Abstract
In canines, excessive activation of select mediastinal nerve inputs to the intrinsic
cardiac nervous system induces atrial fibrillation (AF). Since ablation of neural
elements is proposed as an adjunct to circumferential pulmonary vein ablation for
AF, we investigated the short and long-term effects of mediastinal nerve ablation
on AF inducibility. Under general anesthesia, in 11 dogs several mediastinal nerve
sites were identified on the superior vena cava that, when stimulated electrically
during the atrial refractory period, reproducibly initiated AF. Cryoablation of one
nerve site was then performed and inducibility retested early (1–2 months post Cryo; n=7) or late (4 months post Cryo; n=4). Four additional dogs that underwent a sham procedure were retested 1 to 2 months post-surgery. Stimulation induced AF at 91% of nerve sites tested in control
versus 21% nerve sites early and 54% late post-ablation (both P<0.05). Fewer stimuli were required to induce AF in controls versus the Early Cryo
group; this capacity returned to normal values in the Late Cryo group. AF episodes
were longer in control versus the Early or Late Cryo groups. Heart rate responses
to vagal or stellate ganglion stimulation, as well as to local nicotine infusion into
the right coronary artery, were similar in all groups. In conclusion, focal damage
to intrinsic cardiac neuronal inputs causes short-term stunning of neuronal inducibility
of AF without major loss of overall adrenergic or cholinergic efferent neuronal control.
That recovery of AF inducibility occurs rapidly post-surgery indicates the plasticity
of intrathoracic neuronal elements to focal injury.
Keywords
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Article info
Publication history
Published online: February 09, 2011
Accepted:
December 19,
2010
Received in revised form:
December 13,
2010
Received:
September 27,
2010
Identification
Copyright
© 2011 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
