Low‐Level Vagosympathetic Nerve Stimulation Inhibits Atrial Fibrillation Inducibility: Direct Evidence by Neural Recordings from Intrinsic Cardiac Ganglia

Yu, Lilei; Scherlag, Benjamin J.; Li, Shuyan; Sheng, Xia; Lu, Zhibing; Nakagawa, Hiroshi; Zhang, Ying; Jackman, Warren M.; Lazzara, Ralph; Jiang, Hong; Po, Sunny S.

doi:10.1111/j.1540-8167.2010.01908.x

Cited by 115 publications

(111 citation statements)

References 31 publications

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“…[32][33][34] Other neurotransmitters may also explain the ability of low-level stimulation of the vagal nerves to suppress GP activity and fractionated electrograms. 35 We agree with the authors 1 and with Lockwood and Nademanee 25 that a greater understanding of the different patterns of fractionated electrograms could lead to more individualized and effective approaches to AF ablation therapy. The search is complicated by the multiple mechanisms, and it is important to realize that any particular method used to study fractionated electrograms could overemphasize the role of a particular mechanism.…”

Section: Article See P 32supporting

confidence: 79%

Nature of Electrogram Fractionation During Atrial Fibrillation

Jackman

Scherlag

2012

Circ: Arrhythmia and Electrophysiology

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Section: Article See P 32supporting

confidence: 79%

Nature of Electrogram Fractionation During Atrial Fibrillation

Jackman

Scherlag

2012

Circ: Arrhythmia and Electrophysiology

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“…To date, PVI remains the by guest on May 11, 2018 http://circres.ahajournals.org/ Downloaded from most widely used ablation approach to treat AF. However, with a 5-year success rate in some series <30% after a single procedure, 119 and <40% off antiarrhythmic drugs, 120 PVI alone can be insufficient to maintain sinus rhythm.…”

Section: Neural Ablationmentioning

confidence: 99%

“…152 Even if the stimulus strength is 50% below the threshold, LL-VNS still possesses the same effects. 153 Shen et al 30 used direct nerve recordings to demonstrate that continuous LL-VNS suppressed paroxysmal atrial tachyarrhythmias in ambulatory, conscious dogs via the reduction of stellate ganglion nerve activity. This reduction was most apparent in the early morning, when the incidence of AF is highest.…”

Section: Neural Stimulationmentioning

confidence: 99%

Role of the Autonomic Nervous System in Modulating Cardiac Arrhythmias

Shen

Zipes

2014

Circulation Research

685

543

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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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“…18 In a series of studies from our laboratory, we found that low level vagal nerve stimulation (at a voltage 50% lower than that which slows the heart rate) paradoxically suppresses or even prevents pacing induced AF 19,20 by diminishing both the frequency and amplitude of GP firing. 21 Another recent paradoxical finding was a study by Lo et al 21 in which they ablated the superior vena cava-aorta GP, which has been described as the head stage or nexus point GP, 22 connecting the extrinsic and the intrinsic autonomic nervous systems. During a period of 10 weeks, the operated animals progressively developed atrial tachycardia/AF, whereas the sham controls did not.…”

Section: Article See P 711mentioning

confidence: 99%

Unravelling the Paradoxical Effects of Ganglia Ablation

Scherlag

Jackman

2014

Circ: Arrhythmia and Electrophysiology

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570I n 1973, Lazzara et al 1 described 2 clusters of nerve bodies called ganglionated plexi (GP) adjacent to the sinus node and AV junction; high-frequency electric stimulation, which did not excite the underlying atrium, induced heart rate or AV conduction slowing, respectively. We are indebted to Randall et al 2 who spent the next several decades delineating the anatomy and physiology of the intrinsic cardiac autonomic nervous system consisting of GP located at several sites in the atria and ventricles. Carrying on the legacy of Dr Randall, 2 Armour and Ardell 3,4 produced numerous publications and books, providing a hierarchical construct of the neural innervation of the heart, starting at the nuclei and axonal fields in the brain (extrinsic autonomic nervous system) followed by the spinal cord (intrathoracic) ganglia and axons and their connections to the intrinsic cardiac autonomic system with its GP and their axons of passage. The last part of this interconnected chain (the atrial neural network) was delineated anatomically by Armour et al 5 and Pauza et al 6 and functionally by Hou et al. 7Article see p 711The overall function of the intrinsic autonomic nervous system consisting of the GP and the atrial neural network was summarized by Ardell,8 "… the intrinsic cardiac nerve plexus (GP and neural network) acts as more than a simple relay station for extrinsic autonomic projections to the heart…modulat-ing…extrinsic and local cardio-cardiac reflexes. The intrinsic cardiac nerve plexus contains a heterogeneous population of cell types, including parasympathetic and sympathetic efferent neurons as well as afferent neurons." Furthermore, as pointed out by Ardell, 8 these afferent neurons participate in reflex loops between and within the various levels of the extrinsic, intrathoracic, and intrinsic systems, yet each level when disconnected from the other would retain independent functionality.From 1997 to 1998, the seminal studies by Jaïs et al 9 and Haïssaguerre et al 10 showed that the myocardium of the pulmonary veins (PVs) manifested ectopic firing in patients, and this ectopy was directly associated with the initiation and maintenance of atrial fibrillation (AF). As a result, the accepted catheter ablation procedure for AF became isolation of the PVs. These findings engendered basic experimental studies demonstrating that chemical stimulation 11 of the GP at the atrial PV entrances or electric stimulation of the nerves within the PV could induce PV firing and AF. 12 Moreover, these studies specifically implicated the excessive release of both the cholinergic (marked shortening of the refractory period) and the adrenergic (induction of triggered firing) neurotransmitters as the mechanism for PV firing and ensuing AF. Clinical studies, 13,14 including surgical approaches, 15,16 have provided evidence that ablation of GP is an important adjunctive procedure to PV isolation in the treatment of AF.These clinical and recent experimental studies have provided enlightening insights into how the autonomic nervous...

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Low‐Level Vagosympathetic Nerve Stimulation Inhibits Atrial Fibrillation Inducibility: Direct Evidence by Neural Recordings from Intrinsic Cardiac Ganglia

Abstract: LL-VNS suppressed AF inducibility by inhibiting the neural activity of major GP within the ICANS.

Cited by 115 publications

References 31 publications

Nature of Electrogram Fractionation During Atrial Fibrillation

Nature of Electrogram Fractionation During Atrial Fibrillation

Role of the Autonomic Nervous System in Modulating Cardiac Arrhythmias

Unravelling the Paradoxical Effects of Ganglia Ablation

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