Bioelectronic neuromodulation of the paravertebral cardiac efferent sympathetic outflow and its effect on ventricular electrical indices
Bioelectronic neuromodulation of the paravertebral cardiac efferent sympathetic outflow and its effect on ventricular electrical indices
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DOI：
10.1016/j.hrthm.2017.02.020
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发表时间：
2017-07-01
期刊：
影响因子：
5.5
通讯作者：
Ardell, Jeffrey L.
中科院分区：
文献类型：
--
作者：
Buckley, Una;Chui, Ray W.;Ardell, Jeffrey L.
背景通过使用对称电压控制的千赫兹频率交流电（KHFAC）对椎旁神经节进行神经调节，有可能成为难治性室性心律失常患者手术干预的可逆替代方案。KHFAC创建可扩展的局灶性抑制的动作电位conduction.Objective本文的目的是评估KHFAC的疗效时，适用于T1-T2椎旁链，以减轻交感神经流出到heart.METHODS在麻醉，vagotomized，猪科目，心脏暴露通过中线胸骨切开术沿着与椎旁链神经节。电刺激T3椎旁神经节，并从放置在两个心室上的56电极套获得激活恢复间期（阿里斯）。双极Ag电极缠绕在T1和T2之间的椎旁链上，并连接到对称电压控制的KHFAC发生器。心脏指数在T3刺激条件下的比较，有和没有KHFAC，提供了一个衡量的块effictiveness.RESULTS右侧T3刺激（在4 Hz）滴定产生可重复的ARI变化从基线（52 +/- 30 ms）。KHFAC导致T3电刺激对ARI的影响减轻67%（18.5 +/- 22 ms; P < .005）。KHFAC后重复T3刺激产生与对照相当的ARI变化。KHFAC诱发了短暂的功能性交感神经兴奋发作时，频率呈负相关，强度直接相关。最佳阻滞阈值为15 kHz和15 V。结论KHFAC作用于心脏神经系统的会聚点，可对下方轴突产生分级的可逆性阻滞。因此，KHFAC具有按需和可逆缓解交感神经兴奋的治疗潜力。(C)2017心脏节律协会。All rights reserved.
BACKGROUND Neuromodulation of the paravertebral ganglia by using symmetric voltage controlled kilohertz frequency alternating current (KHFAC) has the potential to be a reversible alternative to surgical intervention in patients with refractory ventricular arrhythmias. KHFAC creates scalable focal inhibition of action potential conduction.OBJECTIVE The purpose of this article was to evaluate the efficacy of KHFAC when applied to the T1-T2 paravertebral chain to mitigate sympathetic outflow to the heart.METHODS In anesthetized, vagotomized, porcine subjects, the heart was exposed via a midline sternotomy along with paravertebral chain ganglia. The T3 paravertebral ganglion was electrically stimulated, and activation recovery intervals (ARIs) were obtained from a 56-electrode sock placed over both ventricles. A bipolar Ag electrode was wrapped around the paravertebral chain between T1 and T2 and connected to a symmetric voltage controlled KHFAC generator. A comparison of cardiac indices during T3 stimulation conditions, with and without KHFAC, provided a measure of block efficacy.RESULTS Right-sided T3 stimulation (at 4 Hz) was titrated to produce reproducible ARI changes from baseline (52 +/- 30 ms). KHFAC resulted in a 67% mitigation of T3 electrical stimulation effects on ARI (18.5 +/- 22 ms; P < .005). T3 stimulation repeated after KHFAC produced equivalent ARI changes as control. KHFAC evoked a transient functional sympathoexcitation at onset that was inversely related to frequency and directly related to intensity. The optimum block threshold was 15 kHz and 15 V.CONCLUSION KHFAC applied to nexus (convergence) points of the cardiac nervous system produces a graded and reversible block of underlying axons. As such, KHFAC has the therapeutic potential for on-demand and reversible mitigation of sympathoexcitation. (C) 2017 Heart Rhythm Society. All rights reserved.