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CLINICAL STUDIES

Ventricular rate control during atrial fibrillation by cardiac parasympathetic nerve stimulation: a transvenous approach

^a Cardiovascular Section, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
^b Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA

Manuscript received March 12, 1999; revised manuscript received July 2, 1999, accepted September 1, 1999.

Reprint requests and correspondence: Benjamin J Scherlag, Research Service 151-F, D.V.A. Medical Center, 921 NE 13^th Street, Oklahoma City, OK 73104.
benjamin-scherlag{at}ouhsc.edu

OBJECTIVES

To identify intravascular sites for continuous, stable parasympathetic stimulation (PS) in order to control the ventricular rate during atrial fibrillation (AF).

BACKGROUND

Ventricular rate control during AF in patients with congestive heart failure is a significant clinical problem because many drugs that slow the ventricular rate may depress ventricular function and cause hypotension. Parasympathetic stimulation can exert negative dromotropic effects without significantly affecting the ventricles.

METHODS

In 22 dogs, PS was performed using rectangular stimuli (0.05 ms duration, 20 Hz) delivered through a catheter with an expandable electrode-basket at its end. The catheter was positioned either in the superior vena cava (SVC, n = 6), coronary sinus (CS, n = 10) or right pulmonary artery (RPA, n = 6). The basket was then expanded to obtain long-term catheter stability. Atrial fibrillation was induced and maintained by rapid atrial pacing.

RESULTS

Nonfluoroscopic (SVC) and fluoroscopic (CS/RPA) identification of effective intravascular PS sites was achieved within 3 to 10 min. The ventricular rate slowing effect during AF started and ceased immediately after on-offset of PS, respectively, and could be maintained over 20 h. In the SVC, at least a 50% increase of ventricular rate (R-R) intervals occurred at 22 ± 11 V (331 ± 139 ms to 653 ± 286 ms, p < 0.001), in the CS at 16 ± 10 V (312 ± 102 ms vs. 561 ± 172 ms, p < 0.001) and in the RPA at 18 ± 7 V (307 ± 62 ms to 681 ± 151 ms, p < 0.001). Parasympathetic stimulation did not change ventricular refractory periods.

CONCLUSIONS

Intravascular PS results in a significant ventricular rate slowing during AF in dogs. This may be beneficial in patients with AF and rapid ventricular response since many drugs that decrease atrioventricular conduction have negative inotropic effects which could worsen concomitant congestive heart failure.

Abbreviations and Acronyms   AF = atrial fibrillation   AV = atrioventricular   CS = coronary sinus   ERP = effective refractory period   PS = parasympathetic stimulation   RAA = right atrial appendage   RPA = right pulmonary artery   R-R = ventricular rate   SST = stimulus strength   SVC = superior vena cava

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