The Netherlands
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lieke van Roon
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yang Ge
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Janine M van Gils
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands
| | - Marco C DeRuiter
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiology, Center of Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands.
- Department of Cardiology, Center of Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands.
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Kahle AK, Klatt N, Jungen C, Dietenberger A, Kuklik P, Münkler P, Willems S, Nikolaev V, Pauza DH, Scherschel K, Meyer C. Acute Modulation of Left Ventricular Control by Selective Intracardiac Sympathetic Denervation. JACC Clin Electrophysiol 2022; 9:371-384. [PMID: 36752452 DOI: 10.1016/j.jacep.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The sympathetic nervous system plays an integral role in cardiac physiology. Nerve fibers innervating the left ventricle are amenable to transvenous catheter stimulation along the coronary sinus (CS). OBJECTIVES The aim of the present study was to modulate left ventricular control by selective intracardiac sympathetic denervation. METHODS First, the impact of epicardial CS ablation on cardiac electrophysiology was studied in a Langendorff model of decentralized murine hearts (n = 10 each, ablation and control groups). Second, the impact of transvenous, anatomically driven axotomy by catheter-based radiofrequency ablation via the CS was evaluated in healthy sheep (n = 8) before and during stellate ganglion stimulation. RESULTS CS ablation prolonged epicardial ventricular refractory period without (41.8 ± 8.4 ms vs 53.0 ± 13.5 ms; P = 0.049) and with β1-2-adrenergic receptor blockade (47.8 ± 7.8 ms vs 73.1 ± 13.2 ms; P < 0.001) in mice. Supported by neuromorphological studies illustrating a circumferential CS neural network, intracardiac axotomy by catheter ablation via the CS in healthy sheep diminished the blood pressure increase during stellate ganglion stimulation (Δ systolic blood pressure 21.9 ± 10.9 mm Hg vs 10.5 ± 12.0 mm Hg; P = 0.023; Δ diastolic blood pressure 9.0 ± 5.5 mm Hg vs 3.0 ± 3.5 mm Hg; P = 0.039). CONCLUSIONS Transvenous, anatomically driven axotomy targeting nerve fibers along the CS enables acute modulation of left ventricular control by selective intracardiac sympathetic denervation.
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Affiliation(s)
- Ann-Kathrin Kahle
- Division of Cardiology, Angiology, and Intensive Care Medicine, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany; Institute of Neural and Sensory Physiology, Cardiac Neuro- and Electrophysiology Research Consortium, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Niklas Klatt
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany; Department of Cardiology, Schön Klinik Neustadt in Holstein, Neustadt in Holstein, Germany
| | - Christiane Jungen
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany; Clinic for Cardiology, University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Aaron Dietenberger
- Clinic for Cardiology, University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pawel Kuklik
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Paula Münkler
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany; Clinic for Cardiology, University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stephan Willems
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany; Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Viacheslav Nikolaev
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany; Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dainius H Pauza
- Institute of Anatomy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Katharina Scherschel
- Division of Cardiology, Angiology, and Intensive Care Medicine, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany; Institute of Neural and Sensory Physiology, Cardiac Neuro- and Electrophysiology Research Consortium, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Christian Meyer
- Division of Cardiology, Angiology, and Intensive Care Medicine, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany; Institute of Neural and Sensory Physiology, Cardiac Neuro- and Electrophysiology Research Consortium, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany.
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Pauziene N, Rysevaite-Kyguoliene K, Alaburda P, Pauza AG, Skukauskaite M, Masaityte A, Laucaityte G, Saburkina I, Inokaitis H, Plisiene J, Pauza DH. Neuroanatomy of the Pig Cardiac Ventricles. A Stereomicroscopic, Confocal and Electron Microscope Study. Anat Rec (Hoboken) 2017; 300:1756-1780. [DOI: 10.1002/ar.23619] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 03/10/2017] [Accepted: 03/15/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Neringa Pauziene
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | | | - Paulius Alaburda
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Audrys G. Pauza
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Monika Skukauskaite
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Aiste Masaityte
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Goda Laucaityte
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Inga Saburkina
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Hermanas Inokaitis
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Jurgita Plisiene
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Dainius H. Pauza
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
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Shiina T, Shima T, Suzuki Y, Wörl J, Shimizu Y. Neural regulation of esophageal striated muscle in the house musk shrew (Suncus murinus). Auton Neurosci 2012; 168:25-31. [PMID: 22285704 DOI: 10.1016/j.autneu.2012.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 01/05/2012] [Accepted: 01/08/2012] [Indexed: 12/21/2022]
Abstract
In the present study, we characterized the neural regulation of esophageal striated muscle in Suncus murinus (a house musk shrew; "suncus" used as a laboratory name), which was compared with that in the rat. The tunica muscularis consists of striated muscle in the suncus esophagus. An isolated segment of the suncus esophagus was placed in an organ bath and the contractile responses were recorded using a force transducer. Electrical stimulations to vagus nerves induced contractile responses in the esophageal segment. Treatment with α-bungarotoxin, a blocker of nicotinic acetylcholine receptors, blocked the vagally mediated contractions of the suncus esophagus. D-tubocurarine and succinylcholine, typical antagonists of nicotinic acetylcholine receptors, also inhibited the suncus esophageal contractions, while higher concentrations of the agents were required rather than concentrations for producing an equivalent block in the rat. We used capsaicin, a stimulator of small-caliber afferent neurons, for activating the peripheral neural network. The reagent inhibited the vagally mediated twitch contractions of striated muscle in the suncus esophagus, which was reversed by pretreatment with a nitric oxide synthase inhibitor, N(G)-nitro-L-arginine methyl ester. Application of a nitric oxide donor, diethylamine NONOate diethylammonium salt, mimicked capsaicin-induced inhibition. The results suggest that motility of the suncus esophagus, which consists of striated muscles, is regulated by vagal cholinergic neurons. The local neural network including capsaicin-sensitive neurons and intrinsic nitrergic neurons can modify the vagally mediated motility in the suncus esophagus. In addition, nicotinic acetylcholine receptors of the suncus esophagus might be pharmacologically distinct from those of rodent esophagi.
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Affiliation(s)
- Takahiko Shiina
- Laboratory of Physiology, Department of Basic Veterinary Science, The United Graduate School of Veterinary Sciences, Gifu University, Japan.
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Kawashima T, Sato F. Detailed comparative anatomy of the extrinsic cardiac nerve plexus and postnatal reorganization of the cardiac position and innervation in the great apes: orangutans, gorillas, and chimpanzees. Anat Rec (Hoboken) 2011; 295:438-53. [PMID: 22190256 DOI: 10.1002/ar.21530] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 08/17/2011] [Indexed: 12/16/2022]
Abstract
To speculate how the extrinsic cardiac nerve plexus (ECNP) evolves phyletically and ontogenetically within the primate lineage, we conducted a comparative anatomical study of the ECNP, including an imaging examination in the great apes using 20 sides from 11 bodies from three species and a range of postnatal stages from newborns to mature adults. Although the position of the middle cervical ganglion (MG) in the great apes tended to be relatively lower than that in humans, the morphology of the ECNP in adult great apes was almost consistent with that in adult humans but essentially different from that in the lesser apes or gibbons. Therefore, the well-argued anatomical question of when did the MG acquire communicating branches with the spinal cervical nerves and appear constantly in all sympathetic cardiac nerves during primate evolution is clearly considered to be after the great apes and gibbons split. Moreover, a horizontal four-chambered heart and a lifted cardiac apex with a relatively large volume in newborn great apes rapidly changed its position downward, as seen in humans during postnatal growth and was associated with a reduction in the hepatic volume by imaging diagnosis and gross anatomy. In addition, our observation using a range of postnatal stages exhibits that two sympathetic ganglia, the middle cervical and cervicothoracic ganglia, differed between the early and later postnatal stages.
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Affiliation(s)
- Tomokazu Kawashima
- Department of Anatomy, School of Medicine, Toho University, Tokyo, Japan.
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Kawashima T. Anatomy of the cardiac nervous system with clinical and comparative morphological implications. Anat Sci Int 2010; 86:30-49. [PMID: 21116884 DOI: 10.1007/s12565-010-0096-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 09/29/2010] [Indexed: 01/05/2023]
Abstract
Unlike autonomic nervous preservation in other surgeries for improving patient quality of life, autonomic cardiac nervous system (ACNS) preservation has been neglected in cardiovascular surgery because of technical difficulties and other unsolved issues. Because such ACNS preservation in cardiovascular surgery is anticipated in the future, detailed anatomical investigation of the human ACNS is required. Therefore, we have conducted morphological studies of the ACNS from macroscopic, clinical, and evolutionary anatomical viewpoints. In this study, I review detailed anatomical studies of the human ACNS together with their clinical implications. In addition, the evolutionary comparative anatomical significance of primate ACNS is also summarized to help understand and translate the findings of functional experiments to humans. These integrated findings will be the subject of a future study unifying molecular embryological and anatomical findings to clarify cardiac functions based on functional animal experiments, clinical applications such as improving surgery techniques and individual order-made surgery in cardiac surgery, and for future evaluation in regenerative medicine.
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Affiliation(s)
- Tomokazu Kawashima
- Department of Anatomy, School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
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