Carotid Chemoreceptor Ablation Improves Survival in Heart Failure: Rescuing Autonomic Control of Cardiorespiratory Function

Sep 04, 2013
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Authors:
Del Rio R, Marcus NJ, Schultz HD.
Citation:
J Am Coll Cardiol 2013;Sep 4:[Epub ahead of print].
Summary By:
Hitinder S. Gurm, MBBS, FACC

Study Questions:

What is the impact of carotid chemoreceptor ablation on survival in animal models of heart failure (HF)?

Methods:

Congestive HF (CHF) was induced by coronary ligation in rats. Selective CB denervation (CBD) was performed to remove carotid chemoreflex drive 16 weeks post–myocardial infarction (MI). Indices of autonomic and respiratory function were assessed in CB intact and CBD animals.

Results:

Selective CB ablation was associated with a reduction in central presympathetic neuronal activation by 40%, normalization of indices of sympathetic outflow and baroreflex sensitivity, and reduced incidence of apnea in CHF animals from 16.8 ± 1.8 events/hour to 8.0 ± 1.4 events/hour. CBD was associated with a reduction in cardiac remodeling, greater preservation of left ventricular ejection fraction, and reduction in cardiac arrhythmias. CBD was associated with an improved survival (85% vs. 45%).

Conclusions:

The authors concluded that CBD early after MI is associated with a reduction in autonomic dysfunction and improvement in survival.

Perspective:

CBD is an interesting therapeutic approach, but it requires validation in larger animals before it can be considered for phase I evaluation in humans. The magnitude of survival demonstrated in this study is impressive, although it would be important to assess the incremental benefit of CBD on a background of contemporary HF therapy.

Keywords: Myocardial Infarction, Denervation, Autonomic Nervous System, Heart Diseases, Incidence, Chemoreceptor Cells, Cardiology, Ventricular Remodeling, Heart Failure, Stroke Volume, Ventricular Function, Respiration, Survival


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