ongestive heart failure (CHF) is associated with an augmentation of sympathetic nerve activity and a reduction in parasympathetic nerve activity. 1,2 This autonomic imbalance may underlie the increased risk of sudden cardiac death in CHF patients. 3 In normal individuals, parasympathetic impulses are transmitted from the solitary nucleus in the brain to the heart through efferent preand post-ganglionic vagal neurons. Upon vagal stimulation, acetylcholine (ACh) released from the nerve terminals binds to muscarinic (M2) receptors of the heart. Emerging evidence shows that the ACh release at both pre-and postganglionic levels is facilitated by nitric oxide (NO) generated by neuronal NO synthase (nNOS) at nerve terminals. 4,5 Stimulation of the M2 receptor in the sinoatrial (SA) node pacemaker cells results in a reduction of heart rate (HR) via increase of ACh-sensitive potassium channel current (IK,ACh) and decrease of hyperpolarization-activated cation channel current (If). 6 The level within the vagal cascade, at which a defect results in parasympathetic withdrawal, is unknown.In a dog model of CHF induced by rapid ventricular pacing, Bibevski and Dunlap demonstrated that although the HR response to pre-ganglionic vagal nerve stimulation was attenuated compared with controls, the HR response to post-ganglionic vagal nerve stimulation was significantly enhanced, suggesting a defect located within the parasympathetic ganglion. 7 However, these sparse data require confirmation in general, but especially in other animal models and human patients. Also, the anatomic site(s) and molecular mechanisms of parasympathetic withdrawal in failing hearts remains to be clarified. We investigated the effects of pre-and post-ganglionic vagal nerve stimulation (VS), and those of direct application of ACh on HR or spontaneous activity of the SA node in rats with right-sided CHF secondary to pulmonary hypertension, induced by monocrotaline (MCT, 60 mg/kg, sc). Our results point to vagal nerve dysfunction at both pre-and post-ganglionic levels despite enhanced sensitivity of the SA node to ACh. Downregulation of nNOS and upregulation of M2 receptor are associated with these changes in the right atria of CHF rats.
Methods
Animal ModelRight ventricular hypertrophy with CHF was produced in 5-week-old male Wistar rats by a single subcutaneous injection of MCT (60 mg/kg; Sigma Chemical Co, St. Louis, MO, USA). 8 As previously described, right ventricular hypertrophy and heart failure were completed 4 weeks after MCT injection. Rats injected with saline were used as controls. 8 The rats were killed for in vivo and in vitro experi- Background Parasympathetic drive is attenuated in heart failure, and resulting autonomic imbalance may increase the risk of sudden cardiac death. The anatomic site(s) and molecular mechanisms underlying this parasympathetic withdrawal are unknown.
Methods and ResultsWe examined the effects of pre-and post-ganglionic vagal nerve stimulation (VS) and acetylcholine (ACh) application on the heart rate of rats with ri...