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Plappert F, Engström G, Platonov PG, Wallman M, Sandberg F. ECG-based estimation of respiration-induced autonomic modulation of AV nodal conduction during atrial fibrillation. Front Physiol 2024; 15:1281343. [PMID: 38779321 PMCID: PMC11110927 DOI: 10.3389/fphys.2024.1281343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 04/08/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction: Information about autonomic nervous system (ANS) activity may offer insights about atrial fibrillation (AF) progression and support personalized AF treatment but is not easily accessible from the ECG. In this study, we propose a new approach for ECG-based assessment of respiratory modulation in atrioventricular (AV) nodal refractory period and conduction delay. Methods: A 1-dimensional convolutional neural network (1D-CNN) was trained to estimate respiratory modulation of AV nodal conduction properties from 1-minute segments of RR series, respiration signals, and atrial fibrillatory rates (AFR) using synthetic data that replicates clinical ECG-derived data. The synthetic data were generated using a network model of the AV node and 4 million unique model parameter sets. The 1D-CNN was then used to analyze respiratory modulation in clinical deep breathing test data of 28 patients in AF, where an ECG-derived respiration signal was extracted using a novel approach based on periodic component analysis. Results: We demonstrated using synthetic data that the 1D-CNN can estimate the respiratory modulation from RR series alone with a Pearson sample correlation of r = 0.805 and that the addition of either respiration signal (r = 0.830), AFR (r = 0.837), or both (r = 0.855) improves the estimation. Discussion: Initial results from analysis of ECG data suggest that our proposed estimate of respiration-induced autonomic modulation, a resp, is reproducible and sufficiently sensitive to monitor changes and detect individual differences. However, further studies are needed to verify the reproducibility, sensitivity, and clinical significance of a resp.
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Affiliation(s)
- Felix Plappert
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Cardiovascular Research–Epidemiology, Malmö, Sweden
| | - Pyotr G. Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Mikael Wallman
- Fraunhofer-Chalmers Centre, Department of Systems and Data Analysis, Gothenburg, Sweden
| | - Frida Sandberg
- Department of Biomedical Engineering, Lund University, Lund, Sweden
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Mundisugih J, Kumar S, Kizana E. Adeno-associated virus-mediated gene therapy for cardiac tachyarrhythmia: A systematic review and meta-analysis. Heart Rhythm 2024:S1547-5271(24)00111-5. [PMID: 38336191 DOI: 10.1016/j.hrthm.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
Cardiac tachyarrhythmia presents a significant health care challenge, causing notable morbidity and mortality. Conventional treatments have limitations and potential risks, resulting in an elevated disease burden. Adeno-associated virus (AAV)-mediated gene therapy holds promise as a potential future treatment option. Therefore, we aimed to provide a measured overview of the latest developments in this rapidly growing field. PubMed and Embase databases were searched up to January 2024. Studies that employed AAV as a vector for delivery of therapeutic agents to treat cardiac tachyarrhythmia were included. Of the 26 studies included, 20 published in the last 5 years. There were 22 novel molecular targets identified. More than 80% of the included studies employed small-animal models or used AAV9. In atrial fibrillation preclinical studies, AAV-mediated gene therapy reduced atrial fibrillation inducibility by 81% (odds ratio, 0.19 [0.08-0.45]; P < .01). Similarly, for acquired and inherited ventricular arrhythmia, animal models receiving gene therapy had less inducible ventricular arrhythmia (odds ratio, 0.06 [0.03-0.11]; P < .01). This review highlights the rapid progress of AAV-mediated gene therapy for cardiac tachyarrhythmia. Although these investigations are currently in the early stages of clinical application, they present promising prospects for gene therapy. (PROSPERO registry: CRD42023479448).
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Affiliation(s)
- Juan Mundisugih
- Centre for Heart Research, Westmead Institute for Medical Research, New South Wales, Australia; Department of Cardiology, Westmead Hospital, New South Wales, Australia; Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, New South Wales, Australia; Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Eddy Kizana
- Centre for Heart Research, Westmead Institute for Medical Research, New South Wales, Australia; Department of Cardiology, Westmead Hospital, New South Wales, Australia; Sydney Medical School, The University of Sydney, New South Wales, Australia.
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3
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Mamontov OV, Zaytsev VV, Kamshilin AA. Plethysmographic assessment of vasomotor response in patients with congestive heart failure before and after heart transplantation. BIOMEDICAL OPTICS EXPRESS 2024; 15:687-699. [PMID: 38404348 PMCID: PMC10890858 DOI: 10.1364/boe.511925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 02/27/2024]
Abstract
Sympathetic vasomotor response is the most important part of the autonomic regulation of circulation, which determines the quality of life. It is disrupted in a number of diseases, particularly in patients with congestive heart failure (CHF). However, experimental evaluation of reflex vasoconstriction is still a non-trivial task due to the limited set of available technologies. The aim of this study is to assess the dynamics of vasomotor response of forearm vessels due to both the deactivation of cardiopulmonary baroreceptors and cold stress using a newly designed imaging plethysmograph (IPG) and compare its performance with classical air plethysmograph (APG). In both vasoconstriction tests, vasomotor response was assessed as a change in the blood flow rate due to venous occlusion compared to that at rest. Both tests were carried out in 45 CHF patients both before and after heart transplantation, as well as in 11 age-matched healthy volunteers. Prior to transplantation, both APG and IPG showed a significant decrease in vasomotor response in CHF patients due to both tests as compared to the control group. After heart transplantation, an increase in vasomotor reactivity was revealed in both vasoconstriction tests. We have found that both plethysmographic techniques provide correlated assessment of changes in the vasomotor response. In addition, we have found that IPG is more resistant to artifacts than APG. The new IPG method has the advantage of measuring blood flow in a contactless manner, making it very promising for experimental evaluation of vasomotor response in clinical conditions.
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Affiliation(s)
- Oleg V. Mamontov
- Laboratory of New Functional Materials for Photonics, Institute of Automation and Control Processes of Far East Branch of the Russian Academy of Sciences, 690041 Vladivostok, Russia
- Department of Circulation Physiology, Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
- Department of Departmental Therapy, Pavlov First Saint Petersburg State Medical University, 197022 St. Petersburg, Russia
| | - Valeriy V. Zaytsev
- Laboratory of New Functional Materials for Photonics, Institute of Automation and Control Processes of Far East Branch of the Russian Academy of Sciences, 690041 Vladivostok, Russia
- Department of Circulation Physiology, Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
| | - Alexei A. Kamshilin
- Laboratory of New Functional Materials for Photonics, Institute of Automation and Control Processes of Far East Branch of the Russian Academy of Sciences, 690041 Vladivostok, Russia
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4
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1-e156. [PMID: 38033089 PMCID: PMC11095842 DOI: 10.1161/cir.0000000000001193] [Citation(s) in RCA: 76] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines liaison
| | | | | | | | | | - Paul L Hess
- ACC/AHA Joint Committee on Performance Measures liaison
| | | | | | | | | | - Kazuhiko Kido
- American College of Clinical Pharmacy representative
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Hurtado GM, Clarke JRD, Zimerman A, Maher T, Tavares L, d’Avila A. Speech-induced atrial tachycardia: A narrative review of putative mechanisms implicating the autonomic nervous system. Heart Rhythm O2 2023; 4:574-580. [PMID: 37744943 PMCID: PMC10513919 DOI: 10.1016/j.hroo.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Despite being uncommon, speech-induced atrial tachycardias carry significant morbidity and affect predominantly healthy individuals. Little is known about their mechanism, treatment, and prognosis. In this review, we seek to identify the underlying connections and pathophysiology between speech and arrhythmias while providing an informed approach to evaluation and management.
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Affiliation(s)
- Gabriel M.Pajares Hurtado
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - John-Ross D. Clarke
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Andre Zimerman
- TIMI Study Group, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy Maher
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Liliana Tavares
- Department of Medicine, MetroWest Medical Center, Tufts School of Medicine, Framingham, Massachusetts
| | - Andre d’Avila
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Carlisle MA, Piccini JP, Fudim M. The interplay between autonomic tone and atrial arrhythmias. Clin Auton Res 2022; 32:223-225. [PMID: 35882685 DOI: 10.1007/s10286-022-00881-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Matthew A Carlisle
- Department of Medicine, Division of Cardiology, Duke University Medical Center, 40 Duke Medicine Cir Clinic 2f/2g, Durham, NC, 27710, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Jonathan P Piccini
- Department of Medicine, Division of Cardiology, Duke University Medical Center, 40 Duke Medicine Cir Clinic 2f/2g, Durham, NC, 27710, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Marat Fudim
- Department of Medicine, Division of Cardiology, Duke University Medical Center, 40 Duke Medicine Cir Clinic 2f/2g, Durham, NC, 27710, USA. .,Duke Clinical Research Institute, Durham, NC, USA.
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Mukai Y, Murai H, Hamaoka T, Sugimoto H, Inoue O, Goten C, Kusayama T, Takashima SI, Kato T, Usui S, Sakata K, Takata S, Takamura M. Effect of pulmonary vein isolation on the relationship between left atrial reverse remodeling and sympathetic nerve activity in patients with atrial fibrillation. Clin Auton Res 2022; 32:229-235. [PMID: 35737214 DOI: 10.1007/s10286-022-00873-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/06/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Catheter ablation (CA) to isolate the pulmonary vein, which is an established treatment for atrial fibrillation (AF), is associated with left atrium reverse remodeling (LARR). The intrinsic cardiac autonomic nervous system includes the ganglion plexi adjacent to the pulmonary vein in the left atrium (LA). However, little is known about the effect of CA on the relationship between LARR and sympathetic nerve activity in patients with AF. METHODS This study enrolled 22 AF patients with a normal left ventricular ejection fraction (LVEF) aged 64.6 ± 12.9 years who were scheduled for CA. Sympathetic nerve activity was evaluated by direct recording of muscle sympathetic nerve activity (MSNA) before and 12 weeks after CA. Blood pressure, heart rate (HR), HR variability, and echocardiography were also measured. RESULTS The heart rate increased significantly after CA (63 ± 10.9 vs. 70.6 ± 7.7 beats/min, p < 0.01), but blood pressure did not change. A high frequency (HF) and low frequency (LF) of HR variability decreased significantly after ablation, but no significant change in LF/HF was observed. CA significantly decreased MSNA (38.9 ± 9.9 vs. 28 ± 9.1 bursts/min, p < 0.01). Moreover, regression analysis revealed a positive correlation between the percentage change in MSNA and the LA volume index (r = 0.442, p < 0.05). CONCLUSIONS Our results show that CA for AF reduced MSNA and the decrease was associated with the LA volume index in AF patients with a normal LVEF. These findings suggest that LARR induced by CA for AF decrease sympathetic nerve activity.
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Affiliation(s)
- Yusuke Mukai
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences Kanazawa, Kanazawa, Japan
| | - Hisayoshi Murai
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences Kanazawa, Kanazawa, Japan. .,Department of Cardiology, Kanazawa Municipal Hospital, Kanazawa, Japan.
| | - Takuto Hamaoka
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences Kanazawa, Kanazawa, Japan
| | - Hiroyuki Sugimoto
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences Kanazawa, Kanazawa, Japan
| | - Oto Inoue
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences Kanazawa, Kanazawa, Japan
| | - Chiaki Goten
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences Kanazawa, Kanazawa, Japan
| | - Takashi Kusayama
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences Kanazawa, Kanazawa, Japan
| | - Shin-Ichiro Takashima
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences Kanazawa, Kanazawa, Japan
| | - Takeshi Kato
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences Kanazawa, Kanazawa, Japan
| | - Soichiro Usui
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences Kanazawa, Kanazawa, Japan
| | - Kenji Sakata
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences Kanazawa, Kanazawa, Japan
| | - Shigeo Takata
- Department of Cardiology, Kanazawa Municipal Hospital, Kanazawa, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences Kanazawa, Kanazawa, Japan
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