Nonpharmacologic rate control of postoperative atrial fibrillation in the canine sterile pericarditis model.
atrioventricular node fat pad stimulation
nonpharmacologic rate control therapy
postoperative atrial fibrillation
rate control
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
27 Mar 2024
27 Mar 2024
Historique:
revised:
28
02
2024
received:
15
12
2023
accepted:
13
03
2024
medline:
27
3
2024
pubmed:
27
3
2024
entrez:
27
3
2024
Statut:
aheadofprint
Résumé
Postoperative atrial fibrillation (POAF) is common following open heart surgery, and is associated with significant morbidity. Medications used for ventricular rate control of POAF may not be effective in controlling rapid ventricular rates during the postoperative period because of increased sympathetic tone. The purpose of this study was to develop nonpharmacologic rate control of POAF by atrioventricular node (AVN) fat pad stimulation using clinically available temporary pacing wires in the canine sterile pericarditis model. We studied 10 sterile pericarditis dogs in the closed-chest state on postoperative days 1-3. The AVN fat pad stimulation (amplitude 2-15 mA; frequency 20 Hz; pulse width 0.03-0.2 ms) was performed during sustained POAF (>5 min). We measured ventricular rate and inefficient ventricular contractions during sustained POAF and compared it with and without AVN fat pad stimulation. Also, the parameters of AVN fat pad stimulation to achieve a rate control of POAF were measured over the postoperative days. Eleven episodes of sustained POAF were induced in 5/10 sterile pericarditis dogs in the closed-chest state on postoperative days 1-2. During POAF, the AVN fat pad stimulation decreased the ventricular rate from 178 ± 52 bpm to 100 ± 8 bpm in nine episodes. Nonpharmacologic rate control therapy successfully controlled the ventricular rate and eliminated inefficient ventricular contractions during POAF for the duration of the AVN fat pad stimulation. The AVN fat pad stimulation output remained relatively stable over the postoperative days. During sustained POAF, nonpharmacologic rate control by AVN fat pad stimulation effectively and safely controlled rapid ventricular rates throughout the postoperative period.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NHLBI NIH HHS
Pays : United States
Informations de copyright
Journal of Cardiovascular Electrophysiology© 2024 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.
Références
Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg. 1993;56:539‐549.
Almassi GH, Schowalter T, Nicolosi AC, et al. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg. 1997;226:501‐513.
discussion 511‐503.
Shen J, Lall S, Zheng V, Buckley P, Damiano Jr. RJ, Schuessler RB. The persistent problem of new‐onset postoperative atrial fibrillation: a single‐institution experience over two decades. J Thorac Cardiovasc Surg. 2011;141:559‐570.
Gillinov AM, Bagiella E, Moskowitz AJ, et al. Rate control versus rhythm control for atrial fibrillation after cardiac surgery. N Engl J Med. 2016;374:1911‐1921.
Wallick DW, Zhang Y, Tabata T, et al. Selective AV nodal vagal stimulation improves hemodynamics during acute atrial fibrillation in dogs. American J Physiol Heart Circul Physiol. 2001;281:H1490‐H1497.
Park H‐W, Shen MJ, Han S, et al. Neural control of ventricular rate in ambulatory dogs with Pacing‐Induced sustained atrial fibrillation. Circ Arrhyth Electrophysiol. 2012;5:571‐580.
Mercader MA, He D, Sharma AC, et al. Selective autonomic stimulation of the AV node fat pad to control rapid post‐operative atrial arrhythmias. PLoS One. 2017;12:e0183804.
Lee S, Vitebskiy S, Goldstein RN, Khrestian CM, Waldo AL. Reliable pace termination of postoperative atrial fibrillation in the canine sterile pericarditis model: implications for atypical atrial flutter. Heart Rhythm O2. 2022;3:91‐96.
Mulpuru SK, Madhavan M, McLeod CJ, Cha Y‐M, Friedman PA. Cardiac pacemakers: function, troubleshooting, and management. J Am Coll Cardiol. 2017;69:189‐210.
Rossi P, Bianchi S, Barretta A, et al. Post‐operative atrial fibrillation management by selective epicardial vagal fat pad stimulation. J Interv Card Electrophysiol. 2009;24:37‐45.
Carlson MD, Geha AS, Hsu J, et al. Selective stimulation of parasympathetic nerve fibers to the human sinoatrial node. Circulation. 1992;85:1311‐1317.
Schauerte P, Scherlag BJ, Scherlag MA, Goli S, Jackman WM, Lazzara R. Ventricular rate control during atrial fibrillation by cardiac parasympathetic nerve stimulation: a transvenous approach. J Am Coll Cardiol. 1999;34:2043‐2050.
Bianchi S, Rossi P, Della Scala A, et al. Atrioventricular (AV) node vagal stimulation by transvenous permanent lead implantation to modulate AV node function: safety and feasibility in humans. Heart Rhythm. 2009;6:1282‐1286.
Bianchi S, Rossi P, Schauerte P, et al. Increase of ventricular interval during atrial fibrillation by atrioventricular node vagal stimulation: chronic clinical atrioventricular‐nodal stimulation download study. Circ Arrhyth Electrophysiol. 2015;8:562‐568.
Dobrev D, Aguilar M, Heijman J, Guichard JB, Nattel S. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol. 2019;16:417‐436.
Burrage PS, Low YH, Campbell NG, O'Brien B. New‐Onset atrial fibrillation in adult patients after cardiac surgery. Curr Anesthesiol Rep. 2019;9:174‐193.
Burgess DC, Kilborn MJ, Keech AC. Interventions for prevention of post‐operative atrial fibrillation and its complications after cardiac surgery: a meta‐analysis. Eur Heart J. 2006;27:2846‐2857.
Maaroos M, Halonen J, Kiviniemi V, Hartikainen J, Hakala T. Intravenous metoprolol versus biatrial pacing in the prevention of atrial fibrillation after coronary artery bypass surgery: a prospective randomized open trial. Scandinavian J Surg. 2012;101:292‐296.
Akbarzadeh F, Kazemi‐Arb B, Golmohamma A, Pourafkari L. Biatrial pacing vs. intravenous amiodarone in prevention of atrial fibrillation after coronary artery bypass surgery. Pak J Biol Sci. 2009;12:1325‐1329.
Goldstein RN, Ryu K, Khrestian C, van Wagoner DR, Waldo AL. Prednisone prevents inducible atrial flutter in the canine sterile pericarditis model. J Cardiovasc Electrophysiol. 2008;19:74‐81.
Heijman J, Muna AP, Veleva T, et al. Atrial myocyte NLRP3/CaMKII nexus forms a substrate for postoperative atrial fibrillation. Circ Res. 2020;127:1036‐1055.