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Kahnert K, Soattin L, Mills RW, Wilson C, Maurya S, Sorrentino A, Al-Othman S, Tikhomirov R, van de Vegte YJ, Hansen FB, Achter J, Hu W, Zi M, Smith M, van der Harst P, Olesen MS, Olsen KB, Banner J, Jensen THL, Zhang H, Boyett MR, D'Souza A, Lundby A. Proteomics couples electrical remodelling to inflammation in a murine model of heart failure with sinus node dysfunction. Cardiovasc Res 2024:cvae054. [PMID: 38661182 DOI: 10.1093/cvr/cvae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 04/26/2024] Open
Abstract
AIMS In patients with heart failure (HF), concomitant sinus node dysfunction (SND) is an important predictor of mortality, yet its molecular underpinnings are poorly understood. Using proteomics, this study aimed to dissect the protein and phosphorylation remodelling within the sinus node in an animal model of HF with concurrent SND. METHODS AND RESULTS We acquired deep sinus node proteomes and phosphoproteomes in mice with heart failure and SND and report extensive remodelling. Intersecting the measured (phospho)proteome changes with human genomics pharmacovigilance data, highlighted downregulated proteins involved in electrical activity such as the pacemaker ion channel, Hcn4. We confirmed the importance of ion channel downregulation for sinus node physiology using computer modelling. Guided by the proteomics data, we hypothesized that an inflammatory response may drive the electrophysiological remodeling underlying SND in heart failure. In support of this, experimentally induced inflammation downregulated Hcn4 and slowed pacemaking in the isolated sinus node. From the proteomics data we identified proinflammatory cytokine-like protein galectin-3 as a potential target to mitigate the effect. Indeed, in vivo suppression of galectin-3 in the animal model of heart failure prevented SND. CONCLUSION Collectively, we outline the protein and phosphorylation remodeling of SND in heart failure, we highlight a role for inflammation in electrophysiological remodelling of the sinus node, and we present galectin-3 signalling as a target to ameliorate SND in heart failure.
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Affiliation(s)
- Konstantin Kahnert
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Luca Soattin
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Robert W Mills
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Claire Wilson
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
| | - Svetlana Maurya
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Andrea Sorrentino
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Sami Al-Othman
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Roman Tikhomirov
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
- National Heart and Lung Institute, Imperial College London, Imperial Centre for Translational and Experimental Medicine (ICTEM), 72 Du Cane Road, London W12 0NN, UK
| | - Yordi J van de Vegte
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Finn B Hansen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Jonathan Achter
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Wei Hu
- Department of Physics & Astronomy, Biological Physics Group, University of Manchester, Manchester, UK
| | - Min Zi
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Matthew Smith
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
- National Heart and Lung Institute, Imperial College London, Imperial Centre for Translational and Experimental Medicine (ICTEM), 72 Du Cane Road, London W12 0NN, UK
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Durrer Center for Cardiogenetic Research, Netherlands Heart Institute, Utrecht, the Netherlands
| | - Morten S Olesen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Kristine Boisen Olsen
- Department of Forensic Medicine, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Jytte Banner
- Department of Forensic Medicine, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | | | - Henggui Zhang
- Department of Physics & Astronomy, Biological Physics Group, University of Manchester, Manchester, UK
| | - Mark R Boyett
- Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - Alicia D'Souza
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
- National Heart and Lung Institute, Imperial College London, Imperial Centre for Translational and Experimental Medicine (ICTEM), 72 Du Cane Road, London W12 0NN, UK
| | - Alicia Lundby
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
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Okumus NK, Zeitler EP, Moustafa A, Iglesias M, Khanna R, Rong Y, Karim S. Three-year incidence of pacemaker implantation in patients with atrial fibrillation and sinus node dysfunction receiving ablation versus antiarrhythmic drugs. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01790-2. [PMID: 38632136 DOI: 10.1007/s10840-024-01790-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/11/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Sinus node dysfunction (SND) is commonly seen in patients with atrial fibrillation (AF). The purpose of this study was to compare the incidence of pacemaker implantation among patients with SND and AF treated with catheter ablation (CA) versus anti-arrhythmic drugs (AADs). METHODS The 2013-2022 Optum Clinformatics database, an administrative claims database for commercially insured individuals in the United States (US), was used for this study. Patients with AF and SND and a history of at least one AAD prescription were identified and classified into CA or AAD cohorts based on subsequent treatment received. Inverse probability treatment weighting was applied to balance socio-demographic and clinical characteristics between the cohorts. Weighted Cox regression modeling was used to evaluate the differential risk of incident permanent pacemaker (PPM) implantation. Sub-analyses were performed by AF type (paroxysmal versus persistent). RESULTS A total of 1206 patients in the AAD cohort and 1624 patients in the CA cohort were included. Study cohorts were well-balanced post-weighting. The incidence rate of PPM implantation (per 1000 person-year) was 55.8 for the CA cohort and 117.8 for the AAD cohort. Regression analysis demonstrated that the CA cohort had 42% lower risk of incident PPM implantation than those treated with AADs (hazard ratio [HR], 0.58; 95% CI, 0.46-0.72, p < 0.001). CA-treated patients had lower risks of PPM implantation versus AAD-treated patients among those with paroxysmal AF (HR, 0.48; 95% CI, 0.34-0.69, p < 0.001) and persistent AF (HR, 0.57; 95% CI, 0.40-0.81, p = 0.002). CONCLUSIONS Patients with AF and SND treated with CA have significantly lower risks of incident PPM implantation compared with those treated with an AAD.
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Affiliation(s)
| | | | | | - Maximiliano Iglesias
- Franchise Health Economics and Market Access, Johnson & Johnson, Irvine, CA, USA
| | - Rahul Khanna
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, NJ, USA
| | - Yiran Rong
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, NJ, USA
| | - Saima Karim
- Heart and Vascular Institute, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Dr, Cleveland, OH, USA.
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3
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William J, Nanayakkara S, Chieng D, Sugumar H, Ling LH, Patel H, Mariani J, Prabhu S, Kistler PM, Voskoboinik A. Predictors of pacemaker requirement in patients receiving implantable loop recorders for unexplained syncope: A systematic review and meta-analysis. Heart Rhythm 2024:S1547-5271(24)00284-4. [PMID: 38508296 DOI: 10.1016/j.hrthm.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/12/2024] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Implantable loop recorders (ILRs) are increasingly used to evaluate patients with unexplained syncope. Identification of all predictors of bradycardic syncope and consequent permanent pacemaker (PPM) insertion is of substantial clinical interest as patients in the highest risk category may benefit from upfront pacemaker insertion. OBJECTIVE We performed a systematic review and meta-analysis to identify risk predictors for PPM insertion in ILR recipients with unexplained syncope. METHODS An electronic database search (MEDLINE, Embase, Scopus, Cochrane) was performed in June 2023. Studies evaluating ILR recipients with unexplained syncope and recording risk factors for eventual PPM insertion were included. A random effects model was used to calculate the pooled odds ratio (OR) for clinical and electrocardiographic characteristics with respect to future PPM requirement. RESULTS Eight studies evaluating 1007 ILR recipients were included; 268 patients (26.6%) underwent PPM insertion during study follow-up. PPM recipients were older (mean age, 70.2 ± 15.4 years vs 61.6 ± 19.7 years; P < .001). PR prolongation on baseline electrocardiography was a significant predictor of PPM requirement (pooled OR, 2.91; 95% confidence interval, 1.63-5.20). The presence of distal conduction system disease, encompassing any bundle branch or fascicular block, yielded a pooled OR of 2.88 for PPM insertion (95% confidence interval, 1.53-5.41). Injurious syncope and lack of syncopal prodrome were not significant predictors of PPM insertion. Sinus node dysfunction accounted for 62% of PPM insertions, whereas atrioventricular block accounted for 26%. CONCLUSION Approximately one-quarter of ILR recipients for unexplained syncope require eventual PPM insertion. Advancing age, PR prolongation, and distal conduction disease are the strongest predictors for PPM requirement.
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Affiliation(s)
- Jeremy William
- The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - Shane Nanayakkara
- The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - David Chieng
- The Alfred Hospital, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - Hariharan Sugumar
- The Alfred Hospital, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - Liang-Han Ling
- The Alfred Hospital, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - Hitesh Patel
- The Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Sandeep Prabhu
- The Alfred Hospital, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - Peter M Kistler
- The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Aleksandr Voskoboinik
- The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia.
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Schulze-Bahr E. [Cardiogenetics in Germany- a view and review]. Herzschrittmacherther Elektrophysiol 2024; 35:127-137. [PMID: 38418599 PMCID: PMC10924006 DOI: 10.1007/s00399-024-01008-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/01/2024]
Abstract
The development of the cardiogenetics field in Germany has been increasing since the mid-1990s with many national contributions, some of them were really important and groundbreaking. The starting point was and still is the patient and his family, e.g. with a familial form of arrhythmia or cardiomyopathy, the clarification of the genetic cause and the personalized treatment of those being affected. The scientific, always translationally oriented interest in identifying a causative gene and uncovering the underlying pathomechanisms has led to notable contributions for Brugada syndrome, short QT syndrome and cardiac conduction disorders or sinus node dysfunction, but also in DCM or ARVC. What is important, however, is always the way back (bench > bed side): implementation of national and international recommendations for cardiogenetic diagnostics in daily cardiological routine and the personalized care and therapy of those being affected.
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Affiliation(s)
- E Schulze-Bahr
- Institut für Genetik von Herzerkrankungen (IfGH), Spezialambulanz für Patienten mit genetischen Herzerkrankungen, Universitätsklinikum Münster (UKM), Domagkstr. 3, 48145, Münster, Deutschland.
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Padda I, Sebastian SA, Khehra N, Mahtani A, Sethi Y, Panthangi V, Fulton M, Bandyopadhyay D, Johal G. Tachy-brady syndrome: Electrophysiology and evolving principles of management. Dis Mon 2024; 70:101637. [PMID: 37690863 DOI: 10.1016/j.disamonth.2023.101637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Sudden alterations in the heart rate may be associated with diverse symptoms. Sinus node dysfunction (SND), also known as sick sinus syndrome, is a sinoatrial (SA) node disorder. SND is primarily caused by the dysfunction of the pacemaker, as well as impaired impulse transmission resulting in a multitude of abnormalities in the heart rhythms, such as bradycardia-tachycardia, atrial bradyarrhythmias, and atrial tachyarrhythmias. The transition from bradycardia to tachycardia is generally referred to as "tachy-brady syndrome" (TBS). Although TBS is etiologically variable, the manifestations remain consistent throughout. Abnormal heart rhythms have the propensity to limit tissue perfusion resulting in palpitations, fatigue, lightheadedness, presyncope, and syncope. In this review, we examine the physiology of tachy-brady syndrome, the practical approach to its diagnosis and management, and the role of adenosine in treating SND.
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Affiliation(s)
- Inderbir Padda
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA.
| | | | - Nimrat Khehra
- Saint James School of Medicine, Arnos Vale, Saint Vincent and the Grenadines
| | - Arun Mahtani
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA
| | - Yashendra Sethi
- Department of Internal Medicine, Government Doon Medical College, Dehradun, India
| | | | - Matthew Fulton
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA
| | | | - Gurpreet Johal
- Department of Cardiology, University of Washington, Valley Medical Center, Seattle, WA, USA
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Yang EL, Evers PD, Long MJ, Mostafavifar M, Balaji S. Impact of Atrial Pacing in Fontan Patients with Junctional Rhythm: A Prospective Echocardiographic Study. Pediatr Cardiol 2024; 45:361-367. [PMID: 38062259 DOI: 10.1007/s00246-023-03345-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/03/2023] [Indexed: 01/28/2024]
Abstract
Sinus node dysfunction (SND) with junctional rhythm (JR) is common after the Fontan operation. Atrial pacing (AP) restores atrioventricular (AV) synchrony, but the placement of a pacemaker carries significant morbidity. To study the impact of AP on echocardiographic parameters of function in Fontan patients with SND and JR. Nine Fontan patients with AP for SND and JR were prospectively studied with echocardiography in the following conditions-baseline paced rhythm, underlying JR and, if possible, slow-paced rhythm below their baseline paced rate (~ 10 bpm faster than their JR rate). Cardiac index was significantly lower in JR (3 ± 1.1 L/min/m2) vs AP (4.2 ± 1.4 L/min/m2; p = 0.002). Diastolic function also significantly worsened with increased ratio of early diastolic systemic AV valve inflow velocity to early diastolic systemic AV valve annulus velocity (E/e' ratio) by tissue Doppler imaging (TDI) in JR (11.6 ± 4.6) vs AP (8.8 ± 2.2, p = 0.016). Pulmonary venous flow reversal was present in 7/9 patients in JR vs 0/9 in AP (p = 0.016). There were no significant differences in these echocardiographic measurements between the paced and slow-paced conditions. When compared to AP, JR was associated with a significant reduction in cardiac output and diastolic function, and an increased prevalence of pulmonary vein flow reversal. There were no differences between paced and slow-paced conditions, suggesting that AV synchrony rather than heart rate was primarily contributing to cardiac output. Further studies are needed to understand the chronic impact of JR on Fontan outcomes.
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Affiliation(s)
- Emily L Yang
- Division of Pediatric Cardiology, Oregon Health and Science University, 707 SW Gaines Street, Mail code: CDRC-P, Portland, OR, 97239, USA.
| | - Patrick D Evers
- Division of Pediatric Cardiology, Oregon Health and Science University, 707 SW Gaines Street, Mail code: CDRC-P, Portland, OR, 97239, USA
| | - Mia J Long
- Division of Pediatric Cardiology, Oregon Health and Science University, 707 SW Gaines Street, Mail code: CDRC-P, Portland, OR, 97239, USA
| | - Mina Mostafavifar
- Division of Pediatric Cardiology, Oregon Health and Science University, 707 SW Gaines Street, Mail code: CDRC-P, Portland, OR, 97239, USA
| | - Seshadri Balaji
- Division of Pediatric Cardiology, Oregon Health and Science University, 707 SW Gaines Street, Mail code: CDRC-P, Portland, OR, 97239, USA
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Gowani Z, Tomashitis B, Ospina MK, Waring A, Northup A, Ramu B, Van Bakel A, Gregoski M, Anderson J, Gold MR. Need for cardiac implantable electronic devices and long-term follow-up in recipients of orthotopic heart transplants. Heart Rhythm 2024; 21:153-160. [PMID: 37879547 DOI: 10.1016/j.hrthm.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Cardiac pacemaker implantation after orthotopic heart transplantation declined dramatically after development of the bicaval anastomosis technique. However, much less is known about the rate, indications, and predictors of device implantation procedures with the current surgical technique. OBJECTIVE The purpose of this study was to evaluate the indications, patient characteristics, incidence, and survival related to cardiac implantable electronic device (CIED) implantation after heart transplantation. METHODS This was a single-center study of 399 consecutive adult recipients of orthotopic heart transplants with bicaval anastomosis from 1991 to 2017. The primary end point was freedom from pacemaker or implantable cardioverter-defibrillator (ICD) implantation, and the secondary end point was all-cause mortality. RESULTS At the time of transplantation, the mean age of recipients was 50 ± 12 years and that of donors 31 ± 12 years. CIEDs were implanted in 8% of recipients (n = 31): 11 pacemakers (35%) for sinus node dysfunction, 17 (55%) for high-grade heart block, and 3 ICDs (10%) for the primary prevention of sudden cardiac death. Early CIED implantation (<30 days) was rare and absent for sinus node dysfunction. The risk for CIED implantation increased progressively during follow-up (0-30 years; median 11 years), with low-, moderate-, and high-risk periods between 0 and 10, between 10 and 20, and between 20 and 30 years, respectively. Recipients receiving CIEDs survived longer after transplantation (21 years vs 13 years; P < .01). Recipients receiving pacemakers for heart block were more likely to receive older donor hearts at the time of transplantation. CONCLUSION The risk of pacemaker implantation increases progressively, while ICD implantation is rare. Donor age is the predominant risk factor for subsequent heart block. Early sinus node dysfunction requiring permanent pacing is rare.
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Affiliation(s)
- Zain Gowani
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Brett Tomashitis
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Meg K Ospina
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Ashley Waring
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Amanda Northup
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Bhavadharini Ramu
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Adrian Van Bakel
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Mathew Gregoski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Julie Anderson
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Michael R Gold
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
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8
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Butensky AM, Patten WF, Silver ES, Liberman L. Oral Albuterol Treatment in Three Pediatric Patients with Bradycardia: A Novel Therapy. Pediatr Cardiol 2024; 45:441-445. [PMID: 38145427 DOI: 10.1007/s00246-023-03379-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/07/2023] [Indexed: 12/26/2023]
Abstract
Clinically significant bradycardia is an uncommon problem in children, but one that can cause significant morbidity and sometimes necessitates implantation of a pacemaker. The most common causes of bradycardia are complete heart block (CHB), which can be congenital or acquired, and sinus node dysfunction, which is rare in children with structurally normal hearts. Pacemaker is indicated as therapy for the majority of children with CHB, and while early mortality is lower in postnatally diagnosed CHB than in fetal CHB, it is still up to 16%. In young children, less invasive transvenous pacemaker systems can be technically challenging to place and carry a high risk of complications, often necessitating surgical epicardial pacemaker placement, which usually entails a median sternotomy. We report three cases of pediatric patients referred for pacemaker implantation for different types of bradycardia, treated at our institution with oral albuterol with therapeutic results that avoided the need for surgical pacemaker implantation at that time.
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Affiliation(s)
- Adam M Butensky
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
| | - William F Patten
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Eric S Silver
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Leonardo Liberman
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
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9
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Velayuthan R, Sukumar SK, Bootla D, Balaguru S, Anantharaj A, Satheesh S, Selvaraj RJ. Pacing mode survival in patients with single chamber atrial pacemaker for sinus node dysfunction. Indian Heart J 2024; 76:27-30. [PMID: 38070672 PMCID: PMC10943561 DOI: 10.1016/j.ihj.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 11/13/2023] [Accepted: 12/02/2023] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Single chamber atrial pacemaker should be sufficient for patients with sinus node dysfunction (SND) with normal atrioventricular (AV) conduction. However, most patients undergo dual chamber pacemaker implantation because of concern of new onset AV block. The annual incidence of new AV block has been reported from 0.6 to 4.4 % in various studies. OBJECTIVES Our aim is to assess mode survival in sinus node dysfunction with normal AV conduction patients implanted with AAIR. METHODS Patients who underwent single chamber atrial pacemaker implantation for SND with normal AV conduction between January 2014 and December 2021 were followed up for pacemaker device change, new onset AV block, bundle branch block, atrial fibrillation (AF), lead complications, reoperation and mortality rate. RESULTS A total of 113 patients underwent single chamber atrial pacemaker implantation for SND during the study period. Mean age was 55.6 ± 12.7 years. During a mean follow up of 48.7 ± 24.9 months, none of the patients required pacemaker device change to VVIR/DDDR. Nine patients underwent reoperation, 5 for lead dislodgment, 1 for high threshold, 1 for pocket site erosion and 3 for pulse generator change. None developed AV block or AF with slow ventricular rate. Only 4 patients developed AF (3 paroxysmal,1 permanent). There were 3 deaths during follow up and none were sudden deaths. CONCLUSION Single chamber atrial pacing is an acceptable mode of pacing in patients with SND in developing countries. Development of AV conduction abnormalities is rare in this relatively younger population.
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Affiliation(s)
- Ramanathan Velayuthan
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Suresh Kumar Sukumar
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Dinakar Bootla
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sridhar Balaguru
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Avinash Anantharaj
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Santhosh Satheesh
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raja J Selvaraj
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
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10
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Balaji S, Evers PD, Batra AS, Moore J. Management of Junctional Rhythm in Patients After the Fontan Operation: A Multicenter Congenital Cardiology Survey. Pediatr Cardiol 2024; 45:63-67. [PMID: 37740738 DOI: 10.1007/s00246-023-03296-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 09/05/2023] [Indexed: 09/25/2023]
Abstract
Sinus node dysfunction with concomitant junctional rhythm (JR) is frequently observed among Fontan patients and has been recognized as a contributor to heart failure. The impact and management of JR is unclear. A survey was mailed to all members of the Pediatric and Congenital Electrophysiology society (PACES) and members were asked to forward the questionnaire to their non-electrophysiology colleagues. Responses were received from 154 physicians (88 electrophysiologists (EP's) and 66 non-EP's (46 pediatric cardiologists and 20 adult congenital cardiologists). There were few differences in the response between EP's and non-EP's. Overall, 57% recommended an annual ambulatory ECG (AECG). A significant majority (80%) opted to continue to follow patients with significant periods of JR on AECG as long as the patients were asymptomatic, and showed no echocardiographic signs of cardiac decompensation. However, 84% would place a pacemaker in a patient with JR who was having open chest surgery for other reasons. Finally, pacemaker placement would be performed by 91% if a patient with JR showed signs of heart failure. Most congenital cardiologists would not recommend pacemaker placement in asymptomatic Fontan patients with JR. Further studies are needed on the Fontan population to determine the impact of SND and JR on longer term outcomes and to determine the role and optimal timing of pacemaker placement in these patients.
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Affiliation(s)
- Seshadri Balaji
- Division of Cardiology, Department of Pediatrics, Oregon Health & Science University, 707, SW Gaines Street, Mailcode: CDRC-P, Portland, OR, 97239, USA.
| | - Patrick D Evers
- Division of Cardiology, Department of Pediatrics, Oregon Health & Science University, 707, SW Gaines Street, Mailcode: CDRC-P, Portland, OR, 97239, USA
| | - Anjan S Batra
- Division of Cardiology, Department of Pediatrics, University of California, Irvine, CA, USA
| | - Jeremy Moore
- Division of Cardiology, Department of Pediatrics, University of California, Los Angeles, CA, USA
- Ahmanson/UCLA Adult Congenital Heart Disease Program, University of California, Los Angeles, CA, USA
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11
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Patsiou V, Haidich AB, Baroutidou A, Giannopoulos A, Giannakoulas G. Epicardial Versus Endocardial Pacing in Paediatric Patients with Atrioventricular Block or Sinus Node Dysfunction: A Systematic Review and Meta-analysis. Pediatr Cardiol 2023; 44:1641-1648. [PMID: 37480376 PMCID: PMC10520152 DOI: 10.1007/s00246-023-03213-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 01/26/2023] [Accepted: 06/14/2023] [Indexed: 07/24/2023]
Abstract
Pacing indications in children are clearly defined, but whether an epicardial (EPI) or an endocardial (ENDO) pacemaker performs better remains to be elucidated. This systematic review and meta-analysis aimed to directly compare the incidence of pacemaker (PM) lead-related complications, mortality, hemothorax and venous occlusion between EPI and ENDO in children with atrioventricular block (AVB) or sinus node dysfunction (SND). Literature search was conducted in MEDLINE (via PubMed), Scopus by ELSEVIER, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and OpenGrey databases until June 25, 2022. Random-effects meta-analyses were performed to assess the pacing method's effect on lead failure, threshold rise, post-implantation infection and battery depletion and secondarily on all-cause mortality, hemothorax and venous occlusion. Several sensitivity analyses were also performed. Of 22 studies initially retrieved, 18 were deemed eligible for systematic review and 15 for meta-analysis. Of 1348 pediatric patients that underwent EPI or ENDO implantation, 542 (40.2%) had a diagnosis of congenital heart disease (CHD). EPI was significantly associated with higher possibility of PM-lead failure [pooled odds ratio (pOR) 3.00, 95% confidence interval (CI) 2.05-4.39; I2 = 0%]; while possibility for threshold rise, post-implantation infection and battery depletion did not differ between the PM types. Regarding the secondary outcome, the mortality rates between EPI and ENDO did not differ. In sensitivity analyses the results were consistent results between the two PM types. The findings suggest that EPI may be associated with increased PM-lead failure compared to ENDO while threshold rise, infection, battery depletion and mortality rates did not differ.
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Affiliation(s)
- Vasiliki Patsiou
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
| | - Amalia Baroutidou
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Giannopoulos
- Second Department of Pediatrics, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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12
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Reider J, Ward K. An unexpected finding in a symptomatic athlete with congenital heart disease and an epicardial pacemaker. HeartRhythm Case Rep 2023; 9:836-839. [PMID: 38023686 PMCID: PMC10667121 DOI: 10.1016/j.hrcr.2023.08.018] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Affiliation(s)
- Jaclyn Reider
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Kendra Ward
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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13
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Kisling A, Klusewitz S, Pagani A, Haigney M, Needleman M. A novel association between sinus node dysfunction and an SCN5A variant presenting as persistent symptomatic bradycardia in a young adult. HeartRhythm Case Rep 2023; 9:662-666. [PMID: 37746560 PMCID: PMC10511908 DOI: 10.1016/j.hrcr.2023.06.017] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Affiliation(s)
- Adam Kisling
- Department of Cardiology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Seth Klusewitz
- Department of Cardiology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Austin Pagani
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
- Center for Military Precision Health, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Mark Haigney
- Military Cardiovascular Outcomes Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Matthew Needleman
- Department of Cardiology, Walter Reed National Military Medical Center, Bethesda, Maryland
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14
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Dong H, Zhang Y, Sun D, Wang G, Zhang Q, Hidru TH, Yang Y, Wang S, Wei Y, Liu F, Zhang J, Xia Y, Yang X. Refining prediction of stroke in sinus node dysfunction patients without atrial fibrillation using a P-combined score: a multi-centre study. Eur J Prev Cardiol 2023:zwad267. [PMID: 37651722 DOI: 10.1093/eurjpc/zwad267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/28/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023]
Abstract
AIMS Isolated sinus node dysfunction (ISND) is a sinus node dysfunction without atrial fibrillation. A high risk of ischaemic stroke (IS) has been reported in ISND populations. However, current guidelines do not recommend anticoagulation in ISND management. P-wave indicates ISND-related atrial remodelling. P-wave indices and the CHA2DS2-VASc score may contribute to risk stratification for ISND-related IS. METHODS AND RESULTS In this multi-centre longitudinal cohort, ISND patients were divided into development (n = 1185) and external validation (n = 988) cohorts. Ischaemic stroke prediction capacity of the P-combined score was assessed with regard to discrimination, calibration, and clinical effectiveness. The cut-off value of the score was confirmed by using a restricted cubic spline curve. One hundred and twenty-four (10.46%) ISND patients developed IS [1.63%/year; 95% confidence interval (CI): 1.49-1.78%/year] after a median 3.02-year follow-up in the development cohort. The P-wave terminal force in electrocardiogram-lead V1 (PTFV1) was the only significantly abnormal P-wave index (adjusted hazard ratio: 2.56; 95% CI: 1.72-3.80). Therefore, we incorporated the PTFV1 with the CHA2DS2-VASc score to generate a P-combined score. For a 5-year IS risk, the P-combined score improved Harrell's C-statistic (95% CI) from 0.678 (0.618-0.738) to 0.716 (0.657-0.774) and 0.747 (0.677-0.816) to 0.808 (0.747-0.868) in the development and validation cohorts, respectively, along with calibration and decision curve analyses. The cut-off value of the score was 3 in the development cohort and well-discriminated in the validation cohort. CONCLUSION Chinese ISND patients have a higher IS risk than the general population. Compared with the CHA2DS2-VASc score, the PTFV1-combined CHA2DS2-VASc score shows a better risk-stratification capacity for ISND-related IS.
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Affiliation(s)
- Haoyu Dong
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
| | - Yan Zhang
- Institute of Cardiovascular Sciences and Key Laboratory of Molecular Cardiovascular Sciences, School of Basic Medical Sciences, Ministry of Education, Peking University Health Science Center, Beijing, China
- Beijing Key Laboratory of Cardiovascular Receptors Research, Peking University, Beijing 100191, China
| | - Dongxu Sun
- Vascular Surgery Subgroup, Department of General Surgery, Qilu Hospital of Shandong University (Qingdao), No. 758 Hefei Road, Shibei District, Qing Dao 266011, China
| | - Gaopin Wang
- Department of Cardiology, First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121000, China
| | - Qinglong Zhang
- Department of Cardiology, First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121000, China
| | - Tesfaldet H Hidru
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
| | - Yiheng Yang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
| | - Shihao Wang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
| | - Yushan Wei
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
| | - Fei Liu
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
| | - Jinpu Zhang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
| | - Xiaolei Yang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
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15
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Abstract
Sinus node dysfunction (SND) is a multifaceted disorder most prevalent in older individuals, but may also occur at an earlier age. In most cases, the SND diagnosis is ultimately established by documenting its ECG manifestations. EPS has limited utility. The treatment strategy is largely dictated by symptoms and ECG manifestations. Not infrequently, both bradycardia and tachycardia coexist in the same patients, along with other diseases common in the elderly (e.g., hypertension, coronary artery disease), thereby complicating treatment strategy. Prevention of the adverse consequences of both bradyarrhythmia and tachyarrhythmia is important to reduce susceptibility to syncope, falls, and thromboembolic complications.
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Affiliation(s)
- Neeraj Sathnur
- Cardiac Arrhythmia Service, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA; Cardiovascular Medicine, University of Minnesota Medical School, Mail Code 508, 420 Delaware St SE, Minneapolis, MN 55455, USA; Cardiac Electrophysiology, Park-Nicollet Medical Center, St Louis Park, Minneapolis, MN, USA
| | - Emanuel Ebin
- Cardiac Arrhythmia Service, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA; Cardiovascular Medicine, University of Minnesota Medical School, Mail Code 508, 420 Delaware St SE, Minneapolis, MN 55455, USA
| | - David G Benditt
- Cardiac Arrhythmia Service, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA; Cardiovascular Medicine, University of Minnesota Medical School, Mail Code 508, 420 Delaware St SE, Minneapolis, MN 55455, USA.
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16
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Chen M, Wu Q. Roles and mechanisms of natural drugs on sinus node dysfunction. Biomed Pharmacother 2023; 164:114777. [PMID: 37229801 DOI: 10.1016/j.biopha.2023.114777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/23/2023] [Revised: 04/18/2023] [Accepted: 04/23/2023] [Indexed: 05/27/2023] Open
Abstract
Sinus node dysfunction is a common arrhythmia disorder with a high incidence and significant social and economic burden. Currently, there are no effective drugs for treating chronic sinus node dysfunction. The disease is associated with ion channel disturbances caused by aging, fibrosis, inflammation, oxidative stress, and autonomic dysfunction. Natural active substances and Chinese herbal medicines have been widely used and extensively studied in the medical community for the treatment of arrhythmias. Multiple studies have demonstrated that various active ingredients and Chinese herbal medicines, such as astragaloside IV, quercetin, and ginsenosides, exhibit antioxidant effects, reduce fibrosis, and maintain ion channel stability, providing promising drugs for treating sinus node dysfunction. This article summarizes the research progress on natural active ingredients and Chinese herbal formulas that regulate sick sinoatrial node function, providing valuable references for the treatment of sinus node dysfunction.
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Affiliation(s)
- Meilian Chen
- Quanzhou Hospital of Traditional Chinese Medicine, Fujian 362000, China
| | - Qiaomin Wu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China.
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17
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Arnold M, Richards M, D’Onofrio A, Faulknier B, Gulizia M, Thakur R, Sakata Y, Lin W, Pollastrelli A, Grammatico A, Auricchio A, Boriani G. Avoiding unnecessary ventricular pacing is associated with reduced incidence of heart failure hospitalizations and persistent atrial fibrillation in pacemaker patients. Europace 2023; 25:euad065. [PMID: 36942949 PMCID: PMC10227662 DOI: 10.1093/europace/euad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/11/2023] [Indexed: 03/23/2023] Open
Abstract
AIMS In bradycardia patients treated with dual-chamber pacing, we aimed to evaluate whether pacing with atrioventricular (AV) delay management [AV hysteresis (AVH)], compared with standard pacing with fixed AV delays, reduces unnecessary ventricular pacing percentage (VPP) and is associated with better clinical outcomes. Main study endpoints were the incidence of heart failure hospitalizations (HFH), persistent atrial fibrillation (AF), and cardiac death. METHODS AND RESULTS Data from two identical prospective observational studies, BRADYCARE I in the USA and BRADYCARE II in Europe, Africa, and Asia, were pooled. Overall, 2592 patients (75 ± 10 years, 45.1% female, 50% with AVH) had complete clinical and device data at 1-year follow-up and were analysed. Primary pacing indication was sinus node disease (SND) in 1177 (45.4%), AV block (AVB) in 974 (37.6%), and other indications in 441 (17.0%) patients. Pacing with AVH, compared with standard pacing, was associated with a lower 1-year incidence of HFH [1.3% vs. 3.1%, relative risk reduction (RRR) 57.5%, P = 0.002] and of persistent AF (5.3% vs. 7.7%, RRR = 31.1%, P = 0.028). Cardiac mortality was not different between groups (1.0% vs. 1.4%, RRR = 27.8%, P = 0.366). Pacing with AVH, compared with standard pacing, was associated with a lower (P < 0.001) median VPP in all patients (7% vs. 75%), in SND (3% vs. 44%), in AVB (25% vs. 98%), and in patients with other pacing indications (3% vs. 47%). CONCLUSION Cardiac pacing with AV delay management via AVH is associated with reduced 1-year incidence of HFH and persistent AF, most likely due to a reduction in VPP compared to standard pacing.
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Affiliation(s)
- Martin Arnold
- Cardiology Department, Friedrich-Alexander-Universität, Erlangen, Germany
| | - Mark Richards
- Cardiology Department, Yakima Heart and Vascular, Yakima, WA, USA
| | - Antonio D’Onofrio
- Cardiology Department, UOSD di Elettrofisiologia, Studio e Terapia delle Aritmie A.O.R.N. ‘Ospedali dei Colli’ Osp Monaldi, Napoli, Italy
| | | | - Michele Gulizia
- Cardiology Department, Azienda Ospedaliera Garibaldi Nesima, Catania, Italy
| | - Ranjan Thakur
- Cardiology Department, Thoracic Cardio Healthcare Foundation, Lansing, MI, USA
| | - Yasushi Sakata
- Cardiology Department, Osaka University Hospital, Osaka, Japan
| | | | | | | | - Angelo Auricchio
- Clinical Electrophysiology Unit, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena University Hospital, Via del Pozzo, 71, Modena 41124, Italy
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18
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Breeman KTN, Dijkshoorn LA, Wilde AAM, Tjong FVY, Knops RE. Predicted Need for Atrial and Ventricular Pacing Per Indication Group in Patients With Dual-Chamber Pacemakers. Heart Lung Circ 2023; 32:629-637. [PMID: 36990960 DOI: 10.1016/j.hlc.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Bradyarrhythmias are adequately treated with pacemakers. There are different pacing modes (single-chamber, dual-chamber, cardiac resynchronisation therapy [CRT] and conduction system pacing [CSP]) and a choice between leadless or transvenous pacemakers. The expected pacing need is important for determining optimal pacing mode and device type. This study aimed to evaluate atrial pacing (AP) and ventricular pacing (VP) percentages over time for the most common pacing indications. METHODS Included patients were aged ≥18 years with a dual-chamber rate-modulated [DDD(R)] pacemaker implantation and ≥1 year of follow-up at a tertiary centre between January 2008 and January 2020. Baseline characteristics, AP and VP at yearly follow-up visits up to 6 years after implantation were retrieved from the medical records. RESULTS A total of 381 patients were included. Primary pacing indications were incomplete atrioventricular block (AVB) in 85 (22%), complete AVB in 156 (41%) and sinus node dysfunction (SND) in 140 (37%) patients. Mean age at implantation was 71±14, 69±17 and 68±14 years, respectively (p=0.23). Median follow-up was 42 months (25-68 months). Overall, AP was highest in SND with median 37% (7%-75%) versus 7% (1%-26%) in incomplete AVB and 3% (1%-16%) in complete AVB (p<0.001); VP was highest in complete AVB with median 98% (43%-100%) versus 44% (7%-94%) in incomplete AVB and 3% (1%-14%) in SND (p<0.001). Ventricular pacing significantly increased over time in patients with incomplete AVB and SND (both p=0.001). CONCLUSIONS These results confirm the pathophysiology of different pacing indications, causing clear differences in pacing need and expected battery longevity. They may help guide optimal pacing mode and suitability for leadless or physiological pacing.
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Affiliation(s)
- Karel T N Breeman
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands.
| | - Leonard A Dijkshoorn
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands
| | - Fleur V Y Tjong
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands
| | - Reinoud E Knops
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands
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19
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Duan S, Du J. Sinus node dysfunction and atrial fibrillation-Relationships, clinical phenotypes, new mechanisms, and treatment approaches. Ageing Res Rev 2023; 86:101890. [PMID: 36813137 DOI: 10.1016/j.arr.2023.101890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
Although the anatomical basis of the pathogenesis of sinus node dysfunction (SND) and atrial fibrillation (AF) is located primarily in the left and right atria, increasing evidence suggests a strong correlation between SND and AF, in terms of both clinical presentation and formation mechanisms. However, the exact mechanisms underlying this association are unclear. The relationship between SND and AF may not be causal, but is likely to involve common factors and mechanisms, including ion channel remodeling, gap junction abnormalities, structural remodeling, genetic mutations, neuromodulation abnormalities, the effects of adenosine on cardiomyocytes, oxidative stress, and viral infections. Ion channel remodeling manifests primarily as alterations in the "funny" current (If) and Ca2+ clock associated with cardiomyocyte autoregulation, and gap junction abnormalities are manifested primarily as decreased expression of connexins (Cxs) mediating electrical impulse propagation in cardiomyocytes. Structural remodeling refers primarily to fibrosis and cardiac amyloidosis (CA). Some genetic mutations can also cause arrhythmias, such as SCN5A, HCN4, EMD, and PITX2. The intrinsic cardiac autonomic nervous system (ICANS), a regulator of the heart's physiological functions, triggers arrhythmias.In addition, we discuss arrhythmias caused by viral infections, notably Coronavirus Disease 2019 (COVID-19). Similarly to upstream treatments for atrial cardiomyopathy such as alleviating CA, ganglionated plexus (GP) ablation acts on the common mechanisms between SND and AF, thus achieving a dual therapeutic effect.
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20
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Januszewska K. Postoperative sinus node dysfunctions-maybe not always the surgeon should to be blamed…. Interdiscip Cardiovasc Thorac Surg 2023; 36:6991171. [PMID: 36802261 PMCID: PMC9931066 DOI: 10.1093/icvts/ivad009] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Katarzyna Januszewska
- Corresponding author. Polish Mother’s Memorial Hospital - Research Institute, Rzgowska 281/289, 93-338 Lodz, Poland. Tel: +49-251-83-46104; fax: +0048 42 271 1452; e-mail: (K. Januszewska)
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21
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Hata Y, Ichimata S, Hirono K, Yamaguchi Y, Oku Y, Ichida F, Nishida N. Pathological and Comprehensive Genetic Investigation of Autopsy Cases of Idiopathic Bradyarrhythmia. Circ J 2022; 87:111-119. [PMID: 36070930 DOI: 10.1253/circj.cj-22-0397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/27/2022]
Abstract
BACKGROUND Idiopathic bradyarrhythmia is considered to be due to pathological degeneration of the cardiac conduction system (CCS) during aging. There appears to have been no comprehensive genetic investigations in patients with idiopathic bradyarrhythmia.Methods and Results: Ten autopsy cases with advanced bradyarrhythmia (6 men and 4 women; age: 70-94 years, 81.5±6.9 years; 5 cases each of sinus node dysfunction [SND] and complete atrioventricular block [CAVB]) were genetically investigated by using whole-exome sequencing. Morphometric analysis of the CCS was performed with sex-, age- and comorbidity-matched control cases. As a result, severe loss of nodal cells and distal atrioventricular conduction system were found in SND and CAVB, respectively. However, the conduction tissue loss was not significant in either the atrioventricular node or the proximal bundle of His in CAVB cases. A total of 13 heterozygous potential variants were found in 3 CAVB and 2 SND cases. Of these 13 variants, 4 were missense in the known progressive cardiac conduction disease-related genes: GATA4 and RYR2. In the remaining 9 variants, 5 were loss-of-function mutation with highly possible pathogenicity. CONCLUSIONS In addition to degenerative changes of selectively vulnerable areas in the heart during advancing age, the vulnerability of the CCS, which may be associated with "rare variants of small effect," may also be a contributing factor to the degeneration of CCS, leading to "idiopathic" bradyarrhythmia.
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Affiliation(s)
- Yukiko Hata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama
| | - Shojiro Ichimata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama
| | - Keiichi Hirono
- Department of Pediatrics, Faculty of Medicine, University of Toyama
| | - Yoshiaki Yamaguchi
- Department of Legal Medicine, Faculty of Medicine, University of Toyama.,Department of Cardiology, Saiseikai Takaoka Hospital
| | - Yuko Oku
- Department of Legal Medicine, Faculty of Medicine, University of Toyama
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health & Welfare
| | - Naoki Nishida
- Department of Legal Medicine, Faculty of Medicine, University of Toyama
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Machraa A, Ben Brahim W, Sidaty O, Fellat R, Fellat N. Sustained ventricular arrhythmia and sinus node dysfunction revealing a cardiac amyloidosis: A case report. Ann Med Surg (Lond) 2022; 84:104888. [PMID: 36582903 PMCID: PMC9793156 DOI: 10.1016/j.amsu.2022.104888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/18/2022] [Accepted: 11/07/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction and importance Amyloidosis is an infiltrative multisystem disease due to extracellular deposition of fibrils in tissues and organs. Cardiac involvement can result in progressive heart failure, conduction abnormalities and arrhythmias and is associated with a poor prognosis. Atrial arrhythmias and non-sustained ventricular arrhythmias are the most common arrhythmias in cardiac amyloidosis. However, the association of sinus node dysfunction and sustained ventricular arrhythmia is quite exceptional. Case presentation A 59-year-old male patient was admitted with a gradually worsening dyspnea with a lipothymic discomfort. Upon emergency department, an initial electrocardiogram revealed a severe bradycardia related to a sinus node dysfunction. A transthoracic echocardiography and cardiac magnetic resonance imaging showed features suspicious for cardiac amyloidosis. The diagnosis of AL cardiac amyloidosis with multiple myeloma was confirmed based on histological evidence. During hospitalization, the patient presented a sustained unstable ventricular tachycardia which has been converted by electrical cardioversion. He was treated with an implantable cardioverter-defibrillator (ICD) for secondary prevention with one episode of appropriate therapy. Unfortunately, the patient died few weeks later. Clinical discussion The AL subtype of cardiac amyloidosis is associated with higher rates of arrhythmias, especially VT. The management of arrhythmias in cardiac amyloidosis is complex and remains challenging given the lack of evidence. ICD was not associated with longer survival; these findings underscore the importance of careful patient selection for ICD. Conclusion As prognosis improves with the advances made in the medical treatment of cardiac amyloidosis, further studies are required to guide the management of all types of arrhythmias in cardiac amyloidosis.
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Ramdat Misier NL, Taverne YJHJ, van Schie MS, Kharbanda RK, van Leeuwen WJ, Kammeraad JAE, Bogers AJJC, de Groot NMS. Unravelling early sinus node dysfunction after pediatric cardiac surgery: a pre-existing arrhythmogenic substrate. Interact Cardiovasc Thorac Surg 2022; 36:ivac262. [PMID: 36321962 PMCID: PMC10021071 DOI: 10.1093/icvts/ivac262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/15/2022] [Accepted: 10/30/2022] [Indexed: 03/19/2023] Open
Abstract
Early post-operative sinus node dysfunction (SND) is common in paediatric patients undergoing surgical correction of congenital heart defects (CHD). At present, the pathophysiology of these arrhythmias is incompletely understood. In this case series, we present three paediatric patients in whom we performed intraoperative epicardial mapping and who developed early post-operative SND. All patients had either an inferior or multiple sinoatrial node (SAN) exit sites, in addition to extensive conduction disorders at superior and inferior right atrium. Our findings contribute to the hypothesis that pre-existing alterations in SAN exit sites in combination with atrial conduction disorders may predispose paediatric patients with CHD for early post-operative SND. Such insights in the development of arrhythmias are crucial as it may be the first step in identifying high-risk patients.
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Affiliation(s)
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Rohit K Kharbanda
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Wouter J van Leeuwen
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Janneke A E Kammeraad
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
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24
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Sethi R, Nesa Malik FT, Naik A, Afroz N, Reynolds DW, Kothari Y, Reddy V, Rajan V, Bergemann T, Dedrick A, Pandurangi UM, Khan KN, Narasimhan C. Interventions in the Diagnosis and Adoption of Pacemaker Therapy in Sinus Node Dysfunction Patients: Results from the IMPROVE Brady study. Indian Heart J 2022:S0019-4832(22)00142-0. [PMID: 36130635 DOI: 10.1016/j.ihj.2022.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/30/2022] Open
Abstract
Aims IMPROVE Brady assessed whether a process improvement intervention could increase adoption of guideline-based therapy in sinus node dysfunction (SND) patients. Methods /Results: IMPROVE Brady was a sequential, prospective, quality improvement initiative conducted in India and Bangladesh. Patients with symptomatic bradycardia were enrolled. In Phase I, physicians assessed and treated patients per standard care. Phase II began after implementing educational materials for physicians and patients. Primary objectives were to evaluate the impact of the intervention on SND diagnosis and pacemaker (PPM) implant. SF-12 quality of life (QoL) and Zarit burden surveys were collected pre- and post-PPM implant. A total of 978 patients were enrolled (57.7 ± 14.8 years, 75% male), 508 in Phase I and 470 in Phase II. The diagnosis of SND and implantation of PPM increased significantly from Phase I to Phase II (72% vs. 87%, P < 0.001 and 17% vs. 32%, P < 0.001, respectively). Pacemaker implantation was not feasible in 41% of patients due to insurance/cost barriers which was unaltered by the intervention. Both patient QoL and caregiver burden improved at 6-months post-PPM implant (P < 0.001). Conclusions A process improvement initiative conducted at centers across India and Bangladesh significantly increased the diagnosis of SND and subsequent treatment with PPM therapy despite the socio-economic constraints.
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Abstract
BACKGROUND Cardiac arrhythmias, including bradyarrhythmias, have been described as manifestations of coronavirus disease 2019 (COVID-19). Herein, we present a case of junctional bradycardia secondary to possible sinus node dysfunction in a patient with COVID-19.
CASE SUMMARY The patient was a 32-year-old woman with no significant medical history. On the third day of hospitalization, she developed junctional bradycardia while being hemodynamically stable. The episodes of nodal dysrhythmia with a low heart rate persisted for the next few days and were associated with elevated levels of systemic inflammatory markers. The patient received antiviral and anti-inflammatory treatments for the viral infection but no antiarrhythmic medications. She had a normal sinus rhythm on day 12.
CONCLUSION Cardiac rhythm monitoring, focusing on the association between cardiac arrhythmias and the systemic inflammatory response, is important in COVID-19 patients.
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Affiliation(s)
- Abdullah Ibrahim Aedh
- Department of Internal Medicine, College of Medicine, Najran University, Najran 1988, Saudi Arabia
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26
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Infeld M, Nicoli CD, Meagher S, Tompkins BJ, Wayne S, Irvine B, Betageri O, Habel N, Till S, Lobel J, Meyer M, Lustgarten DL. Clinical impact of Bachmann's bundle pacing defined by electrocardiographic criteria on atrial arrhythmia outcomes. Europace 2022; 24:1460-1468. [PMID: 35304608 DOI: 10.1093/europace/euac029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/08/2021] [Accepted: 02/18/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Evaluate whether Bachmann's bundle pacing (BBp) defined by electrocardiographic (ECG) criteria is associated with less atrial fibrillation/tachycardia (AF/AT) compared with anatomically defined right atrial septal pacing (RASp) and right atrial appendage pacing (RAAp). METHODS AND RESULTS This is a retrospective study comparing BBp with non-specific RASp and RAAp on new incidence, burden, and recurrence of AF/AT. We included patients who underwent atrial lead placement between 2006 and 2019 and received > 20% atrial pacing. BBp was defined by paced P-wave morphology and fluoroscopic lead position. Compared with RASp (n = 107) and RAAp (n = 108), AF/AT burden was lower in the BBp (n = 134) group by repeated measures ANOVA (P < 0.001). Over 2-year follow-up, AF/AT burden increased in the RASp (P < 0.01) and RAAp (P < 0.01) groups but did not significantly change in the BBp group (P = 0.91). Atrial arrhythmia burden was lower in the BBp group than the RASp and RAAp groups at 12-15, 18-21, and 24-27 months (P < 0.05) after pacemaker placement. Risk of AF/AT recurrence was lower in BBp than RASp (HR 0.43; P < 0.01) and RAAp patients (HR 0.29, P < 0.01). Risk of de novo AF/AT was also lower in BBp than in RASp (OR 0.12; P < 0.01) and RAAp patients (OR 0.20, P < 0.01). CONCLUSION Bachmann's bundle pacing defined using P-wave criteria was associated with decreased atrial arrhythmia burden, recurrence, and de novo incidence compared with right atrial septal pacing and right atrial appendage pacing.
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Affiliation(s)
- Margaret Infeld
- Department of Medicine, Larner College of Medicine, University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA
| | - Charles D Nicoli
- Department of Medicine, Larner College of Medicine, University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA
| | - Sean Meagher
- Department of Medicine, Larner College of Medicine, University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA
| | - Bradley J Tompkins
- Department of Medicine, Larner College of Medicine, University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA
| | - Shawn Wayne
- Department of Medicine, Larner College of Medicine, University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA
| | - Benjamin Irvine
- Department of Medicine, Tulane University, New Orleans, Louisiana
| | - Omkar Betageri
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Nicole Habel
- Department of Medicine, Larner College of Medicine, University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA
| | - Sean Till
- Department of Medicine, Larner College of Medicine, University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA
| | - Jennings Lobel
- Department of Medicine, Larner College of Medicine, University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA
| | - Markus Meyer
- Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis, MN, USA
| | - Daniel L Lustgarten
- Department of Medicine, Larner College of Medicine, University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA
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27
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Alnoor M, Burch G, Armsby L, Batra A, Balaji S. Hemodynamic Impact of Atrial Pacing in Patients with Fontan Physiology and Junctional Rhythm: A Cardiac Catheterization Study. Pediatr Cardiol 2022; 43:508-514. [PMID: 34661729 DOI: 10.1007/s00246-021-02747-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 07/30/2021] [Accepted: 09/29/2021] [Indexed: 11/24/2022]
Abstract
Sinus node dysfunction is a common problem and adversely impacts patients who have undergone the Fontan operation. In Fontan patients with an adequate junctional escape rhythm, the benefit of atrial pacing to restore atrioventricular synchrony remains unclear. Data were collected retrospectively on all Fontan patients with junctional rhythm who underwent atrial pacing during cardiac catheterization. Hemodynamics were obtained at baseline and after atrial pacing for 5-10 min. Seven patients, mean age 10 years (3-21) were studied. The type of Fontan was extracardiac in 6 and lateral tunnel in one. Patients were paced at 10 bpm faster than their junctional rate. With pacing, there was a significant decrease in left atrial pressure from (mean ± SEM) 8.8 ± 2.6 to 5.5 ± 2.9 mmHg (p = 0.02), a significant increase in cardiac index from 2.7 ± 0.8 to 3.5 ± 1 L/min/m2 (p = 0.01) and pulmonary blood flow from 2.1 ± 0.6 to 2.7 ± 0.7 L/min/m2 (p = 0.001), and no significant change in pulmonary artery pressure, from 13.4 ± 2.8 to 12.4 mmHg ± 3.6 (p = 0.06) or pulmonary vascular resistance from 2.1 ± 0.86 to 3.25 ± 1.9 WU × M2 (p = 0.1). In Fontan patients with junctional rhythm, atrial pacing decreased the left atrial pressure, increased cardiac output and did not significantly change the pulmonary artery pressure. Our study supports further investigation into the utility of prophylactic atrial pacemaker implantation in Fontan patients with significant durations of JR on ambulatory monitoring.
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Affiliation(s)
- Mohammad Alnoor
- Division of Cardiology, Department of Pediatrics, Oregon Health & Science University, 700 SW Campus Dr, Portland, OR, 97239, USA.
| | - Grant Burch
- Division of Cardiology, Department of Pediatrics, Oregon Health & Science University, 700 SW Campus Dr, Portland, OR, 97239, USA
| | - Laurie Armsby
- Division of Cardiology, Department of Pediatrics, Oregon Health & Science University, 700 SW Campus Dr, Portland, OR, 97239, USA
| | - Anjan Batra
- Division of Cardiology, Department of Pediatrics, University of California-Irvine, Irvine, CA, USA
| | - Seshadri Balaji
- Division of Cardiology, Department of Pediatrics, Oregon Health & Science University, 700 SW Campus Dr, Portland, OR, 97239, USA
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Aminu AJ, Petkova M, Atkinson AJ, Yanni J, Morris AD, Simms RT, Chen W, Yin Z, Kuniewicz M, Holda MK, Kuzmin VS, Perde F, Molenaar P, Dobrzynski H. Further insights into the molecular complexity of the human sinus node - The role of 'novel' transcription factors and microRNAs. Prog Biophys Mol Biol 2021; 166:86-104. [PMID: 34004232 DOI: 10.1016/j.pbiomolbio.2021.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023]
Abstract
RESEARCH PURPOSE The sinus node (SN) is the heart's primary pacemaker. Key ion channels (mainly the funny channel, HCN4) and Ca2+-handling proteins in the SN are responsible for its function. Transcription factors (TFs) regulate gene expression through inhibition or activation and microRNAs (miRs) do this through inhibition. There is high expression of macrophages and mast cells within the SN connective tissue. 'Novel'/unexplored TFs and miRs in the regulation of ion channels and immune cells in the SN are not well understood. Using RNAseq and bioinformatics, the expression profile and predicted interaction of key TFs and cell markers with key miRs in the adult human SN vs. right atrial tissue (RA) were determined. PRINCIPAL RESULTS 68 and 60 TFs significantly more or less expressed in the SN vs. RA respectively. Among those more expressed were ISL1 and TBX3 (involved in embryonic development of the SN) and 'novel' RUNX1-2, CEBPA, GLI1-2 and SOX2. These TFs were predicted to regulate HCN4 expression in the SN. Markers for different cells: fibroblasts (COL1A1), fat (FABP4), macrophages (CSF1R and CD209), natural killer (GZMA) and mast (TPSAB1) were significantly more expressed in the SN vs. RA. Interestingly, RUNX1-3, CEBPA and GLI1 also regulate expression of these cells. MiR-486-3p inhibits HCN4 and markers involved in immune response. MAJOR CONCLUSIONS In conclusion, RUNX1-2, CSF1R, TPSAB1, COL1A1 and HCN4 are highly expressed in the SN but not miR-486-3p. Their complex interactions can be used to treat SN dysfunction such as bradycardia. Interestingly, another research group recently reported miR-486-3p is upregulated in blood samples from severe COVID-19 patients who suffer from bradycardia.
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Affiliation(s)
- Abimbola J Aminu
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Maria Petkova
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Andrew J Atkinson
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Joseph Yanni
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Alex D Morris
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Robert T Simms
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Weixuan Chen
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Zeyuan Yin
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Marcin Kuniewicz
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz K Holda
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Vladislav S Kuzmin
- Department of Human and Animal Physiology, Lomonosov Moscow State University, Moscow, Russia
| | - Filip Perde
- National Institute of Legal Medicine, Bucharest, Romania
| | - Peter Molenaar
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia; Cardiovascular Molecular & Therapeutics Translational Research Group, University of Queensland, The Prince Charles Hospital, Brisbane, Australia
| | - Halina Dobrzynski
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
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29
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Meredith A, Markovic N, Kakar P, Kim H, Aziz EF. Leadless intracardiac pacemaker implantation in patients with bradyarrhythmias after spinal cord injury. HeartRhythm Case Rep 2021; 7:669-673. [PMID: 34712562 PMCID: PMC8530809 DOI: 10.1016/j.hrcr.2021.06.013] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Amanda Meredith
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Nebojsa Markovic
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Parul Kakar
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Hyoeun Kim
- Arrhythmia Institute, University Hospital, Newark, New Jersey
| | - Emad F Aziz
- Arrhythmia Institute, University Hospital, Newark, New Jersey.,Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
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30
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Abstract
Sinus node dysfunction (SND) is a multifaceted disorder most prevalent in older individuals, but may also occur at an earlier age. In most cases, the SND diagnosis is ultimately established by documenting its ECG manifestations. EPS has limited utility. The treatment strategy is largely dictated by symptoms and ECG manifestations. Not infrequently, both bradycardia and tachycardia coexist in the same patients, along with other diseases common in the elderly (e.g., hypertension, coronary artery disease), thereby complicating treatment strategy. Prevention of the adverse consequences of both bradyarrhythmia and tachyarrhythmia is important to reduce susceptibility to syncope, falls, and thromboembolic complications.
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Affiliation(s)
- Neeraj Sathnur
- Cardiac Arrhythmia Service, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA; Cardiovascular Medicine, University of Minnesota Medical School, Mail Code 508, 420 Delaware St SE, Minneapolis, MN 55455, USA; Cardiac Electrophysiology, Park-Nicollet Medical Center, St Louis Park, Minneapolis, MN, USA
| | - Emanuel Ebin
- Cardiac Arrhythmia Service, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA; Cardiovascular Medicine, University of Minnesota Medical School, Mail Code 508, 420 Delaware St SE, Minneapolis, MN 55455, USA
| | - David G Benditt
- Cardiac Arrhythmia Service, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA; Cardiovascular Medicine, University of Minnesota Medical School, Mail Code 508, 420 Delaware St SE, Minneapolis, MN 55455, USA.
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Miyazaki Y, Ueda N, Otsuka F, Miyamoto K, Noguchi T, Kusano K. Rescue percutaneous coronary intervention for sinus node dysfunction following left atrial flutter ablation. HeartRhythm Case Rep 2021; 7:529-32. [PMID: 34434701 DOI: 10.1016/j.hrcr.2021.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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32
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Kohli U, Chaudhuri NR, Sriram CS, Rhodes L. Temporal progression of P wave abnormality in a patient with classical or atriopulmonary Fontan. J Electrocardiol 2021; 68:109-113. [PMID: 34416667 DOI: 10.1016/j.jelectrocard.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/24/2021] [Revised: 07/18/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022]
Abstract
We present the electrocardiographic findings in a 36-year-old female with tricuspid atresia with double-outlet right ventricle and malposition of great arteries who underwent classical or "atriopulmonary" Fontan procedure in childhood. Her electrocardiograms have consistently shown marked intra-atrial delay with an initial positive P wave deflection and terminal negative P deflection in all leads with progressive increase in P wave duration with time. She has had frequent episodes of intra-atrial tachycardia, atrial fibrillation and sinus and post ectopic pauses over the past few years. The findings in our patient, which have not been reported before, illustrate the atrial pathology, which is unique to Fontan physiology, particularly those with classical or atriopulmonary Fontan. We hope that the specific electrocardiographic findings presented will allow for their recognition.
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Affiliation(s)
- Utkarsh Kohli
- Department of Pediatrics, Division of Pediatric Cardiology and Pediatric Cardiac Electrophysiology, West Virginia University Children's Hospital and West Virginia University School of Medicine, Morgantown, WV, USA.
| | - Nita Ray Chaudhuri
- Department of Pediatrics, Division of Pediatric Cardiology, West Virginia University Children's Hospital and West Virginia University School of Medicine, Morgantown, WV, USA
| | - Chenni S Sriram
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - Larry Rhodes
- Department of Pediatrics, Division of Pediatric Cardiology and Pediatric Cardiac Electrophysiology, West Virginia University Children's Hospital and West Virginia University School of Medicine, Morgantown, WV, USA
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Abstract
Sick sinus syndrome (SSS) is a set of diseases with abnormal cardiac pacing, which manifests as diverse cardiac arrhythmias, especially bradycardia. The clinical presentation is inconspicuous in the early stage, but with the progression of this disease, patients may present with symptoms and signs of end-organ hypoperfusion. As a common result in the natural history of the disease, SSS coexisting with atrial fibrillation (AF) forms the basis of bradycardia-tachycardia syndrome. Age-related interstitial fibrosis is considered to be the common pathophysiological mechanism between SSS and AF. The combination of these diseases will adversely affect the condition of patients and the efficiency of subsequent treatment. Although the exact mechanism is not clear to date, the extensive structural and electrical remodeling of the atrium are considered to be the important mechanism for the occurrence of AF in patients with SSS. Pacemaker implantation is the first-line treatment for symptomatic patients with SSS and documented bradycardia history. In view of the adverse effects of AF on the treatment of SSS, researchers have focused on evaluating different pacing modes and algorithms to reduce the risk of AF during pacing. Catheter ablation may also be used as an alternative second-line therapy for some patients with SSS and AF.
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Affiliation(s)
- Wenxing Chang
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, 116027, Dalian, China
| | - Guangsen Li
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, 116027, Dalian, China.
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Shibata M, Hoshino R, Shimizu C, Sato M, Furuta N, Ikeda Y. Lacosamide-induced sinus node dysfunction followed by severe agranulocytosis. BMC Neurol 2021; 21:217. [PMID: 34102997 PMCID: PMC8185934 DOI: 10.1186/s12883-021-02253-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/21/2020] [Accepted: 05/26/2021] [Indexed: 02/22/2023] Open
Abstract
Background Lacosamide (LCM) is the antiepileptic drug approved by the U.S. Food and Drug Administration in 2008 that facilitates slow activation of the voltage-gated sodium channels. Neutropenia and cardiac events including sinus node dysfunction (SND) and atrioventricular block have been previously reported as adverse effects of LCM. To date, there have been no reports of severe agranulocytosis resulting in death associated with LCM. Additionally, there have been no reports of concomitant SND and agranulocytosis after LCM administration. Herein we report the first case of LCM-induced severe SND followed by agranulocytosis. Case presentation The patient with focal epilepsy was initiated on LCM 100 mg/day and the dose was increased to 200 mg/day on the 9th hospital day. Severe SND developed on the 10th hospital day and LCM was discontinued. Thereafter agranulocytosis appeared on the 11th hospital day, and the patient died from septic shock on the 15th hospital day. Conclusions This case illustrates the need for careful follow-up of the electrocardiogram and the complete blood cell counts when initiating LCM. Moreover, it should be noticed that various side effects may occur simultaneously in the early period of LCM use, even for a short time and at low dosages.
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Affiliation(s)
- Makoto Shibata
- Department of Neurology, Takasaki General Medical Center, National Hospital Organization, 36 Takamatsu-cho, Takasaki, 370-0829, Gunma, Japan
| | - Reona Hoshino
- Department of Neurology, Takasaki General Medical Center, National Hospital Organization, 36 Takamatsu-cho, Takasaki, 370-0829, Gunma, Japan
| | - Chisato Shimizu
- Department of Neurology, Takasaki General Medical Center, National Hospital Organization, 36 Takamatsu-cho, Takasaki, 370-0829, Gunma, Japan
| | - Masayuki Sato
- Department of Neurology, Takasaki General Medical Center, National Hospital Organization, 36 Takamatsu-cho, Takasaki, 370-0829, Gunma, Japan
| | - Natsumi Furuta
- Department of Neurology, Takasaki General Medical Center, National Hospital Organization, 36 Takamatsu-cho, Takasaki, 370-0829, Gunma, Japan
| | - Yoshio Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511, Gunma, Japan.
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35
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Affiliation(s)
- Brian Olshansky
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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36
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Kohli U, Sriram CS, Nayak HM. A novel familial SCN5A exon 20 deletion is associated with a heterogeneous phenotype. J Electrocardiol 2021; 66:131-135. [PMID: 33951591 DOI: 10.1016/j.jelectrocard.2021.04.011] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 01/23/2023]
Abstract
The SCN5A gene, located on chromosome 3p21, has 28 exons and is a member of the human voltage-gated sodium channel gene family. Genetic variation in SCN5A is associated with a diverse range of phenotypes. Due to incomplete penetrance, delayed expression, inherent low signal-to-noise ratio, and marked phenotypic heterogeneity, rare novel variants in SCN5A could be misinterpreted. Hence, defining the phenotypic characteristics of these rare SCN5A variants in humans is of importance. We describe the phenotypic heterogeneity noted in 4 familial carriers of a rare, previously unreported, large deletion in exon 20 of SCN5A (c.3667-?_c.3840C +?del) and discuss the mechanisms that underlie this heterogeneity.
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Affiliation(s)
- Utkarsh Kohli
- Division of Pediatric Cardiology, Department of Pediatrics, Comer Children's Hospital and the Pritzker School of Medicine of the University of Chicago, Chicago, IL, USA; Division of Pediatric Cardiology/Electrophysiology, Department of Pediatrics, West Virginia School of Medicine, Morgantown, WV, USA.
| | - Chenni S Sriram
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA
| | - Hemal M Nayak
- Center for Arrhythmia Care, Heart & Vascular Center, Pritzker School of Medicine of the University of Chicago, Chicago, IL, USA
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Pérez-Riera AR, Barbosa-Barros R, Thomaz de Andrade A, Pontes Rodrigues R, Yanowitz F, Daminello Raimundo R, de Abreu LC, Nikus K, Brugada P. Relevance of the vectorcardiogram in the Brugada syndrome with "northwest QRS axis". J Electrocardiol 2021; 66:125-128. [PMID: 33906061 DOI: 10.1016/j.jelectrocard.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/08/2021] [Revised: 04/01/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022]
Abstract
The outcome in the Brugada syndrome (BrS) is more benign in female than in male individuals. However, outcome could be adversely affected by sinus node dysfunction (SND). Long sinus pauses indicate an overlap between the phenotypes of BrS and SND. We present a 29-year-old woman with syncopal episodes at rest since adolescence.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil.
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Antonio Thomaz de Andrade
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Raiza Pontes Rodrigues
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Frank Yanowitz
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, UT, United States; The University of Utah, Department of Internal Medicine, Salt Lake City, UT, United States
| | - Rodrigo Daminello Raimundo
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil; Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Pedro Brugada
- Cardiovascular Division, Free University of Brussels (UZ Brussel) VUB, Brussels, Belgium
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38
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Moïse NS, Flanders WH, Flanders NH, Pariaut R. Optimizing single-chamber pacing in dogs Part 1: Rate determinations, rate interventions and hysteresis. Vet J 2021; 272:105650. [PMID: 33715961 DOI: 10.1016/j.tvjl.2021.105650] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/23/2021] [Accepted: 02/25/2021] [Indexed: 11/30/2022]
Abstract
Determining ideal pacing rates to meet physiological needs and optimizing programming to prevent unnecessary right ventricular pacing in dogs requires an understanding of heart rate profiles and applicable pacing technology. The heart rate and rhythm of the dog is complex necessitating investigation of rate requirements of activity and circadian influences. Overlaying this information are a multiplicity of other factors such as age, breed, temperament, cardiovascular disease and underlining rhythm disorders that contribute to the difficulty in making general conclusions. However, all such information permits better implementation of programming options with the goal of better outcomes. In this review (Part 1 of a two-part review) instantaneous heart rate, rolling average heart rate, simple average heart rate, heart rate tachograms, RR interval tachograms (2D, 3D and dynamic), and Poincaré plots (2D, 3D and dynamic) are discussed as they apply to decisions in the determination and examination of pacing rates for dogs programmed in the VVI pacing mode (Ventricular paced, Ventricular sensed, Inhibited pacing). The applicable pacing operations available for three pacemaker companies are reviewed (Abbott, Biotronik/Dextronix, and Medtronic). The programmable options considered include: slowest pacing rate without additional features to extend the pacing interval, sleep/rest rate preferences, hysteresis to lengthen pacing interval following intrinsic beats, and intermittent increases in pacing following abrupt loss of intrinsic rhythm. Recommendations are suggested for follow-up of individual dogs with examination of pacing statistics and Holter monitoring.
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Affiliation(s)
- N Sydney Moïse
- Section of Cardiology, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
| | - Wyatt H Flanders
- Department of Physics, University of Washington, Seattle, WA 98195, USA
| | | | - Romain Pariaut
- Section of Cardiology, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
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39
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Piccini JP, Stromberg K, Jackson KP, Kowal RC, Duray GZ, El-Chami MF, Crossley GH, Hummel JD, Narasimhan C, Omar R, Ritter P, Roberts PR, Soejima K, Reynolds D, Zhang S, Steinwender C, Chinitz L. Patient selection, pacing indications, and subsequent outcomes with de novo leadless single-chamber VVI pacing. Europace 2020; 21:1686-1693. [PMID: 31681964 DOI: 10.1093/europace/euz230] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/09/2018] [Accepted: 07/29/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Patient selection is a key component of securing optimal patient outcomes with leadless pacing. We sought to describe and compare patient characteristics and outcomes of Micra patients with and without a primary pacing indication associated with atrial fibrillation (AF) in the Micra IDE trial. METHODS AND RESULTS The primary outcome (risk of cardiac failure, pacemaker syndrome, or syncope related to the Micra system or procedure) was compared between successfully implanted patients from the Micra IDE trial with a primary pacing indication associated with AF or history of AF (AF group) and those without (non-AF group). Among 720 patients successfully implanted with Micra, 228 (31.7%) were in the non-AF group. Reasons for selecting VVI pacing in non-AF patients included an expectation for infrequent pacing (66.2%) and advanced age (27.2%). More patients in the non-AF group had a condition that precluded the use of a transvenous pacemaker (9.6% vs. 4.7%, P = 0.013). Atrial fibrillation patients programmed to VVI received significantly more ventricular pacing compared to non-AF patients (median 67.8% vs. 12.6%; P < 0.001). The overall occurrence of the composite outcome at 24 months was 1.8% with no difference between the AF and non-AF groups (hazard ratio 1.36, 95% confidence interval 0.45-4.2; P = 0.59). CONCLUSION Nearly one-third of patients selected to receive Micra VVI therapy were for indications not associated with AF. Non-AF VVI patients required less frequent pacing compared to patients with AF. Risks associated with VVI therapy were low and did not differ in those with and without AF.
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Affiliation(s)
- Jonathan P Piccini
- Electrophysiology Section, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Kevin P Jackson
- Electrophysiology Section, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Gabor Z Duray
- Clinical Electrophysiology Department of Cardiology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | | | | | | | | | - Razali Omar
- Electrophysiology and Pacing Unit, National Heart Institute, Kuala Lumpur, Malaysia
| | - Philippe Ritter
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | | | - Kyoko Soejima
- Department of Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Dwight Reynolds
- Cardiovascular Section, University of Oklahoma Health Sciences Center, OU Medical Center, Oklahoma City, OK, USA
| | | | - Clemens Steinwender
- Kepler University Hospital, Linz, Austria.,Paracelsus Medical University Salzburg, Salzburg, Austria
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40
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Peigh G, Leya MV, Baman JR, Cantey EP, Knight BP, Flaherty JD. Novel coronavirus 19 (COVID-19) associated sinus node dysfunction: a case series. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33089039 PMCID: PMC7239209 DOI: 10.1093/ehjcr/ytaa132] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 04/04/2020] [Revised: 04/16/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Novel coronavirus-19 disease (COVID-19) is associated with significant cardiovascular morbidity and mortality. To date, there have not been reports of sinus node dysfunction (SND) associated with COVID-19. This case series describes clinical characteristics, potential mechanisms, and short-term outcomes of COVID-19 patients who experience de novo SND. CASE SUMMARY We present two cases of new-onset SND in patients recently diagnosed with COVID-19. Patient 1 is a 70-year-old female with no major past medical history who was intubated for acute hypoxic respiratory failure secondary to COVID-19 pneumonia and developed new-onset sinus bradycardia without a compensatory increase in heart rate in response to relative hypotension. Patient 2 is an 81-year-old male with a past medical history of an ascending aortic aneurysm, hypertension, and obstructive sleep apnoea who required intubation for COVID-19-induced acute hypoxic respiratory failure and exhibited new-onset sinus bradycardia followed by numerous episodes of haemodynamically significant accelerated idioventricular rhythm. Two weeks following the onset of SND, both patients remain in sinus bradycardia. DISCUSSION COVID-19-associated SND has not previously been described. The potential mechanisms for SND in patients with COVID-19 include myocardial inflammation or direct viral infiltration. Patients diagnosed with COVID-19 should be monitored closely for the development of bradyarrhythmia and haemodynamic instability.
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Affiliation(s)
- Graham Peigh
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Marysa V Leya
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jayson R Baman
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Eric P Cantey
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Bradley P Knight
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - James D Flaherty
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Babapoor-Farrokhran S, Batnyam U, Wiener PC, Kanjanahattakij N, Khraisha O, Amanullah A, Mainigi SK. Atrioventricular and Sinus Node Dysfunction in Stable COVID-19 Patients. ACTA ACUST UNITED AC 2020; 2:1955-1958. [PMID: 32901230 PMCID: PMC7471580 DOI: 10.1007/s42399-020-00497-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 12/19/2022]
Abstract
There are now well-documented cardiac complications of COVID-19 infection which include myocarditis, heart failure, and acute coronary syndrome resulting from coronary artery thrombosis or SARS-CoV-2-related plaque ruptures. There is growing evidence showing that arrhythmias are also one of the major complications. We report two patients with no known history of cardiac conduction disease who presented with COVID-19 symptoms, positive SARS-CoV-2 infection, and developed cardiac conduction abnormalities. Cardiac conduction system disease involving the sino-atrial (SA) node and atrioventricular (AV) node could be a manifestation of SARS-CoV-2 infection.
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Affiliation(s)
- Savalan Babapoor-Farrokhran
- Division of Cardiology, Department of Medicine, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141 USA
| | - Uyanga Batnyam
- Division of Cardiology, Department of Medicine, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141 USA
| | - Philip C Wiener
- Division of Cardiology, Department of Medicine, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141 USA
| | - Napatt Kanjanahattakij
- Division of Cardiology, Department of Medicine, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141 USA
| | - Ola Khraisha
- Division of Cardiology, Department of Medicine, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141 USA
| | - Aman Amanullah
- Division of Cardiology, Department of Medicine, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141 USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Sumeet K Mainigi
- Division of Cardiology, Department of Medicine, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141 USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107 USA
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42
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Torrente AG, Mesirca P, Bidaud I, Mangoni ME. Channelopathies of voltage-gated L-type Cav1.3/α 1D and T-type Cav3.1/α 1G Ca 2+ channels in dysfunction of heart automaticity. Pflugers Arch 2020; 472:817-830. [PMID: 32601767 DOI: 10.1007/s00424-020-02421-1] [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] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/12/2020] [Accepted: 06/19/2020] [Indexed: 10/24/2022]
Abstract
The heart automaticity is a fundamental physiological function in vertebrates. The cardiac impulse is generated in the sinus node by a specialized population of spontaneously active myocytes known as "pacemaker cells." Failure in generating or conducting spontaneous activity induces dysfunction in cardiac automaticity. Several families of ion channels are involved in the generation and regulation of the heart automaticity. Among those, voltage-gated L-type Cav1.3 (α1D) and T-type Cav3.1 (α1G) Ca2+ channels play important roles in the spontaneous activity of pacemaker cells. Ca2+ channel channelopathies specifically affecting cardiac automaticity are considered rare. Recent research on familial disease has identified mutations in the Cav1.3-encoding CACNA1D gene that underlie congenital sinus node dysfunction and deafness (OMIM # 614896). In addition, both Cav1.3 and Cav3.1 channels have been identified as pathophysiological targets of sinus node dysfunction and heart block, caused by congenital autoimmune disease of the cardiac conduction system. The discovery of channelopathies linked to Cav1.3 and Cav3.1 channels underscores the importance of Ca2+ channels in the generation and regulation of heart's automaticity.
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Affiliation(s)
- Angelo G Torrente
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, 141, rue de la cardonille, 34094, Montpellier, France.,LabEx Ion Channels Science and Therapeutics (ICST), Montpellier, France
| | - Pietro Mesirca
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, 141, rue de la cardonille, 34094, Montpellier, France.,LabEx Ion Channels Science and Therapeutics (ICST), Montpellier, France
| | - Isabelle Bidaud
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, 141, rue de la cardonille, 34094, Montpellier, France.,LabEx Ion Channels Science and Therapeutics (ICST), Montpellier, France
| | - Matteo E Mangoni
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, 141, rue de la cardonille, 34094, Montpellier, France. .,LabEx Ion Channels Science and Therapeutics (ICST), Montpellier, France.
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43
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Abstract
Arrhythmia management in adult congenital heart disease (ACHD) encompasses a wide range of problems from bradyarrhythmia to tachyarrhythmia, sudden death, and heart failure-related electrical dyssynchrony. Major advances in the understanding of the pathophysiology and treatments of these problems over the past decade have resulted in improved therapeutic strategies and outcomes. This article attempts to define these problems and review contemporary management for the patient with ACHD presenting with cardiac arrhythmia.
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Affiliation(s)
- Jeremy P Moore
- Ahmanson-UCLA/Adult Congenital Heart Disease Center, Los Angeles, CA, USA; Department of Pediatrics, UCLA Medical Center, Los Angeles, CA, USA.
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Disease Center; Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 Bélanger Street, Montreal, Quebec H1T 1C8, Canada
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44
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Li C, Ju W, Gu K, Li M, Cui C, Liu H, Wang Z, Chen H, Yang G, Zhang F, Yang B, Wang Z, Chen M. Atrial involvement and progression of sinus node dysfunction in non-senile patients: evidences from electroanatomic mapping and long-term follow-up. J Interv Card Electrophysiol 2021; 60:365-73. [PMID: 32318962 DOI: 10.1007/s10840-020-00735-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Sinus node inability or conduction disorders of its surrounding atrial myocardium cause sinus node dysfunction (SND). This study aimed to characterize right atrium (RA) substrates and long-term atrial lead performance after pacemaker implantation in non-senile SND patients. METHODS Eighteen SND patients (53.3 ± 9.6 years) controlled by 18 age-matched supraventricular tachycardia patients were consecutively enrolled. The P-wave amplitude (PWA) and P-wave duration (PWD) were measured on surface electrocardiography. Electroanatomic mapping was conducted to assess the bipolar voltage, complex signals, volume, and activation time of RA. Pacemaker implantation was performed in SND patients after mapping. RESULTS Compared with controls, SND patients showed significant PWA reduction (0.13 ± 0.02 vs. 0.16 ± 0.04 mV, p = 0.017) and PWD prolongation (120.8 ± 15.2 vs. 105.2 ± 8.6 ms, p = 0.001). The RA endocardial voltage was lower (1.56 ± 0.78 vs. 2.57 ± 0.55 mV, p < 0.001) and activation time was longer (112.1 ± 14.9 vs. 90.8 ± 12.4 ms, p < 0.001) in the study group. Atrial lead was anchored at the lower atrial septum in one patient and failed in another due to extensive atrial scarring. During a median follow-up of 86 (57-88) months, one patient lost atrial capturing, and overall atrial sensing was significantly decreased (2.44 ± 1.16 vs. 1.87 ± 1.01 mV, p = 0.003). CONCLUSIONS Atrial involvement was proved and the process was progressive in non-senile SND patients, as demonstrated by diffused RA lower voltage, slower conduction, and the decrease of the atrial lead sensing.
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45
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Hayashi T, Mizukami A, Kuroda S, Matsumura A, Goya M, Sasano T. Sinus node dysfunction characterized by reduction only in maximum heart rate during exercise after superior vena cava isolation in atrial fibrillation catheter ablation-A potential complication. HeartRhythm Case Rep 2020; 6:206-9. [PMID: 32322498 DOI: 10.1016/j.hrcr.2019.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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46
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Hwang TH, Yu HT, Kim TH, Uhm JS, Kim JY, Joung B, Lee MH, Pak HN. Permanent Pacemaker Implantations after Catheter Ablation in Patients with Atrial Fibrillation Associated with Underlying Sinus Node Dysfunction. Korean Circ J 2019; 50:346-357. [PMID: 31960638 PMCID: PMC7067613 DOI: 10.4070/kcj.2019.0268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 08/20/2019] [Revised: 10/10/2019] [Accepted: 11/19/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The objective of this study was to evaluate the long-term clinical outcomes and the incidence of permanent pacemaker implantation after catheter ablation in patients with of atrial fibrillation (AF) and sinus node dysfunction (SND). METHODS Among 3,068 total consecutive patients who underwent AF catheter ablation (AFCA), this study included 222 (9.5%; men 53.2%, 63.7±9.2 years of age, 81.5% paroxysmal AF) with underlying SND and a regular rhythm follow-up. We analyzed the rhythm outcomes, changes in the mean heart rate or heart rate variability, and permanent pacemaker implantation rate. RESULTS During 47.5±28.8 months of follow-up, 25 (11.3%) patients received pacemaker implantations due to symptomatic SND. More than half (56.0%, 14/25) underwent a pacemaker implantation within 3 months of the AFCA, and the annual pacemaker implantation rate was 2.0% afterwards. Both the early (68.0% vs. 31.0%, p<0.001) and clinical AF recurrence (68.0% vs. 32.5%, p=0.001) rates and continuous antiarrhythmic drug use after 3 months (44.0% vs. 24.4%, p=0.036) were significantly higher in patients requiring pacemaker implantations than those that did not. An anterior linear ablation (odds ratio [OR], 9.37 [3.03-28.9]; p<0.001) and the E/Em (OR, 1.15 [1.02-1.28]; p=0.018) were independently associated with permanent pacemaker implantations after AFCA in patients with AF and SND. CONCLUSIONS After AFCA in patients with AF and SND, 1 of 9 patients needed a pacemaker implantation and half needed implantations within 3 months. The AF recurrence rate was significantly higher in those who required pacemaker implantations after the AFCA.
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Affiliation(s)
- Tae Hyun Hwang
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Hee Tae Yu
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Tae Hoon Kim
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Jae Sun Uhm
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Jong Youn Kim
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Boyoung Joung
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Moon Hyoung Lee
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Hui Nam Pak
- Department of Cardiology, Yonsei University Health System, Seoul, Korea.
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Hayakawa I, Abe Y, Ono H, Kubota M. Severe congenital RYR1-associated myopathy complicated with atrial tachycardia and sinus node dysfunction: a case report. Ital J Pediatr 2019; 45:165. [PMID: 31856875 PMCID: PMC6921593 DOI: 10.1186/s13052-019-0756-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 05/13/2019] [Accepted: 12/03/2019] [Indexed: 11/12/2022] Open
Abstract
Background Cardiac arrhythmias are sometimes encountered in patients with hereditary myopathies and muscular dystrophies. Description of arrhythmias in myopathies and muscular dystrophies is very important, because arrhythmias have a strong impact on the outcomes for these patients and are potentially treatable. Case presentation A girl with severe congenital RYR1-related myopathy exhibited atrial tachycardia and sinus node dysfunction during infancy. She was born after uncomplicated caesarian delivery. She showed no breathing, complete ophthalmoplegia, complete bulbar paralysis, complete facial muscle paralysis, and extreme floppiness. At 5 months old, she developed persistent tachycardia around 200–210 beats per minutes. Holter monitoring revealed ectopic atrial tachycardia during tachyarrhythmia and occasional sinus pauses with junctional escape beats. Propranolol effectively alleviated tachyarrhythmia but was discontinued due to increased frequency and duration of the sinus pauses that led to bradyarrhythmia. There was no evidence of structural heart diseases or heart failure. The arrhythmia gradually resolved spontaneously and at 11 months old, she showed complete sinus rhythm. Conclusions Although supraventricular arrhythmia is sometimes encountered in congenital myopathies, this is the first report of cardiac arrhythmia requiring drug intervention in RYR1-associated myopathy.
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Affiliation(s)
- Itaru Hayakawa
- Division of Neurology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Yuichi Abe
- Division of Neurology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Hiroshi Ono
- Division of Cardiology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Masaya Kubota
- Division of Neurology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
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Cotter R, Lyden J, Mehler PS, Miceli J, Schuller J, Krantz MJ. A case series of profound bradycardia in patients with severe anorexia nervosa: Thou shall not pace? HeartRhythm Case Rep 2019; 5:511-515. [PMID: 31700795 PMCID: PMC6831791 DOI: 10.1016/j.hrcr.2019.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Ryan Cotter
- Division of Cardiology, University of Colorado, Aurora, Colorado
- Address reprint requests and correspondence: Dr Ryan Cotter, Division of Cardiology, University of Colorado, Mail Stop B130, Academic Office 1, Aurora, CO 80045.
| | - Jennifer Lyden
- ACUTE Center for Eating Disorders, Denver Health, Denver, Colorado
- Department of Medicine, Denver Health, Denver, Colorado
| | - Philip S. Mehler
- ACUTE Center for Eating Disorders, Denver Health, Denver, Colorado
- Department of Medicine, Denver Health, Denver, Colorado
- Eating Recovery Center of Denver, Denver, Colorado
| | - Jane Miceli
- Eating Recovery Center of Denver, Denver, Colorado
| | - Joseph Schuller
- Division of Cardiology, Denver Health and the University of Colorado, Denver, Colorado
| | - Mori J. Krantz
- Division of Cardiology, Denver Health and the University of Colorado, Denver, Colorado
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49
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Li H, Li D, Wang Y, Huang Z, Xu J, Yang T, Wang L, Tang Q, Cai CL, Huang H, Zhang Y, Chen Y. Nkx2-5 defines a subpopulation of pacemaker cells and is essential for the physiological function of the sinoatrial node in mice. Development 2019; 146:dev.178145. [PMID: 31320323 DOI: 10.1242/dev.178145] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 03/18/2019] [Accepted: 07/04/2019] [Indexed: 02/05/2023]
Abstract
The sinoatrial node (SAN), the primary cardiac pacemaker, consists of a head domain and a junction/tail domain that exhibit different functional properties. However, the underlying molecular mechanism defining these two pacemaker domains remains elusive. Nkx2-5 is a key transcription factor essential for the formation of the working myocardium, but it was generally thought to be detrimental to SAN development. However, Nkx2-5 is expressed in the developing SAN junction, suggesting a role for Nkx2-5 in SAN junction development and function. In this study, we present unambiguous evidence that SAN junction cells exhibit unique action potential configurations intermediate to those manifested by the SAN head and the surrounding atrial cells, suggesting a specific role for the junction cells in impulse generation and in SAN-atrial exit conduction. Single-cell RNA-seq analyses support this concept. Although Nkx2-5 inactivation in the SAN junction did not cause a malformed SAN at birth, the mutant mice manifested sinus node dysfunction. Thus, Nkx2-5 defines a population of pacemaker cells in the transitional zone. Despite Nkx2-5 being dispensable for SAN morphogenesis during embryogenesis, its deletion hampers atrial activation by the pacemaker.
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Affiliation(s)
- Hua Li
- Southern Center for Biomedical Research and Fujian Key Laboratory of Developmental and Neural Biology, College of Life Sciences, Fujian Normal University, Fuzhou, Fujian Province 350108, PR China.,Department of Cell and Molecular Biology, Tulane University, New Orleans, LA 70118, USA
| | - Dainan Li
- Department of Cell and Molecular Biology, Tulane University, New Orleans, LA 70118, USA
| | - Yuzhi Wang
- Department of Cell and Molecular Biology, Tulane University, New Orleans, LA 70118, USA
| | - Zhen Huang
- Southern Center for Biomedical Research and Fujian Key Laboratory of Developmental and Neural Biology, College of Life Sciences, Fujian Normal University, Fuzhou, Fujian Province 350108, PR China
| | - Jue Xu
- Department of Cell and Molecular Biology, Tulane University, New Orleans, LA 70118, USA.,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan Province 610041, PR China
| | - Tianfang Yang
- Department of Cell and Molecular Biology, Tulane University, New Orleans, LA 70118, USA
| | - Linyan Wang
- Department of Cell and Molecular Biology, Tulane University, New Orleans, LA 70118, USA.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan Province 610041, PR China
| | - Qinghuang Tang
- Department of Cell and Molecular Biology, Tulane University, New Orleans, LA 70118, USA
| | - Chen-Leng Cai
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Hai Huang
- Department of Cell and Molecular Biology, Tulane University, New Orleans, LA 70118, USA
| | - Yanding Zhang
- Southern Center for Biomedical Research and Fujian Key Laboratory of Developmental and Neural Biology, College of Life Sciences, Fujian Normal University, Fuzhou, Fujian Province 350108, PR China
| | - YiPing Chen
- Department of Cell and Molecular Biology, Tulane University, New Orleans, LA 70118, USA
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Leonelli FM, De Ponti R, Bagliani G. Challenges in Bradicardias Interpretation. Card Electrophysiol Clin 2019; 11:261-281. [PMID: 31084850 DOI: 10.1016/j.ccep.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sinus node dysfunction or atrioventricular blocks are the causes of bradycardias. Diagnosis and management begin with evaluation of patient's hemodynamic status and diagnosis of bradycardia's cause. This is followed by an in depth evaluation of pathophysiology of the arrhythmia, its severity, and likelihood of progression. Implementing emergent measures depends on the presence of subsidiary pace makers maintaining cardiac output. Many of these decisions are greatly helped by 12 lead electrocardiogram, because its tracings are often diagnostic of the cause of the bradycardia and help to assess its persistence and progression and to evaluate the presence and reliability of subsidiary pacemakers.
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Affiliation(s)
- Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University South Florida, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612, USA.
| | | | - Giuseppe Bagliani
- Cardiology Department, Arrhythmology Unit, Foligno General Hospital, Foligno, Italy; Cardiovascular Diseases Department, University of Perugia, Perugia, Italy
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