Cryoablation of stellate ganglia and atrial arrhythmia in ambulatory dogs with pacing-induced heart failure

Ogawa, Masahiro; Tan, Alex Y.; Song, Juan; Kobayashi, Kenzaburo; Fishbein, Michael C.; Lin, Shien Fong; Chen, Lan S.; Chen, Peng Sheng

doi:10.1016/j.hrthm.2009.08.011

Cited by 51 publications

(40 citation statements)

References 19 publications

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“…In animal models, this approach has been shown to abolish episodes of atrial tachyarrhythmias. 47,48 These findings argue that the ablation of extrinsic cardiac nerves might be an effective alternative therapy to the ablation of intrinsic cardiac ganglia for the treatment of AF. 12 An area gaining clinical interest is renal denervation.…”

Section: Neural Ablationmentioning

confidence: 98%

“…The results showed the feasibility of chronic cardiac nerve recordings and demonstrated a circadian variation of sympathetic outflow to the heart. 46 Multiple subsequent studies 30,[47][48][49][50][51] with direct nerve activity recordings in diseased animal models have provided insights into the understanding of the role of cardiac ANS in arrhythmogenesis.…”

Section: Measuring Autonomic Nerve Activitiesmentioning

confidence: 99%

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Role of the Autonomic Nervous System in Modulating Cardiac Arrhythmias

Shen

Zipes

2014

Circulation Research

655

512

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I n 1628, William Harvey hinted at a link between the brain and the heart when he wrote, "For every affection of the mind that is attended with either pain or pleasure, hope or fear, is the cause of an agitation whose influence extends to the heart."1 For the past half century, numerous anatomic and physiological studies of cardiac autonomic nervous system (ANS) 2-6 have investigated this link and found it to be very complex. Autonomic activation alters not only heart rate, conduction, and hemodynamics, but also cellular and subcellular properties of individual myocytes. The characterization of extrinsic cardiac ANS and intrinsic cardiac ANS ranges from the recognition of anatomic relationships at the gross level to discovery of chemoreceptors, mechanoreceptors, and intracardiac ganglia lining specific regions along the cardiac chambers and great vessels. Moreover, studies beginning >80 years ago [7][8][9] have demonstrated the critical role of cardiac ANS in cardiac arrhythmogenesis. This topic has garnered much recent interest because of mounting evidence showing that neural modulation either by ablation or stimulation can effectively control a wide spectrum of cardiac arrhythmias. [10][11][12][13] In this review, we will briefly discuss the anatomic aspects of cardiac ANS, focusing on how autonomic activities influence cardiac electrophysiology. We will also discuss specific autonomic triggers of various cardiac arrhythmias, including atrial fibrillation (AF), ventricular arrhythmias, and inherited arrhythmia syndromes. Lastly, we will discuss the latest avenues of research and clinical trials regarding the application of neural modulation in the treatment of specific cardiac arrhythmias.

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Section: Neural Ablationmentioning

confidence: 98%

Section: Measuring Autonomic Nerve Activitiesmentioning

confidence: 99%

Role of the Autonomic Nervous System in Modulating Cardiac Arrhythmias

Shen

Zipes

2014

Circulation Research

655

512

View full text Add to dashboard Cite

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“…[4][5][6] Modulation of the autonomic nervous system by several strategies like ganglion stellatum ablation, 7 high thoracic epidural anesthesia, 8 low level vagal nerve stimulation, 9 or ablation of ganglionated plexi 10 has been shown to attenuate the development of electric, autonomic, and structural atrial remodeling during AF. Another strategy to influence sympathetic nervous system activity is renal denervation (RDN).…”

mentioning

confidence: 99%

Catheter-Based Renal Denervation Reduces Atrial Nerve Sprouting and Complexity of Atrial Fibrillation in Goats

Linz

Hunnik

Hohl

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-Atrial fibrillation (AF) leads to structural and neural remodeling in the atrium, which enhances AF complexity and perpetuation. Renal denervation (RDN) can reduce renal and whole-body sympathetic activity. Aim of this study was to determine the effect of sympathetic nervous system modulation by RDN on atrial arrhythmogenesis. Methods and Result-Eighteen goats were instrumented with an atrial endocardial pacemaker lead and a burst pacemaker.Percutaneous catheter-based RDN was performed in 8 goats (RDN-AF). Ten goats undergoing a sham procedure served as control (SHAM-AF). AF was induced and maintained by burst pacing for 6 weeks. High-resolution mapping was used to record epicardial conduction patterns of the right and left atrium. RDN reduced tyrosine hydroxylase-positive sympathetic nerve staining and resulted in lower transcardiac norepinephrine levels. This was associated with reduced expression of nerve growth factor-β, indicating less atrial nerve sprouting. Atrial endomysial fibrosis content was lower and myocyte diameter was smaller in RDN-AF. Median conduction velocity was higher (75±9 versus 65±10 cm/s, P=0.02), and AF cycle length was shorter in RDN-AF compared with SHAM-AF. Left atrial AF complexity (4.8±0.8 fibrillation waves/AF cycle length versus 8.5±0.8 waves/AF cycle length, P=0.001) and incidence of breakthroughs (2.0±0.3 versus 4.3±0.5 waves/AF cycle length, P=0.059) were lower in RDN-AF compared with SHAM-AF. Blood pressure was normal and not significantly different between the groups. Conclusions-RDN reduces atrial sympathetic nerve sprouting, structural alterations, and AF complexity in goats with persistent AF, independent of changes in blood pressure. (Circ Arrhythm Electrophysiol. 2015;8:466-474.

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“…[8][9][10] However, to the best of our knowledge, the effect of sympathetic nerve activity on vulnerability to atrial arrhythmia in PAH has not been evaluated. The purpose of this study was to test the hypothesis that the activity of intrinsic and extrinsic cardiac nerves has an important role in vulnerability to atrial arrhythmia in a model of PAH.…”

mentioning

confidence: 99%

Effects of Intrinsic and Extrinsic Cardiac Nerves on Atrial Arrhythmia in Experimental Pulmonary Artery Hypertension

Zhao¹,

Deng²,

Jiang³

et al. 2015

Hypertension

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S upraventricular arrhythmias, such as atrial fibrillation (AF) and atrial flutter (AFL), are common in patients with pulmonary arterial hypertension (PAH) and are associated with poor outcomes.1,2 In 1 study, restoration and maintenance of sinus rhythm were invariably associated with clinical improvement and recovery. 3 However, it is difficult to treat AF/AFL in patients with PAH because existing antiarrhythmic agents have substantial side effects in patients with PAH.Previous studies have suggested that increased sympathetic nerve activation could contribute to disease severity in patients with PAH. 4,5 A recent study by Chen et al 6 demonstrated that pulmonary artery denervation decreased pulmonary arterial pressure and increased functional capacity. Our previous study showed that renal denervation attenuates pulmonary vascular remodeling and decreases pulmonary arterial pressure in experimental PAH.7 In a dog model with rapid atrial or ventricular pacing, a reduction in sympathetic tone or cardiac sympathetic denervation achieved by ablating extrinsic cardiac or renal sympathetic nerves was shown to be useful for controlling atrial arrhythmia. [8][9][10] However, to the best of our knowledge, the effect of sympathetic nerve activity on vulnerability to atrial arrhythmia in PAH has not been evaluated. The purpose of this study was to test the hypothesis that the activity of intrinsic and extrinsic cardiac nerves has an important role in vulnerability to atrial arrhythmia in a model of PAH. MethodsAdditional methodological details for each of the sections below are described in the online-only Data Supplement.Abstract-Atrial arrhythmia, which includes atrial fibrillation (AF) and atrial flutter (AFL), is common in patients with pulmonary arterial hypertension (PAH), who often have increased sympathetic nerve activity. Here, we tested the hypothesis that autonomic nerves play important roles in vulnerability to AF/AFL in PAH. The atrial effective refractory period and AF/AFL inducibility at baseline and after anterior right ganglionated plexi ablation were determined during left stellate ganglion stimulation or left renal sympathetic nerve stimulation in beagle dogs with or without PAH. Then, sympathetic nerve, β-adrenergic receptor densities and connexin 43 expression in atrial tissues were assessed. The sum of the window of vulnerability to AF/AFL was increased in the right atrium compared with the left atrium at baseline in the PAH dogs but not in the controls. The atrial effective refractory period dispersion was increased in the control dogs, but not in the PAH dogs, during left stellate ganglion stimulation. The voltage thresholds for inducing AF/AFL during anterior right ganglionated plexi stimulation were lower in the PAH dogs than in the controls. The AF/AFL inducibility was suppressed after ablation of the anterior right ganglionated plexi in the PAH dogs. The PAH dogs had higher sympathetic nerve and β1-adrenergic receptor densities, increased levels of nonphosphorylated connexin 43, and heterogeneo...

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Cryoablation of stellate ganglia and atrial arrhythmia in ambulatory dogs with pacing-induced heart failure

Cited by 51 publications

References 19 publications

Role of the Autonomic Nervous System in Modulating Cardiac Arrhythmias

Role of the Autonomic Nervous System in Modulating Cardiac Arrhythmias

Catheter-Based Renal Denervation Reduces Atrial Nerve Sprouting and Complexity of Atrial Fibrillation in Goats

Effects of Intrinsic and Extrinsic Cardiac Nerves on Atrial Arrhythmia in Experimental Pulmonary Artery Hypertension

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