Electroanatomic Remodeling of the Left Stellate Ganglion After Myocardial Infarction

Objectives The purpose of this study was to evaluate the changes of left stellate ganglionic nerve activity (SGNA) and left thoracic vagal nerve activity (VNA) after acute myocardial infarction (MI). Background Whether MI results in remodeling of extracardiac nerve activity remains unclear. Methods We implanted radiotransmitters to record the SGNA, VNA, and electrocardiogram in 9 ambulatory dogs. After baseline monitoring, MI was created by 1-h balloon occlusion of the coronary arteries. The dogs were then continuously monitored for 2 months. Both stellate ganglia were stained for growth-associated protein 43 and synaptophysin. The stellate ganglia from 5 normal dogs were used as control. Results MI increased 24-h integrated SGNA from 7.44 +/- 7.19 Ln(Vs)/day at baseline to 8.09 +/- 7.75 Ln(Vs)/day after the MI (p < 0.05). The 24-h integrated VNA before and after the MI was 5.29 +/- 5.04 Ln(Vs)/day and 5.58 +/- 5.15 Ln(Vs)/day, respectively (p < 0.05). A significant 24-h circadian variation was noted for the SGNA (p < 0.05) but not the VNA. The SGNA/VNA ratio also showed significant circadian variation. The nerve densities from the left SG were 63,218 +/- 34,719 mu m(2)/mm(2) and 20,623 +/- 4,926 mu m(2)/mm(2) for growth-associated protein 43 (p < 0.05) and were 32,116 +/- 8,190 mu m(2)/mm(2)and 16,326 +/- 4,679 mu m(2)/mm(2) for synaptophysin (p < 0.05) in MI and control groups, respectively. The right SG also showed increased nerve density after MI (p < 0.05). Conclusions MI results in persistent increase in the synaptic density of bilateral stellate ganglia and is associated with increased SGNA and VNA. There is a circadian variation of the SGNA/VNA ratio. These data indicate significant remodeling of the extracardiac autonomic nerve activity and structures after MI. (J Am Coll Cardiol 2012;59:954-61) (C) 2012 by the American College of Cardiology Foundation