Left-sided Noninvasive Vagus Nerve Stimulation Suppresses Atrial Fibrillation by Upregulating Atrial Gap Junctions in Canines. 2015

Mingxian Chen, and Xiaoya Zhou, and Qiming Liu, and Xia Sheng, and Lilei Yu, and Zhuo Wang, and Songyun Wang, and Shenghua Zhou
*Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; †Department of Cardiology, Renmin Hospital, Wuhan University, Wuhan, Hubei, China; and ‡Department of Cardiology, Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, China.

BACKGROUND We have previously shown that right-sided low-level tragus nerve stimulation (LL-TS) is an effective approach for the treatment of atrial fibrillation (AF) induced by rapid atrial pacing (RAP) and acts by preventing the loss of atrial connexins (Cxs). Whether a left-sided approach would achieve the same effect remains unknown. OBJECTIVE We hypothesized that left-sided LL-TS would inhibit AF by preserving atrial Cxs as effectively as right-sided LL-TS. METHODS Bilateral thoracotomies allowed the attachment of multielectrode catheters to the pulmonary vein and non-pulmonary vein sites in 32 anaesthetized beagles. The dogs were randomly divided into 3 groups: RAP group (9 hours of RAP at the left appendage, n = 10), LL-TS group (9-hour RAP plus LL-TS, n = 12), and control group (sham RAP without LL-TS, n = 10). Alligator clips were clipped on the tragus of the left ear for electrical stimulation (20 Hz, 1 millisecond square waves). A voltage of stimulation setting at 80% below the threshold that slowed the sinus rate was defined as LL-TS. Electrophysiological parameters were measured at baseline and 9 hours after pacing. Connexin proteins from atrial tissues were measured at the end of the protocol. RESULTS RAP induced a significant reduction in the effective refractory period and an increase in AF inducibility (P < 0.05). However, left-sided LL-TS reversed the effective refractory period reduction induced by RAP and the increase in AF inducibility. It also shortened the AF duration and prolonged the AF cycle length, which are associated with Cx40 and Cx43 upregulation (P < 0.05). CONCLUSIONS We propose that left-sided LL-TS exerts its anti-AF effects through upregulation of Cxs as effectively as right-sided LL-TS, suggesting that LL-TS for AF suppression is not unique to the right tragus nerve.

UI MeSH Term Description Entries
D008297 Male Males
D004285 Dogs The domestic dog, Canis familiaris, comprising about 400 breeds, of the carnivore family CANIDAE. They are worldwide in distribution and live in association with people. (Walker's Mammals of the World, 5th ed, p1065) Canis familiaris,Dog
D004424 Ear Canal The narrow passage way that conducts the sound collected by the EAR AURICLE to the TYMPANIC MEMBRANE. Auditory Canal, External,External Acoustic Canal,External Acoustic Meatus,External Auditory Canal,External Ear Canal,Acoustic Canal, External,Acoustic Canals, External,Acoustic Meatus, External,Auditory Canals, External,Canal, Ear,Canal, External Ear,Canals, Ear,Canals, External Ear,Ear Canal, External,Ear Canals,Ear Canals, External,External Acoustic Canals,External Auditory Canals,External Ear Canals
D006325 Heart Atria The chambers of the heart, to which the BLOOD returns from the circulation. Heart Atrium,Left Atrium,Right Atrium,Atria, Heart,Atrium, Heart,Atrium, Left,Atrium, Right
D000818 Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, Animalia was one of the kingdoms. Under the modern three domain model, Animalia represents one of the many groups in the domain EUKARYOTA. Animal,Metazoa,Animalia
D001281 Atrial Fibrillation Abnormal cardiac rhythm that is characterized by rapid, uncoordinated firing of electrical impulses in the upper chambers of the heart (HEART ATRIA). In such case, blood cannot be effectively pumped into the lower chambers of the heart (HEART VENTRICLES). It is caused by abnormal impulse generation. Auricular Fibrillation,Familial Atrial Fibrillation,Paroxysmal Atrial Fibrillation,Persistent Atrial Fibrillation,Atrial Fibrillation, Familial,Atrial Fibrillation, Paroxysmal,Atrial Fibrillation, Persistent,Atrial Fibrillations,Atrial Fibrillations, Familial,Atrial Fibrillations, Paroxysmal,Atrial Fibrillations, Persistent,Auricular Fibrillations,Familial Atrial Fibrillations,Fibrillation, Atrial,Fibrillation, Auricular,Fibrillation, Familial Atrial,Fibrillation, Paroxysmal Atrial,Fibrillation, Persistent Atrial,Fibrillations, Atrial,Fibrillations, Auricular,Fibrillations, Familial Atrial,Fibrillations, Paroxysmal Atrial,Fibrillations, Persistent Atrial,Paroxysmal Atrial Fibrillations,Persistent Atrial Fibrillations
D015854 Up-Regulation A positive regulatory effect on physiological processes at the molecular, cellular, or systemic level. At the molecular level, the major regulatory sites include membrane receptors, genes (GENE EXPRESSION REGULATION), mRNAs (RNA, MESSENGER), and proteins. Receptor Up-Regulation,Upregulation,Up-Regulation (Physiology),Up Regulation
D017629 Gap Junctions Connections between cells which allow passage of small molecules and electric current. Gap junctions were first described anatomically as regions of close apposition between cells with a narrow (1-2 nm) gap between cell membranes. The variety in the properties of gap junctions is reflected in the number of CONNEXINS, the family of proteins which form the junctions. Gap Junction,Junction, Gap,Junctions, Gap
D055536 Vagus Nerve Stimulation An adjunctive treatment for PARTIAL EPILEPSY and refractory DEPRESSION that delivers electrical impulses to the brain via the VAGUS NERVE. A battery implanted under the skin supplies the energy. Vagal Nerve Stimulation,Nerve Stimulation, Vagal,Nerve Stimulation, Vagus,Nerve Stimulations, Vagal,Nerve Stimulations, Vagus,Stimulation, Vagal Nerve,Stimulation, Vagus Nerve,Stimulations, Vagal Nerve,Stimulations, Vagus Nerve,Vagal Nerve Stimulations,Vagus Nerve Stimulations

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