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Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

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The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
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Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
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β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
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Acute Modulation of Left Ventricular Control by Selective Intracardiac Sympathetic Denervation.

Ann-Kathrin Kahle1, Niklas Klatt2, Christiane Jungen3

  • 1Division of Cardiology, Angiology, and Intensive Care Medicine, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany; Institute of Neural and Sensory Physiology, Cardiac Neuro- and Electrophysiology Research Consortium, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany.

JACC. Clinical Electrophysiology
|February 8, 2023
PubMed
Summary
This summary is machine-generated.

Selective sympathetic denervation via coronary sinus (CS) catheter ablation modulates left ventricular control. This approach prolongs ventricular refractory periods in mice and reduces blood pressure response to stimulation in sheep, demonstrating effective cardiac sympathetic nerve targeting.

Keywords:
catheter ablationcoronary sinusintracardiac sympathetic denervationintrinsic cardiac nervous systemleft ventricular sympathetic denervation

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Area of Science:

  • Cardiovascular Physiology
  • Interventional Cardiology
  • Neuroscience

Background:

  • The sympathetic nervous system significantly influences cardiac function.
  • Nerve fibers controlling the left ventricle can be accessed via the coronary sinus (CS).

Purpose of the Study:

  • To investigate the modulation of left ventricular control through selective intracardiac sympathetic denervation.
  • To assess the efficacy of targeting sympathetic nerves along the CS.

Main Methods:

  • Epicardial CS ablation was performed in murine hearts to study effects on cardiac electrophysiology.
  • Transvenous catheter radiofrequency ablation via the CS was used for anatomically driven axotomy in sheep, evaluated during stellate ganglion stimulation.

Main Results:

  • CS ablation in mice prolonged epicardial ventricular refractory periods, both with and without beta-adrenergic receptor blockade.
  • In sheep, catheter ablation via the CS significantly reduced the increase in systolic and diastolic blood pressure during stellate ganglion stimulation.
  • Neuromorphological studies confirmed a circumferential neural network within the CS.

Conclusions:

  • Transvenous, anatomically driven axotomy targeting nerve fibers along the CS effectively modulates left ventricular control.
  • This technique allows for selective intracardiac sympathetic denervation, offering a potential therapeutic approach.