The First in Russia Experience of Successful Implementation of Constant Neurostimulation of the Spinal Cord in the Complex Treatment of a Patient with Permanent Form of Atrial Fibrillation Combined with Spinal Stenosis

This article describes for the first time in the domestic literature a clinical case of the therapeutic effect of neuromodulation on the permanent form of atrial fibrillation and chronic heart failure in an elderly patient with spinal stenosis which led to the development of pain syndrome and movement disorders. For the treatment of neurological pathology, at the beginning epidural administration of drugs was applied, followed by spinal cord stimulation trial and implantation of permanent neurostimulator. At each stage of treatment conducted by a functional neurosurgeon the patient had a spontaneous restoration of sinus rhythm, and during continuous neurostimulation a stable retention of sinus rhythm and regression of heart failure symptoms have been observed throughout a long observation period. The article also presents the data of a few experimental and clinical studies on the use of neuromodulation in cardiology, describes the method of implantation of spinal electrodes and analyzes possible mechanisms of modulation of the autonomic innervation of the heart, implemented by spinal cord stimulation.

1. Calkins H, Hindricks G, Cappato R, Kim Y-H, Saad EB, Aguinaga L et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Journal of Arrhythmia. 2017;33(5):369–409. DOI: 10.1016/j.joa.2017.08.001

2. Tse H-F, Turner S, Sanders P, Okuyama Y, Fujiu K, Cheung C-W et al. Thoracic Spinal Cord Stimulation for Heart Failure as a Restorative Treatment (SCS HEART study): First-in-man experience. Heart Rhythm. 2015;12(3):588–95. DOI: 10.1016/j.hrthm.2014.12.014

3. Shen MJ, Choi E-K, Tan AY, Lin S-F, Fishbein MC, Chen LS et al. Neural mechanisms of atrial arrhythmias. Nature Reviews Cardiology. 2012;9(1):30–9. DOI: 10.1038/nrcardio.2011.139

4. Shen MJ, Zipes DP. Role of the Autonomic Nervous System in Modulating Cardiac Arrhythmias. Circulation Research. 2014;114(6):1004–21. DOI: 10.1161/CIRCRESAHA.113.302549

5. He B, Scherlag BJ, Nakagawa H, Lazzara R, Po SS. The Intrinsic Autonomic Nervous System in Atrial Fibrillation: A Review. ISRN Cardiology. 2012;2012:1–8. DOI: 10.5402/2012/490674

6. Cruccu G, Aziz TZ, Garcia-Larrea L, Hansson P, Jensen TS, Lefaucheur J-P et al. EFNS guidelines on neurostimulation therapy for neuropathic pain. European Journal of Neurology. 2007;14(9):952–70. DOI: 10.1111/j.1468-1331.2007.01916.x

7. Packer DL, Mark DB, Robb RA, Monahan KH, Bahnson TD, Moretz K et al. Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) Trial: Study Rationale and Design. American Heart Journal. 2018;199:192–9. DOI: 10.1016/j.ahj.2018.02.015

8. Shen MJ, Choi E-K, Tan AY, Lin S-F, Fishbein MC, Chen LS et al. Neural mechanisms of atrial arrhythmias. Nature Reviews Cardiology. 2012;9(1):30–9. DOI: 10.1038/nrcardio.2011.139

9. Kawashima T. The autonomic nervous system of the human heart with special reference to its origin, course, and peripheral distribution. Anatomy and Embryology. 2005;209(6):425–38. DOI: 10.1007/s00429-005-0462-1

10. Henderson JM, Levy RM, Bedder MD, Staats PS, Slavin KV, Poree LR et al. NANS Training Requirements for Spinal Cord Stimulation Devices: Selection, Implantation, and Follow-up: TRAINING REQUIREMENTS FOR SCS DEVICES. Neuromodulation: Technology at the Neural Interface. 2009;12(3):171–4. DOI: 10.1111/j.1525-1403.2009.00211.x

11. Benoist M, Boulu P, Hayem G. Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety. European Spine Journal. 2012;21(2):204–13. DOI: 10.1007/s00586-011-2007-z

12. He B, Scherlag BJ, Nakagawa H, Lazzara R, Po SS. The Intrinsic Autonomic Nervous System in Atrial Fibrillation: A Review. ISRN Cardiology. 2012;2012:1–8. DOI: 10.5402/2012/490674

13. Armour JA, Murphy DA, Yuan BX, Macdonald S, Hopkins DA. Gross and microscopic anatomy of the human intrinsic cardiac nervous system. The Anatomical Record. 1997;247(2):289–98. DOI: 10.1002/(SICI)1097-0185(199702)247:2<289::AIDAR15>3.0.CO;2-L

14. Kawashima T. The autonomic nervous system of the human heart with special reference to its origin, course, and peripheral distribution. Anatomy and Embryology. 2005;209(6):425–38. DOI: 10.1007/s00429-005-0462-1

15. Buchser E, Durrer A, Albrecht E. Spinal Cord Stimulation for the Management of Refractory Angina Pectoris. Journal of Pain and Symptom Management. 2006;31(4):S36–42. DOI: 10.1016/j.jpainsymman.2005.12.008

16. Ammendolia C, Stuber K, de Bruin LK, Furlan AD, Kennedy CA, Rampersaud YR et al. Nonoperative Treatment of Lumbar Spinal Stenosis With Neurogenic Claudication: A Systematic Review. Spine. 2012;37(10):E609–16. DOI: 10.1097/BRS.0b013e318240d57d

17. Oh S, Zhang Y, Bibevski S, Marrouche NF, Natale A, Mazgalev TN. Vagal denervation and atrial fibrillation inducibility: Epicardial fat pad ablation does not have long-term effects. Heart Rhythm. 2006;3(6):701–8. DOI: 10.1016/j.hrthm.2006.02.020

18. Armour JA, Murphy DA, Yuan BX, Macdonald S, Hopkins DA. Gross and microscopic anatomy of the human intrinsic cardiac nervous system. The Anatomical Record. 1997;247(2):289–98. DOI: 10.1002/(SICI)1097-0185(199702)247:2<289::AIDAR15>3.0.CO;2-L

19. Mesa JE, Yakovlev AE. Treatment of intractable angina pectoris utilizing spinal cord stimulation. Reviews in Cardiovascular Medicine. 2008;9(1):70–4. PMID: 18418311

20. May S, Comer C. Is surgery more effective than non-surgical treatment for spinal stenosis, and which non-surgical treatment is more effective? A systematic review. Physiotherapy. 2013;99(1):12–20. DOI: 10.1016/j.physio.2011.12.004

21. Pokushalov E, Romanov A, Shugayev P, Artyomenko S, Shirokova N, Turov A et al. Selective ganglionated plexi ablation for paroxysmal atrial fibrillation. Heart Rhythm. 2009;6(9):1257–64. DOI: 10.1016/j.hrthm.2009.05.018

22. Oh S, Zhang Y, Bibevski S, Marrouche NF, Natale A, Mazgalev TN. Vagal denervation and atrial fibrillation inducibility: Epicardial fat pad ablation does not have long-term effects. Heart Rhythm. 2006;3(6):701–8. DOI: 10.1016/j.hrthm.2006.02.020

23. Harrast MA. Epidural steroid injections for lumbar spinal stenosis. Current Reviews in Musculoskeletal Medicine. 2008;1(1):32–8. DOI: 10.1007/s12178-007-9003-2

24. Lopshire JC, Zipes DP. Device Therapy to Modulate the Autonomic Nervous System to Treat Heart Failure. Current Cardiology Reports. 2012;14(5):593–600. DOI: 10.1007/s11886-012-0292-8

25. Randall DC, Brown DR, McGuirt AS, Thompson GW, Armour JA, Ardell JL. Interactions within the intrinsic cardiac nervous system contribute to chronotropic regulation. American Journal of Physiology-Regulatory, Integrative and Comparative

26. Pokushalov E, Romanov A, Shugayev P, Artyomenko S, Shirokova N, Turov A et al. Selective ganglionated plexi ablation for paroxysmal atrial fibrillation. Heart Rhythm. 2009;6(9):1257–64. DOI: 10.1016/j.hrthm.2009.05.018

27. Parati G, Esler M. The human sympathetic nervous system: its relevance in hypertension and heart failure. European Heart Journal. 2012;33(9):1058–66. DOI: 10.1093/eurheartj/ehs041

28. Zipes DP, Neuzil P, Theres H, Caraway D, Mann DL, Mannheimer C et al. Determining the Feasibility of Spinal Cord Neuromodulation for the Treatment of Chronic Systolic Heart Failure. JACC: Heart Failure. 2016;4(2):129–36. DOI: 10.1016/j.jchf.2015.10.006

29. Physiology. 2003;285(5):R1066–75. DOI: 10.1152/ajpregu.00167.2003

30. Randall DC, Brown DR, McGuirt AS, Thompson GW, Armour JA, Ardell JL. Interactions within the intrinsic cardiac nervous system contribute to chronotropic regulation. American Journal of Physiology-Regulatory, Integrative and Comparative

31. Singh JP, Kandala J, John Camm A. Non-pharmacological modulation of the autonomic tone to treat heart failure. European Heart Journal. 2014;35(2):77–85. DOI: 10.1093/eurheartj/eht436

32. Sousa-Pinto B, Ferreira-Pinto MJ, Santos M, Leite-Moreira AF. Central nervous system circuits modified in heart failure: pathophysiology and therapeutic implications. Heart Failure Reviews. 2014;19(6):759–79. DOI: 10.1007/s10741-014-9427-x

33. Zipes DP, Rubart M. Neural modulation of cardiac arrhythmias and sudden cardiac death. Heart Rhythm. 2006;3(1):108–13. DOI: 10.1016/j.hrthm.2005.09.021

34. Physiology. 2003;285(5):R1066–75. DOI: 10.1152/ajpregu.00167.2003

35. Triposkiadis F, Karayannis G, Giamouzis G, Skoularigis J, Louridas G, Butler J. The Sympathetic Nervous System in Heart Failure. Journal of the American College of Cardiology. 2009;54(19):1747–62. DOI: 10.1016/j.jacc.2009.05.015

36. Ardashev A.V., Mazurov M.E., Zhelyakov E.G., Kalyuzhniy I.M., Finko V.A., Belenkov Yu.N. Comparison of clinical data and the results of mathematical modeling in radiofrequency ablation of the patients with permanent atrial fibrillation: cardioversion, as the final stage of the combined treatment. Kardiologiia. 2015;55(10):46–51.

37. Vaseghi M, Shivkumar K. The Role of the Autonomic Nervous System in Sudden Cardiac Death. Progress in Cardiovascular Diseases. 2008;50(6):404–19. DOI: 10.1016/j.pcad.2008.01.003

38. Zipes DP, Rubart M. Neural modulation of cardiac arrhythmias and sudden cardiac death. Heart Rhythm. 2006;3(1):108–13. DOI: 10.1016/j.hrthm.2005.09.021

39. Azevedo ER, Parker JD. Parasympathetic Control of Cardiac Sympathetic Activity: Normal Ventricular Function Versus Congestive Heart Failure. Circulation. 1999;100(3):274–9. DOI: 10.1161/01.CIR.100.3.274

40. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. 2016;37(38):2893–962. DOI: 10.1093/eurheartj/ehw210

41. Coote JH. Myths and realities of the cardiac vagus: The cardiac vagus. The Journal of Physiology. 2013;591(17):4073–85. DOI: 10.1113/jphysiol.2013.257758

42. Vaseghi M, Shivkumar K. The Role of the Autonomic Nervous System in Sudden Cardiac Death. Progress in Cardiovascular Diseases. 2008;50(6):404–19. DOI: 10.1016/j.pcad.2008.01.003

43. Calkins H, Hindricks G, Cappato R, Kim Y-H, Saad EB, Aguinaga L et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275–444. DOI: 10.1016/j.hrthm.2017.05.012

44. Olshansky B, Sabbah HN, Hauptman PJ, Colucci WS. Parasympathetic Nervous System and Heart Failure: Pathophysiology and Potential Implications for Therapy. Circulation. 2008;118(8):863–71. DOI: 10.1161/CIRCULATIONAHA.107.760405

45. Armour JA. Potential clinical relevance of the ‘little brain’ on the mammalian heart: The ‘little brain’ on the heart. Experimental Physiology. 2008;93(2):165–76. DOI: 10.1113/expphysiol.2007.041178

46. Coote JH. Myths and realities of the cardiac vagus: The cardiac vagus. The Journal of Physiology. 2013;591(17):4073–85. DOI: 10.1113/jphysiol.2013.257758

47. Calkins H, Hindricks G, Cappato R, Kim Y-H, Saad EB, Aguinaga L et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Journal of Arrhythmia. 2017;33(5):369–409. DOI: 10.1016/j.joa.2017.08.001

48. Kowey PR, Yan G-X, Dimino TL, Kocovic DZ. Overview of the management of atrial fibrillation: what is the current state of the art? Journal of Cardiovascular Electrophysiology. 2003;14(12 Suppl):S275-280; discussion S280. PMID: 15005214

49. Armour JA. Potential clinical relevance of the ‘little brain’ on the mammalian heart: The ‘little brain’ on the heart. Experimental Physiology. 2008;93(2):165–76. DOI: 10.1113/expphysiol.2007.041178

50. Packer DL, Mark DB, Robb RA, Monahan KH, Bahnson TD, Moretz K et al. Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) Trial: Study Rationale and Design. American Heart Journal. 2018;199:192–9. DOI: 10.1016/j.ahj.2018.02.015

51. Meredith IT, Broughton A, Jennings GL, Esler MD. Evidence of a Selective Increase in Cardiac Sympathetic Activity in Patients with Sustained Ventricular Arrhythmias. New England Journal of Medicine. 1991;325(9):618–24. DOI: 10.1056/NEJM199108293250905

52. Kowey PR, Yan G-X, Dimino TL, Kocovic DZ. Overview of the management of atrial fibrillation: what is the current state of the art? Journal of Cardiovascular Electrophysiology. 2003;14(12 Suppl):S275-280; discussion S280. PMID: 15005214

53. Benoist M, Boulu P, Hayem G. Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety. European Spine Journal. 2012;21(2):204–13. DOI: 10.1007/s00586-011-2007-z

54. Grimaldi R, de Luca A, Kornet L, Castagno D, Gaita F. Can spinal cord stimulation reduce ventricular arrhythmias? Heart Rhythm. 2012;9(11):1884–7. DOI: 10.1016/j.hrthm.2012.08.007

55. Ammendolia C, Stuber K, de Bruin LK, Furlan AD, Kennedy CA, Rampersaud YR et al. Nonoperative Treatment of Lumbar Spinal Stenosis With Neurogenic Claudication: A Systematic Review. Spine. 2012;37(10):E609–16. DOI: 10.1097/BRS.0b013e318240d57d

56. Meredith IT, Broughton A, Jennings GL, Esler MD. Evidence of a Selective Increase in Cardiac Sympathetic Activity in Patients with Sustained Ventricular Arrhythmias. New England Journal of Medicine. 1991;325(9):618–24. DOI: 10.1056/NEJM199108293250905

57. Ardell JL, Cardinal R, Beaumont E, Vermeulen M, Smith FM, Andrew Armour J. Chronic spinal cord stimulation modifies intrinsic cardiac synaptic efficacy in the suppression of atrial fibrillation. Autonomic Neuroscience. 2014;186:38–44. DOI: 10.1016/j.autneu.2014.09.017

58. May S, Comer C. Is surgery more effective than non-surgical treatment for spinal stenosis, and which non-surgical treatment is more effective? A systematic review. Physiotherapy. 2013;99(1):12–20. DOI: 10.1016/j.physio.2011.12.004

59. Grimaldi R, de Luca A, Kornet L, Castagno D, Gaita F. Can spinal cord stimulation reduce ventricular arrhythmias? Heart Rhythm. 2012;9(11):1884–7. DOI: 10.1016/j.hrthm.2012.08.007

60. Tse H-F, Turner S, Sanders P, Okuyama Y, Fujiu K, Cheung C-W et al. Thoracic Spinal Cord Stimulation for Heart Failure as a Restorative Treatment (SCS HEART study): First-in-man experience. Heart Rhythm. 2015;12(3):588–95. DOI: 10.1016/j.hrthm.2014.12.014

61. Harrast MA. Epidural steroid injections for lumbar spinal stenosis. Current Reviews in Musculoskeletal Medicine. 2008;1(1):32–8. DOI: 10.1007/s12178-007-9003-2

62. Ardell JL, Cardinal R, Beaumont E, Vermeulen M, Smith FM, Andrew Armour J. Chronic spinal cord stimulation modifies intrinsic cardiac synaptic efficacy in the suppression of atrial fibrillation. Autonomic Neuroscience. 2014;186:38–44. DOI: 10.1016/j.autneu.2014.09.017

63. Cruccu G, Aziz TZ, Garcia-Larrea L, Hansson P, Jensen TS, Lefaucheur J-P et al. EFNS guidelines on neurostimulation therapy for neuropathic pain. European Journal of Neurology. 2007;14(9):952–70. DOI: 10.1111/j.1468-1331.2007.01916.x

64. Parati G, Esler M. The human sympathetic nervous system: its relevance in hypertension and heart failure. European Heart Journal. 2012;33(9):1058–66. DOI: 10.1093/eurheartj/ehs041

65. Tse H-F, Turner S, Sanders P, Okuyama Y, Fujiu K, Cheung C-W et al. Thoracic Spinal Cord Stimulation for Heart Failure as a Restorative Treatment (SCS HEART study): First-in-man experience. Heart Rhythm. 2015;12(3):588–95. DOI: 10.1016/j.hrthm.2014.12.014

66. Henderson JM, Levy RM, Bedder MD, Staats PS, Slavin KV, Poree LR et al. NANS Training Requirements for Spinal Cord Stimulation Devices: Selection, Implantation, and Follow-up: TRAINING REQUIREMENTS FOR SCS DEVICES. Neuromodulation: Technology at the Neural Interface. 2009;12(3):171–4. DOI: 10.1111/j.1525-1403.2009.00211.x

67. Cruccu G, Aziz TZ, Garcia-Larrea L, Hansson P, Jensen TS, Lefaucheur J-P et al. EFNS guidelines on neurostimulation therapy for neuropathic pain. European Journal of Neurology. 2007;14(9):952–70. DOI: 10.1111/j.1468-1331.2007.01916.x

68. Sousa-Pinto B, Ferreira-Pinto MJ, Santos M, Leite-Moreira AF. Central nervous system circuits modified in heart failure: pathophysiology and therapeutic implications. Heart Failure Reviews. 2014;19(6):759–79. DOI: 10.1007/s10741-014-9427-x

69. Buchser E, Durrer A, Albrecht E. Spinal Cord Stimulation for the Management of Refractory Angina Pectoris. Journal of Pain and Symptom Management. 2006;31(4):S36–42. DOI: 10.1016/j.jpainsymman.2005.12.008

70. Henderson JM, Levy RM, Bedder MD, Staats PS, Slavin KV, Poree LR et al. NANS Training Requirements for Spinal Cord Stimulation Devices: Selection, Implantation, and Follow-up: TRAINING REQUIREMENTS FOR SCS DEVICES. Neuromodulation: Technology at the Neural Interface. 2009;12(3):171–4. DOI: 10.1111/j.1525-1403.2009.00211.x

71. Triposkiadis F, Karayannis G, Giamouzis G, Skoularigis J, Louridas G, Butler J. The Sympathetic Nervous System in Heart Failure. Journal of the American College of Cardiology. 2009;54(19):1747–62. DOI: 10.1016/j.jacc.2009.05.015

72. Mesa JE, Yakovlev AE. Treatment of intractable angina pectoris utilizing spinal cord stimulation. Reviews in Cardiovascular Medicine. 2008;9(1):70–4. PMID: 18418311

73. Buchser E, Durrer A, Albrecht E. Spinal Cord Stimulation for the Management of Refractory Angina Pectoris. Journal of Pain and Symptom Management. 2006;31(4):S36–42. DOI: 10.1016/j.jpainsymman.2005.12.008

74. Azevedo ER, Parker JD. Parasympathetic Control of Cardiac Sympathetic Activity: Normal Ventricular Function Versus Congestive Heart Failure. Circulation. 1999;100(3):274–9. DOI: 10.1161/01.CIR.100.3.274

75. Lopshire JC, Zipes DP. Device Therapy to Modulate the Autonomic Nervous System to Treat Heart Failure. Current Cardiology Reports. 2012;14(5):593–600. DOI: 10.1007/s11886-012-0292-8

76. Mesa JE, Yakovlev AE. Treatment of intractable angina pectoris utilizing spinal cord stimulation. Reviews in Cardiovascular Medicine. 2008;9(1):70–4. PMID: 18418311

77. Olshansky B, Sabbah HN, Hauptman PJ, Colucci WS. Parasympathetic Nervous System and Heart Failure: Pathophysiology and Potential Implications for Therapy. Circulation. 2008;118(8):863–71. DOI: 10.1161/CIRCULATIONAHA.107.760405

78. Zipes DP, Neuzil P, Theres H, Caraway D, Mann DL, Mannheimer C et al. Determining the Feasibility of Spinal Cord Neuromodulation for the Treatment of Chronic Systolic Heart Failure. JACC: Heart Failure. 2016;4(2):129–36. DOI: 10.1016/j.jchf.2015.10.006

79. Lopshire JC, Zipes DP. Device Therapy to Modulate the Autonomic Nervous System to Treat Heart Failure. Current Cardiology Reports. 2012;14(5):593–600. DOI: 10.1007/s11886-012-0292-8

80. Singh JP, Kandala J, John Camm A. Non-pharmacological modulation of the autonomic tone to treat heart failure. European Heart Journal. 2014;35(2):77–85. DOI: 10.1093/eurheartj/eht436

81. Zipes DP, Neuzil P, Theres H, Caraway D, Mann DL, Mannheimer C et al. Determining the Feasibility of Spinal Cord Neuromodulation for the Treatment of Chronic Systolic Heart Failure. JACC: Heart Failure. 2016;4(2):129–36. DOI: 10.1016/j.jchf.2015.10.006

82. Ardashev A.V., Mazurov M.E., Zhelyakov E.G., Kalyuzhniy I.M., Finko V.A., Belenkov Yu.N. Comparison of clinical data and the results of mathematical modeling in radiofrequency ablation of the patients with permanent atrial fibrillation: cardioversion, as the final stage of the combined treatment. Kardiologiia. 2015;55(10):46–51.

83. Singh JP, Kandala J, John Camm A. Non-pharmacological modulation of the autonomic tone to treat heart failure. European Heart Journal. 2014;35(2):77–85. DOI: 10.1093/eurheartj/eht436

84. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. 2016;37(38):2893–962. DOI: 10.1093/eurheartj/ehw210

85. Ardashev A.V., Mazurov M.E., Zhelyakov E.G., Kalyuzhniy I.M., Finko V.A., Belenkov Yu.N. Comparison of clinical data and the results of mathematical modeling in radiofrequency ablation of the patients with permanent atrial fibrillation: cardioversion, as the final stage of the combined treatment. Kardiologiia. 2015;55(10):46–51.

86. Calkins H, Hindricks G, Cappato R, Kim Y-H, Saad EB, Aguinaga L et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275–444. DOI: 10.1016/j.hrthm.2017.05.012

87. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. 2016;37(38):2893–962. DOI: 10.1093/eurheartj/ehw210

88. Calkins H, Hindricks G, Cappato R, Kim Y-H, Saad EB, Aguinaga L et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Journal of Arrhythmia. 2017;33(5):369–409. DOI: 10.1016/j.joa.2017.08.001

89. Calkins H, Hindricks G, Cappato R, Kim Y-H, Saad EB, Aguinaga L et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275–444. DOI: 10.1016/j.hrthm.2017.05.012

90. Packer DL, Mark DB, Robb RA, Monahan KH, Bahnson TD, Moretz K et al. Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) Trial: Study Rationale and Design. American Heart Journal. 2018;199:192–9. DOI: 10.1016/j.ahj.2018.02.015

91. Calkins H, Hindricks G, Cappato R, Kim Y-H, Saad EB, Aguinaga L et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Journal of Arrhythmia. 2017;33(5):369–409. DOI: 10.1016/j.joa.2017.08.001

92. Benoist M, Boulu P, Hayem G. Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety. European Spine Journal. 2012;21(2):204–13. DOI: 10.1007/s00586-011-2007-z

93. Packer DL, Mark DB, Robb RA, Monahan KH, Bahnson TD, Moretz K et al. Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) Trial: Study Rationale and Design. American Heart Journal. 2018;199:192–9. DOI: 10.1016/j.ahj.2018.02.015

94. Ammendolia C, Stuber K, de Bruin LK, Furlan AD, Kennedy CA, Rampersaud YR et al. Nonoperative Treatment of Lumbar Spinal Stenosis With Neurogenic Claudication: A Systematic Review. Spine. 2012;37(10):E609–16. DOI: 10.1097/BRS.0b013e318240d57d

95. Benoist M, Boulu P, Hayem G. Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety. European Spine Journal. 2012;21(2):204–13. DOI: 10.1007/s00586-011-2007-z

96. May S, Comer C. Is surgery more effective than non-surgical treatment for spinal stenosis, and which non-surgical treatment is more effective? A systematic review. Physiotherapy. 2013;99(1):12–20. DOI: 10.1016/j.physio.2011.12.004

97. Ammendolia C, Stuber K, de Bruin LK, Furlan AD, Kennedy CA, Rampersaud YR et al. Nonoperative Treatment of Lumbar Spinal Stenosis With Neurogenic Claudication: A Systematic Review. Spine. 2012;37(10):E609–16. DOI: 10.1097/BRS.0b013e318240d57d

98. Harrast MA. Epidural steroid injections for lumbar spinal stenosis. Current Reviews in Musculoskeletal Medicine. 2008;1(1):32–8. DOI: 10.1007/s12178-007-9003-2

99. May S, Comer C. Is surgery more effective than non-surgical treatment for spinal stenosis, and which non-surgical treatment is more effective? A systematic review. Physiotherapy. 2013;99(1):12–20. DOI: 10.1016/j.physio.2011.12.004

100. Parati G, Esler M. The human sympathetic nervous system: its relevance in hypertension and heart failure. European Heart Journal. 2012;33(9):1058–66. DOI: 10.1093/eurheartj/ehs041

101. Harrast MA. Epidural steroid injections for lumbar spinal stenosis. Current Reviews in Musculoskeletal Medicine. 2008;1(1):32–8. DOI: 10.1007/s12178-007-9003-2

102. Sousa-Pinto B, Ferreira-Pinto MJ, Santos M, Leite-Moreira AF. Central nervous system circuits modified in heart failure: pathophysiology and therapeutic implications. Heart Failure Reviews. 2014;19(6):759–79. DOI: 10.1007/s10741-014-9427-x

103. Parati G, Esler M. The human sympathetic nervous system: its relevance in hypertension and heart failure. European Heart Journal. 2012;33(9):1058–66. DOI: 10.1093/eurheartj/ehs041

104. Triposkiadis F, Karayannis G, Giamouzis G, Skoularigis J, Louridas G, Butler J. The Sympathetic Nervous System in Heart Failure. Journal of the American College of Cardiology. 2009;54(19):1747–62. DOI: 10.1016/j.jacc.2009.05.015

105. Sousa-Pinto B, Ferreira-Pinto MJ, Santos M, Leite-Moreira AF. Central nervous system circuits modified in heart failure: pathophysiology and therapeutic implications. Heart Failure Reviews. 2014;19(6):759–79. DOI: 10.1007/s10741-014-9427-x

106. Azevedo ER, Parker JD. Parasympathetic Control of Cardiac Sympathetic Activity: Normal Ventricular Function Versus Congestive Heart Failure. Circulation. 1999;100(3):274–9. DOI: 10.1161/01.CIR.100.3.274

107. Triposkiadis F, Karayannis G, Giamouzis G, Skoularigis J, Louridas G, Butler J. The Sympathetic Nervous System in Heart Failure. Journal of the American College of Cardiology. 2009;54(19):1747–62. DOI: 10.1016/j.jacc.2009.05.015

108. Olshansky B, Sabbah HN, Hauptman PJ, Colucci WS. Parasympathetic Nervous System and Heart Failure: Pathophysiology and Potential Implications for Therapy. Circulation. 2008;118(8):863–71. DOI: 10.1161/CIRCULATIONAHA.107.760405

109. Azevedo ER, Parker JD. Parasympathetic Control of Cardiac Sympathetic Activity: Normal Ventricular Function Versus Congestive Heart Failure. Circulation. 1999;100(3):274–9. DOI: 10.1161/01.CIR.100.3.274

110. Olshansky B, Sabbah HN, Hauptman PJ, Colucci WS. Parasympathetic Nervous System and Heart Failure: Pathophysiology and Potential Implications for Therapy. Circulation. 2008;118(8):863–71. DOI: 10.1161/CIRCULATIONAHA.107.760405