Cardiac Vagal Stimulation Eliminates Detrimental Tachycardia Effects of Dobutamine Used for Inotropic Support Youhua Zhang, MD, PhD, Todor N. Mazgalev,

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Cardiac Vagal Stimulation Eliminates Detrimental Tachycardia Effects of Dobutamine Used for Inotropic Support Youhua Zhang, MD, PhD, Todor N. Mazgalev, PhD, FACC The Annals of Thoracic Surgery Volume 88, Issue 1, Pages 117-122 (July 2009) DOI: 10.1016/j.athoracsur.2009.04.009 Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Photograph showing the anatomic location of the sinus node fat pad. The heart has been slightly rotated to the left to show the anatomic position of the epicardial sinus node fat pad (dashed triangle). (IVC = inferior vena cava; PC = pericardium; RA = right atrium; RAA = right atrial appendage; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein; RV = right ventricle; SVC = superior vena cava.) The Annals of Thoracic Surgery 2009 88, 117-122DOI: (10.1016/j.athoracsur.2009.04.009) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 An example of typical electrical and hemodynamic signals. The records were made in the same dog at baseline control (top), during steady-state dobutamine infusion (middle), and during dobutamine plus sinus node fat pad vagal stimulation (bottom). Note that dobutamine increased pressures and aortic flow signal (CO), but also produced marked tachycardia (short RR interval). Sinus node fat pad vagal stimulation slowed heart rate back to control while preserving inotropic effects. (BP = blood pressure in mm Hg; CO = aortic flow signal used to calculate cardiac output in L/min; ECG = surface electrogram; LVP = left ventricular pressure in mm Hg.) The Annals of Thoracic Surgery 2009 88, 117-122DOI: (10.1016/j.athoracsur.2009.04.009) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Average hemodynamic data obtained at constant atrial rate. The four panels show data during atrial pacing at 133 beats/min (baseline, open bars) and during atrial pacing plus sinus node fat pad vagal stimulation (filled bars). Note that sinus node fat pad vagal stimulation did not affect the measured hemodynamic variables. (±dp/dt = positive and negative maximal derivative of left ventricular pressure.) The Annals of Thoracic Surgery 2009 88, 117-122DOI: (10.1016/j.athoracsur.2009.04.009) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions