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Franco-Riveros VB, Pividori SM, Martin TI, Nicora FE, Lallana MC, Pontecorvo AA, Flores JC, Tubbs RS, Boezaart AP, Reina MA, Buchholz B. Anatomical study with clinical significance of communicating and visceral branching of the cervical and upper thoracic sympathetic trunk. Clin Anat 2024; 37:886-899. [PMID: 38469730 DOI: 10.1002/ca.24149] [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: 02/06/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
Current advances in the management of the autonomic nervous system in various cardiovascular diseases, and in treatments for pain or sympathetic disturbances in the head, neck, or upper limbs, necessitate a thorough understanding of the anatomy of the cervicothoracic sympathetic trunk. Our objective was to enhance our understanding of the origin and distribution of communicating branches and visceral cervicothoracic sympathetic nerves in human fetuses. This was achieved through a comprehensive topographic systematization of the branching patterns observed in the cervical and upper thoracic ganglia, along with the distribution of communicating branches to each cervical spinal nerve. We conducted detailed sub-macroscopic dissections of the cervical and thoracic regions in 20 human fetuses (40 sides). The superior and cervicothoracic ganglia were identified as the cervical sympathetic ganglia that provided the most communicating branches on both sides. The middle and accessory cervical ganglia contributed the fewest branches, with no significant differences between the right and left sides. The cervicothoracic ganglion supplied sympathetic branches to the greatest number of spinal nerves, spanning from C5 to T2. The distribution of communicating branches to spinal nerves was non-uniform. Notably, C3, C4, and C5 received the fewest branches, and more than half of the specimens showed no sympathetic connections. C1 and C2 received sympathetic connections exclusively from the superior ganglion. Spinal nerves that received more branches often did so from multiple ganglia. The vertebral nerve provided deep communicating branches primarily to C6, with lesser contributions to C7, C5, and C8. The vagus nerve stood out as the cranial nerve with the most direct sympathetic connections. The autonomic branching pattern and connections of the cervicothoracic sympathetic trunk are significantly variable in the fetus. A comprehensive understanding of the anatomy of the cervical and upper thoracic sympathetic trunk and its branches is valuable during autonomic interventions and neuromodulation. This knowledge is particularly relevant for addressing various autonomic cardiac diseases and for treating pain and vascular dysfunction in the head, neck, and upper limbs.
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Affiliation(s)
- Verena B Franco-Riveros
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
- School of Medicine, Department of Pathology, Institute of Cardiovascular Physiopathology (INFICA), Buenos Aires University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Institute of Biochemistry and Molecular Medicine (IBIMOL), Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | - Sofía M Pividori
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
- Diagnostic Imaging Department, Hospital Británico, Buenos Aires, Argentina
| | - Tomás I Martin
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
| | - Florencia E Nicora
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
| | - María Cecilia Lallana
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
| | - Agustina A Pontecorvo
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
| | - Juan Carlos Flores
- Postgraduate Universitary Training at Interventional Procedures for Chronic Refractory Pain, CAIDBA Comprehensive Pain Center Foundation; and La Plata University School of Medical Sciences, La Plata, Buenos Aires, Argentina
| | - Richard Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Anatomical Sciences, St. George's University, St. George's, West Indies
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
- Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - André P Boezaart
- Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
- Lumina Health Pain Medicine Collaborative, Surrey, UK
| | - Miguel A Reina
- Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
- School of Medicine, CEU-San-Pablo University, Madrid, Spain
- Department of Anesthesiology, Madrid-Montepríncipe University Hospital, Madrid, Spain
| | - Bruno Buchholz
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
- School of Medicine, Department of Pathology, Institute of Cardiovascular Physiopathology (INFICA), Buenos Aires University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Institute of Biochemistry and Molecular Medicine (IBIMOL), Buenos Aires University School of Medicine, Buenos Aires, Argentina
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Hanna P, Ardell JL. Cardiac Neuroanatomy and Fundamentals of Neurocardiology. Card Electrophysiol Clin 2024; 16:229-237. [PMID: 39084716 DOI: 10.1016/j.ccep.2024.01.002] [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
Cardiac control is mediated via nested-feedback reflex control networks involving the intrinsic cardiac ganglia, intra-thoracic extra-cardiac ganglia, spinal cord, brainstem, and higher centers. This control system is optimized to respond to normal physiologic stressors; however, it can be catastrophically disrupted by pathologic events such as myocardial ischemia. In fact, it is now recognized that cardiac disease progression reflects the dynamic interplay between adverse remodeling of the cardiac substrate coupled with autonomic dysregulation. With advances in understanding of this network dynamic in normal and pathologic states, neuroscience-based neuromodulation therapies can be devised for the management of acute and chronic cardiac pathologies.
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Affiliation(s)
- Peter Hanna
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA; UCLA Neurocardiology Research Program of Excellence, UCLA, Los Angeles, CA 90095, USA
| | - Jeffrey L Ardell
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA; UCLA Neurocardiology Research Program of Excellence, UCLA, Los Angeles, CA 90095, USA.
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van der Pas VR, van Opstal JM, Scholten MF, Monteiro de Oliveira NP, Speekenbrink RGH, van Dessel PFHM. Percutaneous left stellate ganglion block for refractory ventricular tachycardia in structural heart disease: our single-centre experience. Neth Heart J 2024; 32:283-289. [PMID: 38865067 PMCID: PMC11239613 DOI: 10.1007/s12471-024-01880-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION When electrical storm (ES) is amenable to neither antiarrhythmic drugs, nor deep sedation or catheter ablation, autonomic modulation may be considered. We report our experience with percutaneous left stellate ganglion block (PSGB) to temporarily suppress refractory ventricular arrhythmia (VA) in patients with structural heart disease. METHODS A retrospective analysis was performed at our institution of patients with structural heart disease and an implantable cardioverter defibrillator (ICD) who had undergone PSGB for refractory VA between January 2018 and October 2021. The number of times antitachycardia pacing (ATP) was delivered and the number of ICD shocks/external cardioversions performed in the week before and after PSGB were evaluated. Charts were checked for potential complications. RESULTS Twelve patients were identified who underwent a combined total of 15 PSGB and 5 surgical left cardiac sympathetic denervation procedures. Mean age was 73 ± 5.8 years and all patients were male. Nine of 12 (75%) had ischaemic cardiomyopathy, with the remainder having non-ischaemic dilated cardiomyopathy. Mean left ventricular ejection fraction was 35% (± 12.2%). Eight of 12 (66.7%) patients were already being treated with both amiodarone and beta-blockers. The reduction in ATP did not reach statistical significance (p = 0.066); however, ICD shocks (p = 0.028) and ATP/shocks combined were significantly reduced (p = 0.04). At our follow-up electrophysiology meetings PSGB was deemed ineffective in 4 of 12 patients (33%). Temporary anisocoria was seen in 2 of 12 (17%) patients, and temporary hypotension and hoarseness were reported in a single patient. DISCUSSION In this limited series, PSGB showed promise as a method for temporarily stabilising refractory VA and ES in a cohort of male patients with structural heart disease. The side effects observed were mild and temporary.
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Affiliation(s)
- Vincent R van der Pas
- Department of Cardiology, Thorax Centrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Jurren M van Opstal
- Department of Cardiology, Thorax Centrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Marcoen F Scholten
- Department of Cardiology, Thorax Centrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Ron G H Speekenbrink
- Department of Cardiothoracic Surgery, Thorax Centrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Pascal F H M van Dessel
- Department of Cardiology, Thorax Centrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
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Hoang JD, van Weperen VYH, Kang KW, Jani NR, Swid MA, Chan CA, Lokhandwala ZA, Lux RL, Vaseghi M. Antiarrhythmic Mechanisms of Epidural Blockade After Myocardial Infarction. Circ Res 2024; 135:e57-e75. [PMID: 38939925 PMCID: PMC11257785 DOI: 10.1161/circresaha.123.324058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Thoracic epidural anesthesia (TEA) has been shown to reduce the burden of ventricular tachycardia in small case series of patients with refractory ventricular tachyarrhythmias and cardiomyopathy. However, its electrophysiological and autonomic effects in diseased hearts remain unclear, and its use after myocardial infarction is limited by concerns for potential right ventricular dysfunction. METHODS Myocardial infarction was created in Yorkshire pigs (N=22) by left anterior descending coronary artery occlusion. Approximately, six weeks after myocardial infarction, an epidural catheter was placed at the C7-T1 vertebral level for injection of 2% lidocaine. Right and left ventricular hemodynamics were recorded using Millar pressure-conductance catheters, and ventricular activation recovery intervals (ARIs), a surrogate of action potential durations, by a 56-electrode sock and 64-electrode basket catheter. Hemodynamics and ARIs, baroreflex sensitivity and intrinsic cardiac neural activity, and ventricular effective refractory periods and slope of restitution (Smax) were assessed before and after TEA. Ventricular tachyarrhythmia inducibility was assessed by programmed electrical stimulation. RESULTS TEA reduced inducibility of ventricular tachyarrhythmias by 70%. TEA did not affect right ventricular-systolic pressure or contractility, although left ventricular-systolic pressure and contractility decreased modestly. Global and regional ventricular ARIs increased, including in scar and border zone regions post-TEA. TEA reduced ARI dispersion specifically in border zone regions. Ventricular effective refractory periods prolonged significantly at critical sites of arrhythmogenesis, and Smax was reduced. Interestingly, TEA significantly improved cardiac vagal function, as measured by both baroreflex sensitivity and intrinsic cardiac neural activity. CONCLUSIONS TEA does not compromise right ventricular function in infarcted hearts. Its antiarrhythmic mechanisms are mediated by increases in ventricular effective refractory period and ARIs, decreases in Smax, and reductions in border zone electrophysiological heterogeneities. TEA improves parasympathetic function, which may independently underlie some of its observed antiarrhythmic mechanisms. This study provides novel insights into the antiarrhythmic mechanisms of TEA while highlighting its applicability to the clinical setting.
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Affiliation(s)
- Jonathan D Hoang
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, CA
- Neurocardiology Research Center of Excellence, UCLA, Los Angeles, CA
- UCLA Molecular Cellular and Integrative Physiology Interdepartmental Program, Los Angeles, CA
| | - Valerie YH van Weperen
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, CA
- Neurocardiology Research Center of Excellence, UCLA, Los Angeles, CA
| | - Ki-Woon Kang
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, CA
- Neurocardiology Research Center of Excellence, UCLA, Los Angeles, CA
| | - Neil R Jani
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, CA
- Neurocardiology Research Center of Excellence, UCLA, Los Angeles, CA
| | - Mohammed A Swid
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, CA
- Neurocardiology Research Center of Excellence, UCLA, Los Angeles, CA
| | - Christopher A Chan
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, CA
- Neurocardiology Research Center of Excellence, UCLA, Los Angeles, CA
| | - Zulfiqar Ali Lokhandwala
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, CA
- Neurocardiology Research Center of Excellence, UCLA, Los Angeles, CA
| | - Robert L Lux
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Marmar Vaseghi
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, CA
- Neurocardiology Research Center of Excellence, UCLA, Los Angeles, CA
- UCLA Molecular Cellular and Integrative Physiology Interdepartmental Program, Los Angeles, CA
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Dusi V, Angelini F, Baldi E, Toscano A, Gravinese C, Frea S, Compagnoni S, Morena A, Saglietto A, Balzani E, Giunta M, Costamagna A, Rinaldi M, Trompeo AC, Rordorf R, Anselmino M, Savastano S, De Ferrari GM. Continuous stellate ganglion block for ventricular arrhythmias: case series, systematic review, and differences from thoracic epidural anaesthesia. Europace 2024; 26:euae074. [PMID: 38531027 PMCID: PMC11020261 DOI: 10.1093/europace/euae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
AIMS Percutaneous stellate ganglion block (PSGB) through single-bolus injection and thoracic epidural anaesthesia (TEA) have been proposed for the acute management of refractory ventricular arrhythmias (VAs). However, data on continuous PSGB (C-PSGB) are scant. The aim of this study is to report our dual-centre experience with C-PSGB and to perform a systematic review on C-PSGB and TEA. METHODS AND RESULTS Consecutive patients receiving C-PSGB at two centres were enrolled. The systematic literature review follows the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Our case series (26 patients, 88% male, 60 ± 16 years, all with advanced structural heart disease, left ventricular ejection fraction 23 ± 11%, 32 C-PSGBs performed, with a median duration of 3 days) shows that C-PSGB is feasible and safe and leads to complete VAs suppression in 59% and to overall clinical benefit in 94% of cases. Overall, 61 patients received 68 C-PSGBs and 22 TEA, with complete VA suppression in 63% of C-PSGBs (61% of patients). Most TEA procedures (55%) were performed on intubated patients, as opposed to 28% of C-PSGBs (P = 0.02); 63% of cases were on full anticoagulation at C-PSGB, none at TEA (P < 0.001). Ropivacaine and lidocaine were the most used drugs for C-PSGB, and the available data support a starting dose of 12 and 100 mg/h, respectively. No major complications occurred, yet TEA discontinuation rate due to side effects was higher than C-PSGB (18 vs. 1%, P = 0.01). CONCLUSION Continuous PSGB seems feasible, safe, and effective for the acute management of refractory VAs. The antiarrhythmic effect may be accomplished with less concerns for concomitant anticoagulation compared with TEA and with a lower side-effect related discontinuation rate.
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Affiliation(s)
- Veronica Dusi
- Cardiology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Filippo Angelini
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Enrico Baldi
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Toscano
- Department of Anaesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ Hospital, Torino, Italy
| | - Carol Gravinese
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Simone Frea
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Sara Compagnoni
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Viale Golgi 19, 27100 Pavia, Italy
| | - Arianna Morena
- Cardiology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Eleonora Balzani
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Matteo Giunta
- Department of Anaesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ Hospital, Torino, Italy
| | - Andrea Costamagna
- Department of Anaesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ Hospital, Torino, Italy
| | - Mauro Rinaldi
- Department of Surgical Sciences, University of Turin, Torino, Italy
- Department of Cardiovascular and Thoracic Surgery, ‘Città della Salute e della Scienza’ Hospital, Torino, Italy
| | - Anna Chiara Trompeo
- Department of Anaesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ Hospital, Torino, Italy
| | - Roberto Rordorf
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Anselmino
- Cardiology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Simone Savastano
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gaetano Maria De Ferrari
- Cardiology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
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Hoang JD, van Weperen VY, Kang KW, Jani NR, Swid MA, Chan CA, Lokhandwala ZA, Lux RL, Vaseghi M. Thoracic epidural blockade after myocardial infarction benefits from anti-arrhythmic pathways mediated in part by parasympathetic modulation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.14.585127. [PMID: 38559001 PMCID: PMC10980055 DOI: 10.1101/2024.03.14.585127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Thoracic epidural anesthesia (TEA) has been shown to reduce the burden of ventricular tachyarrhythmias (VT) in small case-series of patients with refractory VT and cardiomyopathy. However, its electrophysiological and autonomic effects in diseased hearts remain unclear and its use after myocardial infarction (MI) is limited by concerns for potential RV dysfunction. Methods MI was created in Yorkshire pigs ( N =22) by LAD occlusion. Six weeks post-MI, an epidural catheter was placed at the C7-T1 vertebral level for injection of 2% lidocaine. RV and LV hemodynamics were recorded using Millar pressure-conductance catheters, and ventricular activation-recovery intervals (ARIs), a surrogate of action potential durations, by a 56-electrode sock and 64-electrode basket catheter. Hemodynamics and ARIs, baroreflex sensitivity (BRS) and intrinsic cardiac neural activity, and ventricular effective refractory periods (ERP) and slope of restitution (S max ) were assessed before and after TEA. VT/VF inducibility was assessed by programmed electrical stimulation. Results TEA reduced inducibility of VT/VF by 70%. TEA did not affect RV-systolic pressure or contractility, although LV-systolic pressure and contractility decreased modestly. Global and regional ventricular ARIs increased, including in scar and border zone regions post-TEA. TEA reduced ARI dispersion specifically in border zone regions. Ventricular ERPs prolonged significantly at critical sites of arrhythmogenesis, and S max was reduced. Interestingly, TEA significantly improved cardiac vagal function, as measured by both BRS and intrinsic cardiac neural activity. Conclusion TEA does not compromise RV function in infarcted hearts. Its anti-arrhythmic mechanisms are mediated by increases in ventricular ERP and ARIs, decreases in S max , and reductions in border zone heterogeneity. TEA improves parasympathetic function, which may independently underlie some of its observed anti-arrhythmic mechanisms. This study provides novel insights into the anti-arrhythmic mechanisms of TEA, while highlighting its applicability to the clinical setting. Abstract Illustration Myocardial infarction is known to cause cardiac autonomic dysfunction characterized by sympathoexcitation coupled with reduced vagal tone. This pathological remodeling collectively predisposes to ventricular arrhythmia. Thoracic epidural anesthesia not only blocks central efferent sympathetic outflow, but by also blocking ascending projections of sympathetic afferents, relieving central inhibition of vagal function. These complementary autonomic effects of thoracic epidural anesthesia may thus restore autonomic balance, thereby improving ventricular electrical stability and suppressing arrhythmogenesis. DRG=dorsal root ganglion, SG=stellate ganglion.
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Yin S, Yang X, Li H, Li C, Li C, Chen C, Ye S, Zou L, Liang S, Liu S. P2Y 13 receptor involved in HIV-1 gp120 induced neuropathy in superior cervical ganglia through NLRP3 inflammasome activation. Neuropharmacology 2024; 245:109818. [PMID: 38142931 DOI: 10.1016/j.neuropharm.2023.109818] [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: 06/14/2023] [Revised: 10/06/2023] [Accepted: 12/16/2023] [Indexed: 12/26/2023]
Abstract
Cardiac autonomic neuropathy resulting from human immunodeficiency virus (HIV) infection is common; however, its mechanism remains unknown. The current work attempted to explore the function and mechanism of the P2Y13 receptor in HIV-glycoprotein 120 (gp120)-induced neuropathy in cervical sympathetic ganglion. The superior cervical ganglion (SCG) of the male SD rat was coated with HIV-gp120 to establish a model of autonomic neuropathy. In each group, we measured heart rate, blood pressure, heart rate variability, sympathetic nerve discharge and cardiac function. The expression of P2Y13 mRNA and protein in the SCG was tested by real-time polymerase chain reaction and western blotting. Additionally, this study focused on identifying the protein levels of NOD-like receptor family pyrin domain-containing 3 (NLRP3), Caspase-1, Gasdermin D (GSDMD), interleukin (IL)-1β and IL-18 in the SCG using western blotting and immunofluorescence. In gp120 rats, increased blood pressure, heart rate, cardiac sympathetic nerve activity, P2Y13 receptor levels and decreased cardiac function could be found. P2Y13 shRNA or MRS2211 inhibited the above mentioned changes induced by gp120, suggesting that the P2Y13 receptor may be engaged in gp120-induced sympathetic nerve injury. Moreover, the levels of NLRP3, Caspase-1, GSDMD, IL-1β and IL-18 in the gp120 group were increased, while significantly decreased by P2Y13 shRNA or MRS2211. Therefore, the P2Y13 receptor is involved in gp120-induced sympathetic neuropathy, and its molecular mechanism shows an association with the activation of the NLRP3 inflammasome, followed by GSDMD formation along with the release of inflammatory factors including IL-1β and IL-18. This article is part of the Special Issue on "Purinergic Signaling: 50 years".
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Affiliation(s)
- Sui Yin
- Department of Physiology, School of Basic medicine, Jiangxi Medical College, Nanchang University, China; Jinan Center for Disease Control and Prevention, Jinan, China
| | - Xuexuan Yang
- Department of Physiology, School of Basic medicine, Jiangxi Medical College, Nanchang University, China
| | - Honglei Li
- Department of Basic medicine, School of Basic medicine, Jiangxi Medical College, Nanchang University, China
| | - Chenxi Li
- Department of Physiology, School of Basic medicine, Jiangxi Medical College, Nanchang University, China
| | - Changyi Li
- Department of Physiology, School of Basic medicine, Jiangxi Medical College, Nanchang University, China
| | - Chengxu Chen
- Department of Physiology, School of Basic medicine, Jiangxi Medical College, Nanchang University, China
| | - Shang Ye
- Department of Clinical Medicine, School of Marry Queen, Jiangxi Medical College, Nanchang University, China
| | - Lifang Zou
- Center of Hematology, the 1st affiliated Hospital, Jiangxi Medical College, Nanchang University, China; Institute of Hematology, Academy of Clinical Medicine of Jiangxi Province, Nanchang, China
| | - Shangdong Liang
- Department of Physiology, School of Basic medicine, Jiangxi Medical College, Nanchang University, China
| | - Shuangmei Liu
- Department of Physiology, School of Basic medicine, Jiangxi Medical College, Nanchang University, China.
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Zheng M, Chen S, Zeng Z, Cai H, Zhang H, Yu X, Wang W, Li X, Li CZ, He B, Deng KQ, Lu Z. Targeted ablation of the left middle cervical ganglion prevents ventricular arrhythmias and cardiac injury induced by AMI. Basic Res Cardiol 2024; 119:57-74. [PMID: 38151579 DOI: 10.1007/s00395-023-01026-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/29/2023]
Abstract
Cardiac sympathetic overactivation is a critical driver in the progression of acute myocardial infarction (AMI). The left middle cervical ganglion (LMCG) is an important extracardiac sympathetic ganglion. However, the regulatory effects of LMCG on AMI have not yet been fully documented. In the present study, we detected that the LMCG was innervated by abundant sympathetic components and exerted an excitatory effect on the cardiac sympathetic nervous system in response to stimulation. In canine models of AMI, targeted ablation of LMCG reduced the sympathetic indexes of heart rate variability and serum norepinephrine, resulting in suppressed cardiac sympathetic activity. Moreover, LMCG ablation could improve ventricular electrophysiological stability, evidenced by the prolonged ventricular effective refractory period, elevated action potential duration, increased ventricular fibrillation threshold, and enhanced connexin43 expression, consequently showing antiarrhythmic effects. Additionally, compared with the control group, myocardial infarction size, circulating cardiac troponin I, and myocardial apoptosis were significantly reduced, accompanied by preserved cardiac function in canines subjected to LMCG ablation. Finally, we performed the left stellate ganglion (LSG) ablation and compared its effects with LMCG destruction. The results indicated that LMCG ablation prevented ventricular electrophysiological instability, cardiac sympathetic activation, and AMI-induced ventricular arrhythmias with similar efficiency as LSG denervation. In conclusion, this study demonstrated that LMCG ablation suppressed cardiac sympathetic activity, stabilized ventricular electrophysiological properties and mitigated cardiomyocyte death, resultantly preventing ischemia-induced ventricular arrhythmias, myocardial injury, and cardiac dysfunction. Neuromodulation therapy targeting LMCG represented a promising strategy for the treatment of AMI.
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Affiliation(s)
- Meng Zheng
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430000, Hubei, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Siyu Chen
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430000, Hubei, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Ziyue Zeng
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430000, Hubei, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Huanhuan Cai
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430000, Hubei, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Hanyu Zhang
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430000, Hubei, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Xiaomei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Weina Wang
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430000, Hubei, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Xianqing Li
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430000, Hubei, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Chen-Ze Li
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430000, Hubei, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Bo He
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430000, Hubei, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Ke-Qiong Deng
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430000, Hubei, China.
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China.
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China.
| | - Zhibing Lu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430000, Hubei, China.
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China.
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China.
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9
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Barrett MS, Bauer TC, Li MH, Hegarty DM, Mota CMD, Amaefuna CJ, Ingram SL, Habecker BA, Aicher SA. Ischemia-reperfusion myocardial infarction induces remodeling of left cardiac-projecting stellate ganglia neurons. Am J Physiol Heart Circ Physiol 2024; 326:H166-H179. [PMID: 37947434 PMCID: PMC11213476 DOI: 10.1152/ajpheart.00582.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 11/12/2023]
Abstract
Neurons in the stellate ganglion (SG) provide sympathetic innervation to the heart, brown adipose tissue (BAT), and other organs. Sympathetic innervation to the heart becomes hyperactive following myocardial infarction (MI). The impact of MI on the morphology of cardiac sympathetic neurons is not known, but we hypothesized that MI would stimulate increased cell and dendritic tree size in cardiac neurons. In this study, we examined the effects of ischemia-reperfusion MI on sympathetic neurons using dual retrograde tracing methods to allow detailed characterization of cardiac- and BAT-projecting neurons. Different fluorescently conjugated cholera toxin subunit B (CTb) tracers were injected into the pericardium and the interscapular BAT pads, respectively. Experimental animals received a 45-min occlusion of the left anterior descending coronary artery and controls received sham surgery. One week later, hearts were collected for assessment of MI infarct and SGs were collected for morphological or electrophysiological analysis. Cardiac-projecting SG neurons from MI mice had smaller cell bodies and shorter dendritic trees compared with sham animals, specifically on the left side ipsilateral to the MI. BAT-projecting neurons were not altered by MI, demonstrating the subpopulation specificity of the response. The normal size and distribution differences between BAT- and cardiac-projecting stellate ganglion neurons were not altered by MI. Patch-clamp recordings from cardiac-projecting left SG neurons revealed increased spontaneous excitatory postsynaptic currents despite the decrease in cell and dendritic tree size. Thus, increased dendritic tree size does not contribute to the enhanced sympathetic neural activity seen after MI.NEW & NOTEWORTHY Myocardial infarction (MI) causes structural and functional changes specifically in stellate ganglion neurons that project to the heart, but not in cells that project to brown adipose fat tissue.
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Affiliation(s)
- Madeleine S Barrett
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
| | - Temerity C Bauer
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
| | - Ming-Hua Li
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
| | - Deborah M Hegarty
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
| | - Clarissa M D Mota
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
| | - Chimezie J Amaefuna
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
| | - Susan L Ingram
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
| | - Beth A Habecker
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
| | - Sue A Aicher
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
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10
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Cauti FM, Rossi P, Bianchi S, Magnocavallo M, Capone S, Della Rocca DG, Polselli M, Bruno K, Tozzi P, Rossi C, Vannucci J, Pugliese F, Quaglione R, Venuta F, Anile M. Modified sympathicotomy in patients with refractory ventricular tachycardia and structural heart disease: a single-center experience. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01706-6. [PMID: 38040851 DOI: 10.1007/s10840-023-01706-6] [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: 10/01/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Modified cardiac sympathetic denervation (CSD) with stellate ganglion (SG) sparing is a novel technique for cardiac neuromodulation in patients with refractory ventricular tachycardia (VT). OBJECTIVES Our aim is to describe the mid- to long-term clinical outcome of the modified CSD with SG sparing in a series of patients with structural heart disease (SHD) and refractory VT. METHODS All consecutive patients with SHD and refractory VT undergoing modified CSD were enrolled. Baseline clinical characteristics and periprocedural data were collected for all patients. The primary outcome was any recurrence of sustained VT. RESULTS We enrolled 15 patients (age: 69.2 ± 7.9 years; male 100%) undergoing modified CSD. Left ventricular ejection fraction was 37 ± 11% and all patients had an implantable cardiac defibrillator (ICD); the underlying cardiomyopathy was non-ischemic in 73.3% of them. At least one previous ablation had been attempted in 66.6% of cases. The 73.3% of patients underwent bilateral CSD and the mean effective surgical time was 10.8 ± 2.4 min per side; no major periprocedural complication occurred. After a median follow-up time of 15 months (IQR: 8.5-24.5 months), the primary outcome occurred in 47.6% of cases. All patients experienced a reduction of ICD shocks after CSD (3.1 ICD shocks/patient before vs. 0.3 ICD shocks/patient after CSD; p-value: 0.001). Bilateral CSD and a VT cycle length < 340 ms were associated with better outcomes. CONCLUSIONS A modified CSD approach with stellate ganglion sparing appears to be safe, fast, and effective in the treatment of patients with SHD and refractory VTs.
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Affiliation(s)
- Filippo Maria Cauti
- Arrhythmology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Cardiology Unit, Dipartimento Cuore e Grossi Vasi, Policlinico Umberto I, Sapienza University, Rome, Italy.
| | - Pietro Rossi
- Arrhythmology Unit, Fatebenefratelli Isola - Gemelli Isola, Rome, Italy
| | - Stefano Bianchi
- Arrhythmology Unit, Fatebenefratelli Isola - Gemelli Isola, Rome, Italy
| | | | - Silvia Capone
- Arrhythmology Unit, Fatebenefratelli Isola - Gemelli Isola, Rome, Italy
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard - Heart, Brussels, Belgium
| | - Marco Polselli
- Arrhythmology Unit, Fatebenefratelli Isola - Gemelli Isola, Rome, Italy
| | - Katia Bruno
- Department of Anesthesiology, Sapienza University, Rome, Italy
| | | | - Chiara Rossi
- Presidio Ospedaliero Santo Spirito in Sassia, Rome, Italy
| | - Jacopo Vannucci
- Division of Thoracic Surgery and Lung Transplant, Sapienza University, Rome, Italy
| | | | - Raffaele Quaglione
- Cardiology Unit, Dipartimento Cuore e Grossi Vasi, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Federico Venuta
- Division of Thoracic Surgery and Lung Transplant, Sapienza University, Rome, Italy
| | - Marco Anile
- Division of Thoracic Surgery and Lung Transplant, Sapienza University, Rome, Italy
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11
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Zheng M, Deng KQ, Wang X, Luo D, Qu W, Chen C, Yu X, He W, Xie J, Jiang H, He B, Lu Z. Pulmonary Artery Denervation Inhibits Left Stellate Ganglion Stimulation-Induced Ventricular Arrhythmias Originating From the RVOT. JACC Clin Electrophysiol 2023; 9:1354-1367. [PMID: 37086230 DOI: 10.1016/j.jacep.2023.02.009] [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: 03/10/2022] [Revised: 01/20/2023] [Accepted: 02/15/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Electrical stimulation of the left stellate ganglion (LSG) can evoke ventricular arrhythmias (VAs) that originate from the right ventricular outflow tract (RVOT). The involvement of pulmonary artery innervation is unclear. OBJECTIVES This study investigated the effects of selective pulmonary artery denervation (PADN) on blood pressure (BP), sympathetic activity, ventricular effective refractory period (ERP), and the incidence of VAs induced by LSG stimulation in canines. METHODS Radiofrequency ablation with basic anesthetic monitoring was used to induce PADN in canines. In Protocol 1 (n = 11), heart rate variability, serum norepinephrine and angiotensin-II levels, BP changes and ventricular ERP in response to LSG stimulation were measured before and after PADN. In Protocol 2 (n = 8), the incidence of VAs induced by LSG stimulation was calculated before and after PADN in a canine model of complete atrioventricular block. In addition, sympathetic nerves in the excised pulmonary arteries were immunohistochemically stained with tyrosine hydroxylase. RESULTS The low-frequency components of heart rate variability, serum norepinephrine and angiotensin-II levels were remarkably decreased post-PADN. Systolic BP elevation and RVOT ERP shortening induced by LSG stimulation were mitigated by PADN. The number of RVOT-premature ventricular contractions as well as RVOT tachycardia episodes and duration induced by LSG stimulation were significantly reduced after PADN. In addition, a large number of tyrosine hydroxylase-immunoreactive nerve fibers were located in the anterior wall of the pulmonary artery. CONCLUSIONS PADN ameliorated RVOT ERP shortening, and RVOT-VAs induced by LSG stimulation by inhibiting cardiac sympathetic nerve activity.
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Affiliation(s)
- Meng Zheng
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China; Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China; Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Ke-Qiong Deng
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China; Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China; Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Xiaoying Wang
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China; Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China; Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Da Luo
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Weiyi Qu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chao Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaomei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wenbo He
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jing Xie
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bo He
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China; Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China; Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China.
| | - Zhibing Lu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China; Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China; Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China.
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12
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van Weperen VYH, Ripplinger CM, Vaseghi M. Autonomic control of ventricular function in health and disease: current state of the art. Clin Auton Res 2023; 33:491-517. [PMID: 37166736 PMCID: PMC10173946 DOI: 10.1007/s10286-023-00948-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Cardiac autonomic dysfunction is one of the main pillars of cardiovascular pathophysiology. The purpose of this review is to provide an overview of the current state of the art on the pathological remodeling that occurs within the autonomic nervous system with cardiac injury and available neuromodulatory therapies for autonomic dysfunction in heart failure. METHODS Data from peer-reviewed publications on autonomic function in health and after cardiac injury are reviewed. The role of and evidence behind various neuromodulatory therapies both in preclinical investigation and in-use in clinical practice are summarized. RESULTS A harmonic interplay between the heart and the autonomic nervous system exists at multiple levels of the neuraxis. This interplay becomes disrupted in the setting of cardiovascular disease, resulting in pathological changes at multiple levels, from subcellular cardiac signaling of neurotransmitters to extra-cardiac, extra-thoracic remodeling. The subsequent detrimental cycle of sympathovagal imbalance, characterized by sympathoexcitation and parasympathetic withdrawal, predisposes to ventricular arrhythmias, progression of heart failure, and cardiac mortality. Knowledge on the etiology and pathophysiology of this condition has increased exponentially over the past few decades, resulting in a number of different neuromodulatory approaches. However, significant knowledge gaps in both sympathetic and parasympathetic interactions and causal factors that mediate progressive sympathoexcitation and parasympathetic dysfunction remain. CONCLUSIONS Although our understanding of autonomic imbalance in cardiovascular diseases has significantly increased, specific, pivotal mediators of this imbalance and the recognition and implementation of available autonomic parameters and neuromodulatory therapies are still lagging.
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Affiliation(s)
- Valerie Y H van Weperen
- Division of Cardiology, Department of Medicine, UCLA Cardiac Arrythmia Center, University of California, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | | | - Marmar Vaseghi
- Division of Cardiology, Department of Medicine, UCLA Cardiac Arrythmia Center, University of California, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA.
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13
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Chung WH, Lin YN, Wu MY, Chang KC. Sympathetic Modulation in Cardiac Arrhythmias: Where We Stand and Where We Go. J Pers Med 2023; 13:786. [PMID: 37240956 PMCID: PMC10221179 DOI: 10.3390/jpm13050786] [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: 04/02/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023] Open
Abstract
The nuance of autonomic cardiac control has been studied for more than 400 years, yet little is understood. This review aimed to provide a comprehensive overview of the current understanding, clinical implications, and ongoing studies of cardiac sympathetic modulation and its anti-ventricular arrhythmias' therapeutic potential. Molecular-level studies and clinical studies were reviewed to elucidate the gaps in knowledge and the possible future directions for these strategies to be translated into the clinical setting. Imbalanced sympathoexcitation and parasympathetic withdrawal destabilize cardiac electrophysiology and confer the development of ventricular arrhythmias. Therefore, the current strategy for rebalancing the autonomic system includes attenuating sympathoexcitation and increasing vagal tone. Multilevel targets of the cardiac neuraxis exist, and some have emerged as promising antiarrhythmic strategies. These interventions include pharmacological blockade, permanent cardiac sympathetic denervation, temporal cardiac sympathetic denervation, etc. The gold standard approach, however, has not been known. Although neuromodulatory strategies have been shown to be highly effective in several acute animal studies with very promising results, the individual and interspecies variation between human autonomic systems limits the progress in this young field. There is, however, still much room to refine the current neuromodulation therapy to meet the unmet need for life-threatening ventricular arrhythmias.
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Affiliation(s)
- Wei-Hsin Chung
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA 90024, USA
| | - Yen-Nien Lin
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan
- School of Medicine, China Medical University, Taichung 404333, Taiwan
| | - Mei-Yao Wu
- School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung 404333, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan
| | - Kuan-Cheng Chang
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan
- School of Medicine, China Medical University, Taichung 404333, Taiwan
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14
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Hrabalova P, Bohuslavova R, Matejkova K, Papousek F, Sedmera D, Abaffy P, Kolar F, Pavlinkova G. Dysregulation of hypoxia-inducible factor 1α in the sympathetic nervous system accelerates diabetic cardiomyopathy. Cardiovasc Diabetol 2023; 22:88. [PMID: 37072781 PMCID: PMC10114478 DOI: 10.1186/s12933-023-01824-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 04/03/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND An altered sympathetic nervous system is implicated in many cardiac pathologies, ranging from sudden infant death syndrome to common diseases of adulthood such as hypertension, myocardial ischemia, cardiac arrhythmias, myocardial infarction, and heart failure. Although the mechanisms responsible for disruption of this well-organized system are the subject of intensive investigations, the exact processes controlling the cardiac sympathetic nervous system are still not fully understood. A conditional knockout of the Hif1a gene was reported to affect the development of sympathetic ganglia and sympathetic innervation of the heart. This study characterized how the combination of HIF-1α deficiency and streptozotocin (STZ)-induced diabetes affects the cardiac sympathetic nervous system and heart function of adult animals. METHODS Molecular characteristics of Hif1a deficient sympathetic neurons were identified by RNA sequencing. Diabetes was induced in Hif1a knockout and control mice by low doses of STZ treatment. Heart function was assessed by echocardiography. Mechanisms involved in adverse structural remodeling of the myocardium, i.e. advanced glycation end products, fibrosis, cell death, and inflammation, was assessed by immunohistological analyses. RESULTS We demonstrated that the deletion of Hif1a alters the transcriptome of sympathetic neurons, and that diabetic mice with the Hif1a-deficient sympathetic system have significant systolic dysfunction, worsened cardiac sympathetic innervation, and structural remodeling of the myocardium. CONCLUSIONS We provide evidence that the combination of diabetes and the Hif1a deficient sympathetic nervous system results in compromised cardiac performance and accelerated adverse myocardial remodeling, associated with the progression of diabetic cardiomyopathy.
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Affiliation(s)
- Petra Hrabalova
- Laboratory of Molecular Pathogenetics, Institute of Biotechnology CAS, BIOCEV, Vestec, Czechia
- Charles University, Prague, Czechia
| | - Romana Bohuslavova
- Laboratory of Molecular Pathogenetics, Institute of Biotechnology CAS, BIOCEV, Vestec, Czechia
| | - Katerina Matejkova
- Laboratory of Molecular Pathogenetics, Institute of Biotechnology CAS, BIOCEV, Vestec, Czechia
| | | | - David Sedmera
- Institute of Physiology CAS, Prague, Czechia
- Institute of Anatomy, Charles University, Prague, Czechia
| | - Pavel Abaffy
- Laboratory of Gene Expression, Institute of Biotechnology CAS, BIOCEV, Vestec, Czechia
| | | | - Gabriela Pavlinkova
- Laboratory of Molecular Pathogenetics, Institute of Biotechnology CAS, BIOCEV, Vestec, Czechia.
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15
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González ML, Pividori SM, Fosser G, Pontecorvo AA, Franco-Riveros VB, Tubbs RS, Boezaart AP, Reina MA, Buchholz B. Innervation of the heart: Anatomical study with application to better understanding pathologies of the cardiac autonomics. Clin Anat 2023; 36:550-562. [PMID: 36692348 DOI: 10.1002/ca.24017] [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: 12/25/2022] [Accepted: 01/22/2023] [Indexed: 01/25/2023]
Abstract
Current advances in management of the cardiac neuroaxis in different cardiovascular diseases require a deeper knowledge of cardiac neuroanatomy. The aim of the study was to increase knowledge of the human fetal extrinsic cardiac nervous system. We achieved this by systematizing the origin and formation of the cardiac nerves, branches, and ganglia and their sympathetic/parasympathetic connections. Thirty human fetuses (60 sides) were subjected to detailed sub-macroscopic dissection of the cervical and thoracic regions. Cardiac accessory ganglia lying on a cardiac nerve or in conjunction with two or more (up to four) nerves before entering the mediastinal cardiac plexus were observed in 13 sides. Except for the superior cardiac nerve, the sympathetic cardiac nerves were individually variable and inconstant. In contrast, the cardiac branches of the vagus nerve appeared grossly more constant and invariable, although the individual cardiac branches varied in number and position of origin. Each cervical cardiac nerve or cardiac branch of the vagus nerve could be singular or multiple (up to six) and originated from the sympathetic trunk or the vagus nerve by one, two, or three roots. Sympathetic nerves arose from the cervical-thoracic ganglia or the interganglionic segment of the sympathetic trunk. Connections were found outside the cardiac plexus. Some cardiac nerves were connected to non-cardiac nerves, while others were connected to each other. Common sympathetic/parasympathetic cardiac nerve trunks were more frequent on right (70%) versus left sides (20%). The origin, frequency, and connections of the cardiac nerves and branches are highly variable in the fetus. Detailed knowledge of the normal neuroanatomy of the heart could be useful during cardiac neuromodulation procedures and in better understanding nervous pathologies of the heart.
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Affiliation(s)
- Mailén L González
- School of Medicine, Department of Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina.,Department of Cardiology, Sanatorio San José, Buenos Aires, Argentina
| | - Sofía M Pividori
- School of Medicine, Department of Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina.,Diagnostic Imaging Department, Hospital Británico, Buenos Aires, Argentina
| | - Gregorio Fosser
- School of Medicine, Department of Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina.,Department of Orthopedic Surgery, Sanatorio Güemes, Buenos Aires, Argentina
| | - Agustina A Pontecorvo
- School of Medicine, Department of Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
| | - Verena B Franco-Riveros
- School of Medicine, Department of Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina.,Department of Pathology, Institute of Cardiovascular Physiopathology, Buenos Aires University School of Medicine (INFICA), Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET). Institute of Biochemistry and Molecular Medicine (IBIMOL), Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | - Richard Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada.,Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA.,Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - André P Boezaart
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.,Lumina Health Pain Medicine Collaborative, Surrey, UK
| | - Miguel A Reina
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.,CEU-San-Pablo University School of Medicine, Madrid, Spain
| | - Bruno Buchholz
- School of Medicine, Department of Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina.,Department of Pathology, Institute of Cardiovascular Physiopathology, Buenos Aires University School of Medicine (INFICA), Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET). Institute of Biochemistry and Molecular Medicine (IBIMOL), Buenos Aires University School of Medicine, Buenos Aires, Argentina
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16
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Ye Z, Zhu L, Li XJ, Gao HY, Wang J, Wu SB, Wu ZJ, Gao HR. PC6 electroacupuncture reduces stress-induced autonomic and neuroendocrine responses in rats. Heliyon 2023; 9:e15291. [PMID: 37095918 PMCID: PMC10121450 DOI: 10.1016/j.heliyon.2023.e15291] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 01/25/2023] [Accepted: 03/31/2023] [Indexed: 04/26/2023] Open
Abstract
Stress can trigger cardiovascular disease. Both imbalance of autonomic nervous activity and increase of neurohormonal output are core aspects of stress responses and can lead to cardiovascular disease. PC6 as a very important acupoint is used to prevent and treat cardiovascular disease and to improve stress-related activities. We examined the influence of electroacupuncture (EA) at PC6 on stress-induced imbalance of autonomic nervous activity and increase of neurohormonal output. EA at PC6 relieved increased cardiac sympathetic nervous activity and decreased cardiac vagal nervous activity induced by immobilization stress. Also, EA at PC6 reduced immobilization stress-induced increases of plasma norepinephrine (NE) and adrenaline (E) released from sympatho-adrenal-medullary axis. Finally, EA at PC6 reduced immobilization stress-induced increases of corticotropin-releasing hormone (CRH) in paraventricular hypothalamic nucleus and plasma cortisol (CORT) released from hypothalamic-pituitary-adrenal axis. However, EA at tail had no significant effect on the stress-induced autonomic and neuroendocrine responses. The results demonstrate the role of EA at PC6 regulating the autonomic and neuroendocrine responses induced by stress and provide insight into the prevention and treatment of EA at PC6 for stress-induced cardiovascular disease by targeting autonomic and neuroendocrine systems.
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Affiliation(s)
- Zhen Ye
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, 230038, China
| | - Li Zhu
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, 230038, China
| | - Xiao-jia Li
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, 230038, China
- Research Institute of Acupuncture and Meridian, Anhui Academy of Chinese Medicine, Anhui University of Chinese Medicine, Hefei, 230038, China
| | - He-yuan Gao
- Department of Pediatrics, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, 066000, China
| | - Jie Wang
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, 230038, China
- Research Institute of Acupuncture and Meridian, Anhui Academy of Chinese Medicine, Anhui University of Chinese Medicine, Hefei, 230038, China
| | - Sheng-bing Wu
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, 230038, China
- Research Institute of Acupuncture and Meridian, Anhui Academy of Chinese Medicine, Anhui University of Chinese Medicine, Hefei, 230038, China
- Key Laboratory of Acupuncture-Moxibustion Basis and Technology of Anhui Higher Education Institutes, Anhui University of Chinese Medicine (KLABT), Hefei, Anhui, 230038, China
- Key Laboratory of Xin'an Medicine (Anhui University of Chinese Medicine), The Ministry of Education, Hefei, Anhui, 230038, China
| | - Zi-jian Wu
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, 230038, China
- Research Institute of Acupuncture and Meridian, Anhui Academy of Chinese Medicine, Anhui University of Chinese Medicine, Hefei, 230038, China
- Key Laboratory of Acupuncture-Moxibustion Basis and Technology of Anhui Higher Education Institutes, Anhui University of Chinese Medicine (KLABT), Hefei, Anhui, 230038, China
- Key Laboratory of Xin'an Medicine (Anhui University of Chinese Medicine), The Ministry of Education, Hefei, Anhui, 230038, China
- Corresponding author. School of Acupuncture and Tuina, Research Institute of Acupuncture and Meridian, Anhui Academy of Chinese Medicine, Anhui University of Chinese Medicine, Hefei, 230038, China.
| | - He-ren Gao
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, 230038, China
- Research Institute of Acupuncture and Meridian, Anhui Academy of Chinese Medicine, Anhui University of Chinese Medicine, Hefei, 230038, China
- CAS Key Laboratory of Brain Function and Disease, and School of Life Sciences, University of Science Technology of China, Hefei, 230022, China
- Corresponding author. School of Acupuncture and Tuina, Research Institute of Acupuncture and Meridian, Anhui Academy of Chinese Medicine, Anhui University of Chinese Medicine, Hefei, 230038, China.
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17
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Killu AM, Yang M, Naksuk N, Tri J, Li X, Asirvatham R, Asirvatham SJ, Cha YM. Stellate ganglia stimulation counteracts vagal stimulation by significantly increasing heart rate and blood pressure. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01516-w. [PMID: 36892802 DOI: 10.1007/s10840-023-01516-w] [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: 06/28/2022] [Accepted: 02/16/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Vasovagal syncope (VVS) is the leading cause of syncope. The most frequent mechanism is that of a cardioinhibitory response, vasodepressor response, or mixture of both. Neural stimulation that negates or overcomes the effects of vagal tone may be used as a treatment strategy for VVS. METHODS Six male canines were studied. Stimulation (10-Hz, 2 ms pulse duration, 2 min duration) of the cervical vagus (CV), thoracic vagus (TV), and stellate ganglia (SG) was performed using needle electrodes at 3 V, 5 V, and 10 V output. SG stimulation at an output of 10 V overlaying TV stimulation at the same output was performed. Heart rate (HR), blood pressure (BP), and cardiac output (CO) were measured before, during, and after stimulation. RESULTS Right cervical vagal stimulation was associated with significant hemodynamic changes. HR, SBP, and DBP were reduced (107 ± 16 vs. 78 ± 15 bpm [P < 0.0001], 116 ± 24 vs. 107 ± 28 mmHg [P = 0.002] and 71 ± 18 vs. 58 ± 20 mmHg [P < 0.0001]), respectively, while left cervical vagal stimulation had minimal changes. CV stimulation was associated with greater hemodynamic changes than TV stimulation. Left and right SG stimulation significantly increased systolic blood pressure (SBP), diastolic blood pressure (DBP), and HR at 5 V and 10 V, which could be observed within 30 s after stimulation. An output-dependent increase in hemodynamic parameters was seen with both left and right SG stimulation. No difference between left and right SG stimulation was seen. SG stimulation overlay significantly increased HR, BP, and CO from baseline vagal stimulation bilaterally. CONCLUSIONS Stellate ganglia stimulation leads to increased HR and BP despite significant vagal stimulation. This may be exploited therapeutically in the management of vasovagal syncope.
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Affiliation(s)
- Ammar M Killu
- Department of Cardiovascular Disease, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mei Yang
- Department of Cardiology, Xinhua Hospital, 1665 Kongjiang Rd, Yangpu Qu, Shanghai Shi, 200000, China
| | - Niyada Naksuk
- Department of Cardiovascular Disease, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jason Tri
- Department of Cardiovascular Disease, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Xuping Li
- Department of Cardiovascular medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Roshini Asirvatham
- Department of Cardiovascular Disease, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Disease, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Disease, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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18
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Kahle AK, Klatt N, Jungen C, Dietenberger A, Kuklik P, Münkler P, Willems S, Nikolaev V, Pauza DH, Scherschel K, Meyer C. Acute Modulation of Left Ventricular Control by Selective Intracardiac Sympathetic Denervation. JACC Clin Electrophysiol 2022; 9:371-384. [PMID: 36752452 DOI: 10.1016/j.jacep.2022.10.013] [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: 02/18/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The sympathetic nervous system plays an integral role in cardiac physiology. Nerve fibers innervating the left ventricle are amenable to transvenous catheter stimulation along the coronary sinus (CS). OBJECTIVES The aim of the present study was to modulate left ventricular control by selective intracardiac sympathetic denervation. METHODS First, the impact of epicardial CS ablation on cardiac electrophysiology was studied in a Langendorff model of decentralized murine hearts (n = 10 each, ablation and control groups). Second, the impact of transvenous, anatomically driven axotomy by catheter-based radiofrequency ablation via the CS was evaluated in healthy sheep (n = 8) before and during stellate ganglion stimulation. RESULTS CS ablation prolonged epicardial ventricular refractory period without (41.8 ± 8.4 ms vs 53.0 ± 13.5 ms; P = 0.049) and with β1-2-adrenergic receptor blockade (47.8 ± 7.8 ms vs 73.1 ± 13.2 ms; P < 0.001) in mice. Supported by neuromorphological studies illustrating a circumferential CS neural network, intracardiac axotomy by catheter ablation via the CS in healthy sheep diminished the blood pressure increase during stellate ganglion stimulation (Δ systolic blood pressure 21.9 ± 10.9 mm Hg vs 10.5 ± 12.0 mm Hg; P = 0.023; Δ diastolic blood pressure 9.0 ± 5.5 mm Hg vs 3.0 ± 3.5 mm Hg; P = 0.039). CONCLUSIONS Transvenous, anatomically driven axotomy targeting nerve fibers along the CS enables acute modulation of left ventricular control by selective intracardiac sympathetic denervation.
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Affiliation(s)
- Ann-Kathrin Kahle
- Division of Cardiology, Angiology, and Intensive Care Medicine, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany; Institute of Neural and Sensory Physiology, Cardiac Neuro- and Electrophysiology Research Consortium, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Niklas Klatt
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany; Department of Cardiology, Schön Klinik Neustadt in Holstein, Neustadt in Holstein, Germany
| | - Christiane Jungen
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany; Clinic for Cardiology, University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Aaron Dietenberger
- Clinic for Cardiology, University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pawel Kuklik
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Paula Münkler
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany; Clinic for Cardiology, University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stephan Willems
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany; Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Viacheslav Nikolaev
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany; Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dainius H Pauza
- Institute of Anatomy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Katharina Scherschel
- Division of Cardiology, Angiology, and Intensive Care Medicine, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany; Institute of Neural and Sensory Physiology, Cardiac Neuro- and Electrophysiology Research Consortium, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Christian Meyer
- Division of Cardiology, Angiology, and Intensive Care Medicine, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany; Institute of Neural and Sensory Physiology, Cardiac Neuro- and Electrophysiology Research Consortium, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany.
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19
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Cauti FM, Capone S, Rossi P, Polselli M, Venuta F, Vannucci J, Bruno K, Pugliese F, Tozzi P, Bianchi S, Anile M. Cardiac sympathetic denervation for untreatable ventricular tachycardia in structural heart disease. Strengths and pitfalls of evolving surgical techniques. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01404-9. [PMID: 36282370 DOI: 10.1007/s10840-022-01404-9] [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: 06/14/2022] [Accepted: 10/19/2022] [Indexed: 10/31/2022]
Abstract
Cardiac sympathetic denervation (CSD) is a valuable option in the setting of refractory ventricular arrhythmias in patient with structural heart disease. Since the procedure was introduced for non structural heart disease patients the techniques evolved and were modified to be adopted in several settings. In this state-of-the-art article we revised different techniques, their rationale, strengths, and pitfalls.
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Affiliation(s)
- Filippo Maria Cauti
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy.
| | - Silvia Capone
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy
- Cardiology Unit, Dipartimento Cuore E Grossi Vasi, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Pietro Rossi
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy
| | - Marco Polselli
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy
| | - Federico Venuta
- Thoracic Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Jacopo Vannucci
- Thoracic Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Katia Bruno
- Department of Anesthesiology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Francesco Pugliese
- Department of Anesthesiology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Pierfrancesco Tozzi
- Department of Anesthesiology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Stefano Bianchi
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy
| | - Marco Anile
- Thoracic Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
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20
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Ge Y, van Roon L, van Gils JM, Geestman T, van Munsteren CJ, Smits AM, Goumans MJTH, DeRuiter MC, Jongbloed MRM. Acute myocardial infarction induces remodeling of the murine superior cervical ganglia and the carotid body. Front Cardiovasc Med 2022; 9:758265. [PMID: 36277772 PMCID: PMC9582601 DOI: 10.3389/fcvm.2022.758265] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
A role for cardiac sympathetic hyperinnervation in arrhythmogenesis after myocardial infarction (MI) has increasingly been recognized. In humans and mice, the heart receives cervical as well as thoracic sympathetic contributions. In mice, superior cervical ganglia (SCG) have been shown to contribute significantly to myocardial sympathetic innervation of the left ventricular anterior wall. Of interest, the SCG is situated adjacent to the carotid body (CB), a small organ involved in oxygen and metabolic sensing. We investigated the remodeling of murine SCG and CB over time after MI. Murine SCG were isolated from control mice, as well as 24 h, 3 days, 7 days and 6 weeks after MI. SCG and CBs were stained for the autonomic nervous system markers β3-tubulin, tyrosine hydroxylase (TH) and choline acetyltransferase (ChAT), as well as for the neurotrophic factors brain derived neurotropic factor (BDNF), nerve growth factor (NGF) and their tyrosine receptor kinase (pan TRK). Results show that after MI a significant increase in neuron size occurs, especially in the region bordering the CB. Co-expression of TH and ChAT is observed in SCG neuronal cells, but not in the CB. After MI, a significant decrease in ChAT intensity occurs, which negatively correlated with the increased cell size. In addition, an increase of BDNF and NGF at protein and mRNA levels was observed in both the CB and SCG. This upregulation of neurotropic factors coincides with the upregulation of their receptor within the SCG. These findings were concomitant with an increase in GAP43 expression in the SCG, which is known to contribute to axonal outgrowth and elongation. In conclusion, neuronal remodeling toward an increased adrenergic phenotype occurs in the SCG, which is possibly mediated by the CB and might contribute to pathological hyperinnervation after MI.
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Affiliation(s)
- Yang Ge
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Lieke van Roon
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Janine M. van Gils
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands,Department of Nephrology, Leiden University Medical Center, Leiden, Netherlands
| | - Tom Geestman
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Conny J. van Munsteren
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Anke M. Smits
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Marco C. DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique R. M. Jongbloed
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands,*Correspondence: Monique R. M. Jongbloed, ; orcid.org/0000-0002-9132-0418
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21
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König S, Schröter T, Borger MA, Bertagnolli L, Nedios S, Darma A, Hindricks G, Arya A, Dinov B. Outcomes following cardiac sympathetic denervation in patients with structural heart disease and refractory ventricular arrhythmia. Europace 2022; 24:1800-1808. [DOI: 10.1093/europace/euac078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aim
Cardiac sympathetic denervation (CSD) has been introduced as a bailout therapy in patients with structural heart disease and refractory ventricular arrhythmias (VAs), but available data are scarce. Purpose of this study was to estimate immediate results, complications, and mid-term outcomes of CSD following recurrent VA after catheter ablation.
Methods and results
Adult patients who underwent CSD in the Heart Center Leipzig from March 2017 to February 2021 were retrospectively analysed. Follow-up (FU) was executed via implantable cardioverter defibrillator (ICD) interrogation, telephone interviews, and reviewing medical records. Twenty-one patients (age 63.7 ± 14.4 years, all men, 71.4% non-ischaemic cardiomyopathy, left ventricular ejection fraction 31.6 ± 12.6%) received CSD via video-assisted thoracoscopic surgery (90.5% bilateral, 9.5% left-sided only). Indication for CSD was monomorphic ventricular tachycardia in 76.2% and ventricular fibrillation in 23.8 with 71.4% of patients presenting with electrical storm before index hospitalization. Procedure-related major complications occurred in 9.5% of patients. In-hospital adverse events not related to surgery were common (28.6%) and two patients died during the index hospital stay. During FU (mean duration 9.1 ± 6.5 months), five more patients died. Of the remaining patients, 38.5 and 76.9% were free from any VA or ICD shocks, respectively.
Conclusions
The CSD showed additional moderate efficacy to suppress VAs, when performed as a bailout therapy after previously unsuccessful catheter ablation. At 9 months, it was associated with freedom of ICD shocks in two-thirds of patients. In a population with many comorbidities, the rate of CSD-related complications was acceptable, although there was an overall high risk of procedure unrelated adverse events and death.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig , Strümpellstraße 39, Leipzig 04289 , Germany
- Leipzig Heart Institute , Leipzig , Germany
| | - Thomas Schröter
- Heart Center Leipzig at University of Leipzig, Department of Cardiac Surgery , Leipzig , Germany
| | - Michael A Borger
- Heart Center Leipzig at University of Leipzig, Department of Cardiac Surgery , Leipzig , Germany
| | - Livio Bertagnolli
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig , Strümpellstraße 39, Leipzig 04289 , Germany
| | - Sotirios Nedios
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig , Strümpellstraße 39, Leipzig 04289 , Germany
| | - Angeliki Darma
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig , Strümpellstraße 39, Leipzig 04289 , Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig , Strümpellstraße 39, Leipzig 04289 , Germany
- Leipzig Heart Institute , Leipzig , Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig , Strümpellstraße 39, Leipzig 04289 , Germany
| | - Borislav Dinov
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig , Strümpellstraße 39, Leipzig 04289 , Germany
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22
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Lee ACH, Tung R, Ferguson MK. Thoracoscopic sympathectomy decreases disease burden in patients with medically refractory ventricular arrhythmias. Interact Cardiovasc Thorac Surg 2022; 34:783-790. [PMID: 35015855 PMCID: PMC9070511 DOI: 10.1093/icvts/ivab372] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/22/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
Thoracic sympathectomy has been shown to be effective in reducing implantable cardioverter-defibrillator (ICD) shocks and ventricular tachycardia recurrence in patients with channelopathies, but the evidence supporting its use for refractory ventricular arrhythmias in patients without channelopathies is limited. This is a single-centre cohort study of bilateral R1–R4 thoracoscopic sympathectomy for medically refractory ventricular arrhythmias.
METHODS
Clinical information was examined for all bilateral thoracoscopic R1–R4 sympathectomies for ventricular arrhythmias at our institution from 2016 through 2020.
RESULTS
Thirteen patients underwent bilateral thoracoscopic R1–R4 sympathectomy. All patients had prior ICD implant. Patients had a recent history of multiple ICD discharges (12/13), catheter ablation (10/13) and cardiac arrest (3/13). Ten patients were urgently operated on following transfer to our centre for sustained ventricular tachycardia. Seven patients had ventricular tachycardia ablations preoperatively during the same admission. Five patients were in intensive care immediately preoperatively, with 3 requiring mechanical ventilation. Three patients suffered in-hospital mortality. Kaplan–Meier analysis estimated 73% overall survival at 24-month follow-up. Among the 10 patients who survived to discharge, all were alive at a median follow-up of 8.7 months (interquartile range 0.6–26.7 months). Six of 10 patients had no further ICD discharges. Kaplan–Meier analysis estimated 27% ICD shock-free survival at 24 months follow-up for all patients. Three of 10 patients had additional ablations, while 2 patients underwent cardiac transplantation.
CONCLUSIONS
Bilateral thoracoscopic sympathectomy is an effective option for patients with life-threatening ventricular arrhythmia refractory to pharmacotherapy and catheter ablation.
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Affiliation(s)
- Andy Chao Hsuan Lee
- Section of Thoracic Surgery, Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - Roderick Tung
- Division of Cardiology, Department of Internal Medicine, University of Arizona, Phoenix, AZ, USA
| | - Mark K Ferguson
- Section of Thoracic Surgery, Department of Surgery, The University of Chicago, Chicago, IL, USA
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23
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Hoang JD, Yamakawa K, Rajendran PS, Chan CA, Yagishita D, Nakamura K, Lux RL, Vaseghi M. Proarrhythmic Effects of Sympathetic Activation Are Mitigated by Vagal Nerve Stimulation in Infarcted Hearts. JACC Clin Electrophysiol 2022; 8:513-525. [PMID: 35450607 PMCID: PMC9034056 DOI: 10.1016/j.jacep.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The goal of this study was to evaluate whether intermittent VNS reduces electrical heterogeneities and arrhythmia inducibility during sympathoexcitation. BACKGROUND Sympathoexcitation increases the risk of ventricular tachyarrhythmias (VT). Vagal nerve stimulation (VNS) has been antiarrhythmic in the setting of ischemia-driven arrhythmias, but it is unclear if it can overcome the electrophysiological effects of sympathoexcitation in the setting of chronic myocardial infarction (MI). METHODS In Yorkshire pigs after chronic MI, a sternotomy was performed, a 56-electrode sock was placed over the ventricles (n = 17), and a basket catheter was positioned in the left ventricle (n = 6). Continuous unipolar electrograms from sock and basket arrays were obtained to analyze activation recovery interval (ARI), a surrogate of action potential duration. Bipolar voltage mapping was performed to define scar, border zone, or viable myocardium. Hemodynamic and electrical parameters and VT inducibility were evaluated during sympathoexcitation with bilateral stellate ganglia stimulation (BSS) and during combined BSS with intermittent VNS. RESULTS During BSS, global epicardial ARIs shortened from 384 ± 59 milliseconds to 297 ± 63 milliseconds and endocardial ARIs from 359 ± 36 milliseconds to 318 ± 40 milliseconds. Dispersion in ARIs increased in all regions, with the greatest increase observed in scar and border zone regions. VNS mitigated the effects of BSS on border zone ARIs (from -18.3% ± 6.3% to -2.1% ± 14.7%) and ARI dispersion (from 104 ms2 [1 to 1,108 ms2] to -108 ms2 [IQR: -588 to 30 ms2]). VNS reduced VT inducibility during sympathoexcitation (from 75%-40%; P < 0.05). CONCLUSIONS After chronic MI, VNS overcomes the detrimental effects of sympathoexcitation by reducing electrophysiological heterogeneities exacerbated by sympathetic stimulation, decreasing VT inducibility.
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Affiliation(s)
- Jonathan D Hoang
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California, USA; UCLA Neurocardiology Program of Excellence, University of California, Los Angeles, California, USA; Molecular, Cellular and Integrative Physiology Interdepartmental Program, University of California, Los Angeles, California, USA
| | - Kentaro Yamakawa
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California, USA
| | - Pradeep S Rajendran
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California, USA; UCLA Neurocardiology Program of Excellence, University of California, Los Angeles, California, USA
| | - Christopher A Chan
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California, USA; UCLA Neurocardiology Program of Excellence, University of California, Los Angeles, California, USA
| | - Daigo Yagishita
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California, USA
| | - Keijiro Nakamura
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California, USA
| | - Robert L Lux
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California, USA
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California, USA; UCLA Neurocardiology Program of Excellence, University of California, Los Angeles, California, USA; Molecular, Cellular and Integrative Physiology Interdepartmental Program, University of California, Los Angeles, California, USA.
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24
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Brain-heart communication in health and diseases. Brain Res Bull 2022; 183:27-37. [PMID: 35217133 DOI: 10.1016/j.brainresbull.2022.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 12/19/2022]
Abstract
Tight connections between the brain and heart have attracted a considerable amount of attention. This review focuses on the anatomical (extrinsic cardiac autonomic nervous system and intrinsic cardiac autonomic nervous system) and functional (neuroendocrine-heart axis and neuroimmune-heart axis) connections between the brain and heart, the linkage between central nervous system diseases and cardiovascular diseases, the harm of sympathetic hyperactivity to the heart, and current neuromodulation therapies. Depression is a comorbidity of cardiovascular diseases, and the two are causally related. This review summarizes the mechanisms and treatment of depression and cardiovascular diseases, providing theoretical evidence for basic research and clinical studies to improve treatment options.
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25
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Salavatian S, Hoang JD, Yamaguchi N, Lokhandwala ZA, Swid MA, Armour JA, Ardell JL, Vaseghi M. Myocardial infarction reduces cardiac nociceptive neurotransmission through the vagal ganglia. JCI Insight 2022; 7:155747. [PMID: 35015733 PMCID: PMC8876456 DOI: 10.1172/jci.insight.155747] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/05/2022] [Indexed: 12/05/2022] Open
Abstract
Myocardial infarction causes pathological changes in the autonomic nervous system, which exacerbate heart failure and predispose to fatal ventricular arrhythmias and sudden death. These changes are characterized by sympathetic activation and parasympathetic dysfunction (reduced vagal tone). Reasons for the central vagal withdrawal and, specifically, whether myocardial infarction causes changes in cardiac vagal afferent neurotransmission that then affect efferent tone, remain unknown. The objective of this study was to evaluate whether myocardial infarction causes changes in vagal neuronal afferent signaling. Using in vivo neural recordings from the inferior vagal (nodose) ganglia and immunohistochemical analyses, structural and functional alterations in vagal sensory neurons were characterized in a chronic porcine infarct model and compared with normal animals. Myocardial infarction caused an increase in the number of nociceptive neurons but a paradoxical decrease in functional nociceptive signaling. No changes in mechanosensitive neurons were observed. Notably, nociceptive neurons demonstrated an increase in GABAergic expression. Given that nociceptive signaling through the vagal ganglia increases efferent vagal tone, the results of this study suggest that a decrease in functional nociception, possibly due to an increase in expression of inhibitory neurotransmitters, may contribute to vagal withdrawal after myocardial infarction.
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Affiliation(s)
- Siamak Salavatian
- UCLA Cardiac Arrhythmia Center, UCLA, Los Angeles, United States of America
| | - Jonathan D Hoang
- UCLA Cardiac Arrhythmia Center, UCLA, Los Angeles, United States of America
| | - Naoko Yamaguchi
- UCLA Cardiac Arrhythmia Center, UCLA, Los Angeles, United States of America
| | | | - Mohammed Amer Swid
- UCLA Cardiac Arrhythmia Center, UCLA, Los Angeles, United States of America
| | - J Andrew Armour
- UCLA Cardiac Arrhythmia Center, UCLA, Los Angeles, United States of America
| | - Jeffrey L Ardell
- UCLA Cardiac Arrhythmia Center, UCLA, Los Angeles, United States of America
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA, Los Angeles, United States of America
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Prevention and Management of Perioperative Dysrhythmias. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Stress-related dysautonomias and neurocardiology-based treatment approaches. Auton Neurosci 2022; 239:102944. [DOI: 10.1016/j.autneu.2022.102944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 10/13/2021] [Accepted: 01/16/2022] [Indexed: 11/21/2022]
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Reply: Significance of Stellate Ganglion Removal During Cardiac Sympathetic Denervation. JACC Clin Electrophysiol 2021; 7:1071-1072. [PMID: 34412873 DOI: 10.1016/j.jacep.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 06/30/2021] [Accepted: 07/03/2021] [Indexed: 11/21/2022]
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Reinertsen E, Sabayon M, Riso M, Lloyd M, Spektor B. Stellate ganglion blockade for treating refractory electrical storm: a historical cohort study. Can J Anaesth 2021; 68:1683-1689. [PMID: 34312821 DOI: 10.1007/s12630-021-02068-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Stellate ganglion blockade (SGB) has been used to treat electrical storm (ES) refractory to antiarrhythmic therapy or to stabilize patients before more definitive intervention. Nevertheless, its efficacy is not well understood, with only a few case reports and retrospective case series in the literature. METHODS We conducted a historical cohort study on patients with drug-refractory ES who underwent ultrasound-guided unilateral SGB from 1 January 2010 until 19 July 2019 at two hospital sites. Stellate ganglion blockade was performed with variable combinations of bupivacaine, lidocaine, ropivacaine, and dexamethasone. We collected data on demographic and procedural characteristics, the number of arrhythmias and defibrillation episodes, antiarrhythmic and anticoagulant medication, left ventricular ejection fraction (EF), and respiratory support requirement. RESULTS We identified N = 13 patients; their mean (standard deviation [SD]) age was 64 (13) yr, and 10 (77%) were male. The baseline mean (SD) number of overall arrhythmia and defibrillation episodes per day were 9 (6) and 4 (3), respectively; the mean (SD) pre-SGB EF was 23 (7)%. Seven patients (54%) received dexamethasone in addition to local anesthetic for SGB. One patient experienced hypotension after SGB. Arrhythmias and defibrillation episodes significantly decreased at 24, 48, 72, and 96 hr after SGB; at 96 hr, 62% and 92% of patients had no VA and defibrillation episodes, respectively (P < 0.001 for all time points). Ejection fraction and the number of patients receiving antiarrhythmic medications or requiring respiratory support were unchanged. CONCLUSIONS Unilateral SGB was associated with a reduction in arrhythmias and defibrillation episodes, but did not affect antiarrhythmic medication, respiratory support, or EF. Randomized controlled trials on larger cohorts are needed to confirm these findings.
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Affiliation(s)
| | - Muhie Sabayon
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Margaret Riso
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael Lloyd
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Boris Spektor
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA.
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Hong J, Adam RJ, Gao L, Hahka T, Xia Z, Wang D, Nicholas TA, Zucker IH, Lisco SJ, Wang H. Macrophage activation in stellate ganglia contributes to lung injury-induced arrhythmogenesis in male rats. Acta Physiol (Oxf) 2021; 232:e13657. [PMID: 33817984 DOI: 10.1111/apha.13657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/21/2021] [Accepted: 04/01/2021] [Indexed: 12/21/2022]
Abstract
AIM Patients suffering from acute lung injury (ALI) are at high risk of developing cardiac arrhythmias. We hypothesized that stellate ganglia (SG) neural inflammation contributes to ALI-induced arrhythmia. METHODS We created an ALI rat model using a single tracheal instillation of bleomycin (2.5 mg/kg), with saline as a sham control. We recorded ECGs by implanted radiotelemetry in male bleomycin and sham rats treated with and without oral minocycline (20 mg/kg/d), an anti-inflammatory drug that inhibits microglia/macrophage activation. The SG neuronal excitability was assessed by electrophysiology experiments. RESULTS ECG data showed that bleomycin-exposed rats exhibited significantly more spontaneous premature ventricular contractions (PVCs) from 1- to 3-week post-induction compared with sham rats, which was mitigated by chronic oral administration of minocycline. The bleomycin-exposed rats displayed a robust increase in both the number of Iba1-positive macrophages and protein expression of interferon regulatory factor 8 in the SG starting as early at 1-week post-exposure and lasted for at least 4 weeks, which was largely attenuated by minocycline. Heart rate variability analysis indicated autonomic imbalance during the first 2-week post-bleomycin, which was significantly attenuated by minocycline. Electrical stimulation of the decentralized SG triggered more PVCs in bleomycin-exposed rats than sham and bleomycin + minocycline rats. Patch-clamp data demonstrated enhanced SG neuronal excitability in the bleomycin-exposed rats, which was attenuated by minocycline. Co-culture of lipopolysaccharide (LPS)-pretreated macrophages with normal SG neurons enhanced SG neuronal excitability. CONCLUSION Macrophage activation in the SG contributes to arrhythmogenesis in bleomycin-induced ALI in male rats.
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Affiliation(s)
- Juan Hong
- Department of Anesthesiology University of Nebraska Medical Center Omaha NE USA
| | - Ryan J. Adam
- Department of Anesthesiology University of Nebraska Medical Center Omaha NE USA
- Department of Cellular and Integrative Physiology University of Nebraska Medical Center Omaha NE USA
| | - Lie Gao
- Department of Cellular and Integrative Physiology University of Nebraska Medical Center Omaha NE USA
| | - Taija Hahka
- Department of Anesthesiology University of Nebraska Medical Center Omaha NE USA
| | - Zhiqiu Xia
- Department of Anesthesiology University of Nebraska Medical Center Omaha NE USA
| | - Dong Wang
- Department of Pharmaceutical Sciences University of Nebraska Medical Center Omaha NE USA
| | - Thomas A. Nicholas
- Department of Anesthesiology University of Nebraska Medical Center Omaha NE USA
| | - Irving H. Zucker
- Department of Cellular and Integrative Physiology University of Nebraska Medical Center Omaha NE USA
| | - Steven J. Lisco
- Department of Anesthesiology University of Nebraska Medical Center Omaha NE USA
| | - Han‐Jun Wang
- Department of Anesthesiology University of Nebraska Medical Center Omaha NE USA
- Department of Cellular and Integrative Physiology University of Nebraska Medical Center Omaha NE USA
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Ertugrul I, Donmez YN, Aydın A, Aykan HH, Sel K, Uysal S, Yilmaz M, Karagoz T. Bilateral thoracoscopic sympathectomy for cardiac denervation in pediatric population: Does Kuntz nerve cauterization have an impact on success? J Card Surg 2021; 36:2705-2713. [PMID: 34002873 DOI: 10.1111/jocs.15652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cardiac sympathetic denervation (CSD) is an effective procedure for the treatment of inherited channelopathies. Left CSD has traditionally been recommended as neuromodulation to prevent arrhythmia episodes; however, it is thought that bilateral sympathectomy in combination with Kuntz ablation may have additional effects effective due to the anatomical variability of preganglionic sympathetic fibers. The aim of the study was to share our single-center clinical experience with bilateral thoracoscopic sympathectomy for cardiac denervation in different groups of pediatric patients with malignant arrhythmias. METHODS Fourteen patients (seven with CPVT, five with LQTS, one with resistant ventricular tachycardia as a sequela of myocarditis, and one with cardiomyopathy and atrial tachycardia) underwent bilateral thoracoscopic sympathectomy for cardiac denervation. RESULTS In all patients, arrhythmia episodes persisted despite medical therapy, and patients with implantable cardioverter-defibrillator received appropriate therapies. The rate of appropriate therapies was 3.25 per year (1-5 per year) in the year before sympathectomy. No major complications related to the procedure were observed in any of the patients. The QTc interval of LQTS patients decreased from 506.2 ± 16.9 ms before the procedure to 476 ± 28.8 ms after the procedure. The mean duration of follow-up after the procedure was 23.3 months (11-47 months). Only two patients received single episodes of therapy 12 and 22 months after CSD, and one patient had arrhythmic events due to noncompliance to medical therapy. CONCLUSION Due to the anatomical variability of preganglionic fibers bilateral CSD with Kuntz nerve ablation effective treatment and is a safe option.
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Affiliation(s)
- Ilker Ertugrul
- Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yasemin N Donmez
- Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Aydın
- Department of Pediatric Cardiovascular Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hayrettin H Aykan
- Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kutay Sel
- Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serkan Uysal
- Department of Thoracic Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Yilmaz
- Department of Pediatric Cardiovascular Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tevfik Karagoz
- Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Barwad P, Sinkar K, Bachani N, Shah R, Shah V, Kumar B, Bhoskar S, Desai N, Lokhandwala Y. Long-term clinical outcomes of cardiac sympathetic denervation in patients with refractory ventricular arrhythmias. J Cardiovasc Electrophysiol 2021; 32:1065-1074. [PMID: 33570234 DOI: 10.1111/jce.14947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 12/16/2020] [Accepted: 01/04/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cardiac sympathetic denervation (CSD) is a useful therapeutic option in patients with structural heart disease (SHD) and ventricular tachycardia (VT) who are otherwise refractory to standard antiarrhythmic drug (AAD) therapy or catheter ablation (CA). In this study, we sought to retrospectively analyze the long-term outcomes of CSD in patients with refractory VT and/or VT storm with a majority of the patients being taken up for CSD ahead of CA. METHODS We included consecutive patients with SHD who underwent CBD from 2010 to 2019 owing to refractory VT. A complete response to CSD was defined as a greater than 75% reduction in the frequency of ICD shocks for VT. RESULTS A total of 65 patients (50 male, 15 female) were included. The underlying VT substrate was ischemic heart disease (IHD) in 30 (46.2%) patients while the remaining 35 (53.8%) patients had other nonischemic causes. The mean duration of follow-up was 27 ± 24 months. A complete response to CSD was achieved in 47 (72.3%) patients. There was a significant decline in the number of implantable cardioverter-defibrillator (ICD) or external defibrillator shocks post-CSD (24 ± 37 vs. 2 ± 4, p < .01). Freedom from a combined endpoint of ICD shock or death at 2 years was 51.5%. An advanced New York Heart Association class (III and IV) was the only parameter found to be associated with this combined endpoint. CONCLUSION The current retrospective analysis re-emphasizes the role of surgical CSD and explores its role ahead of CA in the treatment of patients with refractory VT or VT storm.
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Affiliation(s)
- Parag Barwad
- Department of Cardiology, Advance Cardiac Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kunal Sinkar
- Department of Cardiology, Holy Family Hospital, Mumbai, India
| | - Neeta Bachani
- Department of Cardiology, Holy Family Hospital, Mumbai, India
| | - Rushil Shah
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vihang Shah
- Department of Cardiology, Holy Family Hospital, Mumbai, India
| | - Binay Kumar
- Department of Cardiology, Holy Family Hospital, Mumbai, India
| | | | - Neeraj Desai
- Department of Cardiology, Holy Family Hospital, Mumbai, India
| | - Yash Lokhandwala
- Department of Cardiology, Holy Family Heart Institute, Bandra, Mumbai, India
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Krause E, Appelbaum J, Naselsky W, Dickfeld T, Friedberg J, See V, Burrows W. Limited Left Thoracoscopic Sympathectomy Effectively Silences Refractory Electrical Storm. Ann Thorac Surg 2021; 113:217-223. [PMID: 33545155 DOI: 10.1016/j.athoracsur.2021.01.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 12/20/2020] [Accepted: 01/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Electrical Storm is a life-threatening condition that affects up to 20% of patients with ICDs. In this small retrospective study, we report our results with left video-assisted thoracoscopic sympathectomy/ganglionectomy (VATSG) to treat refractory electrical storm in low ejection fraction patients who were not candidates for catheter ablations (CA). METHODS We identified 12 patients who presented with electrical storm and underwent a total of 14 video assisted thoracoscopic sympathectomy/ganglionectomy, including three patients on venoarterial extracorporeal membrane oxygenation (VA ECMO). We reviewed demographic data, survival to discharge, number of cardioversions (before and after VATSG), need for readmissions, and need for right-sided procedures. RESULTS In the 30 days prior to a left VATSG the mean number of shocks was 22.67 for all patients. For the patients who survived to discharge the mean was 3.55 since surgery with a median of zero shocks after a median follow up of 358 days. Six patients have not experienced any further cardioversions since their last VATSG and five have never been readmitted for VT. Two patients had staged bilateral procedures due to recurrences and of those, one never required any further cardioversions. CONCLUSIONS Limited left VATSG is an appropriate and effective initial treatment for ES patients who are not candidates for CA, including patients on VA ECMO for hemodynamic support.
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Affiliation(s)
- Eric Krause
- University of Maryland, Division of Thoracic Surgery, Baltimore, MD.
| | - Jason Appelbaum
- University of Maryland, Department of Cardiology, Division of Clinical Electrophysiology, Baltimore, MD
| | - Warren Naselsky
- University of Maryland, Division of Thoracic Surgery, Baltimore, MD
| | - Timm Dickfeld
- University of Maryland, Department of Cardiology, Division of Clinical Electrophysiology, Baltimore, MD
| | - Joseph Friedberg
- University of Maryland, Division of Thoracic Surgery, Baltimore, MD
| | - Vincent See
- University of Maryland, Department of Cardiology, Division of Clinical Electrophysiology, Baltimore, MD
| | - Whitney Burrows
- University of Maryland, Division of Thoracic Surgery, Baltimore, MD
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Dusi V, Gornbein J, Do DH, Sorg JM, Khakpour H, Krokhaleva Y, Ajijola OA, Macias C, Bradfield JS, Buch E, Fujimura OA, Boyle NG, Yanagawa J, Lee JM, Shivkumar K, Vaseghi M. Arrhythmic Risk Profile and Outcomes of Patients Undergoing Cardiac Sympathetic Denervation for Recurrent Monomorphic Ventricular Tachycardia After Ablation. J Am Heart Assoc 2021; 10:e018371. [PMID: 33441022 PMCID: PMC7955320 DOI: 10.1161/jaha.120.018371] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Cardiac sympathetic denervation (CSD) has been used as a bailout strategy for refractory ventricular tachycardia (VT). Risk of VT recurrence in patients with scar‐related monomorphic VT referred for CSD and the extent to which CSD can modify this risk is unknown. We aimed to quantify arrhythmia recurrence risk and impact of CSD in this population. Methods and Results Adjusted competing risk time to event models were developed to adjust for risk of VT recurrence and sustained VT/implantable cardioverter–defibrillator shocks after VT ablation based on patient comorbidities at the time of VT ablation. Adjusted VT and implantable cardioverter–defibrillator shock recurrence rates were estimated for the subgroup who subsequently required CSD after ablation. The expected adjusted recurrence rates were then compared with the observed rates after CSD. Data from 381 patients with scar‐mediated monomorphic VT who underwent VT ablation were analyzed, excluding patients with polymorphic VT. Sixty eight patients underwent CSD for recurrent VT. CSD reduced the expected adjusted VT recurrence rate by 36% (expected rate of 5.61 versus observed rate of 3.58 per 100 person‐months, P=0.01) and the sustained VT/implantable cardioverter–defibrillator shock rates by 34% (expected rate of 4.34 versus observed 2.85 per 100 person‐months, P=0.03). The median number of sustained VT/implantable cardioverter–defibrillator shocks in the year before versus the year after CSD was reduced by 90% (10 versus 1, P<0.0001). Conclusions Patients referred for CSD for refractory scar‐mediated monomorphic VT are at a higher risk of VT recurrence after ablation as compared with those not requiring CSD, mostly because of their cardiac comorbidities. CSD significantly reduced both the expected risk of recurrences and VT burden.
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Affiliation(s)
- Veronica Dusi
- UCLA Cardiac Arrhythmia Center Los Angeles CA.,Department of Molecular Medicine University of Pavia Pavia Italy
| | - Jeffrey Gornbein
- Departments of Medicine and Computational Medicine University of California Los Angeles CA
| | - Duc H Do
- UCLA Cardiac Arrhythmia Center Los Angeles CA
| | | | | | | | | | | | | | - Eric Buch
- UCLA Cardiac Arrhythmia Center Los Angeles CA
| | | | | | - Jane Yanagawa
- Division of Thoracic Surgery Department of Surgery University of California Los Angeles CA
| | - Jay M Lee
- Division of Thoracic Surgery Department of Surgery University of California Los Angeles CA
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Tsvetkova AS, Bernikova OG, Mikhaleva NJ, Khramova DS, Ovechkin AO, Demidova MM, Platonov PG, Azarov JE. Melatonin Prevents Early but Not Delayed Ventricular Fibrillation in the Experimental Porcine Model of Acute Ischemia. Int J Mol Sci 2020; 22:ijms22010328. [PMID: 33396934 PMCID: PMC7795598 DOI: 10.3390/ijms22010328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/16/2020] [Accepted: 12/26/2020] [Indexed: 01/09/2023] Open
Abstract
Antiarrhythmic effects of melatonin have been demonstrated ex vivo and in rodent models, but its action in a clinically relevant large mammalian model remains largely unknown. Objectives of the present study were to evaluate electrophysiological and antiarrhythmic effects of melatonin in a porcine model of acute myocardial infarction. Myocardial ischemia was induced by 40-min coronary occlusion in 25 anesthetized pigs. After ischemia onset, 12 animals received melatonin (4 mg/kg). 48 intramyocardial electrograms were recorded from left ventricular wall and interventricular septum (IVS). In each lead, activation time (AT) and repolarization time (RT) were determined. During ischemia, ATs and dispersion of repolarization (DOR = RTmax − RTmin) increased reaching maximal values by 3–5 and 20–25 min, respectively. Ventricular fibrillation (VF) incidence demonstrated no relations to redox state markers and was associated with increased DOR and delayed ATs (specifically, in an IVS base, an area adjacent to the ischemic zone) (p = 0.031). Melatonin prevented AT increase in the IVS base, (p < 0.001) precluding development of early VF (1–5 min, p = 0.016). VF occurrence in the delayed phase (17–40 min) where DOR was maximal was not modified by melatonin. Thus, melatonin-related enhancement of activation prevented development of early VF in the myocardial infarction model.
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Affiliation(s)
- Alena S. Tsvetkova
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 167000 Syktyvkar, Russia; (O.G.B.); (N.J.M.); (A.O.O.); (J.E.A.)
- Correspondence: ; Tel.: +7-908-3280-936
| | - Olesya G. Bernikova
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 167000 Syktyvkar, Russia; (O.G.B.); (N.J.M.); (A.O.O.); (J.E.A.)
| | - Natalya J. Mikhaleva
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 167000 Syktyvkar, Russia; (O.G.B.); (N.J.M.); (A.O.O.); (J.E.A.)
| | - Darya S. Khramova
- Department of Molecular Immunology and Biotechnology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 167000 Syktyvkar, Russia;
| | - Alexey O. Ovechkin
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 167000 Syktyvkar, Russia; (O.G.B.); (N.J.M.); (A.O.O.); (J.E.A.)
- Department of Therapy, Institute of Medicine, Pitirim Sorokin Syktyvkar State University, 55 Starovskiist., 167001 Syktyvkar, Russia
| | - Marina M. Demidova
- Department of Cardiology, Clinical Sciences, Lund University, 22185 Lund, Sweden; (M.M.D.); (P.G.P.)
- V.A. Almazov National Medical Research Center, 197341 Saint Petersburg, Russia
| | - Pyotr G. Platonov
- Department of Cardiology, Clinical Sciences, Lund University, 22185 Lund, Sweden; (M.M.D.); (P.G.P.)
- Arrhythmia Clinic, Skåne University Hospital, 22185 Lund, Sweden
| | - Jan E. Azarov
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 167000 Syktyvkar, Russia; (O.G.B.); (N.J.M.); (A.O.O.); (J.E.A.)
- Department of Cardiology, Clinical Sciences, Lund University, 22185 Lund, Sweden; (M.M.D.); (P.G.P.)
- Department of Biochemistry and Physiology, Institute of Medicine, Pitirim Sorokin Syktyvkar State University, 55 Starovskiist., 167001 Syktyvkar, Russia
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Cauti FM, Rossi P, Bianchi S, Bruno K, Iaia L, Rossi C, Pugliese F, Quaglione R, Venuta F, Anile M. Outcome of a Modified Sympathicotomy for Cardiac Neuromodulation of Untreatable Ventricular Tachycardia. JACC Clin Electrophysiol 2020; 7:442-449. [PMID: 33888265 DOI: 10.1016/j.jacep.2020.08.022] [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: 04/13/2020] [Revised: 08/07/2020] [Accepted: 08/24/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study aimed to describe the preliminary results of a modified sympathicotomy for cardiac sympathetic denervation (CSD), which may reduce the predictive risk and intraoperative surgical time of the procedure. BACKGROUND CSD, in patients with refractory ventricular tachycardia (VT), is comprehensively recognized as an important treatment option for patients with structural heart disease as well as congenital inherited arrhythmia syndrome. METHODS We consecutively enrolled 5 patients with refractory VT. Baseline demographic, medical, and surgical data as well as arrhythmia outcomes and procedural complications were evaluated. RESULTS A total of 5 patients (mean age: 67.4 years) were enrolled for the treatment of refractory VT with a modified CSD technique. In 3 of 5 patients, an overall reduction in VT burden (ranging from 75% to 100%) and VT number was observed after the CSD despite an in-hospital early recurrence. CONCLUSIONS A modified CSD (sympathicotomy T2-T5) with stellate ganglion sparing and the use of unipolar radiofrequency is feasible, effective, and safe in the setting of untreatable VT.
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Affiliation(s)
- Filippo M Cauti
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli Isola Tiberina, Rome, Italy.
| | - Pietro Rossi
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli Isola Tiberina, Rome, Italy
| | - Stefano Bianchi
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli Isola Tiberina, Rome, Italy
| | - Katia Bruno
- Department of Anesthesiology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Luigi Iaia
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli Isola Tiberina, Rome, Italy
| | | | - Francesco Pugliese
- Department of Anesthesiology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Raffaele Quaglione
- Cardiology Unit, Dipartimento Cuore e Grossi Vasi, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Federico Venuta
- Thoracic Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Marco Anile
- Thoracic Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
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Bardsley EN, Paterson DJ. Neurocardiac regulation: from cardiac mechanisms to novel therapeutic approaches. J Physiol 2020; 598:2957-2976. [PMID: 30307615 PMCID: PMC7496613 DOI: 10.1113/jp276962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/02/2018] [Indexed: 12/15/2022] Open
Abstract
Cardiac sympathetic overactivity is a well-established contributor to the progression of neurogenic hypertension and heart failure, yet the underlying pathophysiology remains unclear. Recent studies have highlighted the importance of acutely regulated cyclic nucleotides and their effectors in the control of intracellular calcium and exocytosis. Emerging evidence now suggests that a significant component of sympathetic overactivity and enhanced transmission may arise from impaired cyclic nucleotide signalling, resulting from compromised phosphodiesterase activity, as well as alterations in receptor-coupled G-protein activation. In this review, we address some of the key cellular and molecular pathways that contribute to sympathetic overactivity in hypertension and discuss their potential for therapeutic targeting.
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Affiliation(s)
- E. N. Bardsley
- Wellcome Trust OXION Initiative in Ion Channels and DiseaseOxfordUK
- Burdon Sanderson Cardiac Science Centre, Department of PhysiologyAnatomy and Genetics, University of OxfordOxfordOX1 3PTUK
| | - D. J. Paterson
- Wellcome Trust OXION Initiative in Ion Channels and DiseaseOxfordUK
- Burdon Sanderson Cardiac Science Centre, Department of PhysiologyAnatomy and Genetics, University of OxfordOxfordOX1 3PTUK
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Sinkar K, Bagchi A, Mahajan A, Vadivelu R, Venkatraman M, Motwani R, Vichare S, Joshi S, Parikh D, Vaz J, Lokhandwala Y. Acute hemodynamics of cardiac sympathetic denervation. Indian Pacing Electrophysiol J 2020; 20:237-242. [PMID: 32553637 PMCID: PMC7691767 DOI: 10.1016/j.ipej.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/02/2020] [Accepted: 06/11/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION We aimed to study the immediate hemodynamic effects of thoracoscopic bilateral cardiac sympathetic denervation (CSD) for recurrent ventricular tachycardia (VT) or VT storm. METHOD We studied a group of 18 adults who underwent bilateral thoracoscopic CSD; the blood pressure (BP) and Heart Rate (HR) were continuously monitored during the surgery and up to 6 h post-operatively. RESULTS Immediately on removal of the sympathetic ganglia, the patients had a drop in both the systolic (110 mm Hg to 95.8 mm Hg, p < 0.001) and diastolic BP (69.4 mm Hg to65 mm Hg, p = 0.007) along with a drop in the HR (81.6 bpm to 61.2 bpm, p < 0.001).At 6 h after CSD, the systolic and diastolic BP did not recover significantly, while there was recovery in HR (61.2 bpm to 66 bpm, p = 0.02). There was no significant difference between those with and without left ventricular (LV) systolic dysfunction. CONCLUSION The acute hemodynamic changes during the perioperative period of CSD are significant but not serious. Awareness of this is useful for peri-operative management.
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Affiliation(s)
- Kunal Sinkar
- Holy Family Hospital, Bandra West, Mumbai, 400050, India
| | - Avishek Bagchi
- Holy Family Hospital, Bandra West, Mumbai, 400050, India.
| | - Ankit Mahajan
- Holy Family Hospital, Bandra West, Mumbai, 400050, India
| | | | | | - Reshma Motwani
- Holy Family Hospital, Bandra West, Mumbai, 400050, India
| | | | - Suresh Joshi
- Holy Family Hospital, Bandra West, Mumbai, 400050, India
| | - Dinesh Parikh
- Holy Family Hospital, Bandra West, Mumbai, 400050, India
| | - Jude Vaz
- Holy Family Hospital, Bandra West, Mumbai, 400050, India
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Hoang JD, Salavatian S, Yamaguchi N, Swid MA, David H, Vaseghi M. Cardiac sympathetic activation circumvents high-dose beta blocker therapy in part through release of neuropeptide Y. JCI Insight 2020; 5:135519. [PMID: 32493842 DOI: 10.1172/jci.insight.135519] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/30/2020] [Indexed: 01/14/2023] Open
Abstract
The sympathetic nervous system plays an important role in the occurrence of ventricular tachycardia (VT). Many patients, however, experience VT despite maximal doses of beta blocker therapy, possibly due to the effects of sympathetic cotransmitters such as neuropeptide Y (NPY). The purpose of this study was to determine, in a porcine model, whether propranolol at doses higher than clinically recommended could block ventricular electrophysiological effects of sympathoexcitation via stellate ganglia stimulation, and if any residual effects are mediated by NPY. Greater release of cardiac NPY was observed at higher sympathetic stimulation frequencies (10 and 20 vs. 4 Hz). Despite treatment with even higher doses of propranolol (1.0 mg/kg), electrophysiological effects of sympathetic stimulation remained, with residual shortening of activation recovery interval (ARI), a surrogate of action potential duration (APD). Adjuvant treatment with the NPY Y1 receptor antagonist BIBO 3304, however, reduced these electrophysiological effects while augmenting inotropy. These data demonstrate that high-dose beta blocker therapy is insufficient to block electrophysiological effects of sympathoexcitation, and a portion of these electrical effects in vivo are mediated by NPY. Y1 receptor blockade may represent a promising adjuvant therapy to beta-adrenergic receptor blockade.
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Affiliation(s)
- Jonathan D Hoang
- UCLA Cardiac Arrhythmia Center.,Neurocardiology Center for Excellence, and.,UCLA Molecular Cellular and Integrative Physiology Interdepartmental Program, UCLA, Los Angeles, California, USA
| | - Siamak Salavatian
- UCLA Cardiac Arrhythmia Center.,Neurocardiology Center for Excellence, and
| | - Naoko Yamaguchi
- UCLA Cardiac Arrhythmia Center.,Neurocardiology Center for Excellence, and
| | - Mohammed Amer Swid
- UCLA Cardiac Arrhythmia Center.,Neurocardiology Center for Excellence, and
| | - Hamon David
- UCLA Cardiac Arrhythmia Center.,Neurocardiology Center for Excellence, and
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center.,Neurocardiology Center for Excellence, and.,UCLA Molecular Cellular and Integrative Physiology Interdepartmental Program, UCLA, Los Angeles, California, USA
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Dalia A, Essandoh M, Poorsattar S, Kothari P, O'Brien EO, Dimitrov T, Rudnick D, Hussain N, Cronin B. The Year in Electrophysiology: Selected Highlights from 2019. J Cardiothorac Vasc Anesth 2020; 34:1406-1415. [DOI: 10.1053/j.jvca.2020.01.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/30/2020] [Indexed: 12/24/2022]
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41
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L Nguyen H, Vaseghi M. Sympathetic Denervation for Treatment of Ventricular Arrhythmias. J Atr Fibrillation 2020; 13:2404. [PMID: 33024504 DOI: 10.4022/jafib.2404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/22/2020] [Accepted: 03/20/2020] [Indexed: 12/16/2022]
Abstract
Ventricular arrhythmias are a major cause of morbidity and mortality in patients with heart disease. A growing understanding of the cardiac autonomic nervous system's crucial role in the pathogenesis of ventricular arrhythmias has led to the development of several neuromodulation therapies. Sympathetic neuromodulation is being increasingly utilized to treat ventricular arrhythmias refractory to medical therapy and catheter ablation. There is a growing body of preclinical and clinical evidence supporting the use of thoracic epidural anesthesia, stellate ganglion blockade, cardiac sympathetic denervation, and renal denervation in the treatment of recurrent ventricular arrhythmias. This review summarizes the relevant literature and discusses approaches to sympathetic neuromodulation, particularly in the management of scar-related ventricular arrhythmias.
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Affiliation(s)
- Heajung L Nguyen
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
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42
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Optical mapping of the pig heart in situ under artificial blood circulation. Sci Rep 2020; 10:8548. [PMID: 32444634 PMCID: PMC7244500 DOI: 10.1038/s41598-020-65464-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 04/22/2020] [Indexed: 12/05/2022] Open
Abstract
The emergence of optical imaging has revolutionized the investigation of cardiac electrical activity and associated disorders in various cardiac pathologies. The electrical signals of the heart and the propagation pathways are crucial for elucidating the mechanisms of various cardiac pathological conditions, including arrhythmia. The synthesis of near-infrared voltage-sensitive dyes and the voltage sensitivity of the FDA-approved dye Cardiogreen have increased the importance of optical mapping (OM) as a prospective tool in clinical practice. We aimed to develop a method for the high-spatiotemporal-resolution OM of the large animal hearts in situ using di-4-ANBDQBS and Cardiogreen under patho/physiological conditions. OM was adapted to monitor cardiac electrical behaviour in an open-chest pig heart model with physiological or artificial blood circulation. We detail the methods and display the OM data obtained using di-4-ANBDQBS and Cardiogreen. Activation time, action potential duration, repolarization time and conduction velocity maps were constructed. The technique was applied to track cardiac electrical activity during regional ischaemia and arrhythmia. Our study is the first to apply high-spatiotemporal-resolution OM in the pig heart in situ to record cardiac electrical activity qualitatively under artificial blood perfusion. The use of an FDA-approved voltage-sensitive dye and artificial blood perfusion in a swine model, which is generally accepted as a valuable pre-clinical model, demonstrates the promise of OM for clinical application.
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Cardiovascular autonomic reflex function after bilateral cardiac sympathetic denervation for ventricular arrhythmias. Heart Rhythm 2020; 17:1320-1327. [PMID: 32325196 DOI: 10.1016/j.hrthm.2020.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Bilateral cardiac sympathetic denervation (BCSD) is an effective therapy for ventricular arrhythmias (VAs) in cardiomyopathies (CMPs). After BCSD, residual autonomic nervous system (ANS) function is unknown. OBJECTIVE The purpose of this study was to assess ANS responses in patients with CMP before and after BCSD as compared with demographically matched healthy controls. METHODS Patients with CMP undergoing BCSD and matched healthy controls were recruited. Noninvasive measures-finger cuff beat-to-beat blood pressure (BP), electrocardiography, palmar electrodermal activity (EDA), and finger pulse volume (FPV)-were obtained at rest and during autonomic stressors-posture change, handgrip, and mental stress. Maximal as well as specific responses to stressors were compared. RESULTS Eighteen patients with CMP (mean age 54 ± 14 years; 16 men, 89%; left ventricular ejection fraction 36% ± 14%) with refractory VAs and 8 matched healthy controls were studied; 9 patients with CMP underwent testing before and after (median 28 days) BCSD, with comparable ongoing medication. Before BCSD, patients with CMP (n = 13) had lower resting systolic BP and FPV than did healthy controls (P < .01). Maximal FPV and systolic BP reflex responses, expressed as percent change were similar, while diastolic BP, mean BP, and EDA responses were blunted. After BCSD, resting measurements were unchanged relative to presurgical baseline (n = 9). EDA responses to stressors were abolished, confirming BCSD, while maximal FPV and BP responses were preserved. Diastolic BP, mean BP, and FPV responses to orthostatic challenge pointed toward a better tolerance of active standing after BCSD as compared with before. Responses to other stressors remained unchanged. CONCLUSION Patients with CMP and refractory VAs on optimal medical therapy have detectable but blunted adrenergic responses, which are not disrupted by BCSD.
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Wu P, Vaseghi M. The autonomic nervous system and ventricular arrhythmias in myocardial infarction and heart failure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:172-180. [PMID: 31823401 DOI: 10.1111/pace.13856] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/25/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
Ventricular arrhythmias (VA) can range in presentation from asymptomatic to cardiac arrest and sudden cardiac death (SCD). Sustained ventricular tachycardias/ventricular fibrillation (VT/VF) are a common cause of SCD in the setting of myocardial infarction (MI) and heart failure. A particularly arrhythmogenic cardiac syncytia in these conditions can be attributed to both sympathetic activation and parasympathetic dysfunction, while appropriate neuromodulation has the potential to reduce occurrence of VT/VF. In this review, we outline the components of the autonomic nervous system that play an important role in normal cardiac electrophysiology and function. In addition, we discuss changes that occur in the setting of cardiac disease including adverse neural remodeling and neurohormonal activation which significantly contribute to propensity for VT/VF. Finally, we review neuromodulation strategies to mitigate VT/VF which predominantly rely on increasing parasympathetic drive and blockade of sympathetic neurotransmission.
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Affiliation(s)
- Perry Wu
- UCLA Cardiac Arrhythmia Center and UCLA Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center and UCLA Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California
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Goldberger JJ, Arora R, Buckley U, Shivkumar K. Autonomic Nervous System Dysfunction: JACC Focus Seminar. J Am Coll Cardiol 2020; 73:1189-1206. [PMID: 30871703 DOI: 10.1016/j.jacc.2018.12.064] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 12/21/2018] [Accepted: 12/30/2018] [Indexed: 12/20/2022]
Abstract
Autonomic nervous system control of the heart is a dynamic process in both health and disease. A multilevel neural network is responsible for control of chronotropy, lusitropy, dromotropy, and inotropy. Intrinsic autonomic dysfunction arises from diseases that directly affect the autonomic nerves, such as diabetes mellitus and the syndromes of primary autonomic failure. Extrinsic autonomic dysfunction reflects the changes in autonomic function that are secondarily induced by cardiac or other disease. An array of tests interrogate various aspects of cardiac autonomic control in either resting conditions or with physiological perturbations from resting conditions. The prognostic significance of these assessments have been well established. Clinical usefulness has not been established, and the precise mechanistic link to mortality is less well established. Further efforts are required to develop optimal approaches to delineate cardiac autonomic dysfunction and its adverse effects to develop tools that can be used to guide clinical decision-making.
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Affiliation(s)
- Jeffrey J Goldberger
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
| | - Rishi Arora
- Feinberg Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Northwestern University-Feinberg School of Medicine, Chicago, Illinois
| | - Una Buckley
- Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, University of California-Los Angeles Los Angeles, California
| | - Kalyanam Shivkumar
- Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, University of California-Los Angeles Los Angeles, California
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Resiniferatoxin reduces ventricular arrhythmias in heart failure via selectively blunting cardiac sympathetic afferent projection into spinal cord in rats. Eur J Pharmacol 2020; 867:172836. [DOI: 10.1016/j.ejphar.2019.172836] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 12/13/2022]
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Dalmasso C, Leachman JR, Osborn JL, Loria AS. Sensory signals mediating high blood pressure via sympathetic activation: role of adipose afferent reflex. Am J Physiol Regul Integr Comp Physiol 2019; 318:R379-R389. [PMID: 31868518 DOI: 10.1152/ajpregu.00079.2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Blood pressure regulation in health and disease involves a balance between afferent and efferent signals from multiple organs and tissues. Although there are numerous reviews focused on the role of sympathetic nerves in different models of hypertension, few have revised the contribution of afferent nerves innervating adipose tissue and their role in the development of obesity-induced hypertension. Both clinical and basic research support the beneficial effects of bilateral renal denervation in lowering blood pressure. However, recent studies revealed that afferent signals from adipose tissue, in an adipose-brain-peripheral pathway, could contribute to the increased sympathetic activation and blood pressure during obesity. This review focuses on the role of adipose tissue afferent reflexes and briefly describes a number of other afferent reflexes modulating blood pressure. A comprehensive understanding of how multiple afferent reflexes contribute to the pathophysiology of essential and/or obesity-induced hypertension may provide significant insights into improving antihypertensive therapeutic approaches.
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Affiliation(s)
- Carolina Dalmasso
- Department of Pharmacology and Nutritional Sciences, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Jacqueline R Leachman
- Department of Pharmacology and Nutritional Sciences, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Jeffrey L Osborn
- Department of Biology, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky
| | - Analia S Loria
- Department of Pharmacology and Nutritional Sciences, College of Medicine, University of Kentucky, Lexington, Kentucky
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Aydin MD, Acikel M, Aydin N, Aydin ME, Ahiskalioglu A, Atalay C, Ahiskalioglu EO, Erdogan F, Sipal S. Predestinating Role of Cardiac Ganglia on Heart Life Expectancy in Rabbits After Brain Death Following Subarachnoid Hemorrhage: An Experimental Study. Transplant Proc 2019; 52:61-66. [PMID: 31837820 DOI: 10.1016/j.transproceed.2019.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/11/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cardiac ganglia are rechargeable batteries of the heart. The essential role of cardiac ganglia on cardiac life expectancy has not been examined following brain death. The aim of this study was to determine cardiac ganglia numbers and neuron density following subarachnoid hemorrhage (SAH). METHODS Twenty-five hybrid rabbits were grouped as control (n = 5), sham (n = 5), and SAH (n = 15). The SAH groups' animals were subjected to injections of lethal dose of 2.00 cc autologous blood into their cisterna magna until linear EEG was obtained. The hearts of all animals were extracted following intracardiac formalin injection and examined. Cardiac ganglia and normal/degenerated neuron densities of cardiac neurons were recorded. RESULTS The mean volume of normal neuron density of ganglia was 6.980 ± 830/mm3, and the degenerated neuron density of ganglia was 3 ± 1/mm3 in the control group, 6134 ± 712/mm3; 23 ± 9/mm3 in the sham group, 3456 ± 589; 1161 ± 72/mm3 in the surviving group; and 1734 ± 341/mm3, 4259 ± 865/mm3 in the dead animals in the SAH group. The algebraic results of heart work capacity (Wh) were estimated as 1375 ± 210 Wh in the control group, 1036 ± 225 in the sham group, 800 ± 110 Wh in the surviving group, and < 100 ± 20 in the dead animals in the SAH group. Degenerated cardiac neuron density/Wh correlation is statistically meaningful between the dead in the SAH group versus the SAH-surviving, sham, and control groups (P < .0005). CONCLUSIONS Normal cardiac ganglia numbers and/or cardiac ganglia neuron density may be related to cardiac survival following brain death after subarachnoid hemorrhage.
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Affiliation(s)
- Mehmet Dumlu Aydin
- Ataturk University, Medical Faculty, Department of Neurosurgery, Erzurum, Turkey.
| | - Mahmut Acikel
- Ankara Higher Education and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Nazan Aydin
- Uskudar University, Medical Faculty, Department of Psychiatri, Erzurum, Turkey
| | - Muhammed Enes Aydin
- Ataturk University, Medical Faculty, Department of Anesthesiology and Reanimation, Erzurum, Turkey
| | - Ali Ahiskalioglu
- Ataturk University, Medical Faculty, Department of Anesthesiology and Reanimation, Erzurum, Turkey
| | - Canan Atalay
- Ataturk University, Medical Faculty, Department of Anesthesiology and Reanimation, Erzurum, Turkey
| | - Elif Oral Ahiskalioglu
- Ataturk University, Medical Faculty, Department of Anesthesiology and Reanimation, Erzurum, Turkey
| | - Fazlı Erdogan
- Ataturk Training and Research Hospital, Department of Pathology Ankara, Turkey
| | - Sare Sipal
- Ataturk University, Medical Faculty, Department of Pathology, Erzurum, Turkey
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Zhou M, Liu Y, He Y, Xie K, Quan D, Tang Y, Huang H, Huang C. Selective chemical ablation of transient receptor potential vanilloid 1 expressing neurons in the left stellate ganglion protects against ischemia-induced ventricular arrhythmias in dogs. Biomed Pharmacother 2019; 120:109500. [PMID: 31600641 DOI: 10.1016/j.biopha.2019.109500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/12/2019] [Accepted: 09/26/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Findings from prior investigations show that left stellate ganglion (LSG) inhibitory approaches protect the heart from ventricular arrhythmias (VAs) caused by acute myocardial infarction (AMI), which still remain many side effects. Targeted transient receptor potential vanilloid 1/tyrosine hydroxylase (TRPV-1/TH) expressing sympathetic neurons ablation is a novel neuro-ablative strategy. The aim of this investigation was to explore if targeted molecular neuro-ablative strategy by resiniferatoxin (RTX) stellate microinjection could protect against ischemia-induced VAs. METHODS Twenty-four anesthetized beagles were assigned to a control group (n = 12) and RTX group (n = 12) in a random manner. Targeted molecular neuro-ablative was produced by RTX stellate microinjection and DMSO was microinjected into LSG in the same way as control. Plasma norepinephrine (NE) level, heart rate variability (HRV), Tpeak-Tend interval (Tp-Te), LSG neural activity and function, ventricular effective refractory period (ERP), beat-to-beat variability of repolarization (BVR) and ventricular action potential duration (APD) were measured at baseline and 60 min after RTX or DMSO microinjection. AMI model was established by the ligation of left anterior descending coronary artery and 60-minute electrocardiography was continuously recorded for VAs analysis. Subsequently, HRV, Tp-Te, plasma NE level from jugular vein and coronary sinus, LSG neural activity and function, ventricular ERP, ventricular APD, BVR, action potential duration alternans (APDA) cycle length and ventricular fibrillation threshold (VFT) were evaluated after AMI. Finally, tissue collection of LSG was performed for examining the TRPV-1, nerve growth factor (NGF) protein and c-fos protein. RESULTS TRPV-1 was highly expressed in the TH-expressing neurons and RTX injection significantly ablated TRPV-1/TH-positive neurons in LSG. Compared with baseline, RTX stellate microinjection significantly reduced plasma NE level, the sympathetic component of HRV, LSG neural activity and LSG function, shortened Tp-Te, prolonged ventricular ERP and APD, but there were no remarkable differences existed for control group. AMI resulted in the significant raise in plasma NE level from jugular vein and coronary sinus, the sympathetic component of HRV, LSG neural activity and LSG function, the marked prolongation in Tp-Te and BVR, the significant decrease in ERP and APD from ischemia area, and the increase in APDA cycle length in the ischemic region of the control group, which were remarkably attenuated in the RTX group. RTX pretreatment markedly rose the VFT in the RTX group. Furthermore, the AMI-triggered VAs was significantly prevented by RTX injection in the RTX group. RTX microinjection down-regulated significantly TRPV-1, NGF and c-fos expression in the LSG compared with the control group. CONCLUSION Targeted ablation of TRPV-1/TH positive sympathetic neurons induced by RTX stellate microinjection could suppress ischemia-induced cardiac autonomic imbalances and cardiac electrophysiology instability to protect against AMI-induced VAs.
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Affiliation(s)
- Mingmin Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Research Institute of Wuhan University, Wuhan, China; Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Yu Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Research Institute of Wuhan University, Wuhan, China; Hubei Key Laboratory of Cardiology, Wuhan, China.
| | - Yan He
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Research Institute of Wuhan University, Wuhan, China; Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Ke Xie
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Research Institute of Wuhan University, Wuhan, China; Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Dajun Quan
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Research Institute of Wuhan University, Wuhan, China; Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Yanhong Tang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Research Institute of Wuhan University, Wuhan, China; Hubei Key Laboratory of Cardiology, Wuhan, China
| | - He Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Research Institute of Wuhan University, Wuhan, China; Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Congxin Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Research Institute of Wuhan University, Wuhan, China; Hubei Key Laboratory of Cardiology, Wuhan, China
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Krokhaleva Y, Vaseghi M. Update on prevention and treatment of sudden cardiac arrest. Trends Cardiovasc Med 2019; 29:394-400. [PMID: 30449537 PMCID: PMC6685756 DOI: 10.1016/j.tcm.2018.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/10/2018] [Accepted: 11/02/2018] [Indexed: 01/09/2023]
Abstract
Sudden cardiac arrest is the leading cause of cardiovascular mortality, posing a substantial public health burden. The incidence and epidemiology of sudden death are a function of age, with primary arrhythmia syndromes and inherited cardiomyopathies representing the predominant causes in younger patients, while coronary artery disease being the leading etiology in those who are 35 years of age and older. Internal cardioverter defibrillators remain the mainstay of primary and secondary prevention of sudden cardiac arrest. In the acute phase, cardiac chain of survival, early reperfusion, and therapeutic hypothermia are the key steps in improving outcomes. In the chronic settings, ventricular tachycardia ablation has been shown to improve patients' quality of life by reducing frequency of defibrillator shocks. Moreover, recent studies have suggested that it may increase survival. Neuromodulation represents a novel therapeutic modality that has a great potential for improving treatment of ventricular arrhythmias.
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Affiliation(s)
- Yuliya Krokhaleva
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Suite 660, Los Angeles, CA, USA
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Suite 660, Los Angeles, CA, USA.
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