17th European Heart Disease and Heart Failure Congress
University of Oklahoma Health Sciences Center, USA
Title: Autonomic neuromodulaiton to treat atrial fibrillation
Biography: Sunny Po
Atrial fibrillation (AF) is the most commonly encountered arrhythmia. Catheter or surgical ablation, aiming at isolating the pulmonary veins to eliminate the triggers and substrate of AF is the therapy of choice for drug-refractory AF. Despite the advances of the ablation technologies, the success rate of AF ablation remains disappointing. It is evident that pulmonary vein isolation (PVI) is not enough to treat even the earliest stage of AF, paroxysmal AF, not to speak more advanced stages of AF. It is known that simultaneous activation of the sympathetic and parasympathetic nervous system plays a major role in the initiation and maintenance of AF. Interventions targeting these neural elements have been shown to favorably affect the clinical course of AF. Multiple preclinical studies demonstrated that low-level vagal stimulation at the strength not slowing the sinus or atrio-ventricular conduction was capable of suppressing AF initiation as well as terminating AF. Injection of botulinum toxin into major atrial ganglionated plexi, the integration centers of the cardiac autonomic nervous system, not only prevented post-operative AF in paroxysmal AF patients undergoing open-heart surgeries but also significantly suppressed the progression of AF in these patients. Recently, a novel therapy by transcutaneous stimulation of the auricular branch of the vagus nerve demonstrated its efficacy on shortening the AF duration, prolonging the atrial effective refractory period as well as suppressing the inflammatory markers such as TNF-α and CRP in paroxysmal AF patients undergoing AF ablation. Results of these recent clinical studies indicate that autonomic neural modulation may be a novel and noninvasive therapy for patients suffering from drug-refractory AF.
1. Qin M, Liu X, Jiang WF, Wu SH, Zhang XD, Po SS. Vagal response during pulmonary vein isolation: Re-recognized its characteristics and implications in lone paroxysmal atrial fibrillation. Int J Cardiol. 2016 May 15;211:7-13.
2. Lo LW, Chang HY, Scherlag BJ, Lin YJ, Chou YH, Lin WL, Chen SA, Po SS. Temporary Suppression of Cardiac Ganglionated Plexi Leads to Long-Term Suppression of Atrial Fibrillation: Evidence of Early Autonomic Intervention to Break the Vicious Cycle of "AF Begets AF". J Am Heart Assoc. 2016 Jul 5;5(7).
3. Zhang L, Po SS, Wang H, Scherlag BJ, Li H, Sun J, Lu Y, Ma Y, Hou Y.Autonomic Remodeling: How Atrial Fibrillation Begets Atrial Fibrillation in the First 24 Hours. J Cardiovasc Pharmacol. 2015 Sep;66(3):307-15.
4. Yu L, Dyer JW, Scherlag BJ, Stavrakis S, Sha Y, Sheng X, Garabelli P, Jacobson J, Po SS. The use of low-level electromagnetic fields to suppress atrial fibrillation. Heart Rhythm. 2015 Apr;12(4):809-17.
5. Gao M, Zhang L, Scherlag BJ, Huang B, Stavrakis S, Hou YM, Hou Y,Po SS. Low-level vagosympathetic trunk stimulation inhibits atrial fibrillation in a rabbit model of obstructive sleep apnea. Heart Rhythm. 2015 Apr;12(4):818-24.
6. Stavrakis S, Humphrey MB, Scherlag BJ, Hu Y, Jackman WM, Nakagawa H, Lockwood D, Lazzara R, Po SS. Low-level transcutaneous electrical vagus nerve stimulation suppresses atrial fibrillation. J Am Coll Cardiol. 2015 Mar 10;65(9):867-75.
7. Huang B, Yu L, Scherlag BJ, Wang S, He B, Yang K, Liao K, Lu Z, He W, Zhang L, Po SS, Jiang H. Left renal nerves stimulation facilitates ischemia-induced ventricular arrhythmia by increasing nerve activity of left stellate ganglion. J Cardiovasc Electrophysiol. 2014 Nov;25(11):1249-56.
8. Pokushalov E, Kozlov B, Romanov A, Strelnikov A, Bayramova S, Sergeevichev D, Bogachev-Prokophiev A, Zheleznev S, Shipulin V, Salakhutdinov N, Lomivorotov VV, Karaskov A, Po SS, Steinberg JS. Botulinum toxin injection in epicardial fat pads can prevent recurrences of atrial fibrillation after cardiac surgery: results of a randomized pilot study. J Am Coll Cardiol. 2014;12;64(6):628-9.
9. Katritsis DG, Pokushalov E, Romanov A, Giazitzoglou E, Siontis GC, Po SS, Camm AJ, Ioannidis JP. Autonomic Denervation Added to Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation: A Randomized Clinical Trial. J Am Coll Cardiol. 2013, 62(24):2318-25.