Heart rate variability (HRV) is a crucial indicator of cardiovascular health. Low HRV is correlated with disease severity and mortality in heart failure. Heart rate increases and decreases with each breath in normal physiology termed respiratory sinus arrhythmia (RSA). RSA is highly evolutionarily conserved, most prominent in the young and athletic and is lost in cardiovascular disease. Despite this, current pacemakers either pace the heart in a metronomic fashion or sense activity in the sinus node. If RSA has been lost in cardiovascular disease current pacemakers cannot restore it. We hypothesized that restoration of RSA in heart failure would improve cardiac function. Restoration of RSA in heart failure was assessed in an ovine model of heart failure with reduced ejection fraction. Conscious 24 h recordings were made from three groups, RSA paced (n = 6), monotonically paced (n = 6) and heart failure time control (n = 5). Real-time blood pressure, cardiac output, heart rate and diaphragmatic EMG were recorded in all animals. Respiratory modulated pacing was generated by a proprietary device (Ceryx Medical) to pace the heart with real-time respiratory modulation. RSA pacing substantially increased cardiac output by 1.4 L/min (20%) compared to contemporary (monotonic) pacing. This increase in cardiac output led to a significant decrease in apnoeas associated with heart failure, reversed cardiomyocyte hypertrophy, and restored the T-tubule structure that is essential for force generation. Re-instating RSA in heart failure improves cardiac function through mechanisms of reverse re-modelling; the improvement observed is far greater than that seen with current contemporary therapies. These findings support the concept of re-instating RSA as a regime for patients who require a pacemaker.

Activation of the carotid body (CB) using intracarotid potassium cyanide (KCN) injection increases coronary blood flow (CoBF). This increase in CoBF is considered to be mediated by co-activation of both the sympathetic and parasympathetic nerves to the heart. However, whether cardiac sympathetic nerve activity (cardiac SNA) actually increases during CB activation has not been determined previously. We hypothesized that activation of the CB would increase directly recorded cardiac SNA, which would cause coronary vasodilatation. Experiments were conducted in conscious sheep implanted with electrodes to record cardiac SNA and diaphragmatic electromyography (dEMG), flow probes to record CoBF and cardiac output and a catheter to record arterial pressure. Intracarotid KCN injection was used to activate the CB. To eliminate the contribution of metabolic demand on coronary flow, the heart was paced at a constant rate during CB chemoreflex stimulation. Intra-carotid KCN injection resulted in a significant increase in directly recorded cardiac SNA frequency (from 24±2 to 40±4 bursts/minute; p<0.05) as well as a dose-dependent increase in mean arterial pressure (79±15 to 88±14 mmHg; p<0.01) and CoBF (75±37 Vs 86±42 mL/min; p<0.05). The increase in CoBF and coronary vascular conductance to intracarotid KCN injection was abolished after propranolol infusion, suggesting that the increased cardiac SNA mediates coronary vasodilatation. The pressor response to activation of the CB was abolished by pre-treatment with intravenous atropine but there was no change in the coronary flow response. Our results indicate that CB activation increases directly recorded cardiac SNA which mediates vasodilatation of the coronary vasculature.

Carotid bodies (CBs) are peripheral chemoreceptors, which are primary sensors of systemic hypoxia and their activation produces respiratory, autonomic, and cardiovascular adjustments critical for body homeostasis. We have previously shown that carotid chemoreceptor stimulation increases directly recorded cardiac sympathetic nerve activity (cardiac SNA) which increases coronary blood flow (CoBF) in conscious normal sheep. Previous studies have shown that chemoreflex sensitivity is augmented in heart failure (HF). We hypothesized that carotid chemoreceptor stimulation would increase CoBF to a greater extent in HF than control sheep. Experiments were conducted in conscious HF sheep and control sheep (n = 6/group) implanted with electrodes to record diaphragmatic electromyography (dEMG), flow probes to record CoBF as well as arterial pressure. There was a significant increase in mean arterial pressure (MAP), CoBF and coronary vascular conductance (CVC) in response to potassium cyanide (KCN) in both groups of sheep. To eliminate the effects of metabolic vasodilation, the KCN was repeated while the heart was paced at a constant level. In this paradigm, the increase in CoBF and CVC was augmented in the HF group compared to the control group. Pre-treatment with propranolol did not alter the CoBF or the CVC increase in the HF group indicating this was not mediated by an increase in cardiac sympathetic drive. The pressor response to CB activation was abolished by pre-treatment with intravenous atropine in both groups, but there was no change in the CoBF and vascular conductance responses. Our data suggest that in an ovine model of HF, carotid body (CB) mediated increases in CoBF and CVC are augmented compared to control animals. This increase in CoBF is mediated by an increase in cardiac SNA in the control group but not the HF group.

Testing new therapies in heart failure (HF) requires a chronic stable model of HF in large animals. Microembolization of the coronary arteries has been used to model HF previously; however, neural control has not been previously explored in this model. Thus the aim of this study was to further characterize neural control in this model of HF. HF was induced by infusion of microspheres (45 micron; 1.3 ml) into the proximal left coronary artery or left descending coronary arteries, with three sequential embolizations over 3 weeks. Twelve to 14 weeks after the final embolization, and when ejection fraction had decreased below 45%, animals were instrumented to record blood pressure and heart rate. Baroreflex control of heart rate was investigated in conscious animals. Additionally, pressure-volume loops were constructed under anesthesia. Embolization-induced HF was associated with a decrease in mean arterial pressure (67 ± 2 vs. 85 ± 4 mmHg, p < 0.05), an increase in heart rate (108 ± 4 vs. 94 ± 4 bpm, p < 0.05), and a significant increase in left ventricular end-diastolic pressure (11.4 ± 2 vs. 6.2 ± 1 mmHg, p < 0.01). Under conscious conditions, there was a significant decrease in the gain (−8.2 ± 2 vs. −4.1 ± 1 beats/min/mmHg, p < 0.05) as well as the lower plateau of the baroreflex in HF compared to control animals. HF was also associated with significantly increased respiratory rate (107 ± 4 vs. 87 ± 4 breaths/min, p < 0.01) and incidence of apneas (520 ± 24 vs. 191 ± 8 apnea periods >4 s, p < 0.05), compared to control sheep. The microembolization model of heart failure is associated with an increase in left ventricular end-diastolic pressure, impaired cardiac function, and altered baroreflex control of the heart. These findings suggest this chronic model of HF is appropriate to use for investigating interventions aimed at improving neural control in HF.

Our present study examined the effects of heated, humidified, high nasal flow air therapy (HNF) in an ovine model of renovascular hypertension. HNF is commonly used in human patients to treat dyspnoea and respiratory failure. Previous research has indicated that the use of HNF improves oxygenation in respiratory diseases. It is known that the carotid body plays a role in mediating hypertension, although this is in the absence of low oxygenation levels. We hypothesized that HNF may lead to beneficial effects on vascular resistance and decrease mean arterial pressure (MAP). Experiments were conducted on conscious, adult female Romney sheep. Hypertension was surgically‐induced via unilateral constriction of the renal artery (i.e., two‐kidney, one‐clip model; 2K1C). An incision was made over the flank contralateral to the clipped kidney to place an ultrasonic flow probe around the renal artery to measure renal blood flow (RBF). The common carotid artery was exposed, and a pressure catheter was inserted to record MAP. MAP, RBF, and calculated renal vascular conductance (RVC) were recorded during HNF administration. Heated and humidified gas was passed through a wide‐bore nasal cannula (Optiflow™+ Nasal High Flow Cannula) connected to an AIRVO 2 humidification system (AIRVO™ 2 Fisher & Paykel). After 30‐minutes of basal recording, the high nasal flow was started at 10L/min, 20L, 30L, and 40L/min, each for 25 minutes duration. Clipping of the renal artery increased resting MAP (91±5 vs. 131±6 mmHg), but there was no change in heart rate (HR) or RBF. HNF significantly decreased MAP (p<0.001) in both groups of animals (normotensive; from 91±5 to 85±4 mmHg, hypertensive; from 131±6 to 119±5 mmHg). RVC was increased in both normotensive and hypertensive sheep (p<0.05). There was no significant change in RBF in both groups. There was no change in heart rate in the hypertensive group, but there was a substantial decrease in heart rate in the normotensive group (p<0.01). Our data suggest that in an ovine model of hypertension, HNF leads to a substantial decrease in MAP. Whether HNF inhibits the peripheral chemoreflex remains to be determined in future studies. Taken together, these findings suggest improving oxygenation may offer clues to possible mechanisms of hypertension.