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Malik V, Linz D, Sanders P. The Role of the Autonomic Nervous System as Both "Trigger and "Substrate" in Atrial Fibrillation. Card Electrophysiol Clin 2024; 16:271-280. [PMID: 39084720 DOI: 10.1016/j.ccep.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Several complex mechanisms, working alone, or together, initiate and maintain atrial fibrillation (AF). At disease onset, pulmonary vein-atrial triggers, producing ectopy, predominate. Then, as AF progresses, a shift toward substrate occurs, which AF also self-perpetuates. The autonomic nervous system (ANS) plays an important role as trigger and substrate. Although the efferent arm of the ANS as AF trigger is well-established, there is emerging evidence to show that (1) the ANS is a substrate for AF and (2) afferent or regulatory ANS dysfunction occurs in AF patients. These findings could represent a mechanism for the progression of AF.
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Affiliation(s)
- Varun Malik
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Cardiac Arrhythmia Center, University of California, Los Angeles (UCLA), 100 UCLA Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Dominik Linz
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
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2
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Ke Y, Cao Z, Wang X, Liu D, Fu Y, Chen H, Cheng Y, Guo K, Li Y, Long X, Yang M, Zhao Q. KCa3.1 promotes the migration of macrophages from epicardial adipose tissue to induce vulnerability to atrial fibrillation during rapid pacing. Can J Cardiol 2024:S0828-282X(24)00916-4. [PMID: 39147322 DOI: 10.1016/j.cjca.2024.08.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 08/09/2024] [Accepted: 08/09/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND The relationship between local epicardial adipose tissue (EAT) macrophages and atrial fibrillation (AF) remains unclear. The purpose of this study was to investigate the role of KCa3.1 in the migration of macrophages from EAT to adjacent atrial tissue during rapid pacing. METHODS Part 1: Eighteen beagles were randomly divided into the sham group, pacing group, and pacing + clodronate liposome (CL) group. Part 2: Eighteen beagles were randomly divided into the sham group, pacing group, and pacing + TRAM-34 group. HL-1 cells and RAW264.7 cells were cocultured to explore the specific migratory mechanism of macrophages. RESULTS Depleting EAT macrophages significantly reduced macrophage infiltration in the adjacent atrium and the induction of AF in canines with rapid atrial pacing. TRAM-34 significantly inhibited the migration of macrophages from EAT to the adjacent atrium and electrical remodeling in canines with rapid atrial pacing. Compared with those of the control HL-1 cells, the secretion of CCL2 and the number of migrating macrophages in pacing HL-1 cells were significantly increased, which could be reversed by TRAM-34. Further in vitro experiments showed that KCa3.1 regulated CCL2 secretion through the p65/STAT3 signaling pathway. CONCLUSION Inhibiting myocardial KCa3.1 reduced the migration of EAT macrophages to adjacent atrial muscles caused by rapid atrial pacing, thereby decreasing vulnerability to AF. The mechanism by which KCa3.1 regulates CCL2 may be related to the p65/STAT3 signaling pathway.
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Affiliation(s)
- Yuanjia Ke
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China
| | - Zhen Cao
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China
| | - Xuewen Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China
| | - Dishiwen Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China
| | - Yuntao Fu
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China
| | - Huiyu Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China
| | - Yanni Cheng
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China
| | - Kexin Guo
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China
| | - Yajia Li
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China
| | - Xiaojian Long
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China
| | - Mei Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China
| | - Qingyan Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China.
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3
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Akumwami S, Morishita A, Iradukunda A, Kobara H, Nishiyama A. Possible organ-protective effects of renal denervation: insights from basic studies. Hypertens Res 2023; 46:2661-2669. [PMID: 37532952 DOI: 10.1038/s41440-023-01393-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/22/2023] [Accepted: 07/10/2023] [Indexed: 08/04/2023]
Abstract
Inappropriate sympathetic nervous activation is the body's response to biological stress and is thought to be involved in the development of various lifestyle-related diseases through an elevation in blood pressure. Experimental studies have shown that surgical renal denervation decreases blood pressure in hypertensive animals. Recently, minimally invasive catheter-based renal denervation has been clinically developed, which results in a reduction in blood pressure in patients with resistant hypertension. Accumulating evidence in basic studies has shown that renal denervation exerts beneficial effects on cardiovascular disease and chronic kidney disease. Interestingly, recent studies have also indicated that renal denervation improves glucose tolerance and inflammatory changes. In this review article, we summarize the evidence from animal studies to provide comprehensive insight into the organ-protective effects of renal denervation beyond changes in blood pressure.
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Affiliation(s)
- Steeve Akumwami
- Department of Anesthesiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Asahiro Morishita
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | | | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
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4
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Parra-Lucares A, Villa E, Romero-Hernández E, Méndez-Valdés G, Retamal C, Vizcarra G, Henríquez I, Maldonado-Morales EAJ, Grant-Palza JH, Ruíz-Tagle S, Estrada-Bobadilla V, Toro L. Tic-Tac: A Translational Approach in Mechanisms Associated with Irregular Heartbeat and Sinus Rhythm Restoration in Atrial Fibrillation Patients. Int J Mol Sci 2023; 24:12859. [PMID: 37629037 PMCID: PMC10454641 DOI: 10.3390/ijms241612859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Atrial fibrillation (AF) is a prevalent cardiac condition predominantly affecting older adults, characterized by irregular heartbeat rhythm. The condition often leads to significant disability and increased mortality rates. Traditionally, two therapeutic strategies have been employed for its treatment: heart rate control and rhythm control. Recent clinical studies have emphasized the critical role of early restoration of sinus rhythm in improving patient outcomes. The persistence of the irregular rhythm allows for the progression and structural remodeling of the atria, eventually leading to irreversible stages, as observed clinically when AF becomes permanent. Cardioversion to sinus rhythm alters this progression pattern through mechanisms that are still being studied. In this review, we provide an in-depth analysis of the pathophysiological mechanisms responsible for maintaining AF and how they are modified during sinus rhythm restoration using existing therapeutic strategies at different stages of clinical investigation. Moreover, we explore potential future therapeutic approaches, including the promising prospect of gene therapy.
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Affiliation(s)
- Alfredo Parra-Lucares
- Critical Care Unit, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380420, Chile
- Cardiovascular Department, Hospital Clínico Universidad de Chile, Santiago 8380420, Chile
| | - Eduardo Villa
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | | | - Gabriel Méndez-Valdés
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | - Catalina Retamal
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | - Geovana Vizcarra
- Division of Internal Medicine, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380420, Chile
| | - Ignacio Henríquez
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | | | - Juan H. Grant-Palza
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | - Sofía Ruíz-Tagle
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | | | - Luis Toro
- Division of Nephrology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380420, Chile
- Centro de Investigación Clínica Avanzada, Hospital Clínico, Universidad de Chile, Santiago 8380420, Chile
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5
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Scridon A. Autonomic imbalance and atrial ectopic activity-a pathophysiological and clinical view. Front Physiol 2022; 13:1058427. [PMID: 36531175 PMCID: PMC9755506 DOI: 10.3389/fphys.2022.1058427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/22/2022] [Indexed: 09/29/2023] Open
Abstract
The heart is one of the most richly innervated organs and the impact of the complex cardiac autonomic network on atrial electrophysiology and arrhythmogenesis, including on atrial ectopy, is widely recognized. The aim of this review is to discuss the main mechanisms involved in atrial ectopic activity. An overview of the anatomic and physiological aspects of the cardiac autonomic nervous system is provided as well as a discussion of the main pathophysiological pathways linking autonomic imbalance and atrial ectopic activity. The most relevant data on cardiac neuromodulation strategies are emphasized. Unanswered questions and hotspots for future research are also identified.
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Affiliation(s)
- Alina Scridon
- Physiology Department, Center for Advanced Medical and Pharmaceutical Research, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Târgu Mureș, Romania
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6
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Abstract
PURPOSE OF REVIEW During the last decade, several case series and small reports have indicated that pulmonary vein isolation (PVI) in combination with renal denervation (RDN) may increase the rate of atrial fibrillation (AF) freedom in patients with hypertension. We aimed to provide a contemporary systematic overview on the techniques, and the efficacy/safety of RDN on AF recurrence, and the current landscape of ongoing investigation. RECENT FINDINGS The recent Evaluate Renal Denervation in Addition to Catheter Ablation to Eliminate Atrial Fibrillation (ERADICATE-AF) trial has demonstrated convincingly that among patients with paroxysmal AF and poorly controlled (but not "resistant") hypertension, RDN added to catheter ablation, compared with catheter ablation alone, significantly increased the likelihood of freedom from AF at 12 months. RDN has proven to be a unique, effective and safe interventional therapy for the management of AF. Future investigation will likely focus on confirming current findings; expanding the population of eligible patients (eg., non-hypertensives, well controlled hypertensives); determining long-term maintenance of effect and therapeutics.
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Affiliation(s)
- Arwa Younis
- Clinical Cardiovascular Research Center, University of Rochester School of Medicine and Dentistry, 85 Woodland Road, Short Hills, NJ, 07078, USA
| | - Jonathan S Steinberg
- Clinical Cardiovascular Research Center, University of Rochester School of Medicine and Dentistry, 85 Woodland Road, Short Hills, NJ, 07078, USA.
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7
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Hanna P, Buch E, Stavrakis S, Meyer C, Tompkins JD, Ardell JL, Shivkumar K. Neuroscientific therapies for atrial fibrillation. Cardiovasc Res 2021; 117:1732-1745. [PMID: 33989382 PMCID: PMC8208752 DOI: 10.1093/cvr/cvab172] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
The cardiac autonomic nervous system (ANS) plays an integral role in normal cardiac physiology as well as in disease states that cause cardiac arrhythmias. The cardiac ANS, comprised of a complex neural hierarchy in a nested series of interacting feedback loops, regulates atrial electrophysiology and is itself susceptible to remodelling by atrial rhythm. In light of the challenges of treating atrial fibrillation (AF) with conventional pharmacologic and myoablative techniques, increasingly interest has begun to focus on targeting the cardiac neuraxis for AF. Strong evidence from animal models and clinical patients demonstrates that parasympathetic and sympathetic activity within this neuraxis may trigger AF, and the ANS may either induce atrial remodelling or undergo remodelling itself to serve as a substrate for AF. Multiple nexus points within the cardiac neuraxis are therapeutic targets, and neuroablative and neuromodulatory therapies for AF include ganglionated plexus ablation, epicardial botulinum toxin injection, vagal nerve (tragus) stimulation, renal denervation, stellate ganglion block/resection, baroreceptor activation therapy, and spinal cord stimulation. Pre-clinical and clinical studies on these modalities have had promising results and are reviewed here.
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Affiliation(s)
- Peter Hanna
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Eric Buch
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 1100 N Lindsay Ave, Oklahoma City, OK 73104, USA
| | - Christian Meyer
- Division of Cardiology, cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EVK Düsseldorf, Teaching Hospital University of Düsseldorf, Kirchfeldstraße 40, 40217 Düsseldorf, Germany
- Institute of Neural and Sensory Physiology, cardiac Neuro- and Electrophysiology Research Consortium (cNEP), University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - John D Tompkins
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Jeffrey L Ardell
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
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8
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Zhang SJ, Huang CX, Zhao QY, Zhang SD, Dai ZX, Zhao HY, Qian YS, Zhang YJ, Wang YC, He B, Tang YH, Wang T, Wang X. The Role of α7nAChR-Mediated Cholinergic Anti-Inflammatory Pathway in Vagal Nerve Regulated Atrial Fibrillation. Int Heart J 2021; 62:607-615. [PMID: 34054001 DOI: 10.1536/ihj.18-510] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim was to investigate the role of the α7nAChR-mediated cholinergic anti-inflammatory pathway in vagal nerve regulated atrial fibrillation (AF).18 beagles (standard dogs for testing) were used in this study, and the effective refractory period (ERP) of atrium and pulmonary veins and AF inducibility were measured hourly during rapid atrial pacing at 800 beats/minute for 6 hours in all beagles. After cessation of 3 hours of RAP, the low-level vagal nerve stimulation (LL-VNS) group (n = 6) was given LL-VNS and injection of salinne (0.5 mL/GP) into four GPs, the methyllycaconitine (MLA, the antagonist of α7nAChR) group (n = 6) was given LL-VNS and injection of MLA into four GPs, and the Control group (n = 6) was given saline into four GPs and the right cervical vagal nerve was exposed without stimulation. Then, the levels of the tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), acetylcholine (ACh), STAT3, and NF-κB proteins were measured. During the first 3 hours of RAP, the ERPs gradually decreased while the dispersion of ERPs (dERPs) and AF inducibility gradually increased in all three groups. During the last 3 hours of 6 hours' RAP in this study, the ERPs in the LL-VNS group were higher, while the dERPs and AF inducibility were significantly lower when compared with the Control and MLA groups at the same time points. The levels of ACh in the serum and atrium in the LL-VNS and MLA groups were higher than in the Control group, and the levels of TNF-α and IL-6 were higher in the Control and MLA groups than in the LL-VNS group. The concentrations of STAT3 in RA and LA tissues were higher in the LL-VNS group while those of NF-κB were lower.In conclusion, the cholinergic anti-inflammatory pathway mediated by α7nACh plays an important role in low-level vagal nerve-regulated AF.
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Affiliation(s)
- Shu-Juan Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Insititute, Wuhan University.,Hubei Key Laboratory of Cardiology
| | - Cong-Xin Huang
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Insititute, Wuhan University.,Hubei Key Laboratory of Cardiology
| | - Qing-Yan Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Insititute, Wuhan University.,Hubei Key Laboratory of Cardiology
| | - Shu-Di Zhang
- Department of Neurosurgery, Renmin Hospital of Wuhan University
| | - Zi-Xuan Dai
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Insititute, Wuhan University.,Hubei Key Laboratory of Cardiology
| | - Hong-Yi Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Insititute, Wuhan University.,Hubei Key Laboratory of Cardiology
| | - Yong-Sheng Qian
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Insititute, Wuhan University.,Hubei Key Laboratory of Cardiology
| | - You-Jing Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Insititute, Wuhan University.,Hubei Key Laboratory of Cardiology
| | - You-Cheng Wang
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Insititute, Wuhan University.,Hubei Key Laboratory of Cardiology
| | - Bo He
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Insititute, Wuhan University.,Hubei Key Laboratory of Cardiology
| | - Yan-Hong Tang
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Insititute, Wuhan University.,Hubei Key Laboratory of Cardiology
| | - Teng Wang
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Insititute, Wuhan University.,Hubei Key Laboratory of Cardiology
| | - Xi Wang
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Insititute, Wuhan University.,Hubei Key Laboratory of Cardiology
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9
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He S, Wang Y, Yao Y, Cao Z, Yin J, Zi L, Chen H, Fu Y, Wang X, Zhao Q. Inhibition of KCa3.1 Channels Suppresses Atrial Fibrillation via the Attenuation of Macrophage Pro-inflammatory Polarization in a Canine Model With Prolonged Rapid Atrial Pacing. Front Cardiovasc Med 2021; 8:656631. [PMID: 34136541 PMCID: PMC8200470 DOI: 10.3389/fcvm.2021.656631] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/04/2021] [Indexed: 12/04/2022] Open
Abstract
Aims: To investigate the role of KCa3. 1 inhibition in macrophage pro-inflammatory polarization and vulnerability to atrial fibrillation (AF) in a canine model with prolonged rapid atrial pacing. Materials and Methods: Twenty beagle dogs (weighing 8–10 kg) were randomly assigned to a sham group (n = 6), pacing group (n = 7) and pacing+TRAM-34 group (n = 7). An experimental model of AF was established by rapid pacing. TRAM-34 was administered to the Pacing+TRAM-34 group by slow intravenous injection (10 mg/kg), 3 times each day. After 7 days of pacing, the electrophysiology was measured in vivo. The levels of interleukin-1β (IL-1β), monocyte chemotactic protein-1 (MCP-1), tumor necrosis factor-α (TNF-α), CD68, c-Fos, p38, and NF-κB p65 in both atriums were measured by Western blotting, and the levels of inducible nitric oxide synthase (iNOS) and arginase1 (Arg-1) were measured by real-time PCR. Macrophage and KCa3.1 in macrophage in the atrium were quantized following double labeled immunofluorescent. Results: Greater inducibility of AF, an extended duration of AF and lower atrial effective refractory period (AERP) were observed in the pacing group compared with those in the sham group. Both CD68-labeled macrophage and the expression of KCa3.1 in macrophage were elevated in the pacing group and inhibited by TRAM-34, led to higher iNOS expression, lower Arg-1 expression, elevated levels of IL-1β, MCP-1, and TNF-α in the atria, which could be reversed by TRAM-34 treatment (all P < 0.01). KCa3.1 channels were possibly activated via the p38/AP-1/NF-κB signaling pathway. Conclusions: Inhibition of KCa3.1 suppresses vulnerability to AF by attenuating macrophage pro-inflammatory polarization and inflammatory cytokine secretion in a canine model with prolonged rapid atrial pacing.
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Affiliation(s)
- Shanqing He
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Youcheng Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Yajun Yao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Zhen Cao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Junkui Yin
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Liuliu Zi
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Huiyu Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Yuntao Fu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Xi Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Qingyan Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
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10
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Catheter-based renal denervation as adjunct to pulmonary vein isolation for treatment of atrial fibrillation: a systematic review and meta-analysis. J Hypertens 2020; 38:783-790. [DOI: 10.1097/hjh.0000000000002335] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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11
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Steinberg JS, Shabanov V, Ponomarev D, Losik D, Ivanickiy E, Kropotkin E, Polyakov K, Ptaszynski P, Keweloh B, Yao CJ, Pokushalov EA, Romanov AB. Effect of Renal Denervation and Catheter Ablation vs Catheter Ablation Alone on Atrial Fibrillation Recurrence Among Patients With Paroxysmal Atrial Fibrillation and Hypertension: The ERADICATE-AF Randomized Clinical Trial. JAMA 2020; 323:248-255. [PMID: 31961420 PMCID: PMC6990678 DOI: 10.1001/jama.2019.21187] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Renal denervation can reduce cardiac sympathetic activity that may result in an antiarrhythmic effect on atrial fibrillation. OBJECTIVE To determine whether renal denervation when added to pulmonary vein isolation enhances long-term antiarrhythmic efficacy. DESIGN, SETTING, AND PARTICIPANTS The Evaluate Renal Denervation in Addition to Catheter Ablation to Eliminate Atrial Fibrillation (ERADICATE-AF) trial was an investigator-initiated, multicenter, single-blind, randomized clinical trial conducted at 5 referral centers for catheter ablation of atrial fibrillation in the Russian Federation, Poland, and Germany. A total of 302 patients with hypertension despite taking at least 1 antihypertensive medication, paroxysmal atrial fibrillation, and plans for ablation were enrolled from April 2013 to March 2018. Follow-up concluded in March 2019. INTERVENTIONS Patients were randomized to either pulmonary vein isolation alone (n = 148) or pulmonary vein isolation plus renal denervation (n = 154). Complete pulmonary vein isolation to v an end point of elimination of all pulmonary vein potentials; renal denervation using an irrigated-tip ablation catheter delivering radiofrequency energy to discrete sites in a spiral pattern from distal to proximal in both renal arteries. MAIN OUTCOMES AND MEASURES The primary end point was freedom from atrial fibrillation, atrial flutter, or atrial tachycardia at 12 months. Secondary end points included procedural complications within 30 days and blood pressure control at 6 and 12 months. RESULTS Of the 302 randomized patients (median age, 60 years [interquartile range, 55-65 years]; 182 men [60.3%]), 283 (93.7%) completed the trial. All successfully underwent their assigned procedures. Freedom from atrial fibrillation, flutter, or tachycardia at 12 months was observed in 84 of 148 (56.5%) of those undergoing pulmonary vein isolation alone and in 111 of 154 (72.1%) of those undergoing pulmonary vein isolation plus renal denervation (hazard ratio, 0.57; 95% CI, 0.38 to 0.85; P = .006). Of 5 prespecified secondary end points, 4 are reported and 3 differed between groups. Mean systolic blood pressure from baseline to 12 months decreased from 151 mm Hg to 147 mm Hg in the isolation-only group and from 150 mm Hg to 135 mm Hg in the renal denervation group (between-group difference, -13 mm Hg; 95% CI, -15 to -11 mm Hg; P < .001). Procedural complications occurred in 7 patients (4.7%) in the isolation-only group and 7 (4.5%) of the renal denervation group. CONCLUSIONS AND RELEVANCE Among patients with paroxysmal atrial fibrillation and hypertension, renal denervation added to catheter ablation, compared with catheter ablation alone, significantly increased the likelihood of freedom from atrial fibrillation at 12 months. The lack of a formal sham-control renal denervation procedure should be considered in interpreting the results of this trial. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01873352.
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Affiliation(s)
- Jonathan S. Steinberg
- University of Rochester School of Medicine & Dentistry, Heart Research Follow-up Program, Rochester, New York
| | - Vitaliy Shabanov
- E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Dmitry Ponomarev
- E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Denis Losik
- E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Eduard Ivanickiy
- E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Evgeny Kropotkin
- Federal Center of Cardiovascular Surgery, Krasnoyarsk, Russian Federation
| | | | | | | | - Christopher J. Yao
- University of Rochester School of Medicine & Dentistry, Heart Research Follow-up Program, Rochester, New York
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Wang Y, Xiong X, Xie B, Liu J, Yang M, Yin J, Zi L, Wang X, Tang Y, Huang C, Fu H, Zhao Q. A brain-stellate ganglion-atrium network regulates atrial fibrillation vulnerability through macrophages in acute stroke. Life Sci 2019; 237:116949. [PMID: 31605712 DOI: 10.1016/j.lfs.2019.116949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/02/2019] [Accepted: 10/08/2019] [Indexed: 01/06/2023]
Abstract
AIMS New-onset atrial fibrillation (AF) is frequently observed following acute stroke. The aim of this study was to investigate the effects of the brain-stellate ganglion-atrium network on AF vulnerability in a canine model with acute middle cerebral artery occlusion (MCAO). MATERIALS AND METHODS Twenty-six dogs were randomly divided into the sham-operated group (n = 6), acute stroke (AS) group (n = 7), stellate ganglion ablation (SGA) group (n = 6) and clodronate liposome (CL) group (n = 7). In the sham-operated group, dogs received craniotomy without MCAO. Cerebral ischemic model was established in AS dogs by right MCAO. Right MCAO along with SGA and CL injection into the atrium was performed in SGA and CL dogs, respectively. After 3 days, atrial electrophysiology, neural activity, and the phenotype and function of macrophages in the atrium were studied in all the dogs. KEY FINDINGS Higher AF inducibility (24.4 ± 4.4% versus 4.4 ± 2.2%, P < 0.05) and AF duration (15.7 ± 3.8 s versus 2.6 ± 1.1 s, P < 0.05) were observed in the AS group compared with the sham-operated group, and were associated with increased left stellate ganglion activity, higher macrophage infiltration and higher levels of inflammatory cytokines in the atrium. SGA or CL injection sharply suppressed AF inducibility (5.5 ± 2.7% versus 24.4 ± 4.4%; 5.3 ± 3.2% versus 24.4 ± 4.4%, both P < 0.05) and AF duration (2.9 ± 1.2 s versus 15.7 ± 3.8 s; 3.6 ± 1.0 s versus 15.7 ± 3.8 s, both P < 0.05) in canines with acute stroke. SIGNIFICANCE A brain-stellate ganglion-atrium network may increase AF vulnerability through macrophage activation after acute stroke.
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Affiliation(s)
- Youcheng Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan City, Hubei Province, China
| | - Xiaoxing Xiong
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China
| | - Baojun Xie
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China
| | - Jia Liu
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China
| | - Mei Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan City, Hubei Province, China
| | - Junkui Yin
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan City, Hubei Province, China
| | - Liuliu Zi
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan City, Hubei Province, China
| | - Xi Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan City, Hubei Province, China
| | - Yanhong Tang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan City, Hubei Province, China
| | - Congxin Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan City, Hubei Province, China
| | - Haixia Fu
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Henan Provincial Peoples Hospital, Zhengzhou City, Henan Province, China.
| | - Qingyan Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan City, Hubei Province, China.
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13
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Chen S, Kiuchi MG, Yin Y, Liu S, Schratter A, Acou WJ, Meyer C, Pürerfellner H, Chun KRJ, Schmidt B. Synergy of pulmonary vein isolation and catheter renal denervation in atrial fibrillation complicated with uncontrolled hypertension: Mapping the renal sympathetic nerve and pulmonary vein (the pulmonary vein isolation plus renal denervation strategy)? J Cardiovasc Electrophysiol 2019; 30:658-667. [PMID: 30680830 DOI: 10.1111/jce.13858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Disturbance of sympathetic and vagal nervous system participates in the pathogenesis of hypertension and atrial fibrillation (AF). Renal denervation (RDN) can modulate autonomic nervous activity and reduce blood pressure (BP) in hypertensive patients. We aimed to evaluate the effect of RDN combined with pulmonary vein isolation (PVI) in patients with AF and hypertension. METHODS Clinical trials including randomized data comparing PVI plus RDN vs PVI alone were enrolled. Primary outcome was incidence of AF recurrence after procedure. RESULTS A total of 387 patients, of them 252 were randomized and were enrolled. Mean age was 57 ± 10 years, 71% were male, and mean left ventricular ejection fraction was 57.4% ± 6.9%. Follow-up for randomized data was 12 months. Overall comparison for primary outcome showed that PVI + RDN was associated with significantly lower AF recurrence as compared with PVI alone (35.8% vs 55.4%, P < 0.0001). This advantageous effect was consistently maintained among randomized patients (37.3% vs 61.9%, odds ratio = 0.37, P = 0.0001), and among patients with implanted devices for detection of AF recurrence (38.9% vs 61.6%, P = 0.007). Post-hoc sensitivity and regression analysis demonstrated very good stability of this primary result. Pooled Kaplan-Meier analysis further showed that PVI + RDN was associated with significantly higher freedom from AF recurrence as compared with PVI alone (log-rank test, P = 0.001). Besides, RDN resulted in significant BP reduction without additionally increasing the risk of adverse events. CONCLUSIONS RDN may provide synergetic effects with PVI to reduce the burden of AF and improve BP control in patients with AF and uncontrolled hypertension.
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Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Frankfurt Academy For Arrhythmias (FAFA), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Marcio G Kiuchi
- School of Medicine-Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Yuehui Yin
- Department of Cardiology, Chongqing Cardiac Arrhythmia Service Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shaowen Liu
- Department of Cardiology, Shanghai First People's Hospital/Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Alexandra Schratter
- Medizinische Abteilung mit Kardiologie, Krankenhaus Hietzing Wien, Vienna, Austria
| | | | - Christian Meyer
- Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Helmut Pürerfellner
- Abteilung der kardialen Elektrophysiologie/Kardiologie, Akademisches Lehrkrankenhaus der Elisabethinen, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Frankfurt Academy For Arrhythmias (FAFA), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Frankfurt Academy For Arrhythmias (FAFA), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt, Germany
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14
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de Jong MR, Hoogerwaard AF, Adiyaman A, Smit JJJ, Ramdat Misier AR, Heeg JE, van Hasselt BAAM, Van Gelder IC, Crijns HJGM, Lozano IF, Toquero Ramos JE, Javier Alzueta F, Ibañez B, Rubio JM, Arribas F, Porres Aracama JM, Brugada J, Mont L, Elvan A. Treatment of atrial fibrillation in patients with enhanced sympathetic tone by pulmonary vein isolation or pulmonary vein isolation and renal artery denervation: clinical background and study design : The ASAF trial: ablation of sympathetic atrial fibrillation. Clin Res Cardiol 2018; 107:539-547. [PMID: 29487995 DOI: 10.1007/s00392-018-1214-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/08/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hypertension is an important, modifiable risk factor for the development of atrial fibrillation (AF). Even after pulmonary vein isolation (PVI), 20-40% experience recurrent AF. Animal studies have shown that renal denervation (RDN) reduces AF inducibility. One clinical study with important limitations suggested that RDN additional to PVI could reduce recurrent AF. OBJECTIVE The goal of this multicenter randomized controlled study is to investigate whether RDN added to PVI reduces AF recurrence. METHODS The main end point is the time until first AF recurrence according to EHRA guidelines after a blanking period of 3 months. Assuming a 12-month accrual period and 12 months of follow-up, a power of 0.80, a two-sided alpha of 0.05 and an expected drop-out of 10% per group, 69 patients per group are required. We plan to randomize a total of 138 hypertensive patients with AF and signs of sympathetic overdrive in a 1:1 fashion. Patients should use at least two antihypertensive drugs. Sympathetic overdrive includes obesity, exercise-induced excessive blood pressure (BP) increase, significant white coat hypertension, hospital admission or fever induced AF, tachycardia induced AF and diabetes mellitus. The interventional group will undergo PVI + RDN and the control group will undergo PVI. RESULTS Patients will have follow-up for 1 year, and continuous loop monitoring is advocated. CONCLUSION This randomized, controlled study will elucidate if RDN on top of PVI reduces AF recurrence.
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Affiliation(s)
- Mark R de Jong
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | | | - Ahmet Adiyaman
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Jaap Jan J Smit
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | | | - Jan-Evert Heeg
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
| | | | | | - Harry J G M Crijns
- Department of Cardiology, Maastricht Universitair Medisch Centrum, Maastricht, The Netherlands
| | - Ignacio Fernández Lozano
- Department of Arrhythmia Unit, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Jorge E Toquero Ramos
- Department of Arrhythmia Unit, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - F Javier Alzueta
- Department of Arrhythmia Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Borja Ibañez
- Department of Cardiology, Hospital Fundación Jimenez Díaz, Madrid, Spain
| | - José M Rubio
- Department of Cardiology, Hospital Fundación Jimenez Díaz, Madrid, Spain
| | - Fernando Arribas
- Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Josep Brugada
- Arrhythmia Unit, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Lluís Mont
- Arrhythmia Unit, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Arif Elvan
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands.
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15
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Atrial fibrillation: Neurogenic or myogenic? Arch Cardiovasc Dis 2018; 111:59-69. [DOI: 10.1016/j.acvd.2017.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 01/08/2023]
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16
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d’Avila A, (Natasja) de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20:e1-e160. [PMID: 29016840 PMCID: PMC5834122 DOI: 10.1093/europace/eux274] [Citation(s) in RCA: 715] [Impact Index Per Article: 119.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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17
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot N(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14:e275-e444. [PMID: 28506916 PMCID: PMC6019327 DOI: 10.1016/j.hrthm.2017.05.012] [Citation(s) in RCA: 1402] [Impact Index Per Article: 200.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B. Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D. Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D. Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M. Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E. Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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19
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Dzeshka MS, Shahid F, Shantsila A, Lip GYH. Hypertension and Atrial Fibrillation: An Intimate Association of Epidemiology, Pathophysiology, and Outcomes. Am J Hypertens 2017; 30:733-755. [PMID: 28338788 DOI: 10.1093/ajh/hpx013] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 01/18/2023] Open
Abstract
Atrial fibrillation (AF) is the most prevalent sustained arrhythmia found in clinical practice. AF rarely exists as a single entity but rather as part of a diverse clinical spectrum of cardiovascular diseases, related to structural and electrical remodeling within the left atrium, leading to AF onset, perpetuation, and progression. Due to the high overall prevalence within the AF population arterial hypertension plays a significant role in the pathogenesis of AF and its complications. Fibroblast proliferation, apoptosis of cardiomyocytes, gap junction remodeling, accumulation of collagen both in atrial and ventricular myocardium all accompany ageing-related structural remodeling with impact on electrical activity. The presence of hypertension also stimulates oxidative stress, systemic inflammation, rennin-angiotensin-aldosterone and sympathetic activation, which further drives the remodeling process in AF. Importantly, both hypertension and AF independently increase the risk of cardiovascular and cerebrovascular events, e.g., stroke and myocardial infarction. Given that both AF and hypertension often present with limited on patient wellbeing, treatment may be delayed resulting in development of complications as the first clinical manifestation of the disease. Antithrombotic prevention in AF combined with strict blood pressure control is of primary importance, since stroke risk and bleeding risk are both greater with underlying hypertension.
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Affiliation(s)
- Mikhail S Dzeshka
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
- Grodno State Medical University, Grodno, Belarus
| | - Farhan Shahid
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Alena Shantsila
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Dai Z, Huang C, Zhao Q, Zhang S, Zhao H, Zhang Y, Qian Y, Tang Y. Effects of extrinsic cardiac nerve stimulation on atrial fibrillation inducibility: The regulatory role of the spinal cord. J Cardiovasc Electrophysiol 2017; 28:819-827. [PMID: 28422349 DOI: 10.1111/jce.13217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 03/15/2017] [Accepted: 04/03/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate the effect of the mutual regulation of the extrinsic cardiac nerves on atrial electrophysiology and atrial fibrillation (AF) vulnerability. METHODS AND RESULTS Fourteen dogs were randomly divided into two groups: spinal cord stimulation (SCS) group (n = 7) and spinal cord block (SCB) group (n = 7). SCS was performed with 90% of the threshold voltage stimulating the T1 -T2 spinal level, while SCB was performed by injecting 2% lidocaine into the epidural space at the T2-3 level. The effective refractory period (ERP), ERP dispersion, and AF inducibility were measured during atrial pacing combined with different extrinsic cardiac nerve stimulation. ERPs were decreased in the atrium and pulmonary veins and ERP dispersion was increased from baseline during left cervical vagus nerve stimulation (VNS) or left stellate ganglion stimulation (SGS) in the two groups. When combined with SCS, VNS resulted in diminished ERPs at all recording sites, longer ERP dispersion and more episodes of AF than were observed during VNS, whereas ERPs were greater and correspondingly fewer episodes of AF occurred during SCS combined with SGS than SGS. In the SCB group, ERPs were shortened, ERP dispersion was lengthened, and episodes of AF were increased during SGS after SCB. SCS enhanced the activity of the left vagus nerve but attenuated the left stellate ganglion and superior left ganglionated plexus. CONCLUSION SCS modulates extrinsic and intrinsic cardiac nerve activity among the vagus nerve, stellate ganglion, and ganglionated plexus. SCS facilitates the effect of VNS and attenuates the effect of SGS on atrial electrophysiology.
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Affiliation(s)
- Zixuan Dai
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, PR China.,Hubei Key Laboratory of Cardiology, Wuhan, PR China
| | - Congxin Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, PR China.,Hubei Key Laboratory of Cardiology, Wuhan, PR China
| | - Qingyan Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, PR China.,Hubei Key Laboratory of Cardiology, Wuhan, PR China
| | - Shujuan Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, PR China.,Hubei Key Laboratory of Cardiology, Wuhan, PR China
| | - Hongyi Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, PR China.,Hubei Key Laboratory of Cardiology, Wuhan, PR China
| | - Youjing Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, PR China.,Hubei Key Laboratory of Cardiology, Wuhan, PR China
| | - Yongsheng Qian
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, PR China.,Hubei Key Laboratory of Cardiology, Wuhan, PR China
| | - Yanhong Tang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, PR China.,Hubei Key Laboratory of Cardiology, Wuhan, PR China
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Bazoukis G, Korantzopoulos P, Tsioufis C. The impact of renal sympathetic denervation on cardiac electrophysiology and arrhythmias: A systematic review of the literature. Int J Cardiol 2016; 220:87-101. [DOI: 10.1016/j.ijcard.2016.06.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/12/2016] [Indexed: 01/01/2023]
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Nammas W, Airaksinen JKE, Paana T, Karjalainen PP. Renal sympathetic denervation for treatment of patients with atrial fibrillation: Reappraisal of the available evidence. Heart Rhythm 2016; 13:2388-2394. [PMID: 27590432 DOI: 10.1016/j.hrthm.2016.08.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Indexed: 11/25/2022]
Abstract
Afferent renal sympathetic nerve signaling regulates central sympathetic outflow. In this regard, renal sympathetic denervation has emerged as a novel interventional strategy for treatment of patients with resistant hypertension. Despite the disappointing results of the Simplicity HTN-3 randomized controlled trial, promoters of renal denervation argue that the negative results were due to ineffective denervation technique and poor patient selection. Yet, long-term "pathologic" increase of efferent sympathetic nerve activity is observed in many chronic disease states characterized by sympathetic overactivity, such as arrhythmia, heart failure, insulin resistance, and chronic kidney disease. In this review, we highlight the contemporary evidence on the safety/efficacy of renal denervation in the treatment of patients with atrial fibrillation.
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Affiliation(s)
- Wail Nammas
- Heart Center, Satakunta Central Hospital, Pori, Finland
| | | | - Tuomas Paana
- Heart Center, Satakunta Central Hospital, Pori, Finland
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Wei Y, Xu J, Zhou G, Chen S, Ouyang P, Liu S. Renal Denervation Suppresses the Inducibility of Atrial Fibrillation in a Rabbit Model for Atrial Fibrosis. PLoS One 2016; 11:e0160634. [PMID: 27529427 PMCID: PMC4986963 DOI: 10.1371/journal.pone.0160634] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/23/2016] [Indexed: 11/18/2022] Open
Abstract
Renal denervation (RD) was reported to reduce the susceptibility of atrial fibrillation (AF), but the underlying mechanism has not been well understood. This study was performed to investigate the effect of RD on the inducibility of AF in a rabbit model for atrial fibrosis and to explore the potential mechanisms. Thirty-five rabbits were randomly assigned into sham-operated group (n = 12), abdominal aortic constriction (AAC) group (n = 12) and AAC with RD (AAC-RD) group (n = 11). The incidence of AF induced by burst pacing in atriums was determined. Blood was collected to measure the levels of rennin, angiotensin II and aldosterone. Atrial samples were preserved to evaluate protein and gene expression of collagen, connective tissue growth factor (CTGF) and transforming growth factor-β1 (TGF-β1). Our data suggested cardiac structure remodeling and atrial fibrosis were successfully induced by AAC. Compared with the AAC group, the AAC-RD rabbits had smaller ascending aortic diameter and left ventricular end-systolic diameter. For burst pacing at the left atrium (LA), AF was induced in two of the 12 rabbits in the sham-operated group, 10 of the 12 rabbits in the AAC group, and 2 of the 11 rabbits in the AAC-RD group, with great difference among the three groups (P = 0.001). The percentage of LA burst stimulations with induced AF achieved 47.2% in the AAC group, which was higher than those in both the AAC-RD (12.1%) and the Sham-operated (5.6%) groups. Significantly increasing intercellular space in the AAC group (P<0.001) compared with the sham-operated rabbits. RD clearly decreased the volume fraction of collagen in LA and right atrium compared with that of the AAC group (P< 0.01). AAC-induced elevation of collagen I, CTGF and TGF-β1 was suppressed by RD. In conclusion, RD suppressed the inducibility of AF in a rabbit model for pressure associated atrial fibrosis, potentially by modulating renin-angiotensin-aldosterone system and decreasing pro-fibrotic factors.
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Affiliation(s)
- Yong Wei
- Department of cardiology, Shanghai Songjiang Central Hospital, Shanghai, 201600, China
- Department of cardiology, Shanghai First People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200800, China
| | - Juan Xu
- Department of cardiology, Shanghai First People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200800, China
| | - Genqing Zhou
- Department of cardiology, Shanghai First People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200800, China
| | - Songwen Chen
- Department of cardiology, Shanghai First People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200800, China
| | - Ping Ouyang
- Department of cardiology, Shanghai Songjiang Central Hospital, Shanghai, 201600, China
| | - Shaowen Liu
- Department of cardiology, Shanghai First People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200800, China
- * E-mail:
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Pourafshar N, Karimi A, Anderson RD, Alaei-Andabili SH, Kandzari DE. Renal Denervation: Past, Present, and Future. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2016. [DOI: 10.15212/cvia.2016.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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25
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Zhou Q, Zhou X, TuEr-Hong ZL, Wang H, Yin T, Li Y, Zhang L, Lu Y, Xing Q, Zhang J, Yang Y, Tang B. Renal sympathetic denervation suppresses atrial fibrillation induced by acute atrial ischemia/infarction through inhibition of cardiac sympathetic activity. Int J Cardiol 2015; 203:187-95. [PMID: 26512836 DOI: 10.1016/j.ijcard.2015.10.120] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/13/2015] [Accepted: 10/16/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aims to explore the effects of renal sympathetic denervation (RSD) on atrial fibrillation (AF) inducibility and sympathetic activity induced by acute atrial ischemia/infarction. METHODS Acute ischemia/infarction was induced in 12 beagle dogs by ligating coronary arteries that supply the atria. Six dogs in the sham-RSD group did not undergo RSD, and six dogs without coronary artery ligation served as controls. AF induction rate, sympathetic discharge, catecholamine concentration and densities of tyrosine hydroxylase-positive nerves were measured. RESULTS Acute atrial ischemia/infarction resulted in a significant increase of AF induction rate, which was decreased by RSD compared to controls (P<0.05). The root-mean-square peak value, peak area and number of sympathetic discharges were significantly augmented by atrial ischemia relative to the baseline and control (P<0.05). The number of sympathetic discharges was significantly reduced in the RSD group, compared to the control and sham-RSD groups (P<0.05). Norepinephrine and epinephrine concentrations in the atria, ventricle and kidney were elevated by atrial ischemia/infarction, but were reduced by RSD (P<0.05). CONCLUSIONS Sympathetic hyperactivity was associated with pacing-induced AF after acute atrial ischemia/infarction. RSD has the potential to reduce the incidence of new-onset AF after acute atrial ischemia/infarction. The inhibition of cardiac sympathetic activity by RSD may be one of the major underlying mechanisms for the marked reduction of AF inducibility.
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Affiliation(s)
- Qina Zhou
- Clinical Medicine, Postdoctoral Scientific Research Station, Xinjiang Medical University, Urumqi, China
| | - Xianhui Zhou
- Heart Center, Cardiac Pacing and Electrophysiology Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - ZuKe-la TuEr-Hong
- Heart Center, Cardiac Pacing and Electrophysiology Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hongli Wang
- Clinical Medical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Tingting Yin
- Heart Center, Cardiac Pacing and Electrophysiology Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yaodong Li
- Heart Center, Cardiac Pacing and Electrophysiology Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ling Zhang
- Heart Center, Cardiac Pacing and Electrophysiology Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yanmei Lu
- Heart Center, Cardiac Pacing and Electrophysiology Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qiang Xing
- Heart Center, Cardiac Pacing and Electrophysiology Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jianghua Zhang
- Heart Center, Cardiac Pacing and Electrophysiology Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yining Yang
- Clinical Medical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Baopeng Tang
- Heart Center, Cardiac Pacing and Electrophysiology Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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Zhao Q, Deng H, Jiang X, Dai Z, Wang X, Wang X, Guo Z, Hu W, Yu S, Yang B, Tang Y, Huang C. Effects of Intrinsic and Extrinsic Cardiac Nerves on Atrial Arrhythmia in Experimental Pulmonary Artery Hypertension. Hypertension 2015; 66:1042-9. [PMID: 26418021 DOI: 10.1161/hypertensionaha.115.05846] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/02/2015] [Indexed: 11/16/2022]
Abstract
Atrial arrhythmia, which includes atrial fibrillation (AF) and atrial flutter (AFL), is common in patients with pulmonary arterial hypertension (PAH), who often have increased sympathetic nerve activity. Here, we tested the hypothesis that autonomic nerves play important roles in vulnerability to AF/AFL in PAH. The atrial effective refractory period and AF/AFL inducibility at baseline and after anterior right ganglionated plexi ablation were determined during left stellate ganglion stimulation or left renal sympathetic nerve stimulation in beagle dogs with or without PAH. Then, sympathetic nerve, β-adrenergic receptor densities and connexin 43 expression in atrial tissues were assessed. The sum of the window of vulnerability to AF/AFL was increased in the right atrium compared with the left atrium at baseline in the PAH dogs but not in the controls. The atrial effective refractory period dispersion was increased in the control dogs, but not in the PAH dogs, during left stellate ganglion stimulation. The voltage thresholds for inducing AF/AFL during anterior right ganglionated plexi stimulation were lower in the PAH dogs than in the controls. The AF/AFL inducibility was suppressed after ablation of the anterior right ganglionated plexi in the PAH dogs. The PAH dogs had higher sympathetic nerve and β1-adrenergic receptor densities, increased levels of nonphosphorylated connexin 43, and heterogeneous connexin 43 expression in the right atrium when compared with the control dogs. The anterior right ganglionated plexi play important roles in the induction of AF/AFL. AF/AFL induction was associated with right atrium substrate remodeling in dogs with PAH.
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Affiliation(s)
- Qingyan Zhao
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Hongping Deng
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Xuejun Jiang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Zixuan Dai
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Xiaozhan Wang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Xule Wang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Zongwen Guo
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Wei Hu
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Shengbo Yu
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Bo Yang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Yanhong Tang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Congxin Huang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China.
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Hu W, Yu SB, Chen L, Guo RQ, Zhao QY. Renal sympathetic denervation prevents the development of pulmonary arterial hypertension and cardiac dysfunction in dogs. Kaohsiung J Med Sci 2015; 31:405-12. [DOI: 10.1016/j.kjms.2015.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 05/01/2015] [Accepted: 05/19/2015] [Indexed: 01/24/2023] Open
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Qingyan Z, Xuejun J, Yanhong T, Zixuan D, Xiaozhan W, Xule W, Zongwen G, Wei H, Shengbo Y, Congxin H. Efectos beneficiosos de la simpatectomía renal sobre el remodelado vascular pulmonar en la hipertensión arterial primaria experimental. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.11.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Liang Z, Shi XM, Liu LF, Chen XP, Shan ZL, Lin K, Li J, Chen FK, Li YG, Guo HY, Wang YT. Renal denervation suppresses atrial fibrillation in a model of renal impairment. PLoS One 2015; 10:e0124123. [PMID: 25884946 PMCID: PMC4401704 DOI: 10.1371/journal.pone.0124123] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/26/2015] [Indexed: 12/22/2022] Open
Abstract
Background A close association exists between renal impairment (RI) and atrial fibrillation (AF) occurrence. Increased activity of the sympathetic nervous system (SNS) may contribute to the development of AF associated with RI. Renal denervation (RDN) decreases central sympathetic activity. Objective The main objective of the study was to explore the effects of RDN on AF occurrence and its possible mechanisms in beagles with RI. Methods Unilateral RI was induced in beagles by embolization of small branches of the renal artery in the right kidney using gelatin sponge granules in Model (n = 6) and RDN group (n = 6). The Sham group (n = 6) underwent the same procedure, except for embolization. Then animals in RDN group underwent radiofrequency ablation of the renal sympathetic nerve. Cardiac electrophysiological parameters, blood pressure, left ventricular end-diastolic pressure, and AF inducibility were investigated. The activity of the SNS, renin-angiotensin-aldosterone system (RAAS), inflammation and atrial interstitial fibrosis were measured. Results Embolization of small branches of the renal artery in the right kidney led to ischemic RI. Heart rate, P wave duration and BP were increased by RI, which were prevented or attenuated by RDN. Atrial effective refractory period was shortened and AF inducibility was increased by RI, which were prevented by RDN. Antegrade Wenckebach point was shortened, atrial and ventricular rates during AF were increased by RI, which were attenuated or prevented by RDN. Levels of norepinephrine, renin and aldosterone in plasma, norepinephrine, angiotensin II, aldosterone, interleukin-6 and high sensitivity C-reactive protein in atrial tissue were elevated, and atrial interstitial fibrosis was enhanced by RI, which were attenuated by RDN. Conclusions RDN significantly reduced AF inducibility, prevented the atrial electrophysiological changes in a model of RI by combined reduction of sympathetic drive and RAAS activity, and inhibition of inflammation activity and fibrotic pathway in atrial tissue.
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Affiliation(s)
- Zhuo Liang
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Xiang-min Shi
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Li-feng Liu
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Xin-pei Chen
- Department of Emergency, Beijing Tsinghua Changgeng Hospital Medical Center, Tsinghua University, Beijing, China
| | - Zhao-liang Shan
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Kun Lin
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jian Li
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Fu-kun Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yan-guang Li
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Hong-yang Guo
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yu-tang Wang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
- * E-mail:
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Dai M, Bao M, Liao J, Yu L, Tang Y, Huang H, Wang X, Huang C. Effects of low-level carotid baroreflex stimulation on atrial electrophysiology. J Interv Card Electrophysiol 2015; 43:111-9. [DOI: 10.1007/s10840-015-9976-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/20/2015] [Indexed: 11/28/2022]
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Beneficial Effects of Renal Denervation on Pulmonary Vascular Remodeling in Experimental Pulmonary Artery Hypertension. ACTA ACUST UNITED AC 2015; 68:562-70. [PMID: 25804321 DOI: 10.1016/j.rec.2014.11.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 11/24/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES Activation of both the sympathetic nervous system and the renin-angiotensin-aldosterone system is closely associated with pulmonary arterial hypertension. We hypothesized that renal denervation decreases renin-angiotensin-aldosterone activity and inhibits the progression of pulmonary arterial hypertension. METHODS Twenty-two beagles were randomized into 3 groups. The dogs' pulmonary dynamics were measured before and 8 weeks after injection of 0.1mL/kg dimethylformamide (control dogs) or 2mg/kg dehydromonocrotaline (pulmonary arterial hypertension and pulmonary arterial hypertension + renal denervation dogs). Eight weeks after injection, neurohormone levels and pulmonary tissue morphology were measured. RESULTS Levels of plasma angiotensin II and endothelin-1 were significantly increased after 8 weeks in the pulmonary arterial hypertension dogs and were higher in the lung tissues of these dogs than in those of the control and renal denervation dogs (mean [standard deviation] angiotensin II: 65 [9.8] vs 38 [6.7], 46 [8.1]; endothelin-1: 96 [10.3] vs 54 [6.2], 67 [9.4]; P < .01). Dehydromonocrotaline increased the mean pulmonary arterial pressure (16 [3.4] mmHg vs 33 [7.3] mmHg; P < .01), and renal denervation prevented this increase. Pulmonary smooth muscle cell proliferation was higher in the pulmonary arterial hypertension dogs than in the control and pulmonary arterial hypertension + renal denervation dogs. CONCLUSIONS Renal denervation attenuates pulmonary vascular remodeling and decreases pulmonary arterial pressure in experimental pulmonary arterial hypertension. The effect of renal denervation may contribute to decreased neurohormone levels.
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Lewek J, Kaczmarek K, Pokushalov E, Romanov A, Cygankiewicz I, Ptaszynski P. Renal denervation--hypes and hopes. Cardiovasc Ther 2015; 33:141-4. [PMID: 25786785 DOI: 10.1111/1755-5922.12116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Catheter-based renal denervation (RDN) is a novel invasive approach in the treatment of resistant hypertension. It is considered a minimally invasive and safe procedure which, as shown by initial experimental and clinical trials, is able not only to reduce blood pressure but also to modify its risk factors by modulation of autonomic nervous system. Recently published results of a randomized Symplicity HTN-3 trial, which failed to demonstrate RDN-induced reduction of blood pressure at six months, decreased the initial enthusiasm regarding RDN and raised a question about real efficacy of this procedure. Nevertheless, still there are some other conditions characterized by increased sympathetic tone such as heart failure, atrial fibrillation, or ventricular arrhythmias that may benefit from RDN. Furthermore, novel therapeutical approach toward RDN using adapted electrophysiological or new specially designed electrodes may improve effectiveness of RDN procedure.
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Affiliation(s)
- Joanna Lewek
- Department of Electrocardiology, Sterling Regional Heart Disease Center, Medical University, Lodz, Poland
| | - Krzysztof Kaczmarek
- Department of Electrocardiology, Sterling Regional Heart Disease Center, Medical University, Lodz, Poland
| | | | - Alexandr Romanov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Iwona Cygankiewicz
- Department of Electrocardiology, Sterling Regional Heart Disease Center, Medical University, Lodz, Poland
| | - Pawel Ptaszynski
- Department of Electrocardiology, Sterling Regional Heart Disease Center, Medical University, Lodz, Poland
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Abstract
"Heart failure is an increasingly prevalent disease with high mortality and public health burden. It is associated with autonomic imbalance characterized by sympathetic hyperactivity and parasympathetic hypoactivity. Evolving novel interventional and device-based therapies have sought to restore autonomic balance by neuromodulation. Results of preclinical animal studies and early clinical trials have demonstrated the safety and efficacy of these therapies in heart failure. This article discusses specific neuromodulatory treatment modalities individually-spinal cord stimulation, vagus nerve stimulation, baroreceptor activation therapy, and renal sympathetic nerve denervation."
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Wilson S, Kistler P, McLellan AJ, Hering D, Schlaich MP. Renal Denervation And Pulmonary Vein Isolation In Patients With Drug Resistant Hypertension And Symptomatic Atrial Fibrillation. J Atr Fibrillation 2014; 7:1165. [PMID: 27957138 DOI: 10.4022/jafib.1165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/18/2014] [Accepted: 12/18/2014] [Indexed: 11/10/2022]
Abstract
Systemic hypertension is the most consistent modifiable risk factor for atrial fibrillation (AF) in adults with consistent data from both animal models and human studies suggesting a consistent pattern of autonomic imbalance underlying both conditions. Relative sympathetic nervous system activation is a demonstrably common attendant to the local mechanisms in pulmonary veins that sustain persistent or recurrent AF and may represent a new objective for adjunctive treatment. Established management of AF aims to achieve durable control through either pharmacologic or catheter-based interventions. The introduction of catheter-based renal denervation as a safe, alternate approach to target the sympathetic nervous system therapeutically represents a potential opportunity to treat the shared pathophysiological mechanisms with minimal additional treatment burden when added in this context. Preliminary investigations have demonstrated both proof-of-concept and the technical feasibility of combined renal denervation and AF ablation procedures with the suggestion of benefit in terms of freedom from AF recurrence. The available data is promising but absolute confirmation of efficacy remains unconfirmed in the absence of more definitive evidence. This paper reviews the role of autonomic imbalance in the initiation and maintenance of AF by summarizing the observations from both experimental models and clinical studies from the perspective of potential therapeutic overlap between catheter-based treatments.
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Affiliation(s)
- Scott Wilson
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute
| | - Peter Kistler
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - Alex J McLellan
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - Dagmara Hering
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute; Department of Hypertension and Diabetology, Medical University of Gdansk, Poland
| | - Markus P Schlaich
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia; Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia; Royal Perth Hospital Clinical Research Centre, Perth, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia
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Wang X, Huang C, Zhao Q, Huang H, Tang Y, Dai Z, Wang X, Guo Z, Xiao J. Effect of renal sympathetic denervation on the progression of paroxysmal atrial fibrillation in canines with long-term intermittent atrial pacing. Europace 2014; 17:647-54. [PMID: 25349225 DOI: 10.1093/europace/euu212] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/03/2014] [Indexed: 11/13/2022] Open
Abstract
AIMS The aim of the present study was to explore the effect of renal sympathetic denervation (RSD) on the progression of paroxysmal atrial fibrillation (AF) in canines with long-term intermittent atrial pacing. METHODS AND RESULTS Nineteen beagles were randomly divided into sham-operated group (six dogs), control group (six dogs), and RSD group (seven dogs). Sham-operated group were implanted with pacemakers without pacing; control group were implanted with pacemakers with long-term intermittent atrial pacing; and RSD group underwent catheter-based RSD bilaterally and were simultaneously implanted with pacemakers. Atrial pacing was maintained for 8 h a day and a total of 12 weeks in the control group and RSD group. Echocardiography showed that the left atrial structure and function were significantly improved in the RSD group compared with the control group (P < 0.05). Compared with the control group, the RSD group had fewer incidences of AF and a shorter duration of AF (P < 0.05) after long-term intermittent atrial pacing. In addition to increased atrial effective refractory period (AERP) and AF cycle length, AERP dispersion and P-wave duration and dispersion were significantly decreased in the RSD group compared with the control group (P < 0.05). Atrial morphological evaluation suggested that fibrosis and ultrastructural changes induced by long-term intermittent atrial pacing were markedly suppressed in the RSD dogs compared with controls (P < 0.05). Immunohistochemistry results showed that connexin 43 distribution in RSD mid-myocardial was significantly fewer heterogeneous than that in control mid-myocardial (P < 0.05). CONCLUSION Renal denervation inhibits the progression of paroxysmal AF, which might be related to the suppression of atrial electrophysiology and structural heterogeneity.
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Affiliation(s)
- Xule Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan City 430060, People's Republic of China Cardiovascular Research Institute of Wuhan University, Wuhan City 430060, People's Republic of China
| | - Congxin Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan City 430060, People's Republic of China Cardiovascular Research Institute of Wuhan University, Wuhan City 430060, People's Republic of China
| | - Qingyan Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan City 430060, People's Republic of China Cardiovascular Research Institute of Wuhan University, Wuhan City 430060, People's Republic of China
| | - He Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan City 430060, People's Republic of China Cardiovascular Research Institute of Wuhan University, Wuhan City 430060, People's Republic of China
| | - Yanhong Tang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan City 430060, People's Republic of China Cardiovascular Research Institute of Wuhan University, Wuhan City 430060, People's Republic of China
| | - Zixuan Dai
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan City 430060, People's Republic of China Cardiovascular Research Institute of Wuhan University, Wuhan City 430060, People's Republic of China
| | - Xiaozhan Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan City 430060, People's Republic of China Cardiovascular Research Institute of Wuhan University, Wuhan City 430060, People's Republic of China
| | - Zongwen Guo
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan City 430060, People's Republic of China Cardiovascular Research Institute of Wuhan University, Wuhan City 430060, People's Republic of China
| | - Jinping Xiao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan City 430060, People's Republic of China Cardiovascular Research Institute of Wuhan University, Wuhan City 430060, People's Republic of China
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Kosiuk J, Hilbert S, Pokushalov E, Hindricks G, Steinberg JS, Bollmann A. Renal denervation for treatment of cardiac arrhythmias: state of the art and future directions. J Cardiovasc Electrophysiol 2014; 26:233-8. [PMID: 25231911 DOI: 10.1111/jce.12553] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/25/2014] [Accepted: 08/27/2014] [Indexed: 12/14/2022]
Abstract
It has now been more than a quarter of a century since modulation of the sympathetic nervous system was proposed for the treatment of cardiac arrhythmias of different origins. But it has also been some time since some of the early surgical attempts have been abandoned. With the development of ablation techniques, however, new approaches and targets have been recently introduced that have revolutionized our way of thinking about sympathetic modulation. Renal nerve ablation technology is now being successfully used for the treatment of resistant hypertension, but the indication spectrum might broaden and new therapeutic options might arise in the near future. This review focuses on the possible impact of renal sympathetic system modulation on cardiac arrhythmias, the current evidence supporting this approach, and the ongoing trials of this method in electrophysiological laboratories. We will discuss the potential roles that sympathetic modulation may play in the future.
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Affiliation(s)
- Jedrzej Kosiuk
- Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany
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Liang Z, Liu LF, Chen XP, Shi XM, Guo HY, Lin K, Guo JP, Shan ZL, Wang YT. Establishment of a model of renal impairment with mild renal insufficiency associated with atrial fibrillation in canines. PLoS One 2014; 9:e105974. [PMID: 25157494 PMCID: PMC4144969 DOI: 10.1371/journal.pone.0105974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 07/25/2014] [Indexed: 11/19/2022] Open
Abstract
Background Chronic kidney disease and occurrence of atrial fibrillation (AF) are closely related. No studies have examined whether renal impairment (RI) without severe renal dysfunction is associated with the occurrence of AF. Methods Unilateral RI with mild renal insufficiency was induced in beagles by embolization of small branches of the renal artery in the left kidney for 2 weeks using gelatin sponge granules in the model group (n = 5). The sham group (n = 5) underwent the same procedure, except for embolization. Parameters associated with RI and renal function were tested, cardiac electrophysiological parameters, blood pressure, left ventricular pressure, and AF vulnerability were investigated. The activity of the sympathetic nervous system, renin-angiotensin-aldosterone system, inflammation, and oxidative stress were measured. Histological studies associated with atrial interstitial fibrosis were performed. Results Embolization of small branches of the renal artery in the left kidney led to ischemic RI with mild renal insufficiency. The following changes occurred after embolization. Heart rate and P wave duration were increased. Blood pressure and left ventricular systolic pressure were elevated. The atrial effective refractory period and antegrade Wenckebach point were shortened. Episodes and duration of AF, as well as atrial and ventricular rate during AF were increased in the model group. Plasma levels of norepinephrine, renin, and aldosterone were increased, angiotensin II and aldosterone levels in atrial tissue were elevated, and atrial interstitial fibrosis was enhanced after 2 weeks of embolization in the model group. Conclusions We successfully established a model of RI with mild renal insufficiency in a large animal. We found that RI with mild renal insufficiency was associated with AF in this model.
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Affiliation(s)
- Zhuo Liang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Li-feng Liu
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Xin-pei Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Xiang-min Shi
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Hong-yang Guo
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Kun Lin
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jian-ping Guo
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Zhao-liang Shan
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
- * E-mail: (ZLS); (YTW)
| | - Yu-tang Wang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
- * E-mail: (ZLS); (YTW)
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Nishida K, Datino T, Macle L, Nattel S. Atrial Fibrillation Ablation. J Am Coll Cardiol 2014; 64:823-31. [DOI: 10.1016/j.jacc.2014.06.1172] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/26/2014] [Accepted: 06/27/2014] [Indexed: 10/24/2022]
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Dai Z, Yu S, Zhao Q, Meng Y, He H, Tang Y, Wang X, Xiao J, Wang X, Huang C. Renal sympathetic denervation suppresses ventricular substrate remodelling in a canine high-rate pacing model. EUROINTERVENTION 2014; 10:392-9. [DOI: 10.4244/eijv10i3a65] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Papademetriou V, Rashidi AA, Tsioufis C, Doumas M. Renal nerve ablation for resistant hypertension: how did we get here, present status, and future directions. Circulation 2014; 129:1440-51. [PMID: 24687645 DOI: 10.1161/circulationaha.113.005405] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Vasilios Papademetriou
- Department of Veterans Affairs and Georgetown University, Washington, DC (V.P., A.A.R.); Ippokration University Hospital, Athens, Greece (C.T.); Aristotle University of Thessaloniki, Thessaloniki, Greece (M.D.)
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41
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Abstract
The autonomic nervous system plays an important role in the modulation of cardiac electrophysiology and arrhythmogenesis. Decades of research has contributed to a better understanding of the anatomy and physiology of cardiac autonomic nervous system and provided evidence supporting the relationship of autonomic tone to clinically significant arrhythmias. The mechanisms by which autonomic activation is arrhythmogenic or antiarrhythmic are complex and different for specific arrhythmias. In atrial fibrillation, simultaneous sympathetic and parasympathetic activations are the most common trigger. In contrast, in ventricular fibrillation in the setting of cardiac ischemia, sympathetic activation is proarrhythmic, whereas parasympathetic activation is antiarrhythmic. In inherited arrhythmia syndromes, sympathetic stimulation precipitates ventricular tachyarrhythmias and sudden cardiac death except in Brugada and J-wave syndromes where it can prevent them. The identification of specific autonomic triggers in different arrhythmias has brought the idea of modulating autonomic activities for both preventing and treating these arrhythmias. This has been achieved by either neural ablation or stimulation. Neural modulation as a treatment for arrhythmias has been well established in certain diseases, such as long QT syndrome. However, in most other arrhythmia diseases, it is still an emerging modality and under investigation. Recent preliminary trials have yielded encouraging results. Further larger-scale clinical studies are necessary before widespread application can be recommended.
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Affiliation(s)
- Mark J Shen
- From Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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Hucker WJ, Singh JP, Parks K, Armoundas AA. Device-Based Approaches to Modulate the Autonomic Nervous System and Cardiac Electrophysiology. Arrhythm Electrophysiol Rev 2014; 3:30-5. [PMID: 26835062 PMCID: PMC4711497 DOI: 10.15420/aer.2011.3.1.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/04/2014] [Indexed: 01/29/2023] Open
Abstract
Alterations in resting autonomic tone can be pathogenic in many cardiovascular disease states, such as heart failure and hypertension. Indeed, autonomic modulation by way of beta-blockade is a standard treatment of these conditions. There is a significant interest in developing non-pharmacological methods of autonomic modulation as well. For instance, clinical trials of vagal stimulation and spinal cord stimulation in the treatment of heart failure are currently underway, and renal denervation has been studied recently in the treatment of resistant hypertension. Notably, autonomic stimulation is also a potent modulator of cardiac electrophysiology. Manipulating the autonomic nervous system in studies designed to treat heart failure and hypertension have revealed that autonomic modulation may have a role in the treatment of common atrial and ventricular arrhythmias as well. Experimental data on vagal nerve and spinal cord stimulation suggest that each technique may reduce ventricular arrhythmias. Similarly, renal denervation may play a role in the treatment of atrial fibrillation, as well as in controlling refractory ventricular arrhythmias. In this review, we present the current experimental and clinical data on the effect of these therapeutic modalities on cardiac electrophysiology and their potential role in arrhythmia management.
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Affiliation(s)
- William J Hucker
- Fellow in Cardiovascular Medicine, Division of Cardiology, Massachusetts General Hospital, US;
| | - Jagmeet P Singh
- Associate Professor of Medicine, Harvard Medical School, Director, Resynchronization and Advanced Cardiac Therapeutics Program, Massachusetts General Hospital, US
| | - Kimberly Parks
- Instructor in Medicine, Harvard Medical School, Advanced Heart Failure and Transplantation, Massachusetts General Hospital, US
| | - Antonis A Armoundas
- Assistant Professor of Medicine, Harvard Medical School Cardiovascular Research Center, Massachusetts General Hospital, US
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43
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Guo Z, Zhao Q, Deng H, Tang Y, Wang X, Dai Z, Xiao J, Wan P, Wang X, Huang H, Huang C. Renal sympathetic denervation attenuates the ventricular substrate and electrophysiological remodeling in dogs with pacing-induced heart failure. Int J Cardiol 2014; 175:185-6. [PMID: 24801082 DOI: 10.1016/j.ijcard.2014.04.189] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 04/19/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Zongwen Guo
- Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan City, 430060, PR China
| | - Qingyan Zhao
- Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan City, 430060, PR China.
| | - Hongping Deng
- Department of Thoracic and Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan City, PR China
| | - Yanhong Tang
- Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan City, 430060, PR China
| | - Xiaozhan Wang
- Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan City, 430060, PR China
| | - Zixuan Dai
- Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan City, 430060, PR China
| | - Jinping Xiao
- Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan City, 430060, PR China
| | - Peixing Wan
- Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan City, 430060, PR China
| | - Xule Wang
- Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan City, 430060, PR China
| | - He Huang
- Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan City, 430060, PR China
| | - Congxin Huang
- Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan City, 430060, PR China.
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Drug-resistant hypertensive patients responding to multielectrode renal denervation exhibit improved heart rate dynamics and reduced arrhythmia burden. J Hum Hypertens 2014; 28:587-93. [PMID: 24621623 DOI: 10.1038/jhh.2014.14] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/10/2014] [Accepted: 01/27/2014] [Indexed: 02/07/2023]
Abstract
Transluminal renal sympathetic denervation (RDN) reduces blood pressure (BP) in patients with drug-resistant uncontrolled hypertension. We assessed the effect of RDN on heart rate, supraventricular and ventricular ectopic activity and indexes of heart rate variability in 14 patients with drug-resistant uncontrolled hypertension who were all responders to RDN (defined as a reduction in office systolic BP ⩾ 10 mm Hg) at baseline and at 1 and 6 months after the procedure using the multielectrode EnligHTN ablation catheter (St Jude Medical). Office and 24-h systolic and diastolic BP were significantly reduced both at 1 and 6 months after RDN and all patients were office BP responders. There was a trend toward office heart rate reduction (by 6.9 b.p.m., P=0.064) at 1 month and a significant reduction by 10 b.p.m. (P=0.004) at 6 months. Mean 24-h Holter monitoring heart rate was reduced by 6.7 b.p.m. (P=0.022) at 1 month and by 5.3 b.p.m. (P=0.010) at 6 months after RDN. The total number of premature supraventricular and ventricular contractions was significantly decreased and time- and frequency- domain indexes were increased both at 1 and at 6 months after RDN (P<0.05 for both cases). Apart from the substantial BP lowering, RDN results in significant reduction of mean heart rate and arrhythmia burden, restoring autonomic balance in responder patients with drug-resistant uncontrolled hypertension.
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Abstract
Renal artery denervation (RDN) has been introduced as an ablation procedure that can effectively treat drug-resistant forms of hypertension. The ablative lesions reduce the afferent and efferent sympathetic nerve traffic to and from the kidneys, thus improving blood pressure control. Because of better control of blood pressure, and because the procedure reduces central sympathetic output to sensitive structures within the cardiovascular system, it has been hypothesized that RDN may be a valuable antiarrhythmic intervention. Preliminary results using RDN for atrial fibrillation control are promising. This review focuses on the mechanisms by which RDN may function as an antiarrhythmic treatment and early clinical results.
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Kosiuk Md J, Pokushalov Md Phd E, Hilbert Md S, Hindricks Md G, Bollmann Md PhD A, S Steinberg Md J. The Role of Renal Sympathetic Denervation in Atrial Fibrillation. J Atr Fibrillation 2014; 6:987. [PMID: 27957040 PMCID: PMC4956128 DOI: 10.4022/jafib.987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/03/2014] [Accepted: 01/04/2014] [Indexed: 11/10/2022]
Abstract
Endocardial catheter ablation is a widely used alternative for the treatment of atrial fibrillation (AF). Despite technical improvements, and increased understanding of mechanism, and acquired technical experience over many years, the results are not yet optimal. This results in an ongoing search for new therapeutic approaches. Because cardiac sympathetic drive is potentially responsible for triggering and sustaining AF, modulation of sympathetic tone has been proposed as a viable treatment objective. The early attempts to test this concept were limited by nature=highly intrusive techniques but new approaches and targets have been recently introduced. Specifically, renal nerve ablation has been introduced and the first attempts to employ this technique for treatment of cardiac arrhythmias give as a promise of new therapeutic avenues in near future. This review focuses on the possible role of renal denervation in treatment of atrial fibrillation, the contemporary evidence supporting this approach, and the ongoing trials to establish its therapeutic role.
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Affiliation(s)
- Jedrzej Kosiuk Md
- Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany
| | | | | | | | | | - Jonathan S Steinberg Md
- Arrhythmia Institute, The Valley Health System and the Mt. Sinai School of Medicine, New York, NY, USA
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Cardiac sympathetic denervation in patients with refractory ventricular arrhythmias or electrical storm: intermediate and long-term follow-up. Heart Rhythm 2013; 11:360-6. [PMID: 24291775 DOI: 10.1016/j.hrthm.2013.11.028] [Citation(s) in RCA: 260] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Left and bilateral cardiac sympathetic denervation (CSD) have been shown to reduce burden of ventricular arrhythmias acutely in a small number of patients with ventricular tachyarrhythmia (VT) storm. The effects of this procedure beyond the acute setting are unknown. OBJECTIVE The purpose of this study was to evaluate the intermediate and long-term effects of left and bilateral CSD in patients with cardiomyopathy and refractory VT or VT storm. METHODS Retrospective analysis of medical records for patients who underwent either left or bilateral CSD for VT storm or refractory VT between April 2009 and December 2012 was performed. RESULTS Forty-one patients underwent CSD (14 left CSD, 27 bilateral CSD). There was a significant reduction in the burden of implantable cardioverter-defibrillator (ICD) shocks during follow-up compared to the 12 months before the procedure. The number of ICD shocks was reduced from a mean of 19.6 ± 19 preprocedure to 2.3 ± 2.9 postprocedure (P < .001), with 90% of patients experiencing a reduction in ICD shocks. At mean follow-up of 367 ± 251 days postprocedure, survival free of ICD shock was 30% in the left CSD group and 48% in the bilateral CSD group. Shock-free survival was greater in the bilateral group than in the left CSD group (P = .04). CONCLUSION In patients with VT storm, bilateral CSD is more beneficial than left CSD. The beneficial effects of bilateral CSD extend beyond the acute postsympathectomy period, with continued freedom from ICD shocks in 48% of patients and a significant reduction in ICD shocks in 90% of patients.
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Hou Y, Hu J, Po SS, Wang H, Zhang L, Zhang F, Wang K, Zhou Q. Catheter-based renal sympathetic denervation significantly inhibits atrial fibrillation induced by electrical stimulation of the left stellate ganglion and rapid atrial pacing. PLoS One 2013; 8:e78218. [PMID: 24223140 PMCID: PMC3819364 DOI: 10.1371/journal.pone.0078218] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 09/10/2013] [Indexed: 12/22/2022] Open
Abstract
Background Sympathetic activity involves the pathogenesis of atrial fibrillation (AF). Renal sympathetic denervation (RSD) decreases sympathetic renal afferent nerve activity, leading to decreased central sympathetic drive. The aim of this study was to identify the effects of RSD on AF inducibility induced by hyper-sympathetic activity in a canine model. Methods To establish a hyper-sympathetic tone canine model of AF, sixteen dogs were subjected to stimulation of left stellate ganglion (LSG) and rapid atrial pacing (RAP) for 3 hours. Then animals in the RSD group (n = 8) underwent radiofrequency ablation of the renal sympathetic nerve. The control group (n = 8) underwent the same procedure except for ablation. AF inducibility, effective refractory period (ERP), ERP dispersion, heart rate variability and plasma norepinephrine levels were measured at baseline, after stimulation and after ablation. Results LSG stimulation combined RAP significantly induced higher AF induction rate, shorter ERP, larger ERP dispersion at all sites examined and higher plasma norepinephrine levels (P<0.05 in all values), compared to baseline. The increased AF induction rate, shortened ERP, increased ERP dispersion and elevated plasma norepinephrine levels can be almost reversed by RSD, compared to the control group (P<0.05). LSG stimulation combined RAP markedly shortened RR-interval and standard deviation of all RR-intervals (SDNN), Low-frequency (LF), high-frequency (HF) and LF/HF ratio (P<0.05). These changes can be reversed by RSD, compared to the control group (P<0.05). Conclusions RSD significantly reduced AF inducibility and reversed the atrial electrophysiological changes induced by hyper-sympathetic activity.
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Affiliation(s)
- Yuemei Hou
- Department of Cardiovascular Diseases, The 6th People’s Hospital affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Jialu Hu
- Department of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China
| | - Sunny S. Po
- Heart Rhythm Institute and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Huan Wang
- Arrhythmia Research Lab, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ling Zhang
- Arrhythmia Research Lab, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Feng Zhang
- Arrhythmia Research Lab, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Kun Wang
- Arrhythmia Research Lab, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qina Zhou
- Arrhythmia Research Lab, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- * E-mail:
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[Endovascular renal nerve ablation as a treatment for resistant hypertension]. ACTA ACUST UNITED AC 2013; 38:367-72. [PMID: 24135305 DOI: 10.1016/j.jmv.2013.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 08/22/2013] [Indexed: 11/22/2022]
Abstract
Radiofrequency-induced renal ablation is a non-pharmacologic therapeutic approach for the treatment of essential resistant hypertension, with a stable blood pressure lowering effect. However, data from published studies cannot conclude yet on the long-term efficacy and safety of the procedure. Therefore, the various techniques of renal nerve ablation (radiofrequency, cryoablation, ultrasounds) need further evaluation in clinical research trials. According to recent national and international recommendations, renal ablation should be reserved for patients with essential resistant hypertension.
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Vogel B, Kirchberger M, Zeier M, Stoll F, Meder B, Saure D, Andrassy M, Mueller OJ, Hardt S, Schwenger V, Strothmeyer A, Katus HA, Blessing E. Renal sympathetic denervation therapy in the real world: results from the Heidelberg registry. Clin Res Cardiol 2013; 103:117-24. [PMID: 24126436 DOI: 10.1007/s00392-013-0627-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Renal sympathetic denervation (RDN) is a novel treatment option in patients with treatment-resistant arterial hypertension. A subset of recently published randomized and non-randomized trials indicates that RDN leads to sustained lowering of blood pressure (BP) under controlled study conditions. However, registry data that allow evaluation of safety and efficacy in a real-world setting are largely missing. METHODS Sixty-three consecutive patients with treatment-resistant hypertension underwent RDN with the radiofrequency-based Symplicity™ catheter. As part of our prospective registry, treatment efficacy and safety were monitored after 3, 6, and 12 months. RESULTS At 6 months follow-up, office systolic BP significantly improved by 19 + 23 mmHg as compared to baseline, while diastolic BP values reduced by 6 + 13 mmHg (p < 0.05). One year after RDN, office BP levels further improved (26 + 25 mmHg in systolic BP and 9 + 13 mmHg in diastolic BP, respectively), even though 19 patients had reduced the number and/or dosage of antihypertensive agents. The response rate, defined as reduction of office systolic BP of ≥ 10 mmHg, was 73% after 6 months. Baseline BP was the only significant predictor of blood pressure response, whereas no correlation was found between the number of ablation points and the individual changes in office blood pressure. Interestingly, patients with challenging renal anatomy profited somewhat less from the procedure than those with "normal" renal anatomy. Procedure related adverse events occurred in three patients (4.7%) and were limited to vascular access complications. CONCLUSIONS RDN with the Symplicity™ system is safe and effective in patients with treatment-resistant hypertension also in a real-world setting.
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Affiliation(s)
- Britta Vogel
- Medical Clinic III, University of Heidelberg, INF 410, 69120, Heidelberg, Germany,
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