Subclavian Ansae Stimulation on Cardiac Hemodynamics and Electrophysiology in Atrial Fibrillation

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2025-03-01 DOI:10.1016/j.jacep.2024.10.023

Vijayabharathy Kanthasamy MBBS, CCDS, CEPS-A , Richard Ang PhD , Arun Sridhar PhD , Sandip Vyas BSc, CCDS, CEPS-A , Sarah Whittaker-Axon BSc, CCDS , Richard Schilling MD , Shohreh Honarbakhsh PhD , Nikolaos Papageorgiou MD, PhD , Antonio Creta MBBS, PhD , Nikhil Ahluwalia PhD , Ross Hunter PhD , Malcolm Finlay PhD

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引用次数: 0

Abstract

Background

The sympathetic autonomic nervous system plays a major role in arrhythmia development and maintenance. Historical preclinical studies describe preferential increases in cardiac sympathetic tone upon selective stimulation of the subclavian ansae (SA), a nerve cord encircling the subclavian artery.

Objectives

This study sought to define, for the first time, the functional anatomy and physiology of the SA in humans using a percutaneous approach.

Methods

The authors prospectively recruited patients undergoing catheter ablation for paroxysmal atrial fibrillation (AF) under general anesthesia. SA stimulation (SAS) was performed on the left and/or the right (L/SAS and/or R/SAS, respectively) within the subclavian artery using an ablation catheter introduced via a femoral arterial sheath. Stimulation involved up to 70 V, 10 Hz, and a 2- to 4-millisecond pulse width for 15 to 30 seconds. Invasive blood pressure (BP), heart rate, and electrophysiological parameters were recorded. A positive response was a ≥10% increase in BP or heart rate from baseline.

Results

Seventeen patients (median age 60 years [Q1-Q3: 58-67 years];11 male subjects; paroxysmal AF duration 24 months [Q1-Q3: 10-60 months) underwent the stimulation protocol before their clinical AF ablation procedure. A positive hemodynamic response was observed in 11 patients; of these, arrhythmia was inducible in 5 patients. The median sinus cycle length decreased after stimulation, and there was a larger decrease with R/SAS (L/SAS 1,008 milliseconds to 926 milliseconds [P = 0.037] vs R/SAS 1,029.5 milliseconds to 917 milliseconds [P = 0.005]). Both L/SAS and R/SAS led to a notable increase in median systolic BP (L/SAS 81 to 128 mm Hg [P = 0.005] vs R/SAS 85 to 104 mm Hg [P = 0.007]) and a similar trend in diastolic BP. In addition, there was a demonstrable decrease in interatrial conduction time and increase in P-wave dispersion.

Conclusions

This study represents the first successful application of selective SAS in humans. The SA is a potentially important site for targeted autonomic neuromodulation therapy.

查看原文本刊更多论文

锁骨下Ansae刺激对心房颤动心脏血流动力学和电生理的影响：交感神经调节的靶点。

背景：交感自主神经系统在心律失常的发生和维持中起重要作用。历史的临床前研究描述了选择性刺激锁骨下背（SA）时心脏交感神经张力的优先增加，锁骨下背是包围锁骨下动脉的神经索。目的：本研究首次试图通过经皮入路对人类SA的功能解剖学和生理学进行定义。方法：前瞻性招募全麻下行导管消融治疗阵发性心房颤动（AF）的患者。使用经股动脉鞘引入的消融导管，在锁骨下动脉内的左侧和/或右侧（分别为L/SAS和/或R/SAS）进行SA刺激（SAS）。刺激包括高达70 V， 10 Hz， 2到4毫秒的脉冲宽度，持续15到30秒。记录有创血压（BP）、心率和电生理参数。阳性反应是血压或心率较基线升高≥10%。结果：17例患者（中位年龄60岁[四分位1-四分位3:58-67岁]），男性11例；阵发性房颤持续时间24个月[四分位数1-三分位数：10-60个月]的患者在临床房颤消融手术前接受刺激方案。11例患者血流动力学反应阳性；其中诱发心律失常5例。刺激后窦中周期长度减少，R/SAS组减少幅度更大（L/SAS组为1008毫秒至926毫秒[P = 0.037]， R/SAS组为1029.5毫秒至917毫秒[P = 0.005]）。L/SAS和R/SAS均导致中位收缩压显著升高（L/SAS为81 mm Hg至128 mm Hg [P = 0.005]， R/SAS为85 mm Hg至104 mm Hg [P = 0.007]），舒张压也有类似趋势。心房间传导时间明显缩短，p波弥散度明显增加。结论：本研究首次成功地将选择性SAS应用于人体。SA是靶向自主神经调节治疗的潜在重要部位。

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.