Comparison of atrial fibrillation inducibility by electrical stimulation of either the extrinsic or the intrinsic autonomic nervous systems |
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Authors: | Yuan Zhang Benjamin J Scherlag Zhibing Lu Guo-Dong Niu William S Yamanashi Cameron Hogan Jerad Fields Muhammad Ghias Ralph Lazzara Warren M Jackman Sunny Po |
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Institution: | (1) Cardiac Arrhythmia Research Institute, University of Oklahoma Health Sciences Center, 1200 Everett Drive, Room ET6E103, Oklahoma City, OK 73104, USA;(2) Department of Cardiology, 3rd Hospital of Peking University, No. 49 North Garden Rd, Hai Dian District, Beijing, 100083, China |
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Abstract: | Objectives To study the effects of bilateral vagosympathetic nerve stimulation (VNS) and ganglionated plexi stimulation (GPS) on atrial
refractoriness and inducibility of atrial fibrillation (AF).
Methods Studies were performed in fourteen adult mongrel dogs anesthetized with Na-pentobarbital, 30 mg/kg. VNS was achieved by insertion
of wires into the left and right VN trunks. An octapolar catheter was attached to contact the right superior pulmonary vein
(RSPV) and other octapolar catheter electrodes were sutured to the right atrial (RA) free wall and appendage (RAA). GPS was
performed via a plaque electrode sutured to the fat pad containing the anterior right (AR) GP. VNS and GPS were matched to
decrease heart rate by ∼50%. Programmed stimulation delivered from the RSPV or RAA at 2×, 4× and 10× threshold (TH) allowed
the determination of atrial refractory period (ARP) and the AF inducibility. The latter was quantitated by the cumulative
window of vulnerability (WOV), i.e., the longest minus the shortest coupling interval during which AF was induced at 2×, 4×,
10×, TH combined.
Results Programmed electrical stimulation at the RSPV showed that the ARP was significantly shorter for both VNS and GPS than baseline
(baseline, 113 ± 22 ms; VNS, 94 ± 26 ms; GPS, 85 ± 31 ms) but there was no significant difference in ARP between VNS and GPS.
In contrast, the cumulative WOV was significantly wider with GPS (39 ± 36 ms) than either the baseline state (1 ± 1 ms) or
with VNS (14 ± 26 ms), p < 0.05. Moreover, pacing from RAA showed a significantly greater cumulative WOV for VNS (33 ± 36 ms) vs both baseline and
GPS (1 ± 4 ms and 15 ± 26 ms, respectively, p < 0.05). The heart rate slowing caused by GPS and VNS was not significantly different, 82 ± 11/min vs 82 ± 7/min.
Conclusions These data indicate a distinct functional separation of autonomic nerve innervation to the atria from the extrinsic and intrinsic
nervous systems. AF is more liable to occur due to intrinsic nerve stimulation at the PVs whereas peripheral atrial sites
are more readily inducible for AF due to the extrinsic neural input.
Supported, in part by grant #0650077Z from the American Heart Association (SSP), grant #K23HL069972 from the National Heart,
Lung and Blood Institute (SSP) and from the Helen and Wil Webster Research Fund of the Oklahoma University Research Foundation. |
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Keywords: | Atrial fibrillation Autonomic nervous system |
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