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Biomedical subjects

M N Levy

Publications and source records attributed to M N Levy.

At least 19 recordsLinked to original sources
PubMed1992

Analysis of vagally induced sinus arrhythmias.

Vagal stimulation at precise times in successive cardiac cycles can elicit sinus arrhythmias. Two mechanisms have been identified that can, but do not necessarily, cause these vagally induced sinus arrhythmias. First, changes in cycle length elicited by a given concentration of acetylcholine (ACh) depend on the phase of the pacemaker cell action potential when the ACh binds to muscarinic receptors. Second, acetylcholinesterase degrades ACh rapidly enough for the mean concentration of ACh per cardiac cycle to vary from cycle to cycle. We used a mathematical model of the underlying cellular physiology, to examine whether these mechanisms are responsible for arrhythmogenesis. Computer simulation showed that both mechanisms contribute to the vagally induced sinus arrhythmias.

Arrhythmias, Cardiac↗
PubMed1992

Synergism between cAMP and ATP in signal transduction in cardiac myocytes.

ATP transiently increases the intracellular Ca2+ concentration in cardiac myocyte suspensions. Pretreatment with norepinephrine (NE) greatly potentiates the ATP response. We performed experiments on adult rat myocyte suspensions loaded with fura-2 to investigate the mechanism of NE potentiation. We found that forskolin (an activator of adenylate cyclase), 3-isobutyl-1-methylxanthine (an inhibitor of phosphodiesterase), and permeative adenosine 3',5'-cyclic monophosphate (cAMP) analogues potentiate the increase in cytosolic Ca2+ concentration induced by ATP. NE, forskolin, and 8-(4-chlorophenylthio)-cAMP all increase Vmax of the Ca2+ response curve of ATP. Measurement of cAMP by radioimmunoassay confirmed that the changes in the ATP response were accompanied by an increase in cAMP. These results suggest that the noradrenergic potentiation of the ATP-induced Ca2+ mobilization involves cAMP as a second messenger. Patch-clamp studies of isolated myocytes showed that neither NE nor forskolin alters the inward current elicited by ATP, but rather they increase the duration of secondary slow action potentials elicited by ATP. NE also increases the Ca2+ current through L-type Ca2+ channels in the myocytes. We conclude that NE potentiates the ATP-induced Ca2+ transient by increasing cAMP levels and that one of the early events is the increase of the inward Ca2+ current during the action potential.

Adenosine Triphosphate↗
PubMed1992

Ca2+ mobilization by extracellular ATP in rat cardiac myocytes: regulation by protein kinase C and A.

Activation of protein kinase C (PKC) modulates the mobilization of intracellular Ca2+ induced by extracellular ATP in rat ventricular myocytes. Pretreatment of myocytes with PKC activators attenuated both the ATP-induced Ca2+ transient and the noradrenergic potentiation of the Ca2+ response. Various PKC activators decreased both the basal cAMP level and the cAMP levels that had been elevated by norepinephrine, forskolin, or 3-isobutyl-1-methylxanthine. The inhibitory effects of PKC activators were reversed by the PKC inhibitor staurosporine. The ATP-induced Ca2+ response is an integrated response resulting from ATP eliciting an inward cation current (IATP), cellular depolarization, Ca2+ influx through Ca2+ channels, and Ca2+ release from the sarcoplasmic reticulum. We used the whole cell voltage-clamp technique to investigate which steps of this integrated response are affected by PKC. PKC activators did not significantly affect the IATP. In contrast, PKC activators decreased the basal Ca2+ current (ICa) or Ba2+ current and the beta-adrenergic-stimulated ICa. These results suggest that PKC-induced suppression of the ATP-induced Ca2+ response and the beta-adrenergic-potentiated Ca2+ response is achieved at least partially by decreasing the intracellular cAMP level and ICa.

Adenosine Triphosphate↗
PubMed1992

Selective stimulation of parasympathetic nerve fibers to the human sinoatrial node.

BACKGROUND: In animals, parasympathetic nerve fibers that innervate the sinoatrial node can be selectively stimulated to increase atrial cycle length. These nerve fibers course through an epicardial fat pad at the margin of the right superior pulmonary vein, the superior vena cava, and the right atrium. We hypothesized that similar nerves exist and can be selectively stimulated in humans. METHODS AND RESULTS: Microscopic examination of fat pads excised from the margin of the right superior pulmonary vein, the superior vena cava, and the right atrium during two human autopsies revealed the presence of nerve fibers and ganglia. We electrically stimulated this epicardial fat pad in 16 patients during cardiac surgery. The fat pads were stimulated with continuous-pulse trains for 15 seconds via a hand-held bipolar electrode using constant current (10-15 mA), constant pulse width (0.02-0.05 msec), and at 6.6, 10, 20, 25, and 30 Hz. The mean atrial cycle length +/- 1 SEM increased from 734 +/- 34 msec at baseline to a maximum of 823 +/- 61 msec at 6.6 Hz, 1,167 +/- 125 msec at 10 Hz, 1,734 +/- 281 msec at 20 Hz, 2,993 +/- 661 msec at 25 Hz, and 2,461 +/- 668 msec at 30 Hz during nerve stimulation. Linear regression analysis showed that the response of atrial cycle length to sinoatrial parasympathetic nerve stimulation was frequency dependent. The maximum response and complete decay of the response occurred within 4-8 seconds of initiation or termination of sinoatrial parasympathetic nerve stimulation. Atrioventricular conduction time and the PR interval did not change during sinoatrial parasympathetic nerve stimulation, even when the atria were paced at the baseline heart rate. CONCLUSIONS: Electrical stimulation of parasympathetic nerve fibers in a fat pad near the sinoatrial node increased atrial cycle length without affecting atrioventricular nodal conduction. This is the first study in which such nerve fibers that innervate the sinoatrial node have been selectively stimulated in humans.

Adipose Tissue↗
PubMed1992

Sequence of excitation as a factor in sympathetic-parasympathetic interactions in the heart.

We determined the influence of differences in the time of initiation of sympathetic and vagal stimulation (both at 10 Hz) on the cardiac autonomic interactions in 16 open-chest anesthetized dogs. We always ended the concurrent sympathetic and vagal stimulations simultaneously. Sympathetic stimulation alone for 1 minute increased heart rate by 90 +/- 7 (mean +/- SEM) beats per minute, and vagal stimulation alone for 1 minute decreased heart rate by 67 +/- 5 beats per minute; i.e., the algebraic sum of these responses was an increase of 23 beats per minute. However, combined sympathetic and vagal stimulation for 1 minute actually decreased heart rate by 35 beats per minute; i.e., the vagal effects predominated. When vagal stimulation was initiated first, the chronotropic responses to combined stimulation were not significantly affected by the duration of antecedent vagal stimulation. However, when sympathetic stimulation was initiated first, the vagal predominance (disparity between the summated individual responses and the combined response) progressively diminished as we increased the duration of antecedent sympathetic stimulation. The vagal predominance diminished from a value of 67 +/- 21 beats per minute when the stimulations were initiated simultaneously to a value of 37 +/- 21 beats per minute when the duration of antecedent sympathetic stimulation was 10 minutes. Sympathetic stimulation releases not only norepinephrine but also neuropeptide Y, and this neuropeptide inhibits vagal neurotransmission. Our data suggest, therefore, that the longer the antecedent sympathetic stimulation, the greater the inhibition of vagal neurotransmission (presumably by the neuropeptide Y) and, therefore, the less pronounced the vagal predominance.

Animals↗
PubMed1991

Mathematical model of cellular basis for the respiratory sinus arrhythmia.

The respiratory sinus arrhythmia (RSA) is a vagally mediated oscillation in cardiac cycle length at the frequency of breathing. We developed a mathematical model that predicted the temporal and frequency dependence of the RSA. We used the mathematical model to examine the underlying cellular basis for the RSA at the level of the sinus node. We alternated efferent vagal activity between a low and a high frequency at the frequency of breathing. This oscillation caused the rate of acetylcholine (ACh) release to oscillate between a low and a high rate at the frequency of breathing. ACh degradation followed linear pharmacokinetics for physiological concentrations of ACh. Therefore, the concentration of ACh in neuroeffector junctions of the sinus node oscillated at the frequency of breathing. Membrane potential responded rapidly to changes in the concentration of ACh relative to the rate of ACh degradation. Thus, the time course of the RSA depended on the rate of ACh degradation. Membrane potential oscillated at several integer multiples of frequency of breathing and at various higher frequencies, which were integer multiples of the frequency of breathing and the frequencies of firing of the sinus node. However, computing cardiac cycle length from membrane potential eliminated the higher frequencies. Therefore, cardiac cycle length oscillated at several integer multiples of the frequency of breathing, but not at these higher frequencies.

Acetylcholine↗
PubMed1991

Electrophysiologic mechanisms for ventricular arrhythmias in left ventricular dysfunction: electrolytes, catecholamines and drugs.

Cardiac arrhythmias are generated as the result of disorders of automaticity or of impulse conduction. Regardless of the mechanism, calcium is likely to be involved, although calcium antagonists are rarely useful antiarrhythmics in ventricular arrhythmias. Myocardial cells that do not ordinarily initiate action potentials may do so when they are partially depolarized, giving rise to an ectopic focus. Early afterdepolarizations (EADs) are also induced in cardiac cells by partial depolarization, whereas delayed afterdepolarizations (DADs) are induced by Ca++ overloading. EADs may be the initiating mechanism of torsade de pointes, a complication of QT prolongation associated with quinidine therapy. Both in the animal model and in humans, treatment with magnesium, isoproterenol, or pacing, all of which suppress EADs, will also suppress torsade de pointes. Ventricular tachycardia is a manifestation of ordered re-entry, and may be exacerbated by antiarrhythmics, especially class 1c drugs. In the individual patient, prediction of proarrhythmia is not possible. The risk of proarrhythmia is increased in patients with episodes of sustained ventricular tachycardia or with significant left ventricular dysfunction.

Anti-Arrhythmia Agents↗
PubMed1991

Effects of autonomic nerve stimulation, asynchrony, and load on dP/dtmax and on dP/dtmin.

We studied asynchronous depolarization effects on mechanical responses to autonomic nerve stimulation (ANS) in 21 dogs with AV nodal block. In 11 of these dogs, we kept mean aortic pressure (AoP) at 85 mmHg and paced the hearts at 120 beats/min. We paced, in random order, either the LV apex or the RV anterior or lateral wall to increase the asynchrony of ventricular contraction and relaxation. During pacing at each site, we determined maximum rate of LVP rise (dP/dtmax) and fall (dP/dtmin) before and during stimulation of cardiac sympathetic and vagal nerves and during combined nerve stimulation. Changing the pacing site from LV to RV decreased dP/dtmax and also dP/dtmin (P less than 0.001); the decrease was most pronounced when we shifted pacing from LV apex to RV anterior wall. Sympathetic stimulation increased (P less than 0.0001) and vagal stimulation decreased (P less than 0.001) dP/dtmax and dP/dtmin during pacing at each site. Effect of vagal stimulation was substantially enhanced during concomitant sympathetic stimulation. However, the magnitude of changes in dP/dtmax and also in dP/dtmin due to nerve stimulations during pacing at each ventricular site was similar. In 10 additional dog experiments, we also varied AoP from a mean value of 74 to 113 mmHg during pacing at each site. An increase in AoP augmented dP/dtmax by a mean value of 582 mmHg/s and increased dP/dtmin by a mean value of 617 mmHg/s (both P less than 0.0001). Sympathetic stimulation increased, whereas vagal stimulation decreased, dP/dtmax and dP/dtmin at each afterload (P less than 0.001).

Animals↗
PubMed1991

Effects of spatial dispersion of acetylcholine release on AV conduction responses to vagal stimulation in dogs.

We determined the effects on atrioventricular (AV) conduction of changing the spatial dispersion of acetylcholine (ACh) release from vagal nerve fibers in anesthetized dogs. We paced the atria at a constant rate and stimulated the vagus nerves with one stimulus burst per cardiac cycle. We varied the spatial heterogeneity of ACh release in the cardiac tissues by changing the stimulus voltage, and we varied the quantity of ACh release from each excited nerve fiber by changing the number of pulses per stimulus burst. We slightly changed the stimulus timing with each heartbeat to scan the entire cardiac cycle. We constructed phase-response curves (PRCs) by plotting the changes in AV conduction time as a function of the timing of vagal stimulation. We found that the amplitude of the PRC varied directly with average AV conduction time (AV), whereas the minimum-to-maximum phase difference of the PRC varied inversely with AV. However, for any given change in AV, the specific characteristics of the PRCs did not depend on whether we varied the number of pulses per burst or the stimulus voltage. Therefore, the phase-dependent characteristics of the dromotropic responses appear to be unaffected by the spatial dispersion of ACh release from the vagal nerve endings. The effects of vagal activity on the AV conduction time are determined by those conducting fibers that are the least restrained by neurally released ACh.

Acetylcholine↗
PubMed1991

Sympathetic stimulation-evoked overflow of norepinephrine and neuropeptide Y from the heart.

Neuropeptide Y (NPY) and norepinephrine are released together on sympathetic activation. To compare the time courses of NPY and norepinephrine washout from cardiac tissues, we measured the overflow of NPY-like immunoreactivity (NPY-LI) and norepinephrine in coronary sinus blood before, during, and after 3-minute trains of ansae subclaviae stimulation in 13 anesthetized dogs. We also measured vagally induced cardiac cycle length responses before and after ansae stimulation. Ansae stimulation increased NPY-LI and norepinephrine overflow from the heart in a frequency-dependent manner (p less than 0.02). After stimulation of the ansae at 5 and 10 Hz, the peak norepinephrine overflows decayed by 90% within 2 minutes, but the NPY-LI overflows required 17 +/- 11 and 35 +/- 21 minutes, respectively, to decay by 90%. Cardiac vagal effects were inhibited after 5- and 10-Hz ansae stimulations, and the peak inhibitions decayed by 90% after 19 +/- 7 and 39 +/- 16 minutes, respectively. The 90% decay times of the NPY-LI overflows were longer (p less than 0.003) than those of the norepinephrine overflows but did not differ significantly (p greater than 0.4) from the 90% decay times of the inhibition of vagal effects. We characterized NPY-LI in coronary sinus and arterial plasma by reversed-phase high-performance liquid chromatography. Before ansae stimulation, the main peak of NPY-LI in the plasma had a retention time similar to that of the oxidized human NPY-(1-36) standard. During ansae stimulation, however, there was a substantial increase in the peak of NPY-LI that eluted in a position similar to that of the monoxidized human NPY-(1-36) standard. These data support the hypothesis that neurally released NPY mediates the sympathetically evoked inhibition of vagal effects and indicate that the time course of removal of NPY from the heart differs substantially from that of norepinephrine. Moreover, under basal conditions, most NPY in the circulation is present in the oxidized form or as a fragment of the 36-amino-acid peptide. In contrast, cardiac sympathetic stimulation evokes the overflow of monoxidized NPY-(1-36) into the coronary sinus plasma.

Animals↗
PubMed1990

Vagal stimulation attenuates sympathetic enhancement of left ventricular function.

We studied the effects of stimulation of the vagal and sympathetic cardiac nerves on left ventricular contraction and relaxation in 16 anesthetized dogs. In each experiment, we paced the ventricles at a fixed rate of 120 beats/min, and we kept the systemic arterial pressure constant. We used the maximum rates of left ventricular pressure rise (dP/dtmax) and fall (dP/dtmin) as our indexes of ventricular contraction and relaxation. Sympathetic nerve stimulation at a frequency of 6 Hz increased dP/dtmax by 802 mmHg/s and raised dP/dtmin by 847 mmHg/s above the control level. The effect of vagal nerve stimulation was directly dependent on the level of sympathetic stimulation. In the absence of sympathetic stimulation, vagal nerve stimulation at a frequency of 5 Hz decreased dP/dtmax by 187 mmHg/s and reduced dP/dtmin by 199 mmHg/s below the control level. When the sympathetic stimulation was 6 Hz, vagal nerve stimulation at 5 Hz decreased dP/dtmax by 513 mmHg/s and reduced dP/dtmin by 709 mmHg/s. Furthermore, propranolol, in doses of 1.5 mg/kg, abolished any significant vagal effect on ventricular contraction or relaxation. We conclude that combined sympathetic-vagal stimulation results in a substantial antagonistic interaction such that vagal stimulation significantly attenuates the sympathetic enhancement of left ventricular function.

Animals↗
PubMed1990

AV junctional rhythm induced by sympathetic-parasympathetic imbalance in dog hearts.

We studied the atrioventricular (AV) junctional rhythm induced by stimulation of discrete autonomic nerves to the AV nodal area in spontaneously beating hearts of anesthetized dogs where all central autonomic connections to the heart had been cut. Simultaneous stimulation of intracardiac sympathetic and parasympathetic nerves to the AV nodal area (AVSP stimulation, at the junction of the inferior vena cava and left atrium) initially increased and then decreased the AV interval. During such stimuli no AV junctional rhythm was observed; however, after cessation of stimulation, an AV junctional rhythm then appeared in 6 of 12 dogs. Because norepinephrine (NE) persists much longer than acetylcholine in cardiac tissues, we postulated that the junctional rhythm was ascribable to the residual NE that had been released during stimulation. After the animals had been given atropine, an AV junctional rhythm was induced in all animals during AVSP stimulation. These junctional rhythms were suppressed by propranolol or by pacing the atria at a rate faster than the rate of the junctional rhythm. These results suggest that a regional sympathetic-parasympathetic imbalance may unmask subsidiary pacemaking activity, such as an AV junctional rhythm.

Animals↗
PubMed1990

Chronotropic and dromotropic responses to stimulation of intracardiac sympathetic nerves to sinoatrial or atrioventricular nodal region in anesthetized dogs.

We gave atropine intravenously to autonomically decentralized, open-chest, anesthetized dogs and stimulated the discrete intracardiac sympathetic nerve fibers to the sinoatrial (SA) (SAS stimulation) or atrioventricular (AV (AVS stimulation) nodal region. A brief burst of neural stimuli was delivered during each cardiac cycle. SAS stimulation consistently decreased the atrial cycle length but had variable effects on the AV interval. The positive chronotropic response to SAS stimulation increased when the level of stimulation (i.e., stimulus pulse duration, pulse amplitude, and number of pulses per burst) was increased. When the heart rate was held constant by atrial pacing, SAS stimulation did not change the AV interval. AVS stimulation decreased the AV conduction time but did not change the atrial cycle length. The AV conduction response increased when the level of AVS stimulation was increased. A high level of AVS stimulation induced an AV junctional rhythm in seven of eight experiments. When the atrial pacing interval was decreased, the basal AV interval increased, and the decrease in AV interval induced by AVS stimulation was exaggerated. The chronotropic response to SAS stimulation and the dromotropic response to AVS stimulation were abolished by propranolol given systemically and by lidocaine given topically. From these results, we conclude that in anesthetized dogs treated with atropine, activation of the discrete intracardiac sympathetic nerves to the SA and AV nodal regions controls the sinus rate and AV conduction time independently and activation of the discrete sympathetic nerves may shift the dominant pacemaker site to a subsidiary site.

Animals↗
PubMed1990

Insignificant bilateral convergence of preganglionic vagal fibers on postganglionic neurons to the canine heart.

We determined the extent of convergence of preganglionic fibers from the right and left vagus nerves on postganglionic neurons that supply the sinoatrial node in chloralose-anesthetized dogs. We administered hemicholinium-3 and stimulated the right vagus nerve at a high frequency to deplete acetylcholine from the postganglionic parasympathetic neurons supplied by that nerve. We compared the effects of this "depletion regimen" with the responses in two control groups: a stimulation control group, which was subjected to high-frequency right vagus stimulation only, and a drug control group, which received a hemicholinium-3 infusion only. The effects of right vagus stimulation did not differ from those of left vagus stimulation in either of the control groups. In the animals subjected to the depletion regimen, the responses to right vagus stimulation were almost abolished. However, the left vagus nerve retained its ability to prolong cardiac cycle length in these animals. Thus, our experiments indicate that left vagus preganglionic fibers do not converge with right vagus preganglionic fibers on a substantial pool of postganglionic neurons that innervate the canine sinoatrial node.

Acetylcholine↗
PubMed1990

Sinus and atrioventricular nodal distribution of sympathetic fibers that contain neuropeptide Y.

Neuropeptide Y and norepinephrine are localized in sympathetic nerve terminals throughout the heart. We sought to determine the functional distribution of the neuropeptide Y-containing sympathetic fibers to the sinus and atrioventricular (AV) nodal regions. We recorded cycle length, AV interval, and arterial pressure in 14 anesthetized dogs. We assessed the release of neuropeptide Y from sympathetic nerve terminals by measuring the attenuation of the vagal effects on cycle length and AV interval that occurred after unilateral ansa subclavia stimulation. Three-minute trains of right or left ansa stimulation, each applied at frequencies of 2, 5, and 10 Hz, produced a frequency-dependent inhibition of the vagal effects on cycle length and AV interval. After right ansa stimulation (10 Hz), however, the percent inhibition of the vagal effects on cycle length was 21 +/- 5% greater (p less than 0.001) than the percent inhibition of the vagal effects on AV interval. Conversely, after left ansa stimulation (10 Hz), the percent inhibition of the vagal effects on AV interval was 54 +/- 7% greater (p less than 0.001) than the percent inhibition of the vagal effects on cycle length. The vagal stimulus characteristics (frequency or voltage) did not significantly alter the percent inhibition, nor did the percent inhibition depend on the vagus stimulated (right or left vagus). We conclude that most of the neuropeptide Y-containing sympathetic fibers at the sinus node originate in right-sided ganglia, whereas most of those at the AV node originate in left-sided ganglia.

Adrenergic Fibers↗
PubMed1990

Effects of the spatial dispersion of acetylcholine release on the chronotropic responses to vagal stimulation in dogs.

We determined the effects of changing the spatial dispersion of acetylcholine release on the phase-dependent chronotropic responses to vagal stimulation in anesthetized dogs. We stimulated the vagus nerves with one brief burst of electrical pulses each cardiac cycle, and we changed the timing of the stimulus by a small, constant amount each cardiac cycle to scan the entire cycle. To vary the heterogeneity of acetylcholine release, we changed the voltage of the stimulus pulses over a range of submaximal values. To achieve the maximum homogeneity of acetylcholine release, we used supramaximal voltages, and we varied the level of acetylcholine release from each excited fiber by changing the number of pulses per burst. We used the average cardiac cycle length of the phase-response curve to assess the overall vagal effect, independent of its timing within the cardiac cycle. We found that the amplitude of the phase-response curve varied directly and the minimum-to-maximum phase difference varied inversely with the overall efficacy of vagal activity. However, for any given alteration in the overall efficacy, the specific changes in the characteristics of the phase-response curve did not depend on whether the alteration was achieved by varying the number of pulses per burst or by varying the stimulus voltage. Therefore, we conclude that although the cardiac chronotropic response is very sensitive to changes in the timing of vagal stimulation, it is not influenced appreciably by the spatial dispersion of acetylcholine release from the vagal nerve endings over a wide range of stimulation strengths.

Acetylcholine↗