Effects of Thoracic Spinal Cord Stimulation on Cardiac Autonomic Regulation of the Sinus and Atrioventricular Nodes

Olgin, Jeffrey E.; Takahashi, Tamana; Wilson, Emily; Vereckei, András; Steinberg, Helmut O.; Zipes, Douglas P.

doi:10.1046/j.1540-8167.2002.00475.x

Cited by 83 publications

(50 citation statements)

References 6 publications

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“…These changes would suggest a predominantly sympathetic effect of SCS in the atria. However, one important difference in this study as compared with the Olgin et al 54 study is that Bernstein et al 55 applied SCS from T1-T5 whereas Olgin et al applied SCS to T1-T2. Therefore, it is possible that different populations of nerves were recruited with SCS in the two studies, which could have influenced the net effect of SCS stimulation.…”

Section: Spinal Cord Stimulation Spinal Cord Stimulation and Atrial Ementioning

confidence: 75%

“…SCS in dogs applied at the T1-T2 level prolonged sinus cycle length and increased AH interval conduction time, which was abolished by vagotomy, suggesting that SCS at T1-T2 has a predominantly vagal effect. 54 However, a recent study by Bernstein et al 55 applied SCS to a canine model of AF induced by rapid atrial pacing, and showed that SCS prolonged the atrial effective refractory periods in both atria and reduced AF inducibility if SCS was applied at the time that rapid atrial pacing began. These changes would suggest a predominantly sympathetic effect of SCS in the atria.…”

Section: Spinal Cord Stimulation Spinal Cord Stimulation and Atrial Ementioning

confidence: 99%

“…The beneficial effect of SCS on refractory angina and its predominantly sympatholytic effect 54 suggests the possibility that SCS may decrease ventricular arrhythmias as well. 57 Issa et al 58 observed a significant decrease in VT and VF in a canine heart failure model that was exposed to transient ischaemia.…”

Section: Spinal Cord Stimulation and Ventricular Electrophysiologymentioning

confidence: 99%

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Device-Based Approaches to Modulate the Autonomic Nervous System and Cardiac Electrophysiology

Hucker

Singh

Parks

et al. 2014

Arrhythm Electrophysiol Rev

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The interplay between the central nervous system and cardiac electrophysiology is fundamental, and becomes obvious each time one's pulse quickens in response to stress. Normally, cardiac neurohormonal regulation is accomplished through the balanced effects of sympathetic and parasympathetic autonomic stimulation, along with the hormonal regulation of the renin-angiotensinaldosterone system (RAAS). Autonomic and hormonal input modulate multiple facets of cellular electrophysiology -action potential duration, ion channel kinetics and intracellular calcium dynamics (just to name a few) -which translate into macroscopic manifestations of autonomic modulation such as heart rate variability, atrioventricular (AV) conduction time and QT interval variability.1 Therefore, it is no surprise that neurohormonal regulation of cardiac electrophysiology is an area of active investigation for its potential antiarrhythmic effects. Recent reviews have focused on the efficacy of neurohormonal modulation, via non-pharmacological methods, to enhance heart failure treatment. 2,3 This review will attempt to provide a state-of-the-art on the potential antiarrhythmic efficacy of renal artery denervation, spinal cord stimulation and direct vagal stimulation. Neurohormonal Control in the Normal and Failing HeartAutonomic control of cardiac physiology is often conceptualised as parasympathetic (cholinergic) and sympathetic (adrenergic) innervation existing in a 'yin and yang' balance under normal circumstances; however, this concept may be over-simplified. 4 In reality, the intrinsic cardiac nervous system, composed of several ganglia located primarily posterior to the atria, likely acts as a 'little brain' of the heart -it provides efferent input to the myocardium, collects afferent signals on a beat-to-beat basis and performs some integrative functions on its own, all under the tonic modulation of extrinsic sympathetic and parasympathetic input (see Figure 1). 4-8The ganglia are predominantly composed of cholinergic neurons; however, sympathetic efferent neurons are also present. Due to the complex interconnectivity between the ganglia, afferent mechanosensory, nociceptive and chemosensory signals from all four chambers of the heart may be processed within a single ganglion. 4 Such interconnectivity implies that predicting the effect of stimulation or ablation of a particular ganglion may be difficult, because each ganglion performs multiple functions. 7,9Abstract Alterations in resting autonomic tone can be pathogenic in many cardiovascular disease states, such as heart failure and hypertension.Indeed, autonomic modulation by way of beta-blockade is a standard treatment of these conditions. There is a significant interest in developing non-pharmacological methods of autonomic modulation as well. For instance, clinical trials of vagal stimulation and spinal cord stimulation in the treatment of heart failure are currently underway, and renal denervation has been studied recently in the treatment of resistant hypertension. Notably, autonom...

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Section: Spinal Cord Stimulation Spinal Cord Stimulation and Atrial Ementioning

confidence: 75%

Section: Spinal Cord Stimulation Spinal Cord Stimulation and Atrial Ementioning

confidence: 99%

Section: Spinal Cord Stimulation and Ventricular Electrophysiologymentioning

confidence: 99%

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Device-Based Approaches to Modulate the Autonomic Nervous System and Cardiac Electrophysiology

Hucker

Singh

Parks

et al. 2014

Arrhythm Electrophysiol Rev

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“…102 There is basic evidence that SCS enhances the vagal tonus. 103 In concert with this observation, a study in patients with severe coronary artery disease demonstrates that vagal stimulation, inhibiting norepinephrine release from sympathetic nerves to the heart, may subsequently alter the sympatholytic/ vagotonic balance and so dilates cardiac microcirculatory vessels. 104 Mannheimer and coworkers put forward the hypothesis that electrical neuromodulation reduces the myocardial oxygen demand.…”

Section: Electrical Neuromodulation and Myocardial Ischemiamentioning

confidence: 96%

Electrical Neuromodulation and the Heart with Special Emphasis on Myocardial Ischemia

DeJongste¹

2012

Topics in Neuromodulation Treatment

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“…These effects were abolished after transection of bilateral cervical vagus nerves but not transection of ansae subclaviae (sympathectomy), suggesting the effect of SCS is vagally mediated. 12 In a canine model of ischemic HF, SCS during transient myocardial ischemia reduced the incidence of spontaneous ventricular tachyarrhythmias. 13 This antiarrhythmic effect was again associated with vagal effects -reduction in sinus rate, prolongation of PR interval and lowering of blood pressure.…”

Section: Preclinical Researchmentioning

confidence: 99%

Interventional and Device-Based Autonomic Modulation in Heart Failure

Shen¹,

Zipes²

2015

Heart Failure Clinics

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Abstract/SummaryHeart failure is an increasingly prevalent disease with high mortality and public health burden. It is associated with autonomic imbalance characterized by sympathetic hyperactivity and parasympathetic hypoactivity. Evolving novel interventional and device-based therapy has sought to restore autonomic balance by neuromodulation.Results of preclinical animal studies and early clinical trials have demonstrated its safety and efficacy in heart failure. In this review article, we will discuss specific neuromodulatory treatment modalities individually-spinal cord stimulation, vagus nerve stimulation, baroreceptor activation therapy and renal sympathetic nerve denervation. Key Points (3-5)• Heart failure (HF) is a disease categorized by sympathetic hyperactivity, parasympathetic withdrawal and impaired baroreflex control of sympathetic activation.• Several measures of autonomic modulation either by implanted devices or interventions seek to restore the autonomic balance in HF and improve outcomes. These measures include spinal cord stimulation, vagus nerve 3 stimulation, baroreceptor activation therapy and renal sympathetic nerve denervation.• Preclinical work and the majority of early clinical trials demonstrate the benefits of these modalities in HF. Additional larger, well-designed, outcome-based clinical trials are warranted to verify the results and determine whether these evolving, innovative neuromodulation approaches can be recommended to the growing population of HF patients.4

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Effects of Thoracic Spinal Cord Stimulation on Cardiac Autonomic Regulation of the Sinus and Atrioventricular Nodes

Abstract: SCS appears to enhance parasympathetic activity, mediated via the vagus. This may have implications for use of thoracic SCS to treat chronic angina and perhaps prevent sudden cardiac death.

Cited by 83 publications

References 6 publications

Device-Based Approaches to Modulate the Autonomic Nervous System and Cardiac Electrophysiology

Device-Based Approaches to Modulate the Autonomic Nervous System and Cardiac Electrophysiology

Electrical Neuromodulation and the Heart with Special Emphasis on Myocardial Ischemia

Interventional and Device-Based Autonomic Modulation in Heart Failure

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