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Masè M, Cristoforetti A, Pelloni S, Ravelli F. Systematic in-silico evaluation of fibrosis effects on re-entrant wave dynamics in atrial tissue. Sci Rep 2024; 14:11427. [PMID: 38763959 DOI: 10.1038/s41598-024-62002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/13/2024] [Indexed: 05/21/2024] Open
Abstract
Despite the key role of fibrosis in atrial fibrillation (AF), the effects of different spatial distributions and textures of fibrosis on wave propagation mechanisms in AF are not fully understood. To clarify these aspects, we performed a systematic computational study to assess fibrosis effects on the characteristics and stability of re-entrant waves in electrically-remodelled atrial tissues. A stochastic algorithm, which generated fibrotic distributions with controlled overall amount, average size, and orientation of fibrosis elements, was implemented on a monolayer spheric atrial model. 245 simulations were run at changing fibrosis parameters. The emerging propagation patterns were quantified in terms of rate, regularity, and coupling by frequency-domain analysis of correspondent synthetic bipolar electrograms. At the increase of fibrosis amount, the rate of reentrant waves significantly decreased and higher levels of regularity and coupling were observed (p < 0.0001). Higher spatial variability and pattern stochasticity over repetitions was observed for larger amount of fibrosis, especially in the presence of patchy and compact fibrosis. Overall, propagation slowing and organization led to higher stability of re-entrant waves. These results strengthen the evidence that the amount and spatial distribution of fibrosis concur in dictating re-entry dynamics in remodeled tissue and represent key factors in AF maintenance.
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Affiliation(s)
- Michela Masè
- Laboratory of Biophysics and Translational Cardiology, Department of Cellular, Computational and Integrative Biology-CIBIO, University of Trento, Via Sommarive 18, 38123, Povo, Trento, Italy.
| | - Alessandro Cristoforetti
- Laboratory of Biophysics and Translational Cardiology, Department of Cellular, Computational and Integrative Biology-CIBIO, University of Trento, Via Sommarive 18, 38123, Povo, Trento, Italy
| | - Samuele Pelloni
- Laboratory of Biophysics and Translational Cardiology, Department of Cellular, Computational and Integrative Biology-CIBIO, University of Trento, Via Sommarive 18, 38123, Povo, Trento, Italy
| | - Flavia Ravelli
- Laboratory of Biophysics and Translational Cardiology, Department of Cellular, Computational and Integrative Biology-CIBIO, University of Trento, Via Sommarive 18, 38123, Povo, Trento, Italy
- CISMed-Centre for Medical Sciences, University of Trento, 38122, Trento, Italy
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2
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Tubeeckx MRL, De Keulenaer GW, Heidbuchel H, Segers VFM. Pathophysiology and clinical relevance of atrial myopathy. Basic Res Cardiol 2024; 119:215-242. [PMID: 38472506 DOI: 10.1007/s00395-024-01038-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/14/2024]
Abstract
Atrial myopathy is a condition that consists of electrical, structural, contractile, and autonomic remodeling of the atria and is the substrate for development of atrial fibrillation, the most common arrhythmia. Pathophysiologic mechanisms driving atrial myopathy are inflammation, oxidative stress, atrial stretch, and neurohormonal signals, e.g., angiotensin-II and aldosterone. These mechanisms initiate the structural and functional remodeling of the atrial myocardium. Novel therapeutic strategies are being developed that target the pathophysiologic mechanisms of atrial myopathy. In this review, we will discuss the pathophysiology of atrial myopathy, as well as diagnostic and therapeutic strategies.
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Affiliation(s)
- Michiel R L Tubeeckx
- Laboratory of Physiopharmacology, Universiteitsplein 1, Building T (2nd Floor), 2610, Antwerp, Belgium.
| | - Gilles W De Keulenaer
- Laboratory of Physiopharmacology, Universiteitsplein 1, Building T (2nd Floor), 2610, Antwerp, Belgium
- Department of Cardiology, ZNA Middelheim Hospital Antwerp, Antwerp, Belgium
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Vincent F M Segers
- Laboratory of Physiopharmacology, Universiteitsplein 1, Building T (2nd Floor), 2610, Antwerp, Belgium
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
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3
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Bursi F, Enriquez-Sarano M. The Left Atrium: Passive Receptacle or Active Contributor to Mitral Regurgitation Severity and Outcome. JACC Case Rep 2024; 29:102195. [PMID: 38361572 PMCID: PMC10865207 DOI: 10.1016/j.jaccas.2023.102195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Affiliation(s)
- Francesca Bursi
- University of Milan, Department of Health Sciences, Division of Cardiology, San Paolo Hospital, Milan, Italy
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4
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Li X, Garcia-Elias A, Benito B, Nattel S. The effects of cardiac stretch on atrial fibroblasts: Analysis of the evidence and potential role in atrial fibrillation. Cardiovasc Res 2021; 118:440-460. [PMID: 33576384 DOI: 10.1093/cvr/cvab035] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/27/2020] [Accepted: 02/09/2021] [Indexed: 01/06/2023] Open
Abstract
Atrial fibrillation (AF) is an important clinical problem. Chronic pressure/volume overload of the atria promotes AF, particularly via enhanced extracellular matrix (ECM) accumulation manifested as tissue fibrosis. Loading of cardiac cells causes cell-stretch that is generally considered to promote fibrosis by directly activating fibroblasts, the key cell-type responsible for ECM-production. The primary purpose of this article is to review the evidence regarding direct effects of stretch on cardiac fibroblasts, specifically: (i) the similarities and differences among studies in observed effects of stretch on cardiac-fibroblast function; (ii) the signaling-pathways implicated; and (iii) the factors that affect stretch-related phenotypes. Our review summarizes the most important findings and limitations in this area and gives an overview of clinical data and animal models related to cardiac stretch, with particular emphasis on the atria. We suggest that the evidence regarding direct fibroblast activation by stretch is weak and inconsistent, in part because of variability among studies in key experimental conditions that govern the results. Further work is needed to clarify whether, in fact, stretch induces direct activation of cardiac fibroblasts and if so, to elucidate the determining factors to ensure reproducible results. If mechanical load on fibroblasts proves not to be clearly profibrotic by direct actions, other mechanisms like paracrine influences, the effects of systemic mediators and/or the direct consequences of myocardial injury or death, might account for the link between cardiac stretch and fibrosis. Clarity in this area is needed to improve our understanding of AF pathophysiology and assist in therapeutic development.
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Affiliation(s)
- Xixiao Li
- Department of Medicine and Research Center, Montreal Heart Institute, Montreal, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada
| | - Anna Garcia-Elias
- Department of Medicine and Research Center, Montreal Heart Institute, Montreal, Canada
| | - Begoña Benito
- Vascular Biology and Metabolism Program, Vall d'Hebrón Research Institute (VHIR), Barcelona, Spain.,Cardiology Department, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Stanley Nattel
- Department of Medicine and Research Center, Montreal Heart Institute, Montreal, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada.,Department of Pharmacology and Physiology of the Université de Montréal Faculty of Medicine, Montreal, Canada.,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.,IHU LIRYC and Fondation Bordeaux Université, Bordeaux, France
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5
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Darlington A, McCauley MD. Atrial Cardiomyopathy: An Unexplored Limb of Virchow's Triad for AF Stroke Prophylaxis. Front Cardiovasc Med 2020; 7:11. [PMID: 32133372 PMCID: PMC7039862 DOI: 10.3389/fcvm.2020.00011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/27/2020] [Indexed: 01/14/2023] Open
Abstract
The most dreaded complication of atrial fibrillation is stroke, and 70–80% of patients with AF-related stroke die or become disabled. The mechanisms of thromboembolism in AF are multifactorial, with evidence demonstrating that all three criteria of Virchow's triad are satisfied in AF: abnormal stasis of blood, endothelial damage, and hypercoagulability. Mechanistic insights into the latter two limbs have resulted in effective stroke prophylactic therapies (left atrial appendage occlusion and oral anticoagulants); however, despite these advances, there remains an excess of stroke in the AF population that may be due, in part, to a lack of mechanistic understanding of atrial hypocontractility resulting in abnormal stasis of blood within the atrium. These observations support the emerging concept of atrial cardiomyopathy as a cause of stroke. In this Review, we evaluate molecular, translational, and clinical evidence for atrial cardiomyopathy as a cause for stroke from AF, and present a rationale for further investigation of this largely unaddressed limb of Virchow's triad in AF.
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Affiliation(s)
- Ashley Darlington
- Division of Cardiology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States.,Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Mark D McCauley
- Division of Cardiology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States.,Jesse Brown VA Medical Center, Chicago, IL, United States.,Department of Physiology and Biophysics, University of Illinois at Chicago, Chicago, IL, United States
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6
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Li J, Chen R, Wu J. Structural Analysis of Complex Atrial Intramural Microstructure from A Multi-layer Model Based on Siamese Network. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:294-297. [PMID: 31945899 DOI: 10.1109/embc.2019.8857276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Quantitative analysis of complex atrial intramural microstructure is a crucial step towards understanding the mechanism behind atrial fibrillation (AF) maintenance. Siamese network was adopted to extract features from computationally simulated multi-layer fibrosis structure. Through analysis of the features produced by the feature extractor, the difference between Non-sustained and Sustained simulations was comprehended intuitively and electrophysiologically. Complex conduction pathway marked by the feature extractor might be an indicator for AF radio-frequency ablation clinically.
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7
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Essayagh B, Antoine C, Benfari G, Messika-Zeitoun D, Michelena H, Le Tourneau T, Mankad S, Tribouilloy CM, Thapa P, Enriquez-Sarano M. Prognostic Implications of Left Atrial Enlargement in Degenerative Mitral Regurgitation. J Am Coll Cardiol 2019; 74:858-870. [DOI: 10.1016/j.jacc.2019.06.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/08/2019] [Accepted: 06/03/2019] [Indexed: 01/07/2023]
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8
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Asvestas D, Vlachos K, Bazoukis G, Martin CA, Letsas KP, Sakellaropoulou A, Kossyvakis C, Saplaouras A, Prappa E, Goga C, Vassilikos V, Valkanas K, Deftereos S, Sideris A, Efremidis M. Left atrial voltage mapping using a new impedance-based algorithm in patients with paroxysmal atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1447-1453. [DOI: 10.1111/pace.13501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Dimitrios Asvestas
- Second Department of Cardiology; Evangelismos General Hospital; Athens Greece
| | | | - George Bazoukis
- Second Department of Cardiology; Evangelismos General Hospital; Athens Greece
| | | | | | | | | | | | - Efstathia Prappa
- Second Department of Cardiology; Evangelismos General Hospital; Athens Greece
| | - Christina Goga
- Second Department of Cardiology; Evangelismos General Hospital; Athens Greece
| | - Vassilios Vassilikos
- Third Department of Cardiology, Hippokration Hospital, Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Kosmas Valkanas
- Second Department of Cardiology; Evangelismos General Hospital; Athens Greece
| | - Spiridon Deftereos
- 2nd Department of Cardiology, Medical School, Attikon Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Antonios Sideris
- Second Department of Cardiology; Evangelismos General Hospital; Athens Greece
| | - Michael Efremidis
- Second Department of Cardiology; Evangelismos General Hospital; Athens Greece
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9
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Atrial remodeling and metabolic dysfunction in idiopathic isolated fibrotic atrial cardiomyopathy. Int J Cardiol 2018; 265:155-161. [PMID: 29706431 DOI: 10.1016/j.ijcard.2018.04.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/18/2018] [Accepted: 04/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Idiopathic isolated fibrotic atrial cardiomyopathy (IIF-ACM) is a novel subtype of cardiomyopathy characterized by atrial fibrosis that does not involve the ventricular myocardium and is associated with significant atrial tachyarrhythmia. The mechanisms underlying its pathogenesis are unknown. METHODS Atrium samples were obtained from 3 patients with IIF-ACM via surgical intervention. Control samples were consisted of 3 atrium biopsies from patients with congenital heart disease and normal sinus rhythm, matched for gender, age and basic clinical characteristics. Comparative histology, immunofluorescence staining, electron microscopy and proteomics analyses were carried out to explore the unique pathogenesis of IIF-ACM. RESULTS IIF-ACM atria displayed disordered myofibrils, profound fibrosis and mitochondrial damages compared to the control atria. Proteomics profiling identified metabolic pathways as the most profound changes in IIF-ACM. CONCLUSIONS Our study suggested that metabolic changes in the atrial myocardium caused mitochondrial oxidative stress and potential cell damage, which further led to atrial fibrosis and myofibril disorganization, the characteristic phenotype of IIF-ACM.
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10
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Peng W, Li M, Li H, Tang K, Zhuang J, Zhang J, Xiao J, Jiang H, Li D, Yu Y, Sham PC, Nattel S, Xu Y. Dysfunction of Myosin Light-Chain 4 (MYL4) Leads to Heritable Atrial Cardiomyopathy With Electrical, Contractile, and Structural Components: Evidence From Genetically-Engineered Rats. J Am Heart Assoc 2017; 6:JAHA.117.007030. [PMID: 29080865 PMCID: PMC5721782 DOI: 10.1161/jaha.117.007030] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is increasing interest in the concept of atrial cardiomyopathy, but the underlying molecular and mechanistic determinants remain poorly defined. We identified a family with heritable atrial cardiomyopathy manifesting as progressive atrial-selective electromechanical dysfunction, tachyarrhythmias, and bradyarrhythmias requiring pacemaker implantation. Myosin light-chain 4 (MYL4), encoding the atrial-selective essential myosin light chain, was identified as a candidate gene. We used genetically modified rat models to investigate the role of MYL4 in atrial cardiomyopathy. METHODS AND RESULTS Exome sequencing and systematic bioinformatic analyses identified a rare missense variant of MYL4 (c.31G>A [p.E11K]) in a large multiplex atrial cardiomyopathy family pedigree. The mutation cosegregated with atrial standstill (selected as the principal presenting trait) with a logarithm of the odds score of 5.3. The phenotype of rats with MYL4 mutation knock-in confirmed the causative role of the mutation. MYL4 knockout rats showed a similar atrial cardiomyopathy phenotype, whereas rats with an adjacent 4-amino-acid deletion showed no phenotype. Both MYL4 p.E11K knock-in rats and MYL4 knockout rats showed progressive atrial electrophysiological, contractile, and fibrotic abnormalities, similar to affected patients. Biochemical analyses of MYL4 p.E11K mutation rats showed activation of proapoptotic and profibrotic signaling, along with increased atrial-cardiomyocyte terminal deoxynucleotidyl transferase dUTP nick end labeling staining, suggesting enhanced apoptotic cell death, findings that were mimicked by in vitro adenoviral transfer of the mutant gene to neonatal-rat cardiomyocytes. CONCLUSIONS Loss-of-function MYL4 gene variants cause progressive atrial cardiomyopathy in humans and rats. Our findings identify MYL4 as a key gene required for atrial contractile, electrical and structural integrity. These results improve our understanding of the molecular basis of atrial cardiomyopathy and introduce new models for further mechanistic analysis.
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Affiliation(s)
- Wenhui Peng
- Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Miaoxin Li
- Department of Psychiatry, Centre for Genomic Sciences, The University of Hong Kong, Pokfulam, Hong Kong.,State Key Laboratory for Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong.,Department of Medical Genetics, Center for Genome Research, Center for Precision Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Hailing Li
- Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Kai Tang
- Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jianhui Zhuang
- Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | | | | | | | - Dali Li
- Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai, China
| | - Yongchun Yu
- Shanghai Traditional Chinese Medicine Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Pak C Sham
- Department of Psychiatry, Centre for Genomic Sciences, The University of Hong Kong, Pokfulam, Hong Kong.,State Key Laboratory for Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Stanley Nattel
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montréal, Montreal, Quebec, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada.,Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
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11
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Vlachos K, Efremidis M, Letsas KP, Bazoukis G, Martin R, Kalafateli M, Lioni L, Georgopoulos S, Saplaouras A, Efremidis T, Liu T, Valkanas K, Karamichalakis N, Asvestas D, Sideris A. Low-voltage areas detected by high-density electroanatomical mapping predict recurrence after ablation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2017; 28:1393-1402. [PMID: 28884923 DOI: 10.1111/jce.13321] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/30/2017] [Accepted: 08/14/2017] [Indexed: 01/21/2023]
Abstract
INTRODUCTION We aimed to evaluate the extent of atrial fibrosis in paroxysmal atrial fibrillation (AF) and the correlation with ablation outcomes after pulmonary vein antral isolation (PVΑI) using a mapping system with high-resolution and high-spatial sampling. METHODS AND RESULTS We prospectively enrolled 80 consecutive patients (45 males, median age 60.26 years) with symptomatic paroxysmal AF who were scheduled for PVAI. Prior to PVAI, high-density bipolar voltage mapping (median number of 2,485 points) was carried out during sinus rhythm in all patients. Criteria for an adequate left atrium (LA) shell were > 2,000 points. Each acquired point was classified according to the peak-to-peak bipolar voltage electrogram based on two criteria (criterion A: healthy > 0.8 mV, border zone: 0.4-0.8 mV and scarred: < 0.4 mV, criterion Β: healthy: > 0.5 mV, border zone: 0.25-0.5 mV and scarred: < 0.25 mV). The extent of low-voltage area < 0.4 mV significantly predicted atrial tachyarrhythmia recurrence after the blanking period (P = 0.002). In univariate analysis, the presence of LA voltage areas < 0.4 mV more than 10% of the total surface area was the only significant predictor of arrhythmia recurrence. The analysis based on window B cutoff values failed to demonstrate any predictors of arrhythmia recurrence. CONCLUSION These data demonstrate that the existence of LA voltage areas < 0.4 mV more than 10% of the total LA surface area predicts arrhythmia recurrence following PVAI for paroxysmal AF.
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Affiliation(s)
- Konstantinos Vlachos
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Michael Efremidis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Konstantinos P Letsas
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - George Bazoukis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | | | - Maria Kalafateli
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Louiza Lioni
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Stamatis Georgopoulos
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Athanasios Saplaouras
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Theodore Efremidis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Kosmas Valkanas
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Nikolaos Karamichalakis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Dimitrios Asvestas
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Antonios Sideris
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
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12
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Yagishita A, Sparano D, Cakulev I, Gimbel JR, Phelan T, Mustafa H, De Oliveira S, Mackall J, Arruda M. Identification and electrophysiological characterization of early left atrial structural remodeling as a predictor for atrial fibrillation recurrence after pulmonary vein isolation. J Cardiovasc Electrophysiol 2017; 28:642-650. [DOI: 10.1111/jce.13211] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Atsuhiko Yagishita
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
| | - Dina Sparano
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
| | - Ivan Cakulev
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
| | - J. Rod Gimbel
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
| | - Timothy Phelan
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
| | - Hossam Mustafa
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
| | - Samer De Oliveira
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
| | - Judith Mackall
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
| | - Mauricio Arruda
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
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13
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YAGISHITA ATSUHIKO, GIMBEL JROD, DE OLIVEIRA SAMER, MANYAM HARISH, SPARANO DINA, CAKULEV IVAN, MACKALL JUDITH, ARRUDA MAURICIO. Long-Term Outcome of Left Atrial Voltage-Guided Substrate Ablation During Atrial Fibrillation: A Novel Adjunctive Ablation Strategy. J Cardiovasc Electrophysiol 2016; 28:147-155. [DOI: 10.1111/jce.13122] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 11/02/2016] [Accepted: 11/06/2016] [Indexed: 01/30/2023]
Affiliation(s)
- ATSUHIKO YAGISHITA
- University Hospitals Harrington Heart and Vascular Institute; Case Western Reserve University; School of Medicine; Cleveland Ohio United States
| | - J. ROD GIMBEL
- University Hospitals Harrington Heart and Vascular Institute; Case Western Reserve University; School of Medicine; Cleveland Ohio United States
| | - SAMER DE OLIVEIRA
- University Hospitals Harrington Heart and Vascular Institute; Case Western Reserve University; School of Medicine; Cleveland Ohio United States
| | - HARISH MANYAM
- University Hospitals Harrington Heart and Vascular Institute; Case Western Reserve University; School of Medicine; Cleveland Ohio United States
| | - DINA SPARANO
- University Hospitals Harrington Heart and Vascular Institute; Case Western Reserve University; School of Medicine; Cleveland Ohio United States
| | - IVAN CAKULEV
- University Hospitals Harrington Heart and Vascular Institute; Case Western Reserve University; School of Medicine; Cleveland Ohio United States
| | - JUDITH MACKALL
- University Hospitals Harrington Heart and Vascular Institute; Case Western Reserve University; School of Medicine; Cleveland Ohio United States
| | - MAURICIO ARRUDA
- University Hospitals Harrington Heart and Vascular Institute; Case Western Reserve University; School of Medicine; Cleveland Ohio United States
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14
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Abstract
Although sinus node dysfunction (SND) and atrial arrhythmias frequently coexist and interact, the putative mechanism linking the 2 remain unclear. Although SND is accompanied by atrial myocardial structural changes in the right atrium, atrial fibrillation (AF) is a disease of variable interactions between left atrial triggers and substrate most commonly of left atrial origin. Significant advances have been made in our understanding of the genetic and pathophysiologic mechanism underlying the development and progression of SND and AF. Although some patients manifest SND as a result of electric remodeling induced by periods of AF, others develop progressive atrial structural remodeling that gives rise to both conditions together. The treatment strategy will thus vary according to the predominant disease phenotype. Although catheter ablation will benefit patients with predominantly AF and secondary SND, cardiac pacing may be the mainstay of therapy for patients with predominant fibrotic atrial cardiomyopathy. This contemporary review summarizes current knowledge on sinus node pathophysiology with the broader goal of yielding insights into the complex relationship between sinus node disease and atrial arrhythmias.
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Affiliation(s)
- Roy M John
- From Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Saurabh Kumar
- From Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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15
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Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D'Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GYH, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S. EHRA/HRS/APHRS/SOLAECE expert consensus on Atrial cardiomyopathies: Definition, characterisation, and clinical implication. J Arrhythm 2016; 32:247-78. [PMID: 27588148 PMCID: PMC4996910 DOI: 10.1016/j.joa.2016.05.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Andreas Goette
- Departement of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan M Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | | | - Mario Gonzalez
- Penn State Heart and Vascular Institute, Penn State University, Hershey, PA, USA
| | - Stephane N Hatem
- Department of Cardiology, Assistance Publique - Hô pitaux de Paris, Pitié-Salpêtrière Hospital, Sorbonne University, INSERM UMR_S1166, Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Robert Helm
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Siew Yen Ho
- Royal Brompton Hospital and Imperial College London, London, UK
| | - Brian Hoit
- UH Case Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - William Uribe
- Electrophysiology Deparment at Centros Especializados de San Vicente Fundació n and Clínica CES. Universidad CES, Universidad Pontificia Bolivariana (UPB), Medellin, Colombia
| | | | - Stanley Nattel
- Université de Montréal, Montreal Heart Institute Research Center and McGill University, Montreal, Quebec, Canada; Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D'Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GYH, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace 2016; 18:1455-1490. [PMID: 27402624 DOI: 10.1093/europace/euw161] [Citation(s) in RCA: 426] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Andreas Goette
- Departement of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan M Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | | | - Mario Gonzalez
- Penn State Heart and Vascular Institute, Penn State University, Hershey, PA, USA
| | - Stephane N Hatem
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Sorbonne University; INSERM UMR_S1166; Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Robert Helm
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Siew Yen Ho
- Royal Brompton Hospital and Imperial College London, London, UK
| | - Brian Hoit
- UH Case Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - William Uribe
- Electrophysiology Deparment at Centros Especializados de San Vicente Fundación and Clínica CES. Universidad CES, Universidad Pontificia Bolivariana (UPB), Medellin, Colombia
| | | | - Stanley Nattel
- Université de Montréal, Montreal Heart Institute Research Center and McGill University, Montreal, Quebec, Canada .,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication. Heart Rhythm 2016; 14:e3-e40. [PMID: 27320515 DOI: 10.1016/j.hrthm.2016.05.028] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Indexed: 12/21/2022]
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Autosomal recessive atrial disease presenting with sick sinus syndrome (SSS), right atrial fibrosis and biatrial dilatation: Clinical impact of genetic diagnosis. Int J Cardiol 2016; 208:67-9. [DOI: 10.1016/j.ijcard.2016.01.160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 01/07/2023]
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Masè M, Cristoforetti A, Avogaro L, Tessarolo F, Piccoli F, Caola I, Pederzolli C, Graffigna A, Ravelli F. A spectral approach for the quantitative description of cardiac collagen network from nonlinear optical imaging. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:6257-60. [PMID: 26737722 DOI: 10.1109/embc.2015.7319822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The assessment of collagen structure in cardiac pathology, such as atrial fibrillation (AF), is essential for a complete understanding of the disease. This paper introduces a novel methodology for the quantitative description of collagen network properties, based on the combination of nonlinear optical microscopy with a spectral approach of image processing and analysis. Second-harmonic generation (SHG) microscopy was applied to atrial tissue samples from cardiac surgery patients, providing label-free, selective visualization of the collagen structure. The spectral analysis framework, based on 2D-FFT, was applied to the SHG images, yielding a multiparametric description of collagen fiber orientation (angle and anisotropy indexes) and texture scale (dominant wavelength and peak dispersion indexes). The proof-of-concept application of the methodology showed the capability of our approach to detect and quantify differences in the structural properties of the collagen network in AF versus sinus rhythm patients. These results suggest the potential of our approach in the assessment of collagen properties in cardiac pathologies related to a fibrotic structural component.
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20
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Csepe TA, Zhao J, Hansen BJ, Li N, Sul LV, Lim P, Wang Y, Simonetti OP, Kilic A, Mohler PJ, Janssen PML, Fedorov VV. Human sinoatrial node structure: 3D microanatomy of sinoatrial conduction pathways. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2015; 120:164-78. [PMID: 26743207 DOI: 10.1016/j.pbiomolbio.2015.12.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/10/2015] [Accepted: 12/18/2015] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Despite a century of extensive study on the human sinoatrial node (SAN), the structure-to-function features of specialized SAN conduction pathways (SACP) are still unknown and debated. We report a new method for direct analysis of the SAN microstructure in optically-mapped human hearts with and without clinical history of SAN dysfunction. METHODS Two explanted donor human hearts were coronary-perfused and optically-mapped. Structural analyses of histological sections parallel to epicardium (∼13-21 μm intervals) were integrated with optical maps to create 3D computational reconstructions of the SAN complex. High-resolution fiber fields were obtained using 3D Eigen-analysis of the structure tensor, and used to analyze SACP microstructure with a fiber-tracking approach. RESULTS Optical mapping revealed normal SAN activation of the atria through a lateral SACP proximal to the crista terminalis in Heart #1 but persistent SAN exit block in diseased Heart #2. 3D structural analysis displayed a functionally-observed SAN border composed of fibrosis, fat, and/or discontinuous fibers between SAN and atria, which was only crossed by several branching myofiber tracts in SACP regions. Computational 3D fiber-tracking revealed that myofiber tracts of SACPs created continuous connections between SAN #1 and atria, but in SAN #2, SACP region myofiber tracts were discontinuous due to fibrosis and fat. CONCLUSIONS We developed a new integrative functional, structural and computational approach that allowed for the resolution of the specialized 3D microstructure of human SACPs for the first time. Application of this integrated approach will shed new light on the role of the specialized SAN microanatomy in maintaining sinus rhythm.
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Affiliation(s)
- Thomas A Csepe
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Brian J Hansen
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ning Li
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lidiya V Sul
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Praise Lim
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Yufeng Wang
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Orlando P Simonetti
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA; Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ahmet Kilic
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Peter J Mohler
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Paul M L Janssen
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vadim V Fedorov
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Cantwell CD, Roney CH, Ng FS, Siggers JH, Sherwin SJ, Peters NS. Techniques for automated local activation time annotation and conduction velocity estimation in cardiac mapping. Comput Biol Med 2015; 65:229-42. [PMID: 25978869 PMCID: PMC4593301 DOI: 10.1016/j.compbiomed.2015.04.027] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 11/24/2022]
Abstract
Measurements of cardiac conduction velocity provide valuable functional and structural insight into the initiation and perpetuation of cardiac arrhythmias, in both a clinical and laboratory context. The interpretation of activation wavefronts and their propagation can identify mechanistic properties of a broad range of electrophysiological pathologies. However, the sparsity, distribution and uncertainty of recorded data make accurate conduction velocity calculation difficult. A wide range of mathematical approaches have been proposed for addressing this challenge, often targeted towards specific data modalities, species or recording environments. Many of these algorithms require identification of activation times from electrogram recordings which themselves may have complex morphology or low signal-to-noise ratio. This paper surveys algorithms designed for identifying local activation times and computing conduction direction and speed. Their suitability for use in different recording contexts and applications is assessed.
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Affiliation(s)
- C D Cantwell
- Department of Aeronautics, Imperial College London, South Kensington Campus, London, UK; National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK.
| | - C H Roney
- Department of Bioengineering, Imperial College London, South Kensington Campus, London, UK; National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK
| | - F S Ng
- National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK
| | - J H Siggers
- Department of Bioengineering, Imperial College London, South Kensington Campus, London, UK
| | - S J Sherwin
- Department of Aeronautics, Imperial College London, South Kensington Campus, London, UK
| | - N S Peters
- National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK
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Disertori M, Masè M, Narula N, Mazzola S, dal Piaz EC, Quintarelli S, Cristoforetti A, Marini M, Ravelli F, Arbustini E. Atrial fibrillation and NPPA gene p.S64R mutation: are cardiologists helpless spectators of healthy mutation carriers? J Cardiovasc Med (Hagerstown) 2015. [PMID: 26200358 DOI: 10.2459/jcm.0000000000000302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Heterozygous p.(Ser64Arg) mutation in the natriuretic peptide precursor A gene has been associated with atrial fibrillation in the presence of common single nucleotide polymorphisms (rs10033464 and rs2200733; 4q25) that would act as modifiers. METHODS We screened natriuretic peptide precursor A gene in 583 individuals and identified three unrelated carriers of the p.(Ser64Arg) mutation (0.5%). RESULTS Only one of the three mutation carriers had episodes of atrial fibrillation. Cascade screening of the three families identified seven additional mutation carriers, none showing atrial fibrillation. The patients with atrial fibrillation also carried the rs2200733, which was however found in four additional nonatrial fibrillation family members and carriers of the p.(Ser64Arg). The prevalence of atrial fibrillation in p.(Ser64Arg) carriers was 10% and in those combining the mutation with the risk single nucleotide polymorphisms was 20%. In the unique mutated patient with atrial fibrillation, the arrhythmias was refractory to both pharmacological and ablation treatment, during 16 years of follow-up; his electrophysiological phenotype was characterized by short atrial cycle lengths with a median value of 131 ms that suggests shortening of atrial action potential. CONCLUSION The prevalence of p.(Ser64Arg) mutation is low in the general population as is the prevalence of atrial fibrillation in mutation carriers (1/10). Atrial fibrillation in the affected mutated patient was lone at onset and progressively evolved with peculiar electrophysiological patterns.
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Affiliation(s)
- Marcello Disertori
- aDepartment of Cardiology, Santa Chiara HospitalbHealthcare Research and Innovation Program. PAT-FBKcDepartment of Physics, University of Trento, Povo, TrentodCentre for Inherited Cardiovascular Diseases, IRCCS Foundation, Policlinico San Matteo, Pavia, ItalyeMayo Clinic, 200 1st St Sw, Rochester, MN 55905-0001, USA
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Csepe TA, Kalyanasundaram A, Hansen BJ, Zhao J, Fedorov VV. Fibrosis: a structural modulator of sinoatrial node physiology and dysfunction. Front Physiol 2015; 6:37. [PMID: 25729366 PMCID: PMC4325882 DOI: 10.3389/fphys.2015.00037] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/24/2015] [Indexed: 01/01/2023] Open
Abstract
Heart rhythm is initialized and controlled by the Sinoatrial Node (SAN), the primary pacemaker of the heart. The SAN is a heterogeneous multi-compartment structure characterized by clusters of specialized cardiomyocytes enmeshed within strands of connective tissue or fibrosis. Intranodal fibrosis is emerging as an important modulator of structural and functional integrity of the SAN pacemaker complex. In adult human hearts, fatty tissue and fibrosis insulate the SAN from the hyperpolarizing effect of the surrounding atria while electrical communication between the SAN and right atrium is restricted to discrete SAN conduction pathways. The amount of fibrosis within the SAN is inversely correlated with heart rate, while age and heart size are positively correlated with fibrosis. Pathological upregulation of fibrosis within the SAN may lead to tachycardia-bradycardia arrhythmias and cardiac arrest, possibly due to SAN reentry and exit block, and is associated with atrial fibrillation, ventricular arrhythmias, heart failure and myocardial infarction. In this review, we will discuss current literature on the role of fibrosis in normal SAN structure and function, as well as the causes and consequences of SAN fibrosis upregulation in disease conditions.
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Affiliation(s)
- Thomas A Csepe
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center Columbus, OH, USA
| | - Anuradha Kalyanasundaram
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center Columbus, OH, USA
| | - Brian J Hansen
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center Columbus, OH, USA
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland Auckland, New Zealand
| | - Vadim V Fedorov
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center Columbus, OH, USA
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