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Stimulation of the intra-cardiac vagal nerves innervating the AV-node to control ventricular rate during AF: specificity, parameter optimization and chronic use up to 3 months

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Abstract

Background

Stimulation of the intra-cardiac vagal nerves innervating the AV-node (AVNS) is a promising approach to slow down ventricular rate (VR) during atrial fibrillation (AF). Our purpose was to demonstrate that effects on R-R-interval during stable AF can be maintained for several months once optimized and that AVNS affects specifically the nerves innervating the AV-node.

Methods

Our study included both an acute and chronic phase. Fifteen goats were implanted with a pacemaker connected to an atrial and ventricular lead and a neurostimulator connected to an atrial lead placed at a certain septal site, to induce an AV prolongation. In the chronic experiments (n = 9), after assessment of optimal AVNS parameters, the effect of continuous AVNS on VR was studied during stable AF for up to 3 months. The mechanism of AVNS was studied using atropine and esmolol. Next, the effects of AVNS during the atrial refractory period on electrophysiological and hemodynamic parameters were investigated acutely (n = 7).

Results

The maximal effect was found at a stimulation frequency of 40 Hz, and increased with increasing pulse width (at lower voltages) and increasing voltage. After 0, 1, and 3 months of AVNS during stable AF, AVNS decreased average VR, respectively, 55% (n = 9), 48% (n = 8), and 28% (n = 6). The AVNS effect appeared to be dominantly parasympathetic. AVNS did not influence (1) the sinus node, (2) the refractory period of the atrial, ventricular tissue, and His and (3) hemodynamic parameters.

Conclusion

AVNS is efficient in reducing ventricular rate for at least 3 months using optimized parameters and specifically affects the parasympathetic nerves innervating the AV-node.

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Conflict of interest

Lilian Kornet, Roger Kessels, Teena West and Richard Cornelussen are employees of Medtronic. Alberto Della Scala and Koen Michels have worked for Medtronic during the time this study was performed

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Authors and Affiliations

  1. Medtronic, Bakken Research Center, Endepolsdomein-5, 6229GW, Maastricht, the Netherlands

    Lilian Kornet, Koen Michels, Teena West, Roger Kessels & Richard Cornelussen

  2. Department of Physiology, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands

    Arne van Hunnik, Sander Verheule & Richard Cornelussen

  3. Medtronic Italy, Rome, Italy

    Alberto Della Scala

Authors
  1. Lilian Kornet
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  2. Arne van Hunnik
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Correspondence to Lilian Kornet.

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Kornet, L., van Hunnik, A., Michels, K. et al. Stimulation of the intra-cardiac vagal nerves innervating the AV-node to control ventricular rate during AF: specificity, parameter optimization and chronic use up to 3 months. J Interv Card Electrophysiol 33, 7–18 (2012). https://doi.org/10.1007/s10840-011-9619-4

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  • DOI: https://doi.org/10.1007/s10840-011-9619-4

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