Preload reduction with right ventricular pacing: Effects on left ventricular hemodynamics and contractile pattern

Hamby, Robert I.; Aintablian, Agop

doi:10.1002/clc.4960030303

Cited by 7 publications

(2 citation statements)

References 26 publications

(31 reference statements)

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“…VR1 afferent depletion enhances hemodynamic resistance to cardiac stress induced by rapid dyssynchronous RVP. Electrical activation of the ventricles from single point pacing causes electromechanically dyssynchronous contraction of the ventri-H958 TRPV1 DEPLETION AND CARDIAC STRESS cles (37), reduces stroke work (13), and activates intrinsic cardiac neurons (14,31). Rapid ventricular pacing also induces ischemia due to poor coronary perfusion (26,30).…”

Section: Resultsmentioning

confidence: 99%

Cardiac vanilloid receptor-1 afferent depletion enhances stellate ganglion neuronal activity and efferent sympathetic response to cardiac stress

Yoshie

Rajendran

Massoud

et al. 2018

American Journal of Physiology-Heart and Circulatory Physiology

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Afferent fibers expressing the vanilloid receptor 1 (VR1) channel have been implicated in cardiac nociception; however, their role in modulating reflex responses to cardiac stress is not well understood. We evaluated this role in Yorkshire pigs by percutaneous epicardial application of resiniferatoxin (RTX), a toxic activator of the VR1 channel, resulting in the depletion of cardiac VR1-expressing afferents. Hemodynamics, epicardial activation recovery intervals, and in vivo activity of stellate ganglion neurons (SGNs) were recorded in control and RTX-treated animals. Stressors included inferior vena cava or aortic occlusion and rapid right ventricular pacing (RVP) to induce dyssynchrony and ischemia. In the epicardium, stellate ganglia, and dorsal root ganglia, immunostaining for the VR1 channel, calcitonin gene-related peptide, and substance P was significantly diminished by RTX. RTX-treated animals exhibited higher basal systolic blood pressures and contractility than control animals. Reflex responses to epicardial bradykinin and capsaicin were mitigated by RTX. Cardiovascular reflex function, as assessed by inferior vena cava or aortic occlusion, was similar in RTX-treated versus control animals. RTX-treated animals exhibited resistance to hemodynamic collapse induced by RVP. Activation recovery interval shortening during RVP, a marker of cardiac sympathetic outflow, was greater in RTX-treated animals and exhibited significant delay in returning to baseline values after cessation of RVP. The basal firing rate of SGNs and firing rates in response to RVP were also greater in RTX-treated animals, as was the SGN network activity in response to cardiac stressors. These data suggest that elimination of cardiac nociceptive afferents reorganizes the central-peripheral nervous system interaction to enhance cardiac sympathetic outflow. NEW & NOTEWORTHY Our work demonstrates a role for cardiac vanilloid receptor-1-expressing afferents in reflex processing of cardiovascular stress. Current understanding suggests that elimination of vanilloid receptor-1 afferents would decrease reflex cardiac sympathetic outflow. We found, paradoxically, that sympathetic outflow to the heart is instead enhanced at baseline and during cardiac stress.

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Section: Resultsmentioning

confidence: 99%

Cardiac vanilloid receptor-1 afferent depletion enhances stellate ganglion neuronal activity and efferent sympathetic response to cardiac stress

Yoshie

Rajendran

Massoud

et al. 2018

American Journal of Physiology-Heart and Circulatory Physiology

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“…In the present study, we used right ventricular pacing (RVP) to induce moderate reductions in CO. RVP reduces CO by approximately 20% due to loss of atrial contribution [19] and dyssynchrony [20]. To the best of our knowledge, RVP has not previously been used as a model to investigate non- or minimally invasive CO monitoring methods.…”

Section: Introductionmentioning

confidence: 99%

Volumetric and End-Tidal Capnography for the Detection of Cardiac Output Changes in Mechanically Ventilated Patients Early after Open Heart Surgery

Hoff

Høiseth

Kirkebøen

et al. 2019

Critical Care Research and Practice

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Background. Exhaled carbon dioxide (CO2) reflects cardiac output (CO) provided stable ventilation and metabolism. Detecting CO changes may help distinguish hypovolemia or cardiac dysfunction from other causes of haemodynamic instability. We investigated whether CO2 measured as end-tidal concentration (EtCO2) and eliminated volume per breath (VtCO2) reflect sudden changes in cardiac output (CO). Methods. We measured changes in CO, VtCO2, and EtCO2 during right ventricular pacing and passive leg raise in 33 ventilated patients after open heart surgery. CO was measured with oesophageal Doppler. Results. During right ventricular pacing, CO was reduced by 21% (CI 18–24; p<0.001), VtCO2 by 11% (CI 7.9–13; p<0.001), and EtCO2 by 4.9% (CI 3.6–6.1; p<0.001). During passive leg raise, CO increased by 21% (CI 17–24; p<0.001), VtCO2 by 10% (CI 7.8–12; p<0.001), and EtCO2 by 4.2% (CI 3.2–5.1; p<0.001). Changes in VtCO2 were significantly larger than changes in EtCO2 (ventricular pacing: 11% vs. 4.9% (p<0.001); passive leg raise: 10% vs. 4.2% (p<0.001)). Relative changes in CO correlated with changes in VtCO2 (ρ=0.53; p=0.002) and EtCO2 (ρ=0.47; p=0.006) only during reductions in CO. When dichotomising CO changes at 15%, only EtCO2 detected a CO change as judged by area under the receiver operating characteristic curve. Conclusion. VtCO2 and EtCO2 reflected reductions in cardiac output, although correlations were modest. The changes in VtCO2 were larger than the changes in EtCO2, but only EtCO2 detected CO reduction as judged by receiver operating characteristic curves. The predictive ability of EtCO2 in this setting was fair. This trial is registered with NCT02070861.

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Effect of ventricular pacing on left ventricular function assessed by radionuclide angiography

Boucher

Pohost

Okada

et al. 1983

American Heart Journal

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Preload reduction with right ventricular pacing: Effects on left ventricular hemodynamics and contractile pattern

Cited by 7 publications

References 26 publications

Cardiac vanilloid receptor-1 afferent depletion enhances stellate ganglion neuronal activity and efferent sympathetic response to cardiac stress

Cardiac vanilloid receptor-1 afferent depletion enhances stellate ganglion neuronal activity and efferent sympathetic response to cardiac stress

Volumetric and End-Tidal Capnography for the Detection of Cardiac Output Changes in Mechanically Ventilated Patients Early after Open Heart Surgery

Effect of ventricular pacing on left ventricular function assessed by radionuclide angiography

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