Stimulation of the intra-cardiac vagal nerves innervating the AV-node to control ventricular rate during AF: specificity, parameter optimization and chronic use up to 3 months
Stimulation of the intra-cardiac vagal nerves innervating the AV-node to control ventricular rate during AF: specificity, parameter optimization and chronic use up to 3 months
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刺激支配房室结的心内迷走神经以控制 AF 期间的心室率：特异性、参数优化和长期使用长达 3 个月
DOI：
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发表时间：
2011
影响因子：
1.8
通讯作者：
R. Cornelussen
中科院分区：
文献类型：
--
作者：
L. Kornet;A. Hunnik;K. Michels;S. Verheule;Alberto Della Scala;Teena M. West;R. Kessels;R. Cornelussen
刺激支配房室结的心内迷走神经(AVNs)是房颤时减慢心室率(VR)的一种很有前途的方法。我们的目的是证明，房颤稳定期对R-R间期的影响一旦优化可以维持几个月，并且AVNs特异性地影响支配房室结的神经。将15只山羊植入与房室电极相连的起搏器和放置在一定间隔部位的与心房电极相连的神经刺激器，以诱导房室传导延长。在慢性实验中(n = 9)，在确定最佳房室结参数后，研究持续房室结对持续房颤持续3个月的VR的影响。阿托品和艾司洛尔对AVNS的作用机制进行了研究。其次，研究房室不应期房室结对电生理和血流动力学参数的影响(n = 7)。结果在刺激频率为40 Hz时，这种影响最大，并且随着脉冲宽度的增加(低电压)和电压的增加而增加。房颤缓解期AVN0、1、3个月平均VR分别下降55%(n = 9)、48%(n = 8)、28%(n = 6)。AVNs效应似乎主要是副交感神经。AVNS对(1)窦房结、(2)房室组织和His不应期、(3)血流动力学参数无明显影响。结论AVNS能有效地降低心室率至少3个月，且对支配房室结的副交感神经有特异性影响。
BackgroundStimulation of the intra-cardiac vagal nerves innervating the AV-node (AVNS) is a promising approach to slow down ventricular rate (VR) during atrial fibrillation (AF). Our purpose was to demonstrate that effects on R-R-interval during stable AF can be maintained for several months once optimized and that AVNS affects specifically the nerves innervating the AV-node.MethodsOur study included both an acute and chronic phase. Fifteen goats were implanted with a pacemaker connected to an atrial and ventricular lead and a neurostimulator connected to an atrial lead placed at a certain septal site, to induce an AV prolongation. In the chronic experiments (n = 9), after assessment of optimal AVNS parameters, the effect of continuous AVNS on VR was studied during stable AF for up to 3 months. The mechanism of AVNS was studied using atropine and esmolol. Next, the effects of AVNS during the atrial refractory period on electrophysiological and hemodynamic parameters were investigated acutely (n = 7).ResultsThe maximal effect was found at a stimulation frequency of 40 Hz, and increased with increasing pulse width (at lower voltages) and increasing voltage. After 0, 1, and 3 months of AVNS during stable AF, AVNS decreased average VR, respectively, 55% (n = 9), 48% (n = 8), and 28% (n = 6). The AVNS effect appeared to be dominantly parasympathetic. AVNS did not influence (1) the sinus node, (2) the refractory period of the atrial, ventricular tissue, and His and (3) hemodynamic parameters.ConclusionAVNS is efficient in reducing ventricular rate for at least 3 months using optimized parameters and specifically affects the parasympathetic nerves innervating the AV-node.
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
发表时间：
2002
期刊：
American journal of physiology. Heart and circulatory physiology
影响因子：
--
作者：
Zhang,Youhua;Mowrey,KentA;Zhuang,Shaowei;Wallick,DonW;Popović,ZoranB;Mazgalev,TodorN
通讯作者：
Mazgalev,TodorN
影响因子：
158.5
作者：
Wyse, DG;Waldo, AL;Corley, SD
通讯作者：
Corley, SD
DOI：
10.1016/s0735-1097(02)01957-5
发表时间：
2002-07-17
影响因子：
24
作者：
Stein, KM;Euler, DE;Lerman, BB
通讯作者：
Lerman, BB