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The principle of electrical carotid sinus nerve stimulation: A nerve pacemaker system for angina pectoris and hypertension therapy

  • Cardiovascular Control
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Abstract

Electrical carotid sinus nerve stimulation (CSNS) via an implanted electrode receiver assembly, radio frequency coupled to an external signal generator, is an experimental therapy for hypertension and angina pectoris. CSNS increases afferent information to the central nervous system exerting neurally regulated decreases in heart rate, stroke volume, and blood pressure. No nonspecific side effects are observed, in contrast to drug therapy. A nerve pacemaker system is described and compared to the commonly used open-loop stimulator system (fixed frequency and intensity CSNS). It is a closed-loop system, controlled by heart rate (as an indicator of the state of “arousal” and of sympathetic activity) and, thereby, feedback-controlled by its therapeutic effects. The miniaturized (hybrid technology) system consists of an ECG amplifier, a stimulus pattern memory with I-O periphery and a transmitter, including an antenna coil to be coupled to the implanted assembly. Stimulus parameters (frequency and amplitude of impulses) are optimized for each patient individually. Stimulus patterns (pulse synchronous amplitude modulated groups of impulses) are adapted to the patient's cardiovascular situation. The nerve pacemaker may be an alternative to drug therapy or major surgery in both diseases. Compatible with the open-loop system, it replaces the first step in previously treated CSNS patients.

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References

  1. Bilgutay, A.M., and C.W. Lillehei. Surgical treatment of hypertension with references to baropacing.Am. J. Cardiol. 17:663–667, 1966.

    Article  CAS  PubMed  Google Scholar 

  2. Birks, R.I. Regulation by patterned preganglionic neural activity of transmitter stores in a sympathetic ganglion.J. Physiol. 280:559–572, 1978.

    CAS  PubMed  Google Scholar 

  3. Braunwald, E., S.F. Vatner, N.S. Braunwald, and B.E. Sobel. Carotid sinus nerve stimulation in the treatment of angina pectoris and supraventricular tachycardia.Calif. Med. 112:41–50, 1970.

    CAS  PubMed  Google Scholar 

  4. Brest, A.N., L. Wiener, and B. Bachrach. Bilateral carotid sinus nerve stimulation in the treatment of hypertension.Am. J. Cardiol. 29:821–825, 1972.

    Article  CAS  PubMed  Google Scholar 

  5. Daube, R., K.-H. Dittberner, J. Korsukewitz, J. Wagner, and E. Zerbst. The effect of delay time in R-wave triggered baropacing on orthostasis in man.Pflügers Arch. 343:R30, 1973. Abstract.

    Google Scholar 

  6. Dunning, A.J. Electrical stimulation of the carotid sinus nerves.Med. Prog. Technol. 1:75–81, 1972.

    CAS  PubMed  Google Scholar 

  7. Epstein, S.E., G.D. Beiser, R.E. Goldstein, D. Redwood, D.R. Rosing, G. Glick, A.S. Wechsler, M. Stampfer, L.S. Cohen, R.L. Reis, N.S. Braunwald, and E. Braunwald. Treatment of angina pectoris by electrical stimulation of the carotid-sinus nerves.N. Engl. J. Med. 280:971–978, 1969.

    CAS  PubMed  Google Scholar 

  8. Ernst, C.B., L. Hansson, S. Hunyor, and S. Julius. Stimulering av sinusnerverna med implanterad baropacer vid terapiresistent hypertension.Läkartidningen 70:1166–1168, 1973.

    CAS  PubMed  Google Scholar 

  9. Farrehi, C. Stimulation of the carotid sinus nerve in treatment of angina pectoris.Am. Heart J. 80:759–765, 1970.

    Article  CAS  PubMed  Google Scholar 

  10. Geha, A.S., M.S. Robert, E. Kleiger, and A.E. Baue. Bilateral carotid nerve stimulation in the treatment of angina pectoris.Angiology 25:16–20, 1974.

    CAS  PubMed  Google Scholar 

  11. Gobel, F.L., L.A. Nordstrom, R.R. Nelson, C.R. Jorgensen, and Y. Wang. The rate-pressure product as an index of myocardial oxygen consumption during exercise in patients with angina pectoris.Circulation 57:549–556, 1978.

    CAS  PubMed  Google Scholar 

  12. Helmer, E., F. Kaindl, P. Kohn, and E. Navrátil. Karotissinusmerv-Stimulation bei Angina pectoris.Wien. Klin. Wochenschr. 83:753–758, 1971.

    CAS  PubMed  Google Scholar 

  13. Koralewski, H.-E., T. Peters, and E. Zerbst. Optimization of electrical carotid sinus nerve stimulation in man by means of the evolution strategy.Eur. J. Physiol. Pflügers Arch. Suppl. to Vol. 373:R77, 1978.

    Google Scholar 

  14. Korsukewitz, J., J. Wagner, K.-H. Dittberner, and E. Zerbst. Methoden zur Verbesserung der elektrischen Carotissinusnerven-Reizung.Klin. Wochenschr. 51:506–510, 1973.

    Article  CAS  PubMed  Google Scholar 

  15. Korsukewitz, J., J. Wagner, K.-H. Dittberner, and E. Zerbst. Open and closed loop carotid sinus nerve stimulation in man. In:Central Rhythmic and Regulation, edited by W. Umbach and H.P. Koepchen. Stuttgart: Hippokrates-Verlag, 1974, pp. 159–164.

    Google Scholar 

  16. McIntosh, H.D., and J.A. Garcia. The first decade of aortocoronary by pass grafting, 1967–1977.Circulation 57:405–431, 1978.

    CAS  PubMed  Google Scholar 

  17. Peters, T., H.-E. Koralewski, and E. Zerbst. Tierexperimentelle Untersuchungen zum rückgekoppelten Baropacing mit Reizimpulsamplitudenmodulation.Biomed. Tech. 21:Suppl. 199–200, 1976.

    Google Scholar 

  18. Peters, T., T.-E. Koralewski, A. Schulze-Schönenberg, and E. Zerbst. Temporal vs. spatial summation with electrical activation of cardiovascular afferents.Proc. Int. Union Physiol. Sci. 13: 590, 1977 (Abstract)

    Google Scholar 

  19. Peters, T., H.-E. Koralewski, G. Schilling, and E. Zerbst. Determination of individual stimulation parameters in electrical carotid sinus nerve stimulation applied in man.Eur. J. Physiol. Pflügers Arch. Suppl. to Vol. 373:R78, 1978.

    Google Scholar 

  20. Rechenberg, I. Evolutionsstrategien. In:Simulationsmethoden in der Medizin und Biologie, edited by B. Schneider and U. Ranft. Berlin-Heidelber-New York: Springer, 1978, pp. 84–144.

    Google Scholar 

  21. Rotem, C.E. Carotid sinus nerve stimulation in the management of intractable angina pectoris: Four-year follow-up.Can. Med. Assoc. J. 110:285–288, 1974.

    CAS  PubMed  Google Scholar 

  22. Rothfeld, E.L., V. Parsonnet, K.V. Raman, R. Zucker, and R. Tiu. The effect of carotid sinus nerve stimulation on cardiovascular dynamics in man.Angiology XX:213–218, 1969.

    Google Scholar 

  23. Schwartz, S.I., L.S.C. Griffith, A. Neistadt, and N. Hagfors. Chronic carotid sinus nerve stimulation in the treatment of essential hypertension.Am. J. Surg. 114:5–15, 1967.

    Article  CAS  PubMed  Google Scholar 

  24. Solti, F., Z. Szabó, Gy. Kerkovits, G. Budai, E. Bodor, and I. Kalmár. Baropacing of the carotid sinus nerve for treatment of “intractable” hypertension.Z. Kardiol. 64:368–374, 1975.

    CAS  PubMed  Google Scholar 

  25. Torresani, J., G. Heuilletet al. Hypertension artérielle grave. Traitment par stimulation du nerf du sinus carotidien.Arch. Mal. Coeur 60:1032–1040, 1967.

    CAS  PubMed  Google Scholar 

  26. Torresani, J., A.-M. Chevalier-Cholat, G. Heuillet, A. Sommer, and A. Jouve. Stimulation du nerf du sinus carotidien dans l'angine de poitrine. Résultats clinicques.Ann. Cardiol. Angeiol. 20: 119–122, 1971.

    CAS  Google Scholar 

  27. Tuckman, J., T. Reich, A.F. Lyon, B. Goodman, and J.H. Jacobsen II. Sinus nerve stimulation in the control of hypertension. Cerebral Vascular Diseases (Sixth conference), 1968, pp. 137–151.

  28. Wagner, J., J. Korsukewitz, W. Meyer, K.-H. Dittberner, E. Zerbst, and A. Schaede. Carotissinusnerven-Stimulation.Dtsch. Med. Wochenschr. 98:37–43, 1973.

    CAS  PubMed  Google Scholar 

  29. Zerbst, E., K.-H. Dittberner, and V. Kötter. Studies on blood-pressure regulation by the use of a baroreceptor analog.Pflügers Arch. 315:232–249, 1970.

    Article  CAS  PubMed  Google Scholar 

  30. Zerbst, E., K.-H. Ditterner, R. Daube, J. Korsukewitz, J. Wagner, R. Blaser, and M. Schaldach. Electronic closed loop control by means of a baroreceptor analog.Proc. Eur. Soc. Artif. Organs 1:172–175, 1975.

    Google Scholar 

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Authors and Affiliations

  1. Department of Physiology, Free University of Berlin, Arnimallee 22, D 1000, Berlin 33, Federal Republic of Germany

    Tim K. Peters, H. -E. Koralewski & E. Zerbst

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  1. Tim K. Peters
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  2. H. -E. Koralewski
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  3. E. Zerbst
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Additional information

Clinical application was possible through cooperation with the Department of Cardiology, Medical Clinic, Bonn University, Bonn, Germany, FRG (Prof. Schaede, Prof. Simon and Dr. Schilling). The miniaturized (hybrid technology) version of the nerve pacemaker was realized through cooperation with the Berlin Technical University (W. George). Parts of this work were sponsored by Stiftung Volkswagenwerk and Deutsche Forschungsgemeinschaft.

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Peters, T.K., Koralewski, H.E. & Zerbst, E. The principle of electrical carotid sinus nerve stimulation: A nerve pacemaker system for angina pectoris and hypertension therapy. Ann Biomed Eng 8, 445–458 (1980). https://doi.org/10.1007/BF02363445

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