Catheter-Based Renal Sympathetic Denervation Significantly Inhibits Atrial Fibrillation Induced by Electrical Stimulation of the Left Stellate Ganglion and Rapid Atrial Pacing

Hou, Yuemei; Hu, Jialu; Po, Sunny S.; Wang, Huan; Zhang, Ling; Zhang, Feng; Wang, Kun; Zhou, Qina

doi:10.1371/journal.pone.0078218

Cited by 37 publications

(40 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…12 During left stellate ganglion stimulation (LSGNS: 20 Hz, 2 ms) combined with atrial S 1 S 2 stimulation, the AERP and AF/AFL WOV were measured at all 4 sites. The stellate ganglion stimulation threshold is defined as the current required to produce an increase of ≥20% in systolic blood pressure or heart rate.…”

Section: Experimental Protocolmentioning

confidence: 99%

Effects of Intrinsic and Extrinsic Cardiac Nerves on Atrial Arrhythmia in Experimental Pulmonary Artery Hypertension

Zhao¹,

Deng²,

Jiang³

et al. 2015

Hypertension

View full text Add to dashboard Cite

S upraventricular arrhythmias, such as atrial fibrillation (AF) and atrial flutter (AFL), are common in patients with pulmonary arterial hypertension (PAH) and are associated with poor outcomes.1,2 In 1 study, restoration and maintenance of sinus rhythm were invariably associated with clinical improvement and recovery. 3 However, it is difficult to treat AF/AFL in patients with PAH because existing antiarrhythmic agents have substantial side effects in patients with PAH.Previous studies have suggested that increased sympathetic nerve activation could contribute to disease severity in patients with PAH. 4,5 A recent study by Chen et al 6 demonstrated that pulmonary artery denervation decreased pulmonary arterial pressure and increased functional capacity. Our previous study showed that renal denervation attenuates pulmonary vascular remodeling and decreases pulmonary arterial pressure in experimental PAH.7 In a dog model with rapid atrial or ventricular pacing, a reduction in sympathetic tone or cardiac sympathetic denervation achieved by ablating extrinsic cardiac or renal sympathetic nerves was shown to be useful for controlling atrial arrhythmia. [8][9][10] However, to the best of our knowledge, the effect of sympathetic nerve activity on vulnerability to atrial arrhythmia in PAH has not been evaluated. The purpose of this study was to test the hypothesis that the activity of intrinsic and extrinsic cardiac nerves has an important role in vulnerability to atrial arrhythmia in a model of PAH. MethodsAdditional methodological details for each of the sections below are described in the online-only Data Supplement.Abstract-Atrial arrhythmia, which includes atrial fibrillation (AF) and atrial flutter (AFL), is common in patients with pulmonary arterial hypertension (PAH), who often have increased sympathetic nerve activity. Here, we tested the hypothesis that autonomic nerves play important roles in vulnerability to AF/AFL in PAH. The atrial effective refractory period and AF/AFL inducibility at baseline and after anterior right ganglionated plexi ablation were determined during left stellate ganglion stimulation or left renal sympathetic nerve stimulation in beagle dogs with or without PAH. Then, sympathetic nerve, β-adrenergic receptor densities and connexin 43 expression in atrial tissues were assessed. The sum of the window of vulnerability to AF/AFL was increased in the right atrium compared with the left atrium at baseline in the PAH dogs but not in the controls. The atrial effective refractory period dispersion was increased in the control dogs, but not in the PAH dogs, during left stellate ganglion stimulation. The voltage thresholds for inducing AF/AFL during anterior right ganglionated plexi stimulation were lower in the PAH dogs than in the controls. The AF/AFL inducibility was suppressed after ablation of the anterior right ganglionated plexi in the PAH dogs. The PAH dogs had higher sympathetic nerve and β1-adrenergic receptor densities, increased levels of nonphosphorylated connexin 43, and heterogeneo...

show abstract

Section: Experimental Protocolmentioning

confidence: 99%

Effects of Intrinsic and Extrinsic Cardiac Nerves on Atrial Arrhythmia in Experimental Pulmonary Artery Hypertension

Zhao¹,

Deng²,

Jiang³

et al. 2015

Hypertension

View full text Add to dashboard Cite

show abstract

“…With direct nerve activity recordings in ambulatory dogs, Tsai et al [9] observed that RDN could reduce the 24-hour average left stellate ganglion nerve activity and the paroxysmal atrial tachycardia episodes and duration. In a canine AF model with hyper-sympathetic tone induced by left stellate ganglion stimulation plus rapid atrial pacing for 3 h, RDN could almost completely prevent the increased AF inducibility, shortened atrial refractoriness, increased dispersion of atrial refractoriness, as well as elevated plasma norepinephrine [10]. In a pig model of sleep apnea, RDN resulted in an even more pronounced attenuation of atrial refractoriness shortening and AF inducibility when compared to beta-blocker treatment [11].…”

mentioning

confidence: 92%

“…Surprisingly, a recent clinical study (Symplicity HTN-3) showed the absence of beneficial effects with RDN in comparison to the sham procedure in terms of blood pressure reduction [8]. However, experimental studies [9][10][11][12][13][14] in recent years indicate that the antiarrhythmic effects of RDN may be independent of blood pressure control.Sympathetic overactivity, especially left stellate ganglion activation, has been shown to involve in the pathogenesis of AF. With direct nerve activity recordings in ambulatory dogs, Tsai et al [9] observed that RDN could reduce the 24-hour average left stellate ganglion nerve activity and the paroxysmal atrial tachycardia episodes and duration.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Renal denervation for the treatment of atrial fibrillation in hypertensive patients or beyond?

Huang¹,

Yu²,

Zhou³

et al. 2015

International Journal of Cardiology

View full text Add to dashboard Cite

“…It has also been suggested that the treatment may have beneficial effects in other diseases (e.g. heart failure [17], chronic kidney disease [18], sleep apnea [12,19] and arrhythmia diseases [20,21]) with increased sympathetic activity. There was, however, a need for confirmation of the original observations in a larger scaled and blinded study.…”

Section: Introductionmentioning

confidence: 99%

Renal denervation

Olsen

Kamper

Svendsen

et al. 2015

European Journal of Internal Medicine

View full text Add to dashboard Cite

Initial studies demonstrated that RDN in patients with resistant hypertension was both feasible and safe and indicated that RDN may lead to impressive reductions in BP. However, recent controlled studies question the BP lowering effect of RDN treatment. Large-scale registry data still supports the favorable BP reducing effect of RDN. We suggest that, in the near future, RDN should not be performed outside clinical studies. The degree of denervation between individual operators and between different catheters and techniques used should be clarified. The major challenge ahead is to identify which patients could benefit from RDN, to clarify the lack of an immediate procedural success parameter, and to establish further documentation of overall effect of treatment such as long-term cardiovascular morbidity and mortality.

show abstract

Catheter-Based Renal Sympathetic Denervation Significantly Inhibits Atrial Fibrillation Induced by Electrical Stimulation of the Left Stellate Ganglion and Rapid Atrial Pacing

Cited by 37 publications

References 31 publications

Effects of Intrinsic and Extrinsic Cardiac Nerves on Atrial Arrhythmia in Experimental Pulmonary Artery Hypertension

Effects of Intrinsic and Extrinsic Cardiac Nerves on Atrial Arrhythmia in Experimental Pulmonary Artery Hypertension

Renal denervation for the treatment of atrial fibrillation in hypertensive patients or beyond?

Renal denervation

Contact Info

Product

Resources

About