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Lee S, Wallick D, Khrestian C, Juzbasich D, Laurita D, Rushing G, Sahadevan J. Nonpharmacologic rate control of postoperative atrial fibrillation in the canine sterile pericarditis model. J Cardiovasc Electrophysiol 2024; 35:1121-1128. [PMID: 38536760 PMCID: PMC11176034 DOI: 10.1111/jce.16260] [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: 12/15/2023] [Revised: 02/28/2024] [Accepted: 03/13/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Postoperative atrial fibrillation (POAF) is common following open heart surgery, and is associated with significant morbidity. Medications used for ventricular rate control of POAF may not be effective in controlling rapid ventricular rates during the postoperative period because of increased sympathetic tone. The purpose of this study was to develop nonpharmacologic rate control of POAF by atrioventricular node (AVN) fat pad stimulation using clinically available temporary pacing wires in the canine sterile pericarditis model. METHODS We studied 10 sterile pericarditis dogs in the closed-chest state on postoperative days 1-3. The AVN fat pad stimulation (amplitude 2-15 mA; frequency 20 Hz; pulse width 0.03-0.2 ms) was performed during sustained POAF (>5 min). We measured ventricular rate and inefficient ventricular contractions during sustained POAF and compared it with and without AVN fat pad stimulation. Also, the parameters of AVN fat pad stimulation to achieve a rate control of POAF were measured over the postoperative days. RESULTS Eleven episodes of sustained POAF were induced in 5/10 sterile pericarditis dogs in the closed-chest state on postoperative days 1-2. During POAF, the AVN fat pad stimulation decreased the ventricular rate from 178 ± 52 bpm to 100 ± 8 bpm in nine episodes. Nonpharmacologic rate control therapy successfully controlled the ventricular rate and eliminated inefficient ventricular contractions during POAF for the duration of the AVN fat pad stimulation. The AVN fat pad stimulation output remained relatively stable over the postoperative days. CONCLUSION During sustained POAF, nonpharmacologic rate control by AVN fat pad stimulation effectively and safely controlled rapid ventricular rates throughout the postoperative period.
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Affiliation(s)
- Seungyup Lee
- Departments of Medicine, Case Western Reserve University, Cleveland, OH
- Biomedical Engineering, Case Western Reserve University, Cleveland, OH
| | - Don Wallick
- Departments of Medicine, Case Western Reserve University, Cleveland, OH
| | - Celeen Khrestian
- Departments of Medicine, Case Western Reserve University, Cleveland, OH
| | - Dragan Juzbasich
- Departments of Medicine, Case Western Reserve University, Cleveland, OH
| | - Daniel Laurita
- Biomedical Engineering, Case Western Reserve University, Cleveland, OH
| | - Gregory Rushing
- Department of Surgery, Case Western Reserve University, Cleveland, OH
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Elamin ABA, Forsat K, Senok SS, Goswami N. Vagus Nerve Stimulation and Its Cardioprotective Abilities: A Systematic Review. J Clin Med 2023; 12:jcm12051717. [PMID: 36902505 PMCID: PMC10003006 DOI: 10.3390/jcm12051717] [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: 12/29/2022] [Revised: 02/10/2023] [Accepted: 02/18/2023] [Indexed: 02/24/2023] Open
Abstract
Despite the vagus nerve stimulator (VNS) being used in neuroscience, it has recently been highlighted that it has cardioprotective functions. However, many studies related to VNS are not mechanistic in nature. This systematic review aims to focus on the role of VNS in cardioprotective therapy, selective vagus nerve stimulators (sVNS), and their functional capabilities. A systemic review of the current literature was conducted on VNS, sVNS, and their ability to induce positive effects on arrhythmias, cardiac arrest, myocardial ischemia/reperfusion injury, and heart failure. Both experimental and clinical studies were reviewed and assessed separately. Of 522 research articles retrieved from literature archives, 35 met the inclusion criteria and were included in the review. Literature analysis proves that combining fiber-type selectivity with spatially-targeted vagus nerve stimulation is feasible. The role of VNS as a tool for modulating heart dynamics, inflammatory response, and structural cellular components was prominently seen across the literature. The application of transcutaneous VNS, as opposed to implanted electrodes, provides the best clinical outcome with minimal side effects. VNS presents a method for future cardiovascular treatment that can modulate human cardiac physiology. However, continued research is needed for further insight.
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Affiliation(s)
| | - Kowthar Forsat
- College of Medicine, Ajman University, Ajman P.O. Box 346, United Arab Emirates
| | - Solomon Silas Senok
- College of Medicine, Ajman University, Ajman P.O. Box 346, United Arab Emirates
| | - Nandu Goswami
- Institute of Physiology (Gravitational Physiology and Medicine), Medical University of Graz, 8036 Graz, Austria
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai P.O. Box 505055, United Arab Emirates
- Correspondence:
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Chava R, Assis F, Herzka D, Kolandaivelu A. Segmented radial cardiac MRI during arrhythmia using retrospective electrocardiogram and respiratory gating. Magn Reson Med 2018; 81:1726-1738. [PMID: 30362588 DOI: 10.1002/mrm.27533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 08/21/2018] [Accepted: 08/23/2018] [Indexed: 01/21/2023]
Abstract
PURPOSE To improve segmented cardiac MRI image quality during arrhythmia. METHODS Electrocardiogram (ECG) and respiratory waveforms were recorded during imaging. Imaging readouts were retrospectively classified into heartbeat-types based on the RR interval of the current and preceding beats, QRS morphology, and respiratory phase. Image data were sorted by these classifiers to generate separate cine images of different heartbeat-types during sinus rhythm and arrhythmia. A simulation study evaluated the efficiency of K-space sampling over a range of heart rhythms, heart rates, and respiratory rates. In vivo imaging was performed in volunteers with sinus rhythm, swine with arrhythmia simulated by pacing, and a human subject with spontaneous premature beats. RESULTS K-space sampling uniformity and image quality incrementally improve with additional occurrences of the desired normal sinus or arrhythmia heartbeat-type. To approach the image quality of breath-hold imaging, sufficiently restrictive gating parameters are required. Compared with real-time imaging, retrospective gated images had reduced noise and improved sharpness while maintaining desired cine temporal resolution. Variations of cardiac function between arrhythmia heartbeats could be observed in arrhythmia imaging cases that are not captured by conventional segmented imaging. CONCLUSION Retrospective ECG and respiratory gating permits imaging of various heartbeats during arrhythmia with fewer resolution restrictions compared to real-time imaging. For a fixed imaging time, imaging quality depends on frequency of the imaged heartbeat-type. Imaging additional heartbeats permits incremental improvement in image quality.
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Affiliation(s)
- Raghuram Chava
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fabrizio Assis
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel Herzka
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aravindan Kolandaivelu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Selective autonomic stimulation of the AV node fat pad to control rapid post-operative atrial arrhythmias. PLoS One 2017; 12:e0183804. [PMID: 28902899 PMCID: PMC5597131 DOI: 10.1371/journal.pone.0183804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 08/13/2017] [Indexed: 11/24/2022] Open
Abstract
Junctional ectopic tachycardia (JET) and atrial fibrillation (AF) occur in patients recovering from open-heart surgery (OHS). Pharmacologic treatment is used for the control of post-operative atrial arrhythmias (POAA), but is associated with side effects. There is a need for a reversible, modulated solution to rate control. We propose a non-pharmacologic technique that can modulate AV nodal conduction in a selective fashion. Ten mongrel dogs underwent OHS. Stimulation of the anterior right (AR) and inferior right (IR) fat pad (FP) was done using a 7-pole electrode. The IR was more effective in slowing the ventricular rate (VR) to AF (52 +/- 20 vs. 15 +/- 10%, p = 0.003) and JET (12 +/- 7 vs. 0 +/- 0%, p = 0.02). Selective site stimulation within a FP region could augment the effect of stimulation during AF (57 +/- 20% (maximum effect) vs. 0 +/- 0% (minimum effect), p<0.001). FP stimulation at increasing stimulation voltage (SV) demonstrated a voltage-dependent effect (8 +/- 14% (low V) vs. 63 +/- 17 (high V) %, p<0.001). In summary, AV node fat pad stimulation had a selective effect on the AV node by decreasing AV nodal conduction, with little effect on atrial activity.
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Goldberg A, Kusunose K, Qamruddin S, Rodriguez LL, Mazgalev TN, Griffin BP, Van Wagoner DR, Zhang Y, Popović ZB. Left Atrial Size and Function in a Canine Model of Chronic Atrial Fibrillation and Heart Failure. PLoS One 2016; 11:e0147015. [PMID: 26771573 PMCID: PMC4714887 DOI: 10.1371/journal.pone.0147015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/28/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Our aim was to assess how atrial fibrillation (AF) induction, chronicity, and RR interval irregularity affect left atrial (LA) function and size in the setting of underlying heart failure (HF), and to determine whether AF effects can be mitigated by vagal nerve stimulation (VNS). METHODS HF was induced by 4-weeks of rapid ventricular pacing in 24 dogs. Subsequently, AF was induced and maintained by atrial pacing at 600 bpm. Dogs were randomized into control (n = 9) and VNS (n = 15) groups. In the VNS group, atrioventricular node fat pad stimulation (310 μs, 20 Hz, 3-7 mA) was delivered continuously for 6 months. LA volume and LA strain data were calculated from bi-weekly echocardiograms. RESULTS RR intervals decreased with HF in both groups (p = 0.001), and decreased further during AF in control group (p = 0.014), with a non-significant increase in the VNS group during AF. LA size increased with HF (p<0.0001), with no additional increase during AF. LA strain decreased with HF (p = 0.025) and further decreased after induction of AF (p = 0.0001). LA strain decreased less (p = 0.001) in the VNS than in the control group. Beat-by-beat analysis showed a curvilinear increase of LA strain with longer preceding RR interval, (r = 0.45, p <0.0001) with LA strain 1.1% higher (p = 0.02) in the VNS-treated animals, independent of preceding RR interval duration. The curvilinear relationship between ratio of preceding and pre-preceding RR intervals, and subsequent LA strain was weaker, (r = 0.28, p = 0.001). However, VNS-treated animals again had higher LA strain (by 2.2%, p = 0.002) independently of the ratio of preceding and pre-preceding RR intervals. CONCLUSIONS In the underlying presence of pacing-induced HF, AF decreased LA strain, with little impact on LA size. LA strain depends on the preceding RR interval duration.
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Affiliation(s)
- Adam Goldberg
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Salima Qamruddin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - L. Leonardo Rodriguez
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Todor N. Mazgalev
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Brian P. Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - David R. Van Wagoner
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Youhua Zhang
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Zoran B. Popović
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail:
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Abstract
In the last few years, there has been a major shift in the treatment of atrial fibrillation (AF) in the setting of hear failure (HF), from rhythm to ventricular rate control in most patients with both conditions. In this article, the authors focus on ventricular rate control and discuss the indications; the optimal ventricular rate-control target, including detailed results of the Rate Control Efficacy in Permanent Atrial Fibrillation: a Comparison Between Lenient versus Strict Rate Control II (RACE II) study; and the pharmacologic and nonpharmacologic options to control the ventricular rate during AF in the setting of HF.
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Affiliation(s)
- Michiel Rienstra
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Hanzeplein 1, PO Box 30.001, Groningen 9700 RB, The Netherlands
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Moak JP, Mercader MA, He D, Trachiotis G, Langert J, Blicharz A, Montaque E, Li X, Cheng YI, McCarter R, Bornzin GA, Martin GR, Jonas RA. Nonpharmacologic Control of Postoperative Supraventricular Arrhythmias Using AV Nodal Fat Pad Stimulation in a Young Animal Open Heart Surgical Model. Circ Arrhythm Electrophysiol 2013; 6:641-7. [DOI: 10.1161/circep.113.000090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jeffrey P. Moak
- From the Divisions of Cardiology (J.P.M., G.R.M.) and Cardiovascular Surgery (D.H., E.M., R.A.J.), Departments of Biomedical Engineering (A.B.) and Biostatistics and Informatics (Y.I.C., R.M.), Children’s National Medical Center, Washington, DC; Divisions of Cardiology (M.A.M.) and Cardiovascular Surgery (G.T., J.L., X.L.), The George Washington University School of Medicine, Washington, DC; and St Jude Medical CRMD, Sylmar, CA (G.A.B.)
| | - Marco A. Mercader
- From the Divisions of Cardiology (J.P.M., G.R.M.) and Cardiovascular Surgery (D.H., E.M., R.A.J.), Departments of Biomedical Engineering (A.B.) and Biostatistics and Informatics (Y.I.C., R.M.), Children’s National Medical Center, Washington, DC; Divisions of Cardiology (M.A.M.) and Cardiovascular Surgery (G.T., J.L., X.L.), The George Washington University School of Medicine, Washington, DC; and St Jude Medical CRMD, Sylmar, CA (G.A.B.)
| | - Dingchao He
- From the Divisions of Cardiology (J.P.M., G.R.M.) and Cardiovascular Surgery (D.H., E.M., R.A.J.), Departments of Biomedical Engineering (A.B.) and Biostatistics and Informatics (Y.I.C., R.M.), Children’s National Medical Center, Washington, DC; Divisions of Cardiology (M.A.M.) and Cardiovascular Surgery (G.T., J.L., X.L.), The George Washington University School of Medicine, Washington, DC; and St Jude Medical CRMD, Sylmar, CA (G.A.B.)
| | - Gregory Trachiotis
- From the Divisions of Cardiology (J.P.M., G.R.M.) and Cardiovascular Surgery (D.H., E.M., R.A.J.), Departments of Biomedical Engineering (A.B.) and Biostatistics and Informatics (Y.I.C., R.M.), Children’s National Medical Center, Washington, DC; Divisions of Cardiology (M.A.M.) and Cardiovascular Surgery (G.T., J.L., X.L.), The George Washington University School of Medicine, Washington, DC; and St Jude Medical CRMD, Sylmar, CA (G.A.B.)
| | - Joshua Langert
- From the Divisions of Cardiology (J.P.M., G.R.M.) and Cardiovascular Surgery (D.H., E.M., R.A.J.), Departments of Biomedical Engineering (A.B.) and Biostatistics and Informatics (Y.I.C., R.M.), Children’s National Medical Center, Washington, DC; Divisions of Cardiology (M.A.M.) and Cardiovascular Surgery (G.T., J.L., X.L.), The George Washington University School of Medicine, Washington, DC; and St Jude Medical CRMD, Sylmar, CA (G.A.B.)
| | - Andy Blicharz
- From the Divisions of Cardiology (J.P.M., G.R.M.) and Cardiovascular Surgery (D.H., E.M., R.A.J.), Departments of Biomedical Engineering (A.B.) and Biostatistics and Informatics (Y.I.C., R.M.), Children’s National Medical Center, Washington, DC; Divisions of Cardiology (M.A.M.) and Cardiovascular Surgery (G.T., J.L., X.L.), The George Washington University School of Medicine, Washington, DC; and St Jude Medical CRMD, Sylmar, CA (G.A.B.)
| | - Erin Montaque
- From the Divisions of Cardiology (J.P.M., G.R.M.) and Cardiovascular Surgery (D.H., E.M., R.A.J.), Departments of Biomedical Engineering (A.B.) and Biostatistics and Informatics (Y.I.C., R.M.), Children’s National Medical Center, Washington, DC; Divisions of Cardiology (M.A.M.) and Cardiovascular Surgery (G.T., J.L., X.L.), The George Washington University School of Medicine, Washington, DC; and St Jude Medical CRMD, Sylmar, CA (G.A.B.)
| | - Xiyan Li
- From the Divisions of Cardiology (J.P.M., G.R.M.) and Cardiovascular Surgery (D.H., E.M., R.A.J.), Departments of Biomedical Engineering (A.B.) and Biostatistics and Informatics (Y.I.C., R.M.), Children’s National Medical Center, Washington, DC; Divisions of Cardiology (M.A.M.) and Cardiovascular Surgery (G.T., J.L., X.L.), The George Washington University School of Medicine, Washington, DC; and St Jude Medical CRMD, Sylmar, CA (G.A.B.)
| | - Yao I. Cheng
- From the Divisions of Cardiology (J.P.M., G.R.M.) and Cardiovascular Surgery (D.H., E.M., R.A.J.), Departments of Biomedical Engineering (A.B.) and Biostatistics and Informatics (Y.I.C., R.M.), Children’s National Medical Center, Washington, DC; Divisions of Cardiology (M.A.M.) and Cardiovascular Surgery (G.T., J.L., X.L.), The George Washington University School of Medicine, Washington, DC; and St Jude Medical CRMD, Sylmar, CA (G.A.B.)
| | - Robert McCarter
- From the Divisions of Cardiology (J.P.M., G.R.M.) and Cardiovascular Surgery (D.H., E.M., R.A.J.), Departments of Biomedical Engineering (A.B.) and Biostatistics and Informatics (Y.I.C., R.M.), Children’s National Medical Center, Washington, DC; Divisions of Cardiology (M.A.M.) and Cardiovascular Surgery (G.T., J.L., X.L.), The George Washington University School of Medicine, Washington, DC; and St Jude Medical CRMD, Sylmar, CA (G.A.B.)
| | - Gene A. Bornzin
- From the Divisions of Cardiology (J.P.M., G.R.M.) and Cardiovascular Surgery (D.H., E.M., R.A.J.), Departments of Biomedical Engineering (A.B.) and Biostatistics and Informatics (Y.I.C., R.M.), Children’s National Medical Center, Washington, DC; Divisions of Cardiology (M.A.M.) and Cardiovascular Surgery (G.T., J.L., X.L.), The George Washington University School of Medicine, Washington, DC; and St Jude Medical CRMD, Sylmar, CA (G.A.B.)
| | - Gerard R. Martin
- From the Divisions of Cardiology (J.P.M., G.R.M.) and Cardiovascular Surgery (D.H., E.M., R.A.J.), Departments of Biomedical Engineering (A.B.) and Biostatistics and Informatics (Y.I.C., R.M.), Children’s National Medical Center, Washington, DC; Divisions of Cardiology (M.A.M.) and Cardiovascular Surgery (G.T., J.L., X.L.), The George Washington University School of Medicine, Washington, DC; and St Jude Medical CRMD, Sylmar, CA (G.A.B.)
| | - Richard A. Jonas
- From the Divisions of Cardiology (J.P.M., G.R.M.) and Cardiovascular Surgery (D.H., E.M., R.A.J.), Departments of Biomedical Engineering (A.B.) and Biostatistics and Informatics (Y.I.C., R.M.), Children’s National Medical Center, Washington, DC; Divisions of Cardiology (M.A.M.) and Cardiovascular Surgery (G.T., J.L., X.L.), The George Washington University School of Medicine, Washington, DC; and St Jude Medical CRMD, Sylmar, CA (G.A.B.)
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Field ME, Hamdan MH. AV nodal fat pad stimulation for rate control in atrial fibrillation and heart failure: a better solution? J Cardiovasc Electrophysiol 2012; 24:92-3. [PMID: 22966872 DOI: 10.1111/j.1540-8167.2012.02429.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Motoki H, Koyama J, Tomita T, Aizawa K, Kasai H, Koshikawa M, Izawa A, Kumazaki S, Takahashi M, Ikeda U. Transient Pseudorestrictive Pattern of Transmitral Flow Velocity Curve in Patients with Paroxysmal Atrial Fibrillation. Echocardiography 2010; 28:289-97. [DOI: 10.1111/j.1540-8175.2010.01312.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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10
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Vagal tone augmentation to the atrioventricular node in humans: Efficacy and safety of burst endocardial stimulation. Heart Rhythm 2010; 7:683-9. [DOI: 10.1016/j.hrthm.2010.01.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Accepted: 01/21/2010] [Indexed: 11/24/2022]
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Rate control during atrial fibrillation achieved by chronic endocardial vagal stimulation: Proof of principle. Heart Rhythm 2009; 6:1287-8. [DOI: 10.1016/j.hrthm.2009.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Indexed: 10/20/2022]
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12
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Asada-Kamiguchi J, Tabata T, Popovic ZB, Greenberg NL, Kim YJ, Garcia MJ, Wallick DW, Mowrey KA, Zhuang S, Zhang Y, Mazgalev TN, Thomas JD, Grimm RA. Non-invasive assessment of left ventricular relaxation during atrial fibrillation using mitral flow propagation velocity. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:826-32. [PMID: 19692424 DOI: 10.1093/ejechocard/jep083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS To elucidate the usefulness of the early diastolic mitral flow propagation velocity (V(p)) obtained from colour M-mode Doppler for non-invasively assessing left-ventricular (LV) relaxation during atrial fibrillation (AF). METHODS AND RESULTS Ten healthy adult dogs were studied to correlate V(p) with the invasive minimum value of the first derivative of LV pressure decay (dP/dt(min)) and the time constant of isovolumic LV pressure decay (tau) at baseline, during rapid and slow AF, and during AF after inducing myocardial infarction. There were significant positive and negative curvilinear relationships between V(p) and dP/dt(min) and tau, respectively, during rapid AF. After slowing the ventricular rate, the average value of V(p) increased, while dP/dt(min) increased and tau decreased. After inducing myocardial infarction, the average value of V(p) decreased, while dP/dt(min) decreased and tau increased. CONCLUSION The non-invasively obtained V(p) evaluates LV relaxation even during AF regardless of ventricular rhythm or the presence of pathological changes.
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Affiliation(s)
- Junko Asada-Kamiguchi
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Olshansky B, Sabbah HN, Hauptman PJ, Colucci WS. Parasympathetic nervous system and heart failure: pathophysiology and potential implications for therapy. Circulation 2008; 118:863-71. [PMID: 18711023 DOI: 10.1161/circulationaha.107.760405] [Citation(s) in RCA: 287] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Brian Olshansky
- Division of Cardiology, University of Iowa Hospitals, 200 Hawkins Dr 4426a JCP, Iowa City, IA 52242, USA.
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Capucci A, Villani GQ, Igel D, Marotta T. Effect of atrial pacing on ventricular rate during atrial fibrillation. A human study. J Cardiovasc Med (Hagerstown) 2008; 9:256-62. [DOI: 10.2459/jcm.0b013e328012c19c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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Batulevicius D, Skripka V, Pauziene N, Pauza DH. Topography of the porcine epicardiac nerve plexus as revealed by histochemistry for acetylcholinesterase. Auton Neurosci 2007; 138:64-75. [PMID: 18063424 DOI: 10.1016/j.autneu.2007.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 10/16/2007] [Accepted: 10/27/2007] [Indexed: 11/19/2022]
Abstract
The aim of the present study was to map the topography of the porcine epicardiac nerve plexus (ENP) and to re-examine the total number and distribution of the porcine intracardiac ganglia and neurons. Eleven juvenile pigs (Sus scrofa domestica, 3-4 weeks of age) were examined employing histochemistry for acetylcholinesterase to reveal the ENP on total hearts. The nerves entered porcine epicardium at five sites: (1) ventro-medially to the origin of the superior vena cava, (2) dorsally to the origin of the superior vena cava, (3) among the pulmonary veins, (4) dorso-medially to the origin of the left azygos vein, and (5) ventrally to the left pulmonary vein. Within the porcine epicardium, the nerves connected to the groups of the intrinsic ganglia and proceeded into the discrete atrial and ventricular regions via five topographical pathways (subplexuses). In general, the porcine left atrium received nerves by four subplexuses, left ventricle by three subplexuses, right atrium and right ventricle each by two subplexuses. The estimated total number of the intrinsic ganglia per porcine heart was 362+/-52. About 55% of ganglia per porcine heart were accumulated on the left atrium while 36% on the right atrium. The percentage of ganglia within porcine ventricular and para-aortic regions was 7.6% and 1.6%, respectively. On average, porcine heart contained about 12,000 intrinsic neurons. In summary, the results of the present study imply that (1) the porcine epicardiac nerves are grouped into distinct topographical pathways, and (2) the porcine atria contain significantly more intrinsic ganglia and neurons compared to the ventricles.
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Affiliation(s)
- Darius Batulevicius
- Institute of Anatomy, Kaunas University of Medicine, A.Mickeviciaus Street 9, LT-44307 Kaunas, Lithuania.
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Zhang Y, Yamada H, Bibevski S, Zhuang S, Mowrey KA, Wallick DW, Oh S, Mazgalev TN. Chronic atrioventricular nodal vagal stimulation: first evidence for long-term ventricular rate control in canine atrial fibrillation model. Circulation 2005; 112:2904-11. [PMID: 16260638 DOI: 10.1161/circulationaha.105.568832] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND We have previously demonstrated that selective atrioventricular nodal (AVN) vagal stimulation (AVN-VS) can be used to control ventricular rate during atrial fibrillation (AF) in acute experiments. However, it is not known whether this approach could provide a long-term treatment in conscious animals. Thus, this study reports the first observations on the long-term efficacy and safety of this novel approach to control ventricular rate during AF in chronically instrumented dogs. METHODS AND RESULTS In 18 dogs, custom-made bipolar patch electrodes were sutured to the epicardial AVN fat pad for delivery of selective AVN-VS by a subcutaneously implanted nerve stimulator (pulse width 100 micros or 1 ms, frequency 20 or 160 Hz, amplitude 6 to 10 V). Fast-rate right atrial pacing (600 bpm) was used to induce and maintain AF. ECG, blood pressure, and body temperature were monitored telemetrically. One week after the induction of AF, AVN-VS was delivered and maintained for at least 5 weeks. It was found that AVN-VS had a consistent effect on ventricular rate slowing (on average 45+/-13 bpm) over the entire period of observation. Echocardiography showed improvement of cardiac indices with ventricular rate slowing. AVN-VS was well tolerated by the animals, causing no signs of distress or discomfort. CONCLUSIONS Beneficial long-term ventricular rate slowing during AF can be achieved by implantation of a nerve stimulator attached to the epicardial AVN fat pad. This novel concept is an attractive alternative to other methods of rate control and may be applicable in a selected group of patients.
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Affiliation(s)
- Youhua Zhang
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Popović ZB, Yamada H, Mowrey KA, Zhang Y, Wallick DW, Grimm RA, Thomas JD, Mazgalev TN. Frank-Starling mechanism contributes modestly to ventricular performance during atrial fibrillation. Heart Rhythm 2005; 1:482-9. [PMID: 15851203 DOI: 10.1016/j.hrthm.2004.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2004] [Accepted: 06/29/2004] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to assess whether Frank-Starling mechanism has an independent effect on left ventricular (LV) performance in atrial fibrillation (AF). BACKGROUND Ventricular performance in AF depends on variable contractility through the interval-force mechanism based on the ratio of preceding and pre-preceding RR intervals (RR(p)/RR(pp)). The impact of end-diastolic volume (EDV) variability, through the Frank-Starling mechanism, is not well understood. METHODS We induced AF in 16 open chest dogs. RR intervals, LV pressure, LV volume, and aortic flow were collected for >400 beats during rapid AF (ventricular cycle length 292 +/- 66 ms). In six of the dogs, additional data were collected while average ventricular cycle length was prolonged from 258 +/- 34 ms to 445 +/- 80 ms by selective vagal nerve stimulation of the AV node. RESULTS The relations of maximal LV power (LVPower) and peak LV pressure derivative (dP/dt) versus RR(p)/RR(pp) were fitted to the equation y = A * (1 - EXP (RR(p)/RR(pp)min - RR(p)/RR(pp))/C) and the residuals (RES) of these relations were analyzed. LVPower and dP/dt strongly correlated with RR(p)/RR(pp) (r(2) = 0.67 +/- 0.12 and 0.66 +/- 0.12, P < .0001 for all correlations). Importantly, RES-LVPower and RES-dP/dt showed linear correlation with EDV (r(2) = 0.20 +/- 0.14 and r(2) = 0.24 +/- 0.17, P < .01 for all correlations). In the six dogs with slowed average ventricular rate, the slope of both residual relationships (RES-LVPower vs EDV and RES- dP/dt vs EDV) decreased (P < .03 for both). CONCLUSIONS The Frank-Starling mechanism contributes to ventricular performance in AF independently of the interval-force effects of the beat-to-beat variability in cardiac contractility. The Frank-Starling mechanism is sensitive to the average ventricular rate.
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Affiliation(s)
- Zoran B Popović
- Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Ohio 44195, USA
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Melenovsky V, Hay I, Fetics BJ, Borlaug BA, Kramer A, Pastore JM, Berger R, Kass DA. Functional impact of rate irregularity in patients with heart failure and atrial fibrillation receiving cardiac resynchronization therapy. Eur Heart J 2004; 26:705-11. [PMID: 15618039 DOI: 10.1093/eurheartj/ehi066] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Atrial fibrillation (AFib) with a rapid ventricular response may adversely impact cardiac performance, especially in patients with heart failure. However, it remains uncertain whether rhythm irregularity per se has unfavourable effects apart from tachycardia, and whether rate regularization alone can improve heart function. METHODS AND RESULTS Nine subjects with chronic AFib, atrioventricular nodal block, and symptomatic heart failure (ejection fraction 14-30%) were studied using a pressure-volume catheter. Ventricles were biventricularly paced (RV-apex, LV-lateral wall) at 80 or 120 min(-1) mean rate, using regular or irregular, Poisson-distributed stimulation. At 80 min(-1), ventricular function was similar between the two pacing modes. However, at 120 min(-1), irregular pacing impaired systolic (dP/dt(max): -8.2%, P<0.001) and diastolic function (dP/dt(min): +21%, P<0.001, LV end-diastolic pressure: +26%, P=0.007) compared with regular rate pacing. Contractile function during irregular pacing varied with the ratio of preceding/pre-preceding intercycle (RR) interval (dP/dt(max): 80 b.p.m.: r=0.69; 120 b.p.m.: r=0.74), whereas pre-load had little effect on instantaneous contractility. CONCLUSION In heart failure subjects with AFib, RR-interval irregularity worsens cardiac function at elevated but not at normal range heart rate. Overall rate control is most important in these patients while rate regularization of rapid AFib may impart additional benefits.
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Affiliation(s)
- Vojtech Melenovsky
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA
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Tabata T, Grimm RA, Asada J, Popovic ZB, Yamada H, Greenberg NL, Wallick DW, Zhang Y, Zhuang S, Mowrey KA, Thomas JD, Mazgalev TN. Determinants of LV diastolic function during atrial fibrillation: beat-to-beat analysis in acute dog experiments. Am J Physiol Heart Circ Physiol 2004; 286:H145-52. [PMID: 12958036 DOI: 10.1152/ajpheart.00588.2003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Left ventricular (LV) diastolic function during atrial fibrillation (AF) remains poorly understood due to the complex interaction of factors and beat-to-beat variability. The purpose of the present study was to elucidate the physiological determinants of beat-to-beat changes in LV diastolic function during AF. The RR intervals preceding a given cardiac beat were measured from the right ventricular electrogram in 12 healthy open-chest mongrel dogs during AF. Doppler echocardiography and LV pressure and volume beat-to-beat analyses were performed. The LV filling time (FT) and early diastolic mitral inflow velocity-time integral (E(vti)) were measured using the pulsed Doppler method. The LV end-diastolic volume (EDV), peak systolic LV pressure (LVP), minimum value of the first derivative of LV pressure curve (dP/dt(min)), and the time constant of LV pressure decay (tau) were evaluated with the use of a conductance catheter for 100 consecutive cardiac cycles. Beat-to-beat analysis revealed a cascade of important causal relations. LV-FT showed a significant positive linear relationship with E(vti) (r = 0.87). Importantly, there was a significant positive linear relationship between the RR interval and LV-EDV in the same cardiac beat (r = 0.53). Consequently, there was a positive linear relationship between LV-EDV and subsequent peak systolic LVP (r = 0.82). Furthermore, there were significant positive linear and negative curvilinear relationships between peak systolic LVP and dP/dt(min) (r = 0.95) and tau (r = -0.85), respectively, in the same cardiac beat. In addition, there was a significant negative curvilinear relationship between dP/dt(min) and tau (r = -0.86). We have concluded that the determinants of LV diastolic function in individual beats during AF depend strongly on the peak systolic LVP. This suggests that the major benefit of slower ventricular rate appears related to lengthening of LV filling interval, promoting subsequent higher peak systolic LVP and greater LV relaxation.
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Affiliation(s)
- Tomotsugu Tabata
- Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Yamada H, Martin DO, Mowrey KA, Greenberg NL, Wallick DW. Effects of coupled pacing on cardiac performance during acute atrial tachycardia and fibrillation: an old therapy revisited for a new reason. Am J Physiol Heart Circ Physiol 2003; 285:H2630-8. [PMID: 12893639 DOI: 10.1152/ajpheart.00393.2003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Atrial tachycardia (AT) and fibrillation (AF) result in rapid ventricular rates that are detrimental to optimal cardiac function. The purpose of this study was to determine whether the application of a coupled pacing (CP) regimen would improve ventricular function by decreasing the ventricular rate of mechanical contractions (VRMCs). We simulated AT by pacing either atrium at a rate that resulted in a rapid but regular ventricular rate in seven anesthetized dogs. AF was induced by increasing the atrial pacing rate until atrial activation did not follow the pacing. After the induction of either AT or AF, we applied CP after each intrinsic ventricular activation. We measured the VRMCs and left ventricular (LV) pressures and volumes via a pressure-conductance catheter. The marked reductions in VRMCs during CP resulted in increases in LV end-diastolic volume. The CP resulted in virtually no mechanical contractions, whereas the strength of contractions from the normal electrical activation increased. The increases in the positive LV rate of pressure development over time and LV ejection fraction during CP were the result of postextrasystolic potentiation. The average stroke work (area of the pressure-volume loops) increased as a result of CP during both AT and AF. Despite the large increases in stroke volume (approximately 2x) during CP, the changes in cardiac output were moderate because the VRMCs markedly decreased (approximately 1/2). We conclude that CP therapy may be a viable therapy for slowing the heart rate and improving cardiac performance in patients with AT and AF.
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Affiliation(s)
- Hirotsugu Yamada
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, USA
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Popović ZB, Mowrey KA, Zhang Y, Zhuang S, Tabata T, Wallick DW, Grimm RA, Thomas JD, Mazgalev TN. Slow rate during AF improves ventricular performance by reducing sensitivity to cycle length irregularity. Am J Physiol Heart Circ Physiol 2002; 283:H2706-13. [PMID: 12388219 DOI: 10.1152/ajpheart.00571.2002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Atrial fibrillation (AF) is characterized by short and irregular ventricular cycle lengths (VCL). While the beneficial effects of heart rate slowing (i.e., the prolongation of VCL) in AF are well recognized, little is known about the impact of irregularity. In 10 anesthetized dogs, R-R intervals, left ventricular (LV) pressure, and aortic flow were collected for >500 beats during fast AF and when the average VCL was prolonged to 75%, 100%, and 125% of the intrinsic sinus cycle length by selective atrioventricular (AV) nodal vagal stimulation. We used the ratio of the preceding and prepreceding R-R intervals (RR(p)/RR(pp)) as an index of cycle length irregularity and assessed its effects on the maximum LV power, the minimum of the first derivative of LV pressure, and the time constant of relaxation by using nonlinear fitting with monoexponential functions. During prolongation of VCL, there was a pronounced decrease in curvature with the formation of a plateau, indicating a lesser dependence on RR(p)/RR(pp). We conclude that prolongation of the VCL during AF reduces the sensitivity of the LV performance parameters to irregularity.
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Affiliation(s)
- Zoran B Popović
- Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Ohio 44195, USA
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Zhuang S, Zhang Y, Mowrey KA, Li J, Tabata T, Wallick DW, Popović ZB, Grimm RA, Natale A, Mazgalev TN. Ventricular rate control by selective vagal stimulation is superior to rhythm regularization by atrioventricular nodal ablation and pacing during atrial fibrillation. Circulation 2002; 106:1853-8. [PMID: 12356641 DOI: 10.1161/01.cir.0000031802.58532.04] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Selective atrioventricular nodal (AVN) vagal stimulation (AVN-VS) has emerged as a novel strategy for ventricular rate (VR) control in atrial fibrillation (AF). Although AVN-VS preserves the physiological ventricular activation sequence, the resulting rate is slow but irregular. In contrast, AVN ablation with pacemaker implantation produces retrograde activation (starting at the apex), with regular ventricular rhythm. We tested the hypothesis that, at comparable levels of VR slowing, AVN-VS provides hemodynamic benefits similar to those of ablation with pacemaker implantation. METHODS AND RESULTS AVN-VS was delivered to the epicardial fat pad that projects parasympathetic nerve fibers to the AVN in 12 dogs during AF. A computer-controlled algorithm adjusted AVN-VS beat by beat to achieve a mean ventricular RR interval of 75%, 100%, 125%, or 150% of spontaneous sinus cycle length. The AVN was then ablated, and the right ventricular (RV) apex was paced either irregularly (i-RVP) using the RR intervals collected during AVN-VS or regularly (r-RVP) at the corresponding mean RR. The results indicated that all 3 strategies improved hemodynamics compared with AF. However, AVN-VS resulted in significantly better responses than either r-RVP or i-RVP. i-RVP resulted in worse hemodynamic responses than r-RVP. The differences among these modes became less significant when mean VR was slowed to 150% of sinus cycle length. CONCLUSIONS AVN-VS can produce graded slowing of the VR during AF without destroying the AVN. It was hemodynamically superior to AVN ablation with either r-RVP or i-RVP, indicating that the benefits of preserving the physiological antegrade ventricular activation sequence outweigh the detrimental effect of irregularity.
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Affiliation(s)
- Shaowei Zhuang
- Department of Cardiovascular, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Zhang Y, Mowrey KA, Zhuang S, Wallick DW, Popović ZB, Mazgalev TN. Optimal ventricular rate slowing during atrial fibrillation by feedback AV nodal-selective vagal stimulation. Am J Physiol Heart Circ Physiol 2002; 282:H1102-10. [PMID: 11834509 DOI: 10.1152/ajpheart.00738.2001] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although the beneficial effects of ventricular rate (VR) slowing during atrial fibrillation (AF) are axiomatic, the precise relationship between VR and hemodynamics has not been determined. We hypothesized that selective atrioventricular node (AVN) vagal stimulation (AVN-VS) by varying the nerve stimulation intensity could achieve precise graded slowing and permit evaluation of an optimal VR during AF. The aims of the present study were the following: 1) to develop a method for computerized vagally controlled VR slowing during AF, 2) to determine the hemodynamic changes at each level of VR slowing, and 3) to establish the optimal anterograde VR during AF. AVN-VS was delivered to the epicardial fat pad that projects parasympathetic nerve fibers to the AVN in 14 dogs. Four target average VR levels, corresponding to 75%, 100%, 125%, and 150% of the sinus cycle length (SCL), were achieved by computer feedback algorithm. VR slowing resulted in improved hemodynamics and polynomial fit analysis found an optimum for the cardiac output at VR slowing of 87% SCL. We conclude that this novel method can be used to maintain slow anterograde conduction with best hemodynamics during AF.
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Affiliation(s)
- Youhua Zhang
- Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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