This study was supported in part by the Atrial Fibrillation Innovation Center (AFIC), a State of Ohio Wright Center of Innovation, at the Cleveland Clinic.
Therapeutic Effects of Selective Atrioventricular Node Vagal Stimulation in Atrial Fibrillation and Heart Failure
Article first published online: 22 AUG 2012
© 2012 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 24, Issue 1, pages 86–91, January 2013
How to Cite
ZHANG, Y., POPOVIĆ, Z. B., KUSUNOSE, K. and MAZGALEV, T. N. (2013), Therapeutic Effects of Selective Atrioventricular Node Vagal Stimulation in Atrial Fibrillation and Heart Failure. Journal of Cardiovascular Electrophysiology, 24: 86–91. doi: 10.1111/j.1540-8167.2012.02405.x
- Issue published online: 2 JAN 2013
- Article first published online: 22 AUG 2012
- Accepted manuscript online: 9 JUL 2012 10:40AM EST
- Manuscript received 20 April 2012; Revised manuscript received 23 May 2012; Accepted for publication 22 June 2012.
- atrial fibrillation;
- atrioventricular node;
- heart failure;
- rate control;
- vagus nerve
Therapeutic Effects of Selective AVN-VS in AF and HF. Introduction: Atrial fibrillation (AF) and heart failure (HF) frequently coexist. We have previously demonstrated that selective atrioventricular node (AVN) vagal stimulation (AVN-VS) can be used to control ventricular rate during AF. Due to withdrawal of vagal activity in HF, the therapeutic effects of AVN-VS may be compromised in the combined condition of AF and HF. Accordingly, this study was designed to evaluate the therapeutic effects of AVN-VS to control ventricular rate in AF and HF.
Methods and Results: A combined model of AF and HF was created by implanting a dual chamber pacemaker in 24 dogs. A newly designed bipolar electrode was inserted into the ganglionic AVN fat pad and connected to a nerve stimulator for delivering AVN-VS. In all dogs, HF was induced by high rate ventricular pacing at 220 bpm for 4 weeks. AF was then induced and maintained by rapid atrial pacing at 600 bpm after discontinuation of ventricular pacing. These HF + AF dogs were randomized into control (n = 9) and AVN-VS (n = 15) groups. In the latter group, vagal stimulation (310 μs, 20 Hz, 3–7 mA) was delivered continuously for 6 months. Compared with the control, AVN-VS had a consistent effect on ventricular rate slowing (by >50 bpm, all P < 0.001) during the entire 6-month observation period that was associated with left ventricular functional improvement. Moreover, AVN-VS was well tolerated by the treated animals.
Conclusions: AVN-VS achieved consistent rate slowing, which was associated with improved ventricular function in a canine AF and HF model. Thus, AVN-VS may be a novel, effective therapeutic option in the combined condition of AF and HF. (J Cardiovasc Electrophysiol, Vol. 24, pp. 86-91, January 2013)