Unique Autonomic Profile of the Pulmonary Veins and Posterior Left Atrium

Unique Autonomic Profile of the Pulmonary Veins and Posterior Left Atrium Rishi Arora, Jason Ng, Joseph Ulphani, Ilias Mylonas, Haris Subacius, Greg Shade, David Gordon, Alexander Morris, Xiang He, Yi Lu, Rashad Belin, Jeffrey J. Goldberger, Alan H. Kadish The parasympathetic nervous system is thought to contribute significantly to the genesis of focal atrial fibrillation; the detailed autonomic profile of the pulmonary veins (PVs) and posterior left atrium (PLA) is not known. High-density LA mapping was therefore performed in response to various autonomic maneuvers. Effective refractory period (ERP) response to vagal maneuvers was heterogeneous, with intraregional ERP heterogeneity being most pronounced in the PLA; these ERP responses corresponded closely with regional differences in IKAch expression. Activation direction within the PV changed markedly with beta-blockade or vagal stimulation; similar changes were not noted in the left atrium.