Stimulation Mapping of the Pulmonary Artery for Denervation Procedures: an Experimental Study
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ORIGINAL ARTICLE
Stimulation Mapping of the Pulmonary Artery for Denervation Procedures: an Experimental Study Heber Ivan Condori Leandro 1 & Aleksandr D. Vakhrushev 1 & Natalia S. Goncharova 2 & Lev E. Korobchenko 3 & Elena G. Koshevaya 4 & Lubov B. Mitrofanova 4 & Elizaveta M. Andreeva 3 & Olga M. Moiseeva 2 & Dmitry S. Lebedev 5,6 & Evgeny N. Mikhaylov 1,5,6 Received: 29 July 2020 / Accepted: 13 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Transcatheter pulmonary artery denervation (PADN) has been developed for the correction of pulmonary hypertension. We investigated pulmonary artery stimulation mapping and its role in PADN procedures. Artery stimulation was performed in 17 Landrace pigs. Low-frequency stimulation defined areas of ventricular and atrial capture. High-frequency stimulation evoked the following responses: sinus rhythm slowing and/or atrial rhythm acceleration in 59% of animals, phrenic nerve capture in 100%, and laryngeal recurrent nerve capture in 23%. The sites with evoked heart rate responses were marked by discrete radiofrequency ablations (RFA). An autopsy showed nerves in the adventitia and perivascular fat under the RFA sites, and the lack of muscarinic1, tyrosine hydroxylase, and dopamine-5 receptors’ expression. During PADN, areas adjacent to the course of phrenic and recurrent laryngeal nerves should be avoided. RFA at points with heart rate responses leads to the non-reproducibility of evoked reactions and the disappearance of neural markers’ expression.
Keywords Pulmonary arterial denervation . Perivascular nerve stimulation . Mapping . Ablation . Denervation Abbreviations CVP Central venous pressure HFS High-frequency stimulation ISABP Invasive systemic arterial blood pressure Associate Editor Marat Fudim oversaw the review of this article
LFS mPAP PA PADN PAH PAP RFA
Low-frequency stimulation Mean pulmonary artery pressure Pulmonary artery Pulmonary artery denervation Pulmonary arterial hypertension Pulmonary artery pressure Radiofrequency ablation
* Evgeny N. Mikhaylov [email protected] 1
Neuromodulation Laboratory, Almazov National Medical Research Centre, 197341, Akkuratova st.2, Saint Petersburg, Russian Federation
2
Non-coronary Heart Disease Department, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
3
Pavlov First Saint Petersburg Medical University, Saint Petersburg, Russian Federation
4
Pathology Department, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
5
Arrhythmia Department, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
6
Department of Bioengineering Systems, Saint Petersburg Electrotechnical University “LETI”, Saint Petersburg, Russian Federation
Introduction Pulmonary arterial hypertension (PAH) is a progressive disease with a dismal prognosis [1]. The increased sympathetic neural activity has been linked to the pathogenesis of PAH [2]. Rudner et al. reported the presence of sympathetic nerves in the
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