Volume 13, Issue 1, Pages (January 2016)

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Volume 13, Issue 1, Pages 282-288 (January 2016) Targeted stellate decentralization: Implications for sympathetic control of ventricular electrophysiology Una Buckley, MD, Kentaro Yamakawa, MD, Tatsuo Takamiya, MD, J. Andrew Armour, MD, PhD, Kalyanam Shivkumar, MD, PhD, FHRS, Jeffrey L. Ardell, PhD Heart Rhythm Volume 13, Issue 1, Pages 282-288 (January 2016) DOI: 10.1016/j.hrthm.2015.08.022 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 Recording array and neural anatomy. Example of the custom 56-electrode sock placed over both ventricles to measure unipolar epicardial electrograms derived from the ventricular epicardium (B). Each electrode is color-coded to correspond to a numbered specific region on the sock so that regional information can be obtained (A). C: Schematic diagram depicting the gross anatomic arrangement of the porcine right-sided upper thoracic paravertebral chain (T2–T4) and associated mediastinal neural structures, including stellate and middle cervical (MCG) ganglia. X represents thoracic vagosympathetic trunk. CPN = cardiopulmonary nerves. Heart Rhythm 2016 13, 282-288DOI: (10.1016/j.hrthm.2015.08.022) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Heart rate and activation–recovery interval (ARI) responses to right T1 and T3 stimulation before and after stellectomy. Heart rate (A) and percent change in ventricular ARI (B) compared to baseline (BL) in response to right-sided stellate (RT1) and T3 paravertebral (RT3) chain ganglion stimulation before (intact) and after right-sided surgical excision of the caudal stellate ganglia and adjacent T2 chain ganglia (SGx). *P <.05 vs baseline. #P <.05 vs intact state. Heart Rhythm 2016 13, 282-288DOI: (10.1016/j.hrthm.2015.08.022) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 Cardiac activation–recovery interval (ARI) maps before and after stellate removal. Example of polar maps of ARI (ms) in 1 animal, generated from the sock electrode, comparing baseline intact conditions, with right stellate ganglion stimulation (RT1; A) and right T3 stimulation in the intact (RT3) state (B), vs T3 stimulation after partial stellectomy (RT3 post SGx; C). There is significant ARI shortening with RT1 and RT3 stimulation in the intact condition. When RT3 is stimulated after partial stellectomy, there is no significant change in ARI from baseline. Heart Rhythm 2016 13, 282-288DOI: (10.1016/j.hrthm.2015.08.022) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 4 Heart rate and activation–recovery interval (ARI) responses to left T1 and T3 stimulation before and after stellectomy. Heart rate (A) and percent change in ventricular ARI (B) compared to baseline (BL) in response to left-sided stellate (LT1) and T3 paravertebral (LT3) chain ganglion stimulation before (intact) and after left-sided surgical excision of the caudal stellate ganglia and adjacent T2 chain ganglia (SGx). *P <.05 vs baseline. P <.05 vs intact state. Heart Rhythm 2016 13, 282-288DOI: (10.1016/j.hrthm.2015.08.022) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 5 Dispersion of repolarization in response to T1 and T3 stimulation before and after stellectomy. Whole heart dispersion (ms2) for right (A) and left (B) T1 and T3 stimulation compared to baseline (BL) in the intact vs post partial stellectomy (SGx) state. *P <.05 vs baseline. #P <.05 vs intact LT3 stimulation. Heart Rhythm 2016 13, 282-288DOI: (10.1016/j.hrthm.2015.08.022) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 6 Ventricular dP/dt responses to right and left T1 and T3 stimulation before and after stellectomy. Change in left ventricular dP/dt maximum in response to right-sided (A) and left-sided (B) T1 and T3 stimulation compared to baseline (BL) in intact state and after surgical excision of the caudal stellate ganglia and adjacent T2 chain ganglia (SGx). *P <.05 vs baseline. #P <.05 vs intact state. Heart Rhythm 2016 13, 282-288DOI: (10.1016/j.hrthm.2015.08.022) Copyright © 2016 Heart Rhythm Society Terms and Conditions