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Selective Increase of Cardiac Neuronal Sympathetic Tone

A Catheter-Based Access to Modulate Left Ventricular Contractility

Markus Zarse, MD^_*, Jurgita Plisiene, MD, Karl Mischke, MD^_*, Thomas Schimpf, MD^_*, Christian Knackstedt, MD^_*, Felix Gramley, MD^_*, Georg Mühlenbruch, MD^_*, Mathias Waldmann, MD^_*, Michael Schmid, MD^_*,, Nima Hatam, MD^_*,, Jürgen Graf, MD^_*, Dirk Schuster, MD^_*, Peter Hanrath, MD, FACC^_*, Dainius Pauza, PhD and Patrick Schauerte, MD^_*,_*

^_* Department of Cardiology, University of Technology, Aachen, Germany
Departments of Cardiology,Anatomy, University of Kaunas, Kaunas, Lithuania, Germany
Anatomy, University of Kaunas, Kaunas, Lithuania, Germany
Department of Cardio-Thoracic Surgery, RWTH Aachen University, Germany

Manuscript received August 29, 2004; revised manuscript received February 21, 2005, accepted March 10, 2005.

^_* Reprint requests and correspondence: Prof. Patrick Schauerte, Department of Cardiology, University of Technology, Pauwelsstrasse 30, 52074 Aachen, Germany (Email: pschauerte{at}ukaachen.de).

OBJECTIVES: This study was designed to develop a technique to selectively increase the sympathetic tone to the heart by cardiac sympathetic nerve stimulation (SNS).

BACKGROUND: Access to the cardiac sympathetic neurons may allow modulating the adrenergic tone of the heart while avoiding systemic side effects.

METHODS: Cardiac sympathetic nerves course within neural sleeves along the subclavian artery. Because of this proximity, transvascular SNS was attempted with electrode catheters inside the subclavian artery in 16 pigs.

RESULTS: Right/left (R-/L-) SNS (20 Hz) during ventricular pacing at 200/min evoked a >100% increase of left ventricular systolic pressure (baseline: 51 ± 1 mm Hg; L-SNS: 118 ± 26 mm Hg; R-SNS: 116 ± 33 mm Hg; p < 0.001) while systemic vascular resistance remained unchanged. There was a sigmoid dose-response curve with rapid on- and offset of the effect during SNS initiation/cessation. Positive inotropic effects persisted for 12 h of continued SNS (n = 4). Besides positive dromotropic effects, L-SNS/R-SNS yielded a 41% and 77% sinus rate increase, respectively.

CONCLUSIONS: The neural adrenergic tone to the heart can be selectively increased by catheter stimulation of cardiac efferent sympathetic nerves.

Abbreviations and Acronyms   AF = atrial fibrillation   ERP = effective refractory period   L-SNS/R-SNS = left-sided/right-sided sympathetic nerve stimulation   LV = left ventricle/ventricular   SNS = sympathetic nerve stimulation   TPR = total peripheral resistance

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