Reliable pace termination of postoperative atrial fibrillation in the canine sterile pericarditis model: Implications for atypical atrial flutter

Lee, Seungyup; Vitebskiy, Sergey; Goldstein, Robert N.; Khrestian, Celeen M.; Waldo, Albert L.

doi:10.1016/j.hroo.2022.01.003

Cited by 4 publications

(6 citation statements)

References 18 publications

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“…The progressive increases in pacing thresholds and AERP over postoperative periods in the canine model are consistent with prior observations in patients with POAF after surgery 24–26 . In comparison with the swine sterile pericarditis model, all electrophysiologic data from the swine model were consistent with the canine sterile pericarditis model 9,13,15,16 with respect to (1) the range of both pacing threshold and AERP; (2) the progressive increase in threshold and AERP over time; (3) a 40%–50% incidence of POAF. In addition, the swine sterile pericarditis study can be performed in the conscious closed‐chest state on postoperative days.…”

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

“…A canine sterile pericarditis model has been used to understand the mechanism of postoperative arrhythmias such as POAF or atrial flutter for onset, prevention, maintenance, and treatment. 8,13,[15][16][17][18][19][20] Pericarditis is major contributor to the etiology of postoperative arrhythmias by creating an atrial substrate vulnerable to atrial arrhythmias. 8,[21][22][23] In the canine sterile pericarditis model, inflammation of the pericardium and myocardium is created by placing gauze dusted with talcum powder on the atrial epicardium, and our group has shown that it alters the myocyte architecture and gap junctions, which lead to changes in the electrophysiological properties such as AERP and conduction velocity.…”

Section: Swine Versus Canine Sterile Pericarditis Model For Studying ...mentioning

confidence: 99%

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Validation of a new species for studying postoperative atrial fibrillation: Swine sterile pericarditis model

Lee,

Khrestian,

Laurita

et al. 2023

Pacing Clinical Electrophis

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BackgroundThe canine sterile pericarditis model associated with atrial inflammation is an experimental counterpart of postoperative atrial fibrillation (POAF). However, the use of canines for research is restricted by ethics committees in many countries, and social acceptance is declining.ObjectiveTo validate the feasibility of the swine sterile pericarditis model as an experimental counterpart to study POAF.MethodsSeven domestic pigs (35–60 kg) underwent initial pericarditis surgery. On two or more postoperative days in the closed‐chest state, we performed electrophysiological measurements of pacing threshold and atrial effective refractory period (AERP) while pacing from the right atrial appendage (RAA) and the posterior left atrium (PLA). The inducibility of POAF (>5 min) by burst pacing was determined in both the conscious and anesthetized closed‐chest state. These data were compared to previously published canine sterile pericarditis data for validation.ResultsThe pacing threshold increased from day 1 to day 3 (2 ± 0.1 to 3.3 ± 0.6 mA in the RAA, 2.5 ± 0.1 to 4.8 ± 0.2 mA in the PLA). Also, the AERP increased from day 1 to day 3 (118 ± 8 to 157 ± 16 ms in the RAA; 98 ± 4 to 124 ± 2 ms in the PLA, both p < .05). Induction of sustained POAF occurred in 43% (POAF CL range 74–124 ms). All electrophysiologic data from the swine model were consistent with the canine model with respect to (1) the range of both pacing threshold and AERP; (2) the progressive increase in threshold and AERP over time; (3) a 40%–50% incidence of POAF.ConclusionA newly developed swine sterile pericarditis model demonstrated electrophysiologic properties consistent with the canine model and patients after open heart surgery.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Swine Versus Canine Sterile Pericarditis Model For Studying ...mentioning

confidence: 99%

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Validation of a new species for studying postoperative atrial fibrillation: Swine sterile pericarditis model

Lee,

Khrestian,

Laurita

et al. 2023

Pacing Clinical Electrophis

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“…Sterile pericarditis was created in 10 adult mongrel dogs weighing 20-34 kg as previously described. 8 Using sterile technique under general anesthesia, the dogs underwent a right thoracotomy in the fourth intercostal space. The heart was exposed and cradled in the pericardium using standard surgical techniques.…”

Section: Canine Sterile Pericarditis Modelmentioning

confidence: 99%

“…8 However, when POAF mechanism is other than reentrant circuit, a nonpharmacologic rate control therapy is necessary. This study demonstrates that the AVN fat pad stimulation effectively and safely reduces the ventricular rate of POAF and eliminates all inefficient ventricular contractions, thereby improving hemodynamics.…”

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confidence: 99%

Nonpharmacologic rate control of postoperative atrial fibrillation in the canine sterile pericarditis model

Lee,

Wallick,

Khrestian

et al. 2024

Cardiovasc electrophysiol

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IntroductionPostoperative atrial fibrillation (POAF) is common following open heart surgery, and is associated with significant morbidity. Medications used for ventricular rate control of POAF may not be effective in controlling rapid ventricular rates during the postoperative period because of increased sympathetic tone. The purpose of this study was to develop nonpharmacologic rate control of POAF by atrioventricular node (AVN) fat pad stimulation using clinically available temporary pacing wires in the canine sterile pericarditis model.MethodsWe studied 10 sterile pericarditis dogs in the closed‐chest state on postoperative days 1−3. The AVN fat pad stimulation (amplitude 2–15 mA; frequency 20 Hz; pulse width 0.03–0.2 ms) was performed during sustained POAF (>5 min). We measured ventricular rate and inefficient ventricular contractions during sustained POAF and compared it with and without AVN fat pad stimulation. Also, the parameters of AVN fat pad stimulation to achieve a rate control of POAF were measured over the postoperative days.ResultsEleven episodes of sustained POAF were induced in 5/10 sterile pericarditis dogs in the closed‐chest state on postoperative days 1−2. During POAF, the AVN fat pad stimulation decreased the ventricular rate from 178 ± 52 bpm to 100 ± 8 bpm in nine episodes. Nonpharmacologic rate control therapy successfully controlled the ventricular rate and eliminated inefficient ventricular contractions during POAF for the duration of the AVN fat pad stimulation. The AVN fat pad stimulation output remained relatively stable over the postoperative days.ConclusionDuring sustained POAF, nonpharmacologic rate control by AVN fat pad stimulation effectively and safely controlled rapid ventricular rates throughout the postoperative period.

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Albert L. Waldo, the explorer of entrainment—an obituary

Deneke,

Israel,

Lewalter

2023

Herzschr Elektrophys

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Reliable pace termination of postoperative atrial fibrillation in the canine sterile pericarditis model: Implications for atypical atrial flutter

Cited by 4 publications

References 18 publications

Validation of a new species for studying postoperative atrial fibrillation: Swine sterile pericarditis model

Validation of a new species for studying postoperative atrial fibrillation: Swine sterile pericarditis model

Nonpharmacologic rate control of postoperative atrial fibrillation in the canine sterile pericarditis model

Albert L. Waldo, the explorer of entrainment—an obituary

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