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Ann Thorac Surg 2000;69:1769-1781
© 2000 The Society of Thoracic Surgeons

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Original articles: Cardiovascular

The heart reinnervates after transplantation

^a Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
^b Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
^c Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada
^d Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Nova Scotia, Canada
^e Department of Pharmacology, East Tennessee State University, Johnson City, Tennessee, USA
^f Department of Pharmacology, Université de Montréal, Montréal, Québec, Canada
^g Department of Cardiology, Laval University, Québec City, Québec, Canada
^h The Institute of HeartMath, Boulder Creek, California, USA

Address reprint requests to Dr Armour, Department of Physiology and Biophysics, Dalhousie University, Halifax, NS, B3H 4H7, Canada

Background. Whether cardiac reinnervation occurs after transplantation remains controversial. If reinnervation does occur, how sympathetic and parasympathetic efferent neurons do this remains unknown.

Methods. Power spectral analysis of heart rate variability was assessed for 1 year after cardiac autotransplantation in 9 dogs. After induction of anesthesia 13 months after transplantation, cardiac and intrinsic cardiac neuronal responses elicited by both electrical stimulation of parasympathetic or sympathetic efferent neurons and systemic or local coronary artery administration of nicotine (5 µg/kg), angiotensin II (0.75 µg/kg), and tyramine (1.2 µg/kg) were studied. The transmembrane electrical properties of intrinsic cardiac neurons were studied in vitro. Ventricular tissue catecholamine content, -tubulin expression, and ß-adrenergic receptor density and affinity were studied. The presence of axons crossing suture lines was sought histologically.

Results. Nerves were identified crossing suture lines. Electrical or chemical (ie, nicotine or angiotensin II) activation of sympathetic efferent neurons enhanced cardiodynamics, as did tyramine. Stimulating vagal efferent preganglionic axons induced bradycardia in half of the dogs. Functional reinnervation did not correlate with specific power spectra derived from rate variability in the conscious state. Responding to nicotine and angiotensin II in situ, transplanted intrinsic cardiac neurons generated spontaneous activity. These neurons displayed nicotine-dependent synaptic inputs in vitro. Ventricular tissue had normal ß-adrenergic receptor affinity and density but reduced catecholamine and -tubulin contents.

Conclusions. The intrinsic cardiac nervous system receives reduced input from extracardiac sympathetic efferent neurons after transplantation and inconsistent input from parasympathetic efferent preganglionic neurons. These heterogeneous neuronal inputs are not reflected in heart rate variability or ventricular ß-adrenergic receptor function. Transplanted angiotensin II–sensitive intrinsic cardiac neurons exert greater cardiac control than do nicotine-sensitive ones. The intrinsic cardiac nervous system remodels itself after cardiac transplantation, and this indicates that direct assessment of extracardiac and intrinsic cardiac neuronal behavior is required to fully understand cardiac control after transplantation.

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