Subclavian Ansae Stimulation on Cardiac Hemodynamics and Electrophysiology in Atrial Fibrillation

心房颤动 电生理学 医学 刺激 心脏病学 血流动力学 麻醉 心脏电生理学 内科学
作者
Vijayabharathy Kanthasamy,Richard Ang,Arun Sridhar,Sandip Vyas,Sarah Whittaker‐Axon,R. S. F. Schilling,Shohreh Honarbakhsh,Νικόλαος Παπαγεωργίου,António Creta,Nikhil Ahluwalia,Ross Hunter,Malcolm Finlay
出处
期刊:JACC: Clinical Electrophysiology [Elsevier BV]
标识
DOI:10.1016/j.jacep.2024.10.023
摘要

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. This study sought to define, for the first time, the functional anatomy and physiology of the SA in humans using a percutaneous approach. 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. Seventeen patients (median age 60 years [quartile 1-quartile 3: 58-67 years];11 male subjects; paroxysmal AF duration 24 months [quartile 1-quartile 3: 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 mm Hg to 128 mm Hg [P = 0.005] vs R/SAS 85 mm Hg 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. This study represents the first successful application of selective SAS in humans. The SA is a potentially important site for targeted autonomic neuromodulation therapy.
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