Selective autonomic stimulation of the AV node fat pad to control rapid post-operative atrial arrhythmias.

PLoS One 2017 13;12(9):e0183804. Epub 2017 Sep 13.

Department of Pediatrics, Division of Cardiology, Children's National Health System, Washington, D.C., United States of America.

Junctional ectopic tachycardia (JET) and atrial fibrillation (AF) occur in patients recovering from open-heart surgery (OHS). Pharmacologic treatment is used for the control of post-operative atrial arrhythmias (POAA), but is associated with side effects. There is a need for a reversible, modulated solution to rate control. We propose a non-pharmacologic technique that can modulate AV nodal conduction in a selective fashion. Ten mongrel dogs underwent OHS. Stimulation of the anterior right (AR) and inferior right (IR) fat pad (FP) was done using a 7-pole electrode. The IR was more effective in slowing the ventricular rate (VR) to AF (52 +/- 20 vs. 15 +/- 10%, p = 0.003) and JET (12 +/- 7 vs. 0 +/- 0%, p = 0.02). Selective site stimulation within a FP region could augment the effect of stimulation during AF (57 +/- 20% (maximum effect) vs. 0 +/- 0% (minimum effect), p<0.001). FP stimulation at increasing stimulation voltage (SV) demonstrated a voltage-dependent effect (8 +/- 14% (low V) vs. 63 +/- 17 (high V) %, p<0.001). In summary, AV node fat pad stimulation had a selective effect on the AV node by decreasing AV nodal conduction, with little effect on atrial activity.

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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0183804PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597131PMC
October 2017
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References

(Supplied by CrossRef)
J Interv Card Electrophysiol
P Rossi et al.
J Interv Card Electrophysiol 2009

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