Optimal ventricular rate slowing during atrial fibrillation by feedback AV nodal-selective vagal stimulation.
Optimal ventricular rate slowing during atrial fibrillation by feedback AV nodal-selective vagal stimulation.
复制标题
通过反馈房室结选择性迷走神经刺激实现房颤期间最佳心室率减慢。
DOI：
10.1152/ajpheart.00738.2001
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发表时间：
2002
期刊：
影响因子：
--
通讯作者：
Mazgalev,TodorN
中科院分区：
文献类型：
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作者：
Zhang,Youhua;Mowrey,KentA;Zhuang,Shaowei;Wallick,DonW;Popović,ZoranB;Mazgalev,TodorN
虽然心房颤动（AF）期间心室率（VR）减慢的有益效果是不言自明的，但VR与血流动力学之间的精确关系尚未确定。我们假设通过改变神经刺激强度的选择性房室结（AVN）迷走神经刺激（AVN-VS）可以实现精确分级的减慢，并允许在AF期间评估最佳VR。本研究的目的如下：1）开发用于AF期间计算机化迷走神经控制的VR减慢的方法，2）确定VR减慢的每个水平处的血流动力学变化，3）建立房颤时的最佳前向性VR。在14只狗中，将VS递送到将副交感神经纤维投射到AVN的心外膜脂肪垫。通过计算机反馈算法实现四个目标平均VR水平，分别对应于窦性周期长度（SCL）的75%、100%、125%和150%。VR减慢导致血流动力学改善，多项式拟合分析发现，在VR减慢87%SCL时，心输出量最佳。我们的结论是，这种新的方法可以用来维持缓慢的顺行性传导与最佳的血流动力学在AF。
Although the beneficial effects of ventricular rate (VR) slowing during atrial fibrillation (AF) are axiomatic, the precise relationship between VR and hemodynamics has not been determined. We hypothesized that selective atrioventricular node (AVN) vagal stimulation (AVN-VS) by varying the nerve stimulation intensity could achieve precise graded slowing and permit evaluation of an optimal VR during AF. The aims of the present study were the following:1) to develop a method for computerized vagally controlled VR slowing during AF,2) to determine the hemodynamic changes at each level of VR slowing, and3) to establish the optimal anterograde VR during AF. AVN-VS was delivered to the epicardial fat pad that projects parasympathetic nerve fibers to the AVN in 14 dogs. Four target average VR levels, corresponding to 75%, 100%, 125%, and 150% of the sinus cycle length (SCL), were achieved by computer feedback algorithm. VR slowing resulted in improved hemodynamics and polynomial fit analysis found an optimum for the cardiac output at VR slowing of 87% SCL. We conclude that this novel method can be used to maintain slow anterograde conduction with best hemodynamics during AF.