Lubanda Jean-Claude, Kudlicka Jaroslav, Mlcek Mikulas, Chochola Miroslav, Neuzil Petr, Linhart Ales, Kittnar Otomar
2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, Prague 2, 128 00, Czech Republic.
Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Albertov 5, Prague 2, 128 00, Czech Republic.
J Transl Med. 2015 Jan 16;13:4. doi: 10.1186/s12967-014-0367-y.
Ventricular arrhythmias play an important role in cardiovascular mortality especially in patients with impaired cardiac and autonomic function. The aim of this experimental study was to determine, if renal denervation (RDN) could decrease the inducibility of ventricular fibrillation (VF) in a healthy porcine biomodel.
Controlled electrophysiological study was performed in 6 biomodels 40 days after RDN (RDN group) and in 6 healthy animals (control group). The inducibility of VF was tested by programmed ventricular stimulation from the apex of right ventricle (8 basal stimuli coupled with up to 4 extrastimuli) always three times in each biomodel using peripheral extracorporeal oxygenation for hemodynamic support. Further, basal heart rate (HR), PQ and QT intervals and effective refractory period of ventricles (ERP) were measured. Technical success of RDN was evaluated by histological examination.
According to histological findings, RDN procedure was successfully performed in all biomodels. Comparing the groups, basal HR was lower in RDN group: 79 (IQR 58; 88) vs. 93 (72; 95) beats per minute (p = 0.003); PQ interval was longer in RDN group: 145 (133; 153) vs. 115 (113; 120) ms (p < 0.0001) and QTc intervals were comparable: 402 (382; 422) ms in RDN vs. 386 (356; 437) ms in control group (p = 0.1). ERP was prolonged significantly in RDN group: 159 (150; 169) vs. 140 (133; 150) ms (p = 0.001), but VF inducibility was the same (18/18 vs. 18/18 attempts).
RDN decreased the influence of sympathetic nerve system on the heart conduction system in healthy porcine biomodel. However, the electrophysiological study was not associated with a decrease of VF inducibility after RDN.
室性心律失常在心血管疾病死亡率中起着重要作用,尤其是在心脏和自主神经功能受损的患者中。本实验研究的目的是确定肾去神经支配(RDN)是否能降低健康猪生物模型中室颤(VF)的诱发率。
在RDN术后40天对6个生物模型(RDN组)和6只健康动物(对照组)进行了对照电生理研究。通过从右心室心尖进行程序性心室刺激(8次基础刺激加最多4次额外刺激)来测试VF的诱发率,每个生物模型均进行3次,使用外周体外氧合进行血流动力学支持。此外,测量基础心率(HR)、PQ和QT间期以及心室有效不应期(ERP)。通过组织学检查评估RDN的技术成功率。
根据组织学结果,所有生物模型均成功进行了RDN手术。比较两组,RDN组的基础HR较低:每分钟79次(四分位间距58;88),而对照组为93次(72;95)(p = 0.003);RDN组的PQ间期较长:145毫秒(133;153),而对照组为115毫秒(113;120)(p < 0.0001),QTc间期相当:RDN组为402毫秒(382;422),对照组为386毫秒(356;437)(p = 0.1)。RDN组的ERP显著延长:159毫秒(150;169),而对照组为140毫秒(133;150)(p = 0.001),但VF诱发率相同(均为18/18次尝试)。
在健康猪生物模型中,RDN降低了交感神经系统对心脏传导系统的影响。然而,电生理研究显示RDN术后VF诱发率并未降低。