Cardiac sympathectomy and spinal cord stimulation attenuate reflex-mediated norepinephrine release during ischemia preventing ventricular fibrillation
Cardiac sympathectomy and spinal cord stimulation attenuate reflex-mediated norepinephrine release during ischemia preventing ventricular fibrillation
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DOI：
10.1172/jci.insight.131648
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发表时间：
2019-12-05
期刊：
影响因子：
8
通讯作者：
Shivkumar, Kalyanam
中科院分区：
文献类型：
--
作者：
Ardell, Jeffrey L.;Foreman, Robert D.;Shivkumar, Kalyanam
本研究的目的是确定心脏神经轴分散或脊髓刺激（SCS）减少缺血诱导的室颤（VF）的机制。在麻醉犬中，通过微透析直接测定了短暂（15分钟）冠状动脉闭塞（CAO）后左心室间质液（ISF）中去甲肾上腺素（NE）的水平。在具有完整神经轴的动物中研究了反应，并将其与心脏神经轴（星状神经节）的胸内成分或心脏内在神经元（ICN）系统通过手术与中枢神经系统脱钩的动物以及具有完整神经轴的动物进行了比较。在神经轴完整的情况下，由于CAO而过度释放NE的动物出现VF的风险增加。在CAO期间，当神经轴完整时NE增加152%，而星状分散后增加114%，ICN分散后增加16%。在SCS期间，CAO NE水平增加了59%。CAO诱发VF的风险在对照组为38%，分散组为8%，SCS组为11%。这些数据表明，缺血相关的传入神经元传输差异从事中央和胸内交感神经反射和放大交感兴奋。局部心室NE释放的差异与VF风险增加相关。手术分散或SCS减少NE释放和VF。
The purpose of this study was to define the mechanism by which cardiac neuraxial decentralization or spinal cord stimulation (SCS) reduces ischemia-induced ventricular fibrillation (VF). Direct measurements of norepinephrine (NE) levels in the left ventricular interstitial fluid (ISF) by microdialysis, in response to transient (15-minute) coronary artery occlusion (CAO), were performed in anesthetized canines. Responses were studied in animals with intact neuraxes and were compared with those in which the intrathoracic component of the cardiac neuraxes (stellate ganglia) or the intrinsic cardiac neuronal (ICN) system was surgically delinked from the central nervous system and those with intact neuraxes with preemptive SCS (T1-T3). With intact neuraxes, animals with exaggerated NE release due to CAO were at increased risk for VF. During CAO, there was a 152% increase in NE when the neuraxes were intact compared with 114% following stellate decentralization and 16% following ICN decentralization. During SCS, CAO NE levels increased by 59%. Risk for CAO-induced VF was 38% in controls, 8% following decentralization, and 11% following SCS. These data indicate that ischemia-related afferent neuronal transmission differentially engages central and intrathoracic sympathetic reflexes and amplifies sympathoexcitation. Differences in regional ventricular NE release are associated with increased risk for VF. Surgical decentralization or SCS reduced NE release and VF.