Effect of renal sympathetic denervation on the inducibility of atrial fibrillation during rapid atrial pacing

Zhao, Qingyan; Yu, Shan; Zou, Ming‐Hui; Dai, Mingyan; Wang, Xule; Xiao, Jian‐Kang

doi:10.1007/s10840-012-9717-y

Cited by 60 publications

(42 citation statements)

References 33 publications

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“…The potential antiarrhythmic role of renal denervation was demonstrated in animal studies suggesting a beneficial effect on AF inducibility, maintenance, and progression. 307,595,596,597 The positive impact of renal denervation on AF recurrence was demonstrated in a first-in human study, including 27 patients with paroxysmal or persistent AF and refractory hypertension. At 12-month follow up, the group of patients who underwent PVI plus renal denervation had a significantly higher success rate in terms of freedom from AF compared with PVI alone (69% vs 29%, respectively).…”

Section: Section 5: Strategies Techniques and Endpointsmentioning

confidence: 98%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,750

1,461

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Section: Section 5: Strategies Techniques and Endpointsmentioning

confidence: 98%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,750

1,461

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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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“…56 By ablating the efferent nerves, RSDN decreases the renal norepinephrine spillover by 47% 57 and attenuates the activity of renin-angiotensin-aldosterone system, 58 both important in the pathogenesis of LV remodeling in HF. More importantly from a cardiac standpoint, afferent RSDN leads to decreased feedback activation to the central nervous system and thereby decreased sympathetic input to the heart (Figure 4).…”

Section: Preclinical Researchmentioning

confidence: 99%

Interventional and Device-Based Autonomic Modulation in Heart Failure

Shen¹,

Zipes²

2015

Heart Failure Clinics

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Abstract/SummaryHeart failure is an increasingly prevalent disease with high mortality and public health burden. It is associated with autonomic imbalance characterized by sympathetic hyperactivity and parasympathetic hypoactivity. Evolving novel interventional and device-based therapy has sought to restore autonomic balance by neuromodulation.Results of preclinical animal studies and early clinical trials have demonstrated its safety and efficacy in heart failure. In this review article, we will discuss specific neuromodulatory treatment modalities individually-spinal cord stimulation, vagus nerve stimulation, baroreceptor activation therapy and renal sympathetic nerve denervation. Key Points (3-5)• Heart failure (HF) is a disease categorized by sympathetic hyperactivity, parasympathetic withdrawal and impaired baroreflex control of sympathetic activation.• Several measures of autonomic modulation either by implanted devices or interventions seek to restore the autonomic balance in HF and improve outcomes. These measures include spinal cord stimulation, vagus nerve 3 stimulation, baroreceptor activation therapy and renal sympathetic nerve denervation.• Preclinical work and the majority of early clinical trials demonstrate the benefits of these modalities in HF. Additional larger, well-designed, outcome-based clinical trials are warranted to verify the results and determine whether these evolving, innovative neuromodulation approaches can be recommended to the growing population of HF patients.4

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Effect of renal sympathetic denervation on the inducibility of atrial fibrillation during rapid atrial pacing

Abstract: Episodes of AF could be decreased by renal sympathetic denervation during short-time rapid atrial pacing. This effect might have relationship with decreased activity of RAAS.

Cited by 60 publications

References 33 publications

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

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

Interventional and Device-Based Autonomic Modulation in Heart Failure

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