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Kwon S, Choi EK, Ahn HJ, Lee SR, Oh S, Kim SH, Do MT, Han JH, Jeong CW. Novel laparoscopic renal denervation immediately reduces atrial fibrillation inducibility: a swine model study. Sci Rep 2023; 13:19679. [PMID: 37952064 PMCID: PMC10640613 DOI: 10.1038/s41598-023-47077-w] [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: 06/05/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023] Open
Abstract
Catheter-based approaches may have inherent limitations in achieving effective renal denervation (RDN) and treatment of atrial fibrillation (AF). This study aimed to investigate the acute effects of novel laparoscopic RDN on modulating AF inducibility using a swine model. Four and five swine were randomly allocated to the sham and RDN groups, respectively. Each swine underwent measurement of the atrial effective refractory period (AERP) and AF induction tests using burst atrial pacing before and immediately after sham or RDN procedures with and without vagal nerve stimulation (VNS). A laparoscopic RDN procedure circumferentially ablated the renal nerves round the renal arteries using radiofrequency energy. There was no significant difference in the baseline AERP between the two groups (p > 0.05). Under VNS, AERP was significantly increased by 20 ms after laparoscopic RDN (95% CI = 0-30, p = 0.004). Compared to the sham group, the RDN group showed significantly reduced AF inducibility [OR (95% CI) = 0.32 (0.13-0.76) and 0.24 (0.11-0.57) with and without VNS, respectively]. After laparoscopic RDN, the duration of inducible AF episodes was significantly shortened from 28 (10-77) s to 7 (3-11) s (p < 0.001). The novel laparoscopic RDN can immediately reduce AF inducibility in a swine model.
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Affiliation(s)
- Soonil Kwon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Hyo-Jeong Ahn
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seil Oh
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Si Hyun Kim
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Minh-Tung Do
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Surgery, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Jang Hee Han
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Urology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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2
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Rebecchi M, De Ruvo E, Sgueglia M, Lavalle C, Canestrelli S, Politano A, Jacomelli I, Golia P, Crescenzi C, De Luca L, Panuccio M, Fagagnini A, Calò L. Atrial fibrillation and sympatho-vagal imbalance: from the choice of the antiarrhythmic treatment to patients with syncope and ganglionated plexi ablation. Eur Heart J Suppl 2023; 25:C1-C6. [PMID: 37125283 PMCID: PMC10132557 DOI: 10.1093/eurheartjsupp/suad075] [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] [Indexed: 05/02/2023]
Abstract
For several years, the autonomic nervous system has played a central role in the pathophysiological mechanism of atrial fibrillation (AF), so much so that it has been considered one of the cornerstones of Coumel's triangle. The clinical and therapeutic management of AF secondary to sympatho-vagal imbalance represents one of the most important examples of how precision medicine should be applied. Increasing knowledge of this kind of arrhythmias has made it possible to select specific antiarrhythmic drugs and to diversify their use according to vagal or adrenergic AF forms. Ablative strategies, such as cardioneuroablation and non-direct cardiac neuromodulation methods (such as renal denervation and peripheral vagal stimulation), have gradually emerged. In the possibly near future, there will be a development of new acquisitions regarding new pharmacological therapeutic strategies and gene therapy. Finally, finding an AF in patients experiencing syncopal episodes opens a whole chapter regarding interesting, but also complex, diagnostic and therapeutic strategies, ranging from neurally mediated forms to convulsive seizure that could also increase the risk of sudden death.
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Affiliation(s)
- Marco Rebecchi
- Corresponding author. Tel: +390623188406, Fax: +390623188410, ,
| | - Ermenegildo De Ruvo
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
| | | | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico, 155, Rome 00161, Italy
| | - Stefano Canestrelli
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
| | - Alessandro Politano
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
| | - Ilaria Jacomelli
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
| | - Paolo Golia
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
| | - Cinzia Crescenzi
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
| | - Lucia De Luca
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
| | - Marco Panuccio
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
| | - Alessandro Fagagnini
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
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Lien IC, Vinson DR, Ramalingam ND, Nicole Tran H, Liu TI. A Case Report of Cold Drinks and Food as a Trigger of Paroxysmal Atrial Fibrillation. Perm J 2022; 26:110-113. [PMID: 36336673 PMCID: PMC9761284 DOI: 10.7812/tpp/22.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Irvin C Lien
- 1Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - David R Vinson
- 2Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville, CA, USA,3Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Nirmala D Ramalingam
- 4Graduate Medical Education, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA,Nirmala D Ramalingam, MPP
| | - H Nicole Tran
- 1Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Taylor I Liu
- 5Department of Cardiac Electrophysiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, USA
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Gharaviri A, Pezzuto S, Potse M, Conte G, Zeemering S, Sobota V, Verheule S, Krause R, Auricchio A, Schotten U. Synergistic antiarrhythmic effect of inward rectifier current inhibition and pulmonary vein isolation in a 3D computer model for atrial fibrillation. Europace 2021; 23:i161-i168. [PMID: 33751085 DOI: 10.1093/europace/euaa413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/15/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS Recent clinical studies showed that antiarrhythmic drug (AAD) treatment and pulmonary vein isolation (PVI) synergistically reduce atrial fibrillation (AF) recurrences after initially successful ablation. Among newly developed atrial-selective AADs, inhibitors of the G-protein-gated acetylcholine-activated inward rectifier current (IKACh) were shown to effectively suppress AF in an experimental model but have not yet been evaluated clinically. We tested in silico whether inhibition of inward rectifier current or its combination with PVI reduces AF inducibility. METHODS AND RESULTS We simulated the effect of inward rectifier current blockade (IK blockade), PVI, and their combination on AF inducibility in a detailed three-dimensional model of the human atria with different degrees of fibrosis. IK blockade was simulated with a 30% reduction of its conductivity. Atrial fibrillation was initiated using incremental pacing applied at 20 different locations, in both atria. IK blockade effectively prevented AF induction in simulations without fibrosis as did PVI in simulations without fibrosis and with moderate fibrosis. Both interventions lost their efficacy in severe fibrosis. The combination of IK blockade and PVI prevented AF in simulations without fibrosis, with moderate fibrosis, and even with severe fibrosis. The combined therapy strongly decreased the number of fibrillation waves, due to a synergistic reduction of wavefront generation rate while the wavefront lifespan remained unchanged. CONCLUSION Newly developed blockers of atrial-specific inward rectifier currents, such as IKAch, might prevent AF occurrences and when combined with PVI effectively supress AF recurrences in human.
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Affiliation(s)
- Ali Gharaviri
- Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland
| | - Simone Pezzuto
- Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland
| | - Mark Potse
- Carmen Team, Inria Bordeaux-Sud-Ouest, Talence, France.,Université de Bordeaux, IMB, UMR 5251, F-33400, Talence, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Giulio Conte
- Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland.,Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland
| | - Stef Zeemering
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Vladimír Sobota
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Sander Verheule
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Rolf Krause
- Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland
| | - Angelo Auricchio
- Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland.,Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland
| | - Ulrich Schotten
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
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