Post-operative atrial fibrillation management by selective epicardial vagal fat pad stimulation

Rossi, Pietro; Bianchi, Stefano; Barretta, Antonio; Scala, Alberto Della; Kornet, Lilian; Paulis, Ruggero De; Bellisario, Alessandro; D’Addio, Vittorio; Pavaci, Herribert; Miraldi, Fabio

doi:10.1007/s10840-008-9286-2

Cited by 31 publications

(39 citation statements)

References 32 publications

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“…21 Stimulation of epicardial and endocardial electrodes placed in the AV nodal FP region can cause complete AV block, or markedly slow the ventricular rate response during atrial fibrillation. 13,14,21,22 Therefore, we do not anticipate too discrepant observations once tested in children undergoing OHS.…”

Section: Study Limitationsmentioning

confidence: 86%

“…In a similar animal model of sustained atrial fibrillation, Schauerte et al 12 demonstrated using an endocardial approach to AV nodal FP stimulation that the parasympathetic effects were sustained for at least a period of 20 hours and were related to the intensity of nerve stimulation. Rossi et al 13 The use of this technique for control of postoperative atrial fibrillation and atrial tachycardias and its applicability to a younger age group is a logical extension of the studies reported to date. However, no previous data existed on the effects of right inferior FP stimulation on postoperative JET.…”

Section: Pauza Et Almentioning

confidence: 99%

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Nonpharmacologic Control of Postoperative Supraventricular Arrhythmias Using AV Nodal Fat Pad Stimulation in a Young Animal Open Heart Surgical Model

Moak

Mercader

et al. 2013

Circ: Arrhythmia and Electrophysiology

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S upraventricular arrhythmias frequently complicate the postoperative recovery from open heart surgery (OHS) in children. In 2011, Smith et al 1 reported their institutional experience evaluating the frequency of postoperative arrhythmias in 724 children undergoing OHS. In reviewing their experience, the authors noted that junctional ectopic tachycardia (JET) and accelerated junctional rhythm occurred in 18% of their population, and atrial tachyarrhythmias (AT) occurred in 8%. JET and AT can be difficult to medically manage. Pharmacological treatment of JET can result in significant morbidity, such as excessive bradycardia and hypotension.2 Prolonged intubation with neuromuscular paralysis is required if hypothermia and cooling are used. 3Previous research has shown the presence in the heart of localized concentrations of parasympathetic nerve cell bodies in fat pads (FPs). 4,5 Using a chronic canine model of atrial fibrillation, Wallick et al 6 were able to perform FP stimulation to achieve well-tolerated rate control in this animal model.FP stimulation may be a useful new clinical technique for managing children with postoperative atrial arrhythmias that occur after OHS. We hypothesized that the right inferior AV nodal FP has a selective parasympathetic effect on the AV node that may be exploited to help in the control of supraventricular arrhythmias, specifically junctional ectopic tachycardia. Our goal was to develop a nonpharmacological approach using autonomic stimulation of the right inferior FP region of the heart to control 2 common postoperative supraventricular arrhythmias, specifically JET and AT. Methods Experimental PreparationThe research protocol was approved by the Animal Care and Use Committee of The George Washington School of Medicine and Children's National Medical Center. All animals received humane © 2013 American Heart Association, Inc. Key Words: animal model surgery ◼ atrial tachycardia ◼ atrioventricular node ◼ autonomic nervous system ◼ fat pad stimulation ◼ junctional ectopic tachycardia ◼ pediatric

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Section: Study Limitationsmentioning

confidence: 86%

Section: Pauza Et Almentioning

confidence: 99%

Nonpharmacologic Control of Postoperative Supraventricular Arrhythmias Using AV Nodal Fat Pad Stimulation in a Young Animal Open Heart Surgical Model

Moak

Mercader

et al. 2013

Circ: Arrhythmia and Electrophysiology

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“…These nerve fibers extend through the interatrial septum at the coronary sinus ostium or the posteroseptal right atrium. [9][10][11][12][13][14] After right ventricular lead implantation, a standard atrial screw in lead (Medtronic type 5076 [2] and 4076 [29] or St Jude's 2088TC [1]) was directed and screwed into the posteroseptal region of the coronary sinus ostium. The septum is recognized as a feasible and safe site for chronic pacing to reduce paroxysmal AF recurrences, AF burden, and progression to permanent AF, with the rationale of reducing the duration of atrial activation.…”

Section: Atrial Lead Implant Proceduresmentioning

confidence: 99%

Increase of Ventricular Interval During Atrial Fibrillation by Atrioventricular Node Vagal Stimulation

Bianchi

Rossi

Schauerte

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Original ArticleBackground-Patients with a high ventricular rate during atrial fibrillation (AF) are at increased risk of receiving inappropriate implantable cardioverter defibrillator shocks. The objective was to demonstrate the feasibility of high frequency atrioventricular-nodal stimulation (AVNS) to reduce the ventricular rate during AF to prevent inappropriate implantable cardioverter defibrillator shocks. Methods and Results-Patients with a new atrial lead placement as part of a cardiac resynchronization therapy and defibrillator implant and a history of paroxysmal or persistent AF were eligible. If proper atrial lead position was confirmed, AVNS software was uploaded to the cardiac resynchronization therapy device, tested, and optimized. AVNS was delivered via a right atrial pacing lead positioned in the posterior right atrium. Software allowed initiation of high frequency bursts triggered on rapidly conducted AF. Importantly, the efficacy was evaluated during spontaneous AF episodes between 1 and 6 months after implant. Forty-four patients were enrolled in 4 centers. Successful atrial lead placement occurred in 74%. Median implant time of the AVNS lead was 37 minutes. In 26 (81%) patients, manual AVNS tests increased the ventricular interval by >25%. Between 1 and 6 months, automatic AVNS activations occurred in 4 patients with rapidly conducted AF, and in 3 patients, AVNS slowed the ventricular rate out of the implantable cardioverter defibrillator shock zone. No adverse events were associated with the AVNS software. Conclusions-The present study demonstrated the feasibility of implementation of AVNS in a cardiac resynchronization therapy and defibrillator system. AVNS increased ventricular interval >25% in 81% of patients. AVNS did not influence the safety profile of the cardiac resynchronization therapy and defibrillator system.

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“…In the United States, the cost for intensive care for postoperative AF is substantial, with estimated annual expenditures exceeding 1 billion dollars [13,14]. Prediction of incoming AF after CABG soon enough to allow for prophylactic intervention would thus be helpful and cost-effective [2,3,12,13].…”

Section: Introductionmentioning

confidence: 99%

“…The fundamental mechanisms responsible for AF, especially for post-surgery patients, is still not well understood [2,3,12]. Electrical properties, such as heterogeneous spatial distribution of excitability and repolarization, may play an important role in the generation and perpetuation of the arrhythmia [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Electrophysiological Changes Preceding the Onset of Atrial Fibrillation After Coronary Bypass Grafting Surgery

Xiong

Yin

Dubé

et al. 2013

Canadian Journal of Cardiology

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Post-operative atrial fibrillation management by selective epicardial vagal fat pad stimulation

Abstract: Epicardial RIFPS represents an effective and feasible technique to decrease VR during POAF.

Cited by 31 publications

References 32 publications

Nonpharmacologic Control of Postoperative Supraventricular Arrhythmias Using AV Nodal Fat Pad Stimulation in a Young Animal Open Heart Surgical Model

Nonpharmacologic Control of Postoperative Supraventricular Arrhythmias Using AV Nodal Fat Pad Stimulation in a Young Animal Open Heart Surgical Model

Increase of Ventricular Interval During Atrial Fibrillation by Atrioventricular Node Vagal Stimulation

Electrophysiological Changes Preceding the Onset of Atrial Fibrillation After Coronary Bypass Grafting Surgery

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