选择性心内交感神经去神经支配对左心室控制的急性调节

Acute Modulation of Left Ventricular Control by Selective Intracardiac Sympathetic Denervation.

作者信息

Kahle Ann-Kathrin, Klatt Niklas, Jungen Christiane, Dietenberger Aaron, Kuklik Pawel, Münkler Paula, Willems Stephan, Nikolaev Viacheslav, Pauza Dainius H, Scherschel Katharina, Meyer Christian

机构信息

Division of Cardiology, Angiology, and Intensive Care Medicine, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany; Institute of Neural and Sensory Physiology, Cardiac Neuro- and Electrophysiology Research Consortium, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany.

German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany; Department of Cardiology, Schön Klinik Neustadt in Holstein, Neustadt in Holstein, Germany.

出版信息

JACC Clin Electrophysiol. 2023 Mar;9(3):371-384. doi: 10.1016/j.jacep.2022.10.013. Epub 2022 Nov 30.

DOI:10.1016/j.jacep.2022.10.013

PMID:36752452

Abstract

BACKGROUND

The sympathetic nervous system plays an integral role in cardiac physiology. Nerve fibers innervating the left ventricle are amenable to transvenous catheter stimulation along the coronary sinus (CS).

OBJECTIVES

The aim of the present study was to modulate left ventricular control by selective intracardiac sympathetic denervation.

METHODS

First, the impact of epicardial CS ablation on cardiac electrophysiology was studied in a Langendorff model of decentralized murine hearts (n = 10 each, ablation and control groups). Second, the impact of transvenous, anatomically driven axotomy by catheter-based radiofrequency ablation via the CS was evaluated in healthy sheep (n = 8) before and during stellate ganglion stimulation.

RESULTS

CS ablation prolonged epicardial ventricular refractory period without (41.8 ± 8.4 ms vs 53.0 ± 13.5 ms; P = 0.049) and with β-adrenergic receptor blockade (47.8 ± 7.8 ms vs 73.1 ± 13.2 ms; P < 0.001) in mice. Supported by neuromorphological studies illustrating a circumferential CS neural network, intracardiac axotomy by catheter ablation via the CS in healthy sheep diminished the blood pressure increase during stellate ganglion stimulation (Δ systolic blood pressure 21.9 ± 10.9 mm Hg vs 10.5 ± 12.0 mm Hg; P = 0.023; Δ diastolic blood pressure 9.0 ± 5.5 mm Hg vs 3.0 ± 3.5 mm Hg; P = 0.039).

CONCLUSIONS

Transvenous, anatomically driven axotomy targeting nerve fibers along the CS enables acute modulation of left ventricular control by selective intracardiac sympathetic denervation.

摘要

背景

交感神经系统在心脏生理学中发挥着不可或缺的作用。支配左心室的神经纤维可通过沿冠状窦（CS）进行经静脉导管刺激。

目的

本研究的目的是通过选择性心内交感神经去神经支配来调节左心室控制。

方法

首先，在离体小鼠心脏的Langendorff模型中研究了心外膜CS消融对心脏电生理学的影响（消融组和对照组各n = 10）。其次，在健康绵羊（n = 8）中，在星状神经节刺激之前和期间，评估了通过基于导管的射频消融经CS进行的经静脉、解剖学驱动的轴突切断术的影响。

结果

在小鼠中，CS消融延长了心外膜心室不应期，在未使用β-肾上腺素能受体阻滞剂时（41.8±8.4毫秒对53.0±13.5毫秒；P = 0.049）以及使用β-肾上腺素能受体阻滞剂时（47.8±7.8毫秒对73.1±13.2毫秒；P < 0.001）均如此。神经形态学研究表明存在环绕CS的神经网络，这支持了上述结果，在健康绵羊中，通过经CS的导管消融进行心内轴突切断术可减少星状神经节刺激期间的血压升高（收缩压变化21.9±10.9毫米汞柱对10.5±12.0毫米汞柱；P = 0.023；舒张压变化9.0±5.5毫米汞柱对3.0±3.5毫米汞柱；P = 0.039）。