Table 1_Topography of the insular cortex in heart rate control: high-precision mapping reveals critical role of the middle short gyrus.docx

AimsAlthough accumulating evidence has demonstrated the involvement of the insular cortex in autonomic regulation, the precise functional topography of insular subdivisions mediating cardiovascular control remains controversial. This study aimed to investigate the role of the insula, with high anatomic precision, in regulating heart rate (HR).
MethodsOverall, 487 electrical stimulations (E-stim) in patients with refractory epilepsy were used to investigate the incidence of evoked cardiac response after insula E-stim. Correlations between the parameters of E-stim, insula subdivision, and the HR shift profile were analyzed.
ResultsBriefly, 40.8% of insula stimulations evoked a cardiac response. The left insula was more likely to induce cardiac responses. Compared to the electrode contacts in the declining HR group, those in the elevated HR group were predominantly distributed in the posterior insula. Notably, the middle short gyri can rapidly elicit a significant decrease in HR.
ConclusionOur findings suggest that the middle short gyrus of the insula may serve as the primary cortical region mediating HR reduction. This provides new insights for the prevention and treatment of arrhythmias and sudden unexpected death in epilepsy (SUDEP).

【研究目的】尽管已有大量研究证实岛叶皮层（insular cortex）参与自主神经调节，但介导心血管调控的岛叶亚区精确功能拓扑结构仍存在争议。本研究旨在以高精度解剖定位，探究岛叶在心率（heart rate, HR）调控中的作用。
【研究方法】本研究共纳入487例难治性癫痫患者的岛叶电刺激（electrical stimulations, E-stim）数据，用于分析岛叶电刺激后诱发性心脏反应的发生率；同时对电刺激参数、岛叶亚区与心率变化特征之间的相关性进行分析。
【研究结果】总体而言，40.8%的岛叶电刺激可诱发出心脏反应；左侧岛叶更易诱发心脏反应。与心率下降组的电极触点相比，心率上升组的电极触点主要分布于后岛叶。值得注意的是，岛叶中部短回可快速诱发显著的心率下降。
【研究结论】本研究结果表明，岛叶中部短回可能是介导心率下降的主要皮层区域，该发现为癫痫患者心律失常及癫痫猝死（sudden unexpected death in epilepsy, SUDEP）的防治提供了全新视角。