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Delisle BP, Prabhat A, Burgess DE, Ono M, Esser KA, Schroder EA. Circadian Regulation of Cardiac Arrhythmias and Electrophysiology. Circ Res 2024; 134:659-674. [PMID: 38484028 DOI: 10.1161/circresaha.123.323513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Circadian rhythms in physiology and behavior are ≈24-hour biological cycles regulated by internal biological clocks (ie, circadian clocks) that optimize organismal homeostasis in response to predictable environmental changes. These clocks are present in virtually all cells in the body, including cardiomyocytes. Many decades ago, clinicians and researchers became interested in studying daily patterns of triggers for sudden cardiac death, the incidence of sudden cardiac death, and cardiac arrhythmias. This review highlights historical and contemporary studies examining the role of day/night rhythms in the timing of cardiovascular events, delves into changes in the timing of these events over the last few decades, and discusses cardiovascular disease-specific differences in the timing of cardiovascular events. The current understanding of the environmental, behavioral, and circadian mechanisms that regulate cardiac electrophysiology is examined with a focus on the circadian regulation of cardiac ion channels and ion channel regulatory genes. Understanding the contribution of environmental, behavioral, and circadian rhythms on arrhythmia susceptibility and the incidence of sudden cardiac death will be essential in developing future chronotherapies.
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Affiliation(s)
- Brian P Delisle
- Department of Physiology, University of Kentucky, Lexington (B.P.D., A.P., D.E.B.)
| | - Abhilash Prabhat
- Department of Physiology, University of Kentucky, Lexington (B.P.D., A.P., D.E.B.)
| | - Don E Burgess
- Department of Physiology, University of Kentucky, Lexington (B.P.D., A.P., D.E.B.)
| | - Makoto Ono
- Division of Cardiology and Rehabilitation, Tamaki Hospital, Japan (M.O.)
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Personnic E, Gerard G, Poilbout C, Jetten AM, Gómez AM, Benitah JP, Perrier R. Circadian regulation of Ca V 1.2 expression by RORα in the mouse heart. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.15.575657. [PMID: 38293155 PMCID: PMC10827087 DOI: 10.1101/2024.01.15.575657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Background In addition to show autonomous beating rhythmicity, the physiological functions of the heart present daily periodic oscillations. Notably the ventricular repolarization itself varies throughout the circadian cycle which was mainly related to the periodic expression of K + channels. However, the involvement of the L-type Ca 2+ channel (Ca V 1.2 encoded by Cacna1c gene) in these circadian variations remains elusive. Methods We used a transgenic mouse model (PCa-luc) that expresses the luciferase reporter under the control of the cardiac Cacna1c promoter and analyzed promoter activity by bioluminescent imaging, qPCR, immunoblot, Chromatin immunoprecipitation assay (ChIP) and Ca V 1.2 activity. Results Under normal 12:12h light-dark cycle, we observed in vivo a biphasic diurnal variation of promoter activities peaking at 9 and 19.5 Zeitgeber time (ZT). This was associated with a periodicity of Cacna1c mRNA levels preceding 24-h oscillations of Ca V 1.2 protein levels in ventricle (with a 1.5 h phase shift) but not in atrial heart tissues. The periodicity of promoter activities and Ca V 1.2 proteins, which correlated with biphasic oscillations of L-type Ca 2+ current conductance, persisted in isolated ventricular cardiomyocytes from PCa-Luc mice over the course of the 24-h cycle, suggesting an endogenous cardiac circadian regulation. Comparison of 24-h temporal patterns of clock gene expressions in ventricles and atrial tissues of the same mice revealed conserved circadian oscillations of the core clock genes except for the retinoid-related orphan receptor α gene (RORα), which remained constant throughout the course of a day in atrial tissues. In vitro we found that RORα is recruited to two specific regions on the Cacna1c promoter and that incubation with specific RORα inhibitor disrupted 24-h oscillations of ventricular promoter activities and Ca V 1.2 protein levels. Similar results were observed for pore forming subunits of the K + transient outward currents, K V 4.2 and K V 4.3. Conclusions These findings raise the possibility that the RORα-dependent rhythmic regulation of cardiac Ca V 1.2 and K V 4.2/4.3 throughout the daily cycle may play an important role in physiopathology of heart function.
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Ben Ahmed H, Bellali M, Allouche E, Allouche M, Belhadj A, Ben Khelil M, Shimi M, Razghallah R, Banasr A, Benzarti A, Bezdah L, Hamdoun M. [Circadian and septadian variation in sudden cardiac death : Autopsy registry of the Tunisian North]. Ann Cardiol Angeiol (Paris) 2023; 72:101597. [PMID: 37075563 DOI: 10.1016/j.ancard.2023.101597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 02/26/2023] [Accepted: 03/21/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Several studies have suggested a circadian and septadian pattern of incidence of sudden cardiac death with a morning peak and a Monday peak. OBJECTIVE To analyze the circadian and septadian pattern of occurrence of sudden cardiac death in the eight northern Tunisian governorates. METHODS We prospectively collected epidemiological and autopsy data of sudden cardiac death victims occurring in the northern region of Tunisia between January 2013 and December 2019. RESULTS The population included 1834 men (79.6%) and 468 women (20.4%) with a mean age of 56.5 ± 14 years. Smoking (53.9%) was the most prevalent cardiovascular risk factor. One-fifth (20.9%) of victims had known heart disease, and 3% had a family history of sudden death. ischemic heart disease was the leading cause of sudden death (46.8% of cases). One- fourth (25.7%) of autopsies were negative. Analysis of the circadian pattern of occurrence of sudden cardiac death identified a peak (36.1%, p < 0.001) between midnight and 6 am. This nocturnal excess mortality was significant (p < 0.001) and independent of sex (34.1 % in men and 43.8 % in women) and cause of death (39.3 % of cases of sudden ischemic death and 33.3 % of cases of nonischemic death). Moreover, there was a significant septadian variability in the occurrence of sudden death (p: 0.0015), with a peak on Friday (15.8 %, p: 0.042). CONCLUSION This study showed a peak of sudden death between midnight and 6 am, and on Fridays, confirming the modification of the classic circadian and septadian pattern of sudden death occurrence. These results may help optimize the deployment of emergency mobile teams and structures during the most vulnerable periods.
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Affiliation(s)
- H Ben Ahmed
- Service de cardiologie, Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - M Bellali
- Service de Médecine Légale Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - E Allouche
- Service de cardiologie, Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie.
| | - M Allouche
- Service de Médecine Légale Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - A Belhadj
- Service de Médecine Légale Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - M Ben Khelil
- Service de Médecine Légale Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - M Shimi
- Service de Médecine Légale Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - R Razghallah
- Service de cardiologie, Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - A Banasr
- Service de Médecine Légale Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - A Benzarti
- Service de Médecine Légale Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - L Bezdah
- Service de cardiologie, Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - M Hamdoun
- Service de Médecine Légale Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
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Chung WH, Hayase J, Do DH, Dixit N, Ajijola O, Buch E, Boyle N, Shivkumar K, Bradfield JS. Clinical predictors and implications of cardiac inflammation detected on positron emission tomography (PET) in patients referred for premature ventricular complex (PVC) ablation. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01446-z. [PMID: 36510109 DOI: 10.1007/s10840-022-01446-z] [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: 09/28/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Positron emission tomography computed tomography (PET-CT) is not routinely used for premature ventricular complexes (PVCs). Whether specific clinical factors are associated with abnormal PET-CT results is not clear. METHODS The treatment courses and baseline characteristics of consecutive patients in a single center between 2012 and 2021, age > 18 years old, and who received 18F-fluorodeoxyglucose (FDG) PET-CT imaging for evaluation of PVCs were retrospectively analyzed. RESULTS A total of 102 patients was included. Of these, 27 patients (26.4%) had abnormal PET-CT and 61 (59.8%) had normal imaging. Abnormal PET-CT findings were associated with non-sustained ventricular tachycardia (NSVT) (95.2% vs. 52.6%, p = 0.001), higher number of PVC morphologies (2.29 ± 0.7 vs. 1.31 ± 0.6, p < 0.001), greater PVC coupling interval dispersion (72.47 ± 66.4 ms vs. 13.42 ± 17.9 ms, p < 0.001), and greater likelihood of fast heart rate dependent PVCs (78.5% vs. 38.2%, p = 0.017). Fourteen (51.8%) patients had an abnormal PET-CT and abnormal late gadolinium enhancement (LGE). Patients with abnormal PET-CT were more frequently treated with immunosuppression (81.4% vs. 3.2%, p < .0001) than with catheter ablation (11.1% vs. 45.9%, p = 0.002) compared to the normal PET-CT group. Over a median follow-up of 862 days (IQR 134, 1407), PVC burden decreased in both groups [from 23 ± 16% to 9 ± 10% (p < 0.001) in abnormal PET-CT group and from 21 ± 15% to 7 ± 10% (p < 0.001) in normal PET-CT group]. CONCLUSIONS Abnormal PET-CT findings were more commonly associated with NSVT, multiform PVCs, greater PVC coupling interval dispersion, and fast heart rate dependent PVCs. LGE was not sensitive for detecting inflammation. Immunosuppression was effective in managing PVCs with abnormal PET-CT.
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Affiliation(s)
- Wei-Hsin Chung
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA.
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.
| | - Justin Hayase
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Duc H Do
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Neal Dixit
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Olujimi Ajijola
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Eric Buch
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Noel Boyle
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
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Suzuki N, Otsuki S, Izumi D, Akagawa R, Sakaguchi Y, Hakamata T, Ikami Y, Hasegawa Y, Yagihara N, Iijima K, Chinushi M, Inomata T. Clinical impact of nocturnal ventricular tachyarrythmias in electrical storm. Pacing Clin Electrophysiol 2022; 45:1330-1337. [DOI: 10.1111/pace.14592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/28/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Naomasa Suzuki
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Sou Otsuki
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Daisuke Izumi
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Rie Akagawa
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Yuta Sakaguchi
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Takahiro Hakamata
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Yasuhiro Ikami
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Yuki Hasegawa
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Nobue Yagihara
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Kenichi Iijima
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | | | - Takayuki Inomata
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
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Tang Y, Tertulien T, Bhonsale A, Kancharla K, Estes NAM, Jain SK, Saba S. Comparison of Circadian Variation for In-Hospital Versus Out-of-Hospital Sudden Cardiac Arrest Survivors. Am J Cardiol 2021; 160:1-7. [PMID: 34583813 DOI: 10.1016/j.amjcard.2021.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Several studies have reported circadian periodicity of sudden cardiac arrest (SCA). It remains unclear to what extent this circadian rhythm is influenced by variation in patients' activities. One way to elucidate this is to compare patients with out-of-hospital cardiac arrests (OHCAs) with those with in-hospital cardiac arrests (IHCAs). We therefore examined the presence of a circadian pattern of SCA in a large cohort of OHCA and IHCA survivors. A total of 1,433 consecutive survivors of SCA in the Pittsburgh area from 2002 to 2012 were included. Patient demographics, including clinical histories and details of SCA, were collected. The distribution of SCA throughout the day was tested for differences using the chi-square test. Of the 1,224 patients analyzed, 706 had IHCA and 518 OHCA. We observed a nadir of SCA in the nighttime hours between 12 a.m. and 6 a.m. in both IHCA and OHCA groups (p <0.001), although this pattern was more blunted in the IHCA group. Patients who had an SCA in the nighttime window had more co-morbidities (p = 0.01). The circadian pattern was noted to be absent in patients with higher co-morbidity burden in IHCA only. In conclusion, the typical pattern of nighttime nadir in SCA is observed in patients with both OHCA and IHCA but is blunted in the hospital and especially in sicker patients. This suggests a common mechanistic pathway of SCA transcending differences in physical activities of patients and a difference in how co-morbidities interact with the timing of SCA in the inpatient setting.
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Bağcı A, Aksoy F, Baş HA, Işık İB, Akkaya F, Orhan H. Relationship between morning blood pressure surge and the frontal plane QRS-T angle in newly diagnosed hypertensive patients. Clin Exp Hypertens 2021; 43:707-714. [PMID: 34176382 DOI: 10.1080/10641963.2021.1945076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Morning blood pressure surge (MBPS) plays an important role in target organ damage and major adverse cardiac events. The frontal QRS-T [f(QRS-T)] angle is the electrocardiographic marker and index of ventricular arrhythmogenic events. We aimed to investigate the relationship between MBPS and the f(QRS-T) angle, which is an indicator of ventricular repolarization disorder, in patients with newly diagnosed HT. METHODS Between June 2020 and March 2021, 263 patients with newly diagnosed HT who were admitted to our outpatient clinic were prospectively included in the study. According to ambulatory blood pressure monitoring (ABPM), the patients were categorized into two groups: Group-I: low-value MBPS (<37 mm Hg), and group-II: high-value MBPS (≥37 mm Hg). The f(QRS-T) angle calculated from the 12-lead electrocardiogram and all other data were compared between the groups. RESULTS A total of 186 newly diagnosed HT patients who met the inclusion criteria were included in the study. The average f(QRS-T) angle in Groups I and 2 was 21° ± 16° and 51° ± 30°, respectively (P < .001). According to multivariate regression analysis, T peak-end and MBPS were found to be independent predictors of the f(QRS-T) angle. CONCLUSIONS As a result of our study, we found that the f(QRS-T) angle was widened in patients with exaggerated MBPS. The cause of increased cardiovascular outcomes in patients with exaggerated MBPS may be explained by widened in the f(QRS-T) angle that is a ventricular repolarization parameter.
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Affiliation(s)
- Ali Bağcı
- Assistant Professor Professor from the Department of Cardiology, Suleyman Demirel University, Medical School, Isparta, Turkey
| | - Fatih Aksoy
- Associate Professor from the Department of Cardiology, Suleyman Demirel University, Medical School, Isparta, Turkey
| | - Hasan Aydin Baş
- Resident from Department of Cardiology, Isparta City Hospital, Isparta, Turkey
| | - İsmail Barkin Işık
- Resident from Department of Cardiology, Rize State Hospital, Rize, Turkey
| | - Fatih Akkaya
- Assistant Professor Professor from the Department of Cardiology, Ordu University, Medical School, Ordu, Turkey
| | - Hikmet Orhan
- Professor from Department of Biostatistics, Suleyman Demirel University, Medical School, Isparta, Turkey
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Vergara P, Pignalberi C, Pisanò EC, Maglia G, Della Bella P, Zanotto G, Iacopino S, Solimene F, Calvi V, Marini M, Giammaria M, Biffi M, Rovaris G, Caravati F, Quartieri F, Curnis A, Rapacciuolo A, Senatore G, Pedretti S, Saporito D, Dello Russo A, Santobuono VE, Pepi P, Duca A, Baroni M, Falasconi G, Giacopelli D, Gargaro A, D'Onofrio A. Circadian periodicity affects the type of ventricular arrhythmias and efficacy of implantable defibrillator therapies. J Cardiovasc Electrophysiol 2021; 32:2528-2535. [PMID: 34252991 DOI: 10.1111/jce.15154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/14/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Factors influencing malignant arrhythmia onset are not fully understood. We explored the circadian periodicity of ventricular arrhythmias (VAs) in patients with implantable cardioverter and cardiac resynchronization defibrillators (ICD/CRT-D). METHODS Time, morphology (monomorphic/polymorphic), and mode of termination (anti-tachycardia pacing [ATP] or shock) of VAs stored in a database of remote monitoring data were adjudicated. Episodes were grouped in six 4-h timeslots from 00:00 to 24:00. Circadian distributions and adjusted marginal odds ratios (ORs), with 95% confidence interval (CI), were analyzed using mixed-effect models and logit generalized estimating equations, respectively, to account for within-subject correlation of multiple episodes. RESULTS Among 1303 VA episodes from 446 patients (63% ICD and 37% CRT-D), 120 (9%) self-extinguished, and 842 (65%) were terminated by ATP, 343 (26%) by shock. VAs clustered from 08:00 to 16:00 with 44% of episodes, as compared with 22% from 00:00 to 08:00 (p < .001) and 34% from 16:00 to 24:00 (p = .005). Episodes were more likely to be polymorphic at night with an adjusted marginal OR of 1.66 (CI, 1.15-2.40; p = .007) at 00:00-04:00 versus other timeslots. Episodes were less likely to be terminated by ATP in the 00:00-04:00 (success-to-failure ratio, 0.67; CI, 0.46-0.98; p = .039) and 08:00-12:00 (0.70; CI, 0.51-0.96; p = .02) timeslots, and most likely to be terminated by ATP between 12:00 and 16:00 (success-to-failure ratio 1.42; CI, 1.06-1.91; p = .02). CONCLUSION VAs did not distribute uniformly over the 24 h, with a majority of episodes occurring from 08:00 to 16:00. Nocturnal episodes were more likely to be polymorphic. The efficacy of ATP depended on the time of delivery.
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Affiliation(s)
- Pasquale Vergara
- Arrhythmia Unit and Electrophysiology Laboratory, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | | | | | - Paolo Della Bella
- Arrhythmia Unit and Electrophysiology Laboratory, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | | | | | - Valeria Calvi
- Policlinico G. Rodolico, Az. O.U. Policlinico-V. Emanuele, Catania, Italy
| | | | | | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | | | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Stefano Pedretti
- Ospedale Sant'Anna, ASST Lariana, San Fermo della Battaglia, Como, Italy
| | | | | | | | | | | | - Matteo Baroni
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulio Falasconi
- IRCCS San Raffaele Scientific Institute and Vita Salute University, Milano, Italy
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Bernardi J, Aromolaran KA, Zhu H, Aromolaran AS. Circadian Mechanisms: Cardiac Ion Channel Remodeling and Arrhythmias. Front Physiol 2021; 11:611860. [PMID: 33519516 PMCID: PMC7841411 DOI: 10.3389/fphys.2020.611860] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/18/2020] [Indexed: 12/31/2022] Open
Abstract
Circadian rhythms are involved in many physiological and pathological processes in different tissues, including the heart. Circadian rhythms play a critical role in adverse cardiac function with implications for heart failure and sudden cardiac death, highlighting a significant contribution of circadian mechanisms to normal sinus rhythm in health and disease. Cardiac arrhythmias are a leading cause of morbidity and mortality in patients with heart failure and likely cause ∼250,000 deaths annually in the United States alone; however, the molecular mechanisms are poorly understood. This suggests the need to improve our current understanding of the underlying molecular mechanisms that increase vulnerability to arrhythmias. Obesity and its associated pathologies, including diabetes, have emerged as dangerous disease conditions that predispose to adverse cardiac electrical remodeling leading to fatal arrhythmias. The increasing epidemic of obesity and diabetes suggests vulnerability to arrhythmias will remain high in patients. An important objective would be to identify novel and unappreciated cellular mechanisms or signaling pathways that modulate obesity and/or diabetes. In this review we discuss circadian rhythms control of metabolic and environmental cues, cardiac ion channels, and mechanisms that predispose to supraventricular and ventricular arrhythmias including hormonal signaling and the autonomic nervous system, and how understanding their functional interplay may help to inform the development and optimization of effective clinical and therapeutic interventions with implications for chronotherapy.
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Affiliation(s)
- Joyce Bernardi
- Masonic Medical Research Institute, Utica, NY, United States
| | | | - Hua Zhu
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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McTiernan CF, Lemster BH, Bedi KC, Margulies KB, Moravec CS, Hsieh PN, Shusterman V, Saba S. Circadian Pattern of Ion Channel Gene Expression in Failing Human Hearts. Circ Arrhythm Electrophysiol 2020; 14:e009254. [PMID: 33301345 DOI: 10.1161/circep.120.009254] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ventricular tachyarrhythmias and sudden cardiac death show a circadian pattern of occurrence in patients with heart failure. In the rodent ventricle, a significant portion of genes, including some ion channels, shows a circadian pattern of expression. However, genes that define electrophysiological properties in failing human heart ventricles have not been examined for a circadian expression pattern. METHODS Ventricular tissue samples were collected from patients at the time of cardiac transplantation. Two sets of samples (n=37 and 46, one set with a greater arrhythmic history) were selected to generate pseudo-time series according to their collection time. A third set (n=27) of samples was acquired from the nonfailing ventricles of brain-dead donors. The expression of 5 known circadian clock genes and 19 additional ion channel genes plausibly important to electrophysiological properties were analyzed by real-time polymerase chain reaction and then analyzed for the percentage of expression variation attributed to a 24-hour circadian pattern. RESULTS The 5 known circadian clock gene transcripts showed a strong circadian expression pattern. Compared with rodent hearts, the human circadian clock gene transcripts showed a similar temporal order of acrophases but with a ≈7.6 hours phase shift. Five of the ion channel genes also showed strong circadian expression. Comparable studies of circadian clock gene expression in samples recovered from nonheart failure brain-dead donors showed acrophase shifts, or weak or complete loss of circadian rhythmicity, suggesting alterations in circadian gene expression. CONCLUSIONS Ventricular tissue from failing human hearts display a circadian pattern of circadian clock gene expression but phase-shifted relative to rodent hearts. At least 5 ion channels show a circadian expression pattern in the ventricles of failing human hearts, which may underlie a circadian pattern of ventricular tachyarrhythmia/sudden cardiac death. Nonfailing hearts from brain-dead donors show marked differences in circadian clock gene expression patterns, suggesting fundamental deviations from circadian expression.
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Affiliation(s)
- Charles F McTiernan
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, PA (C.F.M., B.H.L., S.S.)
| | - Bonnie H Lemster
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, PA (C.F.M., B.H.L., S.S.)
| | - Kenneth C Bedi
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (K.C.B)
| | - Kenneth B Margulies
- Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia (K.B.M.)
| | - Christine S Moravec
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (C.S.M.)
| | | | | | - Samir Saba
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, PA (C.F.M., B.H.L., S.S.)
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Otsuki S, Aiba T, Tahara Y, Nakajima K, Kataoka N, Kamakura T, Wada M, Ishibashi K, Yamagata K, Inoue Y, Miyamoto K, Nagase S, Noda T, Izumi C, Noguchi T, Nishimura K, Yonemoto N, Nonogi H, Nagao K, Ikeda T, Sato N, Tsutsui H, Yasuda S, Kusano K. Intra-day change in occurrence of out-of-hospital ventricular fibrillation in Japan: The JCS-ReSS study. Int J Cardiol 2020; 318:54-60. [PMID: 32569698 DOI: 10.1016/j.ijcard.2020.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/17/2020] [Accepted: 06/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Real-world evidence of out-of-hospital ventricular fibrillation (VF), especially regarding intra-day change, remains unclear. We aimed to investigate that age- and gender-dependent difference of intra-day change of VF occurrence. METHOD We enrolled 71,692 patients (males: 56,419 [78.7%], females: 15,273 [21.3%]) in whom cardiac VF had been documented from the 2005-2015 All-Japan Utstein Registry data. Subjects were divided into four groups: group-I (<18 years old), group-II (18-39), group-III (40-69), and group-IV (≥70). Among four groups in each of male and female, we compared the intra-day change of VF occurrence, and evaluated the risk factors of the unfavorable neurologic outcomes at 1 month after VF. RESULTS Regardless of age, the incidence of VF was significantly greater in male than in female subjects. In male subjects, VF in group-I, III and IV occurred higher at daytime, however, group-II had no intra-day difference because group-II had a higher VF events at midnight~ early morning compared with other aged groups (Poisson regression analysis, p = .03). While in female, each group showed similar intra-day pattern of VF occurrence. Logistic regression analysis revealed that some of the clinical parameters such as time periods from call receipt to first shock and the presence of bystander cardiopulmonary resuscitation were important for risk of 30-day neurologically unfavorable outcomes. CONCLUSIONS The intra-day change of VF occurrence was age-dependently different in males but not in females, suggesting age- and gender-dependent differences in underlying cardiac diseases. These might affect the significant difference in unfavorable neurologic outcome.
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Affiliation(s)
- Sou Otsuki
- National Cerebral and Cardiovascular Center, Suita, Japan; Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Takeshi Aiba
- National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Yoshio Tahara
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Naoya Kataoka
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Mitsuru Wada
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | | | - Yuko Inoue
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koji Miyamoto
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Nagase
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takashi Noda
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chisato Izumi
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruo Noguchi
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | | | | | | | | | | | | | - Satoshi Yasuda
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kengo Kusano
- National Cerebral and Cardiovascular Center, Suita, Japan
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12
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Koca H, Kucukosmanoglu M, Icen YK, Koca F, Ardıc ML, Koc M. A new approach to radiofrequency catheter ablation of premature ventricular contractions: The diurnal variation index. J Electrocardiol 2020; 59:106-111. [DOI: 10.1016/j.jelectrocard.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/22/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
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13
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Ramireddy A, Chugh SS. Do peak times exist for sudden cardiac arrest? Trends Cardiovasc Med 2020; 31:172-176. [PMID: 32088067 DOI: 10.1016/j.tcm.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/09/2020] [Accepted: 01/31/2020] [Indexed: 11/17/2022]
Abstract
Sudden cardiac arrest remains an unexpected and dynamic cardiovascular disease process that continues to present challenges for accurate risk prediction and prevention. The notion of a circadian pattern in the occurrence of sudden cardiac arrest had long been supported by the presence of an early morning peak; however, more recent studies are calling this observation into question. This likely paradigm shift in the presentation and mechanisms of sudden cardiac arrest has major implications and needs to be carefully considered. In this review, we present the current state of the science of circadian and septadian trends in sudden cardiac arrest through an in-depth analysis of the published literature.
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Affiliation(s)
- Archana Ramireddy
- The Smidt Heart Institute, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, Suite A3100, 127 S. San Vicente Blvd, Los Angeles, CA 90048, United States
| | - Sumeet S Chugh
- The Smidt Heart Institute, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, Suite A3100, 127 S. San Vicente Blvd, Los Angeles, CA 90048, United States.
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14
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Krasińska B, Paluszkiewicz L, Miciak-Lawicka E, Krasiński M, Rzymski P, Tykarski A, Krasiński Z. The effect of acetylsalicylic acid dosed at bedtime on the anti-aggregation effect in patients with coronary heart disease and arterial hypertension: A randomized, controlled trial. Cardiol J 2018; 26:727-735. [PMID: 30484269 DOI: 10.5603/cj.a2018.0142] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/11/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acetylsalicylic acid (ASA) is one of the basic drugs used in the secondary prevention of coronary artery disease (CAD), and in most cases it is taken in the morning in one daily dose. It is suggested that the morning peak of platelet aggregation is responsible for the occurrence of myocardial infarctions and strokes. Hence, the aim of the study was to observe the effect of ASA (morning vs. evening) dosing on the anti-aggregative effect of platelets in patients with CAD and arterial hypertension (AH). METHODS The study involved 175 patients with CAD and AH. Patients were randomly assigned to one of two study groups, taking ASA in the morning or in the evening. The patients had two visits, one baseline and another after 3 months from changing the time of ASA dosage. The platelet aggregation was determined using the VerifyNow analyzer. RESULTS In the ASA evening group, a significant reduction in platelet aggregation was obtained. In the ASA morning group, a significant difference in response to ASA was observed, depending on sex. In men, the reactivity of platelets decreased, but in women it increased. CONCLUSIONS In the group of patients with CAD and AH, bedtime ASA dosing is associated with a significant reduction in platelet aggregation. The response to ASA may differ between sexes. The benefit gained by changing the drug administration from the morning to the evening is greater in women.
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Affiliation(s)
- Beata Krasińska
- Department of Hypertension, Angiology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland.
| | - Lech Paluszkiewicz
- Department of Thoracic And Cardiovascular Surgery/Perioperative diagnostics Bad Oeynhausen, Heart and Diabetes Center NRW, Ruhr-University of Bochum, Germany
| | - Ewa Miciak-Lawicka
- Department of Hypertension, Angiology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Krasiński
- Student, Imperial College London School of Medicine, United Kingdom
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Andrzej Tykarski
- Department of Hypertension, Angiology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Zbigniew Krasiński
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland
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15
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Santoro F, Metzner A, Scholz L, Brunetti ND, Heeger CH, Rillig A, Reissmann B, Lemeš C, Maurer T, Fink T, Inaba O, Hashiguchi N, Kuck KH, Ouyang F, Mathew S. Prognostic significance of ventricular tachycardia clustering after catheter ablation in non-ischemic dilated cardiomyopathy. Clin Res Cardiol 2018; 108:539-548. [PMID: 30350253 DOI: 10.1007/s00392-018-1384-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 10/15/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ventricular tachycardia clustering (VTc) is associated with a worse clinical outcome in patients with non-ischemic dilated cardiomyopathy (NI-DCM) and implantable cardioverter defibrillator (ICD); however, its role after catheter ablation (CA) has still not been investigated. Aim of this study was to evaluate the prognostic significance of VTc after CA. METHODS 96 consecutive patients (59 ± 13 years, 82% males) with NI-DCM underwent CA for drug-refractory VT. After CA, patients with VT recurrence were divided into two groups: (1) patients that presented with VTc defined as the occurrence of three or more appropriate ICD interventions within 2 weeks, and (2) patients without VTc. RESULTS At 56-months follow-up after ablation 52/96 (54%) patients had recurrent VT, 28/52 (54%) patients experienced VTc and 24/52 (46%) no VTc. When comparing patients with VTc after CA with those without, no differences in terms of age, sex, ejection fraction and cardiovascular risk factors were found. However, patients with VTc showed higher mortality rates at follow-up (54% vs 21% p = 0.04; log-rank p ≤ 0.01). No survival differences were found between patients without VT recurrence and those with VT recurrence but without VTc (29% vs 21% p = 0.77). Predictors of VTc were LVEF < 30% at follow-up and endo-epicardial scar at 3D voltage mapping. At stepwise multivariate analysis VTc and NHYA class were the only independent predictors of death (respectively, RR 3.4, CI 95% 1.16-10.3, p = 0.02; RR 4.18, CI 95% 1.3-12.6, p = 0.01). CONCLUSIONS VTc after CA is an independent predictor of survival and is associated with reduced LVEF at follow-up and endo-epicardial scar at 3D voltage mapping.
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Affiliation(s)
- Francesco Santoro
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany. .,Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
| | - Andreas Metzner
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Leonie Scholz
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | | | - Christian-H Heeger
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany.,University Heart Center Lübeck, Lübeck, Germany
| | - Andreas Rillig
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Bruno Reissmann
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Christine Lemeš
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Tilmann Maurer
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Thomas Fink
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Osamu Inaba
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Naotaka Hashiguchi
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Shibu Mathew
- Department of Cardiology, Asklepios Klinik, St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
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16
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Russo V, Solimene F, Zanotto G, Pisanò EC, Della Bella P, Iacopino S, Pignalberi C, Calvi V, Maglia G, Quartieri F, Biffi M, Curnis A, Giacopelli D, Gargaro A, D'Onofrio A. Seasonal trend of ventricular arrhythmias in a nationwide remote monitoring database of implantable defibrillators and cardiac resynchronization devices. Int J Cardiol 2018; 275:104-106. [PMID: 30327133 DOI: 10.1016/j.ijcard.2018.10.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND The occurrence of sustained ventricular arrhythmias (SVA) may be influenced by environmental factors. We aimed to investigate annual periodic trends of SVA from the intracardiac electrograms (IEGMs) stored in the implantable defibrillators (ICDs) or cardiac resynchronization therapy (CRT-D) recipients. METHODS Data from the Home Monitoring Expert Alliance project, a pooled repository of remote monitoring transmissions were analyzed. All IEGMs stored were independently adjudicated by three cardiac electrophysiologists. Periodicity of SVA was evaluated with Generalized Estimating Equations (GEE) models, including periodic terms depending on months in a year. RESULTS A total of 2936 ICD/CRT-D patients (median age 70 years, 79.6% male) were followed for a median period of 25[13-44] months. Most prevalent structural heart diseases were ischemic (50.8%) and idiopathic dilated (30.6%) cardiomyopathies. Overall, 942 (32.1%) patients experienced a total of 4824 SVA. At GEE analysis, we found a significant periodic component (p = 0.048) when considering both shocked and non-shocked episodes. SVA less frequently occurred in Junes and Julies (3.7 × 1000 patient-month). No evidence of significant periodicity was collected in the subgroup of ischemic patients. CONCLUSIONS In this RM-based cohort of ICD/CRT-T patients, we observed an annual periodicity of SVA occurrence, with a lower incidence in summer months.
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Affiliation(s)
- Vincenzo Russo
- University of Campania "Luigi Vanvitelli", Monaldi Hospital, Napoli, Italy.
| | | | | | | | | | | | | | - Valeria Calvi
- Policlinico Vittorio Emanuele PO Ferrarotto, Catania, Italy
| | | | | | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | - Antonio D'Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, Napoli, Italy
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17
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von Allmen DC, Francey LJ, Rogers GM, Ruben MD, Cohen AP, Wu G, Schmidt RE, Ishman SL, Amin RS, Hogenesch JB, Smith DF. Circadian Dysregulation: The Next Frontier in Obstructive Sleep Apnea Research. Otolaryngol Head Neck Surg 2018; 159:948-955. [PMID: 30200807 DOI: 10.1177/0194599818797311] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To review the effects of the circadian clock on homeostasis, the functional interaction between the circadian clock and hypoxia-inducible factors, and the role of circadian dysregulation in the progression of cardiopulmonary disease in obstructive sleep apnea (OSA). DATA SOURCES The MEDLINE database was accessed through PubMed. REVIEW METHODS A general review is presented on molecular pathways disrupted in OSA, circadian rhythms and the role of the circadian clock, hypoxia signaling, crosstalk between the circadian and hypoxia systems, the role of the circadian clock in cardiovascular disease, and implications for practice. Studies included in this State of the Art Review demonstrate the potential contribution of the circadian clock and hypoxia in animal models or human disease. CONCLUSIONS Molecular crosstalk between the circadian clock and hypoxia-inducible factors has not been evaluated in disease models of OSA. IMPLICATIONS FOR PRACTICE Pediatric OSA is highly prevalent and, if left untreated, may lead to cardiopulmonary sequelae. Changes in inflammatory markers that normally demonstrate circadian rhythmicity are also seen among patients with OSA. Hypoxia-inducible transcription factors interact with core circadian clock transcription factors; however, the interplay between these pathways has not been elucidated in the cardiopulmonary system. This gap in knowledge hinders our ability to identify potential biomarkers of OSA and develop alternative therapeutic strategies. A deeper understanding of the mechanisms by which OSA impinges on clock function and the impact of clock dysregulation on the cardiopulmonary system may lead to future advancements for the care of patients with OSA. The aim of this review is to shed light on this important clinical topic.
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Affiliation(s)
- Douglas C von Allmen
- 1 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Lauren J Francey
- 2 Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Garrett M Rogers
- 3 College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Marc D Ruben
- 2 Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Aliza P Cohen
- 4 Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gang Wu
- 2 Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Robert E Schmidt
- 2 Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Stacey L Ishman
- 1 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- 4 Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- 5 Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Raouf S Amin
- 5 Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- 6 Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - John B Hogenesch
- 2 Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- 6 Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - David F Smith
- 1 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- 4 Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- 5 Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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18
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Ni YM, Rusinaru C, Reinier K, Uy-Evanado A, Chugh H, Stecker EC, Jui J, Chugh SS. Unexpected shift in circadian and septadian variation of sudden cardiac arrest: the Oregon Sudden Unexpected Death Study. Heart Rhythm 2018; 16:411-415. [PMID: 30193852 DOI: 10.1016/j.hrthm.2018.08.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Earlier studies have reported both early morning and Monday peaks in occurrence of sudden cardiac arrest (SCA) in the community and appropriate defibrillator shocks in patients with an implantable cardioverter-defibrillator (ICD). However, a more recent analysis of ICD shocks reported absence of these peaks. OBJECTIVE The purpose of this study was to perform a contemporary evaluation of the circadian and septadian variation of SCA in the general population. METHODS The analysis was performed from an ongoing, population-based study of SCA in a Northwestern US community of approximately 1 million residents. To maximize accuracy, we focused on consecutive patients who presented with witnessed SCA and were attended by emergency medical services (EMS). The specific time of each SCA event was determined based on the time of the 911 call to EMS. RESULTS During 2002-2014, we identified 1535 patients age ≥18 years who suffered witnessed SCA, with time of first EMS contact recorded. There was no morning (6 AM to 12 PM) peak, and we observed a nadir in SCA events during 12 AM to 6 AM, with only 13.9% of events occurring during this 6-hour block (P <.0001). There was no peak on Mondays, but a nadir was observed on Sundays that accounted for only 11.3% of SCA events during the week (P = .004). CONCLUSION in this contemporary community-based study, we failed to observe the expected morning peak or the Monday peak in SCA, duplicating recent findings in primary prevention defibrillator patients. The significant public health implications of these findings merit further investigation.
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Affiliation(s)
- Yu-Ming Ni
- The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Carmen Rusinaru
- The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kyndaron Reinier
- The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Audrey Uy-Evanado
- The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Harpriya Chugh
- The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Jonathan Jui
- Oregon Health and Science University, Portland, Oregon
| | - Sumeet S Chugh
- The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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19
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Black N, D'Souza A, Wang Y, Piggins H, Dobrzynski H, Morris G, Boyett MR. Circadian rhythm of cardiac electrophysiology, arrhythmogenesis, and the underlying mechanisms. Heart Rhythm 2018; 16:298-307. [PMID: 30170229 PMCID: PMC6520649 DOI: 10.1016/j.hrthm.2018.08.026] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Indexed: 12/31/2022]
Abstract
Cardiac arrhythmias are a leading cause of cardiovascular death. It has long been accepted that life-threatening cardiac arrhythmias (ventricular tachycardia, ventricular fibrillation, and sudden cardiac death) are more likely to occur in the morning after waking. It is perhaps less well recognized that there is a circadian rhythm in cardiac pacemaking and other electrophysiological properties of the heart. In addition, there is a circadian rhythm in other arrhythmias, for example, bradyarrhythmias and supraventricular arrhythmias. Two mechanisms may underlie this finding: (1) a central circadian clock in the suprachiasmatic nucleus in the hypothalamus may directly affect the electrophysiology of the heart and arrhythmogenesis via various neurohumoral factors, particularly the autonomic nervous system; or (2) a local circadian clock in the heart itself (albeit under the control of the central clock) may drive a circadian rhythm in the expression of ion channels in the heart, which in turn varies arrhythmic substrate. This review summarizes the current understanding of the circadian rhythm in cardiac electrophysiology, arrhythmogenesis, and the underlying molecular mechanisms.
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Affiliation(s)
- Nicholas Black
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Alicia D'Souza
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Yanwen Wang
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Hugh Piggins
- Division of Diabetes, Endocrinology & Gastroenterology, University of Manchester, Manchester, United Kingdom
| | - Halina Dobrzynski
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Gwilym Morris
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Mark R Boyett
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
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21
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Jhuo SJ, Lo LW, Chang SL, Lin YJ, Chung FP, Hu YF, Chao TF, Tuan TC, Liao JN, Lin CY, Chang YT, Lin CH, Walia R, Te ALD, Yamada S, Raharjo SB, Tang WH, Lee KT, Lai WT, Chen SA. Characteristics of diurnal ventricular premature complex variation in right ventricular outflow tract arrhythmias after catheter ablation. Medicine (Baltimore) 2017; 96:e6516. [PMID: 28403080 PMCID: PMC5403077 DOI: 10.1097/md.0000000000006516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Diurnal variations in ventricular tachyarrhythmias (VAs) have been demonstrated in idiopathic arrhythmogenic heart disease. The electrophysiological characteristics of diurnal variations in idiopathic right ventricular outflow tract (RVOT) VA have not previously been elucidated. Sixty-two consecutive patients undergoing catheter ablation for idiopathic RVOT VA (mean age: 42.8 ± 12.3 years, 35 females) were enrolled. The diurnal variation type (group 1, n = 36) was defined as those patients who had most ventricular premature contractions (VPCs) during the night hours by preprocedure Holter recordings. Group 2 (n = 26) was defined as those patients who did not have significant VPC variations. The baseline characteristics and electrophysiological properties were collected and analyzed, and the rates of recurrence after catheter ablation were compared between the 2 groups. In this study, heart rate variability analysis demonstrated lower low frequency/high frequency ratios in group 1 than in group 2 (3.95 ± 3.08 vs 6.26 ± 5.33; P = 0.042). There were no significant differences in baseline characteristics, echocardiography and electrophysiological characteristics between the 2 groups. During a mean follow-up period of 13.5 ± 11.0 months, a total of 16 patients had VA recurrences, including 13 patients from group 1 and 3 patients from group 2 (36.1% vs 12.5%, P = 0.039). This study demonstrated the effect of the autonomic nervous system in idiopathic RVOT VAs and that the diurnal variation type leads to a higher recurrence rate after catheter ablation.
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Affiliation(s)
- Shih-Jie Jhuo
- Division of Cardiology, Kaohsiung Medical University Hospital
- Division of Cardiology, Taipei Veterans General Hospital
| | - Li-Wei Lo
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Shih-Lin Chang
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Yenn-Jiang Lin
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Fa-Po Chung
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Yu-Feng Hu
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Tze-Fan Chao
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Ta-Chuan Tuan
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Jo-Nan Liao
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Chin-Yu Lin
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Yao-Ting Chang
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Chung-Hsing Lin
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Rohit Walia
- Division of Cardiology, Taipei Veterans General Hospital
| | | | - Shinya Yamada
- Division of Cardiology, Taipei Veterans General Hospital
| | | | - Wei-Hua Tang
- Division of Cardiology, Kaohsiung Medical University Hospital
| | - Kun-Tai Lee
- Division of Cardiology, Kaohsiung Medical University Hospital
- Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ter Lai
- Division of Cardiology, Kaohsiung Medical University Hospital
- Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
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22
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Guerra F, Bonelli P, Flori M, Cipolletta L, Carbucicchio C, Izquierdo M, Kozluk E, Shivkumar K, Vaseghi M, Patani F, Cupido C, Pala S, Ruiz-Granell R, Ferrero A, Tondo C, Capucci A. Temporal Trends and Temperature-Related Incidence of Electrical Storm. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004634. [DOI: 10.1161/circep.116.004634] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/27/2016] [Indexed: 01/28/2023]
Abstract
Background—
The occurrence of ventricular tachyarrhythmias seems to follow circadian, daily, and seasonal distributions. Our aim is to identify potential temporal patterns of electrical storm (ES), in which a cluster of ventricular tachycardias or ventricular fibrillation, negatively affects short- and long-term survival.
Methods and Results—
The TEMPEST study (Circannual Pattern and Temperature-Related Incidence of Electrical Storm) is a patient-level, pooled analysis of previously published data sets. Study selection criteria included diagnosis of ES, absence of acute coronary syndrome as the arrhythmic trigger, and ≥10 patients included. At the end of the selection and collection processes, 5 centers had the data set from their article pooled into the present registry. Temperature data and sunrise and sunset hours were retrieved from Weather Underground, the largest weather database available online. Total sample included 246 patients presenting with ES (221 men; age: 65±9 years). Each ES episode included a median of 7 ventricular tachycardia/ventricular fibrillation episodes. Fifty-nine percent of patients experienced ES during daytime hours (
P
<0.001). The prevalence of ES was significantly higher during workdays, with Saturdays and Sundays registering the lowest rates of ES (10.4% and 7.2%, respectively, versus 16.5% daily mean from Monday to Friday;
P
<0.001). ES occurrence was significantly associated with increased monthly temperature range when compared with the month before (
P
=0.003).
Conclusions—
ES incidence is not homogenous over time but seems to have a clustered pattern, with a higher incidence during daytime hours and working days. ES is associated with an increase in monthly temperature variation.
Clinical Trial Registration—
https://www.crd.york.ac.uk
. Unique identifier: CRD42013003744.
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Affiliation(s)
- Federico Guerra
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Paolo Bonelli
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Marco Flori
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Laura Cipolletta
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Corrado Carbucicchio
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Maite Izquierdo
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Edward Kozluk
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Kalyanam Shivkumar
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Marmar Vaseghi
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Francesca Patani
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Claudio Cupido
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Salvatore Pala
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Ricardo Ruiz-Granell
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Angel Ferrero
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Claudio Tondo
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Alessandro Capucci
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
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23
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Chen Y, Zhu D, Yuan J, Han Z, Wang Y, Qian Z, Hou X, Wu T, Zou J. CLOCK-BMAL1 regulate the cardiac L-type calcium channel subunit CACNA1C through PI3K-Akt signaling pathway. Can J Physiol Pharmacol 2016; 94:1023-32. [PMID: 27376484 DOI: 10.1139/cjpp-2015-0398] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The heterodimerized transcription factors CLOCK-BMAL1 regulate the cardiomyocyte circadian rhythms. The L-type calcium currents play important role in the cardiac electrogenesis and arrhythmogenesis. Whether and how the CLOCK-BMAL1 regulate the cardiac L-type calcium channels are yet to be determined. The functions of the L-type calcium channels were evaluated with patch clamping techniques. Recombinant adenoviruses of CLOCK and BMAL1 were used in the expression experiments. We reported that the expressions and functions of CACNA1C (the α-subunit of the L-type calcium channels) showed circadian rhythms, with the peak at zeitgeber time 3 (ZT3). The endocardial action potential durations 90 (APD90) were correspondingly longer at ZT3. The protein levels of the phosphorylated Akt at threonine 308 (pAkt T308) also showed circadian rhythms. Overexpressions of CLOCK-BMAL1 significantly reduced the levels of CACNA1C while increasing the levels of pAkt T308 and pik3r1. Furthermore, the inhibitory effects of CLOCK-BMAL1 on CACNA1C could be abolished by the Akt inhibitor MK2206 or the PDK1 inhibitor GSK2334470. Collectively, our findings suggested that the expressions of the cardiac CACNA1C were under the CLOCK-BMAL1 regulation, probably through the PI3K-Akt signal pathway.
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Affiliation(s)
- Yanhong Chen
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
- Department of Cardiology, Wuhan Asia Heart Hospital, Hubei, China
| | - Didi Zhu
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Jiamin Yuan
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Zhonglin Han
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Yao Wang
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Zhiyong Qian
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaofeng Hou
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Tingting Wu
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Jiangang Zou
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
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24
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Kumagai N, Ogawa M, Zhang B, Koyoshi R, Morii J, Yasuda T, Matsumoto N, Matsuo K, Saku K. Paradoxical nocturnal elevation of sympathetic tone and spontaneous ventricular fibrillation in Brugada syndrome. J Cardiol 2016; 67:229-35. [PMID: 26896306 DOI: 10.1016/j.jjcc.2015.11.002] [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: 08/04/2015] [Revised: 10/20/2015] [Accepted: 11/02/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nocturnal dominance of the incidence of spontaneous ventricular tachyarrhythmias has been reported in patients with Brugada syndrome (BrS). The purpose of the present study is to analyze the QT dynamics and autonomic balance as well as their diurnal variations in BrS patients. METHODS Of the 33 consecutive patients with BrS included in the study, 14 had a history of cardiopulmonary arrest due to spontaneous ventricular fibrillation (VF) episodes (VF-BrS) and 19 had asymptomatic BrS (A-BrS). QT dynamics and heart rate variability were analyzed using 24-h Holter electrocardiogram recordings. RESULTS Of the total 14 first cardiopulmonary arrest episodes due to spontaneous VF, 11 (79%) occurred in VF-BrS patients during the nighttime or at rest. The QT/RR slope during daytime was significantly steeper than that during nighttime in the A-BrS patients (p=0.031), but not in the VF-BrS patients (p=1.0). There were significant diurnal differences pertaining to the high-frequency (HF) and low-frequency (LF)/HF ratios in the A-BrS patients (p=0.019 and p=0.019, respectively), but not in the VF-BrS patients (p=1.0 and p=1.0, respectively). The VF-BrS patients were characterized by relatively high LF/HF ratios, whereas the A-BrS patients were characterized by relatively low LF/HF ratios throughout the daytime and nighttime. Furthermore, the LF/HF ratios during the nighttime in the VF-BrS patients were significantly higher than those in the A-BrS patients (p=0.021). CONCLUSIONS Most first episodes of spontaneous VF in the VF-BrS patients occurred during the nighttime or at rest. The autonomic imbalance of paradoxical nocturnal elevation of the sympathetic tone along with an underlying persistent sympathetic tone throughout the day may play a key role for spontaneous VF initiation in BrS patients.
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Affiliation(s)
- Naoko Kumagai
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Masahiro Ogawa
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; Endowed Department of Advanced Therapeutics for Cardiovascular Disease, Fukuoka University School of Medicine, Fukuoka, Japan.
| | - Bo Zhang
- Department of Biochemistry, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Rie Koyoshi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Joji Morii
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; Endowed Department of Advanced Therapeutics for Cardiovascular Disease, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Tomoo Yasuda
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Naomichi Matsumoto
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kunihiro Matsuo
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; Endowed Department of Advanced Therapeutics for Cardiovascular Disease, Fukuoka University School of Medicine, Fukuoka, Japan
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25
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Takeda N, Maemura K. Circadian clock and the onset of cardiovascular events. Hypertens Res 2016; 39:383-90. [PMID: 26888119 DOI: 10.1038/hr.2016.9] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 02/07/2023]
Abstract
The onset of cardiovascular diseases often shows time-of-day variation. Acute myocardial infarction or ventricular arrhythmia such as ventricular tachycardia occurs mainly in the early morning. Multiple biochemical and physiological parameters show circadian rhythm, which may account for the diurnal variation of cardiovascular events. These include the variations in blood pressure, activity of the autonomic nervous system and renin-angiotensin axis, coagulation cascade, vascular tone and the intracellular metabolism of cardiomyocytes. Importantly, the molecular clock system seems to underlie the circadian variation of these parameters. The center of the biological clock, also known as the central clock, exists in the suprachiasmatic nucleus. In contrast, the molecular clock system is also activated in each cell of the peripheral organs and constitute the peripheral clock. The biological clock system is currently considered to have a beneficial role in maintaining the homeostasis of each organ. Discoordination, however, between the peripheral clock and external environment could potentially underlie the development of cardiovascular events. Therefore, understanding the molecular and cellular pathways by which cardiovascular events occur in a diurnal oscillatory pattern will help the establishment of a novel therapeutic approach to the management of cardiovascular disorders.
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Affiliation(s)
- Norihiko Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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26
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Haemers P, Sutherland G, Cikes M, Jakus N, Holemans P, Sipido KR, Willems R, Claus P. Further insights into blood pressure induced premature beats: Transient depolarizations are associated with fast myocardial deformation upon pressure decline. Heart Rhythm 2015; 12:2305-15. [DOI: 10.1016/j.hrthm.2015.06.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Indexed: 11/28/2022]
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27
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Takeda N, Maemura K. The role of clock genes and circadian rhythm in the development of cardiovascular diseases. Cell Mol Life Sci 2015; 72:3225-34. [PMID: 25972277 PMCID: PMC11113935 DOI: 10.1007/s00018-015-1923-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 05/04/2015] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
Abstract
The time of onset of cardiovascular disorders such as myocardial infarctions or ventricular arrhythmias exhibits a circadian rhythm. Diurnal variations in autonomic nervous activity, plasma cortisol level or renin-angiotensin activity underlie the pathogenesis of cardiovascular diseases. Transcriptional-translational feedback loop of the clock genes constitute a molecular clock system. In addition to the central clock in the suprachiasmatic nucleus, clock genes are also expressed in a circadian fashion in each organ to make up the peripheral clock. The peripheral clock seems to be beneficial for anticipating external stimuli and thus contributes to the maintenance of organ homeostasis. Loss of synchronization between the central and peripheral clocks also augments disease progression. Moreover, accumulating evidence shows that clock genes affect inflammatory and intracellular metabolic signaling. Elucidating the roles of the molecular clock in cardiovascular pathology through the identification of clock controlled genes will help to establish a novel therapeutic approach for cardiovascular disorders.
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Affiliation(s)
- Norihiko Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
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28
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Abstract
Despite the revolutionary advancements in the past 3 decades in the treatment of ventricular tachyarrhythmias with device-based therapy, sudden cardiac death (SCD) remains an enormous public health burden. Survivors of SCD are generally at high risk for recurrent events. The clinical management of such patients requires a multidisciplinary approach from postresuscitative care to a thorough cardiovascular investigation in an attempt to identify the underlying substrate, with potential to eliminate or modify the triggers through catheter ablation and ultimately an implantable cardioverter-defibrillator (ICD) for prompt treatment of recurrences in those at risk. Early recognition of low left ventricular ejection fraction as a strong predictor of death and association of ventricular arrhythmias with sudden death led to significant investigation with antiarrhythmic drugs. The lack of efficacy and the proarrhythmic effects of drugs catalyzed the development and investigation of the ICD through several major clinical trials that proved the efficacy of ICD as a bedrock tool to detect and promptly treat life-threatening arrhythmias. The ICD therapy is routinely used for primary prevention of SCD in patients with cardiomyopathy and high risk inherited arrhythmic conditions and secondary prevention in survivors of sudden cardiac arrest. This compendium will review the clinical management of those surviving SCD and discuss landmark studies of antiarrhythmic drugs, ICD, and cardiac resynchronization therapy in the primary and secondary prevention of SCD.
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Affiliation(s)
- Omair Yousuf
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Jonathan Chrispin
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gordon F Tomaselli
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ronald D Berger
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
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29
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RUWALD MARTINH, MOSS ARTHURJ, ZAREBA WOJCIECH, JONS CHRISTIAN, RUWALD ANNECHRISTINE, MCNITT SCOTT, POLONSKY BRONISLAVA, KUTYIFA VALENTINA. Circadian Distribution of Ventricular Tachyarrhythmias and Association with Mortality in the MADIT-CRT Trial. J Cardiovasc Electrophysiol 2015; 26:291-9. [DOI: 10.1111/jce.12592] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 10/23/2014] [Accepted: 10/30/2014] [Indexed: 11/28/2022]
Affiliation(s)
- MARTIN H. RUWALD
- Heart Research Follow-up Program; University of Rochester Medical Center; Rochester New York USA
- Department of Cardiology; Gentofte Hospital; Hellerup Denmark
| | - ARTHUR J. MOSS
- Heart Research Follow-up Program; University of Rochester Medical Center; Rochester New York USA
| | - WOJCIECH ZAREBA
- Heart Research Follow-up Program; University of Rochester Medical Center; Rochester New York USA
| | - CHRISTIAN JONS
- Department of Cardiology; Gentofte Hospital; Hellerup Denmark
| | - ANNE-CHRISTINE RUWALD
- Heart Research Follow-up Program; University of Rochester Medical Center; Rochester New York USA
- Department of Cardiology; Gentofte Hospital; Hellerup Denmark
| | - SCOTT MCNITT
- Heart Research Follow-up Program; University of Rochester Medical Center; Rochester New York USA
| | - BRONISLAVA POLONSKY
- Heart Research Follow-up Program; University of Rochester Medical Center; Rochester New York USA
| | - VALENTINA KUTYIFA
- Heart Research Follow-up Program; University of Rochester Medical Center; Rochester New York USA
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30
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Zhu Y, Hanafy MA, Killingsworth CR, Walcott GP, Young ME, Pogwizd SM. Morning surge of ventricular arrhythmias in a new arrhythmogenic canine model of chronic heart failure is associated with attenuation of time-of-day dependence of heart rate and autonomic adaptation, and reduced cardiac chaos. PLoS One 2014; 9:e105379. [PMID: 25140699 PMCID: PMC4139365 DOI: 10.1371/journal.pone.0105379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 07/23/2014] [Indexed: 01/08/2023] Open
Abstract
Patients with chronic heart failure (CHF) exhibit a morning surge in ventricular arrhythmias, but the underlying cause remains unknown. The aim of this study was to determine if heart rate dynamics, autonomic input (assessed by heart rate variability (HRV)) and nonlinear dynamics as well as their abnormal time-of-day-dependent oscillations in a newly developed arrhythmogenic canine heart failure model are associated with a morning surge in ventricular arrhythmias. CHF was induced in dogs by aortic insufficiency & aortic constriction, and assessed by echocardiography. Holter monitoring was performed to study time-of-day-dependent variation in ventricular arrhythmias (PVCs, VT), traditional HRV measures, and nonlinear dynamics (including detrended fluctuations analysis α1 and α2 (DFAα1 & DFAα2), correlation dimension (CD), and Shannon entropy (SE)) at baseline, as well as 240 days (240 d) and 720 days (720 d) following CHF induction. LV fractional shortening was decreased at both 240 d and 720 d. Both PVCs and VT increased with CHF duration and showed a morning rise (2.5-fold & 1.8-fold increase at 6 AM-noon vs midnight-6 AM) during CHF. The morning rise in HR at baseline was significantly attenuated by 52% with development of CHF (at both 240 d & 720 d). Morning rise in the ratio of low frequency to high frequency (LF/HF) HRV at baseline was markedly attenuated with CHF. DFAα1, DFAα2, CD and SE all decreased with CHF by 31, 17, 34 and 7%, respectively. Time-of-day-dependent variations in LF/HF, CD, DFA α1 and SE, observed at baseline, were lost during CHF. Thus in this new arrhythmogenic canine CHF model, attenuated morning HR rise, blunted autonomic oscillation, decreased cardiac chaos and complexity of heart rate, as well as aberrant time-of-day-dependent variations in many of these parameters were associated with a morning surge of ventricular arrhythmias.
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Affiliation(s)
- Yujie Zhu
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Mohamed A. Hanafy
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Cheryl R. Killingsworth
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Gregory P. Walcott
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Martin E. Young
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Steven M. Pogwizd
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
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Smolensky MH, Portaluppi F, Manfredini R, Hermida RC, Tiseo R, Sackett-Lundeen LL, Haus EL. Diurnal and twenty-four hour patterning of human diseases: cardiac, vascular, and respiratory diseases, conditions, and syndromes. Sleep Med Rev 2014; 21:3-11. [PMID: 25129838 DOI: 10.1016/j.smrv.2014.07.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 07/04/2014] [Indexed: 11/25/2022]
Abstract
Various medical conditions, disorders, and syndromes exhibit predictable-in-time diurnal and 24 h patterning in the signs, symptoms, and grave nonfatal and fatal events, e.g., respiratory ones of viral and allergic rhinorrhea, reversible (asthma) and non-reversible (bronchitis and emphysema) chronic obstructive pulmonary disease, cystic fibrosis, high altitude pulmonary edema, and decompression sickness; cardiac ones of atrial premature beats and tachycardia, paroxysmal atrial fibrillation, 3rd degree atrial-ventricular block, paroxysmal supraventricular tachycardia, ventricular premature beats, ventricular tachyarrhythmia, symptomatic and non-symptomatic angina pectoris, Prinzmetal vasospastic variant angina, acute (non-fatal and fatal) incidents of myocardial infarction, sudden cardiac arrest, in-bed sudden death syndrome of type-1 diabetes, acute cardiogenic pulmonary edema, and heart failure; vascular and circulatory system ones of hypertension, acute orthostatic postprandial, micturition, and defecation hypotension/syncope, intermittent claudication, venous insufficiency, standing occupation leg edema, arterial and venous branch occlusion of the eye, menopausal hot flash, sickle cell syndrome, abdominal, aortic, and thoracic dissections, pulmonary thromboembolism, and deep venous thrombosis, and cerebrovascular transient ischemic attack and hemorrhagic and ischemic stroke. Knowledge of these temporal patterns not only helps guide patient care but research of their underlying endogenous mechanisms, i.e., circadian and others, and external triggers plus informs the development and application of effective chronopreventive and chronotherapeutic strategies.
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Affiliation(s)
- Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, 1 University Station C0800, Austin, TX 78712-0238, USA.
| | - Francesco Portaluppi
- Hospital S. Anna and Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Roberto Manfredini
- Hospital S. Anna and Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ramon C Hermida
- Bioengineering & Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo, Spain
| | - Ruana Tiseo
- Hospital S. Anna and Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Linda L Sackett-Lundeen
- Department of Laboratory Medicine & Pathology, University of Minnesota, HealthPartners Institute for Education and Research and the Department of Pathology, Regions Hospital, St. Paul, MN, USA
| | - Erhard L Haus
- Department of Laboratory Medicine & Pathology, University of Minnesota, HealthPartners Institute for Education and Research and the Department of Pathology, Regions Hospital, St. Paul, MN, USA
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Biological Clocks and Ventricular Tachyarrhythmias. J Am Coll Cardiol 2014; 63:2709-11. [DOI: 10.1016/j.jacc.2013.12.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 12/16/2013] [Accepted: 12/23/2013] [Indexed: 11/20/2022]
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Patton KK, Hellkamp AS, Lee KL, Mark DB, Johnson GW, Anderson J, Bardy GH, Poole JE. Unexpected deviation in circadian variation of ventricular arrhythmias: the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial). J Am Coll Cardiol 2014; 63:2702-8. [PMID: 24747100 DOI: 10.1016/j.jacc.2013.11.072] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/18/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study sought to determine whether circadian patterns in ventricular arrhythmias (VAs) occur in a current primary prevention defibrillator (implantable cardioverter-defibrillator [ICD]) population. BACKGROUND Cardiovascular events, including VAs, demonstrate biorhythmic periodicity. METHODS We tested for deviation from the previously described occurrences of a morning peak, early morning nadir, and peak on Mondays in ICD therapies using generalized estimating equations and Student t tests. All hypothesis tests were performed in the entire cohort of patients with VAs as well as pre-specified subgroups. RESULTS Of 811 patients with an ICD, 186 subjects experienced 714 ICD therapy episodes for life-threatening VA. There was no morning (6 am to 12 pm) peak in therapies for the entire cohort or any subgroups. The overall cohort and several subgroups had a typical early morning (12 am to 6 am) nadir in therapies, with significantly less than 25% of therapies occurring during this 6-h block (all p < 0.05). A significant peak in therapies on Mondays occurred only in patients not on beta-blocker therapy (22% of events for the week, p = 0.029). CONCLUSIONS In the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial) population, the distribution of life-threatening VA failed to show a typical early morning peak or increased VA events on Mondays. A typical early morning nadir was seen in the entire cohort. An increased rate of events on Mondays was found in the subgroup of subjects not on beta-blocker therapy. These findings may indicate suppression of the neurohormonal triggers for VA by current heart failure therapy, particularly the use of beta-blockers in heart failure.
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Affiliation(s)
- Kristen K Patton
- Department of Medicine, University of Washington, Seattle, Washington
| | | | - Kerry L Lee
- Duke Clinical Research Institute, Durham, North Carolina
| | - Daniel B Mark
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Jill Anderson
- Seattle Institute for Cardiac Research, Seattle, Washington
| | - Gust H Bardy
- Seattle Institute for Cardiac Research, Seattle, Washington
| | - Jeanne E Poole
- Department of Medicine, University of Washington, Seattle, Washington.
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Lim ASP, Chang AM, Shulman JM, Raj T, Chibnik LB, Cain SW, Rothamel K, Benoist C, Myers AJ, Czeisler CA, Buchman AS, Bennett DA, Duffy JF, Saper CB, De Jager PL. A common polymorphism near PER1 and the timing of human behavioral rhythms. Ann Neurol 2012; 72:324-34. [PMID: 23034908 DOI: 10.1002/ana.23636] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Circadian rhythms influence the timing of behavior, neurological diseases, and even death. Rare mutations in homologs of evolutionarily conserved clock genes are found in select pedigrees with extreme sleep timing, and there is suggestive evidence that certain common polymorphisms may be associated with self-reported day/night preference. However, no common polymorphism has been associated with the timing of directly observed human behavioral rhythms or other physiological markers of circadian timing at the population level. METHODS We performed a candidate gene association study with replication, evaluating associations between polymorphisms in homologs of evolutionarily conserved clock genes and the timing of behavioral rhythms measured by actigraphy. For validated polymorphisms, we evaluated associations with transcript expression and time of death in additional cohorts. RESULTS rs7221412, a common polymorphism near period homolog 1 (PER1), was associated with the timing of activity rhythms in both the discovery and replication cohorts (joint p = 2.1 × 10(-7) ). Mean activity timing was delayed by 67 minutes in rs7221412(GG) versus rs7221412(AA) homozygotes. rs7221412 also showed a suggestive time-dependent relationship with both cerebral cortex (p = 0.05) and CD14+ CD16- monocyte (p = 0.02) PER1 expression and an interesting association with time of death (p = 0.015) in which rs7221412(GG) individuals had a mean time of death nearly 7 hours later than rs7221412(AA/AG) . INTERPRETATION A common polymorphism near PER1 is associated with the timing of human behavioral rhythms, and shows evidence of association with time of death. This may be mediated by differential PER1 expression. These results may facilitate individualized scheduling of shift work, medical treatments, or monitoring of vulnerable patient populations.
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Affiliation(s)
- Andrew S P Lim
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Manfredini R, Boari B, Salmi R, Fabbian F, Pala M, Tiseo R, Portaluppi F. Twenty-four-hour patterns in occurrence and pathophysiology of acute cardiovascular events and ischemic heart disease. Chronobiol Int 2012; 30:6-16. [PMID: 23002808 DOI: 10.3109/07420528.2012.715843] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The scientific literature clearly establishes the occurrence of cardiovascular (CV) accidents and myocardial ischemic episodes is unevenly distributed during the 24 h. Such temporal patterns result from corresponding temporal variation in pathophysiologic mechanisms and cyclic environmental triggers that elicit the onset of clinical events. Moreover, both the pharmacokinetics and pharmacodynamics of many, though not all, CV medications have been shown to be influenced by the circadian time of their administration, even though further studies are necessary to better clarify the mechanisms of such influence on different drug classes, drug molecules, and pharmaceutical preparations. Twenty-four-hour rhythmic organization of CV functions is such that defense mechanisms against acute events are incapable of providing the same degree of protection during the day and night. Instead, temporal gates of excessive susceptibility exist, particularly in the morning and to a lesser extent evening (in diurnally active persons), to aggressive mechanisms through which overt clinical manifestations may be triggered. When peak levels of critical physiologic variables, such as blood pressure (BP), heart rate (HR), rate pressure product (systolic BP × HR, surrogate measure of myocardial oxygen demand), sympathetic activation, and plasma levels of endogenous vasoconstricting substances, are aligned together at the same circadian time, the risk of acute events becomes significantly elevated such that even relatively minor and usually harmless physical and mental stress and environmental phenomena can precipitate dramatic life-threatening clinical manifestations. Hence, the delivery of CV medications needs to be synchronized in time, i.e., circadian time, in proportion to need as determined by established temporal patterns in risk of CV events, and in a manner that averts or minimizes undesired side effects.
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Affiliation(s)
- Roberto Manfredini
- Section of Clinica Medica, Department of Clinical and Experimental Medicine, University of Ferrara, Via Savonarola 9, Ferrara, Italy
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Portaluppi F, Tiseo R, Smolensky MH, Hermida RC, Ayala DE, Fabbian F. Circadian rhythms and cardiovascular health. Sleep Med Rev 2011; 16:151-66. [PMID: 21641838 DOI: 10.1016/j.smrv.2011.04.003] [Citation(s) in RCA: 194] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 04/27/2011] [Indexed: 11/30/2022]
Abstract
The functional organization of the cardiovascular system shows clear circadian rhythmicity. These and other circadian rhythms at all levels of organization are orchestrated by a central biological clock, the suprachiasmatic nuclei of the hypothalamus. Preservation of the normal circadian time structure from the level of the cardiomyocyte to the organ system appears to be essential for cardiovascular health and cardiovascular disease prevention. Myocardial ischemia, acute myocardial infarct, and sudden cardiac death are much greater in incidence than expected in the morning. Moreover, supraventricular and ventricular cardiac arrhythmias of various types show specific day-night patterns, with atrial arrhythmias--premature beats, tachycardias, atrial fibrillation, and flutter - generally being of higher frequency during the day than night--and ventricular fibrillation and ventricular premature beats more common, respectively, in the morning and during the daytime activity than sleep span. Furthermore, different circadian patterns of blood pressure are found in arterial hypertension, in relation to different cardiovascular morbidity and mortality risk. Such temporal patterns result from circadian periodicity in pathophysiological mechanisms that give rise to predictable-in-time differences in susceptibility-resistance to cyclic environmental stressors that trigger these clinical events. Circadian rhythms also may affect the pharmacokinetics and pharmacodynamics of cardiovascular and other medications. Knowledge of 24-h patterns in the risk of cardiac arrhythmias and cardiovascular disease morbidity and mortality plus circadian rhythm-dependencies of underlying pathophysiologic mechanisms suggests the requirement for preventive and therapeutic interventions is not the same throughout the day and night, and should be tailored accordingly to improve outcomes.
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Zeidan-Shwiri T, Aronson D, Atalla K, Blich M, Suleiman M, Marai I, Gepstein L, Lavie L, Lavie P, Boulos M. Circadian pattern of life-threatening ventricular arrhythmia in patients with sleep-disordered breathing and implantable cardioverter-defibrillators. Heart Rhythm 2011; 8:657-62. [PMID: 21185402 DOI: 10.1016/j.hrthm.2010.12.030] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 12/15/2010] [Indexed: 01/28/2023]
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Takeda N, Maemura K. Cardiovascular disease, chronopharmacotherapy, and the molecular clock. Adv Drug Deliv Rev 2010; 62:956-66. [PMID: 20451570 DOI: 10.1016/j.addr.2010.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 03/10/2010] [Accepted: 04/28/2010] [Indexed: 10/19/2022]
Abstract
Cardiovascular functions such as heart rate and blood pressure show 24h variation. The incidence of cardiovascular diseases including acute myocardial infarction and arrhythmia also exhibits diurnal variation. The center of this circadian clock is located in the suprachiasmatic nucleus in the hypothalamus. However, recent findings revealed that each organ, including cardiovascular tissues, has its own internal clock, which has been termed a peripheral clock. The functional roles played by peripheral clocks have been reported recently. Since the peripheral clock is considered to play considerable roles in the processes of cardiac tissues, the identification of genes specifically regulated by this clock will provide insights into its role in the pathogenesis of cardiovascular disorders. In addition, the discovery of small compounds that modulate the peripheral clock will help to establish chronotherapeutic approaches. Understanding the biological relevance of the peripheral clock will provide novel approaches to the prevention and treatment of cardiovascular diseases.
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Langley P, Macgowan GA, Murray A. Circadian variation of human ventricular fibrillation dominant frequency. Resuscitation 2010; 81:950-5. [PMID: 20418010 DOI: 10.1016/j.resuscitation.2010.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 03/02/2010] [Accepted: 03/14/2010] [Indexed: 12/19/2022]
Abstract
AIM Circadian variation in human ventricular fibrillation (VF) dominant frequency is unknown. If present this would provide evidence of physiological influence on VF. The objective was to quantify the circadian variation in human VF dominant frequency. METHODS Eight-lead Holter ECG recordings were obtained from a patient with severe myocarditis and chronic VF who was supported by a biventricular assist device. Recordings of up to 24h duration were obtained on 6 days with an average interval between recordings of 7 days. Dominant frequency and amplitude were obtained using spectral analysis and assessed for (i) circadian (ii) inter-recording and (iii) inter-lead differences. RESULTS There was a significant circadian variation in amplitude (night: 0.027+/-0.004mVHz vs day: 0.044+/-0.006mVHz, p<0.0001) but not dominant frequency (night: 7.85+/-0.62Hz vs day: 7.93+/-0.54Hz, p>0.05). There were significant differences between recordings in dominant frequency which ranged from 6.80+/-0.29Hz to 8.36+/-0.38Hz (p<0.0001) and dominant frequency spectral amplitude which ranged from 0.033+/-0.014mVHz to 0.043+/-0.017mVHz (p<0.0001). Histograms of dominant frequencies in leads exhibited strikingly different distributions, particularly in V2 that was characterised by a bimodal distribution, while the other leads were characterised by predominantly unimodal distributions. CONCLUSION VF dominant frequency spectral amplitude exhibited circadian variability. In a patient with severe myocarditis, supported with a biventricular assist device and in chronic VF, these results provide evidence for modulation of VF, probably induced by changes in posture and physical activity.
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Affiliation(s)
- Philip Langley
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE7 7DN, UK.
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KIERNAN THOMASJ, WEIVODA PEGGYL, SOMERS VIRENDK, OMMEN STEVER, GERSH BERNARDJ. Circadian Rhythm of Appropriate Implantable Cardioverter Defibrillator Discharges in Patients with Hypertrophic Cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:1253-8. [DOI: 10.1111/j.1540-8159.2008.01174.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Durgan DJ, Young ME. Linking the cardiomyocyte circadian clock to myocardial metabolism. Cardiovasc Drugs Ther 2008; 22:115-24. [PMID: 18274886 DOI: 10.1007/s10557-008-6086-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 01/17/2008] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The energetic demands imposed upon the heart vary dramatically over the course of the day. In the face of equally commanding oscillations in the neurohumoral mileu, the heart must respond both rapidly and appropriately to its diurnal environment, for the survival of the organism. A major response of the heart to alterations in workload, nutrients, and various neurohumoral stimuli is at the level of metabolism. Failure of the heart to achieve adequate metabolic adaptation results in contractile dysfunction. DISCUSSION Substantial evidence is accumulating which suggests that a transcriptionally based timekeeping mechanism known as the circadian clock plays a role in mediating myocardial metabolic rhythms. Here, we provide an overview of our current knowledge regarding the interplay between the circadian clock within the cardiomyocyte and myocardial metabolism. This includes a particular focus on circadian clock mediated regulation of endogenous energy stores, as well as those mechanisms orchestrating circadian rhythms in metabolic gene expression. CONCLUSION An essential need to elucidate fully the functions of this molecular mechanism in the heart remains.
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Affiliation(s)
- David J Durgan
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030, USA
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Takigawa M, Noda T, Shimizu W, Miyamoto K, Okamura H, Satomi K, Suyama K, Aihara N, Kamakura S, Kurita T. Seasonal and circadian distributions of ventricular fibrillation in patients with Brugada syndrome. Heart Rhythm 2008; 5:1523-7. [PMID: 18984526 DOI: 10.1016/j.hrthm.2008.08.022] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 08/23/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND It is well-known that the incidence of ventricular tachyarrhythmias is the highest in winter and during the daytime in patients with structural heart disease. However, little is known about the seasonal and circadian distributions of ventricular fibrillation (VF) in patients with Brugada syndrome. OBJECTIVE The aim of this study was to investigate seasonal and circadian distributions of VF in patients with Brugada syndrome. METHODS We analyzed the data of appropriate shock episodes for VF recorded by an implantable cardioverter-defibrillator (ICD) in patients with Brugada syndrome. RESULTS Among 62 consecutive Brugada syndrome patients with an ICD (48 +/- 14 years, 58 males), 19 patients had at least one episode of an appropriate ICD shock due to VF during a mean follow-up of 70 +/- 36 months, and 98 episodes were evaluated as isolated VF. There was a significant peak between March and June (P = .03). As for the circadian variation, significantly more VF occurred from midnight to 6:00 (P <.0001). Electrical storms of VF occurred in seven patients. The seasonal and circadian variations of electrical storms were similar to those of the isolated VF episodes. CONCLUSIONS In patients with Brugada syndrome, there was a significant seasonal peak from spring to early summer and a significant circadian peak from midnight to early morning in terms of the occurrences of VF.
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Affiliation(s)
- Masateru Takigawa
- Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center, Suita, Japan
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Albert CM, Rosenthal L, Calkins H, Steinberg JS, Ruskin JN, Wang P, Muller JE, Mittleman MA. Driving and Implantable Cardioverter-Defibrillator Shocks for Ventricular Arrhythmias. J Am Coll Cardiol 2007; 50:2233-40. [DOI: 10.1016/j.jacc.2007.06.059] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 06/13/2007] [Indexed: 10/22/2022]
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Portaluppi F, Hermida RC. Circadian rhythms in cardiac arrhythmias and opportunities for their chronotherapy. Adv Drug Deliv Rev 2007; 59:940-51. [PMID: 17659808 DOI: 10.1016/j.addr.2006.10.011] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 10/01/2006] [Indexed: 11/15/2022]
Abstract
It is now well established that nearly all functions of the body, including those that influence the pharmacokinetics and pharmacodynamics of medications, exhibit significant 24-hour variation. The electrical properties of the heart as well as cardiac arrhythmias also vary as circadian rhythms, even though the suboptimal methods initially used for their investigation slowed their identification and thorough characterization. The application of continuous Holter monitoring of the electrical properties of the heart has revealed 24-hour variation in the occurrence of ventricular premature beats with the peak in events, in diurnally active persons, between 6 a.m. and noon. After the introduction of implantable cardioverter-defibrillators, ventricular tachycardia or fibrillation were also found to peak in the same period of the day. Even defibrillator energy requirements show circadian variation, thus supporting the need for a temporal awareness in the therapeutic approach to arrhythmias. Imbalanced autonomic tone, circulating levels of catecholamines, increased heart rate and blood pressure, all established determinants of cardiac arrhythmias, show circadian variations and underlie the genesis of the circadian pattern of cardiac arrhythmias. Arrhythmogenesis appears to be suppressed during nighttime sleep, and this can influence the evaluation of the efficacy of antiarrhythmic medications in relation to their administration time. Unfortunately, very few studies have been undertaken to assess the proper timing (chronotherapy) of antiarrhythmic medications as means to maximize efficacy and possibly reduce side effects. Further research in this field is warranted and could bring new insight and clinical advantage.
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Affiliation(s)
- Francesco Portaluppi
- Hypertension Center, Department of Clinical and Experimental Medicine, University of Ferrara, via Savonarola 9, I-44100 Ferrara, Italy.
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Bonnemeier H. Chronobiology of sympathetic nervous activity: The same old sun will shine in the morning. Heart Rhythm 2006; 3:86-7. [PMID: 16399060 DOI: 10.1016/j.hrthm.2005.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Indexed: 11/17/2022]
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Dibb KM, Hagarty CL, Loudon ASI, Trafford AW. Photoperiod-dependent modulation of cardiac excitation contraction coupling in the Siberian hamster. Am J Physiol Regul Integr Comp Physiol 2004; 288:R607-14. [PMID: 15528392 DOI: 10.1152/ajpregu.00612.2004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In mammals, changes in photoperiod regulate a diverse array of physiological and behavioral processes, an example of which in the Siberian hamster (Phodopus sungorus) is the expression of bouts of daily torpor following prolonged exposure to a short photoperiod. During torpor, body temperature drops dramatically; however, unlike in nonhibernating or nontorpid species, the myocardium retains the ability to contract and is resistant to the development of arrhythmias. In the present study, we sought to determine whether exposure to a short photoperiod results in alterations to cardiac excitation-contraction coupling, thus potentially enabling the heart to survive periods of low temperature during torpor. Experiments were performed on single ventricular myocytes freshly isolated from the hearts of Siberian hamsters that had been exposed to either 12 wk of short-day lengths (SD) or 12 wk of long-day lengths (LD). In SD-acclimated animals, the amplitude of the systolic Ca(2+) transient was increased (e.g., from 142 +/- 17 nmol/l in LD to 229 +/- 31 nmol/l in SD at 4 Hz; P < 0.001). The increased Ca(2+) transient amplitude in the SD-acclimated animals was not associated with any change in the shape or duration of the action potential. However, sarcoplasmic reticulum Ca(2+) content measured after current-clamp stimulation was increased in the SD-acclimated animals (at 4 Hz, 110 +/- 5 vs. 141 +/- 15 mumol/l, P < 0.05). We propose that short photoperiods reprogram the function of the cardiac sarcoplasmic reticulum, resulting in an increased Ca(2+) content, and that this may be a necessary precursor for maintenance of cardiac function during winter torpor.
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Affiliation(s)
- K M Dibb
- Unit of Cardiac Physiology, The University of Manchester, Manchester M13 9PT, UK
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Cygankiewicz I, Wranicz JK, Bolinska H, Zaslonka J, Zareba W. Circadian changes in heart rate turbulence parameters. J Electrocardiol 2004; 37:297-303. [PMID: 15484158 DOI: 10.1016/j.jelectrocard.2004.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Heart rate turbulence is a novel method to identify patients at risk of cardiac death, and to date, there are no data concerning its circadian changes. In 46 coronary patients (mean age 63 +/- 8 years) with at least 100 ventricular premature beats in 24-hour Holter monitoring, turbulence onset, turbulence slope, and heart rate variability parameters were calculated in 3 equal 4-hour periods during morning, afternoon, and night. No circadian changes in turbulence onset values were found, while TS displayed significantly lower values during afternoon than during morning or night hours (5.08, vs. 7.08 and 7.99 ms/RR, respectively). Some heart rate variability parameters also showed lower values in the afternoon, not in the morning hours. In conclusion, in hospitalized patients with stable coronary artery disease, turbulence slope shows circadian pattern with lowest values observed in the afternoon when compared to morning and night hours.
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Lee AKY, Mardini M, Ross DL, Denniss R. Factors affecting diurnal variability of ventricular tachyarrhythmias detected by multiprogrammable implantable cardioverter-defibrillators. Heart Lung Circ 2004; 13:256-60. [PMID: 16352204 DOI: 10.1016/j.hlc.2004.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Many cardiovascular events, including ventricular arrhythmias, display diurnal variability with a morning peak, and a less pronounced afternoon peak. Since the advent of multiprogrammable implantable cardioverter-defibrillators (ICDs), it has been possible to analyse ventricular tachyarrhythmic events. This study aims to evaluate the circadian pattern of ventricular tachycardias in patients treated with ICDs and examines whether antiarrhythmic medications affect this pattern. Data recorded from 83 patients' ICDs were manually analysed and events other than ventricular arrhythmias were excluded. There was a morning peak of ventricular arrhythmias at around 9.00 a.m. This peak was maintained in patients with ejection fractions of less than 40% and those whose arrhythmias had cycle lengths of less than 230ms. Beta blockers appeared to have no effect on this morning peak but the peak appeared later with amiodarone.
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Affiliation(s)
- Astin K Y Lee
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales 2145, Australia
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