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Abstract
Catheter-based neuromodulation of intrinsic cardiac autonomic nervous system is increasingly being used to improve outcomes in patients with vasovagal syncope and bradyarrhythmias caused by vagal overactivity. However, there is still no consensus for patient selection, technical steps, and procedural end points. This review takes the reader on a practical exploration of neuromodulation for bradyarrhythmias, concentrating on the critical aspects of proper patient selection, evidence-based insights, and anatomic intricacies within the intrinsic cardiac autonomic nervous system. Also discussed are different mapping techniques and outcome measures. Future directions to optimize the utilization of this technique in clinical practice are highlighted.
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Affiliation(s)
- Asad Khan
- Division of Cardiology, Rush University Medical Center, 1717 West Congress Parkway, Chicago, IL 60612, USA
| | - Henry D Huang
- Division of Cardiology, Rush University Medical Center, 1717 West Congress Parkway, Chicago, IL 60612, USA
| | - Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul 34100, Turkey.
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2
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Aksu T, Huang HD. Intracardiac echocardiography and electroanatomical mapping: do we still need fluoroscopy for cardioneuroablation procedures? J Interv Card Electrophysiol 2024:10.1007/s10840-024-01894-9. [PMID: 39088102 DOI: 10.1007/s10840-024-01894-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, 34742, Turkey.
| | - Henry D Huang
- Section of Cardiology, Rush University Medical Center, Chicago, USA
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3
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Chen J, Quam BL, Li C, Liu X, Chen PS, Cha YM. Characterization of skin sympathetic nerve activity in patients undergoing ablation of ventricular tachycardia. Heart Rhythm 2024; 21:1443-1444. [PMID: 38493990 DOI: 10.1016/j.hrthm.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Jingjing Chen
- Department of Cardiovascular Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Brent L Quam
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Chuanwei Li
- Department of Cardiovascular Medicine, Chongqing Emergency Medical Center, Chongqing, China
| | - Xiao Liu
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Peng-Sheng Chen
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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4
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Kvitka D, Pauza DH. Anatomy of blood microcirculation in the pig epicardial ganglionated nerve plexus. Ann Anat 2024; 255:152285. [PMID: 38830557 DOI: 10.1016/j.aanat.2024.152285] [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] [Received: 03/21/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024]
Abstract
Embolization of coronary arteries and their terminal arterioles causes ischemia of all tissues distributed within a cardiac wall including the intrinsic cardiac ganglionated nerve plexus (ICGP). The disturbed blood supply to the ICGP causes chronic sympathetic activation with succeeding atrial and ventricular arrhythmias. This study analyses the anatomy of microcirculation of epicardial nerves and ganglia using the hearts of 11 domestic pigs. Our findings demonstrate that thicker epicardial nerves are normally supplied with blood via 12 epineural arterioles penetrating the endoneurium regularly along a nerve, and forming an endoneurial capillary network, which drains the blood into the myocardial blood flow. The mean diameter of intraneural capillaries was 7.2 ± 0.2 µm, while the diameters of arterioles were 25.8 ± 0.7 μm and involved 45 endothelial cells accompanied by circular smooth muscle cells. Usually, two or three arterioles with a mean diameter of 28.9 ± 1.7 μm supplied blood to any epicardial ganglion, in which arterioles proceeded into a network of capillaries with a mean diameter of 6.9 ± 0.3 μm. Both the epicardial nerves and the ganglia distributed near the porta venarum of the heart had tiny arterioles that anastomosed blood vessels from the right and the left coronary arteries. The density of blood vessels in the epicardial nerves was significantly lesser compared with the ganglia. Our electron microscopic observations provided evidence that blood vessels of the pig epicardial nerves and ganglia may be considered as either arterioles or capillaries that have quantitative and qualitative differences comparing to the corresponding blood vessels in humans and, therefore, a pig should not be considered as an animal model of the first choice for further heart functional studies seeking to improve the treatment of cardiac arrhythmias via trans-coronary cardiac neuroablation. STRUCTURED ABSTRACT: This study details the anatomy of microcirculation of epicardial nerves and ganglia, from which intracardiac nerves and bundles of nerve fibers extend into all layers of the atrial and ventricular walls in the most popular animal model of experimental cardiology and cardiac surgery - the domestic pig. Our findings provided evidence that blood vessels of the pig epicardial nerves and ganglia may be considered as either arterioles or capillaries that have quantitative and qualitative differences comparing to the corresponding blood vessels in humans and, therefore, a pig should not be considered as an animal model of the first choice for further heart functional studies seeking to improve the treatment of cardiac arrhythmias via trans-coronary cardiac neuroablation.
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Affiliation(s)
- Dmitrij Kvitka
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, A. Mickeviciaus Street 9, Kaunas LT 44307, Lithuania
| | - Dainius H Pauza
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, A. Mickeviciaus Street 9, Kaunas LT 44307, Lithuania.
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Paradiso B, Pauza DH, Limback C, Ottaviani G, Thiene G. From Psychostasis to the Discovery of Cardiac Nerves: The Origins of the Modern Cardiac Neuromodulation Concept. BIOLOGY 2024; 13:266. [PMID: 38666878 PMCID: PMC11047897 DOI: 10.3390/biology13040266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
This review explores the historical development of cardiology knowledge, from ancient Egyptian psychostasis to the modern comprehension of cardiac neuromodulation. In ancient Egyptian religion, psychostasis was the ceremony in which the deceased was judged before gaining access to the afterlife. This ritual was also known as the "weighing of the heart" or "weighing of the soul". The Egyptians believed that the heart, not the brain, was the seat of human wisdom, emotions, and memory. They were the first to recognize the cardiocentric nature of the body, identifying the heart as the center of the circulatory system. Aristotle (fourth century BC) considered the importance of the heart in human physiology in his philosophical analyses. For Galen (third century AD), the heart muscle was the site of the vital spirit, which regulated body temperature. Cardiology knowledge advanced significantly in the 15th century, coinciding with Leonardo da Vinci and Vesalius's pioneering anatomical and physiological studies. It was William Harvey, in the 17th century, who introduced the concept of cardiac circulation. Servet's research and Marcello Malpighi's discovery of arterioles and capillaries provided a more detailed understanding of circulation. Richard Lower emerged as the foremost pioneer of experimental cardiology in the late 17th century. He demonstrated the heart's neural control by tying off the vagus nerve. In 1753, Albrecht von Haller, a professor at Göttingen, was the first to discover the heart's automaticity and the excitation of muscle fibers. Towards the end of the 18th century, Antonio Scarpa challenged the theories of Albrecht von Haller and Johann Bernhard Jacob Behrends, who maintained that the myocardium possessed its own "irritability", on which the heartbeat depended, and was independent of neuronal sensitivity. Instead, Scarpa argued that the heart required innervation to maintain life, refuting Galenic notions. In contemporary times, the study of cardiac innervation has regained prominence, particularly in understanding the post-acute sequelae of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection (PASC), which frequently involves cardiorespiratory symptoms and dysregulation of the intrinsic cardiac innervation. Recently, it has been recognized that post-acute sequelae of acute respiratory infections (ARIs) due to other pathogens can also be a cause of long-term vegetative and somatic symptoms. Understanding cardiac innervation and modulation can help to recognize and treat long COVID and long non-COVID-19 (coronavirus disease 2019) ARIs. This analysis explores the historical foundations of cardiac neuromodulation and its contemporary relevance. By focusing on this concept, we aim to bridge the gap between historical understanding and modern applications. This will illuminate the complex interplay between cardiac function, neural modulation, cardiovascular health, and disease management in the context of long-term cardiorespiratory symptoms and dysregulation of intrinsic cardiac innervations.
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Affiliation(s)
- Beatrice Paradiso
- Lino Rossi Research Center, Department of Biomedical, Surgical and Dental Sciences, Faculty of Medicine and Surgery, University of Milan, 20122 Milan, Italy;
- Consultant Cyto/Histopathologist (Anatomic Pathologist) Anatomic Pathology Unit, Dolo Hospital Venice, 30031 Dolo, Italy
| | - Dainius H. Pauza
- Faculty of Medicine, Institute of Anatomy, Lithuanian University of Health Sciences Kaunas, 44307 Kaunas, Lithuania;
| | - Clara Limback
- Oxford University Hospitals, NHS Trust, Oxford OX3 7JH, UK;
| | - Giulia Ottaviani
- Lino Rossi Research Center, Department of Biomedical, Surgical and Dental Sciences, Faculty of Medicine and Surgery, University of Milan, 20122 Milan, Italy;
- Department of Biomedical, Surgical and Dental Sciences, Faculty of Medicine and Surgery, University of Milan, 20122 Milan, Italy
- Department of Pathology and Laboratory Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77054, USA
| | - Gaetano Thiene
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy;
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Aksu T, Chung MK. Cardioneuroablation for Cardioinhibitory Vasovagal Syncope: Rationale, Approaches, and Its Role in Long-Term Management. CURRENT CARDIOVASCULAR RISK REPORTS 2024; 18:55-64. [PMID: 38707611 PMCID: PMC11064987 DOI: 10.1007/s12170-024-00736-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/07/2024]
Abstract
Purpose of Review Cardioneuroablation (CNA) has emerged as a potential alternative to pacemaker therapy in well-selected cases with vasovagal syncope (VVS). In recent years, the number of CNA procedures performed by electrophysiologists has considerably risen. However, some important questions, including proper patient selection and long-term results, remain unanswered. The present article aims to critically review and interpret latest scientific evidence for clinical indications and how to approach long-term management. Recent Findings CNA is a new approach that has been supported mainly by retrospective or observational data for its use in syncope. Overall, in mixed population studies treated with CNA, 83.3 to 100% have been reported to be free of syncope over follow-up periods of 6 to 52.1 months. For studies including patients who underwent CNA with pure VVS, 73.2 to 100% have been reported to be syncope-free over follow-up periods of 4 to 45.1 months. One large meta-analysis showed 91.9% freedom from syncope after CAN. To date, only one randomized controlled trial with small case number has been performed of CNA compared to non-pharmacological treatment in VVS. In this study of 48 patients with an average of 10 ± 9 spontaneous syncopal episodes prior to study enrollment and 3 ± 2 episodes in the year prior to CNA. After CNA, 92% were free of syncope compared with 46% treated with optimal non-pharmacological treatment to prevent new syncope episodes (P = 0.0004). To date, most studies have included younger patients (< 60 years of age). There are only limited data in patients older than 60, and some studies suggest less of an effect in relatively older patients. Summary Cardioneuroablation can be performed to decrease syncope recurrence in adult patients aged < 60 years, with severe or recurrent cardioinhibitory syncope without prodromal symptoms, after proven failure of conventional therapies. Due to a paucity of data supporting efficacy in older individuals or for vasodepressor components, CNA in adult patients aged > 60 years or in the presence of a dominant vasodepressor should be considered investigational in severely symptomatic patients after proven failure of pharmacological and non-pharmacological therapies.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Faculty of Medicine, Yeditepe University Hospital, Istanbul 34742, Turkey
| | - Mina K. Chung
- Heart, Vascular, and Thoracic Institute, and Lerner Research Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
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Rast J, Sohinki D, Warner A. Non-invasive Neuromodulation of Arrhythmias. J Innov Card Rhythm Manag 2024; 15:5757-5766. [PMID: 38444451 PMCID: PMC10911637 DOI: 10.19102/icrm.2024.15022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/28/2023] [Indexed: 03/07/2024] Open
Abstract
Dysfunction of the cardiac autonomic nervous system (CANS) is associated with various cardiac arrhythmias. Subsequently, invasive techniques have successfully targeted the CANS for the treatment of certain arrhythmias, such as sympathetic denervation for ventricular tachycardia storm. Non-invasive strategies capable of modulating the CANS for arrhythmia treatment have begun to gain interest due to their low-risk profile and applicability as an adjuvant therapy. This review provides an evidence-based overview of the currently studied technologies capable of non-invasively modulating CANS for the suppression of atrial fibrillation and ventricular arrhythmias.
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O’Brien B, Reilly J, Coffey K, González-Suárez A, Buchta P, Buszman PP, Lukasik K, Tri J, van Zyl M, Asirvatham S. Epicardial Pulsed Field Ablation of Ganglionated Plexi: Computational and Pre-Clinical Evaluation of a Bipolar Sub-Xiphoid Catheter for the Treatment of Atrial Fibrillation. Bioengineering (Basel) 2023; 11:18. [PMID: 38247895 PMCID: PMC10813135 DOI: 10.3390/bioengineering11010018] [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: 11/15/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Epicardial pulsed field ablation (PFA) of ganglionated plexi (GPs) is being explored as a potential treatment for atrial fibrillation. Initial work using open-chest access with a monopolar ablation device has been completed. This study describes the early development work for a device that can be used with subxiphoid access and deliver bipolar ablation pulses. Electric field computational models have been used for the initial guidance on pulse parameters. An in vivo assessment of these ablation parameters has been performed in an open-chest canine study, while subxiphoid access and navigation of the device has been demonstrated in a porcine model. Results from this acute study have demonstrated the promising potential of this approach.
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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
- Translational Medical Device Laboratory, School of Medicine, University of Galway, H91 YR71 Galway, Ireland
- Valencian International University, Valencia, Spain
| | - Piotr Buchta
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Silesian Center for Heart Diseases, 41-800 Zabrze, Poland
- Center for Cardiovascular Research and Development, American Heart of Poland, Kostkowice, Poland
| | - Piotr P. Buszman
- Center for Cardiovascular Research and Development, American Heart of Poland, Kostkowice, Poland
- Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland
| | - Karolina Lukasik
- Center for Cardiovascular Research and Development, American Heart of Poland, Kostkowice, Poland
| | - Jason Tri
- Mayo Clinic, Rochester, MN 55905, USA
| | - Martin van Zyl
- Royal Jubilee Hospital, University of British Columbia, Victoria, BC, Canada
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Senapati SG, Bhanushali AK, Lahori S, Naagendran MS, Sriram S, Ganguly A, Pusa M, Damani DN, Kulkarni K, Arunachalam SP. Mapping of Neuro-Cardiac Electrophysiology: Interlinking Epilepsy and Arrhythmia. J Cardiovasc Dev Dis 2023; 10:433. [PMID: 37887880 PMCID: PMC10607576 DOI: 10.3390/jcdd10100433] [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: 07/16/2023] [Revised: 08/10/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
The interplay between neurology and cardiology has gained significant attention in recent years, particularly regarding the shared pathophysiological mechanisms and clinical comorbidities observed in epilepsy and arrhythmias. Neuro-cardiac electrophysiology mapping involves the comprehensive assessment of both neural and cardiac electrical activity, aiming to unravel the intricate connections and potential cross-talk between the brain and the heart. The emergence of artificial intelligence (AI) has revolutionized the field by enabling the analysis of large-scale data sets, complex signal processing, and predictive modeling. AI algorithms have been applied to neuroimaging, electroencephalography (EEG), electrocardiography (ECG), and other diagnostic modalities to identify subtle patterns, classify disease subtypes, predict outcomes, and guide personalized treatment strategies. In this review, we highlight the potential clinical implications of neuro-cardiac mapping and AI in the management of epilepsy and arrhythmias. We address the challenges and limitations associated with these approaches, including data quality, interpretability, and ethical considerations. Further research and collaboration between neurologists, cardiologists, and AI experts are needed to fully unlock the potential of this interdisciplinary field.
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Affiliation(s)
- Sidhartha G. Senapati
- Department of Internal Medicine, Texas Tech University Health and Sciences Center, El Paso, TX 79905, USA; (S.G.S.); (D.N.D.)
| | - Aditi K. Bhanushali
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; (A.K.B.); (S.L.)
| | - Simmy Lahori
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; (A.K.B.); (S.L.)
| | | | - Shreya Sriram
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Arghyadeep Ganguly
- Department of Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49007, USA;
| | - Mounika Pusa
- Mamata Medical College, Khammam 507002, Telangana, India;
| | - Devanshi N. Damani
- Department of Internal Medicine, Texas Tech University Health and Sciences Center, El Paso, TX 79905, USA; (S.G.S.); (D.N.D.)
- Department of Cardiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Kanchan Kulkarni
- IHU-LIRYC, Heart Rhythm Disease Institute, Fondation Bordeaux Université, Pessac, 33600 Bordeaux, France;
- INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, U1045, 33000 Bordeaux, France
| | - Shivaram P. Arunachalam
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; (A.K.B.); (S.L.)
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Almeida S. Cardioneuroablation: A game-changer for vasovagal syncope. Rev Port Cardiol 2023; 42:831-833. [PMID: 37263497 DOI: 10.1016/j.repc.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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Pauziene N, Ranceviene D, Rysevaite-Kyguoliene K, Ragauskas T, Inokaitis H, Sabeckis I, Plekhanova K, Khmel O, Pauza DH. Neurochemical alterations of intrinsic cardiac ganglionated nerve plexus caused by arterial hypertension developed during ageing in spontaneously hypertensive and Wistar Kyoto rats. J Anat 2023; 243:630-647. [PMID: 37083051 PMCID: PMC10485580 DOI: 10.1111/joa.13877] [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] [Received: 01/06/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
The acknowledged hypothesis of the cause of arterial hypertension is the emerging disbalance in sympathetic and parasympathetic regulations of the cardiovascular system. This disbalance manifests in a disorder of sustainability of endogenous autonomic and sensory neural substances including calcitonin gene-related peptide (CGRP). This study aimed to examine neurochemical alterations of intrinsic cardiac ganglionated nerve plexus (GP) triggered by arterial hypertension during ageing in spontaneously hypertensive rats of juvenile (prehypertensive, 8-9 weeks), adult (early hypertensive, 12-18 weeks) and elderly (persistent hypertensive, 46-60 weeks) age in comparison with the age-matched Wistar-Kyoto rats as controls. Parasympathetic, sympathetic and sensory neural structures of GP were analysed and evaluated morphometrically in tissue sections and whole-mount cardiac preparations. Both the elevated blood pressure and the evident ultrasonic signs of heart failure were identified for spontaneously hypertensive rats and in part for the aged control rats. The amount of adrenergic and immunoreactive to CGRP neural structures was increased in the adult group of spontaneously hypertensive rats along with the significant alterations that occurred during ageing. In conclusion, the revealed chemical alterations of GP support the hypothesis about the possible disbalance of efferent and afferent heart innervation and may be considered as the basis for the emergence and progression of arterial hypertension and perhaps even as a consequence of hypertension in the aged spontaneously hypertensive rats. The determined anatomical changes in the ageing Wistar-Kyoto rats suggest this breed being as inappropriate for its use as control animals for hypertension studies in older animal age.
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Affiliation(s)
- Neringa Pauziene
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dalia Ranceviene
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Tomas Ragauskas
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Hermanas Inokaitis
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ignas Sabeckis
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Khrystyna Plekhanova
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Olena Khmel
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dainius H Pauza
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
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12
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Lother A, Kohl P. The heterocellular heart: identities, interactions, and implications for cardiology. Basic Res Cardiol 2023; 118:30. [PMID: 37495826 PMCID: PMC10371928 DOI: 10.1007/s00395-023-01000-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
The heterocellular nature of the heart has been receiving increasing attention in recent years. In addition to cardiomyocytes as the prototypical cell type of the heart, non-myocytes such as endothelial cells, fibroblasts, or immune cells are coming more into focus. The rise of single-cell sequencing technologies enables identification of ever more subtle differences and has reignited the question of what defines a cell's identity. Here we provide an overview of the major cardiac cell types, describe their roles in homeostasis, and outline recent findings on non-canonical functions that may be of relevance for cardiology. We highlight modes of biochemical and biophysical interactions between different cardiac cell types and discuss the potential implications of the heterocellular nature of the heart for basic research and therapeutic interventions.
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Affiliation(s)
- Achim Lother
- Institute of Experimental and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Freiburg, Albertstr. 25, 79104, Freiburg, Germany.
- Interdisciplinary Medical Intensive Care, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.
| | - Peter Kohl
- Institute for Experimental Cardiovascular Medicine, Faculty of Medicine, University Heart Center, University of Freiburg, Freiburg, Germany
- CIBSS Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
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13
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Hernandez I, Ramirez SP, Salazar WV, Mendivil S, Guevara A, Patel A, Loyola CD, Dorado ZN, Joddar B. A Semi-Three-Dimensional Bioprinted Neurocardiac System for Tissue Engineering of a Cardiac Autonomic Nervous System Model. Bioengineering (Basel) 2023; 10:834. [PMID: 37508861 PMCID: PMC10376081 DOI: 10.3390/bioengineering10070834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
In this study, we designed a tissue-engineered neurocardiac model to help us examine the role of neuronal regulation and confirm the importance of neural innervation techniques for the regeneration of cardiac tissue. A three-dimensional (3D) bioprinted neurocardiac scaffold composed of a mixture of gelatin-alginate and alginate-genipin-fibrin hydrogels was developed with a 2:1 ratio of AC16 cardiomyocytes (CMs) and retinoic acid-differentiated SH-SY5Y neuronal cells (NCs) respectively. A unique semi-3D bioprinting approach was adopted, where the CMs were mixed in the cardiac bioink and printed using an anisotropic accordion design to mimic the physiological tissue architecture in vivo. The voids in this 3D structure were methodically filled in using a NC-gel mixture and crosslinked. Confocal fluorescent imaging using microtubule-associated protein 2 (MAP-2) and anticholine acetyltransferase (CHAT) antibodies for labeling the NCs and the MyoD1 antibody for the CMs revealed functional coupling between the two cell types in the final crosslinked structure. These data confirmed the development of a relevant neurocardiac model that could be used to study neurocardiac modulation under physiological and pathological conditions.
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Affiliation(s)
- Ivana Hernandez
- Inspired Materials and Stem-Cell Based Tissue Engineering Laboratory (IMSTEL), The University of Texas at El Paso, El Paso, TX 79968, USA
- Department of Metallurgical, Materials and Biomedical Engineering, M201 Engineering, The University of Texas at El Paso, 500 W. University Avenue, El Paso, TX 79968, USA
| | - Salma P Ramirez
- Inspired Materials and Stem-Cell Based Tissue Engineering Laboratory (IMSTEL), The University of Texas at El Paso, El Paso, TX 79968, USA
- Department of Metallurgical, Materials and Biomedical Engineering, M201 Engineering, The University of Texas at El Paso, 500 W. University Avenue, El Paso, TX 79968, USA
| | - Wendy V Salazar
- Inspired Materials and Stem-Cell Based Tissue Engineering Laboratory (IMSTEL), The University of Texas at El Paso, El Paso, TX 79968, USA
| | - Sarahi Mendivil
- Inspired Materials and Stem-Cell Based Tissue Engineering Laboratory (IMSTEL), The University of Texas at El Paso, El Paso, TX 79968, USA
| | - Andrea Guevara
- Inspired Materials and Stem-Cell Based Tissue Engineering Laboratory (IMSTEL), The University of Texas at El Paso, El Paso, TX 79968, USA
| | - Akshay Patel
- Inspired Materials and Stem-Cell Based Tissue Engineering Laboratory (IMSTEL), The University of Texas at El Paso, El Paso, TX 79968, USA
- Department of Chemical Engineering, University of California, Santa Barbara, CA 93106, USA
| | - Carla D Loyola
- Inspired Materials and Stem-Cell Based Tissue Engineering Laboratory (IMSTEL), The University of Texas at El Paso, El Paso, TX 79968, USA
- Department of Metallurgical, Materials and Biomedical Engineering, M201 Engineering, The University of Texas at El Paso, 500 W. University Avenue, El Paso, TX 79968, USA
| | - Zayra N Dorado
- Inspired Materials and Stem-Cell Based Tissue Engineering Laboratory (IMSTEL), The University of Texas at El Paso, El Paso, TX 79968, USA
- Department of Metallurgical, Materials and Biomedical Engineering, M201 Engineering, The University of Texas at El Paso, 500 W. University Avenue, El Paso, TX 79968, USA
| | - Binata Joddar
- Inspired Materials and Stem-Cell Based Tissue Engineering Laboratory (IMSTEL), The University of Texas at El Paso, El Paso, TX 79968, USA
- Department of Metallurgical, Materials and Biomedical Engineering, M201 Engineering, The University of Texas at El Paso, 500 W. University Avenue, El Paso, TX 79968, USA
- Border Biomedical Research Center, The University of Texas at El Paso, 500 W. University Avenue, El Paso, TX 79968, USA
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14
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Li L, Po S, Yao Y. Cardioneuroablation for Treating Vasovagal Syncope: Current Status and Future Directions. Arrhythm Electrophysiol Rev 2023; 12:e18. [PMID: 37457436 PMCID: PMC10345939 DOI: 10.15420/aer.2023.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/05/2023] [Indexed: 07/18/2023] Open
Abstract
Syncope is defined by transient and spontaneous loss of consciousness with rapid recovery. Vasovagal syncope (VVS) is the most common form of syncope and is strongly associated with hypervagotonia. There is, however, a lack of effective therapies for VVS. Cardioneuroablation (CNA) is an emerging and promising intervention for VVS with favourable outcomes. CNA has been shown to suppress excessive excitation of vagal activity through ablating the cardiac ganglionated plexi. CNA in the management of VVS requires more structured and comprehensive studies and several issues concerning patient selection, selection of ablation targets, ablation endpoints and the long-term effect of CNA are yet to be determined. This review describes its clinical applications and future directions based on current research data and the authors' own experiences.
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Affiliation(s)
- Le Li
- Cardiac Arrhythmia Center, Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Sunny Po
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, US
| | - Yan Yao
- Cardiac Arrhythmia Center, Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
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15
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Pachon-M J, Pachon E, Aksu T, Gopinathannair R, Kautzner J, Yao Y, Kusumoto F. Cardioneuroablation: where are we at? Heart Rhythm O2 2023. [DOI: 10.1016/j.hroo.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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16
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Świerżyńska E, Oręziak A, Główczyńska R, Rossillo A, Grabowski M, Szumowski Ł, Caprioglio F, Sterliński M. Rate-Responsive Cardiac Pacing: Technological Solutions and Their Applications. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23031427. [PMID: 36772467 PMCID: PMC9920425 DOI: 10.3390/s23031427] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 05/12/2023]
Abstract
Modern cardiac pacemakers are equipped with a function that allows the heart rate to adapt to the current needs of the patient in situations of increased demand related to exercise and stress ("rate-response" function). This function may be based on a variety of mechanisms, such as a built-in accelerometer responding to increased chest movement or algorithms sensing metabolic demand for oxygen, analysis of intrathoracic impedance, and analysis of the heart rhythm (Q-T interval). The latest technologies in the field of rate-response functionality relate to the use of an accelerometer in leadless endocavitary pacemakers; in these devices, the accelerometer enables mapping of the mechanical wave of the heart's work cycle, enabling the pacemaker to correctly sense native impulses and stimulate the ventricles in synchrony with the cycles of atria and heart valves. Another modern system for synchronizing pacing rate with the patient's real-time needs requires a closed-loop system that continuously monitors changes in the dynamics of heart contractions. This article discusses the technical details of various solutions for detecting and responding to situations related to increased oxygen demand (e.g., exercise or stress) in implantable pacemakers, and reviews the results of clinical trials regarding the use of these algorithms.
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Affiliation(s)
- Ewa Świerżyńska
- Department of Arrhythmia, The Cardinal Stefan Wyszynski National Institute of Cardiology, 04-628 Warsaw, Poland
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
- Correspondence:
| | - Artur Oręziak
- Department of Arrhythmia, The Cardinal Stefan Wyszynski National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Renata Główczyńska
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Antonio Rossillo
- Department of Cardiology, San Bortolo Hospital, 36100 Vicenza, Italy
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Łukasz Szumowski
- Department of Arrhythmia, The Cardinal Stefan Wyszynski National Institute of Cardiology, 04-628 Warsaw, Poland
| | | | - Maciej Sterliński
- Department of Arrhythmia, The Cardinal Stefan Wyszynski National Institute of Cardiology, 04-628 Warsaw, Poland
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17
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Han J, Zhang Y, Wang X, Zhang G, Yu Z, Wang C, Xu T, Zhou Z, Yang X, Jin X, Liu C, Zhou L, Wang Y, Tang B, Guo S, Jiang H, Yu L. Ultrasound-mediated piezoelectric nanoparticle modulation of intrinsic cardiac autonomic nervous system for rate control in atrial fibrillation. Biomater Sci 2023; 11:655-665. [PMID: 36511142 DOI: 10.1039/d2bm01733d] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Rate control is a cornerstone of atrial fibrillation treatment. Barium titanate nanoparticles (BTNPs) are piezoelectric nanomaterials that can generate local electromagnetic fields under ultrasound activation, stimulating nearby neuronal tissue. This study aimed to modulate the inferior right ganglionated plexus (IRGP) of the heart and reduce the ventricular rate during rapid atrial pacing (RAP)-induced atrial fibrillation using ultrasound-mediated BTNPs. Adult male beagles were randomly divided into a phosphate-buffered saline (PBS) group (n = 6) and a BTNP group (n = 6). PBS or nanoparticles were injected into the IRGP of both groups before RAP. The biological safety of the material was evaluated according to electrophysiology recordings, thermal effects and level of inflammation. Compared to the PBS group, the BaTiO3 piezoelectric nanoparticle group had reduced ventricular rates in the sinus rhythm and atrial fibrillation models after stimulating the IRGP by applying ultrasound. In addition, transient stimulation by BTNPs did not lead to sustained neuronal excitation in the IRGP. The activation of the BTNPs did not induce inflammation or thermal damage effects in the IRGP. Ultrasound-mediated BTNP neuromodulation can significantly reduce the ventricular rate by stimulating the IRGP. Thus, ultrasound-mediated BTNP neuromodulation is a potential therapy for atrial fibrillation rate control.
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Affiliation(s)
- Jiapeng Han
- Department of Cardiology, Renmin Hospital of Wuhan University; Hubei Key Laboratory of Autonomic Nervous System Modulation; Cardiac Autonomic Nervous System Research Center of Wuhan University; Taikang Center for Life and Medical Sciences, Wuhan University; Institute of Molecular Medicine, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China.
| | - Yuanzheng Zhang
- Hubei Yangtze Memory Laboratories, Wuhan 430205, PR China; Key Laboratory of Artificial Micro, and Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan 430072, PR China.
| | - Xiaofei Wang
- Department of Cardiology, Renmin Hospital of Wuhan University; Hubei Key Laboratory of Autonomic Nervous System Modulation; Cardiac Autonomic Nervous System Research Center of Wuhan University; Taikang Center for Life and Medical Sciences, Wuhan University; Institute of Molecular Medicine, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China.
| | - Guocheng Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University; Hubei Key Laboratory of Autonomic Nervous System Modulation; Cardiac Autonomic Nervous System Research Center of Wuhan University; Taikang Center for Life and Medical Sciences, Wuhan University; Institute of Molecular Medicine, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China.
| | - Zhiyao Yu
- Department of Cardiology, Renmin Hospital of Wuhan University; Hubei Key Laboratory of Autonomic Nervous System Modulation; Cardiac Autonomic Nervous System Research Center of Wuhan University; Taikang Center for Life and Medical Sciences, Wuhan University; Institute of Molecular Medicine, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China.
| | - Changyi Wang
- Department of Cardiology, Renmin Hospital of Wuhan University; Hubei Key Laboratory of Autonomic Nervous System Modulation; Cardiac Autonomic Nervous System Research Center of Wuhan University; Taikang Center for Life and Medical Sciences, Wuhan University; Institute of Molecular Medicine, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China.
| | - Tianyou Xu
- Department of Cardiology, Renmin Hospital of Wuhan University; Hubei Key Laboratory of Autonomic Nervous System Modulation; Cardiac Autonomic Nervous System Research Center of Wuhan University; Taikang Center for Life and Medical Sciences, Wuhan University; Institute of Molecular Medicine, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China.
| | - Zhen Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University; Hubei Key Laboratory of Autonomic Nervous System Modulation; Cardiac Autonomic Nervous System Research Center of Wuhan University; Taikang Center for Life and Medical Sciences, Wuhan University; Institute of Molecular Medicine, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China.
| | - Xiaomeng Yang
- Department of Cardiology, Renmin Hospital of Wuhan University; Hubei Key Laboratory of Autonomic Nervous System Modulation; Cardiac Autonomic Nervous System Research Center of Wuhan University; Taikang Center for Life and Medical Sciences, Wuhan University; Institute of Molecular Medicine, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China.
| | - Xiaoxing Jin
- Department of Cardiology, Renmin Hospital of Wuhan University; Hubei Key Laboratory of Autonomic Nervous System Modulation; Cardiac Autonomic Nervous System Research Center of Wuhan University; Taikang Center for Life and Medical Sciences, Wuhan University; Institute of Molecular Medicine, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China.
| | - Chenzhe Liu
- Department of Cardiology, Renmin Hospital of Wuhan University; Hubei Key Laboratory of Autonomic Nervous System Modulation; Cardiac Autonomic Nervous System Research Center of Wuhan University; Taikang Center for Life and Medical Sciences, Wuhan University; Institute of Molecular Medicine, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China.
| | - Liping Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University; Hubei Key Laboratory of Autonomic Nervous System Modulation; Cardiac Autonomic Nervous System Research Center of Wuhan University; Taikang Center for Life and Medical Sciences, Wuhan University; Institute of Molecular Medicine, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China.
| | - Yueyi Wang
- Department of Cardiology, Renmin Hospital of Wuhan University; Hubei Key Laboratory of Autonomic Nervous System Modulation; Cardiac Autonomic Nervous System Research Center of Wuhan University; Taikang Center for Life and Medical Sciences, Wuhan University; Institute of Molecular Medicine, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China.
| | - Baopeng Tang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urmuqi, Xinjiang 830011, P.R. China.
| | - Shishang Guo
- Hubei Yangtze Memory Laboratories, Wuhan 430205, PR China; Key Laboratory of Artificial Micro, and Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan 430072, PR China.
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University; Hubei Key Laboratory of Autonomic Nervous System Modulation; Cardiac Autonomic Nervous System Research Center of Wuhan University; Taikang Center for Life and Medical Sciences, Wuhan University; Institute of Molecular Medicine, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China.
| | - Lilei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University; Hubei Key Laboratory of Autonomic Nervous System Modulation; Cardiac Autonomic Nervous System Research Center of Wuhan University; Taikang Center for Life and Medical Sciences, Wuhan University; Institute of Molecular Medicine, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China.
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18
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Piotrowski R, Baran J, Sikorska A, Krynski T, Kulakowski P. Cardioneuroablation for Reflex Syncope: Efficacy and Effects on Autonomic Cardiac Regulation-A Prospective Randomized Trial. JACC Clin Electrophysiol 2023; 9:85-95. [PMID: 36114133 DOI: 10.1016/j.jacep.2022.08.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/05/2022] [Accepted: 08/15/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Treatment of cardioinhibitory vasovagal syncope (VVS) is difficult. Recently, cardioneuroablation (CNA) has emerged as a new therapeutic option. OBJECTIVES This study sought to assess the effects of CNA on syncope recurrences in patients with VVS. METHODS This study was a prospective, open, randomized, controlled, investigator-initiated trial comparing CNA versus optimal nonpharmacologic therapy in patients with cardioinhibitory VVS. Patients were included if they had documented symptomatic cardioinhibitory or mixed VVS and positive atropine test. CNA was performed using radiofrequency ablation of the ganglionated plexi from the left and right atria. Follow-up lasted 2 years. Primary endpoint was time to first syncope recurrence. Secondary endpoints included changes in sinus rhythm and heart rate variability measured in Holter electrocardiography at baseline and 3, 12, and 24 months after CNA, as well as changes in quality of life at baseline and after completion of follow-up. RESULTS A total of 48 patients (17 male, mean age 38 ± 10 years, 24 in CNA group, 24 in control group) entered the study. The primary endpoint occurred in 2 patients (8%) from the CNA group versus 13 control patients (54%) (P = 0.0004). After CNA the mean sinus rhythm at 24-hour Holter electrocardiography was significantly faster and heart rate variability parameters significantly changed toward parasympathetic withdrawal compared with baseline values. Quality of life significantly improved in the CNA group (30 ± 10 points vs 10 ± 7 points; P = 0.0001), whereas it remained stable in control patients (31 ± 10 points vs 30 ± 10 points; P = 0.5501). CONCLUSIONS This is the first randomized study documenting efficacy of CNA in patients with cardioinhibitory VVS. Larger studies are needed to confirm these findings. (Cardioneuroablation for Reflex Syncope [ROMAN]; NCT03903744).
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Affiliation(s)
- Roman Piotrowski
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland.
| | - Jakub Baran
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Agnieszka Sikorska
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Tomasz Krynski
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Piotr Kulakowski
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
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19
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Aksu T, Skeete JR, Huang HH. Ganglionic Plexus Ablation: A Step-by-step Guide for Electrophysiologists and Review of Modalities for Neuromodulation for the Management of Atrial Fibrillation. Arrhythm Electrophysiol Rev 2023; 12:e02. [PMID: 36845167 PMCID: PMC9945432 DOI: 10.15420/aer.2022.37] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/29/2022] [Indexed: 02/01/2023] Open
Abstract
As the most common sustained arrhythmia, AF is a complex clinical entity which remains a difficult condition to durably treat in the majority of patients. Over the past few decades, the management of AF has focused mainly on pulmonary vein triggers for its initiation and perpetuation. It is well known that the autonomic nervous system (ANS) has a significant role in the milieu predisposing to the triggers, perpetuators and substrate for AF. Neuromodulation of ANS - ganglionated plexus ablation, vein of Marshall ethanol infusion, transcutaneous tragal stimulation, renal nerve denervation, stellate ganglion block and baroreceptor stimulation - constitute an emerging therapeutic approach for AF. The purpose of this review is to summarise and critically appraise the currently available evidence for neuromodulation modalities in AF.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | | | - Henry H Huang
- Department of Cardiology, Rush Medical College, Chicago, IL, US
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20
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Baysal E, Mutluer FO, Dagsali AE, Kumrulu UC, Huang HD, Aksu T. Improved health-related quality of life after cardioneuroablation in patients with vasovagal syncope. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01420-9. [PMID: 36357697 DOI: 10.1007/s10840-022-01420-9] [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: 09/22/2022] [Accepted: 11/04/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND As the most common cause of syncope, vasovagal syncope (VVS) is mediated by parasympathetic overactivity and/or sympathetic withdrawal. Although catheter ablation of ganglionated plexi or cardioneuroablation has been used to treat VVS, its role in quality of life (QoL) has not been formally evaluated. The aim of this study was to demonstrate if this novel treatment results in improvement QoL of patients with VVS. METHODS Twenty-seven consecutive patients (age: 34 ± 14 years, 51.8% male) with dominant cardioinhibitory type VVS were prospectively enrolled in the study. After confirmation of > 3 s asystole on head-up tilt testing (HUT), all patients underwent cardioneuroablation. ECGs were obtained prior to procedure and at 12-month follow-up visit. HUTs were repeated 1 month after cardioneuroablation procedures. QoL was assessed with the use of SF-36, EQ-5D, and EQ VAS questionnaires. RESULTS ECG, HUT, and QoL data were available in all patients. At 12-month follow-up, heart rate on rest ECG significantly increased (from 74 ± 15 to 84 ± 14 bpm, p = 0.003). Repeated HUTs were negative in 23 (85.1%) patients. All of 27 patients remained free of syncope. QoL assessed by SF-36 score significantly improved in postprocedural follow-up (92 ± 9 and 96 ± 11, p = 0.016). Similarly, significant improvements in mobility, self-care, and usual activity domains of EQ-5D were observed (mean scores of 3.0 ± 1.5 and 2.1 ± 1.3, p < 0.001; 1.3 ± 0.9 and 1.2 ± 0.6, p = 0.041; 1.7 ± 1.0 and 1.4 ± 0.8 respectively). EQ-VAS score also improved significantly (39 ± 24 to 77 ± 18, p < 0.001). CONCLUSION Our findings suggest that cardioneuroablation may be associated with intermediate term improvement in QoL in patients with VVS.
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Affiliation(s)
- Erkan Baysal
- Department of Cardiology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.
| | - Ferit Onur Mutluer
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | | | | | - Henry D Huang
- Department of Cardiology, Rush Medical College, Chicago, IL, USA
| | - Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
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21
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Abstract
INTRODUCTION Cardioneuroablation is increasingly being utilized to improve outcomes in patients with vagally mediated bradyarrhythmias. However, there are still controversial issues in the field including patient selection, safety and efficacy, and procedural end-points. AREAS COVERED In this review, the current role of cardioneuroablation is summarized, and controversial issues related to the modality are discussed. EXPERT OPINION According to small open-label cohort studies, overall freedom from syncope recurrence was higher than 90% after cardioneuroablation in patients with vasovagal syncope (VVS). Use of the electrogram-based strategy or high-frequency stimulation demonstrate similar success rate except in procedures limited to the right atrium. Based on a recently published randomized controlled trial and metanalysis, it may be possible now to make a strong recommendation for cardioneuroablation in patients <40 years of age, and those with the cardioinhibitory or mixed type of VVS who continue to experience frequent and/or burdensome syncope recurrences. Considering patients with VVS are prone to significant placebo/expectation effect, sham-controlled trials may help to quantify the placebo effect. In well-selected patients with functional atrioventricular block and sinus bradycardia, may result in encouraging medium-term outcomes. However, functional bradycardia is identified in a minority of patients presenting with high-grade atrioventricular block or sinus node dysfunction.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Asad Khan
- Department of Cardiology, Rush Medical College, Chicago, IL, USA
| | - Henry Huang
- Department of Cardiology, Rush Medical College, Chicago, IL, USA
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22
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Bufo MR, Guidotti M, De Faria C, Mofid Y, Bonnet-Brilhault F, Wardak C, Aguillon-Hernandez N. Autonomic tone in children and adults: Pupillary, electrodermal and cardiac activity at rest. Int J Psychophysiol 2022; 180:68-78. [PMID: 35914548 DOI: 10.1016/j.ijpsycho.2022.07.009] [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] [Received: 03/14/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
Considering the suspected involvement of the autonomic nervous system (ANS) in several neurodevelopmental disorders, a description of its tonus in typical populations and of its maturation between childhood and adulthood is necessary. We aimed to arrive at a better understanding of the maturation of the sympathetic (SNS) and parasympathetic (PNS) tonus by comparing children and adults at rest, via recordings of multiple ANS indices. We recorded simultaneously pupil diameter, electrodermal activity (EDA) and cardiac activity (RR interval and HRV: heart rate variability) in 29 children (6-12 years old) and 30 adults (20-42 years old) during a 5-min rest period. Children exhibited lower RR intervals, higher LF peak frequencies, and lower LF/HF (low frequency/high frequency) ratios compared to adults. Children also produced more spontaneous EDA peaks, reflected in a larger EDA AUC (area under the curve), in comparison with adults. Finally, children displayed a larger median pupil diameter and a higher pupillary hippus frequency than adults. Our results converged towards higher SNS and PNS tones in children compared to adults. Childhood would thus be characterized by a high autonomic tone, possibly reflecting a physiological state compatible with developmental acquisitions.
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Affiliation(s)
- Maria Rosa Bufo
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Marco Guidotti
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; Centre universitaire de pédopsychiatrie, CHRU de Tours, Tours, France; Centre Hospitalier du Chinonais, Saint-Benoît-la-Forêt, France
| | - Cindie De Faria
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Yassine Mofid
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Frédérique Bonnet-Brilhault
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; Centre universitaire de pédopsychiatrie, CHRU de Tours, Tours, France
| | - Claire Wardak
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
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Aksu T, Yalin K, Mutluer FO, Farhat K, Tanboga HI, Po SS, Stavrakis S. The impact of the clinical diagnosis on the vagal response and heart rate after ganglionated plexus ablation. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01270-5. [PMID: 35752732 DOI: 10.1007/s10840-022-01270-5] [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: 04/24/2022] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Ganglionated plexi (GP) ablation may be associated with improved syncope or arrhythmia-free survival arrhythmia patients with vasovagal syncope (VVS) and atrial fibrillation (AF), respectively. We aimed to compare the characteristics of vagal response (VR) and clarify the effect on heart rate after GP ablation based on clinical diagnosis. METHODS A total of 83 consecutive patients undergoing GP ablation were divided following two groups: (1) GP ablation for VVS (VVS group, n = 43) and (2) GP ablation in addition to pulmonary vein isolation (AF group, n = 40). We examined VR characteristics during RF ablation and high frequency stimulation, respectively, in the VVS and AF groups. To evaluate immediate and long-term heart rate response, a standard 12-lead ECG was obtained at baseline at 24 h after ablation and at the last follow-up visit. RESULTS In the VVS group, the superior and inferior left atrial GPs were the most common GP sites at which a VR was observed. No VR was seen during radiofrequency application in the superior and inferior right atrial GPs in the VVS group. On the contrary, VR was more prevalent in the right-sided GPs during high-frequency stimulation in the AF group. VR was observed during ablation in only one patient with AF. Although the heart rate increased significantly after ablation in both groups, the effect was more prominent and durable in the VVS group. CONCLUSIONS The autonomic response during GP ablation is different in VVS compared to AF, suggesting that VVS and AF may represent distinct forms of autonomic hyperactivity.
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Affiliation(s)
- Tolga Aksu
- Faculty of Medicine, Yeditepe University, Istanbul, Turkey.
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey.
| | - Kivanc Yalin
- Cerrahpasa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | | | - Kassem Farhat
- University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | | | - Sunny S Po
- University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Stavros Stavrakis
- University of Oklahoma Health Science Center, Oklahoma City, OK, USA
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24
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Kim MY, Aksu T. Ganglionated plexus ablation and pulmonary vein isolation: the future of AF ablation. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01253-6. [PMID: 35593930 DOI: 10.1007/s10840-022-01253-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Min-Young Kim
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, 34742, Turkey.
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Cardioneuroablation for vagally mediated bradyarrhythmias: Are we there yet? Heart Rhythm 2022; 19:1253-1254. [PMID: 35597424 DOI: 10.1016/j.hrthm.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022]
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Aksu T, Gupta D, D'Avila A, Morillo CA. Cardioneuroablation for Vasovagal Syncope and Atrioventricular Block: A Step-by-Step Guide. J Cardiovasc Electrophysiol 2022; 33:2205-2212. [PMID: 35362165 DOI: 10.1111/jce.15480] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022]
Abstract
Catheter based cardioneuroablation is increasingly being utilized to improve outcomes in patients with vasovagal syncope and atrioventricular block due to vagal hyperactivity. There is now increasing convergence amongst enthusiasts on its various aspects, including patient selection, technical steps, and procedural end-points. This pragmatic review aims to take the reader through a step-by-step approach to cardioneuroablation: we begin with a brief overview of the anatomy of intrinsic cardiac autonomic nervous system, before focusing on the indications, pre- and post-procedure management, necessary equipment, and its potential limitations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Tolga Aksu
- Yeditepe University Hospital, Department of Cardiology, Istanbul, Turkey
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Andre D'Avila
- Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Carlos A Morillo
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Kuniewicz M, Karkowski G, Gosnell M, Goncerz G, Badacz R, Rajs T, Legutko J. Anatomical and electrophysiological localization of ganglionated plexi using high-density 3D CARTO mapping system. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ragauskas T, Rysevaite-Kyguoliene K, Pauziene N, Inokaitis H, Pauza DH. Chemical phenotypes of intrinsic cardiac neurons in the newborn pig (Sus scrofa domesticus Erxleben, 1777). J Morphol 2021; 283:51-65. [PMID: 34727377 DOI: 10.1002/jmor.21426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/28/2021] [Accepted: 10/30/2021] [Indexed: 11/12/2022]
Abstract
Intrinsic cardiac neurons (ICNs) are crucial cells in the neural regulation of heart rhythm, myocardial contractility, and coronary blood flow. ICNs exhibit diversity in their morphology and neurotransmitters that probably are age-dependent. Therefore, neuroanatomical heart studies have been currently focused on the identification of chemical phenotypes of ICNs to disclose their possible functions in heart neural regulation. Employing whole-mount immunohistochemistry, we examined ICNs from atria of the newborn pigs (Sus scrofa domesticus) as ICNs at this stage of development have never been neurochemically characterized so far. We found that the majority of the examined ICNs (>60%) were of cholinergic phenotype. Biphenotypic neuronal somata (NS), that is, simultaneously positive for two neuronal markers, were also rather common and distributed evenly within the sampled ganglia. Simultaneous positivity for cholinergic and adrenergic neuromarkers was specific in 16.4%, for cholinergic and nitrergic-in 3.5% of the examined NS. Purely either adrenergic or nitrergic ICNs were observed at 13% and 3.1%, correspondingly. Purely adrenergic and nitrergic NS were the most frequent in the ventral left atrial subplexus. Similarly to neuronal phenotype, sizes of NS also varied depending on the atrial region providing insights into their functional implications. Axons, but not NS, positive for classic sensory neuronal markers (vesicular glutamate transporter 2 and calcitonin gene-related peptide) were identified within epicardiac nerves and ganglia. Moreover, a substantial number of ICNs could not be attributed to any phenotype as they were not immunoreactive for antisera used in this study. Numerous dendrites with putative peptidergic and adrenergic contacts on cholinergic NS contributed to neuropil of ganglia. Our observations demonstrate that intrinsic cardiac ganglionated plexus is not fully developed in the newborn pig despite of dense network of neuronal processes and numerous signs of neural contacts within ganglia.
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Affiliation(s)
- Tomas Ragauskas
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Neringa Pauziene
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Hermanas Inokaitis
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dainius Haroldas Pauza
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Morita N, Iida T, Nanao T, Ushijima A, Ueno A, Ikari Y, Kobayashi Y. Effect of ganglionated plexi ablation by high-density mapping on long-term suppression of paroxysmal atrial fibrillation - The first clinical survey on ablation of the dorsal right plexusus. Heart Rhythm O2 2021; 2:480-488. [PMID: 34667963 PMCID: PMC8505203 DOI: 10.1016/j.hroo.2021.07.002] [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] [Indexed: 10/25/2022] Open
Abstract
Background Long-term outcomes of suppressing paroxysmal atrial fibrillation (PAF) with additive ganglionated plexus (GP) ablation (GPA) remains unknown. Objectives The aim of the study is to assess potential role of additional GPA for PAF suppression. Methods This study consisted of 225 patients; 68 (group A: 58 male, aged 60 ± 11 years) underwent pulmonary vein isolation (PVI) alone and 157 (group B: 137 male, aged 61 ± 11 years) GPA followed by PVI. GPA was performed based on the high-density mapping with high-frequency stimulation (HFS) delivered to left atrial (LA) major GP. The latter 85 group B patients (54%) underwent ablation to a posteromedial area within superior vena cava as a part of dorsal right atrial GP (SVC-Ao GP). Results In group B, HFS was applied to 126 ± 32 sites, with a median of 47 GP sites (40.0%) being ablated. In patients undergoing an SVC-Ao GPA, HFS and the SVC-Ao GPA were applied at a median of 15 and 4 sites (29.4%), respectively. The PVI with a GPA provided higher PAF suppression than a PVI alone during more than 4 years of follow-up (56.7% vs 38.2%, odds ratio: 0.42, 95% confidence interval: 0.23-0.76, P < .05), but the SVC-Ao GPA did not provide further suppressive effects. Multivariate analyses revealed that tachycardia-bradycardia syndrome and non-PV foci were independent predictors of PAF recurrence after PVI with a GPA (P < .01). Conclusion GPA to LA major GP by high-density mapping provides long-term benefits for PAF suppression over 4 years of follow-up, but the effect of an empiric SVC-Ao GPA could not be appreciated, suggesting little effect on suppressing non-PV foci.
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Affiliation(s)
- Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Takayuki Iida
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Tomihisa Nanao
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Akiko Ushijima
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Akira Ueno
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Medicine, Tokai University Hospital, Kanagawa, Japan
| | - Yoshinori Kobayashi
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
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Aksu T, De Potter T, John L, Osorio J, Singh D, Alyesh D, Baysal E, Kumar K, Mikaeili J, Dal Forno A, Yalin K, Akdemir B, Woods CE, Salcedo J, Eftekharzadeh M, Akgun T, Sundaram S, Aras D, Tzou WS, Gopinathannair R, Winterfield J, Gupta D, Davila A. Procedural and short-term results of electroanatomic-mapping-guided ganglionated plexus ablation by first-time operators: A multicenter study. J Cardiovasc Electrophysiol 2021; 33:117-122. [PMID: 34674347 DOI: 10.1111/jce.15278] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/26/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Single-center observational studies have shown promising results with fragmented electrogram (FE)-guided ganglionated plexus (GP) ablation in patients with vagally mediated bradyarrhythmia (VMB). We aimed to compare the acute procedural characteristics during FE-guided GP ablation in patients with VMB performed by first-time operators and those of a single high-volume operator. METHODS AND RESULTS This international multicenter cohort study included data collected over 2 years from 16 cardiac hospitals. The primary operators were classified according to their prior GP ablation experience: a single high-volume operator who had performed > 50 GP ablation procedures (Group 1), and operators performing their first GP ablation cases (Group 2). Acute procedural characteristics and syncope recurrence were compared between groups. Forty-seven consecutive patients with VMB who underwent FE-guided GP ablation were enrolled, n = 31 in Group 1 and n = 16 in Group 2. The mean number of ablation points in each GP was comparable between groups. The ratio of positive vagal response during ablation on the left superior GP was higher in Group 1 (90.3% vs. 62.5%, p = .022). Ablation of the right superior GP increased heart rate acutely without any vagal response in 45 (95.7%) cases. The procedure time was longer in group 2 (83.4 ± 21 vs. 118.0 ± 21 min, respectively, p < .001). Over a mean follow-up duration of 8.0 ± 3 months (range 2-24 months), none of the patients suffered from syncope. CONCLUSION This multi-center pilot study shows for the first time the feasibility of FE-guided GP ablation across a large group of procedure-naïve operators.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Tom De Potter
- Department of Cardiology, OLV Hospital, Aalst, Belgium
| | - Leah John
- Department of Cardiology, Medical University of South Carolina, South Carolina, USA
| | - Jose Osorio
- Department of Electrophysiology, Arrhythmia Institute at Grandview, Alabama, USA
| | - David Singh
- Division of Cardiology, The Queen's Medical Center, Honolulu, Hawaii, USA
| | - Daniel Alyesh
- Department of Electrophysiology, Cardiac Electrophysiology, South Denver Cardiology Associates, Littleton, Colorado, USA
| | - Erkan Baysal
- Department of Cardiology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Kapil Kumar
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, USA
| | - Javad Mikaeili
- Department of Electrophysiology, Day General Hospital, Tehran, Iran
| | | | - Kivanc Yalin
- Department of Cardiology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Baris Akdemir
- Department of Cardiology, Goztepe Medicalpark Hospital, Bahcesehir University, Istanbul, Turkey
| | - Christopher E Woods
- Department of Cardiology, Palo Alto Medical Foundation, Mills-Peninsula Medical Center, Burlingame, California, USA
| | - Jonathan Salcedo
- Department of Cardiology, Palo Alto Medical Foundation, Mills-Peninsula Medical Center, Burlingame, California, USA
| | | | - Taylan Akgun
- Basaksehir Cam and Sakura City Hospital, Başakşehir, Turkey
| | - Sri Sundaram
- Department of Electrophysiology, Cardiac Electrophysiology, South Denver Cardiology Associates, Littleton, Colorado, USA
| | | | - Wendy S Tzou
- Division of Cardiovascular Medicine, Cardiac Electrophysiology Section, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rakesh Gopinathannair
- Department of Cardiology, Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Missouri, USA
| | - Jeffrey Winterfield
- Department of Cardiology, Medical University of South Carolina, South Carolina, USA
| | - Dhiraj Gupta
- Department of Electrophysiology, Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Andre Davila
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, USA.,SOS Cardio Hospital, Florinapolis, Brazil
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The "heart brain" and neuromodulation for vasovagal syncope. Auton Neurosci 2021; 236:102892. [PMID: 34666205 DOI: 10.1016/j.autneu.2021.102892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/02/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022]
Abstract
It is well known that the autonomic nervous system (ANS) is a major contributor in etiopathogenesis of vasovagal syncope (VVS). Catheter based neuromodulation (CNA) of the intrinsic cardiac ANS has evolved rapidly from being an experimental unproven procedure to its current status as an increasingly performed ablation procedure in many major hospitals worldwide. The present review aims to bring the anatomical elements of intrinsic cardiac ANS and clinical application of intrinsic cardiac neuromodulation together, by reviewing anatomical terminologies and clinical data, in order to provide a practical assistance to the electrophysiology community.
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Yalin K, Altinsoy M, Soysal A, Aksu T, Gopinathannair R, Braunstein E, Cheung J. Long-term Success of Partial Ganglionated Plexus Ablation in a Patient with Tachycardia-bradycardia Syndrome and Syncope: Whom and How? J Innov Card Rhythm Manag 2021; 12:4720-4725. [PMID: 34712507 PMCID: PMC8545434 DOI: 10.19102/icrm.2021.121006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Vandenberk B, Morillo CA, Sheldon RS, Chew DS, Aksu T, Raj SR. Clinician needs and perceptions about cardioneuroablation for recurrent vasovagal syncope: An international clinician survey. Heart Rhythm 2021; 18:2160-2166. [PMID: 34419666 DOI: 10.1016/j.hrthm.2021.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/11/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cardioneuroablation (CNA) targets the intrinsic cardiac autonomic nervous system ganglionated plexi located in the peri-atrial epicardial fat. There is increasing interest in CNA as a treatment of vasovagal syncope (VVS), despite no randomized clinical trial (RCT) data. OBJECTIVE The purpose of this study was to poll the opinion on CNA) for VVS. METHODS A REDCap (Research Electronic Data Capture) survey was administered to international physicians treating patients with VVS on their opinion about patient selection criteria, ablation approach, RCT design, and most appropriate end points for CNA procedures. RESULTS The survey was completed by 118 physicians; 86% were cardiac electrophysiologists. The majority of respondents (79%) would consider referring a patient with refractory VVS for CNA, and 27% have performed CNA for VVS themselves. Most felt patient selection should require a head-up tilt test with a cardioinhibitory response (67%) and suggest a minimum age of 18 years with a median of 3 (interquartile range 2-5) episodes in the past year. There were differences in patient selection between physicians who have performed CNA themselves and those who have not. The majority felt that the ablation strategy should include both atria (70%) with an anatomical approach in combination with autonomic stimulation (85%). Performing a sham procedure in the control arm was supported by 56% of respondents, providing equipoise in RCT design. The preferred primary outcome was freedom from syncope within 1 year of follow-up. CONCLUSION There is widespread support for well-designed RCTs to confirm the hypothesized clinical benefit of CNA, provide data to guide the risk-benefit equations during patient selection, and appropriately estimate the placebo effect.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
| | - Carlos A Morillo
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert S Sheldon
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Derek S Chew
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Satish R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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