Darrell O. Wagner

Effects of electrical stimulation of the carotid sinus baroreflex using the Rheos® device on ventricular-vascular coupling and myocardial efficiency assessed by pressure-volume relations in non-vagotomized anesthetized dogs

We investigated the effects of the carotid sinus baroreflex on coupling of the left ventricle (LV) and the arterial system in twelve anesthetized dogs, with all nerves and carotid sinus circulation intact and instrumented to measure LV pressure and volume. The Rheos® device was used to directly electrically stimulate the carotid sinus baroreceptors. Stimulation resulted in a significant reduction in systolic blood pressure (SBP), 95.6±8.1 to 77.3±5.3 mmHg (p<0.0001) and heart rate (HR), 85±13.2 to 67.2±18.8 (p<.001). Cardiac output was unchanged. Ventricular-vascular coupling was determined by the ratio of arterial and ventricular elastance (Ea/Ees). At baseline, Ea/Ees was 1.26±0.27 and after stimulation decreased to 0.51±0.16 (p<0.001), favoring optimization of metabolic efficiency. This decrease was entirely due to a reduction in Ea while Ees was unchanged. The maintenance of end-diastolic volume (EDV) during stimulation allowed stroke work (SW) to remain unchanged as arterial pressure decreased. Thus mechanical efficiency, described as the ratio of stroke work to pressure-volume area (SW/PVA) increased from baseline of 0.51±0.05 to 0.69±0.04 (p<0.0001) during baroreceptor stimulation. We conclude that electrical activation of the carotid sinus baroreceptors results in optimization of both energetic and mechanical efficiency and has no acute effect on LV Ees. These novel findings await confirmation in chronically instrumented animals.