Chronic Augmentation of the Parasympathetic Tone to the Atrioventricular Node: A Nonthoracotomy Neurostimulation Technique for Ventricular Rate Control During Atrial Fibrillation
Long‐Term Cardiac Neurostimulation. Introduction: The right inferior ganglionated plexus (RIGP) selectively innervates the atrioventricular node. Temporary electrical stimulation of this plexus reduces the ventricular rate during atrial fibrillation (AF). We sought to assess the feasibility of chron...
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2010-02, Vol.21 (2), p.193-199 |
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| creator | MISCHKE, KARL ZARSE, MARKUS SCHMID, MICHAEL GEMEIN, CHRISTOPHER HATAM, NIMA SPILLNER, JAN DOHMEN, GUIDO RANA, OBAIDA SAYGILI, EROL KNACKSTEDT, CHRISTIAN WEIS, JOACHIM PAUZA, DAINIUS BIANCHI, STEFANO SCHAUERTE, PATRICK |
| description | Long‐Term Cardiac Neurostimulation.
Introduction:
The right inferior ganglionated plexus (RIGP) selectively innervates the atrioventricular node. Temporary electrical stimulation of this plexus reduces the ventricular rate during atrial fibrillation (AF). We sought to assess the feasibility of chronic parasympathetic stimulation for ventricular rate control during AF with a nonthoracotomy intracardiac neurostimulation approach.
Methods and Results:
In 9 mongrel dogs, the small endocardial area inside the right atrium, which overlies the RIGP, was identified by 20 Hz stimulation over a guiding catheter with integrated electrodes. Once identified, an active‐fixation lead was implanted. The lead was connected to a subcutaneous neurostimulator. An additional dual‐chamber pacemaker was implanted for AF induction by rapid atrial pacing and ventricular rate monitoring. Continuous neurostimulation was delivered for 1–2 years to decrease the ventricular rate during AF to a range of 100–140 bpm. Implantation of a neurostimulation lead was achieved within 37 ± 12 min. The latency of the negative dromotropic response after on/offset or modulation of neurostimulation was |
| doi_str_mv | 10.1111/j.1540-8167.2009.01613.x |
| format | Article |
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Introduction:
The right inferior ganglionated plexus (RIGP) selectively innervates the atrioventricular node. Temporary electrical stimulation of this plexus reduces the ventricular rate during atrial fibrillation (AF). We sought to assess the feasibility of chronic parasympathetic stimulation for ventricular rate control during AF with a nonthoracotomy intracardiac neurostimulation approach.
Methods and Results:
In 9 mongrel dogs, the small endocardial area inside the right atrium, which overlies the RIGP, was identified by 20 Hz stimulation over a guiding catheter with integrated electrodes. Once identified, an active‐fixation lead was implanted. The lead was connected to a subcutaneous neurostimulator. An additional dual‐chamber pacemaker was implanted for AF induction by rapid atrial pacing and ventricular rate monitoring. Continuous neurostimulation was delivered for 1–2 years to decrease the ventricular rate during AF to a range of 100–140 bpm. Implantation of a neurostimulation lead was achieved within 37 ± 12 min. The latency of the negative dromotropic response after on/offset or modulation of neurostimulation was <1 s. Continuous neurostimulation was effective and well tolerated during a 1–2 year follow‐up with a stimulation voltage <5 V. The neurostimulation effect displayed a chronaxie‐rheobase behavior (chronaxie time of 0.07 ± 0.02 ms for a 50% decrease of the ventricular rate during AF).
Conclusion:
Chronic parasympathetic stimulation can be achieved via a cardiac neurostimulator. The approach is safe, effective, and well tolerated in the long term. The atrioventricular nodal selectivity and the opportunity to adjust the negative dromotropic effect within seconds may represent an advantage over pharmacological rate control. (J Cardiovasc Electrophysiol, Vol. 21, pp. 193‐199, February 2010)</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/j.1540-8167.2009.01613.x</identifier><identifier>PMID: 19804547</identifier><language>eng</language><publisher>Malden, USA: Blackwell Publishing Inc</publisher><subject>Animals ; atrial fibrillation ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - prevention & control ; atrioventricular node ; cardiac neurostimulation ; Dogs ; Electric Stimulation Therapy - methods ; Feasibility Studies ; Ganglia, Parasympathetic - physiopathology ; Heart Rate ; Heart Ventricles - physiopathology ; Male ; pacemaker ; rate control ; Thoracotomy ; Treatment Outcome ; vagus nerve</subject><ispartof>Journal of cardiovascular electrophysiology, 2010-02, Vol.21 (2), p.193-199</ispartof><rights>2010 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4383-2a925c3ab7f4fea7a6e430120b7edccfcb690a068b4ab76c4b6fd5c3368d8d6a3</citedby><cites>FETCH-LOGICAL-c4383-2a925c3ab7f4fea7a6e430120b7edccfcb690a068b4ab76c4b6fd5c3368d8d6a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1540-8167.2009.01613.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1540-8167.2009.01613.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19804547$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MISCHKE, KARL</creatorcontrib><creatorcontrib>ZARSE, MARKUS</creatorcontrib><creatorcontrib>SCHMID, MICHAEL</creatorcontrib><creatorcontrib>GEMEIN, CHRISTOPHER</creatorcontrib><creatorcontrib>HATAM, NIMA</creatorcontrib><creatorcontrib>SPILLNER, JAN</creatorcontrib><creatorcontrib>DOHMEN, GUIDO</creatorcontrib><creatorcontrib>RANA, OBAIDA</creatorcontrib><creatorcontrib>SAYGILI, EROL</creatorcontrib><creatorcontrib>KNACKSTEDT, CHRISTIAN</creatorcontrib><creatorcontrib>WEIS, JOACHIM</creatorcontrib><creatorcontrib>PAUZA, DAINIUS</creatorcontrib><creatorcontrib>BIANCHI, STEFANO</creatorcontrib><creatorcontrib>SCHAUERTE, PATRICK</creatorcontrib><title>Chronic Augmentation of the Parasympathetic Tone to the Atrioventricular Node: A Nonthoracotomy Neurostimulation Technique for Ventricular Rate Control During Atrial Fibrillation</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Long‐Term Cardiac Neurostimulation.
Introduction:
The right inferior ganglionated plexus (RIGP) selectively innervates the atrioventricular node. Temporary electrical stimulation of this plexus reduces the ventricular rate during atrial fibrillation (AF). We sought to assess the feasibility of chronic parasympathetic stimulation for ventricular rate control during AF with a nonthoracotomy intracardiac neurostimulation approach.
Methods and Results:
In 9 mongrel dogs, the small endocardial area inside the right atrium, which overlies the RIGP, was identified by 20 Hz stimulation over a guiding catheter with integrated electrodes. Once identified, an active‐fixation lead was implanted. The lead was connected to a subcutaneous neurostimulator. An additional dual‐chamber pacemaker was implanted for AF induction by rapid atrial pacing and ventricular rate monitoring. Continuous neurostimulation was delivered for 1–2 years to decrease the ventricular rate during AF to a range of 100–140 bpm. Implantation of a neurostimulation lead was achieved within 37 ± 12 min. The latency of the negative dromotropic response after on/offset or modulation of neurostimulation was <1 s. Continuous neurostimulation was effective and well tolerated during a 1–2 year follow‐up with a stimulation voltage <5 V. The neurostimulation effect displayed a chronaxie‐rheobase behavior (chronaxie time of 0.07 ± 0.02 ms for a 50% decrease of the ventricular rate during AF).
Conclusion:
Chronic parasympathetic stimulation can be achieved via a cardiac neurostimulator. The approach is safe, effective, and well tolerated in the long term. The atrioventricular nodal selectivity and the opportunity to adjust the negative dromotropic effect within seconds may represent an advantage over pharmacological rate control. (J Cardiovasc Electrophysiol, Vol. 21, pp. 193‐199, February 2010)</description><subject>Animals</subject><subject>atrial fibrillation</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - prevention & control</subject><subject>atrioventricular node</subject><subject>cardiac neurostimulation</subject><subject>Dogs</subject><subject>Electric Stimulation Therapy - methods</subject><subject>Feasibility Studies</subject><subject>Ganglia, Parasympathetic - physiopathology</subject><subject>Heart Rate</subject><subject>Heart Ventricles - physiopathology</subject><subject>Male</subject><subject>pacemaker</subject><subject>rate control</subject><subject>Thoracotomy</subject><subject>Treatment Outcome</subject><subject>vagus nerve</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkdFu0zAUhiMEYmPwCsh3XCXYtWO7SFx06dYBVUFTYZeW4zirSxIX22Hta_GEOE01uAPfHFvn-_9z5D9JAIIZiuftNkM5gSlHlGUTCKcZRBThbP8kOX9sPI13SPIUc4bPkhfebyFEmML8eXKGpjy2CDtPfhUbZzujwKy_b3UXZDC2A7YGYaPBF-mkP7Q7GR8hMmvbaRDssTcLztifUeGM6hvpwMpW-h2YxdqFjXVS2WDbA1jp3lkfTBuho_daq01nfvQa1NaBb3853MqgQRHlzjZg3jvT3R_HyAZcm9KZZnR4mTyrZeP1q1O9SL5eX62Lm3T5efGhmC1TRTDH6UROJ7nCsmQ1qbVkkmqCIZrAkulKqVqVdAolpLwkkaGKlLSuogBTXvGKSnyRvBl9d87GdX0QrfFKxy06bXsvGMkp5xDCf5MY5zmFnEeSj6SKn-KdrsXOmVa6g0BQDNGKrRgSFEOCYohWHKMV-yh9fRrSl62u_ghPWUbg_Qg8mEYf_ttYfCyuhlvUp6Pe-KD3j3rpvgvKMMvF3Woh5ovLT_O75a24xL8BlSHGqw</recordid><startdate>201002</startdate><enddate>201002</enddate><creator>MISCHKE, KARL</creator><creator>ZARSE, MARKUS</creator><creator>SCHMID, MICHAEL</creator><creator>GEMEIN, CHRISTOPHER</creator><creator>HATAM, NIMA</creator><creator>SPILLNER, JAN</creator><creator>DOHMEN, GUIDO</creator><creator>RANA, OBAIDA</creator><creator>SAYGILI, EROL</creator><creator>KNACKSTEDT, CHRISTIAN</creator><creator>WEIS, JOACHIM</creator><creator>PAUZA, DAINIUS</creator><creator>BIANCHI, STEFANO</creator><creator>SCHAUERTE, PATRICK</creator><general>Blackwell Publishing Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7TK</scope></search><sort><creationdate>201002</creationdate><title>Chronic Augmentation of the Parasympathetic Tone to the Atrioventricular Node: A Nonthoracotomy Neurostimulation Technique for Ventricular Rate Control During Atrial Fibrillation</title><author>MISCHKE, KARL ; ZARSE, MARKUS ; SCHMID, MICHAEL ; GEMEIN, CHRISTOPHER ; HATAM, NIMA ; SPILLNER, JAN ; DOHMEN, GUIDO ; RANA, OBAIDA ; SAYGILI, EROL ; KNACKSTEDT, CHRISTIAN ; WEIS, JOACHIM ; PAUZA, DAINIUS ; BIANCHI, STEFANO ; SCHAUERTE, PATRICK</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4383-2a925c3ab7f4fea7a6e430120b7edccfcb690a068b4ab76c4b6fd5c3368d8d6a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Animals</topic><topic>atrial fibrillation</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - prevention & control</topic><topic>atrioventricular node</topic><topic>cardiac neurostimulation</topic><topic>Dogs</topic><topic>Electric Stimulation Therapy - methods</topic><topic>Feasibility Studies</topic><topic>Ganglia, Parasympathetic - physiopathology</topic><topic>Heart Rate</topic><topic>Heart Ventricles - physiopathology</topic><topic>Male</topic><topic>pacemaker</topic><topic>rate control</topic><topic>Thoracotomy</topic><topic>Treatment Outcome</topic><topic>vagus nerve</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MISCHKE, KARL</creatorcontrib><creatorcontrib>ZARSE, MARKUS</creatorcontrib><creatorcontrib>SCHMID, MICHAEL</creatorcontrib><creatorcontrib>GEMEIN, CHRISTOPHER</creatorcontrib><creatorcontrib>HATAM, NIMA</creatorcontrib><creatorcontrib>SPILLNER, JAN</creatorcontrib><creatorcontrib>DOHMEN, GUIDO</creatorcontrib><creatorcontrib>RANA, OBAIDA</creatorcontrib><creatorcontrib>SAYGILI, EROL</creatorcontrib><creatorcontrib>KNACKSTEDT, CHRISTIAN</creatorcontrib><creatorcontrib>WEIS, JOACHIM</creatorcontrib><creatorcontrib>PAUZA, DAINIUS</creatorcontrib><creatorcontrib>BIANCHI, STEFANO</creatorcontrib><creatorcontrib>SCHAUERTE, PATRICK</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Neurosciences Abstracts</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MISCHKE, KARL</au><au>ZARSE, MARKUS</au><au>SCHMID, MICHAEL</au><au>GEMEIN, CHRISTOPHER</au><au>HATAM, NIMA</au><au>SPILLNER, JAN</au><au>DOHMEN, GUIDO</au><au>RANA, OBAIDA</au><au>SAYGILI, EROL</au><au>KNACKSTEDT, CHRISTIAN</au><au>WEIS, JOACHIM</au><au>PAUZA, DAINIUS</au><au>BIANCHI, STEFANO</au><au>SCHAUERTE, PATRICK</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chronic Augmentation of the Parasympathetic Tone to the Atrioventricular Node: A Nonthoracotomy Neurostimulation Technique for Ventricular Rate Control During Atrial Fibrillation</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2010-02</date><risdate>2010</risdate><volume>21</volume><issue>2</issue><spage>193</spage><epage>199</epage><pages>193-199</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>Long‐Term Cardiac Neurostimulation.
Introduction:
The right inferior ganglionated plexus (RIGP) selectively innervates the atrioventricular node. Temporary electrical stimulation of this plexus reduces the ventricular rate during atrial fibrillation (AF). We sought to assess the feasibility of chronic parasympathetic stimulation for ventricular rate control during AF with a nonthoracotomy intracardiac neurostimulation approach.
Methods and Results:
In 9 mongrel dogs, the small endocardial area inside the right atrium, which overlies the RIGP, was identified by 20 Hz stimulation over a guiding catheter with integrated electrodes. Once identified, an active‐fixation lead was implanted. The lead was connected to a subcutaneous neurostimulator. An additional dual‐chamber pacemaker was implanted for AF induction by rapid atrial pacing and ventricular rate monitoring. Continuous neurostimulation was delivered for 1–2 years to decrease the ventricular rate during AF to a range of 100–140 bpm. Implantation of a neurostimulation lead was achieved within 37 ± 12 min. The latency of the negative dromotropic response after on/offset or modulation of neurostimulation was <1 s. Continuous neurostimulation was effective and well tolerated during a 1–2 year follow‐up with a stimulation voltage <5 V. The neurostimulation effect displayed a chronaxie‐rheobase behavior (chronaxie time of 0.07 ± 0.02 ms for a 50% decrease of the ventricular rate during AF).
Conclusion:
Chronic parasympathetic stimulation can be achieved via a cardiac neurostimulator. The approach is safe, effective, and well tolerated in the long term. The atrioventricular nodal selectivity and the opportunity to adjust the negative dromotropic effect within seconds may represent an advantage over pharmacological rate control. (J Cardiovasc Electrophysiol, Vol. 21, pp. 193‐199, February 2010)</abstract><cop>Malden, USA</cop><pub>Blackwell Publishing Inc</pub><pmid>19804547</pmid><doi>10.1111/j.1540-8167.2009.01613.x</doi><tpages>7</tpages></addata></record> |
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| subjects | Animals atrial fibrillation Atrial Fibrillation - physiopathology Atrial Fibrillation - prevention & control atrioventricular node cardiac neurostimulation Dogs Electric Stimulation Therapy - methods Feasibility Studies Ganglia, Parasympathetic - physiopathology Heart Rate Heart Ventricles - physiopathology Male pacemaker rate control Thoracotomy Treatment Outcome vagus nerve |
| title | Chronic Augmentation of the Parasympathetic Tone to the Atrioventricular Node: A Nonthoracotomy Neurostimulation Technique for Ventricular Rate Control During Atrial Fibrillation |
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