From the Department of Internal Medicine (L.B., C.V., G.S., C.P., G.F.)
and Department of Cardiac Surgery (M.R., L.M., M.V.), University of Pavia and
IRCCS S Matteo, Pavia, Italy; the First Department of Cardiology, Medical
University of Gdansk, Poland (J.W.-S.); and the Herz-Zentrum, Bad Krozingen,
Germany (A.W.F.).
Correspondence to Luciano Bernardi, MD, Clinica Medica 1, Università di Pavia–IRCCS S Matteo, 27100 Pavia, Italy. E-mail LBern1ps{at}ipv36.unipv.it
Background—Cardiac autonomic
reinnervation after human cardiac transplantation has been demonstrated
frequently but to date only for sympathetic efferents. Standard
surgical techniques leave many parasympathetic branches intact in the
original atria and thus with less stimulus to reinnervate the
donor atria.
Methods and Results—We used changes in the RR-interval power
spectrum induced by sinusoidal modulation of arterial
baroreceptors by neck suction at different frequencies to detect both
parasympathetic and sympathetic reinnervation in 79 subjects with
"standard" and 10 "bicaval" heart transplants. In 24 subjects
(17 standard and 7 bicaval), the protocol was repeated 6 and 11 months
after transplantation. Neck suction at 0.20 Hz produced a component at
0.20 Hz in the RR-interval spectrum not due to respiration (fixed at
0.25 Hz), which suggested parasympathetic reinnervation, in 4 of 10
bicaval but in only 2 of 79 standard transplant subjects (whose
recipient atria underwent >50% resection to remove scars of previous
interventions), P<.001. In only 1 (bicaval) transplant
subject was parasympathetic reinnervation present 6 months after
transplantation (confirmed 3 months later); in 4 subjects, it was
absent at 6 months but appeared after 11 months after transplantation.
Atropine (0.04 mg/kg IV) abolished the response to fast (0.20 Hz) and
reduced that to slow stimulation, confirming the presence of
parasympathetic reinnervation (4 subjects).
Conclusions—Parasympathetic reinnervation depends on the surgical
technique: because bicaval surgery cuts all sympathetic and
parasympathetic nerves, regeneration might be stimulated similarly in
both branches. Standard surgery cuts only
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Influence of Type of Surgery on the Occurrence of Parasympathetic Reinnervation After Cardiac Transplantation
50% of sympathetic
fibers; most recipient parasympathetic axons remain intact, hence their
regeneration might not be stimulated.
Key Words: heart rate • transplantation • arrhythmia • baroreceptors
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