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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

Abstract

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].

Keywords

Atrial Fibrillation Coronary Sinus Ventricular Rate Rhythm Control Ventricular Rate Control 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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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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