1
|
Soltani D, Stavrakis S. Neuromodulation for the Management of Atrial Fibrillation—How to Optimize Patient Selection and the Procedural Approach. CURRENT CARDIOVASCULAR RISK REPORTS 2023. [DOI: 10.1007/s12170-023-00718-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
|
2
|
Stavrakis S, Kulkarni K, Singh JP, Katritsis DG, Armoundas AA. Autonomic Modulation of Cardiac Arrhythmias: Methods to Assess Treatment and Outcomes. JACC Clin Electrophysiol 2021; 6:467-483. [PMID: 32439031 DOI: 10.1016/j.jacep.2020.02.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/06/2020] [Accepted: 02/14/2020] [Indexed: 02/08/2023]
Abstract
The autonomic nervous system plays a central role in the pathogenesis of multiple cardiac arrhythmias, including atrial fibrillation and ventricular tachycardia. As such, autonomic modulation represents an attractive therapeutic approach in these conditions. Notably, autonomic modulation exploits the plasticity of the neural tissue to induce neural remodeling and thus obtain therapeutic benefit. Different forms of autonomic modulation include vagus nerve stimulation, tragus stimulation, renal denervation, baroreceptor activation therapy, and cardiac sympathetic denervation. This review seeks to highlight these autonomic modulation therapeutic modalities, which have shown promise in early preclinical and clinical trials and represent exciting alternatives to standard arrhythmia treatment. We also present an overview of the various methods used to assess autonomic tone, including heart rate variability, skin sympathetic nerve activity, and alternans, which can be used as surrogate markers and predictors of the treatment effect. Although the use of autonomic modulation to treat cardiac arrhythmias is supported by strong preclinical data and preliminary studies in humans, in light of the disappointing results of a number of recent randomized clinical trials of autonomic modulation therapies in heart failure, the need for optimization of the stimulation parameters and rigorous patient selection based on appropriate biomarkers cannot be overemphasized.
Collapse
Affiliation(s)
- Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
| | - Kanchan Kulkarni
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jagmeet P Singh
- Cardiology Division, Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Antonis A Armoundas
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
| |
Collapse
|
3
|
Chatterjee NA, Singh JP. Autonomic modulation and cardiac arrhythmias: old insights and novel strategies. Europace 2021; 23:1708-1721. [PMID: 34050642 DOI: 10.1093/europace/euab118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
The autonomic nervous system (ANS) plays a critical role in both health and states of cardiovascular disease. There has been a long-recognized role of the ANS in the pathogenesis of both atrial and ventricular arrhythmias (VAs). This historical understanding has been expanded in the context of evolving insights into the anatomy and physiology of the ANS, including dysfunction of the ANS in cardiovascular disease such as heart failure and myocardial infarction. An expanding armamentarium of therapeutic strategies-both invasive and non-invasive-have brought the potential of ANS modulation to contemporary clinical practice. Here, we summarize the integrative neuro-cardiac anatomy underlying the ANS, review the physiological rationale for autonomic modulation in atrial and VAs, highlight strategies for autonomic modulation, and finally frame future challenges and opportunities for ANS therapeutics.
Collapse
Affiliation(s)
- Neal A Chatterjee
- Electrophysiology Section, Cardiology Division, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Jagmeet P Singh
- Cardiac Arrhythmia Service, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Sohinki D, Stavrakis S. New approaches for treating atrial fibrillation: Focus on autonomic modulation. Trends Cardiovasc Med 2019; 30:433-439. [PMID: 31708408 DOI: 10.1016/j.tcm.2019.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/07/2019] [Accepted: 10/23/2019] [Indexed: 12/18/2022]
Abstract
Atrial fibrillation (AF) is a rapidly growing clinical problem in routine practice, both for cardiologists as well as general practitioners. Current therapies aimed at the management of AF include anti-arrhythmic drug therapy and catheter ablation. These therapies have a number of limitations and risks, and have disappointing long-term efficacy in maintaining sinus rhythm and improving hard clinical outcomes. Because of this, there is growing interest in pursuing alternative management strategies in patients with AF. This review seeks to highlight emerging AF therapies, with a specific focus on several modalities aimed at modulation of the autonomic nervous system. These therapies have shown promise in early pre-clinical and clinical trials, and represent exciting alternatives to standard AF treatment.
Collapse
Affiliation(s)
- Daniel Sohinki
- Department of Cardiology, Augusta University Medical Center, Augusta, GA, United States
| | - Stavros Stavrakis
- Department of Cardiology, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd., Suite 5400, Oklahoma, OK, United States; Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma, OK, United States.
| |
Collapse
|
5
|
Cao Q, Zhang J, Yu Q, Wang J, Dai M, Zhang Y, Luo Q, Bao M. Carotid baroreceptor stimulation in obese rats affects white and brown adipose tissues differently in metabolic protection. J Lipid Res 2019; 60:1212-1224. [PMID: 31126973 DOI: 10.1194/jlr.m091256] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/23/2019] [Indexed: 11/20/2022] Open
Abstract
The sympathetic nervous system (SNS) regulates the functions of white adipose tissue (WAT) and brown adipose tissue (BAT) tightly. Carotid baroreceptor stimulation (CBS) efficiently inhibits SNS activation. We hypothesized that CBS would protect against obesity. We administered CBS to obese rats and measured sympathetic and AMP-activated protein kinase (AMPK)/ PPAR pathway responses as well as changes in perirenal WAT (PWAT), epididymal WAT (EWAT), and interscapular BAT (IBAT). CBS alleviated obesity-related metabolic changes, improving insulin resistance; reducing adipocyte hypertrophy, body weight, and adipose tissue weights; and decreasing norepinephrine but increasing acetylcholine in plasma, PWAT, EWAT, and IBAT. CBS also downregulated fatty acid translocase (CD36), fatty acid transport protein (FATP), phosphorylated and total hormone sensitive lipase, phosphorylated and total protein kinase A, and PPARγ in obese rats. Simultaneously, CBS upregulated phosphorylated adipose triglyceride lipase, phosphorylated and total AMPK, and PPARα in PWAT, EWAT, and IBAT. However, BAT and WAT responses differed; although many responses were more sensitive in IBAT, responses of CD36, FATP, and PPARγ were more sensitive in PWAT and EWAT. Overall, CBS decreased chronically activated SNS and ameliorated obesity-related metabolic disorders by regulating the AMPK/PPARα/γ pathway.
Collapse
Affiliation(s)
- Quan Cao
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Institute Wuhan University.,Hubei Key Laboratory of Cardiology Wuhan 430060, China
| | - Junxia Zhang
- Department of Endocrinology, Wuhan General Hospital of the Chinese People's Liberation Army, Wuhan 430060, China
| | - Qiao Yu
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Institute Wuhan University.,Hubei Key Laboratory of Cardiology Wuhan 430060, China
| | - Jing Wang
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Institute Wuhan University.,Hubei Key Laboratory of Cardiology Wuhan 430060, China
| | - Mingyan Dai
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Institute Wuhan University
| | - Yijie Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Institute Wuhan University.,Hubei Key Laboratory of Cardiology Wuhan 430060, China
| | - Qiang Luo
- Department of Cardiology, Renmin Hospital of Wuhan University.,Cardiovascular Research Institute Wuhan University.,Hubei Key Laboratory of Cardiology Wuhan 430060, China
| | - Mingwei Bao
- Department of Cardiology, Renmin Hospital of Wuhan University .,Cardiovascular Research Institute Wuhan University.,Hubei Key Laboratory of Cardiology Wuhan 430060, China
| |
Collapse
|
6
|
Wang J, Yu Q, Dai M, Zhang Y, Cao Q, Luo Q, Tan T, Zhou Y, Shu L, Bao M. Carotid baroreceptor stimulation improves cardiac performance and reverses ventricular remodelling in canines with pacing-induced heart failure. Life Sci 2019; 222:13-21. [DOI: 10.1016/j.lfs.2019.02.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 02/02/2023]
|
7
|
Low-level carotid baroreflex stimulation suppresses atrial fibrillation by inhibiting left stellate ganglion activity in an acute canine model. Heart Rhythm 2016; 13:2203-2212. [DOI: 10.1016/j.hrthm.2016.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Indexed: 11/17/2022]
|
8
|
Linz D. Electrical baroreflex stimulation to treat atrial fibrillation: More complex than expected. Heart Rhythm 2016; 13:2213-2214. [PMID: 27546813 DOI: 10.1016/j.hrthm.2016.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Dominik Linz
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
| |
Collapse
|
9
|
LINZ DOMINIK, HOHL MATHIAS, KHOSHKISH SHAYAN, MAHFOUD FELIX, UKENA CHRISTIAN, NEUBERGER HANSRUPRECHT, WIRTH KLAUS, BÖHM MICHAEL. Low-Level But Not High-Level Baroreceptor Stimulation Inhibits Atrial Fibrillation in a Pig Model of Sleep Apnea. J Cardiovasc Electrophysiol 2016; 27:1086-92. [DOI: 10.1111/jce.13020] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 05/01/2016] [Accepted: 05/16/2016] [Indexed: 11/30/2022]
Affiliation(s)
- DOMINIK LINZ
- Universitätsklinikum des Saarlandes; Klinik für Innere Medizin III; Homburg Saar Germany
| | - MATHIAS HOHL
- Universitätsklinikum des Saarlandes; Klinik für Innere Medizin III; Homburg Saar Germany
| | - SHAYAN KHOSHKISH
- Universitätsklinikum des Saarlandes; Klinik für Innere Medizin III; Homburg Saar Germany
| | - FELIX MAHFOUD
- Universitätsklinikum des Saarlandes; Klinik für Innere Medizin III; Homburg Saar Germany
| | - CHRISTIAN UKENA
- Universitätsklinikum des Saarlandes; Klinik für Innere Medizin III; Homburg Saar Germany
| | | | - KLAUS WIRTH
- Sanofi-Aventis Deutschland GmbH; R&D; Frankfurt Germany
| | - MICHAEL BÖHM
- Universitätsklinikum des Saarlandes; Klinik für Innere Medizin III; Homburg Saar Germany
| |
Collapse
|
10
|
Sheng X, Chen M, Huang B, Liu J, Zhou L, Bao M, Li S. Cardioprotective effects of low-level carotid baroreceptor stimulation against myocardial ischemia-reperfusion injury in canine model. J Interv Card Electrophysiol 2016; 45:131-40. [DOI: 10.1007/s10840-015-0094-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/22/2015] [Indexed: 12/26/2022]
|
11
|
Zhou X, Chen M, Wang S, Yu L, Bao M, Jiang H. Low-level carotid baroreceptor stimulation: a promising feasible modulator for ventricular and atrial arrhythmias. Int J Cardiol 2015; 199:430-1. [PMID: 26263008 DOI: 10.1016/j.ijcard.2015.07.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Xiaoya Zhou
- Department of Cardiology, Renmin Hospital, Wuhan University, Wuhan, Hubei, China
| | - Mingxian Chen
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Songyun Wang
- Department of Cardiology, Renmin Hospital, Wuhan University, Wuhan, Hubei, China
| | - Lilei Yu
- Department of Cardiology, Renmin Hospital, Wuhan University, Wuhan, Hubei, China
| | - Minwei Bao
- Department of Cardiology, Renmin Hospital, Wuhan University, Wuhan, Hubei, China.
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital, Wuhan University, Wuhan, Hubei, China.
| |
Collapse
|
12
|
Krul SPJ, Berger WR, Veldkamp MW, Driessen AHG, Wilde AAM, Deneke T, de Bakker JMT, Coronel R, de Groot JR. Treatment of Atrial and Ventricular Arrhythmias Through Autonomic Modulation. JACC Clin Electrophysiol 2015; 1:496-508. [PMID: 29759403 DOI: 10.1016/j.jacep.2015.09.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 08/19/2015] [Accepted: 09/24/2015] [Indexed: 11/26/2022]
Abstract
This paper reviews the contribution of autonomic nervous system (ANS) modulation in the treatment of arrhythmias. Both the atria and ventricles are innervated by an extensive network of nerve fibers of parasympathetic and sympathetic origin. Both the parasympathetic and sympathetic nervous system exert arrhythmogenic electrophysiological effects on atrial and pulmonary vein myocardium, while in the ventricle the sympathetic nervous system plays a more dominant role in arrhythmogenesis. Identification of ANS activity is possible with nuclear imaging. This technique may provide further insight in mechanisms and treatment targets. Additionally, the myocardial effects of the intrinsic ANS can be identified through stimulation of the ganglionic plexuses. These can be ablated for the treatment of atrial fibrillation. New (non-) invasive treatment options targeting the extrinsic cardiac ANS, such as low-level tragus stimulation and renal denervation, provide interesting future treatment possibilities both for atrial fibrillation and ventricular arrhythmias. However, the first randomized trials have yet to be performed. Future clinical studies on modifying the ANS may not only improve the outcome of ablation therapy but may also advance our understanding of the manner in which the ANS interacts with the myocardium to modify arrhythmogenic triggers and substrate.
Collapse
Affiliation(s)
- Sébastien P J Krul
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Wouter R Berger
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Marieke W Veldkamp
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Antoine H G Driessen
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands; Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
| | - Thomas Deneke
- Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Jacques M T de Bakker
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
| | - Ruben Coronel
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands; L'Institut de RYthmologie et de modélisation Cardiaque (LIRYC), Université Bordeaux Segalen, Bordeaux, France
| | - Joris R de Groot
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
| |
Collapse
|