Effects of Low‐Level Autonomic Stimulation on Prevention of Atrial Fibrillation Induced by Acute Electrical Remodeling

Abstract

Background. Rapid atrial pacing (RAP) can induce electrical and autonomic remodeling and facilitate atrial fibrillation (AF). Recent reports showed that low-level vagosympathetic nerve stimulation (LLVNS) can suppress AF, as an antiarrhythmic effect. We hypothesized that LLVNS can reverse substrate heterogeneity induced by RAP. Methods and Results. Mongrel dogs were divided into (LLVNS+RAP) and RAP groups. Electrode catheters were sutured to multiple atrial sites, and LLVNS was applied to cervical vagosympathetic trunks with voltage 50% below the threshold slowing sinus rate by ⩽30 msec. RAP induced a significant decrease in effective refractory period (ERP) and increase in the window of vulnerability at all sites, characterized by descending and elevated gradient differences towards the ganglionic plexi (GP) sites, respectively. The ERP dispersion was obviously enlarged by RAP and more significant when the ERP of GP-related sites was considered. Recovery time from AF was also prolonged significantly as a result of RAP. LLVNS could reverse all these changes induced by RAP and recover the heterogeneous substrate to baseline. Conclusions. LLVNS can reverse the electrical and autonomic remodeling and abolish the GP-central gradient differences induced by RAP, and thus it can recover the homogeneous substrate, which may be the underlying mechanism of its antiarrhythmic effect.

Acupuncture at the auricular branch of the vagus nerve enhances heart rate variability in humans: An exploratory study

“…Given that low-level vagus nerve stimulation has shown antiarrhythmic effects, 4 , 6 the possibility to reduce AF recurrence by parasympathetic stimulation using acupuncture in addition to antiarrhythmic drug therapy or ablation is a promising approach.…”

“…2,3 Potential additional therapeutic approaches such as cardiac ganglionic ablation or denervation as well as noninvasive approaches via electroacupuncture have delivered promising results concerning a reduction of AF episodes. [4][5][6][7] In a canine model, low-level transcutaneous electrical stimu-lation-defined as stimulation at a voltage approximately 10% beneath the threshold of vagus nerve stimulation inducing any slowing of sinus rate or atrioventricular conduction-of the auricular branch of the vagus nerve (ABVN) showed antiarrhythmic effects by suppressing neural activity within the ganglionated plexi and thereby inhibiting inducibility of AF. 7 In patients with paroxysmal AF, low-level vagal stimulation recently demonstrated significant reduction in AF burden.…”

Heart Rate Variability during Auricular Acupressure at Heart Point in Healthy Volunteers: A Pilot Study

“…The increase in HRV when stimulating heart auricular acupoint can be a potential approach in clinical practice. Previous studies have shown that stimulating the vagus nerve in the ear with an increase in HRV will have an antiarrhythmic effect, potentially reducing the recurrence of atrial fibrillation when combined with an antiarrhythmic drug [ 23 , 24 ]. Therefore, future studies to determine the influence of auricular acupuncture on heart acupoints in patients with atrial fibrillation are particularly promising.…”

Impact of low-level electromagnetic fields on the inducibility of atrial fibrillation in the electrophysiology laboratory

“…Consequently, several recent studies have demonstrated the ability of autonomic modulation to suppress and prevent AF in a variety of animal models [11][12][13][14], as well as in humans [15,16].…”