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Shahrbabaki SS, Strong C, Chapman D, Tonchev I, Jenkins E, Lechat B, Nguyen DP, Mittinty M, Catcheside P, Eckert DJ, Baumert M, Ganesan AN. Characterisation of nocturnal arrhythmia avalanche dynamics: Insights from generalised linear model analysis. J Sleep Res 2025:e14465. [PMID: 39901595 DOI: 10.1111/jsr.14465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 12/19/2024] [Accepted: 01/06/2025] [Indexed: 02/05/2025]
Abstract
Nocturnal arrhythmia avalanche (NAA) episodes, characterised by transient non-sustained cardiac arrhythmias during sleep, have been demonstrated as a predictor of adverse cardiovascular events. However, their dynamics and association with sleep architecture and events remain unclear. While generalised linear models (GLM) have captured sleep-disordered breathing (SDB) dynamics, their application to NAA remains underexplored. This study explored whether changes in sleep architecture contribute to nocturnal arrhythmias and if the impact of sleep stages, SDB, and arousal events on these arrhythmias varies by demographic factors. We analysed 7341 ECG recordings from the multi-ethnic study of atherosclerosis (MESA) and the sleep heart health study (SHHS) datasets. R-R intervals were divided into 10-min periods to detect NAA, defined as a 30% drop from baseline followed by recovery to 90% of baseline. A GLM framework was developed to characterise NAA episodes as functions of SDB, sleep arousal events, sleep stages, and prior NAA episodes. The GLM analysis revealed that NAA occurrence was 18% and 30% higher during non-rapid eye movement (NREM) light sleep compared with deep sleep in SHHS (p < 0.001) and MESA (p < 0.001), respectively. SDB events increased the NAA risk in 34% of participants, and arousals in 29%. In SHHS, the impact of SDB on NAA was 5% greater in men (p = 0.018), while the arousal effects were more pronounced in those over 75, highlighting the role of demographic factors in modulating arrhythmia risk. These findings demonstrate the utility of the GLM framework in modelling the dynamics of nocturnal arrhythmias and their associations with sleep disruptions and architecture.
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Affiliation(s)
| | - Campbell Strong
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Darius Chapman
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Ivaylo Tonchev
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Evan Jenkins
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Bastien Lechat
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Duc Phuc Nguyen
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Murthy Mittinty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Peter Catcheside
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Danny J Eckert
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Mathias Baumert
- Discipline of Biomedical Engineering, School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anand N Ganesan
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
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2
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Li RB, Zhang JD, Cui XR, Cui W. Insomnia is related to long-term atrial fibrillation recurrence following radiofrequency ablation. Ann Med 2024; 56:2323089. [PMID: 38423515 PMCID: PMC10906119 DOI: 10.1080/07853890.2024.2323089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE Atrial fibrillation (AF), the most common cardiac arrhythmia, presents significant health challenges, and the intricate connection between insomnia and AF has garnered substantial attention. This cohort study aims to investigate the relationship between insomnia and AF recurrences following radiofrequency ablation. MATERIALS AND METHODS Data were retrieved from an electronic database of patients who underwent radiofrequency ablation for AF. The primary endpoint was AF recurrence. We utilized a multivariable Cox model, coupled with three propensity score methods, for analysis. RESULTS Between January 1, 2017, and June 1, 2022, 541 patients who underwent radiofrequency ablation for AF were recorded in the database. After excluding 185 patients, the final cohort comprised 356 patients. Among them, 68 were afflicted by insomnia, while 288 were not. Over a median follow-up of 755 days, one patient died, and 130 (36.5%) experienced AF recurrence. Multivariate Cox regression analysis revealed that the insomnia group had a higher risk of AF recurrence compared to the non-insomnia group (HR: 1.83, 95% CI: 1.16-2.89). Further landmark analysis showed no significant difference in AF recurrence rates during the initial 1-year follow-up. However, beyond 1 year, the insomnia group demonstrated a significantly higher AF recurrence rate. As the number of insomnia symptoms increased, the risk of AF recurrence also rose significantly, indicating a dose-response relationship. CONCLUSION This study establishes a significant link between insomnia and long-term AF recurrence following radiofrequency ablation. It underscores the importance of identifying and addressing insomnia in patients with AF undergoing radiofrequency ablation.
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Affiliation(s)
- Rui-bin Li
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ji-dong Zhang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiao-ran Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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3
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Menon T, Ogbu I, Kalra DK. Sleep-Disordered Breathing and Cardiac Arrhythmias. J Clin Med 2024; 13:6635. [PMID: 39597779 PMCID: PMC11595083 DOI: 10.3390/jcm13226635] [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: 09/30/2024] [Revised: 10/29/2024] [Accepted: 10/31/2024] [Indexed: 11/29/2024] Open
Abstract
A narrative review was performed, analyzing peer-reviewed articles from databases such as PubMed, EMBASE, Scopus, and Web of Science to examine the mechanistic links between sleep-disordered breathing (SDB), and cardiac arrhythmias, emphasizing intermittent hypoxia, autonomic imbalance, and intrathoracic pressure swings as key pathways. Studies, including the DREAM and CESAAR trials, consistently demonstrate that SDB patients face elevated risks: more than doubling the likelihood of overall arrhythmias (OR 2.24; 95% CI 1.48-3.39), quadrupling the risk of AF (OR 4.02; 95% CI 1.03-15.74), and tripling the risk of non-sustained ventricular tachycardia (NSVT) with higher apnea-hypopnea index (AHI) values. Additionally, SDB doubles the risk of bradyarrhythmia, such as sinus pause, second and third-degree atrioventricular block, and intraventricular conduction delay (OR 2.50; 95% CI 1.58-3.95). According to meta-analytical findings, continuous positive airway pressure (CPAP) therapy is a pivotal intervention, significantly reducing AF recurrence by 42% and lowering VA incidence by 58%. Moreover, CPAP therapy diminishes sinus bradycardia and occurrences of sinus pause and may reduce the necessity for pacemaker implantation. Recognizing SDB as a modifiable risk factor for cardiac arrhythmias highlights the importance of early diagnosis and effective management, primarily through CPAP therapy, to improve cardiovascular outcomes.
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Affiliation(s)
| | | | - Dinesh K. Kalra
- Division of Cardiology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA; (T.M.); (I.O.)
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4
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Javaheri S, Javaheri S, Somers VK, Gozal D, Mokhlesi B, Mehra R, McNicholas WT, Zee PC, Campos-Rodriguez F, Martinez-Garcia MA, Cistulli P, Malhotra A. Interactions of Obstructive Sleep Apnea With the Pathophysiology of Cardiovascular Disease, Part 1: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:1208-1223. [PMID: 39293884 PMCID: PMC11666391 DOI: 10.1016/j.jacc.2024.02.059] [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: 11/15/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 09/20/2024]
Abstract
The American Heart Association considers sleep health an essential component of cardiovascular health, and sleep is generally a time of cardiovascular quiescence, such that any deviation from normal sleep may be associated with adverse cardiovascular consequences. Many studies have shown that both impaired quantity and quality of sleep, particularly with obstructive sleep apnea (OSA) and comorbid sleep disorders, are associated with incident cardiometabolic consequences. OSA is associated with repetitive episodes of altered blood gases, arousals, large negative swings in intrathoracic pressures, and increased sympathetic activity. Recent studies show that OSA is also associated with altered gut microbiota, which could contribute to increased risk of cardiovascular disease. OSA has been associated with hypertension, atrial fibrillation, heart failure, coronary artery disease, stroke, and excess cardiovascular mortality. Association of OSA with chronic obstructive lung disease (overlap syndrome) and morbid obesity (obesity hypoventilation syndrome) increases the odds of mortality.
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Affiliation(s)
| | - Sogol Javaheri
- TriHealth Bethesda North Hospital, Cincinnati, Ohio, USA
| | | | - David Gozal
- TriHealth Bethesda North Hospital, Cincinnati, Ohio, USA
| | - Babak Mokhlesi
- TriHealth Bethesda North Hospital, Cincinnati, Ohio, USA
| | - Reena Mehra
- TriHealth Bethesda North Hospital, Cincinnati, Ohio, USA
| | | | - Phyllis C Zee
- TriHealth Bethesda North Hospital, Cincinnati, Ohio, USA
| | | | | | - Peter Cistulli
- TriHealth Bethesda North Hospital, Cincinnati, Ohio, USA
| | - Atul Malhotra
- TriHealth Bethesda North Hospital, Cincinnati, Ohio, USA
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5
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Kumar S, Weinstein J, Melchinger HC, Smith A, Capodilupo E, Akar JG, Garg K, O'Connor KD, Staunton MK, Martin M, Akhlaghi N, Edeh O, Perez S, Lee V, Lee KAV, Wilson FP. Observational study protocol for an arrhythmia notification feature. BMJ Open 2024; 14:e075110. [PMID: 38830741 PMCID: PMC11149124 DOI: 10.1136/bmjopen-2023-075110] [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: 04/26/2023] [Accepted: 01/16/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Screening for atrial fibrillation (AF) in the general population may help identify individuals at risk, enabling further assessment of risk factors and institution of appropriate treatment. Algorithms deployed on wearable technologies such as smartwatches and fitness bands may be trained to screen for such arrhythmias. However, their performance needs to be assessed for safety and accuracy prior to wide-scale implementation. METHODS AND ANALYSIS This study will assess the ability of the WHOOP strap to detect AF using its WHOOP Arrhythmia Notification Feature (WARN) algorithm in an enriched cohort with a 2:1 distribution of previously diagnosed AF (persistent and paroxysmal) and healthy controls. Recruited participants will collect data for 7 days with the WHOOP wrist-strap and BioTel ePatch (electrocardiography gold-standard). Primary outcome will be participant level sensitivity and specificity of the WARN algorithm in detecting AF in analysable windows compared with the ECG gold-standard. Similar analyses will be performed on an available epoch-level basis as well as comparison of these findings in important subgroups. ETHICS AND DISSEMINATION The study was approved by the ethics board at the study site. Participants will be enrolled after signing an online informed consent document. Updates will be shared via clinicaltrials.gov. The data obtained from the conclusion of this study will be presented in national and international conferences with publication in clinical research journals. TRIAL REGISTRATION NUMBER NCT05809362.
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Affiliation(s)
- Sanchit Kumar
- Clinical and Translational Research Accelerator, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jason Weinstein
- Clinical and Translational Research Accelerator, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Hannah Camille Melchinger
- Clinical and Translational Research Accelerator, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Abigail Smith
- Clinical and Translational Research Accelerator, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Joseph G Akar
- Division of Cardiology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kanika Garg
- Clinical and Translational Research Accelerator, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kyle D O'Connor
- Clinical and Translational Research Accelerator, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mary Kate Staunton
- Clinical and Translational Research Accelerator, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Melissa Martin
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Narjes Akhlaghi
- Clinical and Translational Research Accelerator, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Oluoma Edeh
- University of New Mexico, Albuquerque, New Mexico, USA
| | - Stephanie Perez
- Clinical and Translational Research Accelerator, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Kyoung A V Lee
- Clinical and Translational Research Accelerator, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Francis P Wilson
- Clinical and Translational Research Accelerator, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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6
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Ráčková L, Pompa T, Zlámal F, Barták M, Nývlt D, Bienertová-Vašků J. Physiological evidence of stress reduction during a summer Antarctic expedition with a significant influence of previous experience and vigor. Sci Rep 2024; 14:3981. [PMID: 38368474 PMCID: PMC10874375 DOI: 10.1038/s41598-024-54203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/09/2024] [Indexed: 02/19/2024] Open
Abstract
Antarctica provides a unique environment for studying human adaptability, characterized by controlled conditions, limited sensory stimulation, and significant challenges in logistics and communication. This longitudinal study investigates the relationship between stress indicators, with a specific focus on mean sleep heart rate, during a COVID-19 quarantine and subsequent 83 days long summer Antarctic expedition at the J. G. Mendel Czech Antarctic Station. Our novel approach includes daily recordings of sleep heart rate and weekly assessments of emotions, stress, and sleep quality. Associations between variables were analyzed using the generalized least squares method, providing unique insights into nuances of adaptation. The results support previous findings by providing empirical evidence on the stress reducing effect of Antarctic summer expedition and highlight the importance of previous experience and positive emotions, with the novel contribution of utilizing physiological data in addition to psychological measures. High-frequency sampling and combination of psychological and physiological data addresses a crucial gap in the research of stress. This study contributes valuable knowledge to the field of psychophysiology and has implications for expedition planners, research organizations, teams in action settings, pandemic prevention protocols, global crises, and long-duration spaceflight missions. Comprehensive insights promote the well-being and success of individuals in extreme conditions.
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Affiliation(s)
- Lucie Ráčková
- RECETOX, Faculty of Sciences, Masaryk University, Brno, Czech Republic
| | - Tomáš Pompa
- Department of Physical Activities and Health Sciences - Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Filip Zlámal
- Department of Physical Activities and Health Sciences - Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Miloš Barták
- Department of Experimental Biology, Masaryk University, Brno, Czech Republic
| | - Daniel Nývlt
- Polar-Geo-Lab, Department of Geography, Masaryk University, Brno, Czech Republic
| | - Julie Bienertová-Vašků
- RECETOX, Faculty of Sciences, Masaryk University, Brno, Czech Republic.
- Department of Physical Activities and Health Sciences - Faculty of Sports Studies, Masaryk University, Brno, Czech Republic.
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7
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Xu PH, Fong DYT, Lui MMS, Lam DCL, Ip MSM. Cardiovascular outcomes in obstructive sleep apnoea and implications of clinical phenotyping on effect of CPAP treatment. Thorax 2023; 78:76-84. [PMID: 35304425 PMCID: PMC9763161 DOI: 10.1136/thoraxjnl-2021-217714] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/05/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a growing awareness of the heterogeneity of obstructive sleep apnoea (OSA). Clinical trials of CPAP treatment on cardiovascular protection have been mostly negative. We aimed to assess the association between polysomnographic parameters and incident major adverse cardiovascular events (MACEs), and to investigate if the CPAP effect could be better delineated among clinical subgroups. METHODS This sleep cohort study was conducted using a clinical database and territory-wide electronic health administration data in Hong Kong. Cox regressions were used to calculate HRs. Latent class analysis was used to cluster patients with OSA according to clinical and polysomnographic features. RESULTS Of 1860 eligible Chinese subjects who underwent polysomnography (2006-2013), 1544 (83%) had OSA. Over median follow-up of 8.3 years, 278 (14.9%) experienced MACEs. Apnoea-hypopnoea index (AHI) did not predict MACEs (HR: 0.95; 95% CI 0.76 to 1.17), whereas sleep time with oxygen saturation <90% (TST90) (HR: 1.41; 95% CI 1.10 to 1.81) was an independent predictor of MACEs, as were wake and nocturnal heart rate. In moderate-severe OSA (n=1108) who were indicated for CPAP treatment, regular CPAP was not associated with reduction of incident MACEs. Further cluster analysis identified a subgroup (n=333) who was younger, more obese, had more severe OSA (higher AHI and TST90) and more cardiovascular risks, in whom regular CPAP was associated with a lower risk of MACEs (HR:0.49, 95% CI 0.25 to 0.95). CONCLUSIONS OSA-related TST90 and mean heart rate, but not AHI, were robust predictors of MACEs. A clinical phenotype subgroup who demonstrated beneficial effect of CPAP treatment was identified.
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Affiliation(s)
- Pei-Hang Xu
- Division of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China,Division of Respiratory and Critical Care Medicine, Department of Medicine, LKS Faculty of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Daniel Y T Fong
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Macy M S Lui
- Division of Respiratory and Critical Care Medicine, Department of Medicine, LKS Faculty of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - David C L Lam
- Division of Respiratory and Critical Care Medicine, Department of Medicine, LKS Faculty of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Mary Sau Man Ip
- Division of Respiratory and Critical Care Medicine, Department of Medicine, LKS Faculty of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China,Division of Respiratory Medicine, Department of Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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8
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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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9
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Mehra R, Tjurmina OA, Ajijola OA, Arora R, Bolser DC, Chapleau MW, Chen PS, Clancy CE, Delisle BP, Gold MR, Goldberger JJ, Goldstein DS, Habecker BA, Handoko ML, Harvey R, Hummel JP, Hund T, Meyer C, Redline S, Ripplinger CM, Simon MA, Somers VK, Stavrakis S, Taylor-Clark T, Undem BJ, Verrier RL, Zucker IH, Sopko G, Shivkumar K. Research Opportunities in Autonomic Neural Mechanisms of Cardiopulmonary Regulation: A Report From the National Heart, Lung, and Blood Institute and the National Institutes of Health Office of the Director Workshop. JACC Basic Transl Sci 2022; 7:265-293. [PMID: 35411324 PMCID: PMC8993767 DOI: 10.1016/j.jacbts.2021.11.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/22/2022]
Abstract
This virtual workshop was convened by the National Heart, Lung, and Blood Institute, in partnership with the Office of Strategic Coordination of the Office of the National Institutes of Health Director, and held September 2 to 3, 2020. The intent was to assemble a multidisciplinary group of experts in basic, translational, and clinical research in neuroscience and cardiopulmonary disorders to identify knowledge gaps, guide future research efforts, and foster multidisciplinary collaborations pertaining to autonomic neural mechanisms of cardiopulmonary regulation. The group critically evaluated the current state of knowledge of the roles that the autonomic nervous system plays in regulation of cardiopulmonary function in health and in pathophysiology of arrhythmias, heart failure, sleep and circadian dysfunction, and breathing disorders. Opportunities to leverage the Common Fund's SPARC (Stimulating Peripheral Activity to Relieve Conditions) program were characterized as related to nonpharmacologic neuromodulation and device-based therapies. Common themes discussed include knowledge gaps, research priorities, and approaches to develop novel predictive markers of autonomic dysfunction. Approaches to precisely target neural pathophysiological mechanisms to herald new therapies for arrhythmias, heart failure, sleep and circadian rhythm physiology, and breathing disorders were also detailed.
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Key Words
- ACE, angiotensin-converting enzyme
- AD, autonomic dysregulation
- AF, atrial fibrillation
- ANS, autonomic nervous system
- Ach, acetylcholine
- CNS, central nervous system
- COPD, chronic obstructive pulmonary disease
- CSA, central sleep apnea
- CVD, cardiovascular disease
- ECG, electrocardiogram
- EV, extracellular vesicle
- GP, ganglionated plexi
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- HRV, heart rate variability
- LQT, long QT
- MI, myocardial infarction
- NE, norepinephrine
- NHLBI, National Heart, Lung, and Blood Institute
- NPY, neuropeptide Y
- NREM, non-rapid eye movement
- OSA, obstructive sleep apnea
- PAH, pulmonary arterial hypertension
- PV, pulmonary vein
- REM, rapid eye movement
- RV, right ventricular
- SCD, sudden cardiac death
- SDB, sleep disordered breathing
- SNA, sympathetic nerve activity
- SNSA, sympathetic nervous system activity
- TLD, targeted lung denervation
- asthma
- atrial fibrillation
- autonomic nervous system
- cardiopulmonary
- chronic obstructive pulmonary disease
- circadian
- heart failure
- pulmonary arterial hypertension
- sleep apnea
- ventricular arrhythmia
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Affiliation(s)
- Reena Mehra
- Cleveland Clinic, Cleveland, Ohio, USA
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Olga A. Tjurmina
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | - Rishi Arora
- Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
| | | | - Mark W. Chapleau
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | | | | | - Michael R. Gold
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - David S. Goldstein
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Beth A. Habecker
- Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - M. Louis Handoko
- Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - James P. Hummel
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | | - Marc A. Simon
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- University of California-San Francisco, San Francisco, California, USA
| | | | - Stavros Stavrakis
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | | | - Richard L. Verrier
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - George Sopko
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
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10
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Chilazi M, Gurakar M, Rosen N, Trivedi R, Vakil RM, Sharma G, Chrispin J. Sudden Cardiac Arrest Secondary to Early Repolarization Syndrome. JACC Case Rep 2021; 3:1422-1426. [PMID: 34557685 PMCID: PMC8446040 DOI: 10.1016/j.jaccas.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/22/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
A healthy 41-year-old man sustained cardiac arrest secondary to ventricular fibrillation. An extensive ischemic, structural, and genetic evaluation did not identify an attributable pathologic condition. Electrocardiograms were notable for early repolarization pattern. Here we review the diagnosis, prevalence, and prognostic significance of the early repolarization syndrome on sudden cardiac death. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Michael Chilazi
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Merve Gurakar
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Natalie Rosen
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rishi Trivedi
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rachit M Vakil
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Garima Sharma
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan Chrispin
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
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11
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Grau N, Martí-Almor J, Félez MA. Relationship between SAHS and cardiac arrhythmias. Arch Bronconeumol 2021; 57:513-514. [PMID: 34147351 DOI: 10.1016/j.arbr.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Nuria Grau
- Unidad Multidisciplinaria de Medicina del Sueño, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Martí-Almor
- Unidad de Arritmias, Servicio de Cardiología, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miquel A Félez
- Unidad Multidisciplinaria de Medicina del Sueño, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
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12
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Martí-Almor J, Jiménez-López J, Casteigt B, Conejos J, Valles E, Farré N, Flor MF. Obstructive Sleep Apnea Syndrome as a Trigger of Cardiac Arrhythmias. Curr Cardiol Rep 2021; 23:20. [PMID: 33611699 DOI: 10.1007/s11886-021-01445-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Obstructive sleep apnea syndrome (OSAS) has a high prevalence in western countries. Many papers have been published with the purpose of demonstrating that OSAS acts as an arrhythmia trigger and is responsible for an increase in cardiovascular morbidity and mortality. The aim of this study was to review our knowledge on this topic. RECENT FINDINGS There is a lot of evidence demonstrating the relationship between OSAS and arrhythmias, but there remains a lack of an interventional randomized trial to demonstrate that by treating OSAS we can reduce arrhythmia burden. OSAS is a highly prevalent illness in western countries and is clearly related to an increase in cardiovascular mortality and morbidity. Cardiac arrhythmias are triggered by a repetitive hypoxemia, hypercapnia, acidosis, intrathoracic pressure fluctuations, reoxygenation, and arousals during apnea and hypopnea episodes. Early diagnosis and treatment of these patients can reduce further cardiovascular morbidity and mortality.
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Affiliation(s)
- Julio Martí-Almor
- Arrhythmia Unit, Cardiology Department, Parc de Salut Mar, Universitat Autonòma de Barcelona, Barcelona, Spain.
| | - Jesús Jiménez-López
- Arrhythmia Unit, Cardiology Department, Parc de Salut Mar, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Benjamin Casteigt
- Arrhythmia Unit, Cardiology Department, Parc de Salut Mar, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Javier Conejos
- Arrhythmia Unit, Cardiology Department, Parc de Salut Mar, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Ermengol Valles
- Arrhythmia Unit, Cardiology Department, Parc de Salut Mar, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Núria Farré
- Heart Failure Unit, Cardiology Department, Parc de Salut Mar, Universitat Autònoma de Barcelona and Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Miquel Félez Flor
- Multidisciplinary Unit of Sleep Medicine, Parc de salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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13
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Grau N, Martí-Almor J, Félez MA. Relationship between SAHS and Cardiac Arrhythmias. Arch Bronconeumol 2021; 57:S0300-2896(21)00004-1. [PMID: 33589346 DOI: 10.1016/j.arbres.2020.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Nuria Grau
- Unidad Multidisciplinaria de Medicina del Sueño, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Julio Martí-Almor
- Unidad de Arritmias, Servicio de Cardiología, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel A Félez
- Unidad Multidisciplinaria de Medicina del Sueño, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, España.
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14
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Liu SH, Lo LW, Tsai TY, Cheng WH, Lin YJ, Chang SL, Hu YF, Chung FP, Chao TF, Liao JN, Lo MT, Tarng DC, Chen SA. Circadian rhythm dynamics on multiscale entropy identifies autonomic dysfunction associated with risk of ventricular arrhythmias and near syncope in chronic kidney disease. J Cardiol 2020; 76:542-548. [PMID: 32631644 DOI: 10.1016/j.jjcc.2020.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/11/2020] [Accepted: 05/27/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND A discordant biological clock could potentially induce sudden cardiac death (SCD). We aimed to evaluate the circadian change of heart rate variability (HRV) and its relationship to the risks of ventricular arrhythmia (VA) and near syncope in patients with chronic kidney disease (CKD). METHODS In this retrospective study, non-CKD and CKD patients were enrolled and underwent a 24-hour Holter examination for linear and nonlinear HRV analyses. The multiscale entropy (MSE) method was selected for nonlinear HRV analyses. The documented VAs or episodes of near syncope were classified as high-risk SCD group (n=8) and others as low-risk SCD group (n=21). RESULTS In linear analyses, time and frequency domains revealed no significant difference between groups. In nonlinear analyses with MSE, MSE5, MSE6-20, and MSEslope 5 were significantly lower (p=0.002, p<0.0001, and p=0.013) in the high-risk SCD group, compared to those in the low-risk SCD group, respectively. Comparing between daytime and nighttime within each group, the MSE5 revealed no difference in the high-risk SCD group (p=0.128), whereas the daytime was significantly higher in the low-risk SCD group (p=0.048). The area under the curve (AUC) analysis revealed MSE6-20 has the best predictive power associated with VAs and near syncope with a cut-off value of ≤24.64 (p<0.001). CONCLUSIONS Nonlinear analysis with MSE demonstrated the loss of circadian change in CKD patients and was associated with a higher risk for VAs and near syncope. The MSE method demonstrated the diurnal change of rhythm dynamics which identifies potential autonomic dysfunction leading to poor prognosis.
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Affiliation(s)
- Shin-Huei Liu
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.
| | - Tsung-Ying Tsai
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Han Cheng
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Fa-Po Chung
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Jo-Nan Liao
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Men-Tzung Lo
- Department of Biomedical Sciences and Engineering and Institute of Translational and Interdisciplinary Medicine, National Central University, Taiwan
| | - Der-Cherng Tarng
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan; Division of Nephrology, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Shih-Ann Chen
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
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15
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Yaman B, Cerit L, Günsel HK, Cerit Z, Usalp S, Yüksek Ü, Coşkun U, Duygu H, Akpınar O. Is there any Link Between Vitamin D and Recurrence of Atrial Fibrillation after Cardioversion? Braz J Cardiovasc Surg 2020; 35:191-197. [PMID: 32369300 PMCID: PMC7199985 DOI: 10.21470/1678-9741-2019-0166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Atrial fibrillation (AF) is the most common chronic arrhythmia in the elderly population. In symptomatic patients, restoration and maintenance of sinus rhythm improve quality of life. Unfortunately, AF recurrence still occurs in a considerable number of patients after cardioversion (CV). In this study, we aimed to evaluate the association between vitamin D (VitD) and AF recurrence after electrical or medical CV. Method A total of 51 patients who underwent CV for symptomatic AF were included in the study. AF recurrence was defined as an AF pattern in 12-lead electrocardiography (ECG) recording after CV within 6 months or ECG Holter recording of AF lasting more than 30 seconds at 6-month follow-up. Results Mean vitD level was 21.4 ng/ml in our study population. VitD level was lower in the AF recurrence group than in the non-recurrence group (18 ng/ml vs. 26.3 ng/ml, respectively; P=0.001). Additionally, left atrial diameter was larger in the AF recurrence group compared to the non-recurrence group (4.4 vs. 4.1, P=0.025). Patients with AF recurrence were older than patients without AF recurrence, and, although the prevalence of hypertension is higher in the AF recurrence group, there was no statistically significant difference (P=0.107, P=0.867). Conclusion In our study, there is a strong association between vitD level and AF recurrence after CV. VitD deficiency might be a predictor of high risk of AF recurrence after CV and vitD supplementation during the follow-up might help the maintenance of sinus rhythm.
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Affiliation(s)
- Belma Yaman
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Levent Cerit
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Hatice Kemal Günsel
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Zeynep Cerit
- Near East University Department of Pediatric Cardiology Nicosia Cyprus Department of Pediatric Cardiology, Near East University, Nicosia, Cyprus
| | - Songül Usalp
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Ümit Yüksek
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Uğur Coşkun
- University of Kyrenia Faculty of Medicine Department of Cardiology Kyrenia Cyprus Department of Cardiology, University of Kyrenia Faculty of Medicine, Kyrenia, Cyprus
| | - Hamza Duygu
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Onur Akpınar
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
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16
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Olubando D, Hopton C, Eden J, Caswell R, Lowri Thomas N, Roberts SA, Morris-Rosendahl D, Venetucci L, Newman WG. Classification and correlation of RYR2 missense variants in individuals with catecholaminergic polymorphic ventricular tachycardia reveals phenotypic relationships. J Hum Genet 2020; 65:531-539. [PMID: 32152366 DOI: 10.1038/s10038-020-0738-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 11/09/2022]
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is predominantly caused by heterozygous missense variants in the cardiac ryanodine receptor, RYR2. However, many RYR2 missense variants are classified as variants of uncertain significance (VUS). We systematically re-evaluated all RYR2 variants in healthy individuals and those with CPVT or arrhythmia using the 2015 American College of Medical Genomics guidelines. RYR2 variants were identified by the NW Genomic Laboratory Hub, from the published literature and databases of sequence variants. Each variant was assessed based on minor allele frequencies, in silico prediction tools and appraisal of functional studies and classified according to the ACMG-AMP guidelines. Phenotype data was collated where available. Of the 326 identified RYR2 missense variants, 55 (16.9%), previously disease-associated variants were reclassified as benign. Application of the gnomAD database of >140,000 controls allowed reclassification of 11 variants more than the ExAC database. CPVT-associated RYR2 variants clustered predominantly between amino acid positions 3949-4332 and 4867-4967 as well as the RyR and IP3R homology-associated and ion transport domains (p < 0.005). CPVT-associated RYR2 variants occurred at more conserved amino acid positions compared with controls, and variants associated with sudden death had higher conservation scores (p < 0.005). There were five potentially pathogenic RYR2 variants associated with sudden death during sleep which were located almost exclusively in the C-terminus of the protein. In conclusion, control sequence databases facilitate reclassification of RYR2 variants but the majority remain as VUS. Notably, pathogenic variants in RYR2 are associated with death in sleep.
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Affiliation(s)
- Damilola Olubando
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Health Innovation Manchester, Manchester, M13 9WL, UK.,Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Human Sciences, University of Manchester, Manchester, UK
| | - Claire Hopton
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Health Innovation Manchester, Manchester, M13 9WL, UK.,Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Human Sciences, University of Manchester, Manchester, UK
| | - James Eden
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Health Innovation Manchester, Manchester, M13 9WL, UK
| | - Richard Caswell
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - N Lowri Thomas
- School of Pharmacy and Pharmaceutical Sciences, Redwood Building, University of Cardiff, Cardiff, CF10 3NB, UK
| | - Stephen A Roberts
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Deborah Morris-Rosendahl
- Clinical Genetics and Genomics, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - Luigi Venetucci
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK.,Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Human Sciences, University of Manchester, Manchester, UK
| | - William G Newman
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Health Innovation Manchester, Manchester, M13 9WL, UK. .,Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Human Sciences, University of Manchester, Manchester, UK. .,Peking University Health Sciences Center, Beijing, PR China.
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17
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Abstract
Sleep is a behavioral phenomenon conserved among mammals and some invertebrates, yet the biological functions of sleep are still being elucidated. In humans, sleep time becomes shorter, more fragmented, and of poorer quality with advancing age. Epidemiologically, the development of age-related neurodegenerative diseases such as Alzheimer's and Parkinson's disease is associated with pronounced sleep disruption, whereas emerging mechanistic studies suggest that sleep disruption may be causally linked to neurodegenerative pathology, suggesting that sleep may represent a key therapeutic target in the prevention of these conditions. In this review, we discuss the physiology of sleep, the pathophysiology of neurodegenerative disease, and the current literature supporting the relationship between sleep, aging, and neurodegenerative disease.
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Affiliation(s)
- Thierno M Bah
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - James Goodman
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeffrey J Iliff
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA.
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA.
- Veterans Integrated Service Network 20 Mental Illness Research, Education and Clinical Center, Puget Sound Health Care System, Mail Stop 116-MIRECC, 1660 South Columbian Way, Seattle, Washington, 98108, USA.
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA.
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18
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Abstract
Understanding the clinical neurophysiology of apnea generation encompasses discussion of the neuroanatomic aspects of central respiratory rhythm and pattern generation, including the central respiratory control networks, central and peripheral chemoreceptors, mechanisms of respiratory muscles, and sleep state dependent differences. Anatomical and functional links to apnea also involve central respiratory motor output recruited from the hypoglossal nerve, which has led to novel treatments for obstructive sleep apnea. Autonomic fluctuations occur in relation to sleep-wake and sleep states (i.e., REM vs NREM sleep), with both parasympathetic and sympathetic contributions. Finally, our understanding of the pathophysiology of obstructive sleep apnea now includes concepts of critical closing pressure of the upper airway, increased loop gain as reflected by high responsiveness to external perturbations, inadequate responsiveness of upper airway muscle recruitment, and reductions in arousal threshold leading to ventilatory instability. In turn, these concepts have led to the development of novel therapies such as hypoglossal nerve stimulation and targeting key culprit physiologic mechanisms specific to the individual.
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19
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A time to fight: Circadian control of aggression and associated autonomic support. Auton Neurosci 2018; 217:35-40. [PMID: 30704973 DOI: 10.1016/j.autneu.2018.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/21/2018] [Accepted: 12/21/2018] [Indexed: 02/06/2023]
Abstract
The central circadian clock, located in the suprachiasmatic nucleus of the mammalian hypothalamus (SCN), regulates daily behavioral rhythms including the temporal propensity for aggressive behavior. Such aggression propensity rhythms are regulated by a functional circuit from the SCN to neurons that drive attack behavior in the ventromedial hypothalamus (VMH), via a relay in the subparaventricular zone (SPZ). In addition to this pathway, the SCN also regulates sleep-wake and locomotor activity rhythms, via the SPZ, in a circuit to the dorsomedial hypothalamus (DMH), a structure that is also known to play a key role in autonomic function and the sympathetic "fight-or-flight" response (which prepares the body for action in stressful situations such as an agonistic encounter). While the autonomic nervous system is known to be under pronounced circadian control, it is less apparent how such autonomic rhythms and their underlying circuitry may support the temporal propensity for aggressive behavior. Additionally, it is unclear how circadian and autonomic dysfunction may contribute to aberrant social and emotional behavior, such as agitation and aggression. Here we review the literature concerning interactions between the circadian and autonomic systems and aggression, and we discuss the implications of these relationships for human neural and behavioral pathologies.
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20
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Christensen MA, Dixit S, Dewland TA, Whitman IR, Nah G, Vittinghoff E, Mukamal KJ, Redline S, Robbins JA, Newman AB, Patel SR, Magnani JW, Psaty BM, Olgin JE, Pletcher MJ, Heckbert SR, Marcus GM. Sleep characteristics that predict atrial fibrillation. Heart Rhythm 2018; 15:1289-1295. [PMID: 29958805 PMCID: PMC6448388 DOI: 10.1016/j.hrthm.2018.05.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The relationship between sleep disruption, independent of obstructive sleep apnea (OSA), and atrial fibrillation (AF) is unknown. OBJECTIVE The purpose of this study was to determine whether poor sleep itself is a risk factor for AF. METHODS We first performed an analysis of participants in the Health eHeart Study and validated those findings in the longitudinal Cardiovascular Health Study, including a subset of patients undergoing polysomnography. To determine whether the observed relationships readily translated to medical practice, we examined 2005-2009 data from the California Healthcare Cost and Utilization Project. RESULTS Among 4553 Health eHeart participants, the 526 with AF exhibited more frequent nighttime awakening (odd ratio [OR] 1.47; 95% confidence interval [CI] 1.14-1.89; P = .003). In 5703 Cardiovascular Health Study participants followed for a median 11.6 years, frequent nighttime awakening predicted a 33% greater risk of AF (hazard ratio [HR] 1.33; 95% CI 1.17-1.51; P <.001). In patients with polysomnography (N = 1127), every standard deviation percentage decrease in rapid eye movement (REM) sleep was associated with a 18% higher risk of developing AF (HR 1.18; 95% CI 1.00-1.38; P = .047). Among 14,330,651 California residents followed for a median 3.9 years, an insomnia diagnosis predicted a 36% increased risk of new AF (HR 1.36; 95% CI 1.30-1.42; P <.001). CONCLUSION Sleep disruption consistently predicted AF before and after adjustment for OSA and other potential confounders across several different populations. Sleep quality itself may be important in the pathogenesis of AF, potentially representing a novel target for prevention.
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Affiliation(s)
- Matthew A Christensen
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California; Department of Internal Medicine, University of Utah Medical School, Salt Lake City, Utah
| | - Shalini Dixit
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Isaac R Whitman
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Gregory Nah
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics University of California, San Francisco, California
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Susan Redline
- Division of Cardiovascular Medicine and Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts
| | - John A Robbins
- Department of Medicine, University of California, Davis, Sacramento, California
| | - Anne B Newman
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sanjay R Patel
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jared W Magnani
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington
| | - Jeffrey E Olgin
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics University of California, San Francisco, California
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Gregory M Marcus
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California.
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21
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Tumiran MA, Rahman NNA, Saat RM, Kabir N, Zulkifli MY, Adli DSH. The Concept of Qailulah (Midday Napping) from Neuroscientific and Islamic Perspectives. JOURNAL OF RELIGION AND HEALTH 2018; 57:1363-1375. [PMID: 26266758 DOI: 10.1007/s10943-015-0093-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Napping/siesta during the day is a phenomenon, which is widely practised in the world. However, the timing, frequency, and duration may vary. The basis of napping is also diverse, but it is mainly done for improvement in alertness and general well-being. Neuroscience reveals that midday napping improves memory, enhances alertness, boosts wakefulness and performance, and recovers certain qualities of lost night sleep. Interestingly, Islam, the religion of the Muslims, advocates midday napping primarily because it was a practice preferred by Prophet Muhammad (pbuh). The objectives of this review were to investigate and compare identical key points on focused topic from both neuroscientific and Islamic perspectives and make recommendations for future researches.
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Affiliation(s)
- Mohd Amzari Tumiran
- Department of Al-Quran and Al-Hadith, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Noor Naemah Abdul Rahman
- Department of Fiqh and Usul, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Rohaida Mohd Saat
- Department of Mathematics and Science Education, Faculty of Education, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nurul Kabir
- Institute of Biological Sciences, Faculty of Science, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mohd Yakub Zulkifli
- Department of Al-Quran and Al-Hadith, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia
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22
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Täubel J, Ferber G, Fernandes S, Camm AJ. Diurnal Profile of the QTc Interval Following Moxifloxacin Administration. J Clin Pharmacol 2018; 59:35-44. [PMID: 30040135 DOI: 10.1002/jcph.1283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 06/21/2018] [Indexed: 12/13/2022]
Abstract
Understanding the physiological fluctuations in the corrected QT (QTc) interval is important to accurately interpret the variations in drug-induced prolongation. The present study aimed to define the time course of the effect of moxifloxacin on the QT interval to understand the duration of the responses to moxifloxacin. This retrospective analysis was performed on data taken from a thorough QT 4-way crossover study with 40 subjects. Each period consisted of a baseline electrocardiogram (ECG) day (day -1) and a treatment day (day 1). On both days, ECGs were recorded simultaneously using 2 different systems operating in parallel: a bedside ECG and a continuous Holter recording. The subjects were randomized to 1 of 4 treatments: 5 mg and 40 mg of intravenous amisulpride, a single oral dose of moxifloxacin (400 mg), or placebo. Standardized meals, identical in all 4 periods, with similar nutritional value were served. Bedside ECG results confirmed that the moxifloxacin peak effect was delayed in the fed state and showed that the Fridericia corrected QT prolongation induced by moxifloxacin persisted until the end of the 24-hour measurement period. The use of continuous Holter monitoring provided further insight, as it revealed that the moxifloxacin effect on QTc was influenced by diurnal and nocturnal environmental factors, and hysteresis effects were noticeable. The findings suggested that moxifloxacin prolongs QTc beyond its elimination from the blood circulation. This is of relevance to current concentration-effect modeling approaches, which presume the absence of hysteresis effects.
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Affiliation(s)
- Jörg Täubel
- Richmond Pharmacology Ltd., St George's University of London, London, UK.,Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Georg Ferber
- Statistik Georg Ferber GmbH, Riehen, Switzerland
| | - Sara Fernandes
- Richmond Pharmacology Ltd., St George's University of London, London, UK
| | - A John Camm
- Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
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23
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Kwon Y, Misialek JR, Duprez D, Jacobs DR, Alonso A, Heckbert SR, Zhao YY, Redline S, Soliman EZ. Sleep-disordered breathing and electrocardiographic QRS-T angle: The MESA study. Ann Noninvasive Electrocardiol 2018; 23:e12579. [PMID: 29963729 DOI: 10.1111/anec.12579] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/06/2018] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Sleep-disordered breathing (SDB) has been linked to sudden cardiac death (SCD) but the mechanism is unclear. Abnormal QRS-T angle, a novel electrocardiographic (ECG) marker of ventricular repolarization, has been linked to adverse cardiovascular outcomes including SCD. We hypothesized that individuals with SDB have more pronounced abnormality in QRS-T angle. METHODS We performed a cross-sectional analysis from the Multi-Ethnic Study of Atherosclerosis (MESA) Exam Sleep ancillary study. We calculated the odds ratio (OR) of abnormal frontal and spatial QRS-T angle (defined as >sex-specific 95th percentile thresholds) related to the apnea-hypopnea index (AHI) using logistic regression, adjusting for demographics, body habitus, cardiovascular risks, and prevalent cardiovascular disease. Linear associations between AHI and frontal and spatial QRS-T angle, separately, were also examined using multiple regression models. RESULTS A total of 1,804 participants (mean age 67.9 (±9.0) years, 55.3% women and 64.1% non-whites) were included in the study. Sleep-disordered breathing was common among participants (median AHI 8.6 events/hr IQR [3.2-19.5/hr]). Higher AHI was associated with the odds of abnormal frontal (≥81° in men and ≥79° in women) and spatial QRS-T angle (≥129.7° in men and ≥115.9° in women; OR [95%CI]: 1.25 [1.02-1.51], p = 0.03; 1.23 [1.01-1.50], p = 0.04 respectively per 1 SD [16.8 events/hr] increase in AHI). Similarly, linear associations were observed (frontal QRS-T angle: beta coefficient: 2.30° [0.92, 3.66], p = 0.001; spatial QRS-T angle: beta coefficient: 2.16° [0.67, 3.64], p = 0.005). CONCLUSION In a racially/ethnically diverse community cohort, severity of SDB is associated with abnormal ventricular repolarization as measured by QRS-T angle.
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Affiliation(s)
- Younghoon Kwon
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Daniel Duprez
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Ying Y Zhao
- Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Sleep Disorders Clinic, Hamilton, Ontario, Canada
| | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Elsayed Z Soliman
- Department of Epidemiology, Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Medicine-Cardiology Section, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Tse G, Yan BP. Traditional and novel electrocardiographic conduction and repolarization markers of sudden cardiac death. Europace 2018; 19:712-721. [PMID: 27702850 DOI: 10.1093/europace/euw280] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/11/2016] [Indexed: 12/20/2022] Open
Abstract
Sudden cardiac death, frequently due to ventricular arrhythmias, is a significant problem globally. Most affected individuals do not arrive at hospital in time for medical treatment. Therefore, there is an urgent need to identify the most-at-risk patients for insertion of prophylactic implantable cardioverter defibrillators. Clinical risk markers derived from electrocardiography are important for this purpose. They can be based on repolarization, including corrected QT (QTc) interval, QT dispersion (QTD), interval from the peak to the end of the T-wave (Tpeak - Tend), (Tpeak - Tend)/QT, T-wave alternans (TWA), and microvolt TWA. Abnormal repolarization properties can increase the risk of triggered activity and re-entrant arrhythmias. Other risk markers are based solely on conduction, such as QRS duration (QRSd), which is a surrogate marker of conduction velocity (CV) and QRS dispersion (QRSD) reflecting CV dispersion. Conduction abnormalities in the form of reduced CV, unidirectional block, together with a functional or a structural obstacle, are conditions required for circus-type or spiral wave re-entry. Conduction and repolarization can be represented by a single parameter, excitation wavelength (λ = CV × effective refractory period). λ is an important determinant of arrhythmogenesis in different settings. Novel conduction-repolarization markers incorporating λ include Lu et al.' index of cardiac electrophysiological balance (iCEB: QT/QRSd), [QRSD× (Tpeak - Tend)/QRSd] and [QRSD × (Tpeak - Tend)/(QRSd × QT)] recently proposed by Tse and Yan. The aim of this review is to provide up to date information on traditional and novel markers and discuss their utility and downfalls for risk stratification.
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Affiliation(s)
- Gary Tse
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Bryan P Yan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, Australia
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25
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Almeneessier AS, Alasousi N, Sharif MM, Pandi-Perumal SR, Hersi AS, BaHammam AS. Prevalence and Predictors of Arrhythmia in Patients with Obstructive Sleep Apnea. ACTA ACUST UNITED AC 2018; 10:142-146. [PMID: 29410745 PMCID: PMC5760047 DOI: 10.5935/1984-0063.20170025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectives To assess the prevalence and types of arrhythmias in Saudi OSA patients and to identify predictors of arrhythmia in this group of patients. Methods This case-control study included all patients who underwent level I attended overnight polysomnography between 2009 and 2012. Electrocardiographic data collected during sleep studies of patients with and without OSA were manually reviewed. Results The study comprised 498 patients (394 OSA patients and 104 non-OSA patients (controls). The prevalence of arrhythmia in OSA patients was higher than that in the controls (26.9% vs. 11.5%; p=0.001). Comparing OSA patients and controls showed: premature atrial contraction (10.2%vs.2.9%;p=0.019), premature ventricular contraction (PVC) (19.3%vs.9.6%;p=0.02), non-isolated PVC (bi/tri/qua) 10.8%vs.2.3%;p=0.04) and atrial fibrillation (1.6%vs.0%;p=0.001). Multiple logistic regression analysis revealed that, patients with OSA had twice the odds of having any cardiac arrhythmia (OR 1.91; CI 95% 1.27-3.11; p <0.05). Conclusions Patients with OSA had a higher prevalence of arrhythmia compared to controls, and OSA is a predictor of arrhythmia during sleep.
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Affiliation(s)
- Aljohara Saud Almeneessier
- King Saud University, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nader Alasousi
- King Saud University, King Fahad Cardiac Center, College of Medicine, King Saud University - Riyadh - Saudi Arabia
| | - Munir M Sharif
- King Saud University, University Sleep Disorders Center, College of Medicine, King Saud University - Riyadh, Saudi Arabia
| | - Seithikurippu R Pandi-Perumal
- King Saud University, University Sleep Disorders Center, College of Medicine, King Saud University - Riyadh, Saudi Arabia
| | - Ahmad Salah Hersi
- King Saud University, King Fahad Cardiac Center, College of Medicine, King Saud University - Riyadh - Saudi Arabia
| | - Ahmed Salem BaHammam
- King Saud University, University Sleep Disorders Center, College of Medicine, King Saud University - Riyadh, Saudi Arabia
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26
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Jamali HK, Waqar F, Gerson MC. Cardiac autonomic innervation. J Nucl Cardiol 2017; 24:1558-1570. [PMID: 27844333 DOI: 10.1007/s12350-016-0725-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Abstract
The autonomic nervous system plays a key role in regulating changes in the cardiovascular system and its adaptation to various human body functions. The sympathetic arm of the autonomic nervous system is associated with the fight and flight response, while the parasympathetic division is responsible for the restorative effects on heart rate, blood pressure, and contractility. Disorders involving these two divisions can lead to, and are seen as, a manifestation of most common cardiovascular disorders. Over the last few decades, extensive research has been performed establishing imaging techniques to quantify the autonomic dysfunction associated with various cardiovascular disorders. Additionally, several techniques have been tested with variable success in modulating the cardiac autonomic nervous system as treatment for these disorders. In this review, we summarize basic anatomy, physiology, and pathophysiology of the cardiac autonomic nervous system including adrenergic receptors. We have also discussed several imaging modalities available to aid in diagnosis of cardiac autonomic dysfunction and autonomic modulation techniques, including pharmacologic and device-based therapies, that have been or are being tested currently.
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Affiliation(s)
- Hina K Jamali
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, P.O. Box 670542, Cincinnati, OH, USA
| | - Fahad Waqar
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, P.O. Box 670542, Cincinnati, OH, USA
| | - Myron C Gerson
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, P.O. Box 670542, Cincinnati, OH, USA.
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Viigimae M, Karai D, Pilt K, Polo O, Huhtala H, Meigas K, Kaik J. Influence of gender on the QT interval variability and duration in different wake–sleep stages in non-sleep apneic individuals: Analysis of polysomnographic recordings. J Electrocardiol 2017; 50:444-449. [DOI: 10.1016/j.jelectrocard.2017.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Indexed: 11/17/2022]
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28
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Vencloviene J, Babarskiene RM, Dobozinskas P, Dedele A, Lopatiene K, Ragaisyte N. The short-term associations of weather and air pollution with emergency ambulance calls for paroxysmal atrial fibrillation. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2017; 24:15031-15043. [PMID: 28493187 DOI: 10.1007/s11356-017-9138-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 04/27/2017] [Indexed: 06/07/2023]
Abstract
A circadian variation in the cardiovascular parameters has been detected. It is plausible that the influence of the environment varies during different periods of the day. We investigated the association between daily emergency ambulance calls (EC) for paroxysmal atrial fibrillation (AF) that occurred during the time intervals of 8:00-13:59, 14:00-21:59, and 22:00-7:59, and weather conditions and exposure to CO and PM10. We used Poisson regression to explore the association between the risk of EC for AF and environmental variables, adjusting for seasonal variation. Before noon, the risk was associated with an IQR (0.333 mg/m3) increase in CO at lag 2-6 days above the median (RR = 1.15, P = 0.002); a protective impact of CO on previous day was observed (RR = 0.91, P = 0.018). During 14:00-21:59, a negative effect of air temperature below 1.9 °C (lag 2-3 days) was detected (per 10 °C decrease: RR = 1.17, P = 0.044). At night, the elevated risk was associated with wind speed above the median (lag 2-4 days) (per 1-kt increase: RR = 1.07, P = 0.001) and with PM10 at lag 2-5 days below the median (per IQR (7.31 μg/m3) increase: RR = 1.21, P = 0.002). Individuals over 65 years of age were more sensitive to air pollution, especially at night (CO lag 2-3 days < median, per IQR (0.12 mg/m3) increase: RR = 1.14, P = 0.045; PM10 lag 2-5 days < median, per IQR increase: RR = 1.32, P = 0.001). The associations of air pollution and other environmental variables with acute events may be analyzed depending on the time of the event.
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Affiliation(s)
- Jone Vencloviene
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, Donelaicio St. 58, 44248, Kaunas, Lithuania.
| | - Ruta Marija Babarskiene
- Department of Cardiology, Lithuanian University of Health Sciences, Eiveniu str. 2, 50028, Kaunas, Lithuania
| | - Paulius Dobozinskas
- Department of Disaster Medicine, Lithuanian University of Health Sciences, Eiveniu str. 4, 50028, Kaunas, Lithuania
| | - Audrius Dedele
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, Donelaicio St. 58, 44248, Kaunas, Lithuania
| | - Kristina Lopatiene
- Department of Orthodontics, Lithuanian University of Health Sciences, Luksos-Daumanto str. 6, 50106, Kaunas, Lithuania
| | - Nijole Ragaisyte
- Department of Cardiology, Lithuanian University of Health Sciences, Eiveniu str. 2, 50028, Kaunas, Lithuania
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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: 2.3] [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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Chowdhury T, Bindu B, Singh GP, Schaller B. Sleep Disorders: Is the Trigemino-Cardiac Reflex a Missing Link? Front Neurol 2017; 8:63. [PMID: 28289401 PMCID: PMC5326750 DOI: 10.3389/fneur.2017.00063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/13/2017] [Indexed: 12/26/2022] Open
Abstract
Trigeminal innervated areas in face, nasolacrimal, and nasal mucosa can produce a wide array of cardiorespiratory manifestations that include apnea, bradypnea, bradycardia, hypotension, and arrhythmias. This reflex is a well-known entity called "trigemino-cardiac reflex" (TCR). The role of TCR is investigated in various pathophysiological conditions especially in neurosurgical, but also skull base surgery procedures. Additionally, its significance in various sleep-related disorders has also been highlighted recently. Though, the role of diving reflex, a subtype of TCR, has been extensively investigated in sudden infant death syndrome. The data related to other sleep disorders including obstructive sleep apnea, bruxism is very limited and thus, this mini review aims to investigate the possible role and correlation of TCR in causing such sleep abnormalities.
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Affiliation(s)
- Tumul Chowdhury
- Department of Anesthesiology and Perioperative Medicine, University of Manitoba , Winnipeg, MB , Canada
| | - Barkha Bindu
- Department of Neuro-anaesthesiology and Critical Care, All India Institute of Medical Sciences , New Delhi , India
| | - Gyaninder Pal Singh
- Department of Neuro-anaesthesiology and Critical Care, All India Institute of Medical Sciences , New Delhi , India
| | - Bernhard Schaller
- Department of Research, University of Southampton , Southampton , UK
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Lack of heart rate variability during sleep-related apnea in patients with temporal lobe epilepsy (TLE)—an indirect marker of SUDEP? Sleep Breath 2017; 21:163-172. [DOI: 10.1007/s11325-016-1453-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/23/2016] [Accepted: 12/28/2016] [Indexed: 01/10/2023]
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QT Interval Variability Index and QT Interval Duration in Different Sleep Stages: Analysis of Polysomnographic Recordings in Nonapneic Male Patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:963028. [PMID: 26693490 PMCID: PMC4676997 DOI: 10.1155/2015/963028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/15/2015] [Indexed: 11/25/2022]
Abstract
The aim of the study was to determine whether different sleep stages, especially REM sleep, affect QT interval duration and variability in male patients without obstructive sleep apnea (OSA). Polysomnographic recordings of 30 patients were analyzed. Beat-to-beat QT interval variability was calculated using QTV index (QTVI) formula. For QTc interval calculation, in addition to Bazett's formula, linear and parabolic heart rate correction formulas with two separate α values were used. QTVI and QTc values were calculated as means of 2 awake, 3 NREM, and 3 REM sleep episodes; the duration of each episode was 300 sec. Mean QTVI values were not statistically different between sleep stages. Therefore, elevated QTVI values found in patients with OSA cannot be interpreted as physiological sympathetic impact during REM sleep and should be considered as a risk factor for potentially life-threatening ventricular arrhythmias. The absence of difference of the mean QTc interval values between NREM and REM stages seems to confirm our conclusion that sympathetic surges during REM stage do not induce repolarization variability. In patients without notable structural and electrical remodeling of myocardium, physiological elevation in sympathetic activity during REM sleep remains subthreshold concerning clinically significant increase of myocardial electrical instability.
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van Brussel PM, Lieve KVV, de Winter RJ, Wilde AAM. Cardiorenal axis and arrhythmias: Will renal sympathetic denervation provide additive value to the therapeutic arsenal? Heart Rhythm 2015; 12:1080-7. [PMID: 25640633 DOI: 10.1016/j.hrthm.2015.01.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Indexed: 11/30/2022]
Abstract
Disruption of sympathetic tone may result in the occurrence or maintenance of cardiac arrhythmias. Multiple arrhythmic therapies that intervene by influencing cardiac sympathetic tone are common in clinical practice. These vary from pharmaceutical (β-blockers, angiotensin-converting enzyme inhibitors, and calcium antagonists) to percutaneous/surgical (cardiac sympathetic denervation) interventions. In some patients, however, these therapies have insufficient prophylactic and therapeutic capabilities. A safe and effective additional therapy wherein sympathetic drive is further attenuated would be expedient. Recently, renal sympathetic denervation (RSD) has been subject of research for various sympathetic nervous system-related diseases. By its presumed afferent and efferent sympatholytic effects, RSD might indirectly attenuate sympathetic outflow via the brain to the heart but might also reduce systemic catecholamine excretion and might therefore reduce catecholamine-sensitive arrhythmias. RSD is subject of research for various sympathetically driven arrhythmias, both supraventricular and ventricular. In this review, we give an overview of the rationale behind RSD as potential therapy in mediating arrhythmias that are triggered by a disrupted sympathetic nervous system and discuss the presently available results from animal and human studies.
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Affiliation(s)
- Peter M van Brussel
- Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Krystien V V Lieve
- Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Robbert J de Winter
- Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Centre, Amsterdam, The Netherlands; Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia.
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Vizzardi E, Curnis A, Latini MG, Salghetti F, Rocco E, Lupi L, Rovetta R, Quinzani F, Bonadei I, Bontempi L, D'Aloia A, Dei Cas L. Risk factors for atrial fibrillation recurrence: a literature review. J Cardiovasc Med (Hagerstown) 2014; 15:235-53. [PMID: 23114271 DOI: 10.2459/jcm.0b013e328358554b] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Atrial fibrillation is the most common arrhythmia managed in clinical practice and it is associated with an increased risk of mortality, stroke and peripheral embolism. Unfortunately, the incidence of atrial fibrillation recurrence ranges from 40 to 50%, despite the attempts of electrical cardioversion and the administration of antiarrhythmic drugs. In this review, the literature data about predictors of atrial fibrillation recurrence are highlighted, with special regard to clinical, therapeutic, biochemical, ECG and echocardiographic parameters after electrical cardioversion and ablation. Identifying predictors of success in maintaining sinus rhythm after cardioversion or ablation may allow a better selection of patients to undergo these procedures. The aim is to reduce healthcare costs and avoid exposing patients to unnecessary procedures and related complications. Recurrent atrial fibrillation depends on a combination of several parameters and each patient should be individually assessed for such a risk of recurrence.
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Affiliation(s)
- Enrico Vizzardi
- Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
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Gerard Leong KT, Walton A, Krum H, Schlaich MP. Potential future denervation targets. Interv Cardiol 2014. [DOI: 10.2217/ica.14.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Verrier RL, Malik M. Quantitative T-wave alternans analysis for guiding medical therapy: an underexploited opportunity. Trends Cardiovasc Med 2014; 25:201-13. [PMID: 25541329 DOI: 10.1016/j.tcm.2014.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 10/09/2014] [Accepted: 10/09/2014] [Indexed: 11/18/2022]
Abstract
Reducing the toll of sudden cardiac death (SCD) remains a major challenge in cardiology, as it is the leading cause of adult mortality in the industrially developed world, claiming 310,000 lives annually in the United States alone. The main contemporary noninvasive index of cardiovascular risk, left ventricular ejection fraction (LVEF), has not proved adequately reliable, as the majority of individuals who die suddenly have relatively preserved cardiac mechanical function. Monitoring of T-wave alternans (TWA), a beat-to-beat fluctuation in ST-segment or T-wave morphology, is an attractive approach to risk stratification on both scientific and clinical grounds, as this ECG phenomenon has been shown using the FDA-cleared Spectral and Modified Moving Average methods to assess risk for cardiovascular mortality including SCD in studies enrolling >12,000 individuals with depressed or preserved LVEF. The evidence supporting TWA as a therapeutic target is reviewed.
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Affiliation(s)
- Richard L Verrier
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA.
| | - Marek Malik
- St. Paul׳s Cardiac Electrophysiology, University of London, and Imperial College, London, United Kingdom
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Dergacheva O. Chronic intermittent hypoxia alters neurotransmission from lateral paragigantocellular nucleus to parasympathetic cardiac neurons in the brain stem. J Neurophysiol 2014; 113:380-9. [PMID: 25318765 DOI: 10.1152/jn.00302.2014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Patients with sleep-related disorders, including obstructive sleep apnea (OSA), have an increased risk of cardiovascular diseases. OSA events are more severe in rapid eye movement (REM) sleep. REM sleep further increases the risk of adverse cardiovascular events by diminishing cardioprotective parasympathetic activity. The mechanisms underlying REM sleep-related reduction in parasympathetic activity likely include activation of inhibitory input to cardiac vagal neurons (CVNs) in the brain stem originating from the lateral paragigantocellular nucleus (LPGi), a nucleus that plays a role in REM sleep control. This study tests the hypothesis that chronic intermittent hypoxia and hypercapnia (CIHH), an animal model of OSA, inhibits CVNs because of exaggeration of the GABAergic pathway from the LPGi to CVNs. GABAergic neurotransmission to CVNs evoked by electrical stimulation of the LPGi was examined with whole cell patch-clamp recordings in an in vitro brain slice preparation in rats exposed to CIHH and control rats. GABAergic synaptic events were enhanced after 4-wk CIHH in both male and female rats, to a greater degree in males. Acute hypoxia and hypercapnia (H/H) reversibly diminished the LPGi-evoked GABAergic neurotransmission to CVNs. However, GABAergic synaptic events were enhanced after acute H/H in CIHH male animals. Orexin-A elicited a reversible inhibition of LPGi-evoked GABAergic currents in control animals but evoked no significant changes in CIHH male rats. In conclusion, exaggerated inhibitory neurotransmission from the LPGi to CVNs in CIHH animals would reduce cardioprotective parasympathetic activity and enhance the risk of adverse cardiovascular events.
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Affiliation(s)
- Olga Dergacheva
- Department of Pharmacology and Physiology, The George Washington University, Washington, District of Columbia
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Padeletti M, Zacà V, Mondillo S, Jelic S. Sleep-disordered breathing increases the risk of arrhythmias. J Cardiovasc Med (Hagerstown) 2014; 15:411-6. [PMID: 24743686 PMCID: PMC4654124 DOI: 10.2459/jcm.0000000000000019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Sleep-disordered breathing (SDB) has been consistently associated with increased risk for cardiovascular diseases, including arrhythmias. The purpose of this review is to elucidate the several pathophysiologic pathways such as repetitive hypoxia and reoxygenation, increased oxidative stress, inflammation and sympathetic activation that may underlie the increased incidence of arrhythmias in SDB patients. We discuss in particular the incidence of ventricular arrhythmias, atrial fibrillation and bradyarrhythmias in SDB patients. In addition, we discuss the electrocardiographic alteration such as ST-T changes during apneic events and QT dispersion induced by SDB that may trigger complex ventricular arrhythmias and sudden cardiac death. Finally, we consider also the therapeutic interventions such as continuous positive airways pressure therapy, a standard treatment for SDB, that may reduce the incidence and recurrence of supraventricular and ventricular arrhythmias in patients with SDB.
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Affiliation(s)
| | - Valerio Zacà
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Sanja Jelic
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, USA
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Giudici MC. It's Always Something…. J Am Heart Assoc 2014; 3:e000947. [PMID: 24755157 PMCID: PMC4187497 DOI: 10.1161/jaha.114.000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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40
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Dergacheva O, Weigand LA, Dyavanapalli J, Mares J, Wang X, Mendelowitz D. Function and modulation of premotor brainstem parasympathetic cardiac neurons that control heart rate by hypoxia-, sleep-, and sleep-related diseases including obstructive sleep apnea. PROGRESS IN BRAIN RESEARCH 2014; 212:39-58. [PMID: 25194192 DOI: 10.1016/b978-0-444-63488-7.00003-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Parasympathetic cardiac vagal neurons (CVNs) in the brainstem dominate the control of heart rate. Previous work has determined that these neurons are inherently silent, and their activity is largely determined by synaptic inputs to CVNs that include four major types of synapses that release glutamate, GABA, glycine, or serotonin. Whereas prior reviews have focused on glutamatergic, GABAergic and glycinergic pathways, and the receptors in CVNs activated by these neurotransmitters, this review focuses on the alterations in CVN activity with hypoxia-, sleep-, and sleep-related cardiovascular diseases including obstructive sleep apnea.
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Affiliation(s)
- Olga Dergacheva
- Department of Pharmacology and Physiology, School of Medicine, George Washington University, Washington, DC, USA
| | - Letitia A Weigand
- Department of Pharmacology and Physiology, School of Medicine, George Washington University, Washington, DC, USA
| | - Jhansi Dyavanapalli
- Department of Pharmacology and Physiology, School of Medicine, George Washington University, Washington, DC, USA
| | - Jacquelyn Mares
- Department of Pharmacology and Physiology, School of Medicine, George Washington University, Washington, DC, USA
| | - Xin Wang
- Department of Pharmacology and Physiology, School of Medicine, George Washington University, Washington, DC, USA
| | - David Mendelowitz
- Department of Pharmacology and Physiology, School of Medicine, George Washington University, Washington, DC, USA.
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Tobaldini E, Nobili L, Strada S, Casali KR, Braghiroli A, Montano N. Heart rate variability in normal and pathological sleep. Front Physiol 2013; 4:294. [PMID: 24137133 PMCID: PMC3797399 DOI: 10.3389/fphys.2013.00294] [Citation(s) in RCA: 207] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 09/26/2013] [Indexed: 01/15/2023] Open
Abstract
Sleep is a physiological process involving different biological systems, from molecular to organ level; its integrity is essential for maintaining health and homeostasis in human beings. Although in the past sleep has been considered a state of quiet, experimental and clinical evidences suggest a noteworthy activation of different biological systems during sleep. A key role is played by the autonomic nervous system (ANS), whose modulation regulates cardiovascular functions during sleep onset and different sleep stages. Therefore, an interest on the evaluation of autonomic cardiovascular control in health and disease is growing by means of linear and non-linear heart rate variability (HRV) analyses. The application of classical tools for ANS analysis, such as HRV during physiological sleep, showed that the rapid eye movement (REM) stage is characterized by a likely sympathetic predominance associated with a vagal withdrawal, while the opposite trend is observed during non-REM sleep. More recently, the use of non-linear tools, such as entropy-derived indices, have provided new insight on the cardiac autonomic regulation, revealing for instance changes in the cardiovascular complexity during REM sleep, supporting the hypothesis of a reduced capability of the cardiovascular system to deal with stress challenges. Interestingly, different HRV tools have been applied to characterize autonomic cardiac control in different pathological conditions, from neurological sleep disorders to sleep disordered breathing (SDB). In summary, linear and non-linear analysis of HRV are reliable approaches to assess changes of autonomic cardiac modulation during sleep both in health and diseases. The use of these tools could provide important information of clinical and prognostic relevance.
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Affiliation(s)
- Eleonora Tobaldini
- Division of Medicine and Pathophysiology, Department of Biomedical and Clinical Sciences "L. Sacco," L. Sacco Hospital, University of Milan Milan, Italy
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Ukena C, Mahfoud F, Linz D, Böhm M, Neuberger HR. Potential role of renal sympathetic denervation for the treatment of cardiac arrhythmias. EUROINTERVENTION 2013; 9 Suppl R:R110-6. [DOI: 10.4244/eijv9sra19] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Young E, Xiong S, Finn L, Young T. Unique sleep disorders profile of a population-based sample of 747 Hmong immigrants in Wisconsin. Soc Sci Med 2013; 79:57-65. [PMID: 22832325 PMCID: PMC3616878 DOI: 10.1016/j.socscimed.2012.06.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 06/06/2012] [Accepted: 06/08/2012] [Indexed: 10/28/2022]
Abstract
Concerns regarding sleep disorders in Hmong immigrants in the US emerged when an astonishingly high mortality rate of Sudden Unexplained Nocturnal Death Syndrome (SUNDS) was documented in Hmong men. Stress, genetics, and cardiac abnormalities interacting with disordered sleep were hypothesized as contributing factors to SUNDS. Most recently, sleep apnea has been implicated in nighttime deaths of Brugada Syndrome. This syndrome is thought to comprise a spectrum of sudden cardiac death disorders, including SUNDS. However, little research since has placed SUNDS in its context of Hmong cultural beliefs, health, or the prevalence of other sleep disorders. Because the epidemiology of sleep disorders and terrifying nighttime experiences in Hmong is poorly documented, we investigated the prevalence and correlates of sleep apnea, rapid eye movement (REM) sleep stage related disorders, and insomnia in 3 population-based samples (collected from 1996 to 2001) comprising 747 Hmong immigrants in Wisconsin. Participants were questioned on sleep problems, cultural beliefs, health, and other factors. A random subsample (n = 37) underwent in-home polysomnography to investigate sleep apnea prevalence. Self-report and laboratory findings were compared with similarly collected data from the Wisconsin Sleep Cohort (WSC) study (n = 1170), a population-based longitudinal study of sleep. The results inform a unique Hmong sleep disorder profile of a high prevalence of sleep apnea, sleep paralysis, and other REM-related sleep abnormalities as well the interaction of culturally related nighttime stressors with these sleep problems. For example, experiences of dab tsog (frightening night spirit pressing on chest) was prevalent and related to sleep apnea indicators, sleep paralysis, nightmares, hypnogogic hallucinations, and insomnia. Understanding the role of sleep disorders and the cultural mechanisms that may trigger or condition response to them could ultimately provide a basis for screening and intervention to reduce the adverse health and emotional consequences of these conditions in Hmong.
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Tan AY, Verrier RL. The role of the autonomic nervous system in cardiac arrhythmias. HANDBOOK OF CLINICAL NEUROLOGY 2013; 117:135-45. [PMID: 24095122 DOI: 10.1016/b978-0-444-53491-0.00012-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Autonomic nervous system activity exerts potent and diverse effects on cardiac rhythm through elaborate neurocircuitry that is integrated at multiple levels. Adrenergic activity such as is associated with mental or physical stress or as a reflex response to myocardial ischemia is capable of generating significant rhythm abnormalities including ventricular fibrillation, the arrhythmia responsible for sudden cardiac death. With respect to the ventricles, vagus nerve activity is generally antiarrhythmic as it inhibits the profibrillatory effects of sympathetic nerve activation, whereas atrial arrhythmias generally derive from heightened levels of both vagus and sympathetic nerve activity. Containment of neural influences by pharmacological and electrical targeted neuromodulation is being pursued as an antiarrhythmic modality.
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Affiliation(s)
- Alex Y Tan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Bojic T, Sudar E, Mikhailidis D, Alavantic D, Isenovic E. The role of G protein coupled receptor kinases in neurocardiovascular pathophysiology. Arch Med Sci 2012; 8:970-7. [PMID: 23319968 PMCID: PMC3542506 DOI: 10.5114/aoms.2012.29996] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 06/14/2012] [Accepted: 06/29/2012] [Indexed: 12/15/2022] Open
Abstract
In coronary artery disease the G protein related kinases (GRKs) play a role in desensitization of β-adrenoreceptors (AR) after coronary occlusion. Targeted deletion and lowering of cardiac myocyte GRK-2 decreases the risk of post-ischemic heart failure (HF). Studies carried out in humans confirm the role of GRK-2 as a marker for the progression of HF after myocardial infarction (MI). The level of GRK-2 could be an indicator of β-AR blocker efficacy in patients with acute coronary syndrome. Elevated levels of GRK-2 are an early ubiquitous consequence of myocardial injury. In hypertension an increased level of GRK-2 was reported in both animal models and human studies. The role of GRKs in vagally mediated disorders such as vasovagal syncope and atrial fibrillation remains controversial. The role of GRKs in the pathogenesis of neurocardiological diseases provides an insight into the molecular pathogenesis process, opens potential therapeutic options and suggests new directins for scientific research.
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Affiliation(s)
- Tijana Bojic
- Institute of Nuclear Sciences Vinča, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, Belgrade, Serbia
| | - Emina Sudar
- Institute of Nuclear Sciences Vinča, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, Belgrade, Serbia
| | - Dimitri Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, UK
| | - Dragan Alavantic
- Institute of Nuclear Sciences Vinča, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, Belgrade, Serbia
| | - Esma Isenovic
- Institute of Nuclear Sciences Vinča, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, Belgrade, Serbia
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Javaheri S, Shukla R, Wexler L. Association of smoking, sleep apnea, and plasma alkalosis with nocturnal ventricular arrhythmias in men with systolic heart failure. Chest 2012; 141:1449-1456. [PMID: 22172636 PMCID: PMC4694179 DOI: 10.1378/chest.11-1724] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Accepted: 11/01/2011] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Excess sudden death due to ventricular tachyarrhythmias remains a major mode of mortality in patients with systolic heart failure. The aim of this study was to determine the association of nocturnal ventricular arrhythmias in patients with low ejection fraction heart failure. We incorporated a large number of known pathophysiologic triggers to identify potential targets for therapy to reduce the persistently high incidence of sudden death in this population despite contemporary treatment. METHODS Eighty-six ambulatory male patients with stable low (≤ 45%) ejection fraction heart failure underwent full-night attendant polysomnography and simultaneous Holter recordings. Patients were divided into groups according to the presence or absence of couplets (paired premature ventricular excitations) and ventricular tachycardia (VT) (at least three consecutive premature ventricular excitations) during sleep. RESULTS In multiple regression analysis, four variables (current smoking status, increased number of arousals, plasma alkalinity, and old age) were associated with VT and two variables (apnea-hypopnea index and low right ventricular ejection fraction) were associated with couplets during sleep. CONCLUSIONS We speculate that cessation of smoking, effective treatment of sleep apnea, and plasma alkalosis could collectively decrease the incidence of nocturnal ventricular tachyarrhythmias and the consequent risk of sudden death, which remains high despite the use of β blockades.
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Affiliation(s)
- Shahrokh Javaheri
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH; Department of Veterans Affairs Medical Center, Cincinnati, OH.
| | - Rakesh Shukla
- Departments of Medicine and Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Laura Wexler
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH; Department of Veterans Affairs Medical Center, Cincinnati, OH
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VERRIER RICHARDL, JOSEPHSON MARKE. The Stress of Sleep in Patients Prone to Atrial Tachyarrhythmias. J Cardiovasc Electrophysiol 2012; 23:612-3. [DOI: 10.1111/j.1540-8167.2012.02294.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hersi A. Relationship Between Arrhythmia and Sleep Disordered Breathing. J Atr Fibrillation 2012; 5:413. [PMID: 28496742 PMCID: PMC5153077 DOI: 10.4022/jafib.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 01/06/2012] [Accepted: 04/19/2012] [Indexed: 06/07/2023]
Abstract
The association between obstructive sleep apnea (OSA) and cardiovascular disease is well known. Data from most studies investigating the prevalence of OSA in atrial fibrillation (AF), and of AF in patients with OSA, have supported the relationship between these common diseases. In addition, several studies have shown a detrimental effect of OSA on AF treatment. These reports vary considerably in methodology, and are particularly diverse in their definitions and diagnosis of OSA and patient populations studied. Considering these studies individually while exploring their methodological variations and the range of results achieved can reinforce the necessity of establishing standards for performing this important research. Reviewing these studies should en courage practitioners to reflect on how the methodologies, patients, and outcomes are relevant to their practices.
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Affiliation(s)
- Ahmad Hersi
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, KSA
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Shusterman V, Warman E, London B, Schwartzman D. Nocturnal peak in atrial tachyarrhythmia occurrence as a function of arrhythmia burden. J Cardiovasc Electrophysiol 2012; 23:604-11. [PMID: 22429736 DOI: 10.1111/j.1540-8167.2011.02263.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We examined circadian periodicity of atrial tachyarrhythmias (AT/AF) in a large group of patients with implantable devices, which allow continuous collection of the event data over prolonged periods of time. METHODS AND RESULTS A total of 16,130 AT/AF events were recorded in 236 patients (age: 63 ± 12 years, 27% female, 90% had a history of cardiovascular disease, 33% ischemic, LVEF: 49 ± 18%) over a period of 12 months. To exclude interactions with therapy, the patterns of arrhythmia occurrence were examined for all events and for those episodes that were preceded by at least 1, 6, and 24 hours of sinus rhythm. To prevent biasing toward patients with more frequent episodes, the patterns of AT/AF onset were analyzed both in absolute and patient-normalized (i.e., divided by the total number of events in each patient) units per hour per patient and then summarized for the entire group. In patients with <4 AT/AF events, the onset times were randomly distributed over 24-hour period. However, as the number of AT/AF events increased, a nocturnal pattern of occurrence (determined by the occurrence of a trough around noon) gradually emerged and became highly statistically significant (P < 10(-4) ). The magnitude of nocturnal peak of AT/AF events was well explained by a single-exponential function (R(2) = 0.97, P < 10(-2) ). CONCLUSION Patients with more frequent atrial tachyarrhythmias are more likely to develop AT/AF at night. Knowledge of patient-specific circadian patterns of arrhythmia occurrence can be useful for personalized management of individuals with significant arrhythmia burden.
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Koehler U, Apelt S, Cassel W, Hildebrandt O, Nell C, Ranft S, Grimm W. [Sleep disordered breathing and nonsustained ventricular tachycardia in patients with chronic heart failure]. Wien Klin Wochenschr 2011; 124:63-8. [PMID: 22080939 DOI: 10.1007/s00508-011-0083-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 10/01/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Patients with chronic heart failure (CHF) have a high incidence of sleep disordered breathing (SDB). It is assumed that patients with the combination of CHF and SDB have more ventricular couplets and nonsustained ventricular tachycardia (NSVT) than patients without SDB. METHODS In 63 patients, 49 men and 14 women with chronic heart failure (EF < 45%), all-night polysomnography and long-term-ECG were performed. Mean age was 59 ± 15 years, mean BMI 27 ± 5 kg/m(2). 56% had an ischemic, 44% a nonischemic heart disease. 51% had heart insufficiency classification NYHA III. RESULTS 42 of the 63 patients (67%) had sleep disordered breathing (SDB) with an AHI ≥5/h. In 24 patients (38%) SDB was central, in 18 (29%) obstructive. More patients with SDB than patients without SDB had NSVT (50% vs. 19%). Nocturnal frequency of NSVT in patients with SDB was about twice as high as the rate observed during daytime (0.48/h vs. 0.21/h). In patients without SDB there was no relevant difference between day and night (0.23/h vs. 0.21/h). AHI correlated with NSVT (r = 0.329, p < 0.01). Day/night comparison of couplets was 2.3/h vs. 1.9/h in SDB patients and 2.0/h vs. 1.6/h in patients without SDB. CONCLUSIONS Patients with chronic heart failure have a high prevalence of SDB. The combination of CHF and SDB predisposes for nocturnal malignant ventricular arrhythmias.
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Affiliation(s)
- Ulrich Koehler
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität Marburg, Marburg, Germany.
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