Ventricular Rate Control by Selective Vagal Stimulation Is Superior to Rhythm Regularization by Atrioventricular Nodal Ablation and Pacing During Atrial Fibrillation

Zhuang, Shaowei; Zhang, Youhua; Mowrey, Kent A.; Li, Jianbo; Tabata, Tomotsugu; Wallick, Don W.; Popović, Zoran B.; Grimm, Richard A.; Natale, Andrea; Mazgalev, Todor N.

doi:10.1161/01.cir.0000031802.58532.04

Cited by 56 publications

(45 citation statements)

References 39 publications

(42 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…125 Additional data support the use of epicardial fat pad stimulation in animals with induced atrial fibrillation over standard atrioventricular nodal ablation and pacing. 126,127 In a recent pilot study, the effects of direct selective right vagus nerve electrical stimulation on LV function were examined in dogs with chronic HF using a new implantable system that also incorporates a right ventricular lead to monitor heart rate (CardioFit, BioControl Medical, Yehud, Israel). Results demonstrate that long-term (3 months) monotherapy with vagus nerve stimulation prevents progressive increases in LV end-diastolic volume, reduces LV end-systolic volume, and significantly increases LV ejection fraction.…”

Section: Could Direct Parasympathetic Stimulation Be Beneficial In Hf?mentioning

confidence: 99%

Parasympathetic Nervous System and Heart Failure

et al. 2008

View full text Add to dashboard Cite

A bundant evidence links sympathetic nervous system activation to outcomes of patients with heart failure (HF). 1 In contrast, parasympathetic activation has complex cardiovascular effects that are only beginning to be recognized. In particular, the pathophysiological roles of normal and disordered parasympathetic innervation in patients with HF are not understood as comprehensively. [2][3][4][5] In the present article, we review cardiovascular responses to parasympathetic activation, address the modulating factors that can affect parasympathetic function, discuss the role of the vagus nerve in ventricular dysfunction, and consider how activation of the parasympathetic nervous system may have important therapeutic implications for patients with congestive HF. Structure of the Parasympathetic Limb of the Autonomic Nervous SystemThe parasympathetic nervous system originates from medial medullary sites (nucleus ambiguous, nucleus tractus solitarius, and dorsal motor nucleus) and is modulated by the hypothalamus. Vagal efferents extend from the medulla to postganglionic nerves that innervate the atria via ganglia located in cardiac fat pads with neurotransmission that is modulated via nicotinic receptors. Postganglionic parasympathetic and sympathetic cholinergic nerves then affect cardiac muscarinic receptors (the Figure). 6 -8 Vagus nerve afferent activation, originating peripherally, can modulate efferent sympathetic and parasympathetic function centrally and at the level of the baroreceptor.Efferent vagus nerve activation can have tonic and basal effects that inhibit sympathetic activation and release of norepinephrine at the presynaptic level. Acetylcholine release from parasympathetic nerve terminals will activate ganglionic nicotinic receptors that in turn activate muscarinic receptors at the cellular level. Cardiovascular effects include heart rate reduction by inhibition of the sympathetic nervous system and by direct hyperpolarization of sinus nodal cells. Parasympathetic activation can affect atrioventricular nodal conduction mediated predominantly through the left vagus nerve. Furthermore, muscarinic receptors on blood vessel walls can cause vasorelaxation through a nitric oxide (NO)-modulated pathway but can also cause vasoconstriction by directly activating smooth muscle. 6 -8 Therefore, although the sympathetic nervous system has global effects on cardiovascular physiology in an all-or-none type of response, the parasympathetic nervous system can have selective modulation at various levels. Parasympathetic/Sympathetic InteractionsThe sympathetic and parasympathetic nervous systems are not "opposites"; rather, the interactions are complex. 9 A dynamic interaction occurs between them; these interactions are modulated partially by secondary messengers (cAMP and cGMP). The parasympathetic nervous system can inhibit sympathetic nerve traffic presynaptically. Likewise, sympathetic activation can inhibit parasympathetic activation presynaptically.Vagal "tone" (tonic parasympathetic activation) predominates...

show abstract

Section: Could Direct Parasympathetic Stimulation Be Beneficial In Hf?mentioning

confidence: 99%

Parasympathetic Nervous System and Heart Failure

et al. 2008

View full text Add to dashboard Cite

show abstract

“…We have previously reported the benefits of slower ventricular rate during AF on LV diastolic function (17,24,26,27). In these studies, the improvement of diastolic parameters was demonstrated during selective atrioventricular nodal vagal stimulation by analysis of averaged values of diastolic parameters for Ͼ100 consecutive cardiac beats.…”

Section: Potential Benefit Of Slowing the Ventricular Rate During Afmentioning

confidence: 99%

“…We have recently reported (24,26,27) that slowing of ventricular rate by selective atrioventricular nodal vagal stimulation during AF improved both LV contractility and relaxation. It has been speculated that rapid ventricular rate with inadequate LV filling time during AF might be the major factor limiting cardiac performance (3).…”

mentioning

confidence: 99%

“…The presence of AF further complicates our ability to identify diastolic dysfunction because irregular RR intervals result in constantly changing loading conditions, and the applicability of Doppler echocardiography methods is impaired by the lack of atrial contraction. In addition, there is still insufficient understanding of the basic physiological mechanisms underlying cardiac hemodynamics during AF.We have recently reported (24,26,27) that slowing of ventricular rate by selective atrioventricular nodal vagal stimulation during AF improved both LV contractility and relaxation. It has been speculated that rapid ventricular rate with inadequate LV filling time during AF might be the major factor limiting cardiac performance (3).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Determinants of LV diastolic function during atrial fibrillation: beat-to-beat analysis in acute dog experiments

Tabata

Grimm

Asada

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

Self Cite

View full text Add to dashboard Cite

N. Mazgalev. Determinants of LV diastolic function during atrial fibrillation: beat-to-beat analysis in acute dog experiments. Am J Physiol Heart Circ Physiol 286: H145-H152, 2004. First published September 4, 2003 10.1152/ ajpheart.00588.2003 diastolic function during atrial fibrillation (AF) remains poorly understood due to the complex interaction of factors and beat-to-beat variability. The purpose of the present study was to elucidate the physiological determinants of beat-to-beat changes in LV diastolic function during AF. The RR intervals preceding a given cardiac beat were measured from the right ventricular electrogram in 12 healthy open-chest mongrel dogs during AF. Doppler echocardiography and LV pressure and volume beat-tobeat analyses were performed. The LV filling time (FT) and early diastolic mitral inflow velocity-time integral (Evti) were measured using the pulsed Doppler method. The LV end-diastolic volume (EDV), peak systolic LV pressure (LVP), minimum value of the first derivative of LV pressure curve (dP/dtmin), and the time constant of LV pressure decay () were evaluated with the use of a conductance catheter for 100 consecutive cardiac cycles. Beat-to-beat analysis revealed a cascade of important causal relations. LV-FT showed a significant positive linear relationship with Evti (r ϭ 0.87). Importantly, there was a significant positive linear relationship between the RR interval and LV-EDV in the same cardiac beat (r ϭ 0.53). Consequently, there was a positive linear relationship between LV-EDV and subsequent peak systolic LVP (r ϭ 0.82). Furthermore, there were significant positive linear and negative curvilinear relationships between peak systolic LVP and dP/dtmin (r ϭ 0.95) and (r ϭ Ϫ0.85), respectively, in the same cardiac beat. In addition, there was a significant negative curvilinear relationship between dP/dt min and (r ϭ Ϫ0.86). We have concluded that the determinants of LV diastolic function in individual beats during AF depend strongly on the peak systolic LVP. This suggests that the major benefit of slower ventricular rate appears related to lengthening of LV filling interval, promoting subsequent higher peak systolic LVP and greater LV relaxation. filling interval; left ventricular pressure ATRIAL FIBRILLATION (AF) has been long recognized as one of the most frequent chronic arrhythmias, affecting 0.9% of the population and characterized by irregular rhythm (6). The rapid ventricular rate adversely affects left ventricular (LV) function as preload and contractility diminish due to shorter filling intervals. Furthermore, the absence of optimal atrial boosterpump function as well as beat-to-beat changes in preload, afterload, and contractility are serious negative hemodynamic consequences of AF. They may cause severe LV systolic dysfunction similar to tachycardia-induced cardiomyopathy, even in the absence of other heart disease (10).It is well recognized that patients with normal sinus rhythm who arrive at the hospital with heart failure are frequently found to have diastolic ra...

show abstract

“…In addition, there are hemodynamic drawbacks because of the retrograde ventricular contraction. 11,12 Recently, lesions encircling rather than destroying the AVN were shown to result in acceptable junctional escape rhythm. 13,14 However, this technique needs further refinements and verification.…”

Section: Clinical Perspective P 2911mentioning

confidence: 99%

Chronic Atrioventricular Nodal Vagal Stimulation

et al. 2005

Self Cite

View full text Add to dashboard Cite

Background-We have previously demonstrated that selective atrioventricular nodal (AVN) vagal stimulation (AVN-VS) can be used to control ventricular rate during atrial fibrillation (AF) in acute experiments. However, it is not known whether this approach could provide a long-term treatment in conscious animals. Thus, this study reports the first observations on the long-term efficacy and safety of this novel approach to control ventricular rate during AF in chronically instrumented dogs. Methods and Results-In 18 dogs, custom-made bipolar patch electrodes were sutured to the epicardial AVN fat pad for delivery of selective AVN-VS by a subcutaneously implanted nerve stimulator (pulse width 100 s or 1 ms, frequency 20 or 160 Hz, amplitude 6 to 10 V). Fast-rate right atrial pacing (600 bpm) was used to induce and maintain AF. ECG, blood pressure, and body temperature were monitored telemetrically. One week after the induction of AF, AVN-VS was delivered and maintained for at least 5 weeks. It was found that AVN-VS had a consistent effect on ventricular rate slowing (on average 45Ϯ13 bpm) over the entire period of observation. Echocardiography showed improvement of cardiac indices with ventricular rate slowing. AVN-VS was well tolerated by the animals, causing no signs of distress or discomfort. Conclusions-Beneficial

show abstract

Ventricular Rate Control by Selective Vagal Stimulation Is Superior to Rhythm Regularization by Atrioventricular Nodal Ablation and Pacing During Atrial Fibrillation

Cited by 56 publications

References 39 publications

Parasympathetic Nervous System and Heart Failure

Parasympathetic Nervous System and Heart Failure

Determinants of LV diastolic function during atrial fibrillation: beat-to-beat analysis in acute dog experiments

Chronic Atrioventricular Nodal Vagal Stimulation

Contact Info

Product

Resources

About