Correlation between programmed stimulation parameters and their efficacy after deep brain electrode implantation for Parkinson’s disease

Purpose:Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an indispensable and effective surgery for patients with primary Parkinson’s disease (PD). Nonetheless, its postoperative effects can be decided by many factors including the optimal programmed stimulation parameters. In this study, we analyzed the correlation between different postoperative programmed stimulation parameters and their efficacy after STN–DBS electrode implantation in patients with PD.Methods:A total of 87 patients underwent electrode implantation and completed at least one year follow-up. Then, various combinations of stimulation parameters, including stimulus intensity, frequency, and pulse width, were examined for their effects on the clinical improvement of the patients. Improvements in motor and nonmotor symptoms were analyzed using Mini-Mental State Examination, Parkinson’s Disease Quality of Life Questionnaire-39, and Unified Parkinson’s Disease Rating Scale (UPDRS) scores before and after surgery.Results:We found significantly improved UPDRS scores, quality of life, and neuropsychiatric symptoms postoperatively considering the findings of the aforementioned stimulation parameters compared with those observed preoperatively.Conclusion:This study provides a better understanding on how programmed stimulation parameters help relieve PD symptoms and improve quality of life in patients with PD undergoing STN–DBS.

P4424Detailed characterization of atrial remodeling induced by exercise training in a rodent model of exercise-induced cardiac hypertrophy

Introduction Atrial fibrillation and heart failure share common risk factors and frequently coexist as atrial fibrillation leads to impaired myocardial function. Although regular exercise training is associated with cardiovascular benefits, the increased risk of atrial arrhythmias has been observed, with differences regarding prevalence between genders. While multiple mechanisms are likely, the atrial alterations induced by long-term physical exercise still need to be elucidated. Purpose We aimed at investigating exercise-induced atrial remodeling in a rat model of athlete's heart and determining sex-specific differences. Methods Age-matched young adult rats were divided into female exercised (FEx), female control (FCo), male exercised (MEx) and male control (MCo) groups. After exercised animals completed a 12-week-long swim training protocol, echocardiography was used to describe atrial alterations. In vivo electrophysiologic investigation was performed by programmed stimulation with an octapolar catheter inserted into the right atrium and atrial gene expression analysis was carried out. Results Post-mortem atrial weight data revealed marked atrial hypertrophy (atrial weight to tibial length: 18.6±2.7g/cm FEx, 10.3±1.0g/cm FCo, 23.7±2.2g/cm MEx, 15.8±1.9g/cm MCo pex<0.01), while echocardiography data showed slight atrial dilatation and improved contraction in both exercised groups. Exercise training was associated with bradycardia, P-wave enlargement and prolonged right atrial effective refractory period (RAERP: 45.7±4.3ms FEx, 40.2±5.9ms, FCo, 49.8±4.2ms MEx, 43.1±4.6ms MCo pex<0.01). Sinus node recovery time (SNRT) did not differ between groups and we could not induce significant number of arrhytmias by programmed stimulation (double extrastimulation, burst pacing) in any groups. We found increased atrial gene expression of antioxidant enzymes (e.g. NADPH oxidase 2, superoxide dismutase 2) in both genders. Despite the marked atrial hypertrophy, no gene expression alteration was found regarding markers that describe pathological remodeling (atrial natriuretic factor), proinflammatoric (tumor necrosis factor-α) and profibrotic [e.g. transforming growth factor-β (TGF-β), matrix metalloproteinase-2 (MMP-2)] processes. While exercise training did not affect on the expression of profibrotic markers, female gender was associated with lower TGF-β and MMP-2 expression. We found altered expression of ion channels participating in atrial depolarization and repolarization. Conclusions Our data suggests that long-term exercise-induced atrial hypertrophy is not associated with harmful electrical remodeling and no inflammatory or profibrotic response was observed in the atrium of exercised rats. Acknowledgement/Funding NKFIH (K 120277), ÚNKP-17-4 (to A.O.), STIA-KF-17 (to A.O.)