Chronic Augmentation of the Parasympathetic Tone to the Atrioventricular Node: A Nonthoracotomy Neurostimulation Technique for Ventricular Rate Control During Atrial Fibrillation
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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DOI：
10.1111/j.1540-8167.2009.01613.x
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发表时间：
2010-02-01
影响因子：
2.7
通讯作者：
Schauerte, Patrick
中科院分区：
文献类型：
--
作者：
Mischke, Karl;Zarse, Markus;Schauerte, Patrick
长期心脏神经刺激。引言：右下神经节丛（RIGP）选择性支配房室结。在心房颤动（AF）期间，对该神经丛的临时电刺激会降低心室率。我们试图评估的可行性，慢性副交感神经刺激的心室率控制在AF与nonthoracotomy intracardiac neurostimulation approach.Methods和结果：在9只杂种狗，小endoorthogonal区域内的右心房，覆盖RIGP，确定了20 Hz的刺激，在一个引导导管与集成电极。一旦确定，植入了主动固定电极导线。电极导线连接到皮下神经刺激器。通过快速心房起搏和心室率监测植入额外的双腔起搏器诱导AF。持续神经刺激1-2年，以将AF期间的心室率降低至100-140 bpm。在37 +/- 12 min内植入神经刺激电极导线。神经刺激开启/偏移或调制后负向传导反应的潜伏期< 1 s。在1-2年的随访期间，连续神经刺激是有效的，并且耐受性良好，刺激电压< 5 V。神经刺激效果显示出时值-基强度行为（对于AF期间心室率降低50%，时值时间为0.07 +/- 0.02 ms）。该方法安全、有效，长期耐受性良好。房室结选择性和在数秒内调整负变频效应的机会可能代表了优于药物心率控制的优势。（J.E. Vasc Electrophysiol，Vol. 21，pp. 193-199，2010年2月）。
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).