Evidence mapPaperPMID 32497872Full record

ReviewAutonomic neuroscience : basic & clinical2020

Human adult cardiac autonomic innervation: Controversies in anatomical knowledge and relevance for cardiac neuromodulation.

J Wink, R van Delft, R G E Notenboom, P F Wouters, M C DeRuiter, J W M Plevier, M R M Jongbloed

2 registry-linked trialsOpen access · hybridAbstract readReview
PubMed Publisher
In one paragraph

Review in Autonomic neuroscience : basic & clinical, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 43 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
43citing papers in PubMed, 3 pooled it
5.7field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06461377 phase4recruitingstarted 2024, after this paper: background citation

The Ameliorative Effects of GLP-1RA on Diabetic Cardiac Autonomatic Neuropathy

Ran2024Enrolled50Registered outcomes20Posted comparisons0ConditionsDiabetes With Diabetic Autonomic Neuropathy (Diagnosis), Type 2 DiabetesArmsGlucagon-like peptide-1 receptor agonist:Semaglutide
Open the trial in the graph
NCT07558863 phase4recruitingstarted 2026, after this paper: background citation

A Study on the Effect of GLP-1 Receptor Agonist (GLP-1RA) Intervention on Cardiac Autonomic Neuropathy in Patients With Type 2 Diabetes Mellitus

Ran2026Enrolled60Registered outcomes6Posted comparisons0ConditionsDiabetes With Diabetic Autonomic Neuropathy (Diagnosis), Type 2 DiabetesArmsGLP-1 Receptor Agonists
Open the trial in the graph
3 · Its place in the literature

Who cites it

43 citing papers in PubMed, 3 syntheses or guidelines pooled it, 70 citations in OpenAlex.

  1. Guideline
  2. The relevance of the superior cervical ganglion for cardiac autonomic innervation in health and disease: a systematic review.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2024
    Pooled it
  3. Pooled it
  4. Review
  5. Article
  6. Cardioneuroablation: A Comprehensive Review.Reviews in cardiovascular medicine · 2026
    Review
  7. Article
  8. Contemporary and Emerging Therapies in the Management of Refractory Angina: A Clinical Review.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2026
    Review
  9. Review
  10. Article
  11. Review
  12. Review
  13. Autonomic dysregulation and atrial arrhythmias.American journal of physiology. Cell physiology · 2025
    Review
  14. Article
  15. Translational approach to ventricular innervation: the posterior descending ganglionated plexus.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025
    Article
  16. Review
  17. Review
  18. Article
  19. Review
  20. Peri-procedural anesthesia and patient pain experience in pulmonary vein isolation by means of very high-power short-duration radiofrequency ablation.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 2 countries.

J WinkDepartment of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: j.wink@lumc.nl.
R van DelftDepartment of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands.
R G E NotenboomDepartment of Anatomy & Embryology, Leiden University Medical Center, Leiden, the Netherlands.
P F WoutersDepartment of Anesthesia, University Hospitals Ghent, Belgium.
M C DeRuiterDepartment of Anatomy & Embryology, Leiden University Medical Center, Leiden, the Netherlands.
J W M PlevierWalaeus Library, Leiden University Medical Center, Leiden, the Netherlands.
M R M JongbloedDepartment of Anatomy & Embryology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Leiden University Medical Center · NLGhent University Hospital · BE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCardiac sympathetic blockade is a therapeutic approach for arrhythmias and heart failure and may be a beneficial effect of high thoracic epidural anesthesia. These treatments require detailed knowledge of the spatial location and distribution of cardiac autonomic nerves, however, there are controversies on this subject in humans.

objectiveTo provide a systematic overview of current knowledge on human anatomy of the cardiac autonomic nervous system.

resultsIn contrast to the often claimed assumption that human preganglionic sympathetic cardiac neurons originate mainly from thoracic spinal segments T1-T4 or T5, there is ample evidence indicating involvement of cervical spinal segment C8 and thoracic spinal segments below T5. Whether cervical ganglia besides the stellate ganglion play a role in transmission of cardiac sympathetic signals is unclear. Similarly, there is debate on the origin of cardiac nerves from different thoracic ganglia. Most human studies report thoracic cardiac nerves emerging from the first to fourth thoracic paravertebral ganglia; others report contributions from the fifth, sixth and even the seventh thoracic ganglia. There is no agreement on the precise composition of nerve plexuses at the cardiac level. After years of debate, it is generally accepted that the vagal nerve contributes to ventricular innervation. Vagal distribution appears higher in atria, whereas adrenergic fibers exceed the number of vagal fibers in the ventricles.

conclusionAnatomy of the human cardiac autonomic nervous system is highly variable and likely extends beyond generally assumed boundaries. This information is relevant for thoracic epidural anesthesia and procedures targeting neuronal modulation of cardiac sympathetic innervation.

Indexed as

AdultAnimalsAutonomic Nervous SystemGanglia, SympatheticHeartHumansCardiac autonomic nervous systemCardiac gangliaCardiac sympathetic blockadeEpicardial plexusHuman anatomyVagal nerve

Identifiers

PMID32497872
OpenAlexW3024101076

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.