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Li N, Hansen BJ, Kennelly J, Kalyanasundaram A, Kanaan A, Simonetti OP, Mohler PJ, Whitson B, Hummel JD, Zhao J, Fedorov VV. High-Resolution 3-Dimensional Multimodality Imaging to Resolve Intramural Human Sinoatrial Node Pacemakers and Epicardial-Endocardial Atrial Exit Sites. Circ Arrhythm Electrophysiol 2023; 16:e011528. [PMID: 36916270 PMCID: PMC10208092 DOI: 10.1161/circep.122.011528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Ning Li
- Department of Physiology & Cell Biology The Ohio State University Wexner Medical Center, Columbus, OH
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center, Columbus, OH
| | - Brian J. Hansen
- Department of Physiology & Cell Biology The Ohio State University Wexner Medical Center, Columbus, OH
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center, Columbus, OH
| | - James Kennelly
- Auckland Bioengineering Institute, The University of Auckland; Auckland, New Zealand
| | - Anuradha Kalyanasundaram
- Department of Physiology & Cell Biology The Ohio State University Wexner Medical Center, Columbus, OH
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center, Columbus, OH
| | - Adel Kanaan
- Department of Physiology & Cell Biology The Ohio State University Wexner Medical Center, Columbus, OH
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center, Columbus, OH
| | - Orlando P. Simonetti
- Division of Cardiovascular Medicine The Ohio State University Wexner Medical Center, Columbus, OH
- Department of Radiology The Ohio State University Wexner Medical Center, Columbus, OH
| | - Peter J. Mohler
- Department of Physiology & Cell Biology The Ohio State University Wexner Medical Center, Columbus, OH
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center, Columbus, OH
| | - Bryan Whitson
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - John D. Hummel
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center, Columbus, OH
- Division of Cardiovascular Medicine The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland; Auckland, New Zealand
| | - Vadim V. Fedorov
- Department of Physiology & Cell Biology The Ohio State University Wexner Medical Center, Columbus, OH
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center, Columbus, OH
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Jiao A, Ricks D, Remick T, Hansen BJ. Establishment of Control Room Habitability Analysis Methodology Postulating the Event of Pressurized Tank/System of Hazardous Gas Release. NUCL SCI ENG 2023. [DOI: 10.1080/00295639.2023.2171274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Anjun Jiao
- Palo Verde Nuclear Generating Station, 5801 South Wintersburg Road, Tonopah, Arizona 85354
| | - David Ricks
- Palo Verde Nuclear Generating Station, 5801 South Wintersburg Road, Tonopah, Arizona 85354
| | - Thomas Remick
- Palo Verde Nuclear Generating Station, 5801 South Wintersburg Road, Tonopah, Arizona 85354
| | - Brian J. Hansen
- Palo Verde Nuclear Generating Station, 5801 South Wintersburg Road, Tonopah, Arizona 85354
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Li N, Artiga E, Kalyanasundaram A, Hansen BJ, Webb A, Pietrzak M, Biesiadecki B, Whitson B, Mokadam NA, Janssen PML, Hummel JD, Mohler PJ, Dobrzynski H, Fedorov VV. Altered microRNA and mRNA profiles during heart failure in the human sinoatrial node. Sci Rep 2021; 11:19328. [PMID: 34588502 PMCID: PMC8481550 DOI: 10.1038/s41598-021-98580-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/03/2021] [Indexed: 11/09/2022] Open
Abstract
Heart failure (HF) is frequently accompanied with the sinoatrial node (SAN) dysfunction, which causes tachy-brady arrhythmias and increased mortality. MicroRNA (miR) alterations are associated with HF progression. However, the transcriptome of HF human SAN, and its role in HF-associated remodeling of ion channels, transporters, and receptors responsible for SAN automaticity and conduction impairments is unknown. We conducted comprehensive high-throughput transcriptomic analysis of pure human SAN primary pacemaker tissue and neighboring right atrial tissue from human transplanted HF hearts (n = 10) and non-failing (nHF) donor hearts (n = 9), using next-generation sequencing. Overall, 47 miRs and 832 mRNAs related to multiple signaling pathways, including cardiac diseases, tachy-brady arrhythmias and fibrosis, were significantly altered in HF SAN. Of the altered miRs, 27 are predicted to regulate mRNAs of major ion channels and neurotransmitter receptors which are involved in SAN automaticity (e.g. HCN1, HCN4, SLC8A1) and intranodal conduction (e.g. SCN5A, SCN8A) or both (e.g. KCNJ3, KCNJ5). Luciferase reporter assays were used to validate interactions of miRs with predicted mRNA targets. In conclusion, our study provides a profile of altered miRs in HF human SAN, and a novel transcriptome blueprint to identify molecular targets for SAN dysfunction and arrhythmia treatments in HF.
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Affiliation(s)
- Ning Li
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, 43210-1218, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Esthela Artiga
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, 43210-1218, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Anuradha Kalyanasundaram
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, 43210-1218, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Brian J Hansen
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, 43210-1218, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Amy Webb
- Biomedical Informatics Shared Resources, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Maciej Pietrzak
- Biomedical Informatics Shared Resources, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Brandon Biesiadecki
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, 43210-1218, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Bryan Whitson
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Nahush A Mokadam
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Paul M L Janssen
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, 43210-1218, USA
| | - John D Hummel
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Peter J Mohler
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, 43210-1218, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Halina Dobrzynski
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.,Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Vadim V Fedorov
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, 43210-1218, USA. .,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA.
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Kalyanasundaram A, Li N, Gardner ML, Artiga EJ, Hansen BJ, Webb A, Freitas MA, Pietrzak M, Whitson BA, Mokadam NA, Janssen PML, Mohler PJ, Fedorov VV. Fibroblast-Specific Proteotranscriptomes Reveal Distinct Fibrotic Signatures of Human Sinoatrial Node in Nonfailing and Failing Hearts. Circulation 2021; 144:126-143. [PMID: 33874740 DOI: 10.1161/circulationaha.120.051583] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Up to 50% of the adult human sinoatrial node (SAN) is composed of dense connective tissue. Cardiac diseases including heart failure (HF) may increase fibrosis within the SAN pacemaker complex, leading to impaired automaticity and conduction of electric activity to the atria. Unlike the role of cardiac fibroblasts in pathologic fibrotic remodeling and tissue repair, nothing is known about fibroblasts that maintain the inherently fibrotic SAN environment. METHODS Intact SAN pacemaker complex was dissected from cardioplegically arrested explanted nonfailing hearts (non-HF; n=22; 48.7±3.1 years of age) and human failing hearts (n=16; 54.9±2.6 years of age). Connective tissue content was quantified from Masson trichrome-stained head-center and center-tail SAN sections. Expression of extracellular matrix proteins, including collagens 1 and 3A1, CILP1 (cartilage intermediate layer protein 1), and POSTN (periostin), and fibroblast and myofibroblast numbers were quantified by in situ and in vitro immunolabeling. Fibroblasts from the central intramural SAN pacemaker compartment (≈10×5×2 mm3) and right atria were isolated, cultured, passaged once, and treated ± transforming growth factor β1 and subjected to comprehensive high-throughput next-generation sequencing of whole transcriptome, microRNA, and proteomic analyses. RESULTS Intranodal fibrotic content was significantly higher in SAN pacemaker complex from HF versus non-HF hearts (57.7±2.6% versus 44.0±1.2%; P<0.0001). Proliferating phosphorylated histone 3+/vimentin+/CD31- (cluster of differentiation 31) fibroblasts were higher in HF SAN. Vimentin+/α-smooth muscle actin+/CD31- myofibroblasts along with increased interstitial POSTN expression were found only in HF SAN. RNA sequencing and proteomic analyses identified unique differences in mRNA, long noncoding RNA, microRNA, and proteomic profiles between non-HF and HF SAN and right atria fibroblasts and transforming growth factor β1-induced myofibroblasts. Specifically, proteins and signaling pathways associated with extracellular matrix flexibility, stiffness, focal adhesion, and metabolism were altered in HF SAN fibroblasts compared with non-HF SAN. CONCLUSIONS This study revealed increased SAN-specific fibrosis with presence of myofibroblasts, CILP1, and POSTN-positive interstitial fibrosis only in HF versus non-HF human hearts. Comprehensive proteotranscriptomic profiles of SAN fibroblasts identified upregulation of genes and proteins promoting stiffer SAN extracellular matrix in HF hearts. Fibroblast-specific profiles generated by our proteotranscriptomic analyses of the human SAN provide a comprehensive framework for future studies to investigate the role of SAN-specific fibrosis in cardiac rhythm regulation and arrhythmias.
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Affiliation(s)
- Anuradha Kalyanasundaram
- Department of Physiology & Cell Biology (A.K., N.L., E.J.A., B.J.H., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute (A.K., N.L., E.J.A., B.J.H., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus
| | - Ning Li
- Department of Physiology & Cell Biology (A.K., N.L., E.J.A., B.J.H., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute (A.K., N.L., E.J.A., B.J.H., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus
| | - Miranda L Gardner
- Cancer Biology and Genetics (M.L.G., M.A.F.), The Ohio State University Wexner Medical Center, Columbus
| | - Esthela J Artiga
- Department of Physiology & Cell Biology (A.K., N.L., E.J.A., B.J.H., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute (A.K., N.L., E.J.A., B.J.H., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus
| | - Brian J Hansen
- Department of Physiology & Cell Biology (A.K., N.L., E.J.A., B.J.H., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute (A.K., N.L., E.J.A., B.J.H., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus
| | - Amy Webb
- Biomedical Informatics Shared Resources (A.W., M.P.), The Ohio State University Wexner Medical Center, Columbus
| | - Michael A Freitas
- Cancer Biology and Genetics (M.L.G., M.A.F.), The Ohio State University Wexner Medical Center, Columbus
| | - Maciej Pietrzak
- Biomedical Informatics Shared Resources (A.W., M.P.), The Ohio State University Wexner Medical Center, Columbus
| | - Bryan A Whitson
- Department of Surgery (B.A.W., N.A.M.), The Ohio State University Wexner Medical Center, Columbus
| | - Nahush A Mokadam
- Department of Surgery (B.A.W., N.A.M.), The Ohio State University Wexner Medical Center, Columbus
| | - Paul M L Janssen
- Department of Physiology & Cell Biology (A.K., N.L., E.J.A., B.J.H., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus
| | - Peter J Mohler
- Department of Physiology & Cell Biology (A.K., N.L., E.J.A., B.J.H., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute (A.K., N.L., E.J.A., B.J.H., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus
| | - Vadim V Fedorov
- Department of Physiology & Cell Biology (A.K., N.L., E.J.A., B.J.H., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute (A.K., N.L., E.J.A., B.J.H., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus
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Mikhailov AV, Kalyanasundaram A, Li N, Scott SS, Artiga EJ, Subr MM, Zhao J, Hansen BJ, Hummel JD, Fedorov VV. Comprehensive evaluation of electrophysiological and 3D structural features of human atrial myocardium with insights on atrial fibrillation maintenance mechanisms. J Mol Cell Cardiol 2020; 151:56-71. [PMID: 33130148 DOI: 10.1016/j.yjmcc.2020.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/14/2022]
Abstract
Atrial fibrillation (AF) occurrence and maintenance is associated with progressive remodeling of electrophysiological (repolarization and conduction) and 3D structural (fibrosis, fiber orientations, and wall thickness) features of the human atria. Significant diversity in AF etiology leads to heterogeneous arrhythmogenic electrophysiological and structural substrates within the 3D structure of the human atria. Since current clinical methods have yet to fully resolve the patient-specific arrhythmogenic substrates, mechanism-based AF treatments remain underdeveloped. Here, we review current knowledge from in-vivo, ex-vivo, and in-vitro human heart studies, and discuss how these studies may provide new insights on the synergy of atrial electrophysiological and 3D structural features in AF maintenance. In-vitro studies on surgically acquired human atrial samples provide a great opportunity to study a wide spectrum of AF pathology, including functional changes in single-cell action potentials, ion channels, and gene/protein expression. However, limited size of the samples prevents evaluation of heterogeneous AF substrates and reentrant mechanisms. In contrast, coronary-perfused ex-vivo human hearts can be studied with state-of-the-art functional and structural technologies, such as high-resolution near-infrared optical mapping and contrast-enhanced MRI. These imaging modalities can resolve atrial arrhythmogenic substrates and their role in reentrant mechanisms maintaining AF and validate clinical approaches. Nonetheless, longitudinal studies are not feasible in explanted human hearts. As no approach is perfect, we suggest that combining the strengths of direct human atrial studies with high fidelity approaches available in the laboratory and in realistic patient-specific computer models would elucidate deeper knowledge of AF mechanisms. We propose that a comprehensive translational pipeline from ex-vivo human heart studies to longitudinal clinically relevant AF animal studies and finally to clinical trials is necessary to identify patient-specific arrhythmogenic substrates and develop novel AF treatments.
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Affiliation(s)
- Aleksei V Mikhailov
- Department of Physiology & Cell Biology, Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Arrhythmology Research Department, Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Anuradha Kalyanasundaram
- Department of Physiology & Cell Biology, Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ning Li
- Department of Physiology & Cell Biology, Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Shane S Scott
- Department of Physiology & Cell Biology, Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Esthela J Artiga
- Department of Physiology & Cell Biology, Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Megan M Subr
- Department of Physiology & Cell Biology, Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Brian J Hansen
- Department of Physiology & Cell Biology, Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John D Hummel
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vadim V Fedorov
- Department of Physiology & Cell Biology, Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Hansen BJ, Zhao J, Helfrich KM, Li N, Iancau A, Zolotarev AM, Zakharkin SO, Kalyanasundaram A, Subr M, Dastagir N, Sharma R, Artiga EJ, Salgia N, Houmsse MM, Kahaly O, Janssen PML, Mohler PJ, Mokadam NA, Whitson BA, Afzal MR, Simonetti OP, Hummel JD, Fedorov VV. Unmasking Arrhythmogenic Hubs of Reentry Driving Persistent Atrial Fibrillation for Patient-Specific Treatment. J Am Heart Assoc 2020; 9:e017789. [PMID: 33006292 PMCID: PMC7792422 DOI: 10.1161/jaha.120.017789] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Atrial fibrillation (AF) driver mechanisms are obscured to clinical multielectrode mapping approaches that provide partial, surface‐only visualization of unstable 3‐dimensional atrial conduction. We hypothesized that transient modulation of refractoriness by pharmacologic challenge during multielectrode mapping improves visualization of hidden paths of reentrant AF drivers for targeted ablation. Methods and Results Pharmacologic challenge with adenosine was tested in ex vivo human hearts with a history of AF and cardiac diseases by multielectrode and high‐resolution subsurface near‐infrared optical mapping, integrated with 3‐dimensional structural imaging and heart‐specific computational simulations. Adenosine challenge was also studied on acutely terminated AF drivers in 10 patients with persistent AF. Ex vivo, adenosine stabilized reentrant driver paths within arrhythmogenic fibrotic hubs and improved visualization of reentrant paths, previously seen as focal or unstable breakthrough activation pattern, for targeted AF ablation. Computational simulations suggested that shortening of atrial refractoriness by adenosine may (1) improve driver stability by annihilating spatially unstable functional blocks and tightening reentrant circuits around fibrotic substrates, thus unmasking the common reentrant path; and (2) destabilize already stable reentrant drivers along fibrotic substrates by accelerating competing fibrillatory wavelets or secondary drivers. In patients with persistent AF, adenosine challenge unmasked hidden common reentry paths (9/15 AF drivers, 41±26% to 68±25% visualization), but worsened visualization of previously visible reentry paths (6/15, 74±14% to 34±12%). AF driver ablation led to acute termination of AF. Conclusions Our ex vivo to in vivo human translational study suggests that transiently altering atrial refractoriness can stabilize reentrant paths and unmask arrhythmogenic hubs to guide targeted AF driver ablation treatment.
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Affiliation(s)
- Brian J Hansen
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH
| | | | - Katelynn M Helfrich
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH
| | - Ning Li
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH
| | - Alexander Iancau
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH
| | - Alexander M Zolotarev
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Skolkovo Institute of Science and Technology Moscow Russia
| | - Stanislav O Zakharkin
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH
| | - Anuradha Kalyanasundaram
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH
| | - Megan Subr
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH
| | | | | | - Esthela J Artiga
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH
| | - Nicholas Salgia
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH
| | - Mustafa M Houmsse
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH
| | - Omar Kahaly
- Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH.,Department of Internal Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Paul M L Janssen
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH
| | - Peter J Mohler
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH
| | - Nahush A Mokadam
- Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH.,Division of Cardiac Surgery The Ohio State University Wexner Medical Center Columbus OH
| | - Bryan A Whitson
- Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH.,Division of Cardiac Surgery The Ohio State University Wexner Medical Center Columbus OH
| | - Muhammad R Afzal
- Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH.,Department of Internal Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Orlando P Simonetti
- Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH.,Department of Biomedical Engineering The Ohio State University Wexner Medical Center Columbus OH
| | - John D Hummel
- Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH.,Department of Internal Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Vadim V Fedorov
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH
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Zolotarev AM, Hansen BJ, Ivanova EA, Helfrich KM, Li N, Janssen PML, Mohler PJ, Mokadam NA, Whitson BA, Fedorov MV, Hummel JD, Dylov DV, Fedorov VV. Optical Mapping-Validated Machine Learning Improves Atrial Fibrillation Driver Detection by Multi-Electrode Mapping. Circ Arrhythm Electrophysiol 2020; 13:e008249. [PMID: 32921129 DOI: 10.1161/circep.119.008249] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) can be maintained by localized intramural reentrant drivers. However, AF driver detection by clinical surface-only multielectrode mapping (MEM) has relied on subjective interpretation of activation maps. We hypothesized that application of machine learning to electrogram frequency spectra may accurately automate driver detection by MEM and add some objectivity to the interpretation of MEM findings. METHODS Temporally and spatially stable single AF drivers were mapped simultaneously in explanted human atria (n=11) by subsurface near-infrared optical mapping (NIOM; 0.3 mm2 resolution) and 64-electrode MEM (higher density or lower density with 3 and 9 mm2 resolution, respectively). Unipolar MEM and NIOM recordings were processed by Fourier transform analysis into 28 407 total Fourier spectra. Thirty-five features for machine learning were extracted from each Fourier spectrum. RESULTS Targeted driver ablation and NIOM activation maps efficiently defined the center and periphery of AF driver preferential tracks and provided validated annotations for driver versus nondriver electrodes in MEM arrays. Compared with analysis of single electrogram frequency features, averaging the features from each of the 8 neighboring electrodes, significantly improved classification of AF driver electrograms. The classification metrics increased when less strict annotation, including driver periphery electrodes, were added to driver center annotation. Notably, f1-score for the binary classification of higher-density catheter data set was significantly higher than that of lower-density catheter (0.81±0.02 versus 0.66±0.04, P<0.05). The trained algorithm correctly highlighted 86% of driver regions with higher density but only 80% with lower-density MEM arrays (81% for lower-density+higher-density arrays together). CONCLUSIONS The machine learning model pretrained on Fourier spectrum features allows efficient classification of electrograms recordings as AF driver or nondriver compared with the NIOM gold-standard. Future application of NIOM-validated machine learning approach may improve the accuracy of AF driver detection for targeted ablation treatment in patients.
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Affiliation(s)
- Alexander M Zolotarev
- Department of Physiology and Cell Biology and Bob and Corrine Frick Center for Heart Failure and Arrhythmia (A.M.Z., B.J.H., K.M.H., N.L., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH.,Center of Computational and Data-Intensive Science and Engineering, Skolkovo Institute of Science and Technology, Moscow, Russia (A.M.Z., E.A.I., M.V.F., D.V.D.)
| | - Brian J Hansen
- Department of Physiology and Cell Biology and Bob and Corrine Frick Center for Heart Failure and Arrhythmia (A.M.Z., B.J.H., K.M.H., N.L., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ekaterina A Ivanova
- Center of Computational and Data-Intensive Science and Engineering, Skolkovo Institute of Science and Technology, Moscow, Russia (A.M.Z., E.A.I., M.V.F., D.V.D.)
| | - Katelynn M Helfrich
- Department of Physiology and Cell Biology and Bob and Corrine Frick Center for Heart Failure and Arrhythmia (A.M.Z., B.J.H., K.M.H., N.L., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ning Li
- Department of Physiology and Cell Biology and Bob and Corrine Frick Center for Heart Failure and Arrhythmia (A.M.Z., B.J.H., K.M.H., N.L., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart and Lung Research Institute (N.L., P.M.L.J., P.J.M., N.A.M., B.A.W., J.D.H., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH
| | - Paul M L Janssen
- Department of Physiology and Cell Biology and Bob and Corrine Frick Center for Heart Failure and Arrhythmia (A.M.Z., B.J.H., K.M.H., N.L., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart and Lung Research Institute (N.L., P.M.L.J., P.J.M., N.A.M., B.A.W., J.D.H., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH
| | - Peter J Mohler
- Department of Physiology and Cell Biology and Bob and Corrine Frick Center for Heart Failure and Arrhythmia (A.M.Z., B.J.H., K.M.H., N.L., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart and Lung Research Institute (N.L., P.M.L.J., P.J.M., N.A.M., B.A.W., J.D.H., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nahush A Mokadam
- Davis Heart and Lung Research Institute (N.L., P.M.L.J., P.J.M., N.A.M., B.A.W., J.D.H., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH.,Division of Cardiac Surgery (N.A.M., B.A.W., J.D.H.), The Ohio State University Wexner Medical Center, Columbus, OH
| | - Bryan A Whitson
- Davis Heart and Lung Research Institute (N.L., P.M.L.J., P.J.M., N.A.M., B.A.W., J.D.H., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH.,Division of Cardiac Surgery (N.A.M., B.A.W., J.D.H.), The Ohio State University Wexner Medical Center, Columbus, OH
| | - Maxim V Fedorov
- Center of Computational and Data-Intensive Science and Engineering, Skolkovo Institute of Science and Technology, Moscow, Russia (A.M.Z., E.A.I., M.V.F., D.V.D.)
| | - John D Hummel
- Davis Heart and Lung Research Institute (N.L., P.M.L.J., P.J.M., N.A.M., B.A.W., J.D.H., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH.,Division of Cardiac Surgery (N.A.M., B.A.W., J.D.H.), The Ohio State University Wexner Medical Center, Columbus, OH.,Department of Internal Medicine (J.D.H), The Ohio State University Wexner Medical Center, Columbus, OH
| | - Dmitry V Dylov
- Center of Computational and Data-Intensive Science and Engineering, Skolkovo Institute of Science and Technology, Moscow, Russia (A.M.Z., E.A.I., M.V.F., D.V.D.)
| | - Vadim V Fedorov
- Department of Physiology and Cell Biology and Bob and Corrine Frick Center for Heart Failure and Arrhythmia (A.M.Z., B.J.H., K.M.H., N.L., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart and Lung Research Institute (N.L., P.M.L.J., P.J.M., N.A.M., B.A.W., J.D.H., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH
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8
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Yanni J, D'Souza A, Wang Y, Li N, Hansen BJ, Zakharkin SO, Smith M, Hayward C, Whitson BA, Mohler PJ, Janssen PML, Zeef L, Choudhury M, Zi M, Cai X, Logantha SJRJ, Nakao S, Atkinson A, Petkova M, Doris U, Ariyaratnam J, Cartwright EJ, Griffiths-Jones S, Hart G, Fedorov VV, Oceandy D, Dobrzynski H, Boyett MR. Silencing miR-370-3p rescues funny current and sinus node function in heart failure. Sci Rep 2020; 10:11279. [PMID: 32647133 PMCID: PMC7347645 DOI: 10.1038/s41598-020-67790-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/02/2020] [Indexed: 01/13/2023] Open
Abstract
Bradyarrhythmias are an important cause of mortality in heart failure and previous studies indicate a mechanistic role for electrical remodelling of the key pacemaking ion channel HCN4 in this process. Here we show that, in a mouse model of heart failure in which there is sinus bradycardia, there is upregulation of a microRNA (miR-370-3p), downregulation of the pacemaker ion channel, HCN4, and downregulation of the corresponding ionic current, If, in the sinus node. In vitro, exogenous miR-370-3p inhibits HCN4 mRNA and causes downregulation of HCN4 protein, downregulation of If, and bradycardia in the isolated sinus node. In vivo, intraperitoneal injection of an antimiR to miR-370-3p into heart failure mice silences miR-370-3p and restores HCN4 mRNA and protein and If in the sinus node and blunts the sinus bradycardia. In addition, it partially restores ventricular function and reduces mortality. This represents a novel approach to heart failure treatment.
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Affiliation(s)
- Joseph Yanni
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Alicia D'Souza
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Yanwen Wang
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Ning Li
- Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia Research and Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, 43210, USA
| | - Brian J Hansen
- Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia Research and Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, 43210, USA
| | - Stanislav O Zakharkin
- Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Matthew Smith
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Christina Hayward
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Bryan A Whitson
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia Research and Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, 43210, USA
- Department of Surgery, Division of Cardiac Surgery, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Peter J Mohler
- Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia Research and Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, 43210, USA
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Paul M L Janssen
- Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia Research and Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, 43210, USA
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Leo Zeef
- Bioinformatics Core Facility, University of Manchester, Manchester, UK
| | - Moinuddin Choudhury
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Min Zi
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Xue Cai
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Sunil Jit R J Logantha
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Shu Nakao
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Andrew Atkinson
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Maria Petkova
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Ursula Doris
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Jonathan Ariyaratnam
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Elizabeth J Cartwright
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Sam Griffiths-Jones
- Division of Evolution and Genomics Sciences, University of Manchester, Manchester, UK
| | - George Hart
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Vadim V Fedorov
- Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia Research and Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, 43210, USA
| | - Delvac Oceandy
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Halina Dobrzynski
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mark R Boyett
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200N, Copenhagen, Denmark.
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9
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Svetnik V, Wang T, Xu Y, Hansen BJ, Fox SV. 0432 A Deep Learning Approach for Automated Sleep-Wake Scoring in Pre-Clinical Animal Models. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Experimental investigation of sleep-wake dynamics in animals is an important part of pharmaceutical development. It typically involves recording of electroencephalogram, electromyogram, locomotor activity, and electrooculogram. Visual identification, or scoring, of the sleep-wake states from these recordings is time-consuming. We sought to develop software for automated sleep-wake scoring capable of processing large databases of multi-channel signal recordings in a range of animal species.
Methods
We used a large historical database of signal recordings and scores in non-human primates, dogs, mice, and rats, to develop a deep Convolutional Neural Network (CNN) classification algorithm for automatically scoring sleep-wake states. We compared the performance of the CNN algorithm with that of a widely used Machine Learning algorithm, Random Forest (RF).
Results
In non-human primates and dogs, CNN accuracy in sleep-wake scoring of data was significantly higher than RF accuracy: 0.75 versus 0.66 for non-human primates and 0.73 versus 0.64 for dogs. In rodents, the difference between CNN and RF was smaller: 0.83 versus 0.81 for mice and 0.78 versus 0.77 for rats. The variability of CNN accuracy was lower than that of RF for non-human primates, dogs and mice, but similar for rats.
Conclusion
We recommend use of CNN for sleep-wake scoring in non-human primates and dogs, and RF for sleep-wake scoring in rodents.
Support
Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
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Affiliation(s)
| | - T Wang
- Merck & Co., Inc., Kenilworth, NJ
| | - Y Xu
- Merck & Co., Inc., Kenilworth, NJ
| | | | - S V Fox
- Merck & Co., Inc., Kenilworth, NJ
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10
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Li N, Kalyanasundaram A, Hansen BJ, Artiga EJ, Sharma R, Abudulwahed SH, Helfrich KM, Rozenberg G, Wu PJ, Zakharkin S, Gyorke S, Janssen PM, Whitson BA, Mokadam NA, Biesiadecki BJ, Accornero F, Hummel JD, Mohler PJ, Dobrzynski H, Zhao J, Fedorov VV. Impaired neuronal sodium channels cause intranodal conduction failure and reentrant arrhythmias in human sinoatrial node. Nat Commun 2020; 11:512. [PMID: 31980605 PMCID: PMC6981137 DOI: 10.1038/s41467-019-14039-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 12/16/2019] [Indexed: 01/26/2023] Open
Abstract
Mechanisms for human sinoatrial node (SAN) dysfunction are poorly understood and whether human SAN excitability requires voltage-gated sodium channels (Nav) remains controversial. Here, we report that neuronal (n)Nav blockade and selective nNav1.6 blockade during high-resolution optical mapping in explanted human hearts depress intranodal SAN conduction, which worsens during autonomic stimulation and overdrive suppression to conduction failure. Partial cardiac (c)Nav blockade further impairs automaticity and intranodal conduction, leading to beat-to-beat variability and reentry. Multiple nNav transcripts are higher in SAN vs atria; heterogeneous alterations of several isoforms, specifically nNav1.6, are associated with heart failure and chronic alcohol consumption. In silico simulations of Nav distributions suggest that INa is essential for SAN conduction, especially in fibrotic failing hearts. Our results reveal that not only cNav but nNav are also integral for preventing disease-induced failure in human SAN intranodal conduction. Disease-impaired nNav may underlie patient-specific SAN dysfunctions and should be considered to treat arrhythmias. The role of of voltage-gated sodium channels (Nav) in pacemaking and conduction of the human sinoatrial node is unclear. Here, the authors investigate existence and function of neuronal and cardiac Nav in human sinoatrial nodes, and demonstrate their alterations in explanted human diseased hearts.
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Affiliation(s)
- Ning Li
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Anuradha Kalyanasundaram
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brian J Hansen
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Esthela J Artiga
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Roshan Sharma
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Suhaib H Abudulwahed
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Katelynn M Helfrich
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Galina Rozenberg
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Pei-Jung Wu
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stanislav Zakharkin
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sandor Gyorke
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Paul Ml Janssen
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bryan A Whitson
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nahush A Mokadam
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brandon J Biesiadecki
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Federica Accornero
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John D Hummel
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Peter J Mohler
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Halina Dobrzynski
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Vadim V Fedorov
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA. .,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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11
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Wang Y, Xiong Z, Nalar A, Hansen BJ, Kharche S, Seemann G, Loewe A, Fedorov VV, Zhao J. A robust computational framework for estimating 3D Bi-Atrial chamber wall thickness. Comput Biol Med 2019; 114:103444. [PMID: 31542646 DOI: 10.1016/j.compbiomed.2019.103444] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/23/2019] [Accepted: 09/10/2019] [Indexed: 12/14/2022]
Abstract
Atrial fibrillation (AF) is the most prevalent form of cardiac arrhythmia. The atrial wall thickness (AWT) can potentially improve our understanding of the mechanism underlying atrial structure that drives AF and provides important clinical information. However, most existing studies for estimating AWT rely on ruler-based measurements performed on only a few selected locations in 2D or 3D using digital calipers. Only a few studies have developed automatic approaches to estimate the AWT in the left atrium, and there are currently no methods to robustly estimate the AWT of both atrial chambers. Therefore, we have developed a computational pipeline to automatically calculate the 3D AWT across bi-atrial chambers and extensively validated our pipeline on both ex vivo and in vivo human atria data. The atrial geometry was first obtained by segmenting the atrial wall from the MRIs using a novel machine learning approach. The epicardial and endocardial surfaces were then separated using a multi-planar convex hull approach to define boundary conditions, from which, a Laplace equation was solved numerically to automatically separate bi-atrial chambers. To robustly estimate the AWT in each atrial chamber, coupled partial differential equations by coupling the Laplace solution with two surface trajectory functions were formulated and solved. Our pipeline enabled the reconstruction and visualization of the 3D AWT for bi-atrial chambers with a relative error of 8% and outperformed existing algorithms by >7%. Our approach can potentially lead to improved clinical diagnosis, patient stratification, and clinical guidance during ablation treatment for patients with AF.
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Affiliation(s)
- Yufeng Wang
- Auckland Bioengineering Institute, The University of Auckland, Auckland, 1142, New Zealand
| | - Zhaohan Xiong
- Auckland Bioengineering Institute, The University of Auckland, Auckland, 1142, New Zealand
| | - Aaqel Nalar
- Auckland Bioengineering Institute, The University of Auckland, Auckland, 1142, New Zealand
| | - Brian J Hansen
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Sanjay Kharche
- Department of Medical Biophysics, Western University, Canada
| | - Gunnar Seemann
- The Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg, Bad Krozingen, Faculty of Medicine, Albert-Ludwigs University, Freiburg, Germany
| | - Axel Loewe
- The Institute of Biomedical Engineering, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Vadim V Fedorov
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland, Auckland, 1142, New Zealand.
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12
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Hansen BJ, Li N, Helfrich KM, Abudulwahed SH, Artiga E, Joseph M, Mohler PJ, Hummel JD, Fedorov VV. First In Vivo Use of High-Resolution Near-Infrared Optical Mapping to Assess Atrial Activation During Sinus Rhythm and Atrial Fibrillation in a Large Animal Model. Circ Arrhythm Electrophysiol 2018; 11:e006870. [PMID: 30562105 PMCID: PMC6300135 DOI: 10.1161/circep.118.006870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brian J. Hansen
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ning Li
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Katelynn M. Helfrich
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Suhaib H. Abudulwahed
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Esthela Artiga
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Matt Joseph
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Peter J Mohler
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
- Department of Internal Medicine; The Ohio State University Wexner Medical Center, Columbus, OH
| | - John D. Hummel
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
- Department of Internal Medicine; The Ohio State University Wexner Medical Center, Columbus, OH
| | - Vadim V. Fedorov
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
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Hansen BJ, Zhao J, Li N, Zolotarev A, Zakharkin S, Wang Y, Atwal J, Kalyanasundaram A, Abudulwahed SH, Helfrich KM, Bratasz A, Powell KA, Whitson B, Mohler PJ, Janssen PML, Simonetti OP, Hummel JD, Fedorov VV. Human Atrial Fibrillation Drivers Resolved With Integrated Functional and Structural Imaging to Benefit Clinical Mapping. JACC Clin Electrophysiol 2018; 4:1501-1515. [PMID: 30573112 DOI: 10.1016/j.jacep.2018.08.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/19/2018] [Accepted: 08/23/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This study sought to improve atrial fibrillation (AF) driver identification by integrating clinical multielectrode mapping with driver fingerprints defined by high-resolution ex vivo 3-dimensional (3D) functional and structural imaging. BACKGROUND Clinical multielectrode mapping of AF drivers suffers from variable contact, signal processing, and structural complexity within the 3D human atrial wall, raising questions on the validity of such drivers. METHODS Sustained AF was mapped in coronary-perfused explanted human hearts (n = 11) with transmural near-infrared optical mapping (∼0.3 mm2 resolution). Simultaneously, custom FIRMap catheters (∼9 × 9 mm2 resolution) mapped endocardial and epicardial surfaces, which were analyzed by Focal Impulse and Rotor Mapping activation and Rotational Activity Profile (Abbott Labs, Chicago, Illinois). Functional maps were integrated with contrast-enhanced cardiac magnetic resonance imaging (∼0.1 mm3 resolution) analysis of 3D fibrosis architecture. RESULTS During sustained AF, near-infrared optical mapping identified 1 to 2 intramural, spatially stable re-entrant AF drivers per heart. Driver targeted ablation affecting 2.2 ± 1.1% of the atrial surface terminated and prevented AF. Driver regions had significantly higher phase singularity density and dominant frequency than neighboring nondriver regions. Focal Impulse and Rotor Mapping had 80% sensitivity to near-infrared optical mapping-defined driver locations (16 of 20), and matched 14 of 20 driver visualizations: 10 of 14 re-entries seen with Rotational Activity Profile; and 4 of 6 breakthrough/focal patterns. Focal Impulse and Rotor Mapping detected 1.1 ± 0.9 false-positive rotational activity profiles per recording, but these regions had lower intramural contrast-enhanced cardiac magnetic resonance imaging fibrosis than did driver regions (14.9 ± 7.9% vs. 23.2 ± 10.5%; p < 0.005). CONCLUSIONS The study revealed that both re-entrant and breakthrough/focal AF driver patterns visualized by surface-only clinical multielectrodes can represent projections of 3D intramural microanatomic re-entries. Integration of multielectrode mapping and 3D fibrosis analysis may enhance AF driver detection, thereby improving the efficacy of driver-targeted ablation.
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Affiliation(s)
- Brian J Hansen
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Ning Li
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alexander Zolotarev
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Phystech School of Biological and Medical Physics, Moscow Institute of Physic and Technology, Dolgoprudny, Russian Federation
| | - Stanislav Zakharkin
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Yufeng Wang
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Josh Atwal
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Anuradha Kalyanasundaram
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Suhaib H Abudulwahed
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Katelynn M Helfrich
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Anna Bratasz
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kimerly A Powell
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bryan Whitson
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Peter J Mohler
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Paul M L Janssen
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Orlando P Simonetti
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Biomedical Engineering, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John D Hummel
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Vadim V Fedorov
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Hansen BJ, Csepe TA, Zhao J, Ignozzi AJ, Hummel JD, Fedorov VV. Maintenance of Atrial Fibrillation: Are Reentrant Drivers With Spatial Stability the Key? Circ Arrhythm Electrophysiol 2018; 9:CIRCEP.116.004398. [PMID: 27729340 DOI: 10.1161/circep.116.004398] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/07/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Brian J Hansen
- From the Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus (B.J.H., T.A.C., A.J.I., J.D.H., V.V.F.); and Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.)
| | - Thomas A Csepe
- From the Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus (B.J.H., T.A.C., A.J.I., J.D.H., V.V.F.); and Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.)
| | - Jichao Zhao
- From the Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus (B.J.H., T.A.C., A.J.I., J.D.H., V.V.F.); and Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.)
| | - Anthony J Ignozzi
- From the Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus (B.J.H., T.A.C., A.J.I., J.D.H., V.V.F.); and Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.)
| | - John D Hummel
- From the Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus (B.J.H., T.A.C., A.J.I., J.D.H., V.V.F.); and Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.)
| | - Vadim V Fedorov
- From the Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus (B.J.H., T.A.C., A.J.I., J.D.H., V.V.F.); and Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.).
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Li N, Hansen BJ, Fedorov VV. Response by Li et al to Letter Regarding Article, "Adenosine-Induced Atrial Fibrillation: Localized Reentrant Drivers in Lateral Right Atria Due to Heterogeneous Expression of Adenosine A1 Receptors and GIRK4 Subunits in the Human Heart". Circulation 2018; 134:e648-e649. [PMID: 27920078 DOI: 10.1161/circulationaha.116.025797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ning Li
- From Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus
| | - Brian J Hansen
- From Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus
| | - Vadim V Fedorov
- From Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus
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16
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Csepe TA, Zhao J, Sul LV, Wang Y, Hansen BJ, Li N, Ignozzi AJ, Bratasz A, Powell KA, Kilic A, Mohler PJ, Janssen PML, Hummel JD, Simonetti OP, Fedorov VV. Novel application of 3D contrast-enhanced CMR to define fibrotic structure of the human sinoatrial node in vivo. Eur Heart J Cardiovasc Imaging 2018; 18:862-869. [PMID: 28087602 DOI: 10.1093/ehjci/jew304] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/16/2016] [Indexed: 11/13/2022] Open
Abstract
Aims The adult human sinoatrial node (SAN) has a specialized fibrotic intramural structure (35-55% fibrotic tissue) that provides mechanical and electrical protection from the surrounding atria. We hypothesize that late gadolinium-enhanced cardiovascular magnetic resonance (LGE-CMR) can be applied to define the fibrotic human SAN structure in vivo. Methods and results LGE-CMR atrial scans of healthy volunteers (n olu, 23-52 y.o.) using a 3 Tesla magnetic resonance imaging system with a spatial resolution of 1.0 mm3 or 0.625 × 0.625 × 1.25 mm3 were obtained and analysed. Percent fibrosis of total connective and cardiomyocyte tissue area in segmented atrial regions were measured based on signal intensity differences of fibrotic vs. non-fibrotic cardiomyocyte tissue. A distinct ellipsoidal fibrotic region (length: 23.6 ± 1.9 mm; width: 7.2 ± 0.9 mm; depth: 2.9 ± 0.4 mm) in all hearts was observed along the posterior junction of the crista terminalis and superior vena cava extending towards the interatrial septum, corresponding to the anatomical location of the human SAN. The SAN fibrotic region consisted of 41.9 ± 5.4% of LGE voxels above an average threshold of 2.7 SD (range 2-3 SD) from the non-fibrotic right atrial free wall tissue. Fibrosis quantification and SAN identification by in vivo LGE-CMR were validated in optically mapped explanted donor hearts ex vivo (n ivo, 19-65 y.o.) by contrast-enhanced CMR (9.4 Tesla; up to 90 µm3 resolution) correlated with serial histological sections of the SAN. Conclusion This is the first study to visualize the 3D human SAN fibrotic structure in vivo using LGE-CMR. Identification of the 3D SAN location and its high fibrotic content by LGE-CMR may provide a new tool to avoid or target SAN structure during ablation.
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Affiliation(s)
- Thomas A Csepe
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland, 70 Symonds Street, Auckland 1142, New Zealand
| | - Lidiya V Sul
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA
| | - Yufeng Wang
- Auckland Bioengineering Institute, The University of Auckland, 70 Symonds Street, Auckland 1142, New Zealand
| | - Brian J Hansen
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA
| | - Ning Li
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA
| | - Anthony J Ignozzi
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA
| | - Anna Bratasz
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Avenue, Columbus, OH 43210, USA
| | - Kimerly A Powell
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Avenue, Columbus, OH 43210, USA
| | - Ahmet Kilic
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Avenue, Columbus, OH 43210, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH 43210, USA
| | - Peter J Mohler
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Avenue, Columbus, OH 43210, USA.,Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Columbus, OH 43210, USA
| | - Paul M L Janssen
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Avenue, Columbus, OH 43210, USA.,Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Columbus, OH 43210, USA
| | - John D Hummel
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Avenue, Columbus, OH 43210, USA.,Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Columbus, OH 43210, USA
| | - Orlando P Simonetti
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Avenue, Columbus, OH 43210, USA.,Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, 250 Lincoln Tower, 1800 Cannon Drive, Columbus, OH 43210, USA
| | - Vadim V Fedorov
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Avenue, Columbus, OH 43210, USA
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Li N, Hansen BJ, Csepe TA, Zhao J, Ignozzi AJ, Sul LV, Zakharkin SO, Kalyanasundaram A, Davis JP, Biesiadecki BJ, Kilic A, Janssen PML, Mohler PJ, Weiss R, Hummel JD, Fedorov VV. Redundant and diverse intranodal pacemakers and conduction pathways protect the human sinoatrial node from failure. Sci Transl Med 2018; 9:9/400/eaam5607. [PMID: 28747516 DOI: 10.1126/scitranslmed.aam5607] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 06/16/2017] [Indexed: 11/02/2022]
Abstract
The human sinoatrial node (SAN) efficiently maintains heart rhythm even under adverse conditions. However, the specific mechanisms involved in the human SAN's ability to prevent rhythm failure, also referred to as its robustness, are unknown. Challenges exist because the three-dimensional (3D) intramural structure of the human SAN differs from well-studied animal models, and clinical electrode recordings are limited to only surface atrial activation. Hence, to innovate the translational study of human SAN structural and functional robustness, we integrated intramural optical mapping, 3D histology reconstruction, and molecular mapping of the ex vivo human heart. When challenged with adenosine or atrial pacing, redundant intranodal pacemakers within the human SAN maintained automaticity and delivered electrical impulses to the atria through sinoatrial conduction pathways (SACPs), thereby ensuring a fail-safe mechanism for robust maintenance of sinus rhythm. During adenosine perturbation, the primary central SAN pacemaker was suppressed, whereas previously inactive superior or inferior intranodal pacemakers took over automaticity maintenance. Sinus rhythm was also rescued by activation of another SACP when the preferential SACP was suppressed, suggesting two independent fail-safe mechanisms for automaticity and conduction. The fail-safe mechanism in response to adenosine challenge is orchestrated by heterogeneous differences in adenosine A1 receptors and downstream GIRK4 channel protein expressions across the SAN complex. Only failure of all pacemakers and/or SACPs resulted in SAN arrest or conduction block. Our results unmasked reserve mechanisms that protect the human SAN pacemaker and conduction complex from rhythm failure, which may contribute to treatment of SAN arrhythmias.
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Affiliation(s)
- Ning Li
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Brian J Hansen
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Thomas A Csepe
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Jichao Zhao
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand
| | - Anthony J Ignozzi
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Lidiya V Sul
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Stanislav O Zakharkin
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Anuradha Kalyanasundaram
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Jonathan P Davis
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Brandon J Biesiadecki
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Ahmet Kilic
- Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Paul M L Janssen
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Peter J Mohler
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Raul Weiss
- Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - John D Hummel
- Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Vadim V Fedorov
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA. .,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Affiliation(s)
- Vadim V Fedorov
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Brian J Hansen
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Affiliation(s)
- Vadim V Fedorov
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Brian J Hansen
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Zhao J, Hansen BJ, Wang Y, Csepe TA, Sul LV, Tang A, Yuan Y, Li N, Bratasz A, Powell KA, Kilic A, Mohler PJ, Janssen PML, Weiss R, Simonetti OP, Hummel JD, Fedorov VV. Three-dimensional Integrated Functional, Structural, and Computational Mapping to Define the Structural "Fingerprints" of Heart-Specific Atrial Fibrillation Drivers in Human Heart Ex Vivo. J Am Heart Assoc 2017; 6:JAHA.117.005922. [PMID: 28862969 PMCID: PMC5586436 DOI: 10.1161/jaha.117.005922] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Structural remodeling of human atria plays a key role in sustaining atrial fibrillation (AF), but insufficient quantitative analysis of human atrial structure impedes the treatment of AF. We aimed to develop a novel 3-dimensional (3D) structural and computational simulation analysis tool that could reveal the structural contributors to human reentrant AF drivers. METHODS AND RESULTS High-resolution panoramic epicardial optical mapping of the coronary-perfused explanted intact human atria (63-year-old woman, chronic hypertension, heart weight 608 g) was conducted during sinus rhythm and sustained AF maintained by spatially stable reentrant AF drivers in the left and right atrium. The whole atria (107×61×85 mm3) were then imaged with contrast-enhancement MRI (9.4 T, 180×180×360-μm3 resolution). The entire 3D human atria were analyzed for wall thickness (0.4-11.7 mm), myofiber orientations, and transmural fibrosis (36.9% subendocardium; 14.2% midwall; 3.4% subepicardium). The 3D computational analysis revealed that a specific combination of wall thickness and fibrosis ranges were primarily present in the optically defined AF driver regions versus nondriver tissue. Finally, a 3D human heart-specific atrial computer model was developed by integrating 3D structural and functional mapping data to test AF induction, maintenance, and ablation strategies. This 3D model reproduced the optically defined reentrant AF drivers, which were uninducible when fibrosis and myofiber anisotropy were removed from the model. CONCLUSIONS Our novel 3D computational high-resolution framework may be used to quantitatively analyze structural substrates, such as wall thickness, myofiber orientation, and fibrosis, underlying localized AF drivers, and aid the development of new patient-specific treatments.
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Affiliation(s)
- Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland, New Zealand
| | - Brian J Hansen
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Yufeng Wang
- Auckland Bioengineering Institute, The University of Auckland, New Zealand
| | - Thomas A Csepe
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Lidiya V Sul
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Alan Tang
- Auckland Bioengineering Institute, The University of Auckland, New Zealand
| | - Yiming Yuan
- Auckland Bioengineering Institute, The University of Auckland, New Zealand
| | - Ning Li
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Anna Bratasz
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kimerly A Powell
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ahmet Kilic
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Peter J Mohler
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Paul M L Janssen
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Raul Weiss
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Orlando P Simonetti
- Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - John D Hummel
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Vadim V Fedorov
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH .,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
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21
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Li N, Csepe TA, Hansen BJ, Sul LV, Kalyanasundaram A, Zakharkin SO, Zhao J, Guha A, Van Wagoner DR, Kilic A, Mohler PJ, Janssen PML, Biesiadecki BJ, Hummel JD, Weiss R, Fedorov VV. Adenosine-Induced Atrial Fibrillation: Localized Reentrant Drivers in Lateral Right Atria due to Heterogeneous Expression of Adenosine A1 Receptors and GIRK4 Subunits in the Human Heart. Circulation 2016; 134:486-98. [PMID: 27462069 DOI: 10.1161/circulationaha.115.021165] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 06/02/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adenosine provokes atrial fibrillation (AF) with a higher activation frequency in right atria (RA) versus left atria (LA) in patients, but the underlying molecular and functional substrates are unclear. We tested the hypothesis that adenosine-induced AF is driven by localized reentry in RA areas with highest expression of adenosine A1 receptor and its downstream GIRK (G protein-coupled inwardly rectifying potassium channels) channels (IK,Ado). METHODS We applied biatrial optical mapping and immunoblot mapping of various atrial regions to reveal the mechanism of adenosine-induced AF in explanted failing and nonfailing human hearts (n=37). RESULTS Optical mapping of coronary-perfused atria (n=24) revealed that adenosine perfusion (10-100 µmol/L) produced more significant shortening of action potential durations in RA (from 290±45 to 239±41 ms, 17.3±10.4%; P<0.01) than LA (from 307±24 to 286±23 ms, 6.7±6.6%; P<0.01). In 10 hearts, adenosine induced AF (317±116 s) that, when sustained (≥2 minutes), was primarily maintained by 1 to 2 localized reentrant drivers in lateral RA. Tertiapin (10-100 nmol/L), a selective GIRK channel blocker, counteracted adenosine-induced action potential duration shortening and prevented AF induction. Immunoblotting showed that the superior/middle lateral RA had significantly higher adenosine A1 receptor (2.7±1.7-fold; P<0.01) and GIRK4 (1.7±0.8-fold; P<0.05) protein expression than lateral/posterior LA. CONCLUSIONS This study revealed a 3-fold RA-to-LA adenosine A1 receptor protein expression gradient in the human heart, leading to significantly greater RA versus LA repolarization sensitivity in response to adenosine. Sustained adenosine-induced AF is maintained by reentrant drivers localized in lateral RA regions with the highest adenosine A1 receptor/GIRK4 expression. Selective atrial GIRK channel blockade may effectively treat AF during conditions with increased endogenous adenosine.
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Affiliation(s)
- Ning Li
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Thomas A Csepe
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Brian J Hansen
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Lidiya V Sul
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Anuradha Kalyanasundaram
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Stanislav O Zakharkin
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Jichao Zhao
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Avirup Guha
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - David R Van Wagoner
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Ahmet Kilic
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Peter J Mohler
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Paul M L Janssen
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Brandon J Biesiadecki
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - John D Hummel
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Raul Weiss
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Vadim V Fedorov
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.).
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Csepe TA, Hansen BJ, Fedorov VV. Atrial fibrillation driver mechanisms: Insight from the isolated human heart. Trends Cardiovasc Med 2016; 27:1-11. [PMID: 27492815 DOI: 10.1016/j.tcm.2016.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 11/25/2022]
Abstract
Although there have been great technological advances in the treatment of atrial fibrillation (AF), current therapies remain limited due to a narrow understanding of AF mechanisms in the human heart. This review will highlight our recent studies on explanted human hearts where we developed and employed a novel functional-structural mapping approach by integrating high-resolution simultaneous endo-epicardial and panoramic optical mapping with 3D gadolinium-enhanced MRI to define the spatiotemporal characteristics of AF drivers and their structural substrates. The results allow us to postulate that the primary mechanism of AF maintenance in human hearts is a limited number of localized intramural microanatomic reentrant AF drivers anchored to heart-specific 3D fibrotically insulated myobundle tracks, which may remain hidden to clinical single-surface electrode mapping. We suggest that ex vivo human heart studies, by using an integrated 3D functional and structural mapping approach, will help to reveal defining features of AF drivers as well as validate and improve clinical approaches to detect and target these AF drivers in patients with cardiac diseases.
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Affiliation(s)
- Thomas A Csepe
- Department of Physiology & Cell Biology, Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 300 Hamilton Hall, 1645 Neil Ave, Columbus, OH 43210-1218
| | - Brian J Hansen
- Department of Physiology & Cell Biology, Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 300 Hamilton Hall, 1645 Neil Ave, Columbus, OH 43210-1218
| | - Vadim V Fedorov
- Department of Physiology & Cell Biology, Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 300 Hamilton Hall, 1645 Neil Ave, Columbus, OH 43210-1218.
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Zhao J, Hansen BJ, Csepe TA, Lim P, Wang Y, Williams M, Mohler PJ, Janssen PML, Weiss R, Hummel JD, Fedorov VV. Integration of High-Resolution Optical Mapping and 3-Dimensional Micro-Computed Tomographic Imaging to Resolve the Structural Basis of Atrial Conduction in the Human Heart. Circ Arrhythm Electrophysiol 2016; 8:1514-7. [PMID: 26671938 DOI: 10.1161/circep.115.003064] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jichao Zhao
- From the Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand (J.Z., P.L., Y.W.); Department of Physiology and Cell Biology (B.J.H., T.A.C., P.J.M., P.M.L.J., V.V.F.) and Department of Internal Medicine (R.W., J.D.H.), Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus; and Department of Radiology, Wright Center of Innovation in Biomedical Imaging, Ohio State University, Columbus (M.W.)
| | - Brian J Hansen
- From the Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand (J.Z., P.L., Y.W.); Department of Physiology and Cell Biology (B.J.H., T.A.C., P.J.M., P.M.L.J., V.V.F.) and Department of Internal Medicine (R.W., J.D.H.), Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus; and Department of Radiology, Wright Center of Innovation in Biomedical Imaging, Ohio State University, Columbus (M.W.)
| | - Thomas A Csepe
- From the Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand (J.Z., P.L., Y.W.); Department of Physiology and Cell Biology (B.J.H., T.A.C., P.J.M., P.M.L.J., V.V.F.) and Department of Internal Medicine (R.W., J.D.H.), Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus; and Department of Radiology, Wright Center of Innovation in Biomedical Imaging, Ohio State University, Columbus (M.W.)
| | - Praise Lim
- From the Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand (J.Z., P.L., Y.W.); Department of Physiology and Cell Biology (B.J.H., T.A.C., P.J.M., P.M.L.J., V.V.F.) and Department of Internal Medicine (R.W., J.D.H.), Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus; and Department of Radiology, Wright Center of Innovation in Biomedical Imaging, Ohio State University, Columbus (M.W.)
| | - Yufeng Wang
- From the Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand (J.Z., P.L., Y.W.); Department of Physiology and Cell Biology (B.J.H., T.A.C., P.J.M., P.M.L.J., V.V.F.) and Department of Internal Medicine (R.W., J.D.H.), Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus; and Department of Radiology, Wright Center of Innovation in Biomedical Imaging, Ohio State University, Columbus (M.W.)
| | - Michelle Williams
- From the Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand (J.Z., P.L., Y.W.); Department of Physiology and Cell Biology (B.J.H., T.A.C., P.J.M., P.M.L.J., V.V.F.) and Department of Internal Medicine (R.W., J.D.H.), Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus; and Department of Radiology, Wright Center of Innovation in Biomedical Imaging, Ohio State University, Columbus (M.W.)
| | - Peter J Mohler
- From the Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand (J.Z., P.L., Y.W.); Department of Physiology and Cell Biology (B.J.H., T.A.C., P.J.M., P.M.L.J., V.V.F.) and Department of Internal Medicine (R.W., J.D.H.), Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus; and Department of Radiology, Wright Center of Innovation in Biomedical Imaging, Ohio State University, Columbus (M.W.)
| | - Paul M L Janssen
- From the Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand (J.Z., P.L., Y.W.); Department of Physiology and Cell Biology (B.J.H., T.A.C., P.J.M., P.M.L.J., V.V.F.) and Department of Internal Medicine (R.W., J.D.H.), Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus; and Department of Radiology, Wright Center of Innovation in Biomedical Imaging, Ohio State University, Columbus (M.W.)
| | - Raul Weiss
- From the Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand (J.Z., P.L., Y.W.); Department of Physiology and Cell Biology (B.J.H., T.A.C., P.J.M., P.M.L.J., V.V.F.) and Department of Internal Medicine (R.W., J.D.H.), Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus; and Department of Radiology, Wright Center of Innovation in Biomedical Imaging, Ohio State University, Columbus (M.W.)
| | - John D Hummel
- From the Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand (J.Z., P.L., Y.W.); Department of Physiology and Cell Biology (B.J.H., T.A.C., P.J.M., P.M.L.J., V.V.F.) and Department of Internal Medicine (R.W., J.D.H.), Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus; and Department of Radiology, Wright Center of Innovation in Biomedical Imaging, Ohio State University, Columbus (M.W.)
| | - Vadim V Fedorov
- From the Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand (J.Z., P.L., Y.W.); Department of Physiology and Cell Biology (B.J.H., T.A.C., P.J.M., P.M.L.J., V.V.F.) and Department of Internal Medicine (R.W., J.D.H.), Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus; and Department of Radiology, Wright Center of Innovation in Biomedical Imaging, Ohio State University, Columbus (M.W.).
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Shettigar V, Zhang B, Little SC, Salhi HE, Hansen BJ, Li N, Zhang J, Roof SR, Ho HT, Brunello L, Lerch JK, Weisleder N, Fedorov VV, Accornero F, Rafael-Fortney JA, Gyorke S, Janssen PML, Biesiadecki BJ, Ziolo MT, Davis JP. Rationally engineered Troponin C modulates in vivo cardiac function and performance in health and disease. Nat Commun 2016; 7:10794. [PMID: 26908229 PMCID: PMC4770086 DOI: 10.1038/ncomms10794] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 01/21/2016] [Indexed: 12/26/2022] Open
Abstract
Treatment for heart disease, the leading cause of death in the world, has progressed little for several decades. Here we develop a protein engineering approach to directly tune in vivo cardiac contractility by tailoring the ability of the heart to respond to the Ca(2+) signal. Promisingly, our smartly formulated Ca(2+)-sensitizing TnC (L48Q) enhances heart function without any adverse effects that are commonly observed with positive inotropes. In a myocardial infarction (MI) model of heart failure, expression of TnC L48Q before the MI preserves cardiac function and performance. Moreover, expression of TnC L48Q after the MI therapeutically enhances cardiac function and performance, without compromising survival. We demonstrate engineering TnC can specifically and precisely modulate cardiac contractility that when combined with gene therapy can be employed as a therapeutic strategy for heart disease.
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Affiliation(s)
- Vikram Shettigar
- Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, Columbus, Ohio 43210, USA
| | - Bo Zhang
- Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, Columbus, Ohio 43210, USA
| | - Sean C Little
- Bristol-Myers Squibb, Department of Discovery Biology, Wallingford, Connecticut 06492, USA
| | - Hussam E Salhi
- Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, Columbus, Ohio 43210, USA
| | - Brian J Hansen
- Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, Columbus, Ohio 43210, USA
| | - Ning Li
- Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, Columbus, Ohio 43210, USA
| | - Jianchao Zhang
- Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, Columbus, Ohio 43210, USA
| | | | - Hsiang-Ting Ho
- Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, Columbus, Ohio 43210, USA
| | - Lucia Brunello
- Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, Columbus, Ohio 43210, USA
| | - Jessica K Lerch
- Center for Brain and Spinal Cord Repair, Department of Neuroscience, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA
| | - Noah Weisleder
- Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, Columbus, Ohio 43210, USA
| | - Vadim V Fedorov
- Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, Columbus, Ohio 43210, USA
| | - Federica Accornero
- Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, Columbus, Ohio 43210, USA
| | - Jill A Rafael-Fortney
- Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, Columbus, Ohio 43210, USA
| | - Sandor Gyorke
- Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, Columbus, Ohio 43210, USA
| | - Paul M L Janssen
- Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, Columbus, Ohio 43210, USA
| | - Brandon J Biesiadecki
- Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, Columbus, Ohio 43210, USA
| | - Mark T Ziolo
- Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, Columbus, Ohio 43210, USA
| | - Jonathan P Davis
- Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, Columbus, Ohio 43210, USA
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Csepe TA, Zhao J, Hansen BJ, Li N, Sul LV, Lim P, Wang Y, Simonetti OP, Kilic A, Mohler PJ, Janssen PML, Fedorov VV. Human sinoatrial node structure: 3D microanatomy of sinoatrial conduction pathways. Prog Biophys Mol Biol 2015; 120:164-78. [PMID: 26743207 DOI: 10.1016/j.pbiomolbio.2015.12.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/10/2015] [Accepted: 12/18/2015] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Despite a century of extensive study on the human sinoatrial node (SAN), the structure-to-function features of specialized SAN conduction pathways (SACP) are still unknown and debated. We report a new method for direct analysis of the SAN microstructure in optically-mapped human hearts with and without clinical history of SAN dysfunction. METHODS Two explanted donor human hearts were coronary-perfused and optically-mapped. Structural analyses of histological sections parallel to epicardium (∼13-21 μm intervals) were integrated with optical maps to create 3D computational reconstructions of the SAN complex. High-resolution fiber fields were obtained using 3D Eigen-analysis of the structure tensor, and used to analyze SACP microstructure with a fiber-tracking approach. RESULTS Optical mapping revealed normal SAN activation of the atria through a lateral SACP proximal to the crista terminalis in Heart #1 but persistent SAN exit block in diseased Heart #2. 3D structural analysis displayed a functionally-observed SAN border composed of fibrosis, fat, and/or discontinuous fibers between SAN and atria, which was only crossed by several branching myofiber tracts in SACP regions. Computational 3D fiber-tracking revealed that myofiber tracts of SACPs created continuous connections between SAN #1 and atria, but in SAN #2, SACP region myofiber tracts were discontinuous due to fibrosis and fat. CONCLUSIONS We developed a new integrative functional, structural and computational approach that allowed for the resolution of the specialized 3D microstructure of human SACPs for the first time. Application of this integrated approach will shed new light on the role of the specialized SAN microanatomy in maintaining sinus rhythm.
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Affiliation(s)
- Thomas A Csepe
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Brian J Hansen
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ning Li
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lidiya V Sul
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Praise Lim
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Yufeng Wang
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Orlando P Simonetti
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA; Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ahmet Kilic
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Peter J Mohler
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Paul M L Janssen
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vadim V Fedorov
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Li N, Csepe TA, Hansen BJ, Dobrzynski H, Higgins RSD, Kilic A, Mohler PJ, Janssen PML, Rosen MR, Biesiadecki BJ, Fedorov VV. Molecular Mapping of Sinoatrial Node HCN Channel Expression in the Human Heart. Circ Arrhythm Electrophysiol 2015; 8:1219-27. [PMID: 26304511 DOI: 10.1161/circep.115.003070] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/04/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The hyperpolarization-activated current, If, plays an important role in sinoatrial node (SAN) pacemaking. Surprisingly, the distribution of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels in human SAN has only been investigated at the mRNA level. Our aim was to define the expression pattern of HCN proteins in human SAN and different atrial regions. METHODS AND RESULTS Entire SAN complexes were isolated from failing (n=5) and nonfailing (n=9) human hearts cardioplegically arrested in the operating room. Three-dimensional intramural SAN structure was identified as the fibrotic compact region around the SAN artery with Connexin 43-negative pacemaker cardiomyocytes visualized in Masson's trichrome and immunostained cryosections. SAN protein was precisely isolated from the adjacent frozen SAN tissue blocks using a 16G biopsy needle. The purity of the SAN protein was confirmed by Connexin 43 immunoblot. All 3 HCN isoform proteins were detected in SAN. HCN1 was predominantly distributed in the human SAN with a 125.1±40.2 (n=12) expression ratio of SAN to right atrium. HCN2 and HCN4 expression levels were higher in SAN than in atria, with SAN to right atrium ratios of 6.1±0.9 and 4.6±0.6 (n=12), respectively. CONCLUSIONS This is the first study to conduct precise 3D molecular mapping of the human SAN by isolating pure pacemaker SAN tissue. All 3 cardiac HCN isoforms had higher expression in the SAN than in the atria. HCN1 was almost exclusively expressed in SAN, emphasizing its utility as a new specific molecular marker of the human SAN and as a potential target of specific treatments intended to modify sinus rhythm.
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Affiliation(s)
- Ning Li
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Thomas A Csepe
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Brian J Hansen
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Halina Dobrzynski
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Robert S D Higgins
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Ahmet Kilic
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Peter J Mohler
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Paul M L Janssen
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Michael R Rosen
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Brandon J Biesiadecki
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Vadim V Fedorov
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.).
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Hansen BJ, Zhao J, Csepe TA, Moore BT, Li N, Jayne LA, Kalyanasundaram A, Lim P, Bratasz A, Powell KA, Simonetti OP, Higgins RSD, Kilic A, Mohler PJ, Janssen PML, Weiss R, Hummel JD, Fedorov VV. Atrial fibrillation driven by micro-anatomic intramural re-entry revealed by simultaneous sub-epicardial and sub-endocardial optical mapping in explanted human hearts. Eur Heart J 2015; 36:2390-401. [PMID: 26059724 DOI: 10.1093/eurheartj/ehv233] [Citation(s) in RCA: 280] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 05/08/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS The complex architecture of the human atria may create physical substrates for sustained re-entry to drive atrial fibrillation (AF). The existence of sustained, anatomically defined AF drivers in humans has been challenged partly due to the lack of simultaneous endocardial-epicardial (Endo-Epi) mapping coupled with high-resolution 3D structural imaging. METHODS AND RESULTS Coronary-perfused human right atria from explanted diseased hearts (n = 8, 43-72 years old) were optically mapped simultaneously by three high-resolution CMOS cameras (two aligned Endo-Epi views (330 µm2 resolution) and one panoramic view). 3D gadolinium-enhanced magnetic resonance imaging (GE-MRI, 80 µm3 resolution) revealed the atrial wall structure varied in thickness (1.0 ± 0.7-6.8 ± 2.4 mm), transmural fiber angle differences, and interstitial fibrosis causing transmural activation delay from 23 ± 11 to 43 ± 22 ms at increased pacing rates. Sustained AF (>90 min) was induced by burst pacing during pinacidil (30-100 µM) perfusion. Dual-sided sub-Endo-sub-Epi optical mapping revealed that AF was driven by spatially and temporally stable intramural re-entry with 107 ± 50 ms cycle length and transmural activation delay of 67 ± 31 ms. Intramural re-entrant drivers were captured primarily by sub-Endo mapping, while sub-Epi mapping visualized re-entry or 'breakthrough' patterns. Re-entrant drivers were anchored on 3D micro-anatomic tracks (15.4 ± 2.2 × 6.0 ± 2.3 mm2, 2.9 ± 0.9 mm depth) formed by atrial musculature characterized by increased transmural fiber angle differences and interstitial fibrosis. Targeted radiofrequency ablation of the tracks verified these re-entries as drivers of AF. CONCLUSIONS Integrated 3D structural-functional mapping of diseased human right atria ex vivo revealed that the complex atrial microstructure caused significant differences between Endo vs. Epi activation during pacing and sustained AF driven by intramural re-entry anchored to fibrosis-insulated atrial bundles.
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Affiliation(s)
- Brian J Hansen
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, 300 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210-1218, USA
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Thomas A Csepe
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, 300 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210-1218, USA
| | - Brandon T Moore
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, 300 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210-1218, USA
| | - Ning Li
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, 300 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210-1218, USA
| | - Laura A Jayne
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, 300 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210-1218, USA
| | - Anuradha Kalyanasundaram
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, 300 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210-1218, USA
| | - Praise Lim
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Anna Bratasz
- Small Animal Imaging Core, The Ohio State University Wexner Medical Center, Columbus, OH, USA Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kimerly A Powell
- Small Animal Imaging Core, The Ohio State University Wexner Medical Center, Columbus, OH, USA Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Orlando P Simonetti
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Robert S D Higgins
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ahmet Kilic
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Peter J Mohler
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, 300 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210-1218, USA Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Paul M L Janssen
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, 300 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210-1218, USA Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Raul Weiss
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John D Hummel
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vadim V Fedorov
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, 300 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210-1218, USA Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Csepe TA, Kalyanasundaram A, Hansen BJ, Zhao J, Fedorov VV. Fibrosis: a structural modulator of sinoatrial node physiology and dysfunction. Front Physiol 2015; 6:37. [PMID: 25729366 PMCID: PMC4325882 DOI: 10.3389/fphys.2015.00037] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/24/2015] [Indexed: 01/01/2023] Open
Abstract
Heart rhythm is initialized and controlled by the Sinoatrial Node (SAN), the primary pacemaker of the heart. The SAN is a heterogeneous multi-compartment structure characterized by clusters of specialized cardiomyocytes enmeshed within strands of connective tissue or fibrosis. Intranodal fibrosis is emerging as an important modulator of structural and functional integrity of the SAN pacemaker complex. In adult human hearts, fatty tissue and fibrosis insulate the SAN from the hyperpolarizing effect of the surrounding atria while electrical communication between the SAN and right atrium is restricted to discrete SAN conduction pathways. The amount of fibrosis within the SAN is inversely correlated with heart rate, while age and heart size are positively correlated with fibrosis. Pathological upregulation of fibrosis within the SAN may lead to tachycardia-bradycardia arrhythmias and cardiac arrest, possibly due to SAN reentry and exit block, and is associated with atrial fibrillation, ventricular arrhythmias, heart failure and myocardial infarction. In this review, we will discuss current literature on the role of fibrosis in normal SAN structure and function, as well as the causes and consequences of SAN fibrosis upregulation in disease conditions.
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Affiliation(s)
- Thomas A Csepe
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center Columbus, OH, USA
| | - Anuradha Kalyanasundaram
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center Columbus, OH, USA
| | - Brian J Hansen
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center Columbus, OH, USA
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland Auckland, New Zealand
| | - Vadim V Fedorov
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center Columbus, OH, USA
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Lou Q, Hansen BJ, Fedorenko O, Csepe TA, Kalyanasundaram A, Li N, Hage LT, Glukhov AV, Billman GE, Weiss R, Mohler PJ, Györke S, Biesiadecki BJ, Carnes CA, Fedorov VV. Upregulation of adenosine A1 receptors facilitates sinoatrial node dysfunction in chronic canine heart failure by exacerbating nodal conduction abnormalities revealed by novel dual-sided intramural optical mapping. Circulation 2014; 130:315-24. [PMID: 24838362 DOI: 10.1161/circulationaha.113.007086] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although sinoatrial node (SAN) dysfunction is a hallmark of human heart failure (HF), the underlying mechanisms remain poorly understood. We aimed to examine the role of adenosine in SAN dysfunction and tachy-brady arrhythmias in chronic HF. METHODS AND RESULTS We applied multiple approaches to characterize SAN structure, SAN function, and adenosine A1 receptor expression in control (n=17) and 4-month tachypacing-induced chronic HF (n=18) dogs. Novel intramural optical mapping of coronary-perfused right atrial preparations revealed that adenosine (10 μmol/L) markedly prolonged postpacing SAN conduction time in HF by 206 ± 99 milliseconds (versus 66 ± 21 milliseconds in controls; P=0.02). Adenosine induced SAN intranodal conduction block or microreentry in 6 of 8 dogs with HF versus 0 of 7 controls (P=0.007). Adenosine-induced SAN conduction abnormalities and automaticity depression caused postpacing atrial pauses in HF versus control dogs (17.1 ± 28.9 versus 1.5 ± 1.3 seconds; P<0.001). Furthermore, 10 μmol/L adenosine shortened atrial repolarization and led to pacing-induced atrial fibrillation in 6 of 7 HF versus 0 of 7 control dogs (P=0.002). Adenosine-induced SAN dysfunction and atrial fibrillation were abolished or prevented by adenosine A1 receptor antagonists (50 μmol/L theophylline/1 μmol/L 8-cyclopentyl-1,3-dipropylxanthine). Adenosine A1 receptor protein expression was significantly upregulated during HF in the SAN (by 47 ± 19%) and surrounding atrial myocardium (by 90 ± 40%). Interstitial fibrosis was significantly increased within the SAN in HF versus control dogs (38 ± 4% versus 23 ± 4%; P<0.001). CONCLUSIONS In chronic HF, adenosine A1 receptor upregulation in SAN pacemaker and atrial cardiomyocytes may increase cardiac sensitivity to adenosine. This effect may exacerbate conduction abnormalities in the structurally impaired SAN, leading to SAN dysfunction, and potentiate atrial repolarization shortening, thereby facilitating atrial fibrillation. Atrial fibrillation may further depress SAN function and lead to tachy-brady arrhythmias in HF.
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Affiliation(s)
- Qing Lou
- From the Department of Physiology and Cell Biology (Q.L., B.J.H., O.F., T.A.C., A.K., N.L., L.T.H., A.V.G., G.E.B., P.J.M., S.G., B.J.B., V.V.F.), Davis Heart & Lung Research Institute (Q.L., A.K., G.E.B., R.W., P.J.M., S.G., B.J.B., C.A.C., V.V.F.), and Department of Internal Medicine (R.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus, OH; Mental Health Research Institute and National Research Tomsk Polytechnic University, Tomsk, Russia (O.F.); and College of Pharmacy, The Ohio State University, Columbus (C.A.C.)
| | - Brian J Hansen
- From the Department of Physiology and Cell Biology (Q.L., B.J.H., O.F., T.A.C., A.K., N.L., L.T.H., A.V.G., G.E.B., P.J.M., S.G., B.J.B., V.V.F.), Davis Heart & Lung Research Institute (Q.L., A.K., G.E.B., R.W., P.J.M., S.G., B.J.B., C.A.C., V.V.F.), and Department of Internal Medicine (R.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus, OH; Mental Health Research Institute and National Research Tomsk Polytechnic University, Tomsk, Russia (O.F.); and College of Pharmacy, The Ohio State University, Columbus (C.A.C.)
| | - Olga Fedorenko
- From the Department of Physiology and Cell Biology (Q.L., B.J.H., O.F., T.A.C., A.K., N.L., L.T.H., A.V.G., G.E.B., P.J.M., S.G., B.J.B., V.V.F.), Davis Heart & Lung Research Institute (Q.L., A.K., G.E.B., R.W., P.J.M., S.G., B.J.B., C.A.C., V.V.F.), and Department of Internal Medicine (R.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus, OH; Mental Health Research Institute and National Research Tomsk Polytechnic University, Tomsk, Russia (O.F.); and College of Pharmacy, The Ohio State University, Columbus (C.A.C.)
| | - Thomas A Csepe
- From the Department of Physiology and Cell Biology (Q.L., B.J.H., O.F., T.A.C., A.K., N.L., L.T.H., A.V.G., G.E.B., P.J.M., S.G., B.J.B., V.V.F.), Davis Heart & Lung Research Institute (Q.L., A.K., G.E.B., R.W., P.J.M., S.G., B.J.B., C.A.C., V.V.F.), and Department of Internal Medicine (R.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus, OH; Mental Health Research Institute and National Research Tomsk Polytechnic University, Tomsk, Russia (O.F.); and College of Pharmacy, The Ohio State University, Columbus (C.A.C.)
| | - Anuradha Kalyanasundaram
- From the Department of Physiology and Cell Biology (Q.L., B.J.H., O.F., T.A.C., A.K., N.L., L.T.H., A.V.G., G.E.B., P.J.M., S.G., B.J.B., V.V.F.), Davis Heart & Lung Research Institute (Q.L., A.K., G.E.B., R.W., P.J.M., S.G., B.J.B., C.A.C., V.V.F.), and Department of Internal Medicine (R.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus, OH; Mental Health Research Institute and National Research Tomsk Polytechnic University, Tomsk, Russia (O.F.); and College of Pharmacy, The Ohio State University, Columbus (C.A.C.)
| | - Ning Li
- From the Department of Physiology and Cell Biology (Q.L., B.J.H., O.F., T.A.C., A.K., N.L., L.T.H., A.V.G., G.E.B., P.J.M., S.G., B.J.B., V.V.F.), Davis Heart & Lung Research Institute (Q.L., A.K., G.E.B., R.W., P.J.M., S.G., B.J.B., C.A.C., V.V.F.), and Department of Internal Medicine (R.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus, OH; Mental Health Research Institute and National Research Tomsk Polytechnic University, Tomsk, Russia (O.F.); and College of Pharmacy, The Ohio State University, Columbus (C.A.C.)
| | - Lori T Hage
- From the Department of Physiology and Cell Biology (Q.L., B.J.H., O.F., T.A.C., A.K., N.L., L.T.H., A.V.G., G.E.B., P.J.M., S.G., B.J.B., V.V.F.), Davis Heart & Lung Research Institute (Q.L., A.K., G.E.B., R.W., P.J.M., S.G., B.J.B., C.A.C., V.V.F.), and Department of Internal Medicine (R.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus, OH; Mental Health Research Institute and National Research Tomsk Polytechnic University, Tomsk, Russia (O.F.); and College of Pharmacy, The Ohio State University, Columbus (C.A.C.)
| | - Alexey V Glukhov
- From the Department of Physiology and Cell Biology (Q.L., B.J.H., O.F., T.A.C., A.K., N.L., L.T.H., A.V.G., G.E.B., P.J.M., S.G., B.J.B., V.V.F.), Davis Heart & Lung Research Institute (Q.L., A.K., G.E.B., R.W., P.J.M., S.G., B.J.B., C.A.C., V.V.F.), and Department of Internal Medicine (R.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus, OH; Mental Health Research Institute and National Research Tomsk Polytechnic University, Tomsk, Russia (O.F.); and College of Pharmacy, The Ohio State University, Columbus (C.A.C.)
| | - George E Billman
- From the Department of Physiology and Cell Biology (Q.L., B.J.H., O.F., T.A.C., A.K., N.L., L.T.H., A.V.G., G.E.B., P.J.M., S.G., B.J.B., V.V.F.), Davis Heart & Lung Research Institute (Q.L., A.K., G.E.B., R.W., P.J.M., S.G., B.J.B., C.A.C., V.V.F.), and Department of Internal Medicine (R.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus, OH; Mental Health Research Institute and National Research Tomsk Polytechnic University, Tomsk, Russia (O.F.); and College of Pharmacy, The Ohio State University, Columbus (C.A.C.)
| | - Raul Weiss
- From the Department of Physiology and Cell Biology (Q.L., B.J.H., O.F., T.A.C., A.K., N.L., L.T.H., A.V.G., G.E.B., P.J.M., S.G., B.J.B., V.V.F.), Davis Heart & Lung Research Institute (Q.L., A.K., G.E.B., R.W., P.J.M., S.G., B.J.B., C.A.C., V.V.F.), and Department of Internal Medicine (R.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus, OH; Mental Health Research Institute and National Research Tomsk Polytechnic University, Tomsk, Russia (O.F.); and College of Pharmacy, The Ohio State University, Columbus (C.A.C.)
| | - Peter J Mohler
- From the Department of Physiology and Cell Biology (Q.L., B.J.H., O.F., T.A.C., A.K., N.L., L.T.H., A.V.G., G.E.B., P.J.M., S.G., B.J.B., V.V.F.), Davis Heart & Lung Research Institute (Q.L., A.K., G.E.B., R.W., P.J.M., S.G., B.J.B., C.A.C., V.V.F.), and Department of Internal Medicine (R.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus, OH; Mental Health Research Institute and National Research Tomsk Polytechnic University, Tomsk, Russia (O.F.); and College of Pharmacy, The Ohio State University, Columbus (C.A.C.)
| | - Sándor Györke
- From the Department of Physiology and Cell Biology (Q.L., B.J.H., O.F., T.A.C., A.K., N.L., L.T.H., A.V.G., G.E.B., P.J.M., S.G., B.J.B., V.V.F.), Davis Heart & Lung Research Institute (Q.L., A.K., G.E.B., R.W., P.J.M., S.G., B.J.B., C.A.C., V.V.F.), and Department of Internal Medicine (R.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus, OH; Mental Health Research Institute and National Research Tomsk Polytechnic University, Tomsk, Russia (O.F.); and College of Pharmacy, The Ohio State University, Columbus (C.A.C.)
| | - Brandon J Biesiadecki
- From the Department of Physiology and Cell Biology (Q.L., B.J.H., O.F., T.A.C., A.K., N.L., L.T.H., A.V.G., G.E.B., P.J.M., S.G., B.J.B., V.V.F.), Davis Heart & Lung Research Institute (Q.L., A.K., G.E.B., R.W., P.J.M., S.G., B.J.B., C.A.C., V.V.F.), and Department of Internal Medicine (R.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus, OH; Mental Health Research Institute and National Research Tomsk Polytechnic University, Tomsk, Russia (O.F.); and College of Pharmacy, The Ohio State University, Columbus (C.A.C.)
| | - Cynthia A Carnes
- From the Department of Physiology and Cell Biology (Q.L., B.J.H., O.F., T.A.C., A.K., N.L., L.T.H., A.V.G., G.E.B., P.J.M., S.G., B.J.B., V.V.F.), Davis Heart & Lung Research Institute (Q.L., A.K., G.E.B., R.W., P.J.M., S.G., B.J.B., C.A.C., V.V.F.), and Department of Internal Medicine (R.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus, OH; Mental Health Research Institute and National Research Tomsk Polytechnic University, Tomsk, Russia (O.F.); and College of Pharmacy, The Ohio State University, Columbus (C.A.C.)
| | - Vadim V Fedorov
- From the Department of Physiology and Cell Biology (Q.L., B.J.H., O.F., T.A.C., A.K., N.L., L.T.H., A.V.G., G.E.B., P.J.M., S.G., B.J.B., V.V.F.), Davis Heart & Lung Research Institute (Q.L., A.K., G.E.B., R.W., P.J.M., S.G., B.J.B., C.A.C., V.V.F.), and Department of Internal Medicine (R.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus, OH; Mental Health Research Institute and National Research Tomsk Polytechnic University, Tomsk, Russia (O.F.); and College of Pharmacy, The Ohio State University, Columbus (C.A.C.).
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Glukhov AV, Kalyanasundaram A, Lou Q, Hage LT, Hansen BJ, Belevych AE, Mohler PJ, Knollmann BC, Periasamy M, Györke S, Fedorov VV. Calsequestrin 2 deletion causes sinoatrial node dysfunction and atrial arrhythmias associated with altered sarcoplasmic reticulum calcium cycling and degenerative fibrosis within the mouse atrial pacemaker complex1. Eur Heart J 2013; 36:686-97. [PMID: 24216388 DOI: 10.1093/eurheartj/eht452] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AIMS Loss-of-function mutations in Calsequestrin 2 (CASQ2) are associated with catecholaminergic polymorphic ventricular tachycardia (CPVT). CPVT patients also exhibit bradycardia and atrial arrhythmias for which the underlying mechanism remains unknown. We aimed to study the sinoatrial node (SAN) dysfunction due to loss of CASQ2. METHODS AND RESULTS In vivo electrocardiogram (ECG) monitoring, in vitro high-resolution optical mapping, confocal imaging of intracellular Ca(2+) cycling, and 3D atrial immunohistology were performed in wild-type (WT) and Casq2 null (Casq2(-/-)) mice. Casq2(-/-) mice exhibited bradycardia, SAN conduction abnormalities, and beat-to-beat heart rate variability due to enhanced atrial ectopic activity both at baseline and with autonomic stimulation. Loss of CASQ2 increased fibrosis within the pacemaker complex, depressed primary SAN activity, and conduction, but enhanced atrial ectopic activity and atrial fibrillation (AF) associated with macro- and micro-reentry during autonomic stimulation. In SAN myocytes, CASQ2 deficiency induced perturbations in intracellular Ca(2+) cycling, including abnormal Ca(2+) release, periods of significantly elevated diastolic Ca(2+) levels leading to pauses and unstable pacemaker rate. Importantly, Ca(2+) cycling dysfunction occurred not only at the SAN cellular level but was also globally manifested as an increased delay between action potential (AP) and Ca(2+) transient upstrokes throughout the atrial pacemaker complex. CONCLUSIONS Loss of CASQ2 causes abnormal sarcoplasmic reticulum Ca(2+) release and selective interstitial fibrosis in the atrial pacemaker complex, which disrupt SAN pacemaking but enhance latent pacemaker activity, create conduction abnormalities and increase susceptibility to AF. These functional and extensive structural alterations could contribute to SAN dysfunction as well as AF in CPVT patients.
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Affiliation(s)
- Alexey V Glukhov
- Department of Physiology and Cell Biology, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Medical Center, Columbus, OH, USA
| | - Anuradha Kalyanasundaram
- Department of Physiology and Cell Biology, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Medical Center, Columbus, OH, USA
| | - Qing Lou
- Department of Physiology and Cell Biology, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Medical Center, Columbus, OH, USA
| | - Lori T Hage
- Department of Physiology and Cell Biology, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Medical Center, Columbus, OH, USA
| | - Brian J Hansen
- Department of Physiology and Cell Biology, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Medical Center, Columbus, OH, USA
| | - Andriy E Belevych
- Department of Physiology and Cell Biology, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Medical Center, Columbus, OH, USA
| | - Peter J Mohler
- Department of Physiology and Cell Biology, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Medical Center, Columbus, OH, USA
| | - Björn C Knollmann
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Muthu Periasamy
- Department of Physiology and Cell Biology, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Medical Center, Columbus, OH, USA
| | - Sandor Györke
- Department of Physiology and Cell Biology, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Medical Center, Columbus, OH, USA
| | - Vadim V Fedorov
- Department of Physiology and Cell Biology, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Medical Center, Columbus, OH, USA
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Glukhov AV, Hage LT, Hansen BJ, Pedraza-Toscano A, Vargas-Pinto P, Hamlin RL, Weiss R, Carnes CA, Billman GE, Fedorov VV. Sinoatrial node reentry in a canine chronic left ventricular infarct model: role of intranodal fibrosis and heterogeneity of refractoriness. Circ Arrhythm Electrophysiol 2013; 6:984-94. [PMID: 23960214 DOI: 10.1161/circep.113.000404] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Reentrant arrhythmias involving the sinoatrial node (SAN), namely SAN reentry, remain one of the most intriguing enigmas of cardiac electrophysiology. The goal of the present study was to elucidate the mechanism of SAN micro-reentry in canine hearts with post-myocardial infarction (MI) structural remodeling. METHODS AND RESULTS In vivo, Holter monitoring revealed ventricular arrhythmias and SAN dysfunctions in post-left ventricular MI (6-15 weeks) dogs (n=5) compared with control dogs (n=4). In vitro, high-resolution near-infrared optical mapping of intramural SAN activation was performed in coronary perfused atrial preparations from MI (n=5) and controls (n=4). Both SAN macro- (slow-fast; 16-28 mm) and micro-reentry (1-3 mm) were observed in 60% of the MI preparations during moderate autonomic stimulation (acetylcholine [0.1 µmol/L] or isoproterenol [0.01-0.1 µmol/L]) after termination of atrial tachypacing (5-8 Hz), a finding not seen in controls. The autonomic stimulation induced heterogeneous changes in the SAN refractoriness; thus, competing atrial or SAN pacemaker waves could produce unidirectional blocks and initiate intranodal micro-reentry. The micro-reentry pivot waves were anchored to the longitudinal block region and produced both tachycardia and paradoxical bradycardia (due to exit block), despite an atrial ECG morphology identical to regular sinus rhythm. Intranodal longitudinal conduction blocks coincided with interstitial fibrosis strands that were exaggerated in the MI SAN pacemaker complex (fibrosis density: 37±7% MI versus 23±6% control; P<0.001). CONCLUSIONS Both tachy- and brady-arrhythmias can result from SAN micro-reentry. Postinfarction remodeling, including increased intranodal fibrosis and heterogeneity of refractoriness, provides substrates for SAN reentry.
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Affiliation(s)
- Alexey V Glukhov
- Department of Physiology and Cell Biology, College of Veterinary Medicine, Division of Cardiovascular Medicine, and College of Pharmacy, College of Medicine, Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH
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Madsen CP, Klausen TK, Fabian A, Hansen BJ, Pedersen SF, Hoffmann EK. On the role of TRPC1 in control of Ca2+ influx, cell volume, and cell cycle. Am J Physiol Cell Physiol 2012; 303:C625-34. [PMID: 22744003 DOI: 10.1152/ajpcell.00287.2011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ca(+) signaling plays a crucial role in control of cell cycle progression, but the understanding of the dynamics of Ca(2+) influx and release of Ca(2+) from intracellular stores during the cell cycle is far from complete. The aim of the present study was to investigate the role of the free extracellular Ca(2+) concentration ([Ca(2+)](o)) in cell proliferation, the pattern of changes in the free intracellular Ca(2+) concentration ([Ca(2+)](i)) during cell cycle progression, and the role of the transient receptor potential (TRP)C1 in these changes as well as in cell cycle progression and cell volume regulation. In Ehrlich Lettré Ascites (ELA) cells, [Ca(2+)](i) decreased significantly, and the thapsigargin-releasable Ca(2+) pool in the intracellular stores increased in G(1) as compared with G(0). Store-depletion-operated Ca(2+) entry (SOCE) and TRPC1 protein expression level were both higher in G(1) than in G(0) and S phase, in parallel with a more effective volume regulation after swelling [regulatory volume decrease (RVD)] in G(1) as compared with S phase. Furthermore, reduction of [Ca(2+)](o), as well as two unspecific SOCE inhibitors, 2-APB (2-aminoethyldiphenyl borinate) and SKF96365 (1-(β-[3-(4-methoxy-phenyl)propoxyl-4-methoxyphenethyl)1H-imidazole-hydrochloride), inhibited ELA cell proliferation. Finally, Madin-Darby canine kidney cells in which TRPC1 was stably silenced [TRPC1 knockdown (TRPC1-KD) MDCK] exhibited reduced SOCE, slower RVD, and reduced cell proliferation compared with mock controls. In conclusion, in ELA cells, SOCE and TRPC1 both seem to be upregulated in G(1) as compared with S phase, concomitant with an increased rate of RVD. Furthermore, TRPC1-KD MDCK cells exhibit decreased SOCE, decreased RVD, and decreased proliferation, suggesting that, at least in certain cell types, TRPC1 is regulated during cell cycle progression and is involved in SOCE, RVD, and cell proliferation.
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Affiliation(s)
- C P Madsen
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
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Hansen BJ, Robbins FM, Adams S, Byrne KM, Lee H, Stroncek DF. Identification of a KEL7 subtype: implications for genotyping red blood cell Js(a) and Js(b) antigens. Transfus Med 2006; 16:445-6. [PMID: 17163877 DOI: 10.1111/j.1365-3148.2006.00689.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Buchwald H, Varco RL, Boen JR, Williams SE, Hansen BJ, Campos CT, Campbell GS, Pearce MB, Yellin AE, Edmiston WA, Smink RD, Sawin HS. Effective lipid modification by partial ileal bypass reduced long-term coronary heart disease mortality and morbidity: five-year posttrial follow-up report from the POSCH. Program on the Surgical Control of the Hyperlipidemias. Arch Intern Med 1998; 158:1253-61. [PMID: 9625405 DOI: 10.1001/archinte.158.11.1253] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND In 1990, when the Program on the Surgical Control of the Hyperlipidemias (POSCH) reported its in-trial results strongly supporting the conclusion that effective lipid modification reduces progression of atherosclerosis, the differences for the end points of overall mortality and mortality from atherosclerotic coronary heart disease (ACHD) did not reach statistical significance. METHODS The Program on the Surgical Control of the Hyperlipidemias recruited men and women with a single documented myocardial infarction between the ages of 30 and 64 years who had a plasma cholesterol level higher than 5.69 mmol/L (220 mg/dL) or higher than 5.17 mmol/L (200 mg/dL) if the low-density lipoprotein cholesterol level was in excess of 3.62 mmol/L (140 mg/dL). Between 1975 and 1983, 838 patients were randomized: 417 to the diet control group and 421 to the diet plus partial ileal bypass intervention group. Mean patient follow-up for this 5-year posttrial report was 14.7 years (range, 12.2-20 years). RESULTS At 5 years after the trial, statistical significance was obtained for differences in overall mortality (P = .049) and mortality from ACHD (P = .03). Other POSCH end points included overall mortality (left ventricular ejection fraction > or =50%) (P = .01), mortality from ACHD (left ventricular ejection fraction > or =50%) (P = .05), mortality from ACHD and confirmed nonfatal myocardial infarction (P<.001), confirmed nonfatal myocardial infarction (P<.001), mortality from ACHD, confirmed and suspected myocardial infarction and unstable angina (P<.001), incidence of coronary artery bypass grafting or percutaneous transluminal coronary angioplasty (P<.001), and onset of clinical peripheral vascular disease (P = .02). There were no statistically significant differences between groups for cerebrovascular events, mortality from non-ACHD, and cancer. All POSCH patients have been available for follow-up. CONCLUSION At 5 years after the trial, all POSCH mortality and atherosclerosis end points, including overall mortality and mortality from ACHD, demonstrated statistically significant differences between the study groups.
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Affiliation(s)
- H Buchwald
- Department of Surgery, University of Minnesota, Minneapolis 55455, USA
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Buchwald H, Hunter DW, Tuna N, Williams SE, Boen JR, Hansen BJ, Titus JL, Campos CT. Myocardial infarction and percent arteriographic stenosis of culprit lesion: report from the Program on the Surgical Control of the Hyperlipidemias (POSCH). Atherosclerosis 1998; 138:391-401. [PMID: 9690924 DOI: 10.1016/s0021-9150(98)00049-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The objective of this study was to assess the percent stenosis of the culprit lesion responsible for subsequent myocardial infarction in the Program on the Surgical Control of the Hyperlipidemias (POSCH). It is unknown if the susceptible coronary artery culprit lesion responsible for an acute myocardial infarction is relatively large ( > or = 50% arteriographic stenosis) and hemodynamically significant ( > or = 70% stenosis), or small ( < 50%, stenosis) and asymptomatic. Certain necropsy and arteriography studies support the large progenitor lesion concept, and other arteriography studies support the small lesion hypothesis. We analyzed the coronary arteriogram immediately preceding a Q wave (transmural) myocardial infarction for the degree of stenosis of the suspected culprit lesion, which was selected by visual inspection of the coronary circulation supplying the electrocardiogram-defined area of myocardial infarction. There was no perceptible difference with respect to vessel segment distribution of culprit lesions or time to infarction between the 52 control-group patients and the 27 intervention-group patients. For the two groups combined (n=79), the predominantly involved segments were the middle right coronary artery and the proximal left anterior descending coronary artery. The time interval from the preceding coronary arteriogram closest to the index myocardial infarction ranged from 0 days to 10 years; however, 64.6% of the arteriograms were performed 2 years or less prior to the myocardial infarction. Only 5.1% of the patients in both groups combined had a culprit lesion stenosis < 50%, while 88.6% of the patients in both groups combined had a culprit lesion stenosis > or = 70%. The results strongly favor the large lesion hypothesis of causation for myocardial infarction. It is premature, however, to state that the relative size of the culprit lesion has been indisputably determined. The resolution of this problem has exceedingly important practical implications for the management of patients with known atherosclerotic coronary heart disease and for those asymptomatic individuals with silent atherosclerotic coronary heart disease.
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Affiliation(s)
- H Buchwald
- Department of Surgery, University of Minnesota, St. Paul, USA.
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Hansen BJ, Mortensen S, Mensink HJ, Flyger H, Riehmann M, Hendolin N, Nordling J, Hald T. Comparison of the Danish Prostatic Symptom Score with the International Prostatic Symptom Score, the Madsen-Iversen and Boyarsky symptom indexes. ALFECH Study Group. Br J Urol 1998; 81:36-41. [PMID: 9467474 DOI: 10.1046/j.1464-410x.1998.00524.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare the Danish Prostatic Symptom Score (DAN-PSS) with the International Prostatic Symptom Score (IPSS). Madsen-Iversen and Boyarsky symptom indexes in a clinical setting, and to evaluate the potential significance of any differences in information obtained from these questionnaires. PATIENTS AND METHODS The study comprised two substudies: in the first, 205 patients with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO), a Madsen-Iversen score > 6 and a maximum flow rate of < 10 mL/s were randomized to receive either placebo or alfuzosin in a double-blind study of 16 weeks. The symptoms were assessed using the Madsen-Iversen, DAN-PSS and the IPSS questionnaires. In the second, 138 patients with LUTS suggestive of BOO were selected for treatment with transurethral microwave thermotherapy (TUMT, 52 degrees C for 60 min, microwave energy 200 kJ) and their symptoms assessed using the Boyarsky and the DAN-PSS questionnaires. Patients were then followed for one year. Rank correlation coefficients and regression lines were calculated using Spearman's non-parametric test. The relative changes, i.e. responsiveness, calculated for the DAN-PSS, IPSS and Boyarsky indexes were compared pairwise using the Wilcoxon-Pratt test. RESULTS The DAN-PSS, IPSS and Madsen-Iversen indexes were correlated on a pairwise basis. The DAN-PSS and IPSS indexes have significant construct validity in terms of correlation with the Madsen-Iversen system (Spearman's correlation coefficient, rs = 0.51 and rs = 0.45, respectively). The DAN-PSS and the IPSS indexes were correlated (rs = 0.61). The DAN-PSS was more sensitive than the IPSS to changes after pharmacological treatment, with scores decreasing 70% and 29% (P < 0.05), respectively, after treatment with an alpha-blocker for 4 months, and 50% and 29% (P < 0.05), respectively, after 4 months on placebo treatment. Finally, the responsiveness of the Boyarsky and DAN-PSS indexes to TUMT showed that the DAN-PSS system was significantly more responsive than the Boyarsky index, with scores decreasing 57% and 15% (P < 0.05), respectively, after one year. CONCLUSIONS The DAN-PSS index is more sensitive than the IPSS, Madsen-Iversen and Boyarsky symptom indexes, incorporates important outcome events, includes a patient-weighting of each symptom, thereby reflecting better the patients' global assessment of outcome.
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Hansen BJ. Calculation of Quasi-IPSS index. Urology 1997; 50:483-4. [PMID: 9301728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Hansen BJ, Flyger HL, Brasso K, Schou J, Nordling J, Andersen JT, Mortensen SO, Meyhoff HH, Walter S, Hald T. [Validation of the patient-administered Danish Prostate Symptom Score Schedule]. Ugeskr Laeger 1997; 159:591-7. [PMID: 9045449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The DAN-PSS-1 system, a self-administered quality-of-life questionnaire comprising 12 questions related to voiding problems and the perceived bother of each individual symptom, was compared to other extensively used score systems and furthermore included in different clinical situations so as to validate the system. The system was internally consistent (alpha cr = 0.73), the median test-retest reliability of answers to each question was 83.5% (range 0-99.7%). A high degree of construct validity demonstrated in the correlation with the Madsen-Iversen score system (rs = 0.51) and with the patients' answers to questions about how bothersome their symptoms were (rs = 0.71). The discriminant validity of the DAN-PSS-1 was excellent with an area under the ROC curve of 0.94. Finally, the DAN-PSS-1 was sensitive to changes following intervention, with scores decreasing 100% after transurethral prostatectomy and 65% after four months of treatment with an alpha-blocker. The DAN-PSS-1 is reliable, valid and responsive, and therefore can be recommended for assessing the severity of symptoms among patients presenting with lower urinary tract complaints suggestive of BPH and during follow-up.
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Affiliation(s)
- B J Hansen
- Urologisk afdeling, H:S Bispebjerg Hospital
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Affiliation(s)
- M Riehmann
- Department of Urology, Herlev Hospital, University of Copenhagen, Denmark
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Hansen BJ, Meyhoff HH, Nordling J, Mensink HJ, Mogensen P, Larsen EH. Placebo effects in the pharmacological treatment of uncomplicated benign prostatic hyperplasia. The ALFECH Study Group. Scand J Urol Nephrol 1996; 30:373-7. [PMID: 8936626 DOI: 10.3109/00365599609181313] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In order to establish accurately the exact effect of any drug therapy for symptomatic benign prostatic hyperplasia (BPH) it is important to define the effect of placebo treatment. This effect was assessed by throughly analyzing the placebo arm, which included 101 patients, from a randomized, double-blind, placebo-controlled trial of the selective alpha-blocker alfuzosin and comparing the data with those of a variety of independent studies which followed a placebo group of patients with clinical BPH. Following 16 weeks of placebo treatment a decrease of 24% (p < 0.05) in Madsen-Iversen score and an increase of 14% (p < 0.05) in peak flow rate was demonstrated. The percentages of patients who reported worsening, improvement or no change in symptoms were 9.2%, 73.6% and 17.2% respectively. The maximal effect of placebo, approximately 40% reduction in symptom scores, is likely to be achieved within the first four to six months. After this, the placebo effect stabilizes and gradually wears off but is still present following 12 months of treatment. The duration of the placebo effect and the time until it has totally worn off, if ever, remains to be studied in long-term, placebo-controlled trials, including an untreated cohort. The present study emphasizes the importance of properly designed, double-blind, placebo-controlled studies in evaluating any pharmacological intervention in clinical BPH.
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Affiliation(s)
- B J Hansen
- Department of Urology, Bispebjerg Hospital, Denmark
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Hansen BJ. Re: Alpha-blockade in the treatment of symptomatic benign prostatic hyperplasia. J Urol 1996; 156:184-5. [PMID: 8648797 DOI: 10.1016/s0022-5347(01)65991-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Hansen BJ. [Problems with urination?]. Ugeskr Laeger 1996; 158:2999-3000. [PMID: 8686043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Hansen BJ, Flyger H, Mortensen S, Mensink HJ, Meyhoff HH. Symptomatic outcome of transurethral prostatectomy, alpha-blockade and placebo in the treatment of benign prostatic hyperplasia. Evaluation of treatment with the Danish Prostatic Symptom Score (DAN-PSS-1) system. The ALFECH Study Group. Scand J Urol Nephrol 1996; 30:103-7. [PMID: 8738054 DOI: 10.3109/00365599609180898] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
To assess the symptomatic outcome following transurethral prostatectomy (TURP), alpha-blockade and placebo treatment in uncomplicated benign prostatic hyperplasia (BPH), 260 patients were evaluated with the recently formulated Danish Prostatic Symptom Score (DAN-PSS-1) system: 205 were randomized to either the selective alpha-blocker alfuzosin or placebo and 55 underwent TURP. Following TURP, the DAN-PSS-1 score was reduced by 80% after 6-10 weeks (visit 2) and by 100% after 12-16 weeks (visit 3). In the alfuzosin group the corresponding reductions were 40% and 65% (p < 0.02 vs. placebo). In the placebo group the reduction was 25% at visit 2, with no further fall demonstrated thereafter. During alfuzosin treatment the bother score (impact of symptoms on quality of life) fell more than the symptom score. During placebo treatment there was no reduction in symptom score. We conclude that the DAN-PSS-1 questionnaire sensitively identifies clinically important responses to treatment of BPH.
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Affiliation(s)
- B J Hansen
- Department of Urology, Bispebjerg Hospital, Denmark
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Hansen BJ, Flyger H, Brasso K, Schou J, Nordling J, Thorup Andersen J, Mortensen S, Meyhoff HH, Walter S, Hald T. Validation of the self-administered Danish Prostatic Symptom Score (DAN-PSS-1) system for use in benign prostatic hyperplasia. Br J Urol 1995; 76:451-8. [PMID: 7551880 DOI: 10.1111/j.1464-410x.1995.tb07744.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To validate the Danish Prostatic Symptom Score (DAN-PSS-1), a self-administered quality-of-life questionnaire comprising 12 questions related to voiding problems and the perceived bother of each individual symptom. METHODS Using published results from several comparisons of other symptom scoring systems with DAN-PSS-1, the test-retest reliability, internal consistency, construct and content validity, and responsiveness of the DAN-PSS-1 system were assessed. RESULTS The system was internally consistent (Cronbach's alpha = 0.73), the median test-retest reliability of answers to each question was 83.5% (range 0-99.7%) and the questionnaire was well understood by the patients. The DAN-PSS-1 system demonstrated a high degree of construct validity, correlating with the extensively used Madsen-Iversen score system (Spearman's correlation coefficient, rs = 0.51) and with the patients' answers to questions about how bothersome their symptoms were (rs = 0.71). The DAN-PSS-1 system discriminated clearly between patients with benign prostatic hyperplasia (BPH) and control subjects (an area under the receiver operating characteristic curve of 0.94). Finally, the DAN-PSS-1 was sensitive to changes following intervention, with scores decreasing from a median of 20 to zero 4 months after patients underwent transurethral prostatectomy and from a median of 11.5 to 7.5 (65%) after patients had received 4 months treatment with an alpha-blocker. CONCLUSIONS The DAN-PSS-1 system is reliable, valid and responsive, and therefore can be recommended for assessing the severity of symptoms among patients presenting with lower urinary tract complaints suggestive of BPH and in the follow-up after intervention.
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Affiliation(s)
- B J Hansen
- Department of Urology, Bispebjerg Hospital, Copenhagen, Denmark
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Cintin C, Hansen BJ, Joffe P. [Giant fecaloma]. Ugeskr Laeger 1994; 156:6703-4. [PMID: 7839486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A case of a giant faecaloma of the sigmoid colon secondary to surgery is reported. The predisposing factors, the diagnostic and therapeutic approaches are discussed.
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Affiliation(s)
- C Cintin
- Medicinsk gastroenterologisk afdeling, Hvidovre Hospital, København
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Hansen BJ, Nordling J, Mensink HJ, Walter S, Meyhoff HH. Alfuzosin in the treatment of benign prostatic hyperplasia: effects on symptom scores, urinary flow rates and residual volume. A multicentre, double-blind, placebo-controlled trial. ALFECH Study Group. Scand J Urol Nephrol Suppl 1994; 157:169-176. [PMID: 7524141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
In order to assess the efficacy and safety of alfuzosin, a selective alpha-1 receptor antagonist, 205 patients with Benign Prostatic Hyperplasia (BPH) were randomly assigned in a double-blind, placebo-controlled manner, to receive either alfuzosin 2.5 mg TID or placebo TID during 12 weeks. After 12 weeks symptom scores-assessed according to the Madsen-Iversen scale were significantly reduced in the alfuzosin group and peak flow rate significantly increased compared to the placebo group. There were no significant differences concerning adverse events or withdrawals. Alfuzosin proved to have a beneficial effect in patients with symptomatic BPH with few and minor adverse events.
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Affiliation(s)
- B J Hansen
- Department of Urology, Bispebjerg Hospital, Copenhagen, Denmark
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Hansen BJ, Hvidt V. [Finasteride. A new 5 alpha reductase inhibitor registered for treatment of benign prostatic hypertrophy with the purpose of avoiding or postponing surgery]. Ugeskr Laeger 1993; 155:4110-2. [PMID: 7505966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- B J Hansen
- Urologisk afdeling KUR, Bispebjerg Hospital, København
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Buchwald H, Fitch LL, Matts JP, Johnson JW, Hansen BJ, Stuenkel MR, Brooks HB. Perception of quality of life before and after disclosure of trial results: a report from the Program on the Surgical Control of the Hyperlipidemias (POSCH). Control Clin Trials 1993; 14:500-10. [PMID: 8119065 DOI: 10.1016/0197-2456(93)90030-h] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The Program on the Surgical Control of the Hyperlipidemias (POSCH) was a randomized controlled clinical trial designed to ascertain whether cholesterol lowering induced by the partial ileal bypass operation would favorably affect overall mortality and the mortality and morbidity due to coronary heart disease. The trial results provided strong clinical and coronary arteriographic support for the beneficial effects of lipid modification for the reduction of atherosclerosis progression. At the same time, the surgery-assigned group experienced diarrhea and an increased incidence of kidney stones and gallstones compared to the control-assigned group. Identical quality of life determinations were performed in the POSCH study population shortly before disclosure of the trial results to the patients and shortly thereafter. The purpose of this dual assessment was to evaluate the effect of knowledge of outcomes on the patients' subjective evaluation of quality of life. The primary instrument utilized for analysis of the perception of quality of life in POSCH was the McMasters Health Index Questionnaire (MHIQ). In addition, four study-specific questions were asked of the trial patients. The results for the MHIQ before disclosure of trial results showed a difference (p = 0.07) favoring the control-assigned group (diet-treated), for the social function index of the MHIQ. After disclosure of the trial results, the difference was larger (p < 0.05). For the four study-specific questions, all differences favored the control-assigned group (p < 0.01) before and after disclosure of the trial results, with the exception of satisfaction with randomization allocation in the surgery-assigned group (p = 0.08). The intragroup MHIQ indices before and after disclosure of the trial results showed no suggestive significant differences, except in the surgery-assigned group, in which there was an improvement in the emotional function index after disclosure of the trial results (p = 0.03). The intragroup responses to the study-specific questions before and after disclosure of the trial results again showed no significant differences, except in the surgery-assigned group, in which there was an improvement in patient satisfaction with randomization allocation after disclosure of the trial results (p = 0.04).(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- H Buchwald
- Department of Surgery, University of Minnesota, Minneapolis 55455
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Abstract
The pathogenesis of persistent postoperative hiccups is not known. Hiccups can present as a symptom of a subphrenic abscess of gastric distention, and metabolic alterations may also cause hiccups. The hiccups may develop because of increased activity in neural reflex pathways not yet fully defined. Numerous treatment modalities have been tried but with questionable success. Valproate has proven effective in two trials investigating persistent non-surgical hiccups. The simple application of a nasogastric tube may successfully treat the hiccups, possibly because of an alteration of the activity in the reflex neural pathways involved. The available literature on the treatment of persistent hiccups is reviewed, and a treatment protocol for persistent postoperative hiccups is provided.
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Affiliation(s)
- B J Hansen
- Department of Surgical Gastroenterology, Hvidovre University Hospital, Denmark
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Abstract
Over the last 5-10 years new treatment modalities have appeared at an increasing pace. The emerging pharmacological treatment modalities have all been used on a large scale. The exact indications and limitations of these methods have not yet been definitely established. Careful analysis of the symptomatology is crucial in counselling the patient. The Danish prostatic symptom score model is proposed. However, treatment benefits should exceed harm and there must be a reasonable cost-effectiveness. The established clinical experience with pharmacological agents that reduce prostatic size and/or the tone in the prostate are effective in the treatment of benign prostatic hyperplasia. Selective alpha 1 blockers seem to be useful in patients with uncomplicated benign prostatic hyperplasia and mild to moderate symptoms. The side effects of hormone therapy are inhibitive for use in patients with a benign disease. Data currently available indicate a role for 5 alpha-reductase inhibitors yet to be defined.
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Affiliation(s)
- B J Hansen
- Department of Urology, Bispebjerg Hospital, University of Copenhagen, Denmark
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