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Farhat K, Po SS, Stavrakis S. Non-invasive Neuromodulation of Arrhythmias. Card Electrophysiol Clin 2024; 16:307-314. [PMID: 39084723 PMCID: PMC11292161 DOI: 10.1016/j.ccep.2023.12.001] [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] [Indexed: 08/02/2024]
Abstract
The autonomic nervous system plays a central role in the pathogenesis of arrhythmias. Preclinical and clinical studies have demonstrated the therapeutic effect of neuromodulation at multiple anatomic targets across the neurocardiac axis for the treatment of arrhythmias. In this review, we discuss the rationale and clinical application of noninvasive neuromodulation techniques in treating arrhythmias and explore associated barriers and future directions, including optimization of stimulation parameters and patient selection.
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Affiliation(s)
| | - Sunny S Po
- University of Oklahoma Health Sciences Center
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2
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Zuhair M, Keene D, Kanagaratnam P, Lim PB. Percutaneous Neuromodulation for Atrial Fibrillation. Card Electrophysiol Clin 2024; 16:281-296. [PMID: 39084721 DOI: 10.1016/j.ccep.2023.09.001] [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
Percutaneous neuromodulation is emerging as a promising therapeutic approach for atrial fibrillation (AF). This article explores techniques such as ganglionated plexi (GP) ablation, and vagus nerve stimulation, pinpointing their potential in modulating AF triggers and maintenance. Noninvasive methods, such as transcutaneous low-level tragus stimulation, offer innovative treatment pathways, with early trials indicating a significant reduction in AF burden. GP ablation may address autonomic triggers, and the potential for GP ablation in neuromodulation is discussed. The article stresses the necessity for more rigorous clinical trials to validate the safety, reproducibility, and efficacy of these neuromodulation techniques in AF treatment.
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Affiliation(s)
- Mohamed Zuhair
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK.
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
| | - Prapa Kanagaratnam
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
| | - Phang Boon Lim
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
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3
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Andrade JG, Aksu T. Nothing Means Nothing: Pulsed Field Ablation and the Autonomic Nervous System. JACC Clin Electrophysiol 2024; 10:1645-1647. [PMID: 39084739 DOI: 10.1016/j.jacep.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Jason G Andrade
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada; Center for Cardiovascular Innovation, Vancouver, British Columbia, Canada; Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada.
| | - Tolga Aksu
- Yeditepe University Hospital, Istanbul, Turkey
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4
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Tendulkar M, Tendulkar R, Dhanda PS, Yadav A, Jain M, Kaushik P. Clinical potential of sensory neurites in the heart and their role in decision-making. Front Neurosci 2024; 17:1308232. [PMID: 38415053 PMCID: PMC10896837 DOI: 10.3389/fnins.2023.1308232] [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: 10/09/2023] [Accepted: 11/29/2023] [Indexed: 02/29/2024] Open
Abstract
The process of decision-making is quite complex involving different aspects of logic, emotion, and intuition. The process of decision-making can be summarized as choosing the best alternative among a given plethora of options in order to achieve the desired outcome. This requires establishing numerous neural networks between various factors associated with the decision and creation of possible combinations and speculating their possible outcomes. In a nutshell, it is a highly coordinated process consuming the majority of the brain's energy. It has been found that the heart comprises an intrinsic neural system that contributes not only to the decision-making process but also the short-term and long-term memory. There are approximately 40,000 cells present in the heart known as sensory neurites which play a vital role in memory transfer. The heart is quite a mysterious organ, which functions as a blood-pumping machine and an endocrine gland, as well as possesses a nervous system. There are multiple factors that affect this heart ecosystem, and they directly affect our decision-making capabilities. These interlinked relationships hint toward the sensory neurites which modulate cognition and mood regulation. This review article aims to provide deeper insights into the various roles played by sensory neurites in decision-making and other cognitive functions. The article highlights the pivotal role of sensory neurites in the numerous brain functions, and it also meticulously discusses the mechanisms through which they modulate their effects.
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Affiliation(s)
- Mugdha Tendulkar
- K. J. Somaiya Medical College and Research Centre, Mumbai, India
| | - Reshma Tendulkar
- Vivekanand Education Society's College of Pharmacy, Mumbai, India
| | | | - Alpa Yadav
- Department of Botany, Indira Gandhi University, Rewari, India
| | - Mukul Jain
- Cell and Developmental Biology Lab, Center of Research for Development, Parul University, Vadodara, India
- Department of Life Sciences, Parul Institute of Applied Sciences, Parul University, Vadodara, India
| | - Prashant Kaushik
- Chaudhary Charan Singh Haryana Agricultural University, Hisar, India
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5
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O'Brien B, Reilly J, Coffey K, González-Suárez A, Quinlan L, van Zyl M. Cardioneuroablation Using Epicardial Pulsed Field Ablation for the Treatment of Atrial Fibrillation. J Cardiovasc Dev Dis 2023; 10:238. [PMID: 37367403 DOI: 10.3390/jcdd10060238] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting millions of people worldwide. The cardiac autonomic nervous system (ANS) is widely recognized as playing a key role in both the initiation and propagation of AF. This paper reviews the background and development of a unique cardioneuroablation technique for the modulation of the cardiac ANS as a potential treatment for AF. The treatment uses pulsed electric field energy to selectively electroporate ANS structures on the epicardial surface of the heart. Insights from in vitro studies and electric field models are presented as well as data from both pre-clinical and early clinical studies.
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Affiliation(s)
- Barry O'Brien
- AtriAN Medical Ltd., Unit 204, Business Innovation Centre, Upper Newcastle, H91 W60E Galway, Ireland
| | - John Reilly
- AtriAN Medical Ltd., Unit 204, Business Innovation Centre, Upper Newcastle, H91 W60E Galway, Ireland
| | - Ken Coffey
- AtriAN Medical Ltd., Unit 204, Business Innovation Centre, Upper Newcastle, H91 W60E Galway, Ireland
| | - Ana González-Suárez
- School of Engineering, University of Galway, H91 TK33 Galway, Ireland
- Translational Medical Device Lab, University of Galway, H91 YR71 Galway, Ireland
| | - Leo Quinlan
- Physiology and Cellular Physiology Research Laboratory, CURAM SFI Centre for Research in Medical Device, University of Galway, H91 TK33 Galway, Ireland
| | - Martin van Zyl
- Cardiac Electrophysiology, Royal Jubilee Hospital, Victoria, BC V8R 1J8, Canada
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6
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Rebecchi M, Fanisio F, Rizzi F, Politano A, De Ruvo E, Crescenzi C, Panattoni G, Squeglia M, Martino A, Sasso S, Golia P, Pugliese G, Del Gigante S, Giamundo D, Desimone P, Grieco D, De Luca L, Giordano I, Barillà F, Perrone MA, Calò L, Iellamo F. The Autonomic Coumel Triangle: A New Way to Define the Fascinating Relationship between Atrial Fibrillation and the Autonomic Nervous System. Life (Basel) 2023; 13:life13051139. [PMID: 37240784 DOI: 10.3390/life13051139] [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: 04/10/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Arrhythmogenic substrate, modulating factors, and triggering factors (the so-called Coumel's triangle concept) play a primary role in atrial fibrillation (AF) pathophysiology. Several years have elapsed since Coumel and co-workers advanced the concept of the relevance of autonomic nervous system (ANS) influences on atrial cells' electrophysiological characteristics. The ANS is not only associated with cardiac rhythm regulation but also exerts an important role in the triggering and maintenance of atrial fibrillation. This review aims to describe in detail the autonomic mechanisms involved in the pathophysiology of atrial fibrillation (AF), starting from the hypothesis of an "Autonomic Coumel Triangle" that stems from the condition of the fundamental role played by the ANS in all phases of the pathophysiology of AF. In this article, we provide updated information on the biomolecular mechanisms of the ANS role in Coumel's triangle, with the molecular pathways of cardiac autonomic neurotransmission, both adrenergic and cholinergic, and the interplay between the ANS and cardiomyocytes' action potential. The heterogeneity of the clinical spectrum of the ANS and AF, with the ANS playing a relevant role in situations that may promote the initiation and maintenance of AF, is highlighted. We also report on drug, biological, and gene therapy as well as interventional therapy. On the basis of the evidence reviewed, we propose that one should speak of an "Autonomic Coumel's Triangle" instead of simply "Coumel's Triangle".
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Affiliation(s)
- Marco Rebecchi
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | | | - Fabio Rizzi
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | | | | | | | | | | | | | - Stefano Sasso
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Paolo Golia
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | - Giulia Pugliese
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Sofia Del Gigante
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Domenico Giamundo
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Pietro Desimone
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Domenico Grieco
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | - Lucia De Luca
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | - Ignazio Giordano
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Francesco Barillà
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Marco Alfonso Perrone
- Department of Clinical Science and Translational Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Leonardo Calò
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | - Ferdinando Iellamo
- Department of Clinical Science and Translational Medicine, University Tor Vergata, 00133 Rome, Italy
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7
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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]
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8
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Chakraborty P, Farhat K, Po SS, Armoundas AA, Stavrakis S. Autonomic Nervous System and Cardiac Metabolism: Links Between Autonomic and Metabolic Remodeling in Atrial Fibrillation. JACC Clin Electrophysiol 2023:S2405-500X(23)00117-2. [PMID: 37086229 DOI: 10.1016/j.jacep.2023.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/27/2023] [Accepted: 02/16/2023] [Indexed: 04/23/2023]
Abstract
Simultaneous activation of the sympathetic and parasympathetic nervous systems is crucial for the initiation of paroxysmal atrial fibrillation (AF). However, unbalanced activation of the sympathetic system is characteristic of autonomic remodeling in long-standing persistent AF. Moreover, the adrenergic activation-induced metabolic derangements provide a milieu for acute AF and promote the transition from the paroxysmal to the persistent phase of AF. On the other hand, cholinergic activation ameliorates the maladaptive metabolic remodeling in the face of metabolic challenges. Selective inhibition of the sympathetic system and restoration of the balance of the cholinergic system by neuromodulation is emerging as a novel nonpharmacologic strategy for managing AF. This review explores the link between cardiac autonomic and metabolic remodeling and the potential roles of different autonomic modulation strategies on atrial metabolic aberrations in AF.
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Affiliation(s)
- Praloy Chakraborty
- Cardiovascular Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Kassem Farhat
- Cardiovascular Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Sunny S Po
- Cardiovascular Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Antonis A Armoundas
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Broad Institute, Massachusetts Institute of Technology, Boston, Massachusetts, USA
| | - Stavros Stavrakis
- Cardiovascular Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
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9
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Intrinsic Cardiac Neuromodulation in the Management of Atrial Fibrillation- A Potential Missing Link? Life (Basel) 2023; 13:life13020383. [PMID: 36836740 PMCID: PMC9966489 DOI: 10.3390/life13020383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/14/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Atrial fibrillation (AF) is the most common supraventricular arrhythmia that is linked with higher cardiovascular morbidity and mortality. Recent evidence has demonstrated that catheter-based pulmonary vein isolation (PVI) is not only a viable alternative but may be superior to antiarrhythmic drug therapy for long-term freedom from symptomatic AF episodes, a reduction in the arrhythmia burden, and healthcare resource utilization with a similar risk of adverse events. The intrinsic cardiac autonomic nervous system (ANS) has a significant influence on the structural and electrical milieu, and imbalances in the ANS may contribute to the arrhythmogenesis of AF in some individuals. There is now increasing scientific and clinical interest in various aspects of neuromodulation of intrinsic cardiac ANS, including mapping techniques, ablation methods, and patient selection. In the present review, we aimed to summarize and critically appraise the currently available evidence for the neuromodulation of intrinsic cardiac ANS in AF.
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10
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Smith JEG, Ashton JL, Argent LP, Cheyne JE, Montgomery JM. Recording plasticity in neuronal activity in the rodent intrinsic cardiac nervous system using calcium imaging techniques. Front Synaptic Neurosci 2023; 15:1104736. [PMID: 37082542 PMCID: PMC10110955 DOI: 10.3389/fnsyn.2023.1104736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/20/2023] [Indexed: 04/22/2023] Open
Abstract
The intrinsic cardiac nervous system (ICNS) is composed of interconnected clusters of neurons called ganglionated plexi (GP) which play a major role in controlling heart rate and rhythm. The function of these neurons is particularly important due to their involvement in cardiac arrhythmias such as atrial fibrillation (AF), and previous work has shown that plasticity in GP neural networks could underpin aberrant activity patterns that drive AF. As research in this field increases, developing new techniques to visualize the complex interactions and plasticity in this GP network is essential. In this study we have developed a calcium imaging method enabling the simultaneous recording of plasticity in neuronal activity from multiple neurons in intact atrial GP networks. Calcium imaging was performed with Cal-520 AM labeling in aged spontaneously hypertensive rats (SHRs), which display both spontaneous and induced AF, and age-matched Wistar Kyoto (WKY) controls to determine the relationship between chronic hypertension, arrhythmia and GP calcium dynamics. Our data show that SHR GPs have significantly larger calcium responses to cholinergic stimulation compared to WKY controls, as determined by both higher amplitude and longer duration calcium responses. Responses were significantly but not fully blocked by hexamethonium, indicating multiple cholinergic receptor subtypes are involved in the calcium response. Given that SHRs are susceptible to cardiac arrhythmias, our data provide evidence for a potential link between arrhythmia and plasticity in calcium dynamics that occur not only in cardiomyocytes but also in the GP neurons of the heart.
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Affiliation(s)
- Joscelin E. G. Smith
- Department of Physiology, University of Auckland, Auckland, New Zealand
- Pūtahi Manawa, Centre for Heart Research, Auckland, New Zealand
| | - Jesse L. Ashton
- Department of Physiology, University of Auckland, Auckland, New Zealand
- Pūtahi Manawa, Centre for Heart Research, Auckland, New Zealand
| | - Liam P. Argent
- Department of Physiology, University of Auckland, Auckland, New Zealand
- Pūtahi Manawa, Centre for Heart Research, Auckland, New Zealand
| | | | - Johanna M. Montgomery
- Department of Physiology, University of Auckland, Auckland, New Zealand
- Pūtahi Manawa, Centre for Heart Research, Auckland, New Zealand
- *Correspondence: Johanna M. Montgomery,
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11
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Fujisawa T, Nagai T, Kawakami H, Yamaguchi O. Atrial fibrillation arising from a silent superior vena cava. HeartRhythm Case Rep 2022; 9:156-159. [PMID: 36970386 PMCID: PMC10030296 DOI: 10.1016/j.hrcr.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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12
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Clinical Significance of Adenosine-Induced Atrial Fibrillation after Complete Pulmonary Vein Isolation. J Clin Med 2022; 11:jcm11195679. [PMID: 36233544 PMCID: PMC9570534 DOI: 10.3390/jcm11195679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Adenosine can cause dormant electrical conduction between the pulmonary vein and left atrium after pulmonary vein isolation (PVI). Adenosine can also induce atrial fibrillation (AF) during catheter ablation. However, the clinical outcomes and effects of additional ablation for the trigger sites of adenosine-induced AF (AIAF) are unknown. This study therefore aimed to evaluate the clinical significance of AIAF. Methods: Between January 2010 and September 2019, we analyzed 616 consecutive patients with paroxysmal AF (PAF) who underwent radiofrequency catheter ablation (RFCA), including wide-area circumferential pulmonary vein isolation (PVI) and post-PVI adenosine testing. Results: Among 616 patients, 134 (21.7%) and 34 (5.5%) showed dormant conduction and AIAF, respectively. Eight patients (1.3%) had both dormant conduction and AIAF. The AF recurrence rate was not significantly different between patients with and without AIAF (16.7% vs. 18.6%, log-rank p = 0.827) during a mean follow-up period of 17.9 ± 18 months. Additional RFCA for the trigger site was attempted in 10 patients with AIAF; however, the recurrence rate of atrial arrhythmias was also not different between the groups with and without additional ablation (20% vs. 16.7%, log-rank p = 0.704). Conclusions: AIAF after PVI was not clinically associated with recurrence during long-term follow-up. Ablation of the trigger site in AIAF did not improve the clinical outcomes.
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Bekiaridou A, Kartas A, Moysidis DV, Papazoglou AS, Baroutidou A, Papanastasiou A, Giannakoulas G. The bidirectional relationship of thyroid disease and atrial fibrillation: Established knowledge and future considerations. Rev Endocr Metab Disord 2022; 23:621-630. [PMID: 35112273 DOI: 10.1007/s11154-022-09713-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 11/24/2022]
Abstract
Atrial fibrillation (AF) tends to occur frequently in patients with thyroid disease, primarily hyperthyroidism. In hyperthyroidism, increased levels of thyroid hormones, via intra- and extranuclear mechanisms, have profound effects on cardiac electrophysiology. Hypothyroidism carries a lower risk for AF and is mainly associated with the overtreatment of hypothyroid patients. New-onset AF is frequently the only manifestation of thyroid disease, which renders screening for thyroid dysfunction in that scenario clinically useful. Managing thyroid disease and comorbid AF is essential. This includes thyroid hormones control along with conventional AF therapy. However, there are several open issues with this comorbid duo. The optimal management of thyroid disease and its impact on AF burden remains obscure. There is scanty information on clear-cut benefits for therapy of subclinical thyroid disease and screening of asymptomatic patients. Furthermore, the immunogenetic overlap between the autoantibodies in Graves' disease and AF genesis may lead to novel therapeutic implications. The objective of this review is to summarize the up-to-date epidemiology, pathogenesis, pathophysiology and management of interacting thyroid disease and AF.
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Affiliation(s)
- Alexandra Bekiaridou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - Anastasios Kartas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - Dimitrios V Moysidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - Andreas S Papazoglou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - Amalia Baroutidou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - Anastasios Papanastasiou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece.
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14
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Kiedrowicz RM, Wielusinski M, Zakrzewski M, Kazmierczak J. Does a Vagal Response Indicate Cardiac Autonomic Modulation and Improve the Therapeutic Effect of Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation? Insights from Cryoballoon Ablation. J Cardiovasc Dev Dis 2022; 9:jcdd9050142. [PMID: 35621853 PMCID: PMC9148006 DOI: 10.3390/jcdd9050142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The incidence and influence of vagal response (VR) observed during cryoballoon-based pulmonary vein isolation (CBA-based PVI) on the cardiac autonomic nervous system (CANS) and ablation outcomes in paroxysmal atrial fibrillation (PAF) remain unknown. Methods: 296 patients were treated with a 28 mm second-generation cryoballoon (Medtronic). A total of 74 patients without structural heart disease and concomitant diseases were chosen for a detailed CANS assessment with a heart rate variability (HRV) analysis. All patients were screened over a 2-year post-ablation period. Results: VR was detected in 30% of patients and included sinus arrest (64%) or severe sinus bradycardia (46%). The presence of VR was not related to PV ostial dimension, patient clinical characteristics or intraprocedural ablation details. CANS modulation, manifesting as increased median HR and decreased HRV parameters with intact sympatho-vagal balance occurred independently of VR presence or absence and sustained for at least 12 months following ablation. VR was not related with more intensive CANS modulation and did not translate into better ablation outcomes when compared to the non-VR group (74% vs. 71% at 12 months and 69% vs. 65% at 24 months respectively). Conclusions: VR is frequent during CBA-based PVI for PAF and unrelated to any additional clinical benefit.
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15
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Rodríguez-Mañero M, Martínez-Sande JL, García-Seara J, González-Ferrero T, González-Juanatey JR, Schurmann P, Tavares L, Valderrábano M. Neuromodulatory Approaches for Atrial Fibrillation Ablation. Eur Cardiol 2022; 16:e53. [PMID: 35024055 PMCID: PMC8728882 DOI: 10.15420/ecr.2021.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/23/2021] [Indexed: 12/01/2022] Open
Abstract
In this review, the authors describe evolving alternative strategies for the management of AF, focusing on non-invasive and percutaneous autonomic modulation. This modulation can be achieved – among other approaches – via tragus stimulation, renal denervation, cardiac afferent denervation, alcohol injection in the vein of Marshall, baroreceptor activation therapy and endocardial ganglionated plexi ablation. Although promising, these therapies are currently under investigation but could play a role in the treatment of AF in combination with conventional pulmonary vein isolation in the near future.
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Affiliation(s)
- Moisés Rodríguez-Mañero
- Department of Cardiology, University Hospital of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain.,Institute of Health Research, University of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Spain
| | - Jose Luis Martínez-Sande
- Department of Cardiology, University Hospital of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain.,Institute of Health Research, University of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Spain
| | - Javier García-Seara
- Department of Cardiology, University Hospital of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain.,Institute of Health Research, University of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Spain
| | - Teba González-Ferrero
- Department of Cardiology, University Hospital of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain
| | - José Ramón González-Juanatey
- Department of Cardiology, University Hospital of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain.,Institute of Health Research, University of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Spain
| | - Paul Schurmann
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital Houston, TX, US
| | - Liliana Tavares
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital Houston, TX, US
| | - Miguel Valderrábano
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital Houston, TX, US
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16
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Oliveira ÍMD, Silva Júnior ELD, Martins YDO, Rocha HAL, Scanavacca MI, Gutierrez PS. Cardiac Autonomic Nervous System Remodeling May Play a Role in Atrial Fibrillation: A Study of the Autonomic Nervous System and Myocardial Receptors. Arq Bras Cardiol 2021; 117:999-1007. [PMID: 34406322 PMCID: PMC8682090 DOI: 10.36660/abc.20200725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/25/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The primary factors that originate and perpetuate atrial fibrillation (AF) are electrical and anatomical substrate alterations. However, the central mechanisms governing AF perpetuation have not been elucidated yet, which is reflected on the modest results of the treatment in patients with long persistent AF. OBJECTIVE To evaluate if human intrinsic cardiac autonomic nervous system (ICANS) remodeling, including nervous system fibers and muscarinic and β-adrenergic receptors, play a role in permanent AF. METHODS Heart necropsy samples from thirteen patients with heart disease and permanent AF and thirteen controls without AF were used. By using immunoperoxidase and histomorphometry quantification, we identified the following: the density of all fibers of the ICANS, sympathetic and parasympathetic fibers; and the percentage of myocardium positive for β-adrenergic receptors 1, 2 and 3; G protein-coupled receptor kinase-5 (GRK-5); and muscarinic receptors M1 to M5. The results were compared using ANOVA and nested ANOVA and were adjusted according to the left atrium volume for all variables, and β-blocker use to evaluate the expression of β-receptors and GRK-5. RESULTS There was an overall increase in the density of fibers of the ICANS (p=0.006), especially in atrial sympathetic nerve fibers (p=0.017). Only M1 muscarinic receptors were increased (5.87 vs 2.35, p=0.032). For adrenergic receptors, the results were positive for increased expression of β-3 (37.41 vs 34.18, p=0.039) and GRK-5 (51.16 vs 47.66; p<0.001). β-blocker use had no impact on β-receptor expression. CONCLUSION Increased ICANS innervation and remodeling receptor expression in regions prone to triggering AF may play a role in permanent AF.
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Affiliation(s)
- Ítalo Martins de Oliveira
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil.,Hospital Messejana de Coração e Pulmão Dr. Carlos Alberto Studart Gomes , Fortaleza , CE - Brasil
| | - Evilásio Leobino da Silva Júnior
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil.,Hospital Messejana de Coração e Pulmão Dr. Carlos Alberto Studart Gomes , Fortaleza , CE - Brasil
| | | | | | - Maurício Ibrahim Scanavacca
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Paulo Sampaio Gutierrez
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
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17
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Celotto C, Sánchez C, Mountris KA, Laguna P, Pueyo E. Location of Parasympathetic Innervation Regions From Electrograms to Guide Atrial Fibrillation Ablation Therapy: An in silico Modeling Study. Front Physiol 2021; 12:674197. [PMID: 34456743 PMCID: PMC8385640 DOI: 10.3389/fphys.2021.674197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/11/2021] [Indexed: 01/18/2023] Open
Abstract
The autonomic nervous system (ANS) plays an essential role in the generation and maintenance of cardiac arrhythmias. The cardiac ANS can be divided into its extrinsic and intrinsic components, with the latter being organized in an epicardial neural network of interconnecting axons and clusters of autonomic ganglia called ganglionated plexi (GPs). GP ablation has been associated with a decreased risk of atrial fibrillation (AF) recurrence, but the accurate location of GPs is required for ablation to be effective. Although GP stimulation triggers both sympathetic and parasympathetic ANS branches, a predominance of parasympathetic activity has been shown. This study aims was to develop a method to locate atrial parasympathetic innervation sites based on measurements from a grid of electrograms (EGMs). Electrophysiological models representative of non-AF, paroxysmal AF (PxAF), and persistent AF (PsAF) tissues were developed. Parasympathetic effects were modeled by increasing the concentration of the neurotransmitter acetylcholine (ACh) in randomly distributed circles across the tissue. Different circle sizes of ACh and fibrosis geometries were considered, accounting for both uniform diffuse and non-uniform diffuse fibrosis. Computational simulations were performed, from which unipolar EGMs were computed in a 16 × 1 6 electrode mesh. Different distances of the electrodes to the tissue (0.5, 1, and 2 mm) and noise levels with signal-to-noise ratio (SNR) values of 0, 5, 10, 15, and 20 dB were tested. The amplitude of the atrial EGM repolarization wave was found to be representative of the presence or absence of ACh release sites, with larger positive amplitudes indicating that the electrode was placed over an ACh region. Statistical analysis was performed to identify the optimal thresholds for the identification of ACh sites. In all non-AF, PxAF, and PsAF tissues, the repolarization amplitude rendered successful identification. The algorithm performed better in the absence of fibrosis or when fibrosis was uniformly diffuse, with a mean accuracy of 0.94 in contrast with a mean accuracy of 0.89 for non-uniform diffuse fibrotic cases. The algorithm was robust against noise and worked for the tested ranges of electrode-to-tissue distance. In conclusion, the results from this study support the feasibility to locate atrial parasympathetic innervation sites from the amplitude of repolarization wave.
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Affiliation(s)
- Chiara Celotto
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Carlos Sánchez
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Konstantinos A. Mountris
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Pablo Laguna
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Esther Pueyo
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
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18
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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: 29] [Impact Index Per Article: 9.7] [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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19
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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.
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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
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20
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Aksu T, Gopinathannair R, Gupta D, Pauza DH. Intrinsic cardiac autonomic nervous system: What do clinical electrophysiologists need to know about the "heart brain"? J Cardiovasc Electrophysiol 2021; 32:1737-1747. [PMID: 33928710 DOI: 10.1111/jce.15058] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/23/2021] [Indexed: 11/29/2022]
Abstract
It is increasingly recognized that the autonomic nervous system (ANS) is a major contributor in many cardiac arrhythmias. Cardiac ANS can be divided into extrinsic and intrinsic parts according to the course of nerve fibers and localization of ganglia and neuron bodies. Although the role of the extrinsic part has historically gained more attention, the intrinsic cardiac ANS may affect cardiac function independently as well as influence the effects of the extrinsic nerves. Catheter-based modulation of the intrinsic cardiac ANS is emerging as a novel therapy for the management of patients with brady and tachyarrhythmias resulting from hyperactive vagal activation. However, the distribution of intrinsic cardiac nerve plexus in the human heart and the functional properties of intrinsic cardiac neural elements remain insufficiently understood. The present review aims to bring the clinical and anatomical elements of the immune effector cell-associated neurotoxicity together, by reviewing neuroanatomical terminologies and physiological functions, to guide the clinical electrophysiologist in the catheter lab and to serve as a reference for further research.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Rakesh Gopinathannair
- Departments of Electrophysiology, Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Missouri, USA
| | - Dhiraj Gupta
- Department of Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Dainius H Pauza
- Department of Anatomy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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21
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Prediction of atrial fibrillation inducibility using spatiotemporal activation analysis combined with network mapping. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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22
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Rebecchi M, Panattoni G, Edoardo B, de Ruvo E, Sciarra L, Politano A, Sgueglia M, Ricagni C, Verbena S, Crescenzi C, Sangiorgi C, Borrelli A, De Luca L, Scarà A, Grieco D, Jacomelli I, Martino A, Calò L. Atrial fibrillation and autonomic nervous system: A translational approach to guide therapeutic goals. J Arrhythm 2021; 37:320-330. [PMID: 33850573 PMCID: PMC8022002 DOI: 10.1002/joa3.12512] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/21/2020] [Accepted: 01/15/2021] [Indexed: 12/19/2022] Open
Abstract
The autonomic nervous system (ANS) is known to play an important role in the genesis and maintenance of atrial fibrillation (AF). Biomolecular and genetic mechanisms, anatomical knowledges with recent diagnostic techniques acquisitions, both invasive and non-invasive, have enabled greater therapeutic goals in patients affected by AF related to ANS imbalance. Catheter ablation of ganglionated plexi (GP) in the left and right atrium has been proposed in varied clinical conditions. Moreover interesting results arise from renal sympathetic denervation and vagal nerve stimulation. Despite all this, in the scenario of ANS modulation translational strategies we necessary must consider the treatment or correction of dynamic factors such as obesity, obstructive sleep apnea, lifestyle, food, and stress. Finally, new antiarrhythmic drugs, gene therapy and "ablatogenomic" could be represent exciting future therapeutic perspectives.
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Affiliation(s)
| | | | | | | | - Luigi Sciarra
- Department of CardiologyPoliclinico CasilinoRomeItaly
| | | | | | | | - Sara Verbena
- Department of CardiologyPoliclinico CasilinoRomeItaly
| | | | | | | | - Lucia De Luca
- Department of CardiologyPoliclinico CasilinoRomeItaly
| | - Antonio Scarà
- Department of CardiologyPoliclinico CasilinoRomeItaly
| | | | | | | | - Leonardo Calò
- Department of CardiologyPoliclinico CasilinoRomeItaly
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23
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Loen V, Vos MA, van der Heyden MAG. The canine chronic atrioventricular block model in cardiovascular preclinical drug research. Br J Pharmacol 2021; 179:859-881. [PMID: 33684961 PMCID: PMC9291585 DOI: 10.1111/bph.15436] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 12/29/2022] Open
Abstract
Ventricular cardiac arrhythmia is a life threating condition arising from abnormal functioning of many factors in concert. Animal models mirroring human electrophysiology are essential to predict and understand the rare pro- and anti-arrhythmic effects of drugs. This is very well accomplished by the canine chronic atrioventricular block (CAVB) model. Here we summarize canine models for cardiovascular research, and describe the development of the CAVB model from its beginning. Understanding of the structural, contractile and electrical remodelling processes following atrioventricular (AV) block provides insight in the many factors contributing to drug-induced arrhythmia. We also review all safety pharmacology studies, efficacy and mechanistic studies on anti-arrhythmic drugs in CAVB dogs. Finally, we compare pros and cons with other in vivo preclinical animal models. In view of the tremendous amount of data obtained over the last 100 years from the CAVB dog model, it can be considered as man's best friend in preclinical drug research.
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Affiliation(s)
- Vera Loen
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
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24
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Freudenberger T, Kranz B, Lehmann W, Schäfer K, Münter K, Lee K, Ellinor PT, Hucker WJ. Identification of two preclinical canine models of atrial fibrillation to facilitate drug discovery. Heart Rhythm 2020; 18:632-640. [PMID: 33346136 DOI: 10.1016/j.hrthm.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia occurring in humans, and new treatment strategies are critically needed. The lack of reliable preclinical animal models of AF is a major limitation to drug development of novel antiarrhythmic compounds. OBJECTIVE The purpose of this study was to provide a comprehensive head-to-head assessment of 5 canine AF models. METHODS Five canine models were evaluated for the efficacy of AF induction and AF duration. We tested 2 acute models: short-term atrial tachypacing (AT) for 6 hours with analysis of AF at hourly increments, and carbachol injection into a cardiac fat pad followed by short-term AT. We also tested 3 chronic models: pacemaker implantation followed by either 4 weeks of AT and subsequent atrial burst pacing or intermittent long-term AT for up to 4-5 months to generate AF ≥4.5 hours, and finally ventricular tachypacing to induce heart failure followed by atrial burst pacing to induce AF. RESULTS Careful evaluation showed that acute AT, AT for 4 weeks, and the heart failure model all were unsuccessful in generating reproducible AF episodes of sufficient duration to study antiarrhythmic drugs. In contrast, intermittent long-term AT generated AF lasting ≥4.5 hours in ∼30% of animals. The acute model using carbachol and short-term AT resulted in AF induction of ≥15 minutes in ≥75% of animals, thus enabling testing of antiarrhythmic drugs. CONCLUSION Intermittent long-term AT and the combination of local carbachol injection with successive short-term AT may contribute to future drug development efforts for AF treatment.
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Affiliation(s)
- Till Freudenberger
- Bayer AG, Research and Development, Pharmaceuticals, Wuppertal, Germany.
| | - Beate Kranz
- Bayer AG, Research and Development, Pharmaceuticals, Wuppertal, Germany
| | - Waldemar Lehmann
- Bayer AG, Research and Development, Pharmaceuticals, Wuppertal, Germany
| | - Katja Schäfer
- Bayer AG, Research and Development, Pharmaceuticals, Wuppertal, Germany
| | - Klaus Münter
- Bayer AG, Research and Development, Pharmaceuticals, Wuppertal, Germany
| | - Kichang Lee
- Cardiac Arrhythmia Service & Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Patrick T Ellinor
- Cardiac Arrhythmia Service & Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts; The Broad Institute of MIT and Harvard, Cambridge, Massachusetts.
| | - William J Hucker
- Cardiac Arrhythmia Service & Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
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25
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Ganglionated Plexi Ablation for the Treatment of Atrial Fibrillation. J Clin Med 2020; 9:jcm9103081. [PMID: 32987820 PMCID: PMC7598705 DOI: 10.3390/jcm9103081] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 01/11/2023] Open
Abstract
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia and is associated with significant morbidity and mortality. The autonomic nervous system (ANS) plays an important role in the initiation and development of AF, causing alterations in atrial structure and electrophysiological defects. The intrinsic ANS of the heart consists of multiple ganglionated plexi (GP), commonly nestled in epicardial fat pads. These GPs contain both parasympathetic and sympathetic afferent and efferent neuronal circuits that control the electrophysiological properties of the myocardium. Pulmonary vein isolation and other cardiac catheter ablation targets including GP ablation can disrupt the fibers connecting GPs or directly damage the GPs, mediating the benefits of the ablation procedure. Ablation of GPs has been evaluated over the past decade as an adjunctive procedure for the treatment of patients suffering from AF. The success rate of GP ablation is strongly associated with specific ablation sites, surgical techniques, localization techniques, method of access and the incorporation of additional interventions. In this review, we present the current data on the clinical utility of GP ablation and its significance in AF elimination and the restoration of normal sinus rhythm in humans.
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26
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Ladwig KH, Goette A, Atasoy S, Johar H. Psychological aspects of atrial fibrillation: A systematic narrative review : Impact on incidence, cognition, prognosis, and symptom perception. Curr Cardiol Rep 2020; 22:137. [PMID: 32910300 PMCID: PMC7496063 DOI: 10.1007/s11886-020-01396-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF THE REVIEW Atrial fibrillation (AF) is the most frequent arrhythmia in the general population. This review aims to provide a comprehensive overview of the psychological aspects of AF, compiling evidence from epidemiological, clinical, and basic research sources. RECENT FINDINGS Findings from large-scale population-based and clinical longitudinal studies reveal an association between negative affectivity (e.g. depression) and the incidence and clinical prognosis of AF. Studies investigating the impact of work stress parameters on AF onset show conflicting results. Researchers have reported the impact of AF on cognitive decline and on health-related quality of life, and have highlighted the role of interoceptive cues in the development of AF symptom burden and gender differences in psychological covariates of AF. Among biological pathways linking psychosocial factors to AF, research on autonomic regulation has yielded the most evidence so far, showing that the onset of AF is associated with simultaneous sympatho-vagal activation rather than an increase in vagal or sympathetic drive alone. Thus, modulation of the autonomic nervous system is likely to be a promising strategy for protecting the myocardium from pro-arrhythmic autonomic influences. In total, the findings show that AF is embedded as a disease condition in a psycho-societal context and is not an isolated medical problem per se. A broader perspective than a focus on the electrophysiology alone is urgently needed.
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Affiliation(s)
- Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München (TUM), Langerstr. 3, 81675 Munich, Germany
- Institute of Epidemiology, Mental Health Research Unit, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, Munich, Germany
| | - Andreas Goette
- St. Vincenz-Krankenhaus GmbH, Medizinischen Klinik II, Paderborn, Germany
- Working Group on Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Seryan Atasoy
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München (TUM), Langerstr. 3, 81675 Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, Munich, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Marburg, Germany
| | - Hamimatunnisa Johar
- Institute of Epidemiology, Mental Health Research Unit, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Marburg, Germany
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27
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Hardy C, Rivarola E, Scanavacca M. Role of Ganglionated Plexus Ablation in Atrial Fibrillation on the Basis of Supporting Evidence. J Atr Fibrillation 2020; 13:2405. [PMID: 33024505 PMCID: PMC7533146 DOI: 10.4022/jafib.2405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/23/2020] [Accepted: 03/22/2020] [Indexed: 12/14/2022]
Abstract
The role of the autonomic nervous system (ANS) in the onset and maintenance of atrial fibrillation (AF) may be related to autonomic imbalance. The ANS may cause specific cellular electrophysiological phenomena, such as, shortening of the atrial effective refractory periods (ERPs) and ectopy based on firing activity in pulmonary vein myocytes. High frequency stimulation of atrial ganglionated plexi (GPs) may cause an increase in ERP dispersion and induce AF. Autonomic modification strategies by targeting GPs with catheter ablation have emerged as new targets. Various strategies have been used to detect location of GPs.However, it is still not clear which is the best method to localize GPs, how many GPs should be targeted, and what are the long-term consequences of these therapies. In this review, we discuss available evidence on the clinical impact of GP ablation to treat AF.
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Affiliation(s)
- Carina Hardy
- Heart Institute- University of Sao Paulo Medical School, Brazil
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28
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Harky A, Bithas C, Chan JSK, Snosi M, Pousios D, Muir AD. Surgical Treatment of Atrial Fibrillation: Cutting Through the Edges. Braz J Cardiovasc Surg 2020; 35:375-386. [PMID: 32549109 PMCID: PMC7299594 DOI: 10.21470/1678-9741-2019-0057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Medical management of atrial fibrillation can be complex, challenging and requiring time to prove its effectiveness; furthermore, the response can be refractory and inconsistent if the underlying pathology is not permanently addressed. Surgical ablation has become a key intervention, and since its first intervention in 1987 (the Cox-maze procedure), the technique has evolved from a conventional open method to a minimally invasive technique whilst retaining excellent outcomes. Furthermore, recent advances in the use of a hybrid approach have been established as satisfactory approach in managing atrial fibrillation with satisfactory outcomes. This literature review focuses on the evidence behind the surgical success in managing atrial fibrillation throughout the past, present and the future of these surgical interventions.
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Affiliation(s)
- Amer Harky
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool UK Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Christiana Bithas
- University of Liverpool School of Medicine Liverpool UK School of Medicine, University of Liverpool, Liverpool, UK
| | - Jeffrey Shi Kai Chan
- University of Hong Kong Faculty of Medicine Shatin New Territories Hong Kong Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Prince of Wales Hospital Department of Medicine and Therapeutics Division of Cardiology Shatin New Territories Hong Kong Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Mostafa Snosi
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool UK Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Dimitrios Pousios
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool UK Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Andrew D Muir
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool UK Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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Xu Q, Ju W, Xiao F, Yang B, Chen H, Yang G, Zhang F, Gu K, Li M, Wang D, Chen M. Circumferential pulmonary vein antrum ablation for the treatment of paroxysmal atrial fibrillation: A randomized controlled trial. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:280-288. [PMID: 31849079 DOI: 10.1111/pace.13863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/01/2019] [Accepted: 12/13/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Qiang Xu
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical University Nanjing China
- Department of CardiologyZhejiang Provincial People's Hospital Zhejiang China
| | - Weizhu Ju
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Fangyi Xiao
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Bing Yang
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Hongwu Chen
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Gang Yang
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Fengxiang Zhang
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Kai Gu
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Mingfang Li
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Daowu Wang
- The Heart and Lung InstituteThe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Minglong Chen
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical University Nanjing China
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30
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Călburean PA, Osório TG, Sieira J, Ströker E, Maj R, Terasawa M, Rizzo A, Borio G, Scala O, Galli A, Brugada P, Chierchia GB, De Asmundis C. High parasympathetic activity as reflected by deceleration capacity predicts atrial fibrillation recurrence after repeated catheter ablation procedure. J Interv Card Electrophysiol 2020; 60:21-29. [DOI: 10.1007/s10840-019-00687-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
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31
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Iso K, Okumura Y, Watanabe I, Nagashima K, Takahashi K, Arai M, Watanabe R, Wakamatsu Y, Otsuka N, Yagyu S, Kurokawa S, Nakai T, Ohkubo K, Hirayama A. Is Vagal Response During Left Atrial Ganglionated Plexi Stimulation a Normal Phenomenon? Circ Arrhythm Electrophysiol 2019; 12:e007281. [DOI: 10.1161/circep.118.007281] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background:
Ganglionated plexi (GPs) play an important role in both the initiation and maintenance of atrial fibrillation (AF). GPs can be located by using continuous high-frequency stimulation (HFS) to elicit a vagal response, but whether the vagal response phenomenon is common to patients without AF is unknown.
Methods:
HFS of the left atrial GPs was performed in 42 patients (aged 58.0±10.2 years) undergoing ablation for AF and 21 patients (aged 53.2±12.8 years) undergoing ablation for a left-sided accessory pathway. The HFS (20 Hz, 25 mA, 10-ms pulse duration) was applied for 5 seconds at 3 sites within the presumed anatomic area of each of the 5 major left atrial GPs (for a total of 15 sites per patient). We defined vagal response to HFS as prolongation of the R-R interval by >50% in comparison to the mean pre-HFS R-R interval averaged over 10 beats and active-GP areas as areas in which a vagal response was elicited.
Results:
Overall, more active-GP areas were found in the AF group patients than in the non-AF group patients, and at all 5 major GPs, the maximum R-R interval during HFS was significantly prolonged in the AF patients. After multivariate adjustment, association was established between the total number of vagal response sites and the presence of AF.
Conclusions:
The significant increase in vagal responses elicited in patients with AF compared with responses in non-AF patients suggests that vagal responses to HFS reflect abnormally increased GP activity specific to AF substrates.
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Affiliation(s)
- Kazuki Iso
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ichiro Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Keiko Takahashi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Masaru Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ryuta Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Naoto Otsuka
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Seina Yagyu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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32
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The autonomic nervous system and cardiac arrhythmias: current concepts and emerging therapies. Nat Rev Cardiol 2019; 16:707-726. [DOI: 10.1038/s41569-019-0221-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 12/19/2022]
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33
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Kharbanda RK, Özdemir EH, Taverne YJ, Kik C, Bogers AJ, de Groot NM. Current Concepts of Anatomy, Electrophysiology, and Therapeutic Implications of the Interatrial Septum. JACC Clin Electrophysiol 2019; 5:647-656. [DOI: 10.1016/j.jacep.2019.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 12/28/2022]
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34
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Vyas V, Lambiase P. Obesity and Atrial Fibrillation: Epidemiology, Pathophysiology and Novel Therapeutic Opportunities. Arrhythm Electrophysiol Rev 2019; 8:28-36. [PMID: 30918664 PMCID: PMC6434511 DOI: 10.15420/aer.2018.76.2] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Obesity is already a major global public health issue, implicated in a vast array of conditions affecting multiple body systems. It is now also firmly established as an independent risk factor in the incidence and progression of AF. The rapidly rising morbidity, mortality and healthcare costs associated with AF despite implementation of the three pillars of AF management — anticoagulation, rate control and rhythm control — suggest other strategies need to be considered. Compelling data has unveiled novel insights into adipose tissue biology and its effect on arrhythmogenesis while secondary prevention strategies targeting obesity as part of a comprehensive risk factor management programme have been demonstrated to be highly effective. Here, the authors review the epidemiological basis of the obesity—AF relationship, consider its underlying pathophysiology and discuss new therapeutic opportunities on the horizon.
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Affiliation(s)
- Vishal Vyas
- Barts and The London School of Medicine and Dentistry London, UK.,Queen Mary University of London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Pier Lambiase
- Barts Heart Centre, St Bartholomew's Hospital London, UK.,Institute of Cardiovascular Science, University College London London, UK
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35
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Padmanabhan D, Naksuk N, Killu AK, Kapa S, Witt C, Sugrue A, DeSimone CV, Madhavan M, Groot JR, O'Brien B, Rabbette T, Coffey K, Asirvatham SJ. Electroporation of epicardial autonomic ganglia: Safety and efficacy in medium‐term canine models. J Cardiovasc Electrophysiol 2019; 30:607-615. [DOI: 10.1111/jce.13860] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/19/2019] [Accepted: 01/19/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Deepak Padmanabhan
- Department of Cardiovascular MedicineAcademic Medical CenterAmsterdam The Netherlands
| | - Niyada Naksuk
- Department of Cardiovascular MedicineAcademic Medical CenterAmsterdam The Netherlands
| | - Ammar K. Killu
- Department of Cardiovascular MedicineAcademic Medical CenterAmsterdam The Netherlands
| | - Suraj Kapa
- Department of Cardiovascular MedicineAcademic Medical CenterAmsterdam The Netherlands
| | - Chance Witt
- Department of Cardiovascular MedicineAcademic Medical CenterAmsterdam The Netherlands
| | - Alan Sugrue
- Department of Cardiovascular MedicineAcademic Medical CenterAmsterdam The Netherlands
| | | | - Malini Madhavan
- Department of Cardiovascular MedicineAcademic Medical CenterAmsterdam The Netherlands
| | - J. R. Groot
- Heart Center, Department of Cardiology, Academic Medical CenterAmsterdam The Netherlands
| | - Barry O'Brien
- Biomedical engineering, National University of IrelandGalway Ireland
| | - Tadhg Rabbette
- Biomedical engineering, National University of IrelandGalway Ireland
| | - Kenneth Coffey
- Biomedical engineering, National University of IrelandGalway Ireland
| | - Samuel J. Asirvatham
- Division of Pediatric CardiologyAcademic Medical CenterAmsterdam The Netherlands
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36
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Clinical evidence of autonomic dysfunction due to atrial fibrillation: implications for rhythm control strategy. J Interv Card Electrophysiol 2019; 54:299-307. [PMID: 30661160 DOI: 10.1007/s10840-019-00508-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/01/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE The role of the autonomic nervous system in the genesis of atrial fibrillation (AF) has been well studied; however, the converse remains poorly understood. Pulmonary veins (PV) contain receptors important in cardiac reflexes. Here, we evaluated reflex responses in patients with paroxysmal AF (PAF) to lower body negative pressure (LBNP). METHODS Thirty-four PAF patients (including 14 PAF patients post successful PV Isolation; PVI) were compared to 14 age and sex-matched controls. Mean arterial pressure (MAP), heart rate (HR), systemic vascular resistance index (SVRI), cardiac index (CI), and stroke volume index (SVI) were measured continuously during - 0, - 20, and - 40 mmHg LBNP. LBNP reduces venous return, deactivating atrial receptors, thereby eliciting a reflex increase in SVRI to maintain MAP. RESULTS AF patients have higher BMI than the controls (p = 0.02). In control subjects, LBNP did not alter MAP as SVRI increased. In PAF patients, LBNP resulted in a reduction in MAP (- 4.8%) with attenuated SVRI response (+ 4.2%) compared to controls (p < 0.05). However, in the post-PVI group, SVRI increase was similar to controls (p = 0.12) although that was insufficient to maintain MAP. In all patients, both reduction in SVI and CI and increase in HR were similar in response to LBNP. CONCLUSIONS This study provides novel clinical evidence of autonomic dysfunction in PAF patients. Successful PVI results in partial recovery of the cardiac reflex. Therefore, not only does autonomic disturbance predispose to AF but it is also a consequence of AF; potentially contributing to disease progression. This could help explain the dictum "AF begets AF."
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37
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Park HS, Jeong DS, Yu HT, Pak HN, Shim J, Kim JY, Kim J, Lee JM, Kim KH, Roh SY, Cho YJ, Kim YH, Yoon NS. 2018 Korean Guidelines for Catheter Ablation of Atrial Fibrillation: Part I. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2018. [DOI: 10.18501/arrhythmia.2018.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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38
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Time-dependent cervical vagus nerve stimulation and frequency-dependent right atrial pacing mediates induction of atrial fibrillation. Anatol J Cardiol 2018; 20:206-212. [PMID: 30297578 PMCID: PMC6249522 DOI: 10.14744/anatoljcardiol.2018.73558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: This study aimed to investigate the effects of right cervical vagus trunk simulation (RVTS) and/or right atrial pacing (RAP) on the induction of atrial fibrillation (AF). Methods: Twenty-four healthy adult dogs were randomly divided into four groups: RAP groups comprising RAP500 (RAP with 500 beats/min) and RAP1000 (RAP with 1000 beats/min) and RVTS groups comprising RVTS and RAP500+RVTS. All dogs underwent 12-h intermittent RAP and/or RVTS once every 2 h. The AF induction rate, AF duration, atrial effective refractory period (ERP), and dispersion of ERP (dERP) were compared after every 2 h of RAP or/and RVTS. Results: All groups had successful AF induction. The RAP1000 group had the highest AF induction rate and the longest AF duration. The RAP1000 group also had a shortened ERP in comparison to the other groups as well as the maximum dERP. Compared to the RAP500 group, RAP500+RVTS had an increased capacity to induce AF as measured by the AF induction rates, AF duration, ERP, and dERP. Conclusion: Increased tension in the vagus nerve and the intrinsic cardiac autonomic nervous system plays an important role in AF induction through different potential mechanisms. Interventions involving the vagus nerve and/or intrinsic cardiac autonomic nervous system can be a future potential therapy for AF.
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39
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Yu L, Scherlag BS, Dormer K, Rutel I, Huang B, Zhou X, Kuriakose AE, Nguyen KK, Po S. Targeted Ganglionated Plexi Denervation Using Magnetic Nanoparticles Carrying Calcium Chloride Payload. JACC Clin Electrophysiol 2018; 4:1347-1358. [PMID: 30336881 DOI: 10.1016/j.jacep.2018.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/11/2018] [Accepted: 06/13/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study sought to develop a novel targeted delivery therapy to ablate the major atrial ganglionated plexi (GP) using magnetic nanoparticles carrying a CaCl2 payload. BACKGROUND Prior studies indicated the role of hyperactivity of the cardiac autonomic nervous system in the genesis of atrial fibrillation. METHODS Twenty-eight male mongrel dogs underwent a bilateral thoracotomy. CaCl2-encapsulated magnetic nanoparticles (Ca-MNP) included magnetite in a sphere of biocompatible, biodegradable poly(lactic-co-glycolic acid). A custom external electromagnet focusing the magnetic field gradient (2,600 G) on the epicardial surface of the targeted GP was used to pull Ca-MNP into and release CaCl2 within the GP. The ventricular rate slowing response to high frequency stimulation (20 Hz, 0.1 ms) of the GP was used to assess the GP function. RESULTS The minimal effective concentration of CaCl2 to inhibit the GP function was 0.5 mmol/l. Three weeks after CaCl2 (0.5 mmol/l, n = 18 GP) or saline (n = 18 GP) microinjection into GP, the increased GP function, neural activity, and atrial fibrillation inducibility, as well as shortened effective refractory period in response to 6 h of rapid atrial pacing (1,200 beats/min) were suppressed by CaCl2 microinjection. After intracoronary infusion of Ca-MNP, the external electromagnet pulled Ca-MNP to the targeted GP and suppressed the GP function (n = 6 GP) within 15 min. CONCLUSIONS Ca-MNP can be magnetically targeted to suppress GP function by calcium-mediated neurotoxicity. This novel approach may be used to treat arrhythmias related to hyperactivity of the cardiac autonomic nervous system, such as early stage of atrial fibrillation, with minimal myocardial injury.
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Affiliation(s)
- Lilei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Research Institute, Wuhan University, Wuhan, China
| | - Benjamin S Scherlag
- Section of Cardiovascular Diseases and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kenneth Dormer
- Integrative Physiology and Pharmacology Department, College of Osteopathic Medicine, Liberty University, Lynchburg, Virginia
| | - Isaac Rutel
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Bing Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Research Institute, Wuhan University, Wuhan, China
| | - Xiaoya Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Research Institute, Wuhan University, Wuhan, China
| | - Aneetta E Kuriakose
- Department of Bioengineering, the University of Texas at Arlington, Arlington, Texas
| | - Kytai K Nguyen
- Department of Bioengineering, the University of Texas at Arlington, Arlington, Texas
| | - Sunny Po
- Section of Cardiovascular Diseases and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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40
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Garabelli P, Stavrakis S, Kenney JFA, Po SS. Effect of 28-mm Cryoballoon Ablation on Major Atrial Ganglionated Plexi. JACC Clin Electrophysiol 2018; 4:831-838. [PMID: 29929678 DOI: 10.1016/j.jacep.2017.12.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/29/2017] [Accepted: 12/29/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The authors intended to investigate if 28-mm cryoballoon (CB) ablation also modifies the 4 major atrial ganglionaated plexi (GP). BACKGROUND The major atrial GP facilitate the initiation and maintenance of atrial fibrillation (AF). The 28-mm CB covers a large surface area of the left atrium and probably the GP areas. METHODS High-frequency stimulation (20 Hz) was delivered to the area of anterior right GP (ARGP), inferior right GP, superior left (SLGP), and inferior left GP (ILGP). Positive GP sites were defined as a prolongation of R-wave to R-wave (RR) interval during AF by >50%. The area of each GP before and after CB ablation was compared. RESULTS A total of 18 patients with paroxysmal AF who underwent CB and radiofrequency ablation and had positive GP sites were reviewed. The Wilcoxon signed-rank test was used to assess the effects of CB ablation on each GP. There was a statistically significant difference in the area of all 4 GP after CB ablation: 1) ARGP area: 2.9 cm2 (interquartile range [IQR]: 2.1 to 3.5 cm2) pre-CB, 0.1 cm2 (IQR: 0 to 0.6 cm2) post-CB, p = 0.0002; 2) inferior right GP area: 2.1 cm2 (IQR: 0.9 to 2.9 cm2) pre-CB, 0.5 cm2 (IQR: 0 to 1.7 cm2) post-CB, p = 0.001; 3) SLGP area: 1.4 cm2 (IQR: 0.6 to 2.4 cm2) pre-CB, 0 cm2 (IQR: 0 to 0 cm2) post-CB, p = 0.0002; and 4) ILGP area: 1.3 cm2 (IQR: 0.3 to 2.2 cm2) pre-CB, 0.3 cm2 (IQR: 0 to 1.6 cm2) post-CB, p = 0.008. CONCLUSIONS The surface area of all 4 of the major atrial GP was substantially reduced by CB ablation. The SLGP and ARGP had the largest, whereas the ILGP had the least percent of reduction following CB ablation. Part of the therapeutic effects of CB ablation may result from modifying the 4 major atrial GP.
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Affiliation(s)
- Paul Garabelli
- Section of Cardiovascular Diseases and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Stavros Stavrakis
- Section of Cardiovascular Diseases and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - John F A Kenney
- Section of Cardiovascular Diseases and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Sunny S Po
- Section of Cardiovascular Diseases and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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41
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Te ALD, Lo LW, Lin YJ, Chang SL, Hu YF, Chung FP, Tuan TC, Chao TF, Liao JN, Chang YT, Lin CY, Yamada S, Chang TY, Salim S, Hoang MQ, Huang TC, Chen SA. Vasovagal responses during cryoballoon pulmonary vein isolation in paroxysmal atrial fibrillation predict favorable mid-term outcomes. Int J Cardiol 2018; 258:115-120. [DOI: 10.1016/j.ijcard.2018.01.111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/27/2017] [Accepted: 01/23/2018] [Indexed: 11/28/2022]
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42
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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: 708] [Impact Index Per Article: 118.0] [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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Nagamoto Y, Fujii Y, Morita Y, Ueda Y, Yamane K, Miyake Y, Fujiwara M, Mito S, Watari Y, Tamekiyo H, Okimoto T, Muraoka Y, Hayashi Y. Partial left superior pulmonary vein potential elimination by an inferior ganglionated plexus ablation. Clin Case Rep 2017; 5:1826-1829. [PMID: 29152279 PMCID: PMC5676268 DOI: 10.1002/ccr3.1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 08/02/2017] [Accepted: 08/22/2017] [Indexed: 11/30/2022] Open
Abstract
Ganglionated plexus (GP) plays an important role in the initiation and maintenance of atrial fibrillation (AF). The GP ablation has been found to be effective for AF treatment. In this case, we reported an AF case in which the pulmonary vein (PV) potentials of the anterior region of the left superior PV were eliminated by an inferior right GP ablation.
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Affiliation(s)
| | - Yuto Fujii
- Division of Cardiology; Tsuchiya general hospital; Hiroshima Japan
| | - Yuichi Morita
- Division of Cardiology; Tsuchiya general hospital; Hiroshima Japan
| | - Yusuke Ueda
- Division of Cardiology; Tsuchiya general hospital; Hiroshima Japan
| | - Kenichi Yamane
- Division of Cardiology; Tsuchiya general hospital; Hiroshima Japan
| | - Yasuko Miyake
- Division of Cardiology; Tsuchiya general hospital; Hiroshima Japan
| | - Mai Fujiwara
- Division of Cardiology; Tsuchiya general hospital; Hiroshima Japan
| | - Shinji Mito
- Division of Cardiology; Tsuchiya general hospital; Hiroshima Japan
| | - Yuichiro Watari
- Division of Cardiology; Tsuchiya general hospital; Hiroshima Japan
| | | | - Tomokazu Okimoto
- Division of Cardiology; Tsuchiya general hospital; Hiroshima Japan
| | - Yuji Muraoka
- Division of Cardiology; Tsuchiya general hospital; Hiroshima Japan
| | - Yasuhiko Hayashi
- Division of Cardiology; Tsuchiya general hospital; Hiroshima Japan
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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: 1370] [Impact Index Per Article: 195.7] [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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Efficacy of ganglionated plexi ablation in addition to pulmonary vein isolation for paroxysmal versus persistent atrial fibrillation: a meta-analysis of randomized controlled clinical trials. J Interv Card Electrophysiol 2017; 50:253-260. [DOI: 10.1007/s10840-017-0285-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/29/2017] [Indexed: 02/05/2023]
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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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Bárta J, Brát R. Assessment of the effect of left atrial cryoablation enhanced by ganglionated plexi ablation in the treatment of atrial fibrillation in patients undergoing open heart surgery. J Cardiothorac Surg 2017; 12:69. [PMID: 28818088 PMCID: PMC5561587 DOI: 10.1186/s13019-017-0625-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 07/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of our study was to investigate, whether enhancement of left atrial cryoablation by ablation of the autonomic nervous system of left atrium leads to influencing the outcomes of surgical treatment of atrial fibrillation in patients with structural heart disease undergoing open-heart surgery. METHODS The observed patient file consisted of 100 patients, who have undergone a combined open-heart surgery at our department between July 2012 and December 2014. The patients were indicated for the surgical procedure due to structural heart disease, and suffered from paroxysmal, persistent, or long-standing persistent atrial fibrillation. In all cases, left atrial cryoablation was performed in the extent of isolation of pulmonary veins, box lesion, connecting lesion with mitral annulus, amputation of the left atrial appendage and connecting lesion of the appendage base with left pulmonary veins. Furthermore, 35 of the patients underwent mapping and radiofrequency ablation of ganglionated plexi, together with discision and ablation of the ligament of Marshall (Group GP). A control group was consisted of 65 patients without ganglionated plexi intervention (Group LA). The main primary outcome was establishment and duration of sinus rhythm in the course of one-year follow-up. RESULTS Evaluation of the number of patients with a normal sinus rhythm in per cent has shown comparable values in both groups (Group GP - 93.75%, Group LA - 86.67%, p = 0.485); comparable results were also observed in patients with normal sinus rhythm without anti-arrhythmic treatment in the 12th month (Group GP - 50%, Group LA - 47%, p = 0.306). We have not observed any relation between the recurrence of atrial fibrillation and the presence of a mitral valve surgery, or between the presence of a mitral and tricuspid valves surgery and between the left atrial diameter > 50 mm. CONCLUSIONS Enhancement of left atrial cryoablation by gangionated plexi ablation did not influence the outcomes of surgical ablation due to atrial fibrillation in our population in the course of 12-month follow-up. TRIAL REGISTRATION The study was approved retrospectively by the Ethics Committee of the University Hospital Ostrava ( reference number 867/2016).
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Affiliation(s)
- Jiří Bárta
- Cardiac Surgery, University Hospital Ostrava, 17.listopadu 1790, 708 52, Ostrava-Poruba, Czech Republic.
| | - Radim Brát
- Cardiac Surgery, University Hospital Ostrava, 17.listopadu 1790, 708 52, Ostrava-Poruba, Czech Republic
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48
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Cardiac autonomic ganglia ablation suppresses atrial fibrillation in a canine model of acute intermittent hypoxia. Auton Neurosci 2017; 205:26-32. [DOI: 10.1016/j.autneu.2017.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/26/2017] [Accepted: 02/21/2017] [Indexed: 01/08/2023]
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Driessen AHG, Berger WR, Krul SPJ, van den Berg NWE, Neefs J, Piersma FR, Chan Pin Yin DRPP, de Jong JSSG, van Boven WP, de Groot JR. Ganglion Plexus Ablation in Advanced Atrial Fibrillation: The AFACT Study. J Am Coll Cardiol 2017; 68:1155-1165. [PMID: 27609676 DOI: 10.1016/j.jacc.2016.06.036] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients with long duration of atrial fibrillation (AF), enlarged atria, or failed catheter ablation have advanced AF and may require more extensive treatment than pulmonary vein isolation. OBJECTIVES The aim of this study was to investigate the efficacy and safety of additional ganglion plexus (GP) ablation in patients undergoing thoracoscopic AF surgery. METHODS Patients with paroxysmal AF underwent pulmonary vein isolation. Patients with persistent AF also received additional lines (Dallas lesion set). Patients were randomized 1:1 to additional epicardial ablation of the 4 major GPs and Marshall's ligament (GP group) or no extra ablation (control) and followed every 3 months for 1 year. After a 3-month blanking period, all antiarrhythmic drugs were discontinued. RESULTS Two hundred forty patients with a mean AF duration of 5.7 ± 5.1 years (59% persistent) were included. Mean procedure times were 185 ± 54 min and 168 ± 54 min (p = 0.015) in the GP (n = 117) and control groups (n = 123), respectively. GP ablation abated 100% of evoked vagal responses; these responses remained in 87% of control subjects. Major bleeding occurred in 9 patients (all in the GP group; p < 0.001); 8 patients were managed thoracoscopically, and 1 underwent sternotomy. Sinus node dysfunction occurred in 12 patients in the GP group and 4 control subjects (p = 0.038), and 6 pacemakers were implanted (all in the GP group; p = 0.013). After 1 year, 4 patients had died (all in the GP group, not procedure related; p = 0.055), and 9 were lost to follow-up. Freedom from AF recurrence in the GP and control groups was not statistically different whether patients had paroxysmal or persistent AF. At 1 year, 82% of patients were not taking antiarrhythmic drugs. CONCLUSIONS GP ablation during thoracoscopic surgery for advanced AF has no detectable effect on AF recurrence but causes more major adverse events, major bleeding, sinus node dysfunction, and pacemaker implantation. (Atrial Fibrillation Ablation and Autonomic Modulation via Thoracoscopic Surgery [AFACT]; NCT01091389).
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Affiliation(s)
- Antoine H G Driessen
- Department of Cardiothoracic Surgery, Heart Center, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Wouter R Berger
- Department of Cardiothoracic Surgery, Heart Center, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Sébastien P J Krul
- Department of Cardiology, Heart Center, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Nicoline W E van den Berg
- Department of Cardiology, Heart Center, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Jolien Neefs
- Department of Cardiology, Heart Center, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Femke R Piersma
- Department of Cardiology, Heart Center, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Dean R P P Chan Pin Yin
- Department of Cardiology, Heart Center, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Jonas S S G de Jong
- Department of Cardiology, Onze Lieve Vrouwe Hospital, Amsterdam, the Netherlands
| | - WimJan P van Boven
- Department of Cardiothoracic Surgery, Heart Center, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Joris R de Groot
- Department of Cardiology, Heart Center, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands.
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50
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Vandecasteele T, Cornillie P, Vandevelde K, Logothetidou A, Couck L, van Loon G, Van den Broeck W. Presence of Ganglia and Telocytes in Proximity to Myocardial Sleeve Tissue in the Porcine Pulmonary Veins Wall. Anat Histol Embryol 2017; 46:325-333. [DOI: 10.1111/ahe.12273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/22/2017] [Indexed: 12/31/2022]
Affiliation(s)
- T. Vandecasteele
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - P. Cornillie
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - K. Vandevelde
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - A. Logothetidou
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - L. Couck
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - G. van Loon
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - W. Van den Broeck
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
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