Augmentation of Atrial Conduction Velocity With Pharmacological and Direct Electrical Sympathetic Stimulation.

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2024-09-06 DOI:10.1016/j.jacep.2024.08.006

Timothy M Markman, Lingyu Xu, Sohail Zahid, Darshak Patel, Francis E Marchlinski, David Callans, Saman Nazarian

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Abstract

Background: Atrial conduction velocity (CV) is influenced by autonomic tone and contributes to the pathophysiology of re-entrant arrhythmias and atrial fibrillation. Cardiac sympathetic nerve activation has been reported via electrical stimulation within the vertebral vein (VV).

Objectives: This study sought to characterize changes in right atrial (RA) CV associated with sympathetic stimulation from pharmacologic (isoproterenol) or direct electrical (VV stimulation) approaches.

Methods: Subjects undergoing catheter ablation for atrial fibrillation had baseline RA electroanatomic maps performed in sinus rhythm (SR). RA mapping was repeated during right VV stimulation (20 Hz; up to 20 mA) and again with both RA pacing and during isoproterenol infusion, each titrated to the heart rate achieved with VV stimulation.

Results: A total of 100 RA maps were analyzed from 25 subjects (mean age: 58 ± 14 years; 56% male), and CV was calculated from 51,534 electroanatomic map points. VV stimulation increased heart rate from baseline in all subjects (22.5 ± 5.5 beats/min). The average CV increased with VV stimulation (82.0 ± 34.5 cm/s) or isoproterenol (83.7 ± 35.0 cm/s) when compared to SR (70.8 ± 32.5 cm/s; P < 0.001). Heterogeneity of CV decreased with VV stimulation or isoproterenol when compared to SR (coefficient of variation: 0.33 ± 0.21 vs 0.35 ± 0.23 vs 0.57 ± 0.29; P < 0.001). There was no difference in CV or CV heterogeneity between SR and RA pacing, suggesting that these changes were independent of heart rate.

Conclusions: Global RA CV is enhanced, and heterogeneity of CV is reduced, with either pharmacologic or direct electrical sympathetic stimulation via the right VV.

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通过药物和直接交感神经电刺激提高心房传导速度

背景：心房传导速度（CV）受自律神经张力的影响，是再发性心律失常和心房颤动的病理生理学因素之一。有报道称，通过电刺激椎静脉（VV）可激活心脏交感神经：本研究旨在描述与药物（异丙肾上腺素）或直接电刺激（椎静脉刺激）交感神经刺激相关的右心房（RA）CV 变化：方法：接受心房颤动导管消融术的受试者在窦性心律（SR）下进行基线右心房电解剖图绘制。在右侧 VV 刺激（20 Hz；最高 20 mA）期间重复绘制 RA 图，并在 RA 起搏和注入异丙肾上腺素期间再次绘制 RA 图，每次都根据 VV 刺激达到的心率进行滴定：共分析了 25 名受试者（平均年龄：58 ± 14 岁；56% 为男性）的 100 张 RA 图，并根据 51,534 个电解剖图点计算了 CV。所有受试者的 VV 刺激均使心率从基线上升（22.5 ± 5.5 次/分）。与 SR（70.8 ± 32.5 cm/s；P < 0.001）相比，VV 刺激（82.0 ± 34.5 cm/s）或异丙肾上腺素（83.7 ± 35.0 cm/s）可增加平均 CV。与 SR 相比，VV 刺激或异丙肾上腺素可降低 CV 的异质性（变异系数：0.33 ± 0.21 vs 0.35 ± 0.23 vs 0.57 ± 0.29；P < 0.001）。SR和RA起搏之间的CV或CV异质性没有差异，表明这些变化与心率无关：结论：通过右侧 VV 进行药物或直接交感神经电刺激可增强 RA 的整体 CV，并降低 CV 的异质性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.