Abstract Parkinson's disease (PD) is known to affect both the extrapyramidal system and the autonomic nervous system even in the early phases of the disease. This study was designed to evaluate cardiovascular autonomic regulation in early PD by measuring heart rate (HR) variability from 24-hour ECG recordings. The dynamics of blood pressure (BP), HR and sweating in patients with and without wearing-off were assessed during clinical observations after a morning dose of levodopa. In patients with wearing-off the tests were repeated after selegiline withdrawal. The power spectral components of HR variability and the SD1 value of the Poincaré analysis that quantifies the short-term beat-to-beat variability were suppressed at night in the PD patients. During the daytime only the SD1 of the Poincaré was suppressed. The results indicate impairment of parasympathetic cardiovascular regulation in untreated patients with PD. The dysfunction was more pronounced at night and in patients with more severe PD. The patients with wearing-off had fluctuation of BP during the observation period, BP increasing when the motor performance worsened and vice versa (p < 0.001). The patients without wearing-off did not show fluctuation of BP. Sweating increased during the observation period, and reached its maximum level at the time of the highest UPDRS motor score phase (off-stage) in patients with wearing-off, but in the patients without wearing-off no changes in sweating were observed. Sweating of the hands was significantly higher in PD patients with motor fluctuations than in those without. Selegiline withdrawal decreased systolic BP significantly during the on-stage in a supine position as well as during the orthostatic test. The initial drop of BP in the orthostatic test was significantly smaller after selegiline withdrawal. The HR and sweating remained unaffected. The results show that the autonomic nervous system is affected in the early phases of PD. The dysfunction becomes more pronounced with the disease progression. Wearing-off type motor fluctuations are associated with fluctuation of BP and sweating and these fluctuations may represent autonomic dysfunction caused by PD, the effect of PD medication, or both. Selegiline withdrawal seems to alleviate the orthostatic reaction in patients with advanced PD.

Abstract Patients with idiopathic Parkinson's disease (PD) may suffer from autonomic nervous system dysfunction even in the early phase of the disease. We assessed the autonomic cardiovascular and sudomotor regulation in de novo PD patients with and without medication. We also measured the dopamine (DAT) and serotonin transporter (SERT) uptake in the PD patients using 2β-carboxymethoxy-3β-(4-iodophenyl)tropane (β-CIT) SPECT and studied the clinical correlates of the uptake. Sixty PD patients were included in the study and randomised to receive levodopa, bromocriptine or selegiline (n=20 in each) as their treatment. Thirty patients were examined with β-CIT SPECT. The results of the patients were compared with those of healthy controls and within the subgroups at different time points. Cardiovascular autonomic regulation was assessed using standard cardiovascular reflex tests at baseline, after six months' medication and following a 6-week washout period. The heart rate (HR) and blood pressure (BP) regulation was impaired in PD patients at baseline, and PD medications modified the responses further. Bromocriptine and selegiline, in contrast to levodopa, increased the orthostatic BP fall and suppressed the BP response to isometric exercise. The long-term cardiovascular autonomic function was evaluated from ambulatory ECG recordings by analysis of traditional spectral and non-spectral components of HR fluctuation together with two-dimensional vector analysis and power-law relationship analysis of the HR dynamics. All spectral measures and the slope of the power-law relationship demonstrated impaired tonic cardiovascular regulation in the PD patients. Sympathetic sudomotor activity was evaluated using the sympathetic skin response (SSR). The major finding was suppression of the SSR amplitudes with an inverse correlation to clinical disability, whereas PD medication seemed to have only minor effects. The changes in amplitude and repetitiveness of the SSRs with normal adaptation suggest deficits at several levels of the SSR reflex arc. DAT uptake, assessed by β-CIT SPECT, was diminished in the striatum and especially the putamen of the PD patients, and correlated with the results of the cardiovascular reflex tests and ambulatory ECG recordings. Simultaneous measurement of SERT binding demonstrated decreased SERT availability in the thalamic and frontal areas. The results demonstrate disturbances of the reflectory and tonic cardiovascular autonomic regulation caused by PD itself. PD medications further modify the reflectory responses. The degenerative process in PD also involves the sympathetic sudomotor pathway. β-CIT SPECT provides a useful method for simultaneous assessment of DAT and SERT binding, demonstrating the deficit of serotonin metabolism in PD.

Abstract Multiple sclerosis (MS) is one of the major causes of disability in the young, mostly affecting people between 20–45 years of age. MS is considered as an autoimmune disorder, characterized by discrete areas of central nervous system inflammation, demyelination and axonal injury. Symptoms related to alterations of the autonomic nervous system are frequent in patients with MS. Bladder dysfunction or impairment of sexual performance is highly distressing for most MS patients, whereas the clinical relevance of other autonomic symptoms is less clear. The present study was designed to clarify the involvement of cardiovascular and sudomotor dysfunctions in patients with MS, to study the sudomotor functions in patients with optic neuritis (optic neuritis being a frequent initial manifestation of MS), and to assess the extent of demyelinative lesions in the CNS by using magnetic resonance imaging and by correlating the findings thus obtained with autonomic nervous system responses. The study showed cardiovascular autonomic regulation failure in MS patients manifesting itself both in the heart rate responses to deep breathing and in the heart rate and blood pressure responses in the tilt table test. In particular, midbrain lesions were found to be associated with cardiovascular dysfunction. MS patients also showed abnormal sympathetic skin responses indicating sudomotor failure. Focal MS lesions in the temporal lobe, in the pons and in the cerebellum were also associated with abnormal sympathetic skin responses. MS patients were also found to have an impairment in thermoregulatory sweating, which seemed to be related to disease severity and to total lesion volume in the brain. Sympathetic skin responses were also abnormal in optic neuritis patients, suggesting sudomotor autonomic failure. Patients with optic neuritis showed no thermoregulatory dysfunction.

Abstract Epilepsy is associated with changes in autonomic cardioregulatory function. Ictally, autonomic disturbances may be evident with significant changes in heart rate (HR), blood pressure (BP) and respiration. However, interictal dysfunction of autonomic cardiovascular system may be subtle and it may be recognized only by delicate tools designed for that purpose. The aim of this study was to evaluate the function of the cardiovascular autonomic regulatory system in patients with epilepsy. Cardiovascular reflex tests were performed on patients with partial or idiopathic generalized epilepsies. Special attention was paid to temporal lobe epilepsy (TLE). An association of refractory and well controlled TLE and hippocampal sclerosis with altered cardioregulation was evaluated by using cardiovascular reflex tests and an analysis of spectral and non-linear analysis of heart rate variation (HRV). Cardiovascular reflexes were altered both in patients with partial and idiopathic generalized epilepsies who had been treated for epilepsy with antiepileptic drugs (AEDs), whereas patients with newly, untreated epilepsy did not differ from the control subjects. Diminished cardiovascular reflexes also seemed to be associated with carbamazepine (CBZ) treatment. Various parameters of cardiovascular reflex tests and analysis of spectral and dynamic measures of HRV were diminished in patients with TLE compared to the control subejcts. These results indicate that epilepsy, especially TLE, is associated with interictal changes of autonomic cardioregulation. Although these changes seem to be evident in patients with severe form of TLE, patients with well controlled TLE and patients without hippocampal sclerosis also have altered autonomic cardioregulatory function. These results suggest that dysfunction of the cardioregulatory system is rather associated with functional than structural changes of the inner temporal lobe in patients with TLE.

The aim of this paper was to summarize the current knowledge of function and regulation of autonomic nervous system (ANS). We wanted to assess possible involvement of ANS in changes of muscle tension. Sympathetic nervous system affects the sensitivity of somatosenzory afferention, thus effecting the function of whole nervous system. Exists evidence about ANS effect on cutaneous afferents activity as well as muscle spindle afferent activity. Sympathetic modulation of proprioceptive information from muscle spindles may influence α motoneuron excitability. ANS may affect muscle tonus regulation. The selective activation of trigger point (TRP) during heightened muscle sympathetic efferent activity (MSNA) was proved. This supports the idea that the sympathetic nervous system can directly contribute on maintaining of the TRP and myofascial pain syndrome. Powered by TCPDF (www.tcpdf.org)

Biofeedback equipment is intended to train conscious regulation of normally sub-conscious processes like autonomic nervous system activities. The manufacturers claim that measurements made with the equipment are accurate enough for research purposes, but these claims have not been vigorously tested. The subconscious processes recorded with biofeedback equipment are often disturbed by stress, and the aim of this study was to determine if the markers of stress could be accurately determined with biofeedback equipment. The physiological processes that were screened were:<ul><li> Time and frequency domain heart rate variability (HRV) determined from blood-volume-pulse (BVP) </li><li> Time and frequency domain HRV determined from electrocardiogram (ECG) </li><li> The amplitude of the BVP</li><li> Electromyographic (EMG) activity</li><li> The pulse transit time</li><li> Respiration rate and depth</li><li> Skin conductivity</li><li> Fingertip temperature</li><li> Quantitative electroencephalographic (QEEG) activity</li></ul> The accuracy of the HRV measurements were tested by comparing them to readings made simultaneously with a gold-standard device (Actiheart), and the main findings were:<ul><li> The hardware capabilities of the two systems are comparable when it comes to registering heartbeats and calculating heart rate</li><li> The frequency domain biofeedback HRV variables had relatively good correlations to the Actiheart results, but improvements are necessary</li><li> Frequency domain HRV variables differ when calculated with fast Fourier transform or with autoregression</li><li> The BVP signal is prone to movement artifact and other forms of interference</li></ul> The HRV measurements of both the biofeedback and Actiheart device were correlated to psychometric evaluations of anxiety and burnout, two conditions closely related to the concept of stress. The main findings were:<ul><li> Worry and anxiety can have a cardiac accelerating effect, largely mediated by vagal withdrawal </li><li> A decrease in resting autonomic variability associated with anxiety</li><li> Significant autonomic nervous system inflexibility occurs in the face of a cognitive stressor with increased anxiety</li><li> An increase in vagal and a decrease in sympathetic cardiac control correlated with increased levels of vital exhaustion</li><li> HRV assessment with specialized software such as Polar Precision Performance Software and the advanced HRV Analysis 1.1 software for windows (Biomedical Signal Analysis Group) were superior to assessments by means of the Biograph Infinity program</li></ul> Next it was investigated whether any association existed between levels of anxiety, burnout and that of Biograph-derived physiological indicators such as BVP amplitude, BVP HRV, ECG HRV, pulse transit time, EMG, fingertip temperature, respiration rate and amplitude, skin conductivity and QEEG levels. The overriding observations with increases in the levels of stress-related emotional conditions such as anxiety were that of a decrease in variability in almost all physiological functions assessed by Biograph. In conclusion, relatively good associations were found between certain, but not all, Biofeedback monitor results and that of other assessments of stress. The potential exists to develop a program which would accurately reflect stress levels. / Dissertation (MSc)--University of Pretoria, 2012. / School of Health Systems and Public Health (SHSPH) / Unrestricted

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-20T20:21:48Z No. of bitstreams: 1 José Robertto Zaffalon Júnior.pdf: 1226797 bytes, checksum: 98ee59a170b7f0ef47fc560dd2ba5b1f (MD5) / Made available in DSpace on 2018-07-20T20:21:48Z (GMT). No. of bitstreams: 1 José Robertto Zaffalon Júnior.pdf: 1226797 bytes, checksum: 98ee59a170b7f0ef47fc560dd2ba5b1f (MD5) Previous issue date: 2018-03-09 / Subjects with a family history of hypertension (SAH) and Type 2 Diabetes Mellitus (DM2) presented early impairment in heart rate variability (HRV) when compared to those without family history. Despite previous studies reporting the benefits of physical exercise in hypertensive and diabetic subjects, the benefits of a physically active lifestyle in subjects with family history SAH and DM2, especially among young women, have not been fully evaluated. Therefore, the aim of this thesis was to analyze metabolic, hemodynamic and autonomic parameters at rest and in response to sympathetic stimulation in sedentary and physically active women with family history of SAH, DM2 or SAH+DM2. We performed a cross-sectional study with 105 women (age: 18 to 30 years). We evaluated: family history of SAH/DM2; level of physical activity; blood pressure; glycemia; HRV in the time and frequency domain by recording the R-R intervals. For better analysis, the thesis was divided in four studies. In the sStudy 1 we analyzed the quality of life and hemodynamic and autonomic parameters at rest and in response to a mental stress test of sedentary (SW=48) and active (AW=48) young women. The results provided evidence that sedentary lifestyles impaired autonomic cardiac modulation both at rest and in response to physiological stress and worsed quality of life. In the Study 2 we analyzed the HRV in offspring: of normotensive and normoglycemic (NND, n=14), of hypertensive (HD, n=13), of diabetic (DD, n=11), and of diabetic and hypertensive (DFD, n=11). The results showed that the family history of SAH and/or DM2 induced impairment in HRV before clinical cardiovascular or glycemic alterations. In the Study 3 we analyzed the impact of lifestyle on the autonomic cardiac modulation in women with a family history of DM2. We compared offspring of: normoglycemic sedentary (SDN, n = 14), diabetic sedentary (DSD, n=11) and diabetic active (DAD, n = 14). We demonstrated that physically active lifestyles improve cardiac autonomic modulation in diabetic offspring. In the Study 4 we evaluated the influence of the family history of hypertension associated to DM2 on HRV at rest and in response to a mental stress test. We evaluated sedentary offspring of normotensive and normoglycemic (SDNN, n=13), sedentary and active offspring of hypertensive (SHD, n=13 and SAH, n=14), and sedentary and active offspring of hypertensive and diabetic (SHD, n=11 and AHD, n=14). We showed that physically active lifestyles induced improvement on cardiac autonomic modulation of women with a family history of SAH, but that the association with the family history of DM2 is responsible for attenuation of these benefits, especially in response to a mental stress test. In summary, our results demonstrated impairment on HRV in women with family history of SAH and DM2, highlight the importance of a physically active lifestyle in the prevention of early autonomic dysfunctions associated with the development of SAH and DM2 in genetically predisposed women, and also reinforced the HRV analysis as a possible early marker of cardiovascular risk in this population. / Indivíduos com histórico familiar de hipertensão arterial sistêmica (HAS) e Diabetes Mellitus do tipo 2 (DM2) apresentam precocemente prejuízo na variabilidade da frequência cardíaca (VFC) quando comparados aos filhos de normotensos/normoglicêmicos. Apesar de diversos estudos avaliarem os benefícios do exercício físico em hipertensos e diabéticos, poucos analisaram a influência do estilo de vida fisicamente ativo em filhos de pais com HAS e DM2, principalmente entre mulheres jovens. Destarte, o objetivo desta tese foi analisar parâmetros metabólicos, hemodinâmicos e autonômicos em repouso e em resposta a estimulação simpática de mulheres sedentárias e fisicamente ativas com histórico familiar positivo de HAS, DM2 e HAS+DM2. Foi conduzido um estudo analítico transversal, com 105 mulheres (18 a 30 anos de idade). Foi avaliado: histórico familiar de HAS/DM2; nível de atividade física; pressão arterial; glicemia; VFC no domínio do tempo e da frequência por meio do registro dos intervalos R-R. Os resultados foram divididos em quatro estudos. No estudo 1 foi analisada a qualidade de vida e os parâmetros hemodinâmicos e autonômicos em repouso e em resposta ao teste de estresse mental em mulheres jovens sedentárias (MS=48) e fisicamente ativas (MA=48). Os achados evidenciaram que o sedentarismo em mulheres induziu prejuízo na modulação autonômica cardíaca em repouso e em resposta ao estresse fisiológico e piorou a qualidade de vida, antes mesmo de alterar parâmetros clínicos cardiovasculares ou metabólicos. No Estudo 2, foi comparada a VFC de mulheres filhas: de normotensos e normoglicêmicos (FNN, n=14), de hipertensos (FH, n=13), de diabéticos (FD, n=11) e de diabéticos e hipertensos (FHD, n=11). Os resultados demonstraram que o histórico familiar de HAS e/ou DM2 induziu prejuízo na VFC antes de alterações clínicas cardiovasculares ou glicêmicas. No estudo 3 foi avaliado o impacto do estilo de vida sobre a modulação autonômica cardíaca de mulheres com histórico familiar de DM2. Foram avaliadas filhas: sedentárias de normoglicêmicos (FSN, n=14), sedentárias de diabéticos (FSD, n=11) e ativas de diabéticos (FAD, n=14), concluindo que o estilo de vida fisicamente ativo foi associado a melhor modulação autonômica cardíaca do grupo FAD. No Estudo 4 foi avaliado a influência do histórico familiar de HAS associado ou não à DM2 sobre a VFC em repouso e em resposta a um teste de estresse mental de mulheres sedentárias e fisicamente ativas. Foram avaliadas filhas: sedentárias de normotensos e normoglicêmicos (FSNN, n=14), sedentárias de hipertensos (FSH, n=13), ativas de hipertensos (FAH, n=14); e sedentárias de hipertensos e diabéticos (FSHD, n=11) e ativas de hipertensos e diabéticos (FAHD, n=14). Os achados deste estudo mostraram que o estilo de vida fisicamente ativo é responsável pela melhor modulação autonômica cardíaca de mulheres com histórico familiar de HAS, mas que a associação com o histórico de DM2 atenua estes benefícios, não só na condição de repouso, mas principalmente frente ao teste de estresse mental. Em conjunto nossos resultados evidenciam prejuízo na VFC em mulheres com histórico familiar de HAS e/ou DM2, ressaltam a importância de uma vida fisicamente ativa na prevenção de disfunções autonômicas precoces associadas ao desenvolvimento de HAS e DM2 em mulheres geneticamente predispostas, e reforçam a análise da VFC como um possível marcador precoce de risco cardiovascular nessa população.

A simpatectomia é uma modalidade terapêutica ampla e consagrada há décadas para determinadas patologias. Recentemente, alguns trabalhos sugerem a aplicação de tal técnica no tratamento da insuficiência cardíaca. Contudo, seus efeitos fisiológicos cardíacos em modelos experimentais foram pouco estudados. O objetivo deste trabalho é avaliar os efeitos fisiológicos da simpatectomia no coração. Para tal, foi utilizado o modelo experimental de simpatectomia em ratos pela técnica de esclerose do gânglio estrelado por punção e injeção de álcool absoluto. O estudo avaliou cinco grupos: controle (15 animais), simpatectomia unilateral esquerda (15 animais), simpatectomia bilateral (31 animais), simpatectomia unilateral esquerda com atenolol (15 animais) e atenolol sem simpatectomia (15 animais). Foram avaliadas as variáveis relacionadas ao sistema nervoso autônomo, como propriedades cronotrópicas em repouso e ao esforço, modulação autonômica cardiovascular, catecolaminas miocárdicas e periféricas e receptores beta-adrenérgicos do miocárdio. Também foram analisados os efeitos na função ventricular e no tamanho do miócito. As variáveis propostas para análise foram obtidas por ECG de repouso, ecocardiograma, teste de esforço máximo, frequência cardíaca ao esforço e variabilidade da FC e da PAS avaliadas no domínio do tempo e da frequência. As informações do miocárdio quanto a receptores, catecolaminas miocárdicas, catecolaminas periféricas e tamanho dos miócitos foram obtidas por PCR, ELISA, HPLC e morfometria do miócito, respectivamente. Este estudo evidenciou que os animais do grupo bilateral apresentam maiores níveis de catecolaminas periféricas e, consequentemente, são mais taquicárdicos e hipertensos. Os achados sugerem a ativação, neste grupo, de uma via compensatória que pode ter efeitos deletérios / Sympathectomy is a therapeutic modality used to treat certain diseases during decades. Recently, some studies suggest the application of this technique in the treatment of heart failure. However, its physiological effects upon the heart have been slightly studied. The objective of this study was to evaluate the physiological effects of sympathectomy in the heart. For this purpose, we used the experimental model of sympathectomy in rats by stellate ganglion sclerosis technique starring puncture and absolute alcohol injection. The study evaluated five groups of wistar rats: control (15), left unilateral sympathectomy (15), bilateral sympathectomy (31), left unilateral sympathectomy with atenolol (15) and atenolol without sympathectomy (15). We assessed variables related to the autonomic nervous system, such as chronotropic properties at rest and stress, cardiovascular autonomic modulation, myocardial and peripheral catecholamines and beta-adrenergic receptors in the myocardium. As well, we studied the effects on ventricular function and myocyte size. The proposed variables for analysis were obtained by resting electrocardiogram, echocardiography, maximal exercise test, heart rate at exercise and heart rate and systolic blood pressure variability in the time and frequency domain. The myocardial receptors, myocardial and peripheral catecholamines and myocyte size were obtained by PCR, ELISA, HPLC and myocyte morphometry, respectively. This study showed that the animals in the bilateral group had higher levels of peripheral catecholamine and, consequently, a higher heart rate and blood pressure. These findings suggest the activation of a compensatory pathway in the sympathectomy group that may have deleterious effects

Eventuais alterações no substrato anatômico miocárdico, no sistema nervoso autônomo (SNA) cardíaco intrínseco, envolvendo os plexos ganglionares (PG) comumente presentes em organizações de gordura epicárdicas denominadas fatpads (FP) ou a expressão dos receptores muscarínicos, poderiam ser responsáveis pela gênese e manutenção da fibrilação atrial (FA). Com o objetivo de analisar a relação entre fibrilação atrial permanente (FAP) e possíveis alterações anatômicas e micromorfológicas do coração, do SNA cardíaco intrínseco e da expressão dos receptores muscarínicos miocárdicos, foram estudados 13 corações de autópsias de portadores de FAP e cardiopatia crônica definida (grupo I) e 13 casos pareados pela mesma doença cardíaca, porém sem esta arritmia (grupo II). Foram analisados a anatomia da drenagem venosa do átrio esquerdo (AE), peso do coração, espessura do septo ventricular e diâmetro dos FP epicárdicos. Foram ressecadas duas amostras no átrio direito (AD1 e AD2), três no átrio esquerdo - no trajeto médio da VoAe (AE1), na junção da veia pulmonar superior esquerda (AE2) e na aurícula (AE3), três em FPs, atrial esquerdo superior (FP1), atrial direito posterior (FP 2) e no atrial esquerdo póstero-medial (FP 3) e uma amostra do septo ventricular (SIV), como controle. As alterações estruturais das fibras miocárdicas, as espessuras do epicárdio, endocárdio e miocárdio e o percentual de colágeno intersticial no miocárdio foram analisados através de histomorfometria computadorizada sob coloração de tricrômio de Masson. O SNA cardíaco intrínseco foi analisado através imuno-histoquímica para S-100 e tirosina-hidroxilase quanto a: quantidade e área das fibras nervosas, quantidade e área média de fibras simpáticas, quantidade e área média de fibras parassimpáticas e proporção de fibras simpáticas/parassimpáticas. A expressão miocárdica dos receptores muscarínicos 1 a 5 (M1 a M5) foi avaliada pela proporção positiva no miocárdio nos cortes AD1, AE1, AE2 e FP1. Não houve diferenças entre os grupos quanto às variáveis anatômicas e ao percentual de colágeno intersticial. A análise do SNA revelou fibras nervosas com menor área no grupo I, redução do número de fibras nervosas totais e parassimpáticas nos cortes AD1 e SIV, aumento de fibras totais e parassimpáticas AE2 e FP2 e aumento do número de fibras simpáticas nos cortes AD2, AE1, AE2 e AE3. Quanto à expressão dos receptores muscarínicos, houve aumento significante na porcentagem positiva para M1 em todas as regiões, exceto na AE1 (média de todos os cortes, grupo I 5,84 e grupo II 2,92, p=0,002); o M2 e M3 apenas junto ao FP1 (M2 grupo I 5,67 e grupo II 3,63, p=0,037; M3 grupo I 30,95 e grupo II 20,13, p=0,026) e o M4 foi aumentado no grupo I na região AE1 (grupo I 9,90 e grupo II 4,45, p=0,023); não houve alteração estatisticamente significante no M5. A anatomia e a disposição das fibras musculares atriais, bem como a fibrose intersticial não parecem estar relacionadas à FAP nos grupos estudados. Alterações no número de fibras nervosas bem como e alterações na expressão dos receptores muscarínicos atriais, especialmente o M1, particularmente em regiões próximas aos PG, parecem estar relacionadas à FAP, indicando a importância da modulação autonômica nesta arritmia / Possible changes in myocardial substrate, in the intrinsic cardiac autonomic nervous system (ANS), involving the ganglionated plexus (GP) present in fat-pads (FP) or the expression of muscarinic receptors could be responsible for the genesis and maintenance of atrial fibrillation (AF). Aiming to analyze the relationship between permanent atrial fibrillation (pAF) and possible anatomical and micromorphological heart changes, intrinsic cardiac ANS and expression of myocardial muscarinic receptors, 13 hearts from autopsies of patients with PAF and chronic heart disease (group I) were studied; and 13 cases matched by the same heart disease, but without this arrhythmia (group II). It was analyzed the anatomy of the venous drainage of the left atrium (LA), heart weight, ventricular septal thickness and diameter of epicardial FP. Two samples were taken in the right atrium (RA1 and RA2), three in the left atrium - in the middle portion of the left atrium oblique vein (LaOv LA1), at the junction of left superior pulmonary vein (LA2) and in the auricle (LA3), three FPs, left atrial superior (FP 1), right atrial posterior (FP 2) and the left atrial posteromedial (FP 3) and one sample of the ventricular septum (VS), as control. The structural changes of the myocardial fibers, thickness of the epicardium, endocardium and myocardium, and the percentage of interstitial collagen in the myocardium were analyzed by computerized histomorphometry on Masson trichrome staining. The intrinsic cardiac ANS was analyzed through immunohistochemistry for S-100 and tyrosine hydroxylase regarding the: amount and area of nerve fibers, amount and average area of sympathetic fibers, number and average area of parasympathetic fibers and sympathetic/parasympathetic fiber proportion. The myocardial expression of muscarinic receptors 1-5 (M1 to M5) was evaluated by positive ratio in the myocardium in sections RA1, LA1, LA2 and FP1. There were no differences between groups regarding the anatomical variant and the percentage of interstitial collagen. Analysis of the ANS revealed nerve fibers with the smallest area in group I, reduction in the number of total and parasympathetic nerve fibers of sections RA1 and VS, increase of total and parasympathetic fibers LA2 and FP2 and increased numbers of sympathetic fibers in sections RA2, LA1, LA2 and LA3. Regarding the expression of muscarinic receptors, there was a significantly increase in the positive percentage for M1 in all regions except for LA1 (average of all the sections, group I 5.84 and group II 2.92, p = 0.002), M2 and M3 just adjacent to the FP1 (M2 Group I 5.67 and Group II 3.63, p = 0.037; M3 Group I 30.95 and Group II 20.13, p = 0.026) and the M4 was increased in group I in the region LA1 (group I 9.90 and group II 4.45, p = 0.023) and there was no statistically significant change in the M5. The anatomy and arrangement of atrial muscle fibers, as well as the interstitial fibrosis did not appear to be related to PAF in both studied groups. Changes in the number of nerve fibers as well as changes in expression of atrial muscarinic receptors, specially the M1, particularly in regions close to the GP appear to be related to pAF, indicating the importance of autonomic modulation in this arrhythmia

Physiological state greatly influences one’s ability to emotionally regulate and connect to a partner in couple therapy. As individuals encounter real or perceived threats in relationships, they are likely to experience sympathetic nervous system (SNS) responses of fight, flight, or freeze, thereby inhibiting the ability to connect with a partner or therapist made possible by the parasympathetic nervous system (PNS). This study, guided by the Polyvagal theory, examines the influence of client sleep, daily stress, and exercise on physiological baseline prior to a couple therapy session. Participants included 23 married couples who attended couple therapy at the Brigham Young University (BYU) Comprehensive Clinic. We examined the influence of client number of awakenings, sleep fragmentation index (SFI), daily stress time, and daily exercise time on measures of physiological baseline which included Galvanic skin response (GSR), respiratory sinus arrhythmia (RSA) and pre-ejection period (PEP) of the left ventricle of the heart. Three multi-level models were conducted to analyze the influence of sleep, stress, and exercise on GSR, RSA, and PEP respectively. Results indicated that daily stress significantly predicts PEP baseline as a measure of SNS fight-or-flight activation. A discussion of potential limitations, recommendations for therapists, and suggestions for future research are included.