Heart Rhythm
Volume 7, Issue 5 , Pages 683-689 , May 2010

Vagal tone augmentation to the atrioventricular node in humans: Efficacy and safety of burst endocardial stimulation

  • Pietro Rossi, MD

      Affiliations

    • Department of Medicine, Electrophysiology and Pacing Unit, Belcolle Hospital, Viterbo, Italy
    • Corresponding Author InformationAddress reprint requests and correspondence: Dr. Pietro Rossi, Department of Medicine, Electrophysiology and Pacing Unit, Via Nerva 4, 00012 Guidonia-Montecelio, Rome, Italy
    • ,
  • Stefano Bianchi, MD

      Affiliations

    • Cardiology Division, S. Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
    • ,
  • Giancarlo Monari, MS

      Affiliations

    • ENEA, Frascati (RM), Italy
    • ,
  • Alberto Della Scala, MS

      Affiliations

    • Medtronic Italy, Sesto S. Giovanni (MI), Italy
    • ,
  • Daniele Porcelli, MD

      Affiliations

    • Cardiology Division, S. Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
    • ,
  • Sergio Valsecchi, PhD

      Affiliations

    • Medtronic Italy, Sesto S. Giovanni (MI), Italy
    • ,
  • Sergio Canonaco, MS

      Affiliations

    • Medtronic Italy, Sesto S. Giovanni (MI), Italy
    • ,
  • Lilian Kornet, PhD

      Affiliations

    • Medtronic BRC, Maastricht, The Netherlands
    • ,
  • Paolo Azzolini, MD

      Affiliations

    • Cardiology Division, S. Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy

Received 28 December 2009 ,Accepted 21 January 2010.

References 

  1. Zhang Y, Mowrey KA, Zhuang S, Wallick DW, Popović ZB, Mazgalev TN. Optimal ventricular rate slowing during atrial fibrillation by feedback AV nodal-selective vagal stimulation. Am J Physiol Heart Circ Physiol. 2002;282:H1102–H1110
  2. Schauerte P, Mischke K, Plisiene J, et al. Catheter stimulation of cardiac parasympathetic nerves in humans: a novel approach to the cardiac autonomic nervous system. Circulation. 2001;104:2430–2435
  3. Rossi P, Bianchi S, Barretta A, et al. Post-operative atrial fibrillation management by selective epicardial vagal fat pad stimulation. J Interv Card Electrophysiol. 2009;24:37–45
  4. Quan KJ, Lee JH, Van Hare GF, Biblo LA, Mackall JA, Carlson MD. Identification and characterization of atrioventricular parasympathetic innervation in humans. J Cardiovasc Electrophysiol. 2002;13:735–739
  5. Bianchi S, Rossi P, Della Scala A, Kornet L. Endocardial transcatheter stimulation of the AV nodal fat pad: stabilization of rapid ventricular rate response during atrial fibrillation in left ventricular failure. J Cardiovasc Electrophysiol. 2009;20:103–105
  6. Bianchi S, Rossi P, Della Scala A, et al. Atrioventricular (AV) node vagal stimulation by transvenous permanent lead implantation to modulate AV node function: safety and feasibility in humans. Heart Rhythm. 2009;6:1282–1286
  7. Gemein C, Schauerte P, Hatam N, et al. Targeting of cardiac autonomic plexus for modulation of intracardiac neural tone. Europace. 2009;11:1090–1096
  8. McComb JM. Rate control during atrial fibrillation achieved by chronic endocardial vagal stimulation: proof of principle. Heart Rhythm. 2009;6:1287–1288
  9. Zhang Y, Yamada H, Bibevski S, et al. Chronic atrioventricular nodal vagal stimulation: first evidence for long-term ventricular rate control in canine atrial fibrillation model. Circulation. 2005;112:2904–2911
  10. Mischke K, Zarse M, Schmid M, et al. Chronic Augmentation of the Parasympathetic Tone to the Atrioventricular Node: A Nonthoracotomy Neurostimulation Technique for Ventricular Rate Control During Atrial Fibrillation. J Cardiovasc Electrophysiol. 2009 Oct 5;[Epub ahead of print] PubMed PMID: 19804547
  11. Daoud EG, Weiss R, Bahu M, et al. Effect of an irregular ventricular rhythm on cardiac output. Am J Cardiol. 1996;78:1433–1436
  12. Wallick DW, Zhang Y, Tabata T, et al. Selective AV nodal vagal stimulation improves hemodynamics during acute atrial fibrillation in dogs. Am J Physiol Heart Circ Physiol. 2001;281:H1490–H1497
  13. Brignole M, Menozzi C, Gianfranchi L, et al. Assessment of atrioventricular junction ablation and VVIR pacemaker versus pharmacological treatment in patients with heart failure and chronic atrial fibrillation: a randomized, controlled study. Circulation. 1998;98:953–960
  14. Natale A, Zimerman L, Tomassoni G, et al. AV node ablation and pacemaker implantation after withdrawal of effective rate-control medications for chronic atrial fibrillation: effect on quality of life and exercise performance. Pacing Clin Electrophysiol. 1999;22:1634–1639
  15. Zhuang S, Zhang Y, Mowrey KA, et al. Ventricular rate control by selective vagal stimulation is superior to rhythm regularization by atrioventricular nodal ablation and pacing during atrial fibrillation. Circulation. 2002;106:1853–1858
  16. Zhang Y, Mazgalev TN. Achieving regular slow rhythm during atrial fibrillation without atrioventricular nodal ablation: selective vagal stimulation plus ventricular pacing. Heart Rhythm. 2004;4:469–475
  17. Wittkampf FHM, De Jongste MJL, Lie HI, Meijler FL. Effect of right ventricular pacing on ventricular rhythm during atrial fibrillation. J Am Coll Cardiol. 1988;11:539–545
  18. Wittkampf FHM, De Jongste MJL. Rate stabilization by right ventricular on-demand pacing in patients with atrial fibrillation. Pacing Clin Electrophysiol. 1986;9:1147–1153
  19. Puglisi A, Gasparini M, Lunati M, et al. Persistent atrial fibrillation worsens heart rate variability, activity and heart rate, as shown by a continuous monitoring by implantable biventricular pacemakers in heart failure patients. J Cardiovasc Electrophysiol. 2008;19:693–701
  20. Hoppe UC, Casares JM, Eiskjaer H, et al. Effect of cardiac resynchronization on the incidence of atrial fibrillation in patients with severe heart failure. Circulation. 2006;114:18–25
  21. Knight BP, Desai A, Coman J, Faddis M, Yong P. Long-term retention of cardiac resynchronization therapy. J Am Coll Cardiol. 2004;44:72–77
  22. Bibevski S, Dunlap ME. Ganglionic mechanisms contribute to diminished vagal control in heart failure. Circulation. 1999;99:2958–2963
  23. Po SS, Li Y, Tang D, et al. Rapid and stable re-entry within the pulmonary vein as a mechanism initiating paroxysmal atrial fibrillation. J Am Coll Cardiol. 2005;45:1871–1877
  24. Po SS, Scherlag BJ, Yamanashi WS, et al. Experimental model for paroxysmal atrial fibrillation arising at the pulmonary vein-atrial junctions. Heart Rhythm. 2006;3:201–208
  25. Soos P, Merkely B, Horvat PM, Zima E, Schauerte P. Determinants and effects of electrical stimulation of the inferior interatrial parasympathetic plexus during atrial fibrillation. J Cardiovasc Electrophysiol. 2005;16:1362–1367
  26. Jhanjee R, Templeton GA, Sattiraju S, et al. Relationship of paroxysmal atrial tachyarrhythmias to volume overload: assessment by implanted transpulmonary impedance monitoring. Circ Arrhythm Electrophysiol. 2009;2:488–494
  27. Daubert JP, Zareba W, Cannom DS, et al. Inappropriate implantable cardioverter-defibrillator shocks in MADIT II: frequency, mechanisms, predictors, and survival impact. J Am Coll Cardiol. 2008;51:1357–1365
  28. Kamphuis HC, De Leeuw JR, Derksen R, Hauer R, Winnubst JA. A 12 month quality of life assessment of cardiac arrest survivors treated with or without an implantable cardioverter defibrillator. Europace. 2002;4:417–425

 A. Della Scala, Dr. Valsecchi, S. Canonaco, and Dr. Kornet are employees of Medtronic, Inc.,

PII: S1547-5271(10)00060-3

doi: 10.1016/j.hrthm.2010.01.029

Heart Rhythm
Volume 7, Issue 5 , Pages 683-689 , May 2010

Article Tools

* Image Usage & Resolution