Stavros Stavrakis et al. JACEP 2015;1:1-13

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Stavros Stavrakis et al. JACEP 2015;1:1-13 The Role of Autonomic Ganglia in AF Initiation at the Cellular Level (A) Microelectrode recordings from the left atrium and left superior pulmonary vein (LSPV) at baseline and during high-frequency stimulation (HFS) at the left atrial (LA) myocardium, 3 mm from the pulmonary vein (PV) ostium. At baseline, the LSPV has a shorter action potential duration (APD) than adjacent LA myocardium. With HFS, early afterdepolarizations (EADs) and triggered firing are induced in the LSPV, preceding the LA activation. (B) In PV myocytes, cells with an abbreviated action potential, the duration of the calcium transient exceeds APD, leading to activation of the forward mode of the sodium-calcium exchanger, which in turn generates an EAD. With increased ganglionated plexi (GP) activity, parasympathetic activation, which causes action potential shortening, and sympathetic activation, which enhances calcium loading, result in EAD formation and triggered firing. Stavros Stavrakis et al. JACEP 2015;1:1-13 American College of Cardiology Foundation