nitroarginine and Ventricular-Fibrillation

We have previously shown that direct vagus nerve stimulation (VNS) reduces the slope of action potential duration (APD) restitution while simultaneously protecting the heart against induction of ventricular fibrillation (VF) in the absence of any sympathetic activity or tone. In the current study we have examined the role of nitric oxide (NO) in the effect of VNS. Monophasic action potentials were recorded from a left ventricular epicardial site on innervated, isolated rabbit hearts (n = 7). Standard restitution, effective refractory period (ERP) and VF threshold (VFT) were measured at baseline and during VNS in the presence of the NO synthase inhibitor N(G)-nitro-L-arginine (L-NA, 200 microm) and during reversing NO blockade with L-arginine (L-Arg, 1 mm). Data represent the mean +/- S.E.M. The restitution curve was shifted upwards and became less steep with VNS when compared to baseline. L-NA blocked the effect of VNS whereas L-Arg restored the effect of VNS. The maximum slope of restitution was reduced from 1.17 +/- 0.14 to 0.60 +/- 0.09 (50 +/- 5%, P < 0.0001) during control, from 0.98 +/- 0.14 to 0.93 +/- 0.12 (2 +/- 10%, P = NS) in the presence of L-NA and from 1.16 +/- 0.17 to 0.50 +/- 0.10 (41 +/- 9%, P = 0.003) with L-Arg plus L-NA. ERP was increased by VNS in control from 119 +/- 6 ms to 130 +/- 6 ms (10 +/- 5%, P = 0.045) and this increase was not affected by L-NA (120 +/- 4 to 133 +/- 4 ms, 11 +/- 3%, P = 0.0019) or L-Arg with L-NA (114 +/- 4 to 123 +/- 4 ms, 8 +/- 2%, P = 0.006). VFT was increased from 3.0 +/- 0.3 to 5.8 +/- 0.5 mA (98 +/- 12%, P = 0.0017) in control, 3.4 +/- 0.4 to 3.8 +/- 0.5 mA (13 +/- 12%, P = 0.6) during perfusion with L-NA and 2.5 +/- 0.4 to 6.0 +/- 0.7 mA (175 +/- 50%, P = 0.0017) during perfusion with L-Arg plus L-NA. Direct VNS increased VFT and flattened the slope of APD restitution curve in this isolated rabbit heart preparation with intact autonomic nerves. These effects were blocked using L-NA and reversed by replenishing the substrate for NO production with L-Arg. This is the first study to demonstrate that NO plays an important role in the anti-fibrillatory effect of VNS on the rabbit ventricle, possibly via effects on APD restitution.

Topics: Action Potentials; Animals; Arginine; Autonomic Nervous System; Cardiac Pacing, Artificial; Disease Models, Animal; Electric Stimulation; Enzyme Inhibitors; Heart; Heart Rate; Heart Ventricles; In Vitro Techniques; Male; Myocardium; Nitric Oxide; Nitric Oxide Synthase; Nitroarginine; Perfusion; Rabbits; Time Factors; Vagus Nerve; Ventricular Fibrillation; Ventricular Function

We have demonstrated previously that the nitric oxide synthase (NOS) inhibitor N(G)-nitro-L-arginine (L-NNA) decreases free radical generation and nitrosative injury via peroxynitrite formation after epicardial dc shocks.. Our purpose was to explore the effects of NOS inhibition and NOS donation on cardiopulmonary resuscitation (CPR) success after cardiac arrest of variable duration. We used the non-selective NOS inhibitor L-NNA and the selective neuronal NOS inhibitor ARR-17477, the NOS donor S-nitroso-N-acetylpenicillamine (SNAP) and the vasodilator Enalaprilat, which lowers arterial pressure via a non-NO mechanism.. Part I: 17 pigs undergoing 4 min supported (i.e. with closed-chest compression and ventilation) ventricular fibrillation (VF) were divided into two groups: a no-L-NNA group (n=8) receiving IV saline and an L-NNA group (n=9) receiving IV L-NNA (5 mg/kg) for 8 min before VF was induced. Part II: 35 pigs undergoing 6-8 min VF were randomized to three groups: a no-L-NNA group (n=13) receiving IV saline, an L-NNA group (n=11) receiving IV L-NNA (5 mg/kg) and an ARR17477 group (n=11) receiving IV ARR17477 (5 mg/kg) before VF. All animals in Part II underwent unsupported VF (no chest compression or ventilation) for 6 min (n=13) or 8 min (n=22); closed-chest compression, ventilation and epinephrine (adrenaline) were employed after defibrillation. Part III: 12 swine were divided into two groups: control (n=6) receiving saline and an LNNA group (n=6) receiving IV LNNA (5 mg/kg). Swine underwent 6 min unsupported VF and 2 min supported VF before defibrillation. Part IV: 25 animals were studied to determine the effect of the NO donor SNAP and the angiotensin-converting enzyme inhibitor Enalaprilat on coronary perfusion pressure (CPP).. In Part I, after defibrillation, with continued ventilation, chest compression and epinephrine, 8/9 L-NNA pigs achieved ROSC versus 4/8 control pigs (p=0.11). After 60 s of CPR, 7/9 pigs in the L-NNA group achieved ROSC versus 2/8 pigs in the no-L-NNA group (p<0.05). Only 2/9 pigs receiving L-NNA required epinephrine (1 mg) after defibrillation, compared to 6/8 pigs requiring at least one dose of epinephrine in the no-L-NNA group (p<0.05). In Part II, there was no significant difference between L-NNA, ARR17477 and control pigs in ROSC. However, control pigs required 6.8+/-1.4S.E. mg epinephrine; L-NNA pigs and ARR17477 pigs required less epinephrine (3.7+/-0.7 and 3.0+/-0.3 mg, both p=0.01). Shorter chest compression was required in the L-NNA group (252+/-38 s, p<0.05) and in ARR17477 group (222+/-15 s, p<0.05) compared to the control group (405+/-77 s). In Part III, L-NNA infusion caused a significant increase in mean blood pressure at baseline, but did not change CPP throughout the experiment. In Part IV, there were no significant differences in the changes of mean blood pressure and CPP between SNAP and Enalaprilat group in all animals throughout the experiment.. NOS inhibition pre-arrest did not improve survival, but did reduce requirements for epinephrine and closed-chest compression in a swine resuscitation model.

Topics: Animals; Cardiopulmonary Resuscitation; Combined Modality Therapy; Coronary Circulation; Disease Models, Animal; Electric Countershock; Enzyme Inhibitors; Heart Arrest; Hemodynamics; Models, Cardiovascular; Nitric Oxide Synthase; Nitroarginine; Random Allocation; Sensitivity and Specificity; Survival Rate; Sus scrofa; Ventricular Fibrillation

To assess the role of reactive oxygen species and nitric oxide (NO) in the genesis of reperfusion-induced arrhythmias, the effects of reactive oxygen species scavengers and NO synthase inhibitors on the incidence of ventricular fibrillation and irreversible ventricular fibrillation (mortality) were examined. Hearts of anesthetized rats were subjected to 4 min regional ischemia followed by 4 min reperfusion. The animals were treated i.v. with superoxide dismutase, a O2- scavenger, catalase, a H2O2 scavenger, dimethylthiourea, a .OH scavenger, or NG-nitro-L-arginine methyl ester (L-NAME) and NG-nitro-L-arginine (L-NNA), NO synthase inhibitors. Superoxide dismutase (430 and 4300 U/kg/min) reduced the mortality from 93% to 43% and 57%, respectively, whereas treatment with catalase or dimethylthiourea did not affect these arrhythmias. L-NAME (0.1 and 0.3 mg/kg/min) reduced the mortality from 93% to 50% and 43%, respectively. L-NNA (0.3 mg/kg/min) reduced the mortality from 93% to 50%. This reduction by the NO synthase inhibitors was abolished by administration of L-Arg. However, L-Arg blocked neither a small increase in systolic blood pressure nor a decrease in heart rate elicited by the NO synthase inhibitors. The combinated treatment of superoxide dismutase (4300 U/kg/min) with L-NAME (0.3 mg/kg/min) reduced the mortality from 93% to 7%. These results suggest that the genesis of reperfusion-induced arrhythmias observed in this model may be in part due to O2- and NO.

Topics: Analysis of Variance; Animals; Catalase; Cryoprotective Agents; Dimethyl Sulfoxide; Enzyme Inhibitors; Free Radical Scavengers; Male; NG-Nitroarginine Methyl Ester; Nitric Oxide; Nitroarginine; Rats; Rats, Sprague-Dawley; Reactive Oxygen Species; Thiourea; Ventricular Fibrillation