Korean Circ J.  2010 Aug;40(8):387-390. 10.4070/kcj.2010.40.8.387.

Short-Term Autonomic Denervation of the Atria Using Botulinum Toxin

• Oh S
• Choi EK
• Choi YS

• KMID: 2145530
• DOI: http://doi.org/10.4070/kcj.2010.40.8.387

Abstract

BACKGROUND AND OBJECTIVES
Major epicardial fat pads contain cardiac ganglionated plexi (GP) of the autonomic nervous system. Autonomic denervation may improve the success rate of atrial fibrillation (AF) ablation. This study was designed to elucidate the acute effects of blocking the right atrium-pulmonary vein (RA-PV) and left atrium-inferior vena cava (LA-IVC) fat pads on the electrophysiologic characteristics of the atrium and AF inducibility with a botulinum toxin injection. Materials and Methods: Eight mongrel dogs were studied. The RA-PV and LA-IVC fat pads were exposed through a median thoracotomy. Botulinum toxin (BT, 50 U to each fat pad, n=6) or normal saline (NS, n=2) was injected in the entire area of two fat pads. The study protocol was applied before injection and repeated at 1, 2, 3, 4, and 5 hours thereafter. The sinus rate, ventricular rate during rapid atrial pacing with a cycle length of 50 ms, and AF inducibility were measured with and without vagal stimulation (VS). Bilateral cervical VS was applied (20 Hz, 0.2 ms, 5.6+/-2.0 V). AF inducibility was evaluated with burst pacing with 200 impulses at a 50-ms cycle length.
RESULTS
VS effects on the sinus node and AF inducibility were eliminated a few hours after injection of BT; these changes were not observed after injection of NS.
CONCLUSION
Short-term autonomic denervation of the atria was achieved by blocking the major epicardial GP with BT.

Keyword

Botulinum toxins; Autonomic nerves; Atrium

MeSH Terms

Adipose Tissue
Animals
Atrial Fibrillation
Autonomic Denervation
Autonomic Nervous System
Autonomic Pathways
Botulinum Toxins
Dogs
Ganglion Cysts
Sinoatrial Node
Thoracotomy
Veins
Botulinum Toxins

Figure

• 

  Fig. 1 Vagal stimulation effect on the sinus and atrioventricular nodes. A: sinus rate during VS (%) vs. non-VS. B: ventricular response rate during VS (%) vs. non-VS. The abscissa indicates time after injection (BT or NS). Error bars indicate one standard deviation. *p<0.05 for BT vs. NS. VS: vagal stimulation, non-VS: baseline state without VS, BT: botulinum toxin group, NS: normal saline group.

• 

  Fig. 2 AF inducibility. The abscissa indicates time after injection (BT or NS). Error bars indicate one standard deviation. Error bars indicate one standard error. *p<0.05 for BT vs. NS. AF: atrial fibrillation, BT: botulinum toxin group, NS: normal saline group.

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