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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

View larger version (140K): [in a new window]   Figure 1 Anterior-posterior view of electrode catheters with their tips (*) at sympathetic nerve stimulation sites in both subclavian arteries.

View larger version (186K): [in a new window]   Figure 2 Sympathetic nerve stimulation site in right subclavian artery. Before connective tissue dissection, there was a 1.5 to 2 cm separation of the vagal nerve and ansa subclavia. *Radiofrequency burn.

View larger version (40K): [in a new window]   Figure 3 Left-sided sympathetic nerve stimulation (SNS) during ventricular pacing. Left arrow = SNS initiation. After 30 s (*) SNS was terminated (right arrow). There was a doubling of left ventricular pressure (LVP). Note the shortening of the ventriculo (V)-atrial (A) interval consistent with a positive dromotropic effect.

View larger version (18K): [in a new window]   Figure 4 Dose-response curve of left-sided sympathetic nerve stimulation. (A) Sinus rhythm; (B) ventricular pacing (200/min). ANOVA = analysis of variance; bpm = beats per minute; HR = heart rate; LVP = left ventricular pressure; LVPsys = left ventricular systolic pressure.

View larger version (21K): [in a new window]   Figure 5 Kinetics of left ventricular (LV) systolic pressure during left-sided sympathetic nerve stimulation (SNS) at 37.5 V and ventricular pacing at 200/min. ANOVA = analysis of variance.

View larger version (22K): [in a new window]   Figure 6 Twelve hours of continuous sympathetic nerve stimulation (SNS). (A) Left ventricular systolic pressure (LVPsyst); (B) rate of systolic pressure development (RPDsyst); (C) cardiac output (CO); (D) total peripheral resistance (TPR). SR = sinus rhythm; v-pace = ventricular pacing at 200/min.