Transvascular Parasympathetic Stimulation for Ventricular Rate Control During Atrial Fibrillation: A Bionic Approach

  • P. Schauerte
  • M. Schmidt
  • T. Schimpf
  • I. Plisiene
  • M. Zarse
  • K. Mischke
Conference paper


Of all arrhythmias atrial fibrillation (AF) is the most frequent, with a prevalence of 5–9% among the older population [1]. AF accounts for most rhythm-related hospital treatments [2]. Recently, equal outcomes have been reported for treatment strategies aiming at the restoration and maintenance of sinus rhythm (rhythm control) or at persistence of AF with ventricular rate control [3, 4], provided that the patients are sufficiently anticoagulated. Ventricular rate control, however, is a significant problem as the chaotic bombardment of the atrioventricular (AV) node by the fibrillating wavelets causes almost unpredictable sequences of ventricular activation, leading to both tachycardic and bradycardic episodes. Particularly during physical exertion, the adaptation of the heart rate to an increasing physical demand is impaired and often results in excess tachycardia. This adds to the reduced exercise capacity which is already impaired by the loss of the atrial contribution to ventricular filling. Therefore, pharmacological therapy with negative dromotropic drugs is necessary in the vast majority of AF patients in whom rate control is pursued. Unfortunately, this is often a trade-off, because the patients may experience symptomatic bradycardia despite effective suppression of tachycardic episodes, leading to pacemaker implantation in a substantial proportion of patients. Even more importantly, apart from cardiac glycosides, most of the drugs that exert negative dromotropic effects also have significant ventricular negative inotropic and vasodilating properties at dosages which effectively decrease the rapid ventricular rate during AF. This limits their benefit in patients with congestive heart failure or arterial hypotension. Cardiac glycosides, in turn, have limited rate-slowing effects during rapid ventricular rates caused by physical activity [5].


Atrial Fibrillation Coronary Sinus Ventricular Rate Rhythm Control Ventricular Rate Control 
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  1. 1.
    Kannel WB, Wolf P (1992) Epidemiology of atrial fibrillation. In: Falk RH, Podrid PJ (eds) Atrial fibrillation: mechanism and management. Raven, New YorkGoogle Scholar
  2. 2.
    Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG (1995) Prevalence, age distribution, and gender of patients with atrial fibrillation. Arch Intern Med 155:469–473PubMedCrossRefGoogle Scholar
  3. 3.
    Van Gelder IC, Hagens VE, Bosker HA et al (2002) A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 347:1834–1840PubMedCrossRefGoogle Scholar
  4. 4.
    Wyse DG, Waldo AL, DiMarco JP et al (2002) A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 347:1825–1833PubMedCrossRefGoogle Scholar
  5. 5.
    David E, Segni ED, Klein HO, Kaplinsky E (1979) Inefficacy of digitalis in the control of heart rate in patients with chronic atrial fibrillation: beneficial effect of an added beta adrenergic blocking agent. Am J Cardiol 44:1378–1382PubMedCrossRefGoogle Scholar
  6. 6.
    Randall WC, Ardell JL, Calderwood D, Milosavljevic M, Goyal SC (1986) Parasympathetic ganglia innervating the canine atrioventricular nodal region. J Auton Nerv Syst 16:311–323PubMedCrossRefGoogle Scholar
  7. 7.
    Dahlstrom A, Mya-Tu M, Fuxe K, Zetterstrom BE (1965) Observations on adrenergic innervation of dog heart. Am J Physiol 209:689–692PubMedGoogle Scholar
  8. 8.
    Pauza DH, Skripka V, Pauziene N et al (2000) Morphology, distribution, and variability of the epicardiac neural ganglionated subplexuses in the human heart. Anat Rec 259:353–382PubMedCrossRefGoogle Scholar
  9. 9.
    Lazzara R, Scherlag BJ, Robinson MJ, Samet P (1973) Selective in situ parasympathetic control of the canine sinuatrial and atrioventricular node. Circ Res 32:393–401PubMedCrossRefGoogle Scholar
  10. 10.
    Wallick DW, Martin PJ (1990) Separate parasympathetic control of heart rate and atrioventricular conduction of dogs. Am J Physiol 259:H536–542PubMedGoogle Scholar
  11. 11.
    Yuan BX, Ardell JL, Hopkins DA Losier AM, Armour JA (1994) Gross and microscopic anatomy of the canine intrinsic cardiac nervous system. Anat Rec 239:75–87PubMedCrossRefGoogle Scholar
  12. 12.
    Schauerte P, Scherlag BJ, Scherlag MA, Jackman WM, Lazzara R (2000) Transvenous parasympathetic nerve stimulation in the inferior vena cava and atrioventricular conduction. J Cardiovasc Electrophysiol 11:64–69PubMedCrossRefGoogle Scholar
  13. 13.
    Schauerte P, Scherlag BJ, Pitha J et al (2000) Transvascular radiofrequency current catheter ablation of parasympathetic cardiac nerves abolishes vagally mediated atrial fibrillation. Circulation 28:2774–2780CrossRefGoogle Scholar
  14. 14.
    Schauerte P, Mischke K, Plisiene J et al (2001) Catheter stimulation of cardiac parasympathetic nerves in humans. A novel approach to the cardiac autonomic nervous system. Circulation 104:2430–2435PubMedCrossRefGoogle Scholar
  15. 15.
    Zhuang S, Zhang Y, Mowrey KA et al (2002) Ventricular rate control by selective vagal stimulation is superior to rhythm regularization by atrioventricular nodal ablation and pacing during atrial fibrillation. Circulation 106:1853–1858PubMedCrossRefGoogle Scholar
  16. 16.
    Schauerte P, Scherlag BJ, Scherlag MA et al (1999) Ventricular rate control during atrial fibrillation by cardiac parasympathetic nerve stimulation. A transvenous approach. J Am Coll Cardiol 34:2043–2050PubMedCrossRefGoogle Scholar
  17. 17.
    Bharati S, Zhang Y, Mazgalev TN (2003) Localized hypertrophy of nerves as a result of long-term selective AVN vagal stimulation. Pacing Clin Electrophysiol 26(4-II):1030 (abstract)Google Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • P. Schauerte
    • 1
  • M. Schmidt
    • 2
  • T. Schimpf
    • 1
  • I. Plisiene
    • 1
  • M. Zarse
    • 1
  • K. Mischke
    • 1
  1. 1.Department of CardiologyAachenGermany
  2. 2.Department of Cardiovascular and Thoracic SurgeryUniversity of TechnologyAachenGermany

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