Spinal Cord Stimulation Improves Ventricular Function and Reduces Ventricular Arrhythmias in a Canine Postinfarction Heart Failure Model
Spinal Cord Stimulation Improves Ventricular Function and Reduces Ventricular Arrhythmias in a Canine Postinfarction Heart Failure Model
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DOI：
10.1161/circulationaha.108.812412
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发表时间：
2009-07-28
期刊：
影响因子：
37.8
通讯作者：
Zipes, Douglas P.
中科院分区：
文献类型：
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作者：
Lopshire, John C.;Zhou, Xiaohong;Zipes, Douglas P.
背景-在实验模型中，脊髓刺激(SCS)可降低室性快速性心律失常的发生率。方法和结果：在第一阶段，犬进行了埋藏式心脏复律除颤器植入和左前降支栓塞术，然后进行右室起搏(240ppm)3周，以产生心力衰竭。在第二阶段，28只存活的动物被分配到SCS组(每天3次，在T4/T5脊髓区注射2小时)、药物组(MED；卡维地洛12.5 mg，po，2次)或对照组(CTRL；不治疗)，用于最初的第一阶段研究。在随后的第2阶段研究中，32名第1期幸存者被随机分为SCS组、MEDS组(卡维地洛+雷米普利2.5 mg，每日1次口服)、SCS+MEDS组(同时治疗)或CTRL组。观察动物5周(第1期)或10周(第2期)。在第3阶段，所有第1期动物均行旋支动脉球囊闭塞1h。SCS组左室射血分数基线为65+/-5%，1期末17+/-3%，2期末47+/-7%。MED组左室射血分数基线61+/-4%，1期末18+/-3%，2期末34+/-4%。与MED组和CTRL组相比，SCS组的左心室射血分数明显改善(P<；两个都是0.001)。SCS组(27+/-17和27%)和MED组(58+/-42和33%；P<；0.05)与CTRL组(88+/-52和76%)相比，SCS组和MED组第2期自发性非持续性室性心律失常和第3期缺血性室性心律失常的发生率均显著减少(P<0.05)。2期试验10周后，SCS组(52+/-5%)和SCS+MEDS组(46+/-4%)较MEDS组(38+/-2%)和CTRL组(31+/-4%)的射血分数恢复最快。结论SCS可显著改善心力衰竭犬的心脏收缩功能，减少室性心律失常。(发行量。2009年；120：286-294。)
Background-Spinal cord stimulation (SCS) reduces the incidence of ventricular tachyarrhythmias in experimental models. This study investigated the effects of long-term SCS on ventricular function in a postinfarction canine heart failure model.Methods and Results-In stage 1, dogs underwent implantable cardioverter-defibrillator implantation and embolization of the left anterior descending artery followed by right ventricular pacing (240 ppm) for 3 weeks to produce heart failure. In stage 2, 28 surviving animals were assigned to the SCS (delivered at the T4/T5 spinal region for 2 hours 3 times a day), medicine (MED; carvedilol therapy at 12.5 mg PO BID), or control (CTRL; no therapy) group for the initial phase 1 study. In a subsequent phase 2 study, 32 stage 1 survivors were equally randomized to the SCS, MEDS (carvedilol plus ramipril 2.5 mg PO QD), SCS plus MEDS (concurrent therapy), or CTRL group. Animals were monitored for 5 weeks (phase 1) or 10 weeks (phase 2). In stage 3, all phase 1 animals underwent circumflex artery balloon occlusion for 1 hour. In the SCS group, left ventricular ejection fraction was 65 +/- 5% at baseline, 17 +/- 3% at the end of stage 1, and 47 +/- 7% at the end of stage 2. In the MED group, left ventricular ejection fraction was 61 +/- 4% at baseline, 18 +/- 3% at the end of stage 1, and 34 +/- 4% at the end of stage 2. In the CTRL group, left ventricular ejection fraction was 64 +/- 5% at baseline, 19 +/- 5% at the end of stage 1, and 28 +/- 3% at the end of stage 2. Left ventricular ejection fraction was significantly improved in the SCS compared with the MED and CTRL groups (P < 0.001 for both). The mean number of spontaneous nonsustained ventricular tachyarrhythmias during stage 2 and the occurrence of ischemic ventricular tachyarrhythmias during stage 3 also were significantly decreased in the SCS (27 +/- 17 and 27%, respectively; P < 0.03) and MED (58 +/- 42 and 33%; P < 0.05) versus CTRL (88 +/- 52 and 76%) group. After 10 weeks in the phase 2 studies, the greatest recovery in ejection fraction was noted in the SCS (52 +/- 5%) and SCS + MEDS (46 +/- 4%) groups compared with the MEDS (38 +/- 2%) and CTRL (31 +/- 4%) groups.Conclusion-SCS significantly improved cardiac contractile function and decreased ventricular arrhythmias in canine heart failure. (Circulation. 2009;120:286-294.)