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Habecker BA, Bers DM, Birren SJ, Chang R, Herring N, Kay MW, Li D, Mendelowitz D, Mongillo M, Montgomery JM, Ripplinger CM, Tampakakis E, Winbo A, Zaglia T, Zeltner N, Paterson DJ. Molecular and cellular neurocardiology in heart disease. J Physiol 2024. [PMID: 38778747 DOI: 10.1113/jp284739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/16/2024] [Indexed: 05/25/2024] Open
Abstract
This paper updates and builds on a previous White Paper in this journal that some of us contributed to concerning the molecular and cellular basis of cardiac neurobiology of heart disease. Here we focus on recent findings that underpin cardiac autonomic development, novel intracellular pathways and neuroplasticity. Throughout we highlight unanswered questions and areas of controversy. Whilst some neurochemical pathways are already demonstrating prognostic viability in patients with heart failure, we also discuss the opportunity to better understand sympathetic impairment by using patient specific stem cells that provides pathophysiological contextualization to study 'disease in a dish'. Novel imaging techniques and spatial transcriptomics are also facilitating a road map for target discovery of molecular pathways that may form a therapeutic opportunity to treat cardiac dysautonomia.
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Affiliation(s)
- Beth A Habecker
- Department of Chemical Physiology & Biochemistry, Department of Medicine Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Donald M Bers
- Department of Pharmacology, University of California, Davis School of Medicine, Davis, CA, USA
| | - Susan J Birren
- Department of Biology, Volen Center for Complex Systems, Brandeis University, Waltham, MA, USA
| | - Rui Chang
- Department of Neuroscience, Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT, USA
| | - Neil Herring
- Burdon Sanderson Cardiac Science Centre and BHF Centre of Research Excellence, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Matthew W Kay
- Department of Biomedical Engineering, George Washington University, Washington, DC, USA
| | - Dan Li
- Burdon Sanderson Cardiac Science Centre and BHF Centre of Research Excellence, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - David Mendelowitz
- Department of Pharmacology and Physiology, George Washington University, Washington, DC, USA
| | - Marco Mongillo
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Johanna M Montgomery
- Department of Physiology and Manaaki Manawa Centre for Heart Research, University of Auckland, Auckland, New Zealand
| | - Crystal M Ripplinger
- Department of Pharmacology, University of California, Davis School of Medicine, Davis, CA, USA
| | | | - Annika Winbo
- Department of Physiology and Manaaki Manawa Centre for Heart Research, University of Auckland, Auckland, New Zealand
| | - Tania Zaglia
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Nadja Zeltner
- Departments of Biochemistry and Molecular Biology, Cell Biology, and Center for Molecular Medicine, University of Georgia, Athens, GA, USA
| | - David J Paterson
- Burdon Sanderson Cardiac Science Centre and BHF Centre of Research Excellence, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
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Chen HS, van Roon L, Ge Y, van Gils JM, Schoones JW, DeRuiter MC, Zeppenfeld K, Jongbloed MRM. The relevance of the superior cervical ganglion for cardiac autonomic innervation in health and disease: a systematic review. Clin Auton Res 2024; 34:45-77. [PMID: 38393672 PMCID: PMC10944423 DOI: 10.1007/s10286-024-01019-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/22/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE The heart receives cervical and thoracic sympathetic contributions. Although the stellate ganglion is considered the main contributor to cardiac sympathetic innervation, the superior cervical ganglia (SCG) is used in many experimental studies. The clinical relevance of the SCG to cardiac innervation is controversial. We investigated current morphological and functional evidence as well as controversies on the contribution of the SCG to cardiac innervation. METHODS A systematic literature review was conducted in PubMed, Embase, Web of Science, and COCHRANE Library. Included studies received a full/text review and quality appraisal. RESULTS Seventy-six eligible studies performed between 1976 and 2023 were identified. In all species studied, morphological evidence of direct or indirect SCG contribution to cardiac innervation was found, but its contribution was limited. Morphologically, SCG sidedness may be relevant. There is indirect functional evidence that the SCG contributes to cardiac innervation as shown by its involvement in sympathetic overdrive reactions in cardiac disease states. A direct functional contribution was not found. Functional data on SCG sidedness was largely unavailable. Information about sex differences and pre- and postnatal differences was lacking. CONCLUSION Current literature mainly supports an indirect involvement of the SCG in cardiac innervation, via other structures and plexuses or via sympathetic overdrive in response to cardiac diseases. Morphological evidence of a direct involvement was found, but its contribution seems limited. The relevance of SCG sidedness, sex, and developmental stage in health and disease remains unclear and warrants further exploration.
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Affiliation(s)
- H Sophia Chen
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, The Netherlands
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lieke van Roon
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yang Ge
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Janine M van Gils
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands
| | - Marco C DeRuiter
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiology, Center of Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands.
- Department of Cardiology, Center of Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands.
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Vandenberk B, Haemers P, Morillo C. The autonomic nervous system in atrial fibrillation-pathophysiology and non-invasive assessment. Front Cardiovasc Med 2024; 10:1327387. [PMID: 38239878 PMCID: PMC10794613 DOI: 10.3389/fcvm.2023.1327387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/13/2023] [Indexed: 01/22/2024] Open
Abstract
The autonomic nervous system plays a crucial role in atrial fibrillation pathophysiology. Parasympathetic hyperactivity result in a shortening of the action potential duration, a reduction of the conduction wavelength, and as such facilitates reentry in the presence of triggers. Further, autonomic remodeling of atrial myocytes in AF includes progressive sympathetic hyperinnervation by increased atrial sympathetic nerve density and sympathetic atrial nerve sprouting. Knowledge on the pathophysiological process in AF, including the contribution of the autonomic nervous system, may in the near future guide personalized AF management. This review focuses on the role of the autonomic nervous system in atrial fibrillation pathophysiology and non-invasive assessment of the autonomic nervous system.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Peter Haemers
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Carlos Morillo
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
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Barrett MS, Bauer TC, Li MH, Hegarty DM, Mota CMD, Amaefuna CJ, Ingram SL, Habecker BA, Aicher SA. Ischemia-reperfusion myocardial infarction induces remodeling of left cardiac-projecting stellate ganglia neurons. Am J Physiol Heart Circ Physiol 2024; 326:H166-H179. [PMID: 37947434 DOI: 10.1152/ajpheart.00582.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 11/12/2023]
Abstract
Neurons in the stellate ganglion (SG) provide sympathetic innervation to the heart, brown adipose tissue (BAT), and other organs. Sympathetic innervation to the heart becomes hyperactive following myocardial infarction (MI). The impact of MI on the morphology of cardiac sympathetic neurons is not known, but we hypothesized that MI would stimulate increased cell and dendritic tree size in cardiac neurons. In this study, we examined the effects of ischemia-reperfusion MI on sympathetic neurons using dual retrograde tracing methods to allow detailed characterization of cardiac- and BAT-projecting neurons. Different fluorescently conjugated cholera toxin subunit B (CTb) tracers were injected into the pericardium and the interscapular BAT pads, respectively. Experimental animals received a 45-min occlusion of the left anterior descending coronary artery and controls received sham surgery. One week later, hearts were collected for assessment of MI infarct and SGs were collected for morphological or electrophysiological analysis. Cardiac-projecting SG neurons from MI mice had smaller cell bodies and shorter dendritic trees compared with sham animals, specifically on the left side ipsilateral to the MI. BAT-projecting neurons were not altered by MI, demonstrating the subpopulation specificity of the response. The normal size and distribution differences between BAT- and cardiac-projecting stellate ganglion neurons were not altered by MI. Patch-clamp recordings from cardiac-projecting left SG neurons revealed increased spontaneous excitatory postsynaptic currents despite the decrease in cell and dendritic tree size. Thus, increased dendritic tree size does not contribute to the enhanced sympathetic neural activity seen after MI.NEW & NOTEWORTHY Myocardial infarction (MI) causes structural and functional changes specifically in stellate ganglion neurons that project to the heart, but not in cells that project to brown adipose fat tissue.
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Affiliation(s)
- Madeleine S Barrett
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
| | - Temerity C Bauer
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
| | - Ming-Hua Li
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
| | - Deborah M Hegarty
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
| | - Clarissa M D Mota
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
| | - Chimezie J Amaefuna
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
| | - Susan L Ingram
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
| | - Beth A Habecker
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
| | - Sue A Aicher
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
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Wang Y, Zhao ZG, Chai Z, Fang JC, Chen M. Electromagnetic field and cardiovascular diseases: A state-of-the-art review of diagnostic, therapeutic, and predictive values. FASEB J 2023; 37:e23142. [PMID: 37650634 DOI: 10.1096/fj.202300201rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023]
Abstract
Despite encouraging advances in early diagnosis and treatment, cardiovascular diseases (CVDs) remained a leading cause of morbidity and mortality worldwide. Increasing evidence has shown that the electromagnetic field (EMF) influences many biological processes, which has attracted much attention for its potential therapeutic and diagnostic modalities in multiple diseases, such as musculoskeletal disorders and neurodegenerative diseases. Nonionizing EMF has been studied as a therapeutic or diagnostic tool in CVDs. In this review, we summarize the current literature ranging from in vitro to clinical studies focusing on the therapeutic potential (external EMF) and diagnostic potential (internal EMF generated from the heart) of EMF in CVDs. First, we provided an overview of the therapeutic potential of EMF and associated mechanisms in the context of CVDs, including cardiac arrhythmia, myocardial ischemia, atherosclerosis, and hypertension. Furthermore, we investigated the diagnostic and predictive value of magnetocardiography in CVDs. Finally, we discussed the critical steps necessary to translate this promising approach into clinical practice.
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Affiliation(s)
- Yan Wang
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhen-Gang Zhao
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheng Chai
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jian-Cheng Fang
- School of Instrumentation Science and Opto-Electronics Engineering, Beihang University, Beijing, China
| | - Mao Chen
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Tsai W, Hung TC, Kusayama T, Han S, Fishbein MC, Chen LS, Chen PS. Autonomic Modulation of Atrial Fibrillation. JACC Basic Transl Sci 2023; 8:1398-1410. [PMID: 38094692 PMCID: PMC10714180 DOI: 10.1016/j.jacbts.2023.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 01/13/2024]
Abstract
The autonomic nervous system plays a vital role in cardiac arrhythmias, including atrial fibrillation (AF). Therefore, reducing the sympathetic tone via neuromodulation methods may be helpful in AF control. Myocardial ischemia is associated with increased sympathetic tone and incidence of AF. It is an excellent disease model to understand the neural mechanisms of AF and the effects of neuromodulation. This review summarizes the relationship between autonomic nervous system and AF and reviews methods and mechanisms of neuromodulation. This review proposes that noninvasive or minimally invasive neuromodulation methods will be most useful in the future management of AF.
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Affiliation(s)
- Wei–Chung Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tien-Chi Hung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Takashi Kusayama
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences Kanazawa, Kanazawa, Japan
| | - Seongwook Han
- Department of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Michael C. Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, USA
| | - Lan S. Chen
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Peng-Sheng Chen
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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van Weperen VYH, Ripplinger CM, Vaseghi M. Autonomic control of ventricular function in health and disease: current state of the art. Clin Auton Res 2023; 33:491-517. [PMID: 37166736 PMCID: PMC10173946 DOI: 10.1007/s10286-023-00948-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Cardiac autonomic dysfunction is one of the main pillars of cardiovascular pathophysiology. The purpose of this review is to provide an overview of the current state of the art on the pathological remodeling that occurs within the autonomic nervous system with cardiac injury and available neuromodulatory therapies for autonomic dysfunction in heart failure. METHODS Data from peer-reviewed publications on autonomic function in health and after cardiac injury are reviewed. The role of and evidence behind various neuromodulatory therapies both in preclinical investigation and in-use in clinical practice are summarized. RESULTS A harmonic interplay between the heart and the autonomic nervous system exists at multiple levels of the neuraxis. This interplay becomes disrupted in the setting of cardiovascular disease, resulting in pathological changes at multiple levels, from subcellular cardiac signaling of neurotransmitters to extra-cardiac, extra-thoracic remodeling. The subsequent detrimental cycle of sympathovagal imbalance, characterized by sympathoexcitation and parasympathetic withdrawal, predisposes to ventricular arrhythmias, progression of heart failure, and cardiac mortality. Knowledge on the etiology and pathophysiology of this condition has increased exponentially over the past few decades, resulting in a number of different neuromodulatory approaches. However, significant knowledge gaps in both sympathetic and parasympathetic interactions and causal factors that mediate progressive sympathoexcitation and parasympathetic dysfunction remain. CONCLUSIONS Although our understanding of autonomic imbalance in cardiovascular diseases has significantly increased, specific, pivotal mediators of this imbalance and the recognition and implementation of available autonomic parameters and neuromodulatory therapies are still lagging.
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Affiliation(s)
- Valerie Y H van Weperen
- Division of Cardiology, Department of Medicine, UCLA Cardiac Arrythmia Center, University of California, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | | | - Marmar Vaseghi
- Division of Cardiology, Department of Medicine, UCLA Cardiac Arrythmia Center, University of California, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA.
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Chen PS, Fishbein MC. Neural Remodeling After Myocardial Infarction: The Importance of Heterogeneity. JACC Clin Electrophysiol 2023; 9:1665-1667. [PMID: 37480865 DOI: 10.1016/j.jacep.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 07/24/2023]
Affiliation(s)
- Peng-Sheng Chen
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Küçükbingöz Ç, Tepe Ö, Özmen Ç, Özbek HT, Deniz A. Can stellate ganglion blockage be an alternative treatment for refractory ventricular arrhythmias: Case series. Medicine (Baltimore) 2023; 102:e34135. [PMID: 37390263 PMCID: PMC10313254 DOI: 10.1097/md.0000000000034135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/08/2023] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION Ventricular tachycardia (VT) and ventricular fibrillation (VF) are life-threatening conditions which increase in frequency over the years. Electrical storm (ES) is defined as the occurrence of 3 or more continuous ventricular arrhythmia. The sympathetic nervous system has an important role in Ventricular arrythmias (VA) and is the target of treatment. Studies show that stellate ganglion blockade (SGB) can reduce cardiac sympathetic tone and is an alternative bridge therapy in VAs. PATIENT CONCERNS Among the patients who were admitted to the hospital with the complaints of general condition disorder and palpitation. DIAGNOSIS Patients were referred to the Cardiology department and diagnosed VA and ES. Patients who applied to the Cardiology Department with the diagnosis of VA or ES and did not benefit from antiarrhythmic drug therapy were selected and evaluated by a team of 2 anesthesiologists (cardiothoracic and pain specialists) and 2 cardiologists (1 of whom is an electrophysiology specialist). INTERVENTION In our study, ultrasound (USG) guided left SGB was applied to 10 VA and ES patients with implantable cardiac defibrillator (ICD). The 6-month results of the patients were evaluated retrospectively. For blockage, the solution was prepared by adding 8 mg dexamethasone, 40 mg lidocaine and 10 mg bupivacaine to 10 mL with physiological saline. The success of the procedure was evaluated with the development of Horner syndrome in the left eye. OUTCOMES Resistant VA developed in 2 of 10 patients who had left SGB due to VF/VT ES and were excluded from the study. One (1) month after the procedure it was seen that there was a statistically significant decrease in the number of shocks in 8 patients in the 6th month controls compared to the pre-procedure. The number of VES in the 1st and 6th months of the patients was also statistically significantly decreased compared to the pre-SSD (P = .01, P = .01, P = .01, respectively). CONCLUSION Unilateral USG-guided SGB application is an effective and safe method in patients with ES and VA. Long-term results can be satisfactory in successful responders in whom SGB is performed with a combination of local anesthetic and steroid.
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Affiliation(s)
- Çağatay Küçükbingöz
- Ministry of Health Adana City Training & Research Hospital, Department of Anesthesiology & Reanimation, Discipline of Pain Medicine, Adana, Turkey
| | - Ömer Tepe
- Osmaniye State Hospital, Department of Cardiology, Adana, Turkey
| | - Çağlar Özmen
- Cukurova University Faculty of Medicine, Department of Cardiology, Adana, Turkey
| | - Hayri T. Özbek
- Cukurova University Faculty of Medicine, Department of Anesthesiology & Reanimation, Discipline of Pain Medicine, Adana, Turkey
| | - Ali Deniz
- Cukurova University Faculty of Medicine, Department of Cardiology, Adana, Turkey
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Zhou L, Zhang Y, Cao G, Zhang C, Zheng C, Meng G, Lai Y, Zhou Z, Liu Z, Liu Z, Guo F, Dong X, Liang Z, Wang Y, Guo S, Zhou X, Jiang H, Yu L. Wireless Self-Powered Optogenetic System for Long-Term Cardiac Neuromodulation to Improve Post-MI Cardiac Remodeling and Malignant Arrhythmia. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2205551. [PMID: 36698262 PMCID: PMC10037959 DOI: 10.1002/advs.202205551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/02/2022] [Indexed: 06/17/2023]
Abstract
Autonomic imbalance is an important characteristic of patients after myocardial infarction (MI) and adversely contributes to post-MI cardiac remodeling and ventricular arrhythmias (VAs). A previous study proved that optogenetic modulation could precisely inhibit cardiac sympathetic hyperactivity and prevent acute ischemia-induced VAs. Here, a wireless self-powered optogenetic modulation system is introduced, which achieves long-term precise cardiac neuromodulation in ambulatory canines. The wireless self-powered optical system based on a triboelectric nanogenerator is powered by energy harvested from body motion and realized the effective optical illumination that is required for optogenetic neuromodulation (ON). It is further demonstrated that long-term ON significantly mitigates MI-induced sympathetic remodeling and hyperactivity, and improves a variety of clinically relevant outcomes such as improves ventricular dysfunction, reduces infarct size, increases electrophysiological stability, and reduces susceptibility to VAs. These novel insights suggest that wireless ON holds translational potential for the clinical treatment of arrhythmia and other cardiovascular diseases related to sympathetic hyperactivity. Moreover, this innovative self-powered optical system may provide an opportunity to develop implantable/wearable and self-controllable devices for long-term optogenetic therapy.
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Affiliation(s)
- Liping Zhou
- Department of CardiologyRenmin Hospital of Wuhan UniversityHubei Key Laboratory of Autonomic Nervous System ModulationCardiac Autonomic Nervous System Research Center of Wuhan UniversityTaikang Center for Life and Medical SciencesWuhan UniversityCardiovascular Research InstituteWuhan UniversityHubei Key Laboratory of CardiologyWuhan430060P. R. China
| | - Yuanzheng Zhang
- Department of CardiologyRenmin Hospital of Wuhan UniversityHubei Key Laboratory of Autonomic Nervous System ModulationCardiac Autonomic Nervous System Research Center of Wuhan UniversityTaikang Center for Life and Medical SciencesWuhan UniversityCardiovascular Research InstituteWuhan UniversityHubei Key Laboratory of CardiologyWuhan430060P. R. China
- Hubei Yangtze Memory LaboratoriesKey Laboratory of Artificial Micro, and Nano‐structures of Ministry of EducationSchool of Physics and TechnologyWuhan UniversityWuhan430072P. R. China
| | - Gang Cao
- Biomedical CenterCollege of Veterinary MedicineHuazhong Agricultural UniversityWuhan430072P. R. China
| | - Chi Zhang
- Wuhan National Laboratory for OptoelectronicsHuazhong University of Science and TechnologyWuhan430072P. R. China
| | - Chen Zheng
- Wuhan National Laboratory for OptoelectronicsHuazhong University of Science and TechnologyWuhan430072P. R. China
| | - Guannan Meng
- Department of CardiologyRenmin Hospital of Wuhan UniversityHubei Key Laboratory of Autonomic Nervous System ModulationCardiac Autonomic Nervous System Research Center of Wuhan UniversityTaikang Center for Life and Medical SciencesWuhan UniversityCardiovascular Research InstituteWuhan UniversityHubei Key Laboratory of CardiologyWuhan430060P. R. China
| | - Yanqiu Lai
- Department of CardiologyRenmin Hospital of Wuhan UniversityHubei Key Laboratory of Autonomic Nervous System ModulationCardiac Autonomic Nervous System Research Center of Wuhan UniversityTaikang Center for Life and Medical SciencesWuhan UniversityCardiovascular Research InstituteWuhan UniversityHubei Key Laboratory of CardiologyWuhan430060P. R. China
| | - Zhen Zhou
- Department of CardiologyRenmin Hospital of Wuhan UniversityHubei Key Laboratory of Autonomic Nervous System ModulationCardiac Autonomic Nervous System Research Center of Wuhan UniversityTaikang Center for Life and Medical SciencesWuhan UniversityCardiovascular Research InstituteWuhan UniversityHubei Key Laboratory of CardiologyWuhan430060P. R. China
| | - Zhihao Liu
- Department of CardiologyRenmin Hospital of Wuhan UniversityHubei Key Laboratory of Autonomic Nervous System ModulationCardiac Autonomic Nervous System Research Center of Wuhan UniversityTaikang Center for Life and Medical SciencesWuhan UniversityCardiovascular Research InstituteWuhan UniversityHubei Key Laboratory of CardiologyWuhan430060P. R. China
| | - Zihan Liu
- Department of CardiologyRenmin Hospital of Wuhan UniversityHubei Key Laboratory of Autonomic Nervous System ModulationCardiac Autonomic Nervous System Research Center of Wuhan UniversityTaikang Center for Life and Medical SciencesWuhan UniversityCardiovascular Research InstituteWuhan UniversityHubei Key Laboratory of CardiologyWuhan430060P. R. China
| | - Fuding Guo
- Department of CardiologyRenmin Hospital of Wuhan UniversityHubei Key Laboratory of Autonomic Nervous System ModulationCardiac Autonomic Nervous System Research Center of Wuhan UniversityTaikang Center for Life and Medical SciencesWuhan UniversityCardiovascular Research InstituteWuhan UniversityHubei Key Laboratory of CardiologyWuhan430060P. R. China
| | - Xin Dong
- Wuhan National Laboratory for OptoelectronicsHuazhong University of Science and TechnologyWuhan430072P. R. China
| | - Zhizhuo Liang
- Wuhan National Laboratory for OptoelectronicsHuazhong University of Science and TechnologyWuhan430072P. R. China
| | - Yueyi Wang
- Department of CardiologyRenmin Hospital of Wuhan UniversityHubei Key Laboratory of Autonomic Nervous System ModulationCardiac Autonomic Nervous System Research Center of Wuhan UniversityTaikang Center for Life and Medical SciencesWuhan UniversityCardiovascular Research InstituteWuhan UniversityHubei Key Laboratory of CardiologyWuhan430060P. R. China
| | - Shishang Guo
- Hubei Yangtze Memory LaboratoriesKey Laboratory of Artificial Micro, and Nano‐structures of Ministry of EducationSchool of Physics and TechnologyWuhan UniversityWuhan430072P. R. China
| | - Xiaoya Zhou
- Department of CardiologyRenmin Hospital of Wuhan UniversityHubei Key Laboratory of Autonomic Nervous System ModulationCardiac Autonomic Nervous System Research Center of Wuhan UniversityTaikang Center for Life and Medical SciencesWuhan UniversityCardiovascular Research InstituteWuhan UniversityHubei Key Laboratory of CardiologyWuhan430060P. R. China
| | - Hong Jiang
- Department of CardiologyRenmin Hospital of Wuhan UniversityHubei Key Laboratory of Autonomic Nervous System ModulationCardiac Autonomic Nervous System Research Center of Wuhan UniversityTaikang Center for Life and Medical SciencesWuhan UniversityCardiovascular Research InstituteWuhan UniversityHubei Key Laboratory of CardiologyWuhan430060P. R. China
| | - Lilei Yu
- Department of CardiologyRenmin Hospital of Wuhan UniversityHubei Key Laboratory of Autonomic Nervous System ModulationCardiac Autonomic Nervous System Research Center of Wuhan UniversityTaikang Center for Life and Medical SciencesWuhan UniversityCardiovascular Research InstituteWuhan UniversityHubei Key Laboratory of CardiologyWuhan430060P. R. China
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Sharma S, Littman R, Tompkins J, Arneson D, Contreras J, Dajani AH, Ang K, Tsanhani A, Sun X, Jay PY, Herzog H, Yang X, Ajijola OA. Tiered Sympathetic Control of Cardiac Function Revealed by Viral Tracing and Single Cell Transcriptome Profiling. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.18.524575. [PMID: 36711942 PMCID: PMC9882306 DOI: 10.1101/2023.01.18.524575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The cell bodies of postganglionic sympathetic neurons innervating the heart primarily reside in the stellate ganglion (SG), alongside neurons innervating other organs and tissues. Whether cardiac-innervating stellate ganglionic neurons (SGNs) exhibit diversity and distinction from those innervating other tissues is not known. To identify and resolve the transcriptomic profiles of SGNs innervating the heart we leveraged retrograde tracing techniques using adeno-associated virus (AAV) expressing fluorescent proteins (GFP or Td-tomato) with single cell RNA sequencing. We investigated electrophysiologic, morphologic, and physiologic roles for subsets of cardiac-specific neurons and found that three of five adrenergic SGN subtypes innervate the heart. These three subtypes stratify into two subpopulations; high (NA1a) and low (NA1b and NA1c) Npy-expressing cells, exhibit distinct morphological, neurochemical, and electrophysiologic characteristics. In physiologic studies in transgenic mouse models modulating NPY signaling, we identified differential control of cardiac responses by these two subpopulations to high and low stress states. These findings provide novel insights into the unique properties of neurons responsible for cardiac sympathetic regulation, with implications for novel strategies to target specific neuronal subtypes for sympathetic blockade in cardiac disease.
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12
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Sridharan A, Bradfield JS, Shivkumar K, Ajijola OA. Autonomic nervous system and arrhythmias in structural heart disease. Auton Neurosci 2022; 243:103037. [DOI: 10.1016/j.autneu.2022.103037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/28/2022]
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13
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Cardiac Sympathetic Denervation for the Management of Ventricular Arrhythmias. J Interv Card Electrophysiol 2022; 65:813-826. [PMID: 35397706 DOI: 10.1007/s10840-022-01211-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/29/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The autonomic nervous system contributes to the pathogenesis of ventricular arrhythmias (VA). Though anti-arrhythmic drug therapy and catheter ablation are the mainstay of management of VAs, success may be limited in patients with more refractory arrhythmias. Sympathetic modulation is increasingly recognized as a valuable adjunct tool for managing VAs in patients with structural heart disease and inherited arrhythmias. RESULTS In this review, we explore the role of the sympathetic nervous system and rationale for cardiac sympathetic denervation (CSD) in VAs and provide a disease-focused review of the utility of CSD for patients both with and without structural heart disease. CONCLUSIONS We conclude that CSD is a reasonable therapeutic option for patients with VA, both with and without structural heart disease. Though not curative, many studies have demonstrated a significant reduction in the burden of VAs for the majority of patients undergoing the procedure. However, in patients with unilateral CSD and subsequent VA recurrence, complete bilateral CSD may provide long-lasting reprieve from VA.
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14
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Gurel NZ, Sudarshan KB, Hadaya J, Karavos A, Temma T, Hori Y, Armour JA, Kember G, Ajijola OA. Metrics of high cofluctuation and entropy to describe control of cardiac function in the stellate ganglion. eLife 2022; 11:e78520. [PMID: 36426848 PMCID: PMC9815826 DOI: 10.7554/elife.78520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 11/25/2022] [Indexed: 11/27/2022] Open
Abstract
Stellate ganglia within the intrathoracic cardiac control system receive and integrate central, peripheral, and cardiopulmonary information to produce postganglionic cardiac sympathetic inputs. Pathological anatomical and structural remodeling occurs within the neurons of the stellate ganglion (SG) in the setting of heart failure (HF). A large proportion of SG neurons function as interneurons whose networking capabilities are largely unknown. Current therapies are limited to targeting sympathetic activity at the cardiac level or surgical interventions such as stellectomy, to treat HF. Future therapies that target the SG will require understanding of their networking capabilities to modify any pathological remodeling. We observe SG networking by examining cofluctuation and specificity of SG networked activity to cardiac cycle phases. We investigate network processing of cardiopulmonary transduction by SG neuronal populations in porcine with chronic pacing-induced HF and control subjects during extended in-vivo extracellular microelectrode recordings. We find that information processing and cardiac control in chronic HF by the SG, relative to controls, exhibits: (i) more frequent, short-lived, high magnitude cofluctuations, (ii) greater variation in neural specificity to cardiac cycles, and (iii) neural network activity and cardiac control linkage that depends on disease state and cofluctuation magnitude.
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Affiliation(s)
- Nil Z Gurel
- UCLA Cardiac Arrhythmia Center and UCLA Neurocardiology Research Program of ExcellenceLos AngelesUnited States
| | - Koustubh B Sudarshan
- Department of Engineering Mathematics and Internetworking, Dalhousie UniversityNova ScotiaCanada
| | - Joseph Hadaya
- UCLA Cardiac Arrhythmia Center and UCLA Neurocardiology Research Program of ExcellenceLos AngelesUnited States
- UCLA Molecular, Cellular, and Integrative Physiology ProgramLos AngelesUnited States
| | - Alex Karavos
- Department of Engineering Mathematics and Internetworking, Dalhousie UniversityNova ScotiaCanada
| | - Taro Temma
- UCLA Cardiac Arrhythmia Center and UCLA Neurocardiology Research Program of ExcellenceLos AngelesUnited States
| | - Yuichi Hori
- UCLA Cardiac Arrhythmia Center and UCLA Neurocardiology Research Program of ExcellenceLos AngelesUnited States
| | - J Andrew Armour
- UCLA Cardiac Arrhythmia Center and UCLA Neurocardiology Research Program of ExcellenceLos AngelesUnited States
| | - Guy Kember
- Department of Engineering Mathematics and Internetworking, Dalhousie UniversityNova ScotiaCanada
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center and UCLA Neurocardiology Research Program of ExcellenceLos AngelesUnited States
- UCLA Molecular, Cellular, and Integrative Physiology ProgramLos AngelesUnited States
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15
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Li YL. Stellate Ganglia and Cardiac Sympathetic Overactivation in Heart Failure. Int J Mol Sci 2022; 23:ijms232113311. [PMID: 36362099 PMCID: PMC9653702 DOI: 10.3390/ijms232113311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
Heart failure (HF) is a major public health problem worldwide, especially coronary heart disease (myocardial infarction)-induced HF with reduced ejection fraction (HFrEF), which accounts for over 50% of all HF cases. An estimated 6 million American adults have HF. As a major feature of HF, cardiac sympathetic overactivation triggers arrhythmias and sudden cardiac death, which accounts for nearly 50–60% of mortality in HF patients. Regulation of cardiac sympathetic activation is highly integrated by the regulatory circuitry at multiple levels, including afferent, central, and efferent components of the sympathetic nervous system. Much evidence, from other investigators and us, has confirmed the afferent and central neural mechanisms causing sympathoexcitation in HF. The stellate ganglion is a peripheral sympathetic ganglion formed by the fusion of the 7th cervical and 1st thoracic sympathetic ganglion. As the efferent component of the sympathetic nervous system, cardiac postganglionic sympathetic neurons located in stellate ganglia provide local neural coordination independent of higher brain centers. Structural and functional impairments of cardiac postganglionic sympathetic neurons can be involved in cardiac sympathetic overactivation in HF because normally, many effects of the cardiac sympathetic nervous system on cardiac function are mediated via neurotransmitters (e.g., norepinephrine) released from cardiac postganglionic sympathetic neurons innervating the heart. This review provides an overview of cardiac sympathetic remodeling in stellate ganglia and potential mechanisms and the role of cardiac sympathetic remodeling in cardiac sympathetic overactivation and arrhythmias in HF. Targeting cardiac sympathetic remodeling in stellate ganglia could be a therapeutic strategy against malignant cardiac arrhythmias in HF.
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Affiliation(s)
- Yu-Long Li
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA; ; Tel.: +1-402-559-3016; Fax: +1-402-559-9659
- Department of Cellular & Integrative Physiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
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16
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Ge Y, van Roon L, van Gils JM, Geestman T, van Munsteren CJ, Smits AM, Goumans MJTH, DeRuiter MC, Jongbloed MRM. Acute myocardial infarction induces remodeling of the murine superior cervical ganglia and the carotid body. Front Cardiovasc Med 2022; 9:758265. [PMID: 36277772 PMCID: PMC9582601 DOI: 10.3389/fcvm.2022.758265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
A role for cardiac sympathetic hyperinnervation in arrhythmogenesis after myocardial infarction (MI) has increasingly been recognized. In humans and mice, the heart receives cervical as well as thoracic sympathetic contributions. In mice, superior cervical ganglia (SCG) have been shown to contribute significantly to myocardial sympathetic innervation of the left ventricular anterior wall. Of interest, the SCG is situated adjacent to the carotid body (CB), a small organ involved in oxygen and metabolic sensing. We investigated the remodeling of murine SCG and CB over time after MI. Murine SCG were isolated from control mice, as well as 24 h, 3 days, 7 days and 6 weeks after MI. SCG and CBs were stained for the autonomic nervous system markers β3-tubulin, tyrosine hydroxylase (TH) and choline acetyltransferase (ChAT), as well as for the neurotrophic factors brain derived neurotropic factor (BDNF), nerve growth factor (NGF) and their tyrosine receptor kinase (pan TRK). Results show that after MI a significant increase in neuron size occurs, especially in the region bordering the CB. Co-expression of TH and ChAT is observed in SCG neuronal cells, but not in the CB. After MI, a significant decrease in ChAT intensity occurs, which negatively correlated with the increased cell size. In addition, an increase of BDNF and NGF at protein and mRNA levels was observed in both the CB and SCG. This upregulation of neurotropic factors coincides with the upregulation of their receptor within the SCG. These findings were concomitant with an increase in GAP43 expression in the SCG, which is known to contribute to axonal outgrowth and elongation. In conclusion, neuronal remodeling toward an increased adrenergic phenotype occurs in the SCG, which is possibly mediated by the CB and might contribute to pathological hyperinnervation after MI.
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Affiliation(s)
- Yang Ge
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Lieke van Roon
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Janine M. van Gils
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands,Department of Nephrology, Leiden University Medical Center, Leiden, Netherlands
| | - Tom Geestman
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Conny J. van Munsteren
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Anke M. Smits
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Marco C. DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique R. M. Jongbloed
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands,*Correspondence: Monique R. M. Jongbloed, ; orcid.org/0000-0002-9132-0418
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17
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Zhou Z, Liu C, Xu S, Wang J, Guo F, Duan S, Deng Q, Sun J, Yu F, Zhou Y, Wang M, Wang Y, Zhou L, Jiang H, Yu L. Metabolism regulator adiponectin prevents cardiac remodeling and ventricular arrhythmias via sympathetic modulation in a myocardial infarction model. Basic Res Cardiol 2022; 117:34. [PMID: 35819552 DOI: 10.1007/s00395-022-00939-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 01/31/2023]
Abstract
The stellate ganglia play an important role in cardiac remodeling after myocardial infarction (MI). This study aimed to investigate whether adiponectin (APN), an adipokine mainly secreted by adipose tissue, could modulate the left stellate ganglion (LSG) and exert cardioprotective effects through the sympathetic nervous system (SNS) in a canine model of MI. APN microinjection and APN overexpression with recombinant adeno-associated virus vector in the LSG were performed in acute and chronic MI models, respectively. The results showed that acute APN microinjection decreased LSG function and neural activity, and suppressed ischemia-induced ventricular arrhythmia. Chronic MI led to a decrease in the effective refractory period and action potential duration at 90% and deterioration in echocardiography performance, all of which was blunted by APN overexpression. Moreover, APN gene transfer resulted in favorable heart rate variability alteration, and decreased cardiac SNS activity, serum noradrenaline and neuropeptide Y, which were augmented after MI. APN overexpression also decreased the expression of nerve growth factor and growth associated protein 43 in the LSG and peri-infarct myocardium, respectively. Furthermore, RNA sequencing of LSG indicated that 4-week MI up-regulated the mRNA levels of macrophage/microglia activation marker Iba1, chemokine ligands (CXCL10, CCL20), chemokine receptor CCR5 and pro-inflammatory cytokine IL6, and downregulated IL1RN and IL10 mRNA, which were reversed by APN overexpression. Our results reveal that APN inhibits cardiac sympathetic remodeling and mitigates cardiac remodeling after MI. APN-mediated gene therapy may provide a potential therapeutic strategy for the treatment of MI.
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Affiliation(s)
- Zhen Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China.,Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, 430060, People's Republic of China.,Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
| | - Chengzhe Liu
- Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, 430060, People's Republic of China.,Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
| | - Saiting Xu
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China.,Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, 430060, People's Republic of China.,Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
| | - Jun Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China.,Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, 430060, People's Republic of China.,Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
| | - Fuding Guo
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China.,Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, 430060, People's Republic of China.,Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
| | - Shoupeng Duan
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China.,Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, 430060, People's Republic of China.,Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
| | - Qiang Deng
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China.,Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, 430060, People's Republic of China.,Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
| | - Ji Sun
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China.,Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, 430060, People's Republic of China.,Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
| | - Fu Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China.,Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, 430060, People's Republic of China.,Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
| | - Yuyang Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China.,Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, 430060, People's Republic of China.,Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
| | - Meng Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China.,Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, 430060, People's Republic of China.,Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
| | - Yueyi Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China.,Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, 430060, People's Republic of China.,Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
| | - Liping Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China.,Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, 430060, People's Republic of China.,Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China. .,Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, 430060, People's Republic of China. .,Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China. .,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China. .,Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China.
| | - Lilei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China. .,Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, 430060, People's Republic of China. .,Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China. .,Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China. .,Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China.
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18
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Li J, Zheng L. The Mechanism of Cardiac Sympathetic Activity Assessment Methods: Current Knowledge. Front Cardiovasc Med 2022; 9:931219. [PMID: 35811701 PMCID: PMC9262089 DOI: 10.3389/fcvm.2022.931219] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/20/2022] [Indexed: 01/03/2023] Open
Abstract
This review has summarized the methods currently available for cardiac sympathetic assessment in clinical or under research, with emphasis on the principles behind these methodologies. Heart rate variability (HRV) and other methods based on heart rate pattern analysis can reflect the dominance of sympathetic nerve to sinoatrial node function and indirectly show the average activity level of cardiac sympathetic nerve in a period of time. Sympathetic neurotransmitters play a key role of signal transduction after sympathetic nerve discharges. Plasma or local sympathetic neurotransmitter detection can mediately display sympathetic nerve activity. Given cardiac sympathetic nerve innervation, i.e., the distribution of stellate ganglion and its nerve fibers, stellate ganglion activity can be recorded either directly or subcutaneously, or through the surface of the skin using a neurophysiological approach. Stellate ganglion nerve activity (SGNA), subcutaneous nerve activity (SCNA), and skin sympathetic nerve activity (SKNA) can reflect immediate stellate ganglion discharge activity, i.e., cardiac sympathetic nerve activity. These cardiac sympathetic activity assessment methods are all based on the anatomy and physiology of the heart, especially the sympathetic innervation and the sympathetic regulation of the heart. Technological advances, discipline overlapping, and more understanding of the sympathetic innervation and sympathetic regulation of the heart will promote the development of cardiac sympathetic activity assessment methods.
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19
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Mehra R, Tjurmina OA, Ajijola OA, Arora R, Bolser DC, Chapleau MW, Chen PS, Clancy CE, Delisle BP, Gold MR, Goldberger JJ, Goldstein DS, Habecker BA, Handoko ML, Harvey R, Hummel JP, Hund T, Meyer C, Redline S, Ripplinger CM, Simon MA, Somers VK, Stavrakis S, Taylor-Clark T, Undem BJ, Verrier RL, Zucker IH, Sopko G, Shivkumar K. Research Opportunities in Autonomic Neural Mechanisms of Cardiopulmonary Regulation: A Report From the National Heart, Lung, and Blood Institute and the National Institutes of Health Office of the Director Workshop. JACC Basic Transl Sci 2022; 7:265-293. [PMID: 35411324 PMCID: PMC8993767 DOI: 10.1016/j.jacbts.2021.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/22/2022]
Abstract
This virtual workshop was convened by the National Heart, Lung, and Blood Institute, in partnership with the Office of Strategic Coordination of the Office of the National Institutes of Health Director, and held September 2 to 3, 2020. The intent was to assemble a multidisciplinary group of experts in basic, translational, and clinical research in neuroscience and cardiopulmonary disorders to identify knowledge gaps, guide future research efforts, and foster multidisciplinary collaborations pertaining to autonomic neural mechanisms of cardiopulmonary regulation. The group critically evaluated the current state of knowledge of the roles that the autonomic nervous system plays in regulation of cardiopulmonary function in health and in pathophysiology of arrhythmias, heart failure, sleep and circadian dysfunction, and breathing disorders. Opportunities to leverage the Common Fund's SPARC (Stimulating Peripheral Activity to Relieve Conditions) program were characterized as related to nonpharmacologic neuromodulation and device-based therapies. Common themes discussed include knowledge gaps, research priorities, and approaches to develop novel predictive markers of autonomic dysfunction. Approaches to precisely target neural pathophysiological mechanisms to herald new therapies for arrhythmias, heart failure, sleep and circadian rhythm physiology, and breathing disorders were also detailed.
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Key Words
- ACE, angiotensin-converting enzyme
- AD, autonomic dysregulation
- AF, atrial fibrillation
- ANS, autonomic nervous system
- Ach, acetylcholine
- CNS, central nervous system
- COPD, chronic obstructive pulmonary disease
- CSA, central sleep apnea
- CVD, cardiovascular disease
- ECG, electrocardiogram
- EV, extracellular vesicle
- GP, ganglionated plexi
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- HRV, heart rate variability
- LQT, long QT
- MI, myocardial infarction
- NE, norepinephrine
- NHLBI, National Heart, Lung, and Blood Institute
- NPY, neuropeptide Y
- NREM, non-rapid eye movement
- OSA, obstructive sleep apnea
- PAH, pulmonary arterial hypertension
- PV, pulmonary vein
- REM, rapid eye movement
- RV, right ventricular
- SCD, sudden cardiac death
- SDB, sleep disordered breathing
- SNA, sympathetic nerve activity
- SNSA, sympathetic nervous system activity
- TLD, targeted lung denervation
- asthma
- atrial fibrillation
- autonomic nervous system
- cardiopulmonary
- chronic obstructive pulmonary disease
- circadian
- heart failure
- pulmonary arterial hypertension
- sleep apnea
- ventricular arrhythmia
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Affiliation(s)
- Reena Mehra
- Cleveland Clinic, Cleveland, Ohio, USA
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Olga A. Tjurmina
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | - Rishi Arora
- Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
| | | | - Mark W. Chapleau
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | | | | | - Michael R. Gold
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - David S. Goldstein
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Beth A. Habecker
- Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - M. Louis Handoko
- Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - James P. Hummel
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | | - Marc A. Simon
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- University of California-San Francisco, San Francisco, California, USA
| | | | - Stavros Stavrakis
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | | | - Richard L. Verrier
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - George Sopko
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
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20
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Liu C, Lee CH, Lin SF, Tsai WC. Temporal Clustering of Skin Sympathetic Nerve Activity Bursts in Acute Myocardial Infarction Patients. Front Neurosci 2021; 15:720827. [PMID: 34916895 PMCID: PMC8669957 DOI: 10.3389/fnins.2021.720827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Backgrounds: Acute myocardial infarction (AMI) affects the autonomic nervous system (ANS) function. The aim of our study is to detect the particular patterns of ANS regulation in AMI. We hypothesize that altered ANS regulation in AMI patients causes synchronized neural discharge (clustering phenomenon) detected by non-invasive skin sympathetic nerve activity (SKNA). Methods: Forty subjects, including 20 AMI patients and 20 non-AMI controls, participated in the study. The wide-band bioelectrical signals (neuECG) were continuously recorded on the body surface for 5 min. SKNA was signal processed to depict the envelope of SKNA (eSKNA). By labeling the clusters, the AMI subjects were separated into non-AMI, non-cluster appearing (AMINCA), and cluster appearing (AMICA) groups. Results: The average eSKNA was significantly correlated with HRV low-frequency (LF) power (rho = −0.336) and high-frequency power (rho = −0.372). The cross-comparison results demonstrated that eSKNA is a valid surrogate marker to assess ANS in AMI patients. The frequency of cluster occurrence was 0.01–0.03 Hz and the amplitude was about 3 μV. The LF/HF ratio of AMICA (median: 1.877; Q1–Q3: 1.483–2.413) revealed significantly lower than AMINCA (median: 3.959; Q1–Q3: 1.840–6.562). The results suggest that the SKNA clustering is a unique temporal pattern of ANS synchronized discharge, which could indicate the lower sympathetic status (by HRV) in AMI patients. Conclusion: This is the first study to identify SKNA clustering phenomenon in AMI patients. Such a synchronized nerve discharge pattern could be detected with non-invasive SKNA signals. SKNA temporal clustering could be a novel biomarker to classify ANS regulation ability in AMI patients. Clinical and Translational Significance: SKNA is higher in AMI patients than in control and negatively correlates with parasympathetic parameters. SKNA clustering is associated with a lower LF/HF ratio that has been shown to correlate with sudden cardiac death in AMI. The lack of SKNA temporal clustering could indicate poor ANS regulation in AMI patients.
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Affiliation(s)
- Chun Liu
- Department of Electrical and Computer Engineering, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Chien-Hung Lee
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.,Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shien-Fong Lin
- Department of Electrical and Computer Engineering, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan.,Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Wei-Chung Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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21
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Clyburn C, Sepe JJ, Habecker BA. What gets on the nerves of cardiac patients? Pathophysiological changes in cardiac innervation. J Physiol 2021; 600:451-461. [PMID: 34921407 PMCID: PMC8810748 DOI: 10.1113/jp281118] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/10/2021] [Indexed: 11/08/2022] Open
Abstract
The autonomic nervous system regulates cardiac function by balancing the actions of sympathetic and parasympathetic inputs to the heart. Intrinsic cardiac neurocircuits integrate these autonomic signals to fine-tune cardiac control, and sensory feedback loops regulate autonomic transmission in the face of external stimuli. These interconnected neural systems allow the heart to adapt to constantly changing circumstances that range from simple fluctuations in body position to running a marathon. The cardiac reflexes that serve to maintain homeostasis in health are disrupted in many disease states. This is often characterized by increased sympathetic and decreased parasympathetic transmission. Studies of cardiovascular disease reveal remodelling of cardiac neurocircuits at several functional and anatomical levels. Central circuits change so that sympathetic pathways become hyperactive, while parasympathetic circuits exhibit decreased activity. Peripheral sensory nerves also become hyperactive in disease, which increases patients' risk for poor cardiac outcomes. Injury and disease also alter the types of neurotransmitters and neuropeptides released by autonomic nerves in the heart, and can lead to regional hyperinnervation (increased nerve density) or denervation (decreased nerve density) of cardiac tissue. The mechanisms responsible for neural remodelling are not fully understood, but neurotrophins and inflammatory cytokines are likely involved. Areas of active investigation include the role of immune cells and inflammation in neural remodelling, as well as the role of glia in modulating peripheral neuronal activity. Our growing understanding of autonomic dysfunction in disease has facilitated development of new therapeutic strategies to improve health outcomes.
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Affiliation(s)
- Courtney Clyburn
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, USA
| | - Joseph J Sepe
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, USA
| | - Beth A Habecker
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, Oregon, USA
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22
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Cheng L, Wang X, Chou H, Liu T, Fu H, Li G. Proteomic Sequencing of Stellate Ganglions in Rabbits With Myocardial Infarction. Front Physiol 2021; 12:687424. [PMID: 34975513 PMCID: PMC8716754 DOI: 10.3389/fphys.2021.687424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/17/2021] [Indexed: 11/20/2022] Open
Abstract
The stellate ganglion (SG) of the autonomic nervous system plays important role in cardiovascular diseases (CDs). Myocardial infarction (MI) is associated with sustained increasing cardiac sympathetic nerve activity. Expressions and functions of proteins in SG tissue after MI are remaining unclear. This study is to explore the expression characteristics of proteins in SGs associated with MI. Japanese big-ear white rabbits (n = 22) were randomly assigned to the control group and MI group. The MI model was established by left anterior descending coronary artery ligation and confirmed by serum myocardial enzymes increasing 2,3,5-triphenyltetrazolium (TTC) staining and echocardiography. The expressions of proteins in rabbit SGs after MI were detected using tandem mass tags (TMT) quantitative proteomic sequencing. There were 3,043 credible proteins were predicted in rabbit SG tissues and 383 differentially expressed proteins (DEPs) including 143 upregulated and 240 downregulated proteins. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis showed that the DEPs involved in adrenergic signaling in cardiomyocytes, positive regulation of ERK1 and ERK2 cascade, and other biological processes. Three kinds of proteins directly correlated to CDs were selected to be validated by the subsequent western blot experiment. This study first identified the characterization of proteins in rabbit SG after MI, which laid a solid foundation for revealing the mechanism of roles of SG on the MI process.
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23
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Guo Y, Zhang C, Ye T, Chen X, Liu X, Chen X, Sun Y, Qu C, Liang J, Shi S, Yang B. Pinocembrin ameliorates arrhythmias in rats with chronic ischaemic heart failure. Ann Med 2021; 53:830-840. [PMID: 34060948 PMCID: PMC8172224 DOI: 10.1080/07853890.2021.1927168] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Ventricular arrhythmias (VAs) are a common complication of chronic ischaemic heart failure (CIHF). The purpose of this study is to investigate the efficacy of pinocembrin in a rat model of VAs induced by CIHF and further examine the possible mechanism. METHODS Rats were subjected to ligation of left anterior descending coronary artery to mimic CIHF and then received pinocembrin treatment daily for 2 months. The vivo electrophysiology were performed to determine the effect of pinocembrin on ventricular electrical activity. The expression of Cav1.2, Kv4.2, and NGF was determined by Western blot. The structural change of ventricle was tested by the Echocardiography, Masson staining, and HE staining. The effect of pinocembrin on sympathetic nerve-related markers was detected by the immunostaining and the ELISA was used to test for biomarkers associated with heart failure. RESULTS Pinocembrin increased the expression of ion channel protein Cav1.2 and Kv4.3, ameliorated the shortening of action potential duration (APD) and reduced the incidence and duration of ventricular fibrillation (VF). Pinocembrin also reduced the expression of nerve growth factor (NGF) and improved the autonomic nerve remodelling. In addition, pinocembrin reduced the area of infarct area and myocardial fibrosis, accompanied by increasing the expression of connexin protein 43 (CX43). CONCLUSION We demonstrate that pinocembrin reduces cardiac nerve remodelling and protects against Vas induced by CIHF. The findings suggest that pinocembrin can be a promising candidate for the treatment of VAs.
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Affiliation(s)
- Yan Guo
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Cui Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Tianxin Ye
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Xiuhuan Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Xin Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Xiaoli Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Yazhou Sun
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Chuan Qu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Jinjun Liang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Shaobo Shi
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Bo Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
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24
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Amoni M, Dries E, Ingelaere S, Vermoortele D, Roderick HL, Claus P, Willems R, Sipido KR. Ventricular Arrhythmias in Ischemic Cardiomyopathy-New Avenues for Mechanism-Guided Treatment. Cells 2021; 10:2629. [PMID: 34685609 PMCID: PMC8534043 DOI: 10.3390/cells10102629] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 12/13/2022] Open
Abstract
Ischemic heart disease is the most common cause of lethal ventricular arrhythmias and sudden cardiac death (SCD). In patients who are at high risk after myocardial infarction, implantable cardioverter defibrillators are the most effective treatment to reduce incidence of SCD and ablation therapy can be effective for ventricular arrhythmias with identifiable culprit lesions. Yet, these approaches are not always successful and come with a considerable cost, while pharmacological management is often poor and ineffective, and occasionally proarrhythmic. Advances in mechanistic insights of arrhythmias and technological innovation have led to improved interventional approaches that are being evaluated clinically, yet pharmacological advancement has remained behind. We review the mechanistic basis for current management and provide a perspective for gaining new insights that centre on the complex tissue architecture of the arrhythmogenic infarct and border zone with surviving cardiac myocytes as the source of triggers and central players in re-entry circuits. Identification of the arrhythmia critical sites and characterisation of the molecular signature unique to these sites can open avenues for targeted therapy and reduce off-target effects that have hampered systemic pharmacotherapy. Such advances are in line with precision medicine and a patient-tailored therapy.
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Affiliation(s)
- Matthew Amoni
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium; (M.A.); (E.D.); (S.I.); (H.L.R.); (R.W.)
- Division of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa
| | - Eef Dries
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium; (M.A.); (E.D.); (S.I.); (H.L.R.); (R.W.)
| | - Sebastian Ingelaere
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium; (M.A.); (E.D.); (S.I.); (H.L.R.); (R.W.)
- Division of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Dylan Vermoortele
- Imaging and Cardiovascular Dynamics, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium; (D.V.); (P.C.)
| | - H. Llewelyn Roderick
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium; (M.A.); (E.D.); (S.I.); (H.L.R.); (R.W.)
| | - Piet Claus
- Imaging and Cardiovascular Dynamics, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium; (D.V.); (P.C.)
| | - Rik Willems
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium; (M.A.); (E.D.); (S.I.); (H.L.R.); (R.W.)
- Division of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Karin R. Sipido
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium; (M.A.); (E.D.); (S.I.); (H.L.R.); (R.W.)
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25
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Effects of Yiqi Huoxue Decoction on Post-Myocardial Infarction Cardiac Nerve Remodeling and Cardiomyocyte Hypertrophy in Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5168574. [PMID: 34471416 PMCID: PMC8405294 DOI: 10.1155/2021/5168574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/29/2021] [Accepted: 08/16/2021] [Indexed: 12/14/2022]
Abstract
Myocardial infarction can lead to ventricular remodeling and arrhythmia, which is closely related to nerve remodeling. Our previous study found that Yiqi Huoxue decoction (YQHX) can improve ventricular remodeling and reduce myocardial damage. Therefore, in this study, we observed the effect of YQHX on cardiac neural remodeling and cardiomyocyte hypertrophy and its possible mechanism. This research is composed of two parts: animal and H9c2 cells experiments. The animal model of acute myocardial infarction was established by ligating the left anterior descending coronary artery in Sprague Dawley (SD) rats. H9c2 cells were placed in 94% N2, 5% CO2, and 1% O2 hypoxic environment for 12 hours to replicate the hypoglycemic hypoxia model. The experimental results showed that, compared with the MI group, YQHX can significantly improve heart function after myocardial infarction and reduce nerve remodeling and myocardial hypertrophy. Pathological structure observation demonstrated reducing myocardial tissue damage and decreasing of cell cross-sectional area, diameter, and circumference. The positive rate of TH declined apparently, and the sympathetic nerve density was lower than that of the MI group. After YQHX was given for 28 days, the proneural remodeling factors TH, NGF, and GAP43 in the marginal zone of infarction and stellate ganglion decreased obviously while the inhibitory nerve remodeling factor Sema-3A increased. The myocardial hypertrophic protein ANP and β-MHC were also significantly inhibited with p-ERK1/2 protein expression level prominently reduced. There was no difference between the YQHX group and the Meto group. After myocardial infarction, nerve remodeling was seen in the marginal area of infarction and stellate ganglion, and the neuropeptides released by which promoted myocardial hypertrophy. The mechanism may be related to the ERK1/2 signaling pathway. YQHX could regulate the ERK1/2 signaling pathway, inhibit the release of nerve remodeling factors and myocardial hypertrophy protein to reduce nerve remodeling, and relieve myocardial hypertrophy.
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26
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The cardiac autonomic nervous system: an introduction. Herzschrittmacherther Elektrophysiol 2021; 32:295-301. [PMID: 34389873 DOI: 10.1007/s00399-021-00776-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
In recent decades, numerous anatomical and physiological studies of the cardiac autonomic nervous system (ANS) have investigated the complex relationships between the brain and the heart. Autonomic activation not only alters heart rate, conduction, and hemodynamics, but also cellular and subcellular properties of individual myocytes. Moreover, the cardiac ANS plays an essential role in cardiac arrhythmogenesis. There is mounting evidence that neural modulation either by ablation or stimulation can effectively control a wide spectrum of cardiac arrhythmias. This article discusses anatomic aspects of the cardiac ANS, focusing on how autonomic activities influence cardiac electrophysiology. Specific autonomic triggers of various cardiac arrhythmias, in particular atrial fibrillation (AF) and ventricular arrhythmias, are also briefly discussed. Studies with heart-rate variability analysis indicate that, rather than being triggered by either vagal or sympathetic activity, the onset of AF can be associated with simultaneous discharge of both limbs, leading to an imbalance between these two arms of the cardiac ANS. At the same time, sudden cardiac death resulting from ventricular arrhythmias continues to be a significant health and societal burden. These nerve activities of the cardiac ANS can be targeted for the treatment for cardiac arrhythmias, in particular AF and ventricular tachyarrhythmias.
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27
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Sahoo RK, Kar R, Dev I, Kumar M, Parida AK, Ganguly A. Stellate ganglion block as rescue therapy in drug-resistant electrical storm. Ann Card Anaesth 2021; 24:415-418. [PMID: 34269285 PMCID: PMC8404609 DOI: 10.4103/aca.aca_168_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Electrical storm or incessant ventricular tachycardia is a life-threatening condition and is associated with high morbidity and mortality. Often patients respond to traditional anti-arrhythmia treatment. However, some patients are resistant to the drug therapy and thus, pose huge challenges in effective management. Though stellate ganglion block has been found to be effective in treating patients with electrical storm, it is still under-utilized. In this case report, we successfully managed to revert the drug-resistant arrhythmia to sinus rhythm after ultrasound-guided stellate ganglion block. Earlier utilization of the block can possibly provide effective treatment in drug-resistant ventricular arrhythmias and prevent morbidity and mortality.
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Affiliation(s)
- Rajendra K Sahoo
- Department of Anesthesiology and Pain Management, HealthWorld Hospitals, Durgapur, West Bengal, India
| | - Rajesh Kar
- Department of Anesthesiology and Pain Management, HealthWorld Hospitals, Durgapur, West Bengal, India
| | - Indranil Dev
- Department of Cardiology, HealthWorld Hospitals, Durgapur, West Bengal, India
| | - Mukesh Kumar
- Department of Anesthesiology and Pain Management, HealthWorld Hospitals, Durgapur, West Bengal, India
| | - Ashok Kumar Parida
- Department of Cardiology, HealthWorld Hospitals, Durgapur, West Bengal, India
| | - Arunangshu Ganguly
- Department of Cardiology, HealthWorld Hospitals, Durgapur, West Bengal, India
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28
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Sudarshan KB, Hori Y, Swid MA, Karavos AC, Wooten C, Armour JA, Kember G, Ajijola OA. A novel metric linking stellate ganglion neuronal population dynamics to cardiopulmonary physiology. Am J Physiol Heart Circ Physiol 2021; 321:H369-H381. [PMID: 34213390 DOI: 10.1152/ajpheart.00138.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cardiopulmonary sympathetic control is exerted via stellate ganglia (SG); however, little is known about how neuronal firing patterns in the stellate ganglion relate to dynamic physiological function in the heart and lungs. We performed continuous extracellular recordings from SG neurons using multielectrode arrays in chloralose-anesthetized pigs (n = 6) for 8-9 h. Respiratory and left ventricular pressures (RP and LVP, respectively) and the electrocardiogram (ECG) were recorded concomitantly. Linkages between sampled spikes and LVP or RP were determined using a novel metric to evaluate specificity in neural activity for phases of the cardiac and pulmonary cycles during resting conditions and under various cardiopulmonary stressors. Firing frequency (mean 4.6 ± 1.2 Hz) varied spatially across the stellate ganglion, suggesting regional processing. The firing pattern of most neurons was synchronized with both cardiac (LVP) and pulmonary (RP) activity indicative of cardiopulmonary integration. Using the novel metric to determine cardiac phase specificity of neuronal activity, we found that spike density was highest during diastole and near-peak systole. This specificity was independent of the actual LVP or population firing frequency as revealed by perturbations to the LVP. The observed specificity was weaker for RP. Stellate ganglion neuronal populations exhibit cardiopulmonary integration and profound specificity toward the near-peak systolic phase of the cardiac cycle. This novel approach provides practically deployable tools to probe stellate ganglion function and its relationship to cardiopulmonary pathophysiology.NEW & NOTEWORTHY Activity of stellate ganglion neurons is often linking indirectly to cardiac function. Using novel approaches coupled with extended period of recordings in large animals, we link neuronal population dynamics to mechanical events occurring at near-peak systole. This metric can be deployed to probe stellate ganglion neuronal control of cardiopulmonary function in normal and disease states.
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Affiliation(s)
- Koustubh B Sudarshan
- Department of Engineering Mathematics and Internetworking, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yuichi Hori
- Cardiac Arrhythmia Center and Neurocardiology Research Program, University of California, Los Angeles, California
| | - M Amer Swid
- Cardiac Arrhythmia Center and Neurocardiology Research Program, University of California, Los Angeles, California
| | - Alexander C Karavos
- Department of Engineering Mathematics and Internetworking, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christian Wooten
- Cardiac Arrhythmia Center and Neurocardiology Research Program, University of California, Los Angeles, California
| | - J Andrew Armour
- Cardiac Arrhythmia Center and Neurocardiology Research Program, University of California, Los Angeles, California
| | - Guy Kember
- Department of Engineering Mathematics and Internetworking, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Olujimi A Ajijola
- Cardiac Arrhythmia Center and Neurocardiology Research Program, University of California, Los Angeles, California.,Molecular, Cellular, and Integrative Physiology Interdepartmental Program, University of California, Los Angeles, California
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29
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Deshpande K, Gama W, Emerick T. An Alternative Role for the Pain Physician: Utilization of Stellate Block for Treatment Resistant Cardiac Arrhythmias. PAIN MEDICINE 2021; 22:1447-1451. [PMID: 33616170 DOI: 10.1093/pm/pnaa445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- K Deshpande
- Department of Anesthesiology and Perioperative Medicine, Division of Chronic Pain, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - W Gama
- Department of Anesthesiology and Perioperative Medicine, Division of Chronic Pain, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - T Emerick
- Department of Anesthesiology and Perioperative Medicine, Division of Chronic Pain, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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30
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Chatterjee NA, Singh JP. Autonomic modulation and cardiac arrhythmias: old insights and novel strategies. Europace 2021; 23:1708-1721. [PMID: 34050642 DOI: 10.1093/europace/euab118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
The autonomic nervous system (ANS) plays a critical role in both health and states of cardiovascular disease. There has been a long-recognized role of the ANS in the pathogenesis of both atrial and ventricular arrhythmias (VAs). This historical understanding has been expanded in the context of evolving insights into the anatomy and physiology of the ANS, including dysfunction of the ANS in cardiovascular disease such as heart failure and myocardial infarction. An expanding armamentarium of therapeutic strategies-both invasive and non-invasive-have brought the potential of ANS modulation to contemporary clinical practice. Here, we summarize the integrative neuro-cardiac anatomy underlying the ANS, review the physiological rationale for autonomic modulation in atrial and VAs, highlight strategies for autonomic modulation, and finally frame future challenges and opportunities for ANS therapeutics.
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Affiliation(s)
- Neal A Chatterjee
- Electrophysiology Section, Cardiology Division, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Jagmeet P Singh
- Cardiac Arrhythmia Service, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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31
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Sanghai S, Abbott NJ, Dewland TA, Henrikson CA, Elman MR, Wollenberg M, Ivie R, Gonzalez-Sotomayor J, Nazer B. Stellate Ganglion Blockade With Continuous Infusion Versus Single Injection for Treatment of Ventricular Arrhythmia Storm. JACC Clin Electrophysiol 2020; 7:452-460. [PMID: 33358672 DOI: 10.1016/j.jacep.2020.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study sought to compare the efficacy and safety of single-injection stellate ganglion block (SGB) with a novel continuous-infusion SGB procedure. BACKGROUND SGB for ventricular arrhythmia (VA) storm is typically performed with a single injection of local anesthetic agents. METHODS Eighteen patients underwent left-sided SGB (9 single injection and 9 continuous infusion). The number of implantable cardioverter-defibrillator therapies and sustained VAs/24 h were compared between the pre-SGB and post-SGB periods. Adverse effects of SGB and in-hospital outcomes were also compared. RESULTS The mean age was 61.1 ± 13.7 years. The presenting arrhythmia was ventricular tachycardia in 13 (72%) patients, ventricular fibrillation in 4 (22%), and both in 1 (6%). Single-injection SGB reduced VA/24 h by a median of 0.3 (interquartile range: 0.2 to 0.9), which was a 45% reduction (p = 0.008), resulting in 5 of 9 patients with no recurrent VA. Continuous-infusion SGB reduced VA/24 h by a median of 2.0 (interquartile range: 1.3 to 3.0), which was a 94% reduction (p = 0.004), resulting in 7 of 9 patients with no recurrent VA (p = 0.006 for comparison with single injection). Transient left arm weakness and voice hoarseness were each noted in 1 patient in both groups. Repeat SGB was required in 4 (44%) patients in the single-injection group. In-hospital outcomes were similar between the groups. CONCLUSIONS In patients with VA storm, SGB performed via both continuous-infusion and single-injection approaches provided significant reductions in VA burden. Compared to single-injection SGB, continuous-infusion was associated with a greater reduction in VA burden and similar adverse events, without the need for repeat procedures.
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Affiliation(s)
- Saket Sanghai
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Nicholas J Abbott
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Charles A Henrikson
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Miriam R Elman
- Biostatistics and Design Program, Oregon Health and Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Michael Wollenberg
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Ryan Ivie
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Julio Gonzalez-Sotomayor
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA.
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Hadaya J, Ardell JL. Autonomic Modulation for Cardiovascular Disease. Front Physiol 2020; 11:617459. [PMID: 33414727 PMCID: PMC7783451 DOI: 10.3389/fphys.2020.617459] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022] Open
Abstract
Dysfunction of the autonomic nervous system has been implicated in the pathogenesis of cardiovascular disease, including congestive heart failure and cardiac arrhythmias. Despite advances in the medical and surgical management of these entities, progression of disease persists as does the risk for sudden cardiac death. With improved knowledge of the dynamic relationships between the nervous system and heart, neuromodulatory techniques such as cardiac sympathetic denervation and vagal nerve stimulation (VNS) have emerged as possible therapeutic approaches for the management of these disorders. In this review, we present the structure and function of the cardiac nervous system and the remodeling that occurs in disease states, emphasizing the concept of increased sympathoexcitation and reduced parasympathetic tone. We review preclinical evidence for vagal nerve stimulation, and early results of clinical trials in the setting of congestive heart failure. Vagal nerve stimulation, and other neuromodulatory techniques, may improve the management of cardiovascular disorders, and warrant further study.
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Affiliation(s)
- Joseph Hadaya
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, Los Angeles, CA, United States.,UCLA Neurocardiology Research Program of Excellence, UCLA, Los Angeles, CA, United States.,Molecular, Cellular, and Integrative Physiology Program, UCLA, Los Angeles, CA, United States
| | - Jeffrey L Ardell
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, Los Angeles, CA, United States.,UCLA Neurocardiology Research Program of Excellence, UCLA, Los Angeles, CA, United States
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Li TY, Tsai WC, Lin SF. Non-invasive Recording of Parasympathetic Nervous System Activity on Auricular Vagal Nerve Branch. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:4337-4340. [PMID: 33018955 DOI: 10.1109/embc44109.2020.9176098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The function of the autonomic nervous system (ANS) influences most of the physiological mechanisms. The popular non-invasive method to estimate the activities of the autonomic nervous system (ANS) is the heart rate variability (HRV). However, the HRV cannot provide real-time information of the ANS function. The skin sympathetic nerve activity (SKNA) is a novel method to evaluate sympathetic nerve system (SNS) activity. The SKNA technique has shown promise in clinical applications but is limited to evaluating SNS activities. To date, a direct non-invasive method for measuring the parasympathetic nerve system (PNS) function is urgently needed. According to anatomy, the auricular branch of the vagus nerve (aVN) is near the concha surface. In this study, we hypothesize that we can measure the aVN activity (aVNA) with the same technique developed for SKNA recording. Flexible auricular electrodes were developed for continuous long-term recording of aVN activity. The SKNA and aVNA were simultaneously recorded during the experiment. The cold face test and cold pressor test were performed to physiologically activate ANS. The SKNA and aVNA can be obtained simultaneously, and they are correlated with the heart rate change during the physiological challenge. The aVNA has a high potential to be developed into a novel method to measure the PNS activity.
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Cheng L, Fu H, Wang X, Ye L, Lakhani I, Tse G, Zhang Z, Liu T, Li G. Effects of ticagrelor pretreatment on electrophysiological properties of stellate ganglion neurons following myocardial infarction. Clin Exp Pharmacol Physiol 2020; 47:1932-1942. [PMID: 33459403 DOI: 10.1111/1440-1681.13385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 06/21/2020] [Accepted: 07/15/2020] [Indexed: 12/26/2022]
Abstract
Higher sympathetic activity predisposes to malignant ventricular arrhythmias in the context of myocardial infarction (MI). This is, in part, mediated by the electrical activity of the stellate ganglion (SG). The aim of this study is to examine the effects of ticagrelor pretreatment on the electrophysiological properties of SG neurons following MI in rabbits. MI was induced by isoproterenol (ISO) of 150 mg kg-1 d-1 (twice at an interval of 24 hours). Ticagrelor pretreatment was administered at low- (10 mg kg-1 d-1) or high-dose (20 mg kg-1 d-1). Protein and RNA expression were determined by immunohistochemical analysis and real-time PCR, respectively. The activity of sodium channel current (INa), delayed rectifier potassium current (IKDR), M-type potassium current (IKM) as well as action potentials (APs) from SG neurons were measured by whole-cell patch-clamp. Intracellular calcium concentrations were measured by confocal microscopy. Compared with the control group, the MI group exhibited a greater amplitude of INa, IKDR and IKM, significantly altered activation and inactivation characteristics of INa, no significant alterations in protein or mRNA expression of sodium and M-type potassium channels, along with higher AP amplitude and frequency and intracellular calcium concentrations. Most of these abnormalities were prevented by pretreatment with low- or high-dose ticagrelor. Our data suggest that ticagrelor exerts cardioprotective effects, potentially through modulating the activity of different ion channels in SG neurons.
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Affiliation(s)
- Lijun Cheng
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Huaying Fu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xinghua Wang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Lan Ye
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ishan Lakhani
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhiwei Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, China
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Wittwer ED, Radosevich MA, Ritter M, Cha YM. Stellate Ganglion Blockade for Refractory Ventricular Arrhythmias: Implications of Ultrasound-Guided Technique and Review of the Evidence. J Cardiothorac Vasc Anesth 2020; 34:2245-2252. [DOI: 10.1053/j.jvca.2019.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 01/29/2023]
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Ang R, Marina N. Low-Frequency Oscillations in Cardiac Sympathetic Neuronal Activity. Front Physiol 2020; 11:236. [PMID: 32256390 PMCID: PMC7093552 DOI: 10.3389/fphys.2020.00236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/02/2020] [Indexed: 12/25/2022] Open
Abstract
Sudden cardiac death caused by ventricular arrhythmias is among the leading causes of mortality, with approximately half of all deaths attributed to heart disease worldwide. Periodic repolarization dynamics (PRD) is a novel marker of repolarization instability and strong predictor of death in patients post-myocardial infarction that is believed to occur in association with low-frequency oscillations in sympathetic nerve activity. However, this hypothesis is based on associations of PRD with indices of sympathetic activity that are not directly linked to cardiac function, such as muscle vasoconstrictor activity and the variability of cardiovascular autospectra. In this review article, we critically evaluate existing scientific evidence obtained primarily in experimental animal models, with the aim of identifying the neuronal networks responsible for the generation of low-frequency sympathetic rhythms along the neurocardiac axis. We discuss the functional significance of rhythmic sympathetic activity on neurotransmission efficacy and explore its role in the pathogenesis of ventricular repolarization instability. Most importantly, we discuss important gaps in our knowledge that require further investigation in order to confirm the hypothesis that low frequency cardiac sympathetic oscillations play a causative role in the generation of PRD.
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Affiliation(s)
- Richard Ang
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Nephtali Marina
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom.,Division of Medicine, University College London, London, United Kingdom
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Fudim M, Qadri YJ, Waldron NH, Boortz-Marx RL, Ganesh A, Patel CB, Podgoreanu MV, Sun AY, Milano CA, Tong BC, Harpole DH, Mathew JP, Piccini JP. Stellate Ganglion Blockade for the Treatment of Refractory Ventricular Arrhythmias. JACC Clin Electrophysiol 2020; 6:562-571. [PMID: 32439042 DOI: 10.1016/j.jacep.2019.12.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/13/2019] [Accepted: 12/27/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study sought to describe our institutional experience with establishing a neurocardiology service in an attempt to provide autonomic modulation as a treatment for ventricular arrhythmias (VAs). BACKGROUND Treatment-refractory VAs are commonly driven and exacerbated by heightened sympathetic tone. METHODS Among patients referred to the neurocardiology service (August 2016 to December 2018), we performed ultrasound-based, bilateral, temporary stellate ganglion blockade (SGB) in 20 consecutive patients. We analyzed outcomes of interest including sustained VA or VA requiring defibrillation in the 24 and 48 h before and 24 and 48 h after SGB. RESULTS The majority of patients were men (n = 19, 95%), with a mean age of 58 ± 14 years. At the time of SGB, 10 (50%) were on inotropic support and 9 (45%) were on mechanical circulatory support. Besides 1 case of hoarseness, there were no apparent procedural complications. SGB was associated with a reduction in the number of VA episodes from the 24 h before (median 5.5 [interquartile range (IQR): 2.0 to 15.8]) to 24 h after SGB (median 0 [IQR: 0 to 3.8]) (p < 0.001). The number of defibrillation events decreased from 2.5 (IQR: 0 to 10.3) to 0 (IQR: 0 to 2.5) (p = 0.002). Similar findings were observed over the 48-h period before and after the SGB. Overall, 9 of 20 (45%) patients had a complete response with no recurrence of ventricular tachycardia (VT) or ventricular fibrillation (VF) for 48 h after SGB. Four (20%) patients had no recurrent VT or VF following SGB through discharge. Similar response rates were observed in those with ischemic (median 6 [IQR: 1.8 to 18.8] to 0.5 [IQR: 0 to 5.3] events; p = 0.031) and nonischemic (median 3.5 [IQR: 1.8 to 6.8] to 0 [IQR: 0 to 1.3] events; p = 0.012) cardiomyopathy. CONCLUSIONS Minimally invasive, ultrasound-guided bilateral SGB appears safe and provides substantial reduction in VA burden with approximately 1 in 2 patients exhibiting complete suppression of VT or VF for 48 h.
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Affiliation(s)
- Marat Fudim
- Duke Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
| | - Yawar J Qadri
- Duke Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nathan H Waldron
- Duke Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Richard L Boortz-Marx
- Duke Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Arun Ganesh
- Duke Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Chetan B Patel
- Duke Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Mihai V Podgoreanu
- Duke Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Albert Y Sun
- Duke Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Carmelo A Milano
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Betty C Tong
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - David H Harpole
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Duke University, Durham, North Carolina, USA
| | - Joseph P Mathew
- Duke Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jonathan P Piccini
- Duke Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
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Yuan Y, Zhao Y, Wong J, Tsai WC, Jiang Z, Kabir RA, Han S, Shen C, Fishbein MC, Chen LS, Chen Z, Everett TH, Chen PS. Subcutaneous nerve stimulation reduces sympathetic nerve activity in ambulatory dogs with myocardial infarction. Heart Rhythm 2020; 17:1167-1175. [PMID: 32068184 DOI: 10.1016/j.hrthm.2020.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/04/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Subcutaneous nerve stimulation (ScNS) remodels the stellate ganglion and reduces stellate ganglion nerve activity (SGNA) in dogs. Acute myocardial infarction (MI) increases SGNA through nerve sprouting. OBJECTIVE The purpose of this study was to test the hypothesis that ScNS remodels the stellate ganglion and reduces SGNA in ambulatory dogs with acute MI. METHODS In the experimental group, a radio transmitter was implanted during the first sterile surgery to record nerve activity and an electrocardiogram, followed by a second sterile surgery to create MI. Dogs then underwent ScNS for 2 months. The average SGNA (aSGNA) was compared with that in a historical control group (n = 9), with acute MI monitored for 2 months without ScNS. RESULTS In the experimental group, the baseline aSGNA and heart rate were 4.08±0.35 μV and 98±12 beats/min, respectively. They increased within 1 week after MI to 6.91±1.91 μV (P=.007) and 107±10 beats/min (P=.028), respectively. ScNS reduced aSGNA to 3.46±0.44 μV (P<.039) and 2.14±0.50 μV (P<.001) at 4 and 8 weeks, respectively, after MI. In comparison, aSGNA at 4 and 8 weeks in dogs with MI but no ScNS was 8.26±6.31 μV (P=.005) and 10.82±7.86 μV (P=0002), respectively. Immunostaining showed confluent areas of remodeling in bilateral stellate ganglia and a high percentage of tyrosine hydroxylase-negative ganglion cells. Terminal deoxynucleotidyl transferase dUTP nick end labeling was positive in 26.61%±11.54% of ganglion cells in the left stellate ganglion and 15.94%±3.62% of ganglion cells in the right stellate ganglion. CONCLUSION ScNS remodels the stellate ganglion, reduces SGNA, and suppresses cardiac nerve sprouting after acute MI.
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Affiliation(s)
- Yuan Yuan
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ye Zhao
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiac Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Johnson Wong
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Wei-Chung Tsai
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zhaolei Jiang
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ryan A Kabir
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Seongwook Han
- Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Changyu Shen
- Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Lan S Chen
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Zhenhui Chen
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas H Everett
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Peng-Sheng Chen
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
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Wu P, Vaseghi M. The autonomic nervous system and ventricular arrhythmias in myocardial infarction and heart failure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:172-180. [PMID: 31823401 DOI: 10.1111/pace.13856] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/25/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
Ventricular arrhythmias (VA) can range in presentation from asymptomatic to cardiac arrest and sudden cardiac death (SCD). Sustained ventricular tachycardias/ventricular fibrillation (VT/VF) are a common cause of SCD in the setting of myocardial infarction (MI) and heart failure. A particularly arrhythmogenic cardiac syncytia in these conditions can be attributed to both sympathetic activation and parasympathetic dysfunction, while appropriate neuromodulation has the potential to reduce occurrence of VT/VF. In this review, we outline the components of the autonomic nervous system that play an important role in normal cardiac electrophysiology and function. In addition, we discuss changes that occur in the setting of cardiac disease including adverse neural remodeling and neurohormonal activation which significantly contribute to propensity for VT/VF. Finally, we review neuromodulation strategies to mitigate VT/VF which predominantly rely on increasing parasympathetic drive and blockade of sympathetic neurotransmission.
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Affiliation(s)
- Perry Wu
- UCLA Cardiac Arrhythmia Center and UCLA Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center and UCLA Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California
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40
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Capilupi MJ, Kerath SM, Becker LB. Vagus Nerve Stimulation and the Cardiovascular System. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a034173. [PMID: 31109966 DOI: 10.1101/cshperspect.a034173] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The vagus nerve plays an important role in maintaining physiological homeostasis, which includes reflex pathways that regulate cardiac function. The link between vagus nerve activity and the high-frequency component of heart rate variability (HRV) has been well established, correlating with vagal tone. Recently, vagus nerve stimulation (VNS) has been investigated as a therapeutic for a multitude of diseases, such as treatment-resistant epilepsy, rheumatoid arthritis, Crohn's disease, and asthma. Because of the vagus nerve's innervation of the heart, VNS has been identified as a potential therapy for cardiovascular disorders, such as cardiac arrest, acute myocardial infarction, and stroke. Here, we review the current state of preclinical and clinical studies, as well as the potential application of VNS in relation to the cardiovascular system.
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Affiliation(s)
- Michael J Capilupi
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, New York 11030
| | - Samantha M Kerath
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York 11030
| | - Lance B Becker
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, New York 11030.,Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York 11030.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549
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Abstract
Ventricular arrhythmias are associated with significant morbidity and mortality. In the perioperative period, more than 10% of patients undergoing a general anesthetic have an abnormal heart rhythm. Arrhythmia development is a dynamic interplay between an arrhythmogenic substrate, myocardial electrophysiologic properties, modifying factors, and triggering factors. Imbalances in the autonomic nervous system can lead to increased myocardial excitability, which is a major contributor to the pathophysiology of ventricular tachyarrhythmias. Myocardial excitability and ventricular arrhythmogenesis is modulated perioperatively through hemodynamic management, electrolyte balance, anesthetic agents, or regional anesthetic and surgical techniques.
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Affiliation(s)
- Kimberly Howard-Quijano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Biomedical Science Tower W1401, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
| | - Yuki Kuwabara
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Biomedical Science Tower W1401, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Zhang WH, Zhou QN, Lu YM, Li YD, Zhang L, Zhang JH, Xing Q, Lv WK, Cheng XC, Zhang GG, Wang XS, Gu Q, Lou X, Guli B, Tang BP, Zhou XH. Renal Denervation Reduced Ventricular Arrhythmia After Myocardial Infarction by Inhibiting Sympathetic Activity and Remodeling. J Am Heart Assoc 2019; 7:e009938. [PMID: 30371294 PMCID: PMC6474949 DOI: 10.1161/jaha.118.009938] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Ventricular arrhythmia after myocardial infarction is the most important risk factor for sudden cardiac death, which poses a serious threat to human health. As the correlation between autonomic nervous systemic dysfunction and heart rhythm abnormality has been gradually revealed, remedies targeting autonomic nervous system dysfunction, especially the sympathetic nerve, have emerged. Among them, renal denervation is noted for its powerful effect on the inhibition of sympathetic nerve activity. We aim to investigate whether renal denervation can reduce ventricular arrhythmia after myocardial infarction and thus decrease the risk of sudden cardiac death. In addition, we explore the potential mechanism with respect to nerve activity and remodeling. Methods and Results Twenty-four beagles were randomized into the control (n=4), renal denervation (n=10), and sham (n=10) groups. Permanent left anterior descending artery ligation was performed to establish myocardial infarction in the latter 2 groups. Animals in the renal denervation group underwent both surgical and chemical renal denervation. Compared with dogs in the sham group, dogs in the renal denervation group demonstrated attenuated effective refractory period shortening and inhomogeneity, flattened restitution curve, increased ventricular threshold, and decreased ventricular arrhythmia. Heart rate variability assessment, catecholamine measurement, and nerve discharge recordings all indicated that renal denervation could reduce whole-body and local tissue sympathetic tone. Tissue analysis revealed a significant decrease in neural remodeling in both the heart and stellate ganglion. Conclusions Surgical and chemical renal denervation decreased whole-body and local tissue sympathetic activity and reversed neural remodeling in the heart and stellate ganglion. Consequently, renal denervation led to beneficial remodeling of the electrophysiological characteristics in the infarction border zone, translating to a decrease in ventricular arrhythmia after myocardial infarction.
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Affiliation(s)
- Wen-Hui Zhang
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Qi-Na Zhou
- 2 Xinjiang Key Laboratory of Medical Animal Model Research Clinical Medical Research Institute The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Yan-Mei Lu
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Yao-Dong Li
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Ling Zhang
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Jiang-Hua Zhang
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Qiang Xing
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Wen-Kui Lv
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Xin-Chun Cheng
- 3 Geriatric Center The People's Hospital of Xinjiang Uygur Autonomous Region Urumqi Xinjiang China
| | - Ge-Ge Zhang
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Xue-Sheng Wang
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Qi Gu
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Xue Lou
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Buajier Guli
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Bao-Peng Tang
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Xian-Hui Zhou
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
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Xiong L, Liu Y, Zhou M, Wang G, Quan D, Shen C, Shuai W, Kong B, Huang C, Huang H. Targeted ablation of cardiac sympathetic neurons improves ventricular electrical remodelling in a canine model of chronic myocardial infarction. Europace 2019; 20:2036-2044. [PMID: 29860489 DOI: 10.1093/europace/euy090] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/05/2018] [Indexed: 12/25/2022] Open
Abstract
Aims The purpose of this study was to evaluate the cardiac electrophysiologic effects of targeted ablation of cardiac sympathetic neurons (TACSN) in a canine model of chronic myocardial infarction (MI). Methods and results Thirty-eight anaesthetized dogs were randomly assigned into the sham-operated, MI, and MI-TACSN groups, respectively. Myocardial infarction-targeted ablation of cardiac sympathetic neuron was induced by injecting cholera toxin B subunit-saporin compound in the left stellate ganglion (LSG). Five weeks after surgery, the cardiac function, heart rate variability (HRV), ventricular electrophysiological parameters, LSG function and neural activity, serum norepinephrine (NE), nerve growth factor (NGF), and brain natriuretic peptide (BNP) levels were measured. Cardiac sympathetic innervation was determined with immunofluorescence staining of growth associated protein-43 (GAP43) and tyrosine hydroxylase (TH). Compared with MI group, TACSN significantly improved HRV, attenuated LSG function and activity, prolonged corrected QT interval, decreased Tpeak-Tend interval, prolonged ventricular effective refractory period (ERP), and action potential duration (APD), decreased the slopes of APD restitution curves, suppressed the APD alternans, increased ventricular fibrillation threshold, and reduced serum NE, NGF, and BNP levels. Moreover, the densities of GAP43 and TH-positive nerve fibres in the infarcted border zone in the MI-TACSN group were lower than those in the MI group. Conclusion Targeted ablation of cardiac sympathetic neuron attenuates sympathetic remodelling and improves ventricular electrical remodelling in the chronic phase of MI. These data suggest that TACSN may be a novel approach to treating ventricular arrhythmias.
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Affiliation(s)
- Liang Xiong
- Department of Cardiology, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Hubei Key Laboratory of Cardiology, No.238 Jiefang Road, Wuchang, Wuhan, China
| | - Yu Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Hubei Key Laboratory of Cardiology, No.238 Jiefang Road, Wuchang, Wuhan, China
| | - Mingmin Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Hubei Key Laboratory of Cardiology, No.238 Jiefang Road, Wuchang, Wuhan, China
| | - Guangji Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Hubei Key Laboratory of Cardiology, No.238 Jiefang Road, Wuchang, Wuhan, China
| | - Dajun Quan
- Department of Cardiology, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Hubei Key Laboratory of Cardiology, No.238 Jiefang Road, Wuchang, Wuhan, China
| | - Caijie Shen
- Department of Cardiology, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Hubei Key Laboratory of Cardiology, No.238 Jiefang Road, Wuchang, Wuhan, China
| | - Wei Shuai
- Department of Cardiology, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Hubei Key Laboratory of Cardiology, No.238 Jiefang Road, Wuchang, Wuhan, China
| | - Bin Kong
- Department of Cardiology, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Hubei Key Laboratory of Cardiology, No.238 Jiefang Road, Wuchang, Wuhan, China
| | - Congxin Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Hubei Key Laboratory of Cardiology, No.238 Jiefang Road, Wuchang, Wuhan, China
| | - He Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, No.238 Jiefang Road, Wuchang, Wuhan, China.,Hubei Key Laboratory of Cardiology, No.238 Jiefang Road, Wuchang, Wuhan, China
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Waldron NH, Fudim M, Mathew JP, Piccini JP. Neuromodulation for the Treatment of Heart Rhythm Disorders. JACC Basic Transl Sci 2019; 4:546-562. [PMID: 31468010 PMCID: PMC6712352 DOI: 10.1016/j.jacbts.2019.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 12/13/2022]
Abstract
Derangement of autonomic nervous signaling is an important contributor to cardiac arrhythmogenesis. Modulation of autonomic nervous signaling holds significant promise for the prevention and treatment of cardiac arrhythmias. Further clinical investigation is necessary to establish the efficacy and safety of autonomic modulatory therapies in reducing cardiac arrhythmias.
There is an increasing recognition of the importance of interactions between the heart and the autonomic nervous system in the pathophysiology of arrhythmias. These interactions play a role in both the initiation and maintenance of arrhythmias and are important in both atrial and ventricular arrhythmia. Given the importance of the autonomic nervous system in the pathophysiology of arrhythmias, there has been notable effort in the field to improve existing therapies and pioneer additional interventions directed at cardiac-autonomic targets. The interventions are targeted to multiple and different anatomic targets across the neurocardiac axis. The purpose of this review is to provide an overview of the rationale for neuromodulation in the treatment of arrhythmias and to review the specific treatments under evaluation and development for the treatment of both atrial fibrillation and ventricular arrhythmias.
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Key Words
- AERP, atrial effective refractory period
- AF, atrial fibrillation
- AGP, autonomic ganglionic plexus
- ANS, autonomic nervous system
- CABG, coronary artery bypass grafting
- HRV, heart rate variability
- ICD, implantable cardioverter-defibrillator
- LLVNS, low-level vagal nerve stimulation
- OSA, obstructive sleep apnea
- POAF, post-operative atrial fibrillation
- PVI, pulmonary vein isolation
- RDN, renal denervation
- SCS, spinal cord stimulation
- SGB, stellate ganglion blockade
- SNS, sympathetic nervous system
- VF, ventricular fibrillation
- VNS, vagal nerve stimulation
- VT, ventricular tachycardia
- arrhythmia
- atrial fibrillation
- autonomic nervous system
- ganglionated plexi
- neuromodulation
- ventricular arrhythmias
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Affiliation(s)
- Nathan H Waldron
- Department of Anesthesia, Duke University Medical Center, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Marat Fudim
- Duke Clinical Research Institute, Durham, North Carolina.,Electrophysiology Section, Duke University Medical Center, Durham, North Carolina
| | - Joseph P Mathew
- Department of Anesthesia, Duke University Medical Center, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Durham, North Carolina.,Electrophysiology Section, Duke University Medical Center, Durham, North Carolina
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45
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Wang S, Wu L, Zhai Y, Li X, Li B, Zhao D, Jiang H. Noninvasive light emitting diode therapy: A novel approach for postinfarction ventricular arrhythmias and neuroimmune modulation. J Cardiovasc Electrophysiol 2019; 30:1138-1147. [PMID: 31104349 DOI: 10.1111/jce.13974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sympathetic neural activation plays a key role in the incidence and maintenance of acute myocardial infarction (AMI) induced ventricular arrhythmia (VA). Furthermore, previous studies showed that AMI might induce microglia and sympathetic activation and that microglial activation might contribute to sympathetic activation. Recently, studies showed that light emitting diode (LED) therapy might attenuate microglial activation. Therefore, we hypothesized that LED therapy might reduce AMI-induced VA by attenuating microglia and sympathetic activation. METHODS Thirty anesthetized rats were randomly divided into three groups: the Control group (n = 6), AMI group (n = 12), and AMI + LED group (n = 12). Electrocardiogram (ECG) and left stellate ganglion (LSG) neural activity were continuously recorded. The incidence of VAs was recorded during the first hour after AMI. Furthermore, we sampled the brain and myocardium tissue of the different groups to examine the microglial activation and expression of nerve growth factor (NGF), interleukin-18 (IL-18), and IL-1β, respectively. RESULTS Compared to the AMI group, LED therapy significantly reduced the incidence of AMI-induced VAs (ventricular premature beats [VPB] number: 85.08 ± 13.91 vs 27.5 ± 9.168, P < .01; nonsustained ventricular tachycardia (nSVT) duration: 34.39 ± 8.562 vs 9.005 ± 3.442, P < .05; nSVT number: 18.92 ± 4.52 vs 7.583 ± 3.019, P < .05; incidence rate of SVT/VF: 58.33% vs. 8.33%, P < .05) and reduced the LSG neural activity (P < .01) in the AMI + LED group. Furthermore, LED significantly attenuated microglial activation and reduced IL-18, IL-1β, and NGF expression in the peri-infarct myocardium. CONCLUSION LED therapy may protect against AMI-induced VAs by suppressing sympathetic neural activity and the inflammatory response.
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Affiliation(s)
- Songyun Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Lin Wu
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Yi Zhai
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Xuemeng Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Binxun Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Dongdong Zhao
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, People's Republic of China
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Nasi-Er BG, Lou X, Zhang Y, Sun H, Zhou X, Li Y, Zhou Q, Zhang J, Tang B, Lu Y. Renal Sympathetic Denervation Improves Outcomes in a Canine Myocardial Infarction Model. Med Sci Monit 2019; 25:3887-3893. [PMID: 31127792 PMCID: PMC6556070 DOI: 10.12659/msm.914384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Myocardial infarction (MI) is the main cause of heart failure (HF), and sympathetic nerve activity is associated with prognosis chronic heart failure. Renal sympathetic denervation (RDN) is noted for its powerful effect on the inhibition of sympathetic nerve activity. This study investigated the effect of RDN on heart failure in dogs after myocardial infarction. Material/Methods The experimental animals were randomized into 2 groups: the MI group (n=12) and the sham operation group (n=6). In the MI group we established an MI model by permanently ligating the left anterior descending branch. After 4 weeks, the MI dogs were randomly divided into 2 groups: the MI+RDN group (MI+renal sympathetic denervation, n=6) and the simple MI group (n=6). Animals in the MI+RDN group underwent both surgical and chemical renal denervation. Results Compared with sham operation group, left ventricular fraction shortening (LVFS) and left ventricular ejection fraction (LVEF) were significantly reduced in the simple MI group, while the reduction was partly reversed in the MI+RDN group. RDN reduced sympathetic nerve activity and release of B-type natriuretic peptide (BNP) and Angiotensin II (AngII) in the MI+ RDN group but not in the simple MI group. Conclusions Canine renal sympathetic denervation prevents myocardial malignant remodeling by lowering the activity of the systemic sympathetic nerve and inhibiting renin-angiotensin-aldosterone system (RASS) activation, providing a new target and method for the treatment of heart failure.
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Affiliation(s)
- Buajieer-Guli Nasi-Er
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Xue Lou
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Yinling Zhang
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Huaxin Sun
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Xianhui Zhou
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Yaodong Li
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Qina Zhou
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Jianghua Zhang
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Baopeng Tang
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Yanmei Lu
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
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Abstract
PURPOSE OF REVIEW This review aims to describe the latest advances in autonomic neuromodulation approaches to treating cardiac arrhythmias, with a focus on ventricular arrhythmias. RECENT FINDINGS The increasing understanding of neuronal remodeling in cardiac diseases has led to the development and improvement of novel neuromodulation therapies targeting multiple levels of the autonomic nervous system. Thoracic epidural anesthesia, spinal cord stimulation, stellate ganglion modulatory therapies, vagal stimulation, renal denervation, and interventions on the intracardiac nervous system have all been studied in preclinical models, with encouraging preliminary clinical data. The autonomic nervous system regulates all the electrical processes of the heart and plays an important role in the pathophysiology of cardiac arrhythmias. Despite recent advances in the clinical application of cardiac neuromodulation, our comprehension of the anatomy and function of the cardiac autonomic nervous system is still limited. Hopefully in the near future, more preclinical data combined with larger clinical trials will lead to further improvements in neuromodulatory treatment for heart rhythm disorders.
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Lai Y, Yu L, Jiang H. Autonomic Neuromodulation for Preventing and Treating Ventricular Arrhythmias. Front Physiol 2019; 10:200. [PMID: 30914967 PMCID: PMC6421499 DOI: 10.3389/fphys.2019.00200] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/15/2019] [Indexed: 12/18/2022] Open
Abstract
The cardiac autonomic nervous system (CANS) is associated with modulation of cardiac electrophysiology and arrhythmogenesis. In this mini review, we will briefly introduce cardiac autonomic anatomy and autonomic activity in ventricular arrhythmias (VAs) and discuss novel approaches of CANS modulation for treating VAs. Studies over the decades have provided a better understanding of cardiac autonomic innervation and revealed overwhelming evidence of the relationship between autonomic tone and VAs. A high sympathetic tone and low parasympathetic (vagal) tone are considered as the major triggers of VAs in patients with myocardial ischemia, which can cause sudden cardiac death. In recent years, novel methods of autonomic neuromodulation have been investigated to prevent VAs, and they have been verified as being beneficial for malignant VAs in animal models and humans. The clinical outcome of autonomic neuromodulation depends on the level of cardiac neuraxis, stimulation parameters, and patient's pathological status. Since autonomic modulation for VA treatment is still in the early stage of clinical application, more basic and clinical studies should be performed to clarify these mechanisms and optimize autonomic neuromodulation therapies for patients with VAs in the future.
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Affiliation(s)
- Yanqiu Lai
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Lilei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
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49
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Kumar S, Tedrow UB, Stevenson WG. Adjunctive Interventional Techniques When Percutaneous Catheter Ablation for Drug Refractory Ventricular Arrhythmias Fail: A Contemporary Review. Circ Arrhythm Electrophysiol 2019; 10:e003676. [PMID: 28213504 DOI: 10.1161/circep.116.003676] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Saurabh Kumar
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.K., U.B.T., W.G.S.); and Department of Cardiology, Westmead Hospital, University of Sydney, NSW, Australia (S.K.)
| | - Usha B Tedrow
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.K., U.B.T., W.G.S.); and Department of Cardiology, Westmead Hospital, University of Sydney, NSW, Australia (S.K.)
| | - William G Stevenson
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.K., U.B.T., W.G.S.); and Department of Cardiology, Westmead Hospital, University of Sydney, NSW, Australia (S.K.).
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50
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Yao Y, Qian J, Rong S, Huang Y, Xiong B, Yang G, Zhang D, Deng S, Tan J, Zhu Q, Deng C, Liu D, Ran H, Wang Z, Huang J. Cardiac Denervation for Arrhythmia Treatment with Transesophageal Ultrasonic Strategy in Canine Models. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:490-499. [PMID: 30527842 DOI: 10.1016/j.ultrasmedbio.2018.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 09/27/2018] [Accepted: 10/03/2018] [Indexed: 06/09/2023]
Abstract
Stellate ganglion (SG) modification has been investigated for arrhythmia treatment. In this study, transesophageal SG imaging and intervention were explored using a homemade 30F integrated focused ultrasonic catheter in healthy mongrel canines in vivo. Anatomic details of SGs were ultrasonically imaged and evaluated. SG had a heterogeneous echoic structure and characteristic profiles sketched by hyper-echoic outlines in an ultrasonogram. Left SGs in the experimental group were successfully ablated through the esophagus under ultrasonic guidance provided by the catheter itself. Two weeks after the ablation, the QT and QTc of the experimental group decreased compared with those of the sham group and at baseline (both p values < 0.001). Histologic examination revealed that left SGs were destroyed. No major complications were observed. This approach may be further explored as a method for ganglia remodeling evaluation and as a strategy of ganglia modification for arrhythmia and for other diseases.
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Affiliation(s)
- Yuanqing Yao
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Ultrasonographic Institute of Chongqing Medical University and Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing, China
| | - Jun Qian
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shunkang Rong
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuwen Huang
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Ultrasonographic Institute of Chongqing Medical University and Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing, China
| | - Bo Xiong
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Ultrasonographic Institute of Chongqing Medical University and Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing, China
| | - Gang Yang
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dengqing Zhang
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Ultrasonographic Institute of Chongqing Medical University and Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing, China
| | - Shimin Deng
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Tan
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Que Zhu
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Changming Deng
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dichuan Liu
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haitao Ran
- Ultrasonographic Institute of Chongqing Medical University and Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing, China; Department of Ultrasound, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhigang Wang
- Ultrasonographic Institute of Chongqing Medical University and Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing, China; Department of Ultrasound, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Huang
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Ultrasonographic Institute of Chongqing Medical University and Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing, China.
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