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PRECLINICAL STUDY

Left Stellate Ganglion and Vagal Nerve Activity and Cardiac Arrhythmias in Ambulatory Dogs With Pacing-Induced Congestive Heart Failure

Masahiro Ogawa, MD, PhD^_*, Shengmei Zhou, MD^_*, Alex Y. Tan, MD^_*, Juan Song, PhD^_*, Ghassan Gholmieh, MD, PhD, Michael C. Fishbein, MD, FACC, Huai Luo, MD^_*, Robert J. Siegel, MD, FACC^_*, Hrayr S. Karagueuzian, PhD^_*, Lan S. Chen, MD, Shien-Fong Lin, PhD^_* and Peng-Sheng Chen, MD, FACC^_*,_*

^_* Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
Division of Neurology, Department of Pediatrics, Children’s Hospital, Los Angeles and USC Keck School of Medicine, Los Angeles, California
Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California.

Manuscript received December 11, 2006; revised manuscript received February 20, 2007, accepted March 6, 2007.

^_* Reprint requests and correspondence: Dr. Peng-Sheng Chen, Krannert Institute of Cardiology, 1801 North Capitol Avenue, E475, Indianapolis, Indiana 46202. (Email: chenpp{at}iupui.edu).

Objectives: The purpose of this study was to determine the patterns of autonomic nerve activity in congestive heart failure (CHF).

Background: The relationship between autonomic nerve activity and cardiac arrhythmias in CHF is unclear.

Methods: We implanted radiotransmitters in 6 dogs for continuous (24/7) simultaneous monitoring of left stellate ganglion nerve activity (SGNA), vagal nerve activity (VNA), and electrocardiography before and after pacing-induced CHF.

Results: Congestive heart failure increased both SGNA and VNA. The SGNA but not VNA manifested a circadian variation pattern. There was extensive sinus node fibrosis. We analyzed 2,263 episodes of prolonged (>3 s) sinus pauses (PSP) and 1,420 long (>10 s) episodes of paroxysmal atrial tachycardia (PAT). Most (95.3%) PSP episodes occurred at night, and 56% were preceded by a short burst of SGNA that induced transient sinus tachycardia. Long PAT episodes were typically (83%) induced by simultaneous SGNA and VNA discharge, followed by VNA withdrawal. Premature ventricular contractions and ventricular tachycardia were preceded by elevated SGNA.

Conclusions: The reduction of sympathovagal balance at night in ambulatory dogs was due to reduced sympathetic discharge rather than a net increase of vagal discharge. The tachybrady syndrome in CHF might be triggered by an intermittent short burst of SGNA that resulted in tachycardia and sinus node suppression. Simultaneous sympathovagal discharge is a cause of long PAT episodes. These data indicate that there is an association between the specific patterns of autonomic nerve discharges and cardiac arrhythmia during CHF.

Abbreviations and Acronyms   ANS = autonomic nervous system   CHF = congestive heart failure   ECG = electrocardiography   HASDA = high amplitude spike discharge activity   LABDA = low amplitude burst discharge activity   PAT = paroxysmal atrial tachycardia   PSP = prolonged sinus pause   SGNA = stellate ganglion nerve activity   VNA = vagal nerve activity

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