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Long-term subthreshold electrical stimulation of the left stellate ganglion and a canine model of sudden cardiac death

Moshe Swissa, MD^*, Shengmei Zhou, MD^*, Ignacio Gonzalez-Gomez, MD, Che-Ming Chang, MD^*, Angela C. Lai, BA^*, Adam W. Cates, PhD, Michael C. Fishbein, MD, Hrayr S. Karagueuzian, PhD^*, Peng-Sheng Chen, MD^* and Lan S. Chen, MD^,*

^* Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
Guidant Corporation, St. Paul, Minnesota, USA
Department of Pathology and Laboratory Medicine, Geffen School of Medicine, University of California, Los Angeles, USA
Children's Hospital of Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California, USA

View larger version (87K): [in a new window]   Figure 1 Cardiac nerves immunolabeled with growth-associated protein-43 (GAP43), synaptophysin (SYN), and tyrosine hydroxylase (TH) (brown twigs) in normal dogs with left stellate ganglion stimulation. Magnification 40x. LV = left ventricle; RV = right ventricle.

View larger version (24K): [in a new window]   Figure 2 Cardiac nerve density in dogs with left stellate ganglion subthreshold electrical stimulation (LSGS) and in normal control dogs (CNT). (Upper panel) Nerve density measured as the number of nerves per mm2. (Lower panel) Nerve density measured as the total area of nerves (µm2) per mm2. *p < 0.01 compared with matched control. Solid bars = LSGS; open bars = CNT. Abbreviations as in Figure 1.

View larger version (77K): [in a new window]   Figure 3 Cardiac nerves immunolabeled with GAP43, SYN, and TH (brown twigs) in protocol 2. The nerve density of the myocardium in dogs with left stellate ganglion stimulation (LSGS) is higher than the nerve density in dogs with NGF infusion to the LSG. Magnification 40x. Abbreviations as in Figure 1.

View larger version (59K): [in a new window]   Figure 4 Ventricular arrhythmias recorded by Data Sciences International (DSI). Parts A and B show 24-h histograms of the atrial and ventricular rates, respectively. Time 0 corresponds to 12:00 AM. There were numerous high-rate events in the morning (between the two arrows). (C) Example of nonsustained ventricular tachycardia recorded by the DSI system. The arrows indicate the P waves.

View larger version (59K): [in a new window]   Figure 5 Examples of spontaneous ventricular fibrillation (VF) leading to sudden cardiac death, as documented by the Data Sciences International system (A) and an implantable cardioverter-defibrillator (B).