Ventricular Rate Control by Selective Vagal Stimulation Is Superior to Rhythm Regularization by Atrioventricular Nodal Ablation and Pacing During Atrial Fibrillation
- 1 October 2002
- journal article
- research article
- Published by Wolters Kluwer Health in Circulation
- Vol. 106 (14) , 1853-1858
- https://doi.org/10.1161/01.cir.0000031802.58532.04
Abstract
Background— Selective atrioventricular nodal (AVN) vagal stimulation (AVN-VS) has emerged as a novel strategy for ventricular rate (VR) control in atrial fibrillation (AF). Although AVN-VS preserves the physiological ventricular activation sequence, the resulting rate is slow but irregular. In contrast, AVN ablation with pacemaker implantation produces retrograde activation (starting at the apex), with regular ventricular rhythm. We tested the hypothesis that, at comparable levels of VR slowing, AVN-VS provides hemodynamic benefits similar to those of ablation with pacemaker implantation. Methods and Results— AVN-VS was delivered to the epicardial fat pad that projects parasympathetic nerve fibers to the AVN in 12 dogs during AF. A computer-controlled algorithm adjusted AVN-VS beat by beat to achieve a mean ventricular RR interval of 75%, 100%, 125%, or 150% of spontaneous sinus cycle length. The AVN was then ablated, and the right ventricular (RV) apex was paced either irregularly (i-RVP) using the RR in...Keywords
This publication has 25 references indexed in Scilit:
- Hemodynamic importance of preserving the normal sequence of ventricular activation in permanent cardiac pacingPublished by Elsevier ,2004
- Importance of rate control or rate regulation for improving exercise capacity and quality of life in patients with permanent atrial fibrillation and normal left ventricular function: a randomised controlled studyHeart, 2001
- Long-Term Effect of Right Ventricular Pacing on Myocardial Perfusion and FunctionJournal of the American College of Cardiology, 1997
- Impact on ventricular function and quality of life of transcatheter ablation of the atrioventricular junction in chronic atrial fibrillation with a normal ventricular responseThe American Journal of Cardiology, 1996
- Effect of an irregular ventricular rhythm on cardiac outputThe American Journal of Cardiology, 1996
- The Effect of Ventricular Activation Sequence on Cardiac Performance During PacingPacing and Clinical Electrophysiology, 1996
- Asymmetric thickness of the left ventricular wall resulting from asynchronous electric activation: A study in dogs with ventricular pacing and in patients with left bundle branch blockAmerican Heart Journal, 1995
- Effects of long-term right ventricular apical pacing on left ventricular perfusion, innervation, function and histologyJournal of the American College of Cardiology, 1994
- Comparison of the Effects of Right Atrial, Right Ventricular Apex and Atrioventricular Sequential Pacing on Myocardial Oxygen Consumption and Cardiac Efficiency: A Laboratory Investigation*Pacing and Clinical Electrophysiology, 1988
- The hemodynamic consequences of cardiac arrhythmias: Evaluation of the relative roles of abnormal atrioventricular sequencing, irregularity of ventricular rhythm and atrial fibrillation in a canine modelAmerican Heart Journal, 1983