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Kurata M, Batnyam U, Tedrow UB, Richardson TD, Kanagasundram AN, Hasegawa K, Uetake S, Manuelian D, Pellegrini C, Stevenson WG. Intramural needle ablation or repeated standard ablation in patients referred for repeat ablation of scar-related ventricular tachycardia. J Cardiovasc Electrophysiol 2024; 35:994-1004. [PMID: 38501333 DOI: 10.1111/jce.16250] [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: 10/27/2023] [Revised: 01/18/2024] [Accepted: 03/04/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION When ventricular tachycardia (VT) recurs after standard RF ablation (sRFA) some patients benefit from repeat sRFA, whereas others warrant advanced methods such as intramural needle ablation (INA). Our objectives are to assess the utility of repeat sRFA and to clarify the benefit of INA when repeat sRFA fails in patients with VT due to structural heart disease. METHODS In consecutive patients who were prospectively enrolled in a study for INA for recurrent sustained monomorphic VT despite sRFA, repeat sRFA was considered first. INA was performed during the same procedure if repeat sRFA failed or no targets for sRFA were identified. RESULTS Of 85 patients enrolled, acute success with repeat sRFA was achieved in 30 patients (35%), and during the 6-month follow-up, 87% (20/23) were free of VT hospitalization, 78% were free of any VT, and 7 were lost to follow-up. INA was performed in 55 patients (65%) after sRFA failed, or no endocardial targets were found abolished or modified inducible VT in 35/55 patients (64%). During follow-up, 72% (39/54) were free of VT hospitalization, 41% were free of any VT, and 1 was lost to follow-up. Overall, 59 out of 77 (77%) patients were free of hospitalization and 52% were free of any VT. Septal-origin VTs were more likely to need INA, whereas RV and papillary muscle VTs were less likely to require INA. CONCLUSIONS Repeat sRFA was beneficial in 23% (18/77) of patients with recurrent sustained VT who were referred for INA. The availability of INA increased favorable outcomes to 52%.
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Affiliation(s)
- Masaaki Kurata
- Division of Cardiovascular, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Uyanga Batnyam
- Division of Cardiovascular, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Usha B Tedrow
- Division of Cardiovascular, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Travis D Richardson
- Division of Cardiovascular, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arvindh N Kanagasundram
- Division of Cardiovascular, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kanae Hasegawa
- Division of Cardiovascular, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shunsuke Uetake
- Division of Cardiovascular, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Deborah Manuelian
- Division of Cardiovascular, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christine Pellegrini
- Division of Cardiovascular, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - William G Stevenson
- Division of Cardiovascular, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Brooks K, Yoshimura H, Gonzalez-Izquierdo A, Zakkak N, Kukendra-Rajah K, Lip GYH, Providencia R. The association between atrial fibrillation and dementia: A UK linked electronic health records cohort study. Eur J Clin Invest 2024; 54:e14154. [PMID: 38217524 DOI: 10.1111/eci.14154] [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: 11/16/2023] [Revised: 12/27/2023] [Accepted: 01/01/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND We investigated the association between atrial fibrillation (AF) and dementia, and its subtypes (vascular-VaD, Alzheimer, mixed and rare dementia), and identified predictors for dementia in AF patients. METHODS The analysis was based on 183,610 patients with new-onset AF and 367,220 non-AF controls in the United Kingdom between 1998 and 2016, identified in three prospectively collected, linked electronic health records sources. Time-to-event (dementia or subtypes) analyses were performed using Cox proportional hazards and weighted Cox. Sub-analyses performed: including & censoring stroke and age (median used as cut-off). RESULTS Over a median follow-up of 2.67 years (IQR .65-6.02) for AF patients and 5.84 years for non-AF patients (IQR 2.26-11.80), incidence of dementia in the AF cohort was 2.65 per 100 person-years, compared to 2.02 in the non-AF cohort. After adjustment, a significant association was observed between AF and all-cause dementia (HR = 1.38, 95% CI: 1.31-1.45), driven by a strong association with VaD (HR = 1.55, 95% CI: 1.41-1.70). AF was also associated with mixed dementia (HR = 1.26, 95% CI: 1.01-1.56), but we could not confirm an association with Alzheimer (HR = 1.05, 95% CI: .94-1.16) and rare dementia forms (HR = 1.19, 95% CI: .90-1.56). Ischemic stroke (HR = 1.40, 95% CI: 1.26-1.56), subarachnoid haemorrhage (HR = 2.08, 95% CI: 1.47-2.96), intracerebral haemorrhage (HR = 1.95, 95% CI: 1.54-2.48) and diabetes (HR = 1.32, 95% CI: 1.24-1.41) were identified as the strongest predictors of dementia in AF patients. CONCLUSIONS AF patients have an increased risk of dementia, independent of stroke, with highest risk of VaD. Management and prevention of the identified risk factors could be crucial to reduce the increasing burden of dementia.
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Affiliation(s)
- Kieran Brooks
- Institute of Health Informatics Research, University College London, London, UK
| | - Hiroyuki Yoshimura
- Institute of Health Informatics Research, University College London, London, UK
| | | | - Nadine Zakkak
- Institute of Health Informatics Research, University College London, London, UK
| | - Kishore Kukendra-Rajah
- Institute of Health Informatics Research, University College London, London, UK
- Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - Rui Providencia
- Institute of Health Informatics Research, University College London, London, UK
- Barts Heart Centre, Barts Health NHS Trust, London, UK
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Hansen S, Otten ND, Nissen SD, Carstensen H, Hopster-Iversen C, Fjeldborg J, Staun SH, Fenner M, Hesselkilde EM, Buhl R. Atrial fibrillation as a risk factor for exercise-induced pulmonary haemorrhage following a standardised exercise test. Equine Vet J 2024; 56:552-561. [PMID: 37654233 DOI: 10.1111/evj.13995] [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: 03/31/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) has been proposed as a risk factor for exercise-induced pulmonary haemorrhage (EIPH) due to increased pressure in the left atrium. OBJECTIVE To evaluate if AF was associated with EIPH following a standardised exercise test (SET) to fatigue. STUDY DESIGN Two-arm controlled experiment. METHODS Ten untrained Standardbred mares mean (standard deviation [SD]) age 6 (2) years performed a SET on the treadmill in sinus rhythm (SR) (SET1) and 25-44 days after induction of self-sustained AF (SET2). AF was induced by tachypacing using a pacing device. Endoscopy, including tracheal wash and bronchoalveolar lavage (BAL), was performed 48-72 h before and 24 h after the two SETs. In addition, endoscopic grading of tracheal blood was performed 2 h after each SET. RESULTS After SET1, none of the horses showed blood in the trachea, and two horses showed erythrophagocytosis. Following SET2, two horses had grade 1 blood in the trachea and free erythrocytes and erythrophagocytosis in the BAL, while another two horses had erythrophagocytosis in the BAL. In SET2, the overall performance on the treadmill was decreased with a lower maximum velocity (SET1 10.3 ± 0.8 m/s vs. SET2 8.9 ± 0.9 m/s, p = 0.004), a higher heart rate (284 ± 21 vs. 221 ± 18 bpm, p = 0.003) and more abnormal QRS complexes (p < 0.001) compared with SET1. CONCLUSIONS Two horses showed signs of EIPH, resulting in visible blood in the trachea, when exercising in AF compared with SR. However, a possible link between EIPH, pulmonary pressure and AF needs to be further elucidated.
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Affiliation(s)
- Sanni Hansen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Nina D Otten
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Sarah D Nissen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Helena Carstensen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Charlotte Hopster-Iversen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Julie Fjeldborg
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Sophie H Staun
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Merle Fenner
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Eva M Hesselkilde
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Rikke Buhl
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
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Hofmann C, Syrbe S, Hebe J, Kreft J, Stark S, Milde T, Völkers M, Hoffmann GF, Gorenflo M, Kovacevic A. Long-term use of everolimus for refractory arrhythmia in a child with tuberous sclerosis complex. Am J Med Genet A 2024; 194:e63508. [PMID: 38130096 DOI: 10.1002/ajmg.a.63508] [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: 09/15/2023] [Revised: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
Tuberous sclerosis complex is associated with the occurrence of cardiac rhabdomyomas that may result in life-threatening arrhythmia unresponsive to standard antiarrhythmic therapy. We report the case of an infant with multiple cardiac rhabdomyomas who developed severe refractory supraventricular tachycardia (SVT) that was successfully treated with everolimus. Pharmacological mTOR inhibition rapidly improved arrhythmia within few weeks after treatment initiation and correlated with a reduction in tumor size. Intermediate attempts to discontinue everolimus resulted in rhabdomyoma size rebound and recurrence of arrhythmic episodes, which resolved on resumption of therapy. While everolimus treatment led to successful control of arrhythmia in the first years of life, episodes of SVT reoccurred at the age of 6 years. Electrophysiologic testing confirmed an accessory pathway that was successfully ablated, resulting in freedom of arrhythmic events. In summary we present an in-depth evaluation of the long-term use of everolimus in a child with TSC-associated SVT, including the correlation between drug use and arrhythmia outcome. This case report provides important information on the safety and efficacy of an mTOR inhibitor for the treatment of a potentially life-threatening cardiac disease manifestation in TSC for which the optimal treatment strategy is still not well established.
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Affiliation(s)
- Christoph Hofmann
- Department of Internal Medicine III (Cardiology, Angiology, and Pneumology), Heidelberg University Hospital, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Steffen Syrbe
- Department of General Pediatrics, Division of Neuropediatrics and Metabolic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Joachim Hebe
- Center for Electrophysiology Bremen, Bremen, Germany
| | - Jannis Kreft
- Department of Internal Medicine III (Cardiology, Angiology, and Pneumology), Heidelberg University Hospital, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Sebastian Stark
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, Partnership Between German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Germany
- Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Till Milde
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, Partnership Between German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Germany
- Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Mirko Völkers
- Department of Internal Medicine III (Cardiology, Angiology, and Pneumology), Heidelberg University Hospital, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Georg Friedrich Hoffmann
- Department of General Pediatrics, Division of Neuropediatrics and Metabolic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Gorenflo
- Department of Pediatric and Congenital Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Kovacevic
- Department of Pediatric and Congenital Cardiology, Heidelberg University Hospital, Heidelberg, Germany
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5
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Iyengar S, Reddy S, Khetarpal BK, Elzamar M, Srivathsan K. Challenges of atrial fibrillation and atrial flutter ablation in patients with pectus excavatum. Pacing Clin Electrophysiol 2024; 47:668-672. [PMID: 37594226 DOI: 10.1111/pace.14805] [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: 02/27/2023] [Revised: 07/12/2023] [Accepted: 08/05/2023] [Indexed: 08/19/2023]
Abstract
Atrial fibrillation (AF) may be associated with chest wall abnormalities such as pectus excavatum (PE). Pulmonary vein isolation (PVI) has proven to be a useful strategy for radiofrequency catheter ablation (RFCA) of AF. However, the presence of chest wall abnormalities, such as pectus excavatum, imposes certain challenges during ablation due to the anatomic distortion that it causes. We highlight these challenges during ablation in this three-patient case series.
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Affiliation(s)
- Sumedh Iyengar
- Department of Cardiovascular Diseases, Mayo Clinic Hospital, Arizona, USA
| | - Sudeepthi Reddy
- Department of Cardiovascular Diseases, Mayo Clinic Hospital, Arizona, USA
| | | | - Mohamed Elzamar
- Department of Cardiovascular Diseases, Mayo Clinic Hospital, Arizona, USA
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6
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Roshanbinfar K, Schiffer M, Carls E, Angeloni M, Koleśnik-Gray M, Schruefer S, Schubert DW, Ferrazzi F, Krstić V, Fleischmann BK, Roell W, Engel FB. Electrically Conductive Collagen-PEDOT:PSS Hydrogel Prevents Post-Infarct Cardiac Arrhythmia and Supports hiPSC-Cardiomyocyte Function. Adv Mater 2024:e2403642. [PMID: 38653478 DOI: 10.1002/adma.202403642] [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] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Indexed: 04/25/2024]
Abstract
Myocardial infarction (MI) causes cell death, disrupts electrical activity, triggers arrhythmia, and results in heart failure, whereby 50-60% of MI-associated deaths manifest as sudden cardiac deaths (SCD). The most effective therapy for SCD prevention is implantable cardioverter defibrillators (ICDs). However, ICDs contribute to adverse remodeling and disease progression and do not prevent arrhythmia. We developed an injectable collagen-PEDOT:PSS hydrogel that protects infarcted hearts against ventricular tachycardia (VT) and can be combined with hiPSC-cardiomyocytes to promote partial cardiac remuscularization. PEDOT:PSS improves collagen gel formation, micromorphology, and conductivity. hiPSC-cardiomyocytes in collagen-PEDOT:PSS hydrogels exhibit near-adult sarcomeric length, improved contractility, enhanced calcium handling, and conduction velocity. RNA-sequencing data indicate enhanced maturation and improved cell-matrix interactions. Injecting collagen-PEDOT:PSS hydrogels in infarcted mouse hearts decreases VT to the levels of healthy hearts. Collectively, collagen-PEDOT:PSS hydrogels offer a versatile platform for treating cardiac injuries. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kaveh Roshanbinfar
- Experimental Renal and Cardiovascular Research, Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Miriam Schiffer
- Institute of Physiology I, Life and Brain Center, Medical Faculty, University of Bonn, Germany
| | - Esther Carls
- Department of Cardiac Surgery, UKB, University of Bonn, Germany
| | - Miriam Angeloni
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Maria Koleśnik-Gray
- Department of Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Staudtstr. 7, 91058, Erlangen, Germany
| | - Stefan Schruefer
- Institute of Polymer Materials, Department of Materials Science and Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Martensstr. 7, 91058, Erlangen, Germany
| | - Dirk W Schubert
- Institute of Polymer Materials, Department of Materials Science and Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Martensstr. 7, 91058, Erlangen, Germany
| | - Fulvia Ferrazzi
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Muscle Research Center Erlangen (MURCE), 91054, Erlangen, Germany
| | - Vojislav Krstić
- Department of Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Staudtstr. 7, 91058, Erlangen, Germany
| | - Bernd K Fleischmann
- Institute of Physiology I, Life and Brain Center, Medical Faculty, University of Bonn, Germany
| | - Wilhelm Roell
- Department of Cardiac Surgery, UKB, University of Bonn, Germany
| | - Felix B Engel
- Experimental Renal and Cardiovascular Research, Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
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7
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Tiver KD, Strong C, Dharmaprani D, Chapman D, Jenkins E, Shahrbabaki SS, Ganesan AN. A real-time signal processing software package for the electrophysiology laboratory. J Cardiovasc Electrophysiol 2024. [PMID: 38654418 DOI: 10.1111/jce.16281] [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: 01/18/2024] [Revised: 03/13/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Real-time signal processing has to date been difficult to implement in the clinical electrophysiology laboratory. To date, no open access software solutions are available in electrophysiology (EP) laboratories to facilitate real-time intraprocedural signal analysis. We aimed to develop an open access, scalable Python plug-in to allow real-time signal processing during human EP procedures. METHODS AND RESULTS A Python-based plug in for the widely available EnsiteX mapping system was developed. This plug-in utilized the LiveSync feature of the system to allow real-time signal analysis. An open access library was developed to allow end-users to implement real-time signal analysis using this platform, implemented in the Python programming language https://github.com/anand9176/WaveWatch5000Public. CONCLUSION We have developed and demonstrated the feasibility of a readily scalable and open-access Python-based plug in to an electroanatomic mapping system (EnSiteX) to allow real-time processing and display of electrogram (EGM) based information for the procedural electrophysiologist to view intraprocedurally in the electrophysiology laboratory. The availability, to the clinician, of traditional and novel EGM-based metrics at the time of intervention, such as atrial fibrillation ablation, allows for key mechanistic insights into critical unresolved questions regarding arrhythmia mechanism.
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Affiliation(s)
- Kathryn D Tiver
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Cardiology, Flinders Medical Centre, Adelaide, Australia
| | - Campbell Strong
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Dhani Dharmaprani
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Darius Chapman
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Evan Jenkins
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | | | - Anand N Ganesan
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Cardiology, Flinders Medical Centre, Adelaide, Australia
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8
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Liutkute A, Prosser BL, Voigt N. Microtubules: highway to … arrhythmia? Cardiovasc Res 2024:cvae072. [PMID: 38637305 DOI: 10.1093/cvr/cvae072] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Affiliation(s)
- Aiste Liutkute
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Germany
- Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Germany
| | - Benjamin L Prosser
- Department of Physiology, Pennsylvania Muscle Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Niels Voigt
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Germany
- Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Germany
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9
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Kawasaki J, Mato N, Fujii H, Miura K, Mashiko T, Katayama S, Yamanouchi Y, Sato M, Takasaki T, Takigami A, Hisata S, Nunomiya S, Hagiwara K, Maemondo M. Significance of Persistent Systemic Support in the Clinical Course of Delayed Post-hypoxic Leukoencephalopathy Following Severe Coronavirus Disease 2019. Intern Med 2024; 63:1167-1172. [PMID: 38296478 DOI: 10.2169/internalmedicine.1412-22] [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] [Indexed: 04/16/2024] Open
Abstract
A 45-year-old woman was hospitalized with severe coronavirus disease 2019 pneumonia. Following cytokine storm-induced multiorgan failure and lethal arrhythmia, the patient developed a sustained coma with flaccid quadriplegia. A cerebrospinal fluid examination excluded infectious and immunogenic encephalopathies, and diffusion-weighted magnetic resonance imaging demonstrated high-intensity areas in the white matter with a cortex-sparing distribution, suggesting delayed post-hypoxic leukoencephalopathy. As a result of intensive cardiopulmonary support for a month, the neurological function gradually recovered. Based on the reversible clinical course noted in this patient, accurate diagnosis and persistent medical approaches are important for the management of coronavirus disease 2019-related delayed post-hypoxic leukoencephalopathy.
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Affiliation(s)
- Juri Kawasaki
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Naoko Mato
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Hiroyuki Fujii
- Department of Radiology, Jichi Medical University, Japan
| | - Kumiko Miura
- Division of Neurology, Department of Medicine, Jichi Medical University, Japan
| | - Takafumi Mashiko
- Division of Neurology, Department of Medicine, Jichi Medical University, Japan
| | - Shinshu Katayama
- Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University, Japan
| | - Yoshitaka Yamanouchi
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Miki Sato
- Postgraduate Clinical Training Center, Jichi Medical University Hospital, Japan
| | - Toshikazu Takasaki
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Ayako Takigami
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Shu Hisata
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Shin Nunomiya
- Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University, Japan
| | - Koichi Hagiwara
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Makoto Maemondo
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
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10
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Rav-Acha M, Shah K, Hasin T, Gumuser E, Tovia-Brodie O, Shauer A, Konstantino Y, Yair E, Wolak A, Sinai E, Ziv-Baran T, Amsalem I, Michowitz Y, Glikson M, Heist K, Ng CY. Incidence and Predictors for Recurrence of Ventricular Arrhythmia Presenting During Acute Myocarditis: A Multicenter Study. JACC Clin Electrophysiol 2024:S2405-500X(24)00173-7. [PMID: 38661603 DOI: 10.1016/j.jacep.2024.02.027] [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: 10/25/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Management of acute myocarditis (AM) patients experiencing ventricular arrhythmia (VA) during acute illness is controversial, especially regarding early implantable cardioverter-defibrillator (ICD) implantation. OBJECTIVES The purpose of this study was to evaluate the prevalence of and find predictors for long-term sustained VA recurrence and overall mortality among AM patients with VA. METHODS This was a multicenter retrospective analysis of AM patients (verified by cardiac magnetic resonance imaging or myocardial biopsy) with documented VA during the acute illness ("initial VA"). Patients with history of myocardial infarction, heart failure, or VA were excluded. The study endpoint was a composite of sustained VA and overall mortality during follow-up. RESULTS The study included 69 AM patients with initial VA: sustained monomorphic ventricular tachycardia (MMVT) (n = 25), sustained polymorphic ventricular tachycardia (VT)/ventricular fibrillation (n = 13), and nonsustained VT (n = 31). Age was 44 ± 13 years, and 23 of 69 (33.3%) were women. During median follow-up of 5.5 years, 27 of 69 (39%) patients reached the composite endpoint including sustained VA (n = 24) and death (n = 11). Initial MMVT, predischarge left ventricular dysfunction (left ventricular ejection fraction <50%), and anteroseptal delayed enhancement on cardiac magnetic resonance imaging were significantly associated with the composite endpoint. On multivariable analysis, initial MMVT (HR: 5.17; 95% CI: 1.81-14.6; P = 0.001) and predischarge LV dysfunction (HR: 4.57; 95% CI: 1.83-11.5; P = 0.005) were independently associated with the composite endpoint. Using these 2 predictors, we could delineate subgroups with low (∼4%), medium (∼42%), and high (∼82%) 10-year incidence of composite endpoint. CONCLUSIONS AM patients presenting with VA have high incidence of sustained VA recurrence and mortality posthospitalization. Initial MMVT and predischarge LV dysfunction are independently associated with VA recurrence and mortality. Implantable cardioverter-defibrillator implantation may be considered in such high-risk patients.
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Affiliation(s)
- Moshe Rav-Acha
- Integrated Heart Center, Shaare Zedek Hospital, Hebrew University, Jerusalem, Israel.
| | - Kushal Shah
- Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Tal Hasin
- Integrated Heart Center, Shaare Zedek Hospital, Hebrew University, Jerusalem, Israel
| | - Ezra Gumuser
- Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Oholi Tovia-Brodie
- Integrated Heart Center, Shaare Zedek Hospital, Hebrew University, Jerusalem, Israel
| | - Ayelet Shauer
- Cardiology Dept. Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Yuval Konstantino
- Cardiology Department, Soroka Medical Center, Ben-Gurion University, Beer-Sheva, Israel
| | - Eyal Yair
- Bar-Ilan University, Tek-Aviv, Israel
| | - Arik Wolak
- Integrated Heart Center, Shaare Zedek Hospital, Hebrew University, Jerusalem, Israel
| | - Eden Sinai
- Integrated Heart Center, Shaare Zedek Hospital, Hebrew University, Jerusalem, Israel
| | - Tomer Ziv-Baran
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itzak Amsalem
- Integrated Heart Center, Shaare Zedek Hospital, Hebrew University, Jerusalem, Israel
| | - Yoav Michowitz
- Integrated Heart Center, Shaare Zedek Hospital, Hebrew University, Jerusalem, Israel
| | - Michael Glikson
- Integrated Heart Center, Shaare Zedek Hospital, Hebrew University, Jerusalem, Israel
| | - Kevin Heist
- Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Chee Yuan Ng
- Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
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Nham T, Garcia MC, Tsang KLJ, Silva JM, Schneider T, Deng J, Lohit S, Mbuagbaw L, Holbrook A. Proarrhythmic major adverse cardiac events with donepezil: A systematic review with meta-analysis. J Am Geriatr Soc 2024. [PMID: 38580328 DOI: 10.1111/jgs.18909] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 02/05/2024] [Accepted: 03/16/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Cholinesterase inhibitors (ChEIs) are regularly used in Alzheimer's disease. Of the three ChEIs approved for dementia, donepezil is among the most prescribed drugs in the United States with nearly 6 million prescriptions in 2020; however, it is classified as a "known risk" QT interval-prolonging medication (QTPmed). Given this claim is derived from observational data including single case reports, we aimed to evaluate high-quality literature on the frequency and nature of proarrhythmic major adverse cardiac events (MACE) associated with donepezil. METHODS We searched Medline, Embase, International Pharmaceutical Abstracts, and Cochrane Central from 1996 onwards for randomized controlled trials (RCTs) involving patients age ≥18 years comparing donepezil to placebo. The MACE composite included mortality, sudden cardiac death, non-fatal cardiac arrest, Torsades de pointes, ventricular tachyarrhythmia, seizure or syncope. Random-effects meta-analyses were performed with a treatment-arm continuity correction for single and double zero event studies. RESULTS Sixty RCTs (n = 12,463) were included. Twenty-five of 60 trials (n = 5886) investigated participants with Alzheimer's disease and 33 trials monitored electrocardiogram data. The mean follow-up duration was 31 weeks (SD = 36). Mortality was the most commonly reported MACE (252/331, 75.8% events), the remainder were syncope or seizures, with no arrhythmia events. There was no increased risk of MACE with exposure to donepezil compared to placebo (risk ratio [RR] 1.08, 95% CI 0.88-1.33, I2 = 0%) and this was consistent in the subgroup analysis of trials including participants with cardiovascular morbidities (RR 1.14, 95% CI 0.88-1.47). Subgroup analysis suggested a trend toward more events with donepezil with follow-up ≥52 weeks (RR: 1.32, 0.98-1.79). CONCLUSIONS This systematic review with meta-analysis found donepezil may not be arrhythmogenic. Donepezil was not associated with mortality, ventricular arrhythmias, seizure or syncope, although longer durations of therapy need more study. Further research to clarify actual clinical outcomes related to QTPmed is important to inform prescribing practices.
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Affiliation(s)
- Tina Nham
- Division of Geriatrics, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michael Cristian Garcia
- Clinical Pharmacology & Toxicology Research Group, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kai La Jennifer Tsang
- Clinical Pharmacology & Toxicology Research Group, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Queens University, Kingston, Ontario, Canada
| | - Jessyca Matos Silva
- Clinical Pharmacology & Toxicology Research Group, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Tyler Schneider
- Clinical Pharmacology & Toxicology Research Group, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Jiawen Deng
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Simran Lohit
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Anne Holbrook
- Clinical Pharmacology & Toxicology Research Group, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Clinical Pharmacology & Toxicology, Department of Medicine, St Joseph's Healthcare, Hamilton, Ontario, Canada
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12
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Yoo RM, Viggiano BT, Pundi KN, Fries JA, Zahedivash A, Podchiyska T, Din N, Shah NH. Scalable Approach to Consumer Wearable Postmarket Surveillance: Development and Validation Study. JMIR Med Inform 2024; 12:e51171. [PMID: 38596848 PMCID: PMC11024395 DOI: 10.2196/51171] [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: 07/29/2023] [Revised: 01/15/2024] [Accepted: 02/04/2024] [Indexed: 04/11/2024] Open
Abstract
Background With the capability to render prediagnoses, consumer wearables have the potential to affect subsequent diagnoses and the level of care in the health care delivery setting. Despite this, postmarket surveillance of consumer wearables has been hindered by the lack of codified terms in electronic health records (EHRs) to capture wearable use. Objective We sought to develop a weak supervision-based approach to demonstrate the feasibility and efficacy of EHR-based postmarket surveillance on consumer wearables that render atrial fibrillation (AF) prediagnoses. Methods We applied data programming, where labeling heuristics are expressed as code-based labeling functions, to detect incidents of AF prediagnoses. A labeler model was then derived from the predictions of the labeling functions using the Snorkel framework. The labeler model was applied to clinical notes to probabilistically label them, and the labeled notes were then used as a training set to fine-tune a classifier called Clinical-Longformer. The resulting classifier identified patients with an AF prediagnosis. A retrospective cohort study was conducted, where the baseline characteristics and subsequent care patterns of patients identified by the classifier were compared against those who did not receive a prediagnosis. Results The labeler model derived from the labeling functions showed high accuracy (0.92; F1-score=0.77) on the training set. The classifier trained on the probabilistically labeled notes accurately identified patients with an AF prediagnosis (0.95; F1-score=0.83). The cohort study conducted using the constructed system carried enough statistical power to verify the key findings of the Apple Heart Study, which enrolled a much larger number of participants, where patients who received a prediagnosis tended to be older, male, and White with higher CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, sex category) scores (P<.001). We also made a novel discovery that patients with a prediagnosis were more likely to use anticoagulants (525/1037, 50.63% vs 5936/16,560, 35.85%) and have an eventual AF diagnosis (305/1037, 29.41% vs 262/16,560, 1.58%). At the index diagnosis, the existence of a prediagnosis did not distinguish patients based on clinical characteristics, but did correlate with anticoagulant prescription (P=.004 for apixaban and P=.01 for rivaroxaban). Conclusions Our work establishes the feasibility and efficacy of an EHR-based surveillance system for consumer wearables that render AF prediagnoses. Further work is necessary to generalize these findings for patient populations at other sites.
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Affiliation(s)
- Richard M Yoo
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Ben T Viggiano
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Krishna N Pundi
- Department of Cardiovascular Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Jason A Fries
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Aydin Zahedivash
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States
| | - Tanya Podchiyska
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Natasha Din
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Nigam H Shah
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, CA, United States
- Technology and Digital Services, Stanford Health Care, Stanford, CA, United States
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13
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Jha CK. Automated cardiac arrhythmia detection techniques: a comprehensive review for prospective approach. Comput Methods Biomech Biomed Engin 2024:1-16. [PMID: 38566498 DOI: 10.1080/10255842.2024.2332942] [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: 04/20/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
Abnormal cardiac functionality produces irregular heart rhythms which are commonly known as arrhythmias. In some conditions, arrhythmias are treated as very dangerous which may lead to sudden cardiac arrest. The incidence and prevalence of cardiac anomalies seeks early detection of arrhythmias using automated classification techniques. In the past, numerous automated arrhythmia detection techniques have been developed that are based on electrocardiogram (ECG) signal analysis. Focusing on the prospective research in this field, this article reports a comprehensive review of existing techniques that are obtained using search engines such as IEEE explore, Google scholar and science direct. Based on the review, the existing techniques are broadly categorized into two types: machine-learning and deep-learning-based techniques. In this study, it is noticed that the performance of the machine-learning-based arrhythmia detection techniques depend on pre-processing of ECG signal, R-peaks detection, features extraction and classification tools while the deep-learning-based techniques do not require the features extraction step. Generally, the existing techniques utilize Massachusetts Institute of Technology-Beth Israel Hospital arrhythmia database to evaluate the classification performance. The classification performance of automated techniques also depends on ECG data used for training and testing of the classifier. It is expected that the performance should be evaluated using a variety of ECG signals including the cases of inter-patient and intra-patient paradigm. The existing techniques also require to deal with the class-imbalance problem. In addition to this, a specific partition-ratio between training and testing datasets should be maintained for fair comparison of performance of different techniques.
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Affiliation(s)
- Chandan Kumar Jha
- Department of Electronics & Communication Engineering, Indian Institute of Information Technology Bhagalpur, India
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14
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Havig SM, Berg-Pedersen RM, Krabseth HM, Müller LD, Haugaa K, Zare HK, Gjesdal K, Krajci P, Opdal MS. Effect on QTc interval by switching from methadone to equipotent R-methadone dose in methadone maintenance treatment patients. Basic Clin Pharmacol Toxicol 2024; 134:519-530. [PMID: 38308508 DOI: 10.1111/bcpt.13982] [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: 10/10/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 02/04/2024]
Abstract
Methadone (R,S-methadone) can prolong the QT interval. R-methadone inhibits cardiac potassium channel function less than S-methadone. We tested if switching from methadone to R-methadone would reduce corrected QT (QTc) intervals in methadone maintenance treatment (MMT) patients. Nine patients, with automatically read QTc intervals ≥450 ms, were required to detect a 20 ms (clinically relevant) reduction in QTc intervals with 15 ms standard deviation (SD) and 90% power. Nine stabilized MMT patients, using median (range) 70 (40-120) mg methadone, were included. Data (ECG recordings, serum samples, and withdrawal symptoms) were collected both before drug intake (Cmin ) and at 3 h after drug intake (Cmax ), and were collected on the day before the switch from methadone to equipotent R-methadone dose and at 14 and 28 days after the switch. A cardiologist calculated QTc intervals retrospectively. Serum electrolytes and methadone concentrations were measured. Mean QTc intervals at Cmin were 472 ms and 422 ms on methadone (automatically and manually read) and 414 ms on R-methadone (manually read). Mean (SD) change in QTc intervals was -8 (10) ms (p = 0.047) at Cmin but non-significant at Cmax . R-methadone showed a concentration-dependent relationship with QTc intervals. Switching to R-methadone reduced QTc intervals, but far less than the 20 ms considered clinically relevant.
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Affiliation(s)
| | | | | | | | - Kristina Haugaa
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Knut Gjesdal
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter Krajci
- Department of Substance Use Disorder Treatment, Oslo University Hospital, Oslo, Norway
| | - Mimi Stokke Opdal
- Department of Pharmacology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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15
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Pironet A, Vandewiele F, Vennekens R. Exploring the role of TRPM4 in calcium-dependent triggered activity and cardiac arrhythmias. J Physiol 2024; 602:1605-1621. [PMID: 37128952 DOI: 10.1113/jp283831] [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: 01/26/2023] [Accepted: 04/28/2023] [Indexed: 05/03/2023] Open
Abstract
Cardiac arrhythmias pose a major threat to a patient's health, yet prove to be often difficult to predict, prevent and treat. A key mechanism in the occurrence of arrhythmias is disturbed Ca2+ homeostasis in cardiac muscle cells. As a Ca2+-activated non-selective cation channel, TRPM4 has been linked to Ca2+-induced arrhythmias, potentially contributing to translating an increase in intracellular Ca2+ concentration into membrane depolarisation and an increase in cellular excitability. Indeed, evidence from genetically modified mice, analysis of mutations in human patients and the identification of a TRPM4 blocking compound that can be applied in vivo further underscore this hypothesis. Here, we provide an overview of these data in the context of our current understanding of Ca2+-dependent arrhythmias.
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Affiliation(s)
- Andy Pironet
- Laboratory of Ion Channel Research, VIB Centre for Brain and Disease Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Frone Vandewiele
- Laboratory of Ion Channel Research, VIB Centre for Brain and Disease Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Rudi Vennekens
- Laboratory of Ion Channel Research, VIB Centre for Brain and Disease Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
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16
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Fan X, Cao J, Li M, Zhang D, El‐Battrawy I, Chen G, Zhou X, Yang G, Akin I. Stroke Related Brain-Heart Crosstalk: Pathophysiology, Clinical Implications, and Underlying Mechanisms. Adv Sci (Weinh) 2024; 11:e2307698. [PMID: 38308187 PMCID: PMC11005719 DOI: 10.1002/advs.202307698] [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] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/09/2024] [Indexed: 02/04/2024]
Abstract
The emergence of acute ischemic stroke (AIS) induced cardiovascular dysfunctions as a bidirectional interaction has gained paramount importance in understanding the intricate relationship between the brain and heart. Post AIS, the ensuing cardiovascular dysfunctions encompass a spectrum of complications, including heart attack, congestive heart failure, systolic or diastolic dysfunction, arrhythmias, electrocardiographic anomalies, hemodynamic instability, cardiac arrest, among others, all of which are correlated with adverse outcomes and mortality. Mounting evidence underscores the intimate crosstalk between the heart and the brain, facilitated by intricate physiological and neurohumoral complex networks. The primary pathophysiological mechanisms contributing to these severe cardiac complications involve the hypothalamic-pituitary-adrenal (HPA) axis, sympathetic and parasympathetic hyperactivity, immune and inflammatory responses, and gut dysbiosis, collectively shaping the stroke-related brain-heart axis. Ongoing research endeavors are concentrated on devising strategies to prevent AIS-induced cardiovascular dysfunctions. Notably, labetalol, nicardipine, and nitroprusside are recommended for hypertension control, while β-blockers are employed to avert chronic remodeling and address arrhythmias. However, despite these therapeutic interventions, therapeutic targets remain elusive, necessitating further investigations into this complex challenge. This review aims to delineate the state-of-the-art pathophysiological mechanisms in AIS through preclinical and clinical research, unraveling their intricate interplay within the brain-heart axis, and offering pragmatic suggestions for managing AIS-induced cardiovascular dysfunctions.
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Affiliation(s)
- Xuehui Fan
- Key Laboratory of Medical ElectrophysiologyMinistry of Education and Medical Electrophysiological Key Laboratory of Sichuan ProvinceCollaborative Innovation Center for Prevention of Cardiovascular DiseasesInstitute of Cardiovascular ResearchSouthwest Medical UniversityLuzhou646000China
- CardiologyAngiologyHaemostaseologyand Medical Intensive CareMedical Centre MannheimMedical Faculty MannheimHeidelberg University68167HeidelbergGermany
- European Center for AngioScience (ECAS)German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheimand Centre for Cardiovascular Acute Medicine Mannheim (ZKAM)Medical Centre MannheimHeidelberg University68167HeidelbergGermany
| | - Jianyang Cao
- School of Physical EducationSouthwest Medical UniversityLuzhouSichuan Province646000China
- Acupuncture and Rehabilitation DepartmentThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhou646000China
| | - Mingxia Li
- School of Physical EducationSouthwest Medical UniversityLuzhouSichuan Province646000China
- Acupuncture and Rehabilitation DepartmentThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhou646000China
| | - Dechou Zhang
- Department of NeurologyThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhou646000China
| | - Ibrahim El‐Battrawy
- Department of Cardiology and AngiologyRuhr University44780BochumGermany
- Institut für Forschung und Lehre (IFL)Department of Molecular and Experimental CardiologyRuhr‐University Bochum44780BochumGermany
| | - Guiquan Chen
- Acupuncture and Rehabilitation DepartmentThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhou646000China
| | - Xiaobo Zhou
- Key Laboratory of Medical ElectrophysiologyMinistry of Education and Medical Electrophysiological Key Laboratory of Sichuan ProvinceCollaborative Innovation Center for Prevention of Cardiovascular DiseasesInstitute of Cardiovascular ResearchSouthwest Medical UniversityLuzhou646000China
- CardiologyAngiologyHaemostaseologyand Medical Intensive CareMedical Centre MannheimMedical Faculty MannheimHeidelberg University68167HeidelbergGermany
- European Center for AngioScience (ECAS)German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheimand Centre for Cardiovascular Acute Medicine Mannheim (ZKAM)Medical Centre MannheimHeidelberg University68167HeidelbergGermany
| | - Guoqiang Yang
- CardiologyAngiologyHaemostaseologyand Medical Intensive CareMedical Centre MannheimMedical Faculty MannheimHeidelberg University68167HeidelbergGermany
- European Center for AngioScience (ECAS)German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheimand Centre for Cardiovascular Acute Medicine Mannheim (ZKAM)Medical Centre MannheimHeidelberg University68167HeidelbergGermany
- Acupuncture and Rehabilitation DepartmentThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhou646000China
| | - Ibrahim Akin
- CardiologyAngiologyHaemostaseologyand Medical Intensive CareMedical Centre MannheimMedical Faculty MannheimHeidelberg University68167HeidelbergGermany
- European Center for AngioScience (ECAS)German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheimand Centre for Cardiovascular Acute Medicine Mannheim (ZKAM)Medical Centre MannheimHeidelberg University68167HeidelbergGermany
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Park IJ, Kim D, Yu HT, Kim T, Uhm J, Joung B, Lee M, Hwang C, Pak H. Association of extra-pulmonary vein triggers with low-voltage area and clinical recurrence in patients with atrial fibrillation undergoing catheter ablation. J Arrhythm 2024; 40:278-288. [PMID: 38586845 PMCID: PMC10995600 DOI: 10.1002/joa3.13003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/29/2023] [Accepted: 01/29/2024] [Indexed: 04/09/2024] Open
Abstract
Background and Objectives Although extra-pulmonary vein (PV) triggers (ExPVTs) play a role in atrial fibrillation (AF) recurrence after catheter ablation (AFCA), the mechanism is unknown. We explored whether the locations of ExPVTs were associated with low-voltage scar areas (LVAs). Methods Among 2255 consecutive patients who underwent a de novo AFCA, 1696 (male 72.1%, median 60 years old, paroxysmal 64.7%) were included who underwent isoproterenol provocation and voltage mapping of the left atrium (LA) during their procedures. We investigated the associations between ExPVTs and their mean LA voltage and colocalization of ExPVTs within LVAs (<0.2 mV). Results We observed ExPVTs in 181 (10.7%) patients (60 in the LA, 99 in the right atrium [RA], 16 biatrial, and 6 unmappable). A lower mean LA voltage was independently associated with the existence of ExPVTs (OR 0.77 per 1 SD mV increase, 95% CI 0.60-0.99, p = .039). Among 76 patients who had ExPVTs[LA], 43 (56.6%) had ExPVTs within LVAs. During a median of a 42-month follow-up, patients with ExPVTs had a higher AF recurrence than those without (HR 1.87, 95% CI 1.48-2.37, Log-rank p < .001), but colocalization of ExPVTs and LVAs (Log-rank p = .544) and the anatomical location of ExPVTs (Log-rank p = .084) did not affect the rhythm outcome. Conclusions The presence of ExPVTs was associated with low LA voltage and poor rhythm outcome post-AFCA, but the colocalization of ExPVTs and LVA in LA did not affect rhythm outcome.
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Affiliation(s)
- In Jae Park
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
| | - Daehoon Kim
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
| | - Hee Tae Yu
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
| | - Tae‐Hoon Kim
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
| | - Jae‐Sun Uhm
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
| | - Boyoung Joung
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
| | - Moon‐Hyoung Lee
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
| | - Chun Hwang
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
| | - Hui‐Nam Pak
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
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18
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Barold SS, Herweg B. Centennial of the original description of Mobitz type II second-degree atrioventricular block. J Cardiovasc Electrophysiol 2024; 35:846-847. [PMID: 38348495 DOI: 10.1111/jce.16199] [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: 01/14/2024] [Accepted: 01/21/2024] [Indexed: 04/10/2024]
Abstract
The year 2024 marks the centenary of Mobitz's description of type II second-degree atrioventricular block. Its definition remains valid to this day with only minor modification for the diagnosis of infranodal conduction block. Mobitz a century ago indicated that his type II atrioventricular block was associated with Stock-Adams attacks and a prolonged duration of the QRS complex before the eventual description of bundle branch block.
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Affiliation(s)
- S Serge Barold
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Bengt Herweg
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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19
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Yasa KP, Katritama AA, Harta IKAP, Sudarma IW. Prevalence and risk factors analysis of early postoperative arrhythmia after congenital heart surgery in pediatric patients. J Arrhythm 2024; 40:356-362. [PMID: 38586833 PMCID: PMC10995601 DOI: 10.1002/joa3.13011] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/18/2024] [Accepted: 02/02/2024] [Indexed: 04/09/2024] Open
Abstract
Background Arrhythmia is one of the most common complications after cardiac surgery. The objectives of this study were to determine the prevalence and analyze the risk factors of postoperative arrhythmia in pediatric patients after cardiac surgery for congenital heart defects (CHD) at a single center in Bali, Indonesia over 2 years period. Methods A cross-sectional study, among 120 pediatric patients with CHD who underwent cardiac surgery, 92 patients met inclusion criteria in this study. The data were taken from medical records included demographic data, anthropometry, electrocardiography, surgical procedures, perioperative parameters, electrolyte levels, and management of postoperative arrhythmias. Results Among 92 patients, 14 (15.2%) developed postoperative arrhythmias. Complete heart block (CHB) the most common arrhythmia, observed in five patients (35.7%), followed by supraventricular tachycardia three patients (21.4%). There were statistically significant differences between arrhythmia and nonarrhythmia groups for cardiopulmonary bypass (CPB) duration (171.23 vs. 108.01 min), aortic cross-clamp duration (115.58 vs. 73.59 min), ischemia duration (106.33 vs. 65.43 min), and potassium level (3.33 vs. 3.88 mmol/L) with p < .05. Based on multivariate linear regression analysis, CPB time and potassium level were found to be independent risk factor. Conclusions Early postoperative arrhythmia observed 15.2% in this study, dominated by CHB. CPB duration, aortic cross-clamping, ischemia time, and potassium level were statistically significantly different between arrhythmia and nonarrhythmia groups.
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Affiliation(s)
- Ketut Putu Yasa
- Cardiothoracic and Vascular Surgery Division, Department of SurgeryUdayana University/Prof Dr I.G.N.G Ngoerah General HospitalDenpasarBaliIndonesia
| | - Arinda Agung Katritama
- Cardiothoracic and Vascular Surgery Division, Department of SurgeryUdayana University/Prof Dr I.G.N.G Ngoerah General HospitalDenpasarBaliIndonesia
| | - I. Komang Adhi Parama Harta
- Cardiothoracic and Vascular Surgery Division, Department of SurgeryUdayana University/Prof Dr I.G.N.G Ngoerah General HospitalDenpasarBaliIndonesia
| | - I. Wayan Sudarma
- Cardiothoracic and Vascular Surgery Division, Department of SurgeryUdayana University/Prof Dr I.G.N.G Ngoerah General HospitalDenpasarBaliIndonesia
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20
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Guevara A, Smith CER, Caldwell JL, Ngo L, Mott LR, Lee IJ, Tapa S, Wang Z, Wang L, Woodward WR, Ng GA, Habecker BA, Ripplinger CM. Chronic nicotine exposure is associated with electrophysiological and sympathetic remodeling in the intact rabbit heart. Am J Physiol Heart Circ Physiol 2024. [PMID: 38551482 DOI: 10.1152/ajpheart.00749.2023] [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: 11/28/2023] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
Nicotine is the primary addictive component in tobacco products. Through its actions on the heart and autonomic nervous system, nicotine exposure is associated with electrophysiological changes and increased arrhythmia susceptibility. To assess underlying mechanisms, we treated rabbits with transdermal nicotine (NIC, 21 mg/day) or control (CT) patches for 28 days prior to performing dual optical mapping of transmembrane potential (RH237) and intracellular Ca2+ (Rhod-2 AM) in isolated hearts with intact sympathetic innervation. Sympathetic nerve stimulation (SNS) was performed at the 1st - 3rd thoracic vertebrae, and β-adrenergic responsiveness was additionally evaluated following norepinephrine (NE) perfusion. Baseline ex vivo HR and SNS stimulation threshold were higher in NIC vs. CT (P = 0.004 and P = 0.003, respectively). Action potential duration alternans emerged at longer pacing cycle lengths (PCL) in NIC vs. CT at baseline (P = 0.002) and during SNS (P = 0.0003), with similar results obtained for Ca2+ transient alternans. SNS shortened the PCL at which alternans emerged in CT but not NIC hearts. NIC exposed hearts tended to have slower and reduced HR responses to NE perfusion, but ventricular responses to NE were comparable between groups. While fibrosis was unaltered, NIC hearts had lower sympathetic nerve density (P = 0.03) but no difference in NE content vs. CT. These results suggest both sympathetic hypo-innervation of the myocardium and regional differences in β-adrenergic responsiveness with NIC. This autonomic remodeling may contribute to the increased risk of arrhythmias associated with nicotine exposure, which may be further exacerbated with long-term use.
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Affiliation(s)
- Amanda Guevara
- Pharmacology, University of California, Davis, Davis, California, United States
| | | | | | - Lena Ngo
- Pharmacology, University of California, Davis, United States
| | - Lilian R Mott
- Pharmacology, University of California, Davis, Davis, CA, United States
| | - I-Ju Lee
- Pharmacology, University of California, Davis, United States
| | - Srinivas Tapa
- Pharmacology, University of California, Davis, Davis, CA, United States
| | - Zhen Wang
- Shantou University Medical College, Shantou, Guangdong, China
| | - Lianguo Wang
- Pharmacology, University of California, Davis, Davis, CA, United States
| | - William R Woodward
- Neurology, Oregon Health & Science University, Portland, Oregon, United States
| | | | - Beth A Habecker
- Chemical Physiology & Biochemistry, Oregon Health and Science University, Portland, Oregon, United States
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21
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Wang N, Cao Y, Wang J, Zhang Q. Case Report: Multiple types of arrhythmias in a late-confirmed Danon disease. Front Cardiovasc Med 2024; 11:1369680. [PMID: 38606381 PMCID: PMC11007043 DOI: 10.3389/fcvm.2024.1369680] [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: 01/12/2024] [Accepted: 02/29/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Danon disease is an X-linked disorder caused by pathogenic variants in lysosome-associated membrane protein 2 (LAMP2) gene, typically characterized by the triad of hypertrophic cardiomyopathy, myopathy, and intellectual disability. However, many patients may not present the typical presentation, especially in the early stage. Electrocardiogram (ECG) abnormalities can be found in almost all patients, with Wolff-Parkinson-White (WPW) syndrome being the most common. We reported the case of a 51-year-old woman who experienced multiple types of arrhythmias over three decades and was diagnosed with Danon disease late by genetic testing. Case summary A 51-year-old woman with a 36-year history of intermittent palpitations was admitted due to hemodynamically stable ventricular tachycardia (VT). Her past medical history revealed multiple arrhythmias and ECG abnormalities in her 30s and 40s, including WPW syndrome with paroxysmal supraventricular tachycardia, paroxysmal atrial flutter, atrial fibrillation, ventricular tachycardia, and complete left bundle branch block. She denied any family history of cardiovascular disease or sudden death. Upon arrival, her vital signs were unremarkable. Cardiovascular magnetic resonance (CMR) imaging revealed left ventricular enlargement and late gadolinium enhancement (LGE) in the anterior, inferior, and lateral walls. Subsequent, whole-exome sequencing (WES) gene testing revealed a pathogenic heterozygous variant in LAMP2 gene (c.696T>A; p.Cys232Ter), which confirmed the diagnosis of Danon disease. Conclusion Genetic testing should be considered in patients who display multiple arrhythmias with LV structural abnormalities of unknown etiology for a possible Danon disease.
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Affiliation(s)
| | | | | | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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22
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Polman R, Hurst JR, Uysal OF, Mandal S, Linz D, Simons S. Cardiovascular disease and risk in COPD: a state of the art review. Expert Rev Cardiovasc Ther 2024. [PMID: 38529639 DOI: 10.1080/14779072.2024.2333786] [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: 11/29/2023] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD) and cardiovascular diseases (CVD) commonly co-exist. Outcomes of people living with both conditions are poor in terms of symptom burden, receiving evidence-based treatment and mortality. Increased understanding of the underlying mechanisms may help to identify treatments to relieve this disease burden. This narrative review covers the overlap of COPD and CVD with a focus on clinical presentation, mechanisms, and interventions. Literature up to December 2023 are cited. AREAS COVERED 1. What is COPD 2. The co-existence of COPD and cardiovascular disease 3. Mechanisms of cardiovascular disease in COPD. 4. Populations with COPD are at risk of CVD 5. Complexity in the co-diagnosis of COPD in those with cardiovascular disease. 6. Therapy for COPD and implications for cardiovascular events and risk. 7. S Cardiovascular risk and exacerbations of COPD. 8. Pro-active identification and management of CV risk in COPD. EXPERT OPINION The prospective identification of co-morbid COPD in CVD patients and of CVD and CV risk in people with COPD is crucial for optimizing clinical outcomes. This includes the identification of novel treatment targets and the design of clinical trials specifically designed to reduce the cardiovascular burden and mortality associated with COPD. Databases searched: Pubmed, 2006-2024.
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Affiliation(s)
- Ricardo Polman
- Department of Respiratory Medicine, Maastricht UMC+, Maastricht, the Netherlands
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | | | - Swapna Mandal
- UCL Respiratory, University College London, London, UK
| | - Dominik Linz
- Faculty of Health and Medical Sciences, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, Royal Adelaide Hospital, University of Adelaide, Australia
| | - Sami Simons
- Department of Respiratory Medicine, Maastricht UMC+, Maastricht, the Netherlands
- Department of Respiratory Medicine, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
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23
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Slavotinek AM, Thompson ML, Martin LJ, Gelb BD. Diagnostic yield after next-generation sequencing in pediatric cardiovascular disease. HGG Adv 2024; 5:100286. [PMID: 38521975 PMCID: PMC11024993 DOI: 10.1016/j.xhgg.2024.100286] [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: 01/23/2024] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024] Open
Abstract
Genetic testing with exome sequencing and genome sequencing is increasingly offered to infants and children with cardiovascular diseases. However, the rates of positive diagnoses after genetic testing within the different categories of cardiac disease and phenotypic subtypes of congenital heart disease (CHD) have been little studied. We report the diagnostic yield after next-generation sequencing in 500 patients with CHD from diverse population subgroups that were enrolled at three different sites in the Clinical Sequencing Evidence-Generating Research consortium. Patients were ascertained due to a primary cardiovascular issue comprising arrhythmia, cardiomyopathy, and/or CHD, and corresponding human phenotype ontology terms were selected to describe the cardiac and extracardiac findings. We examined the diagnostic yield for patients with arrhythmia, cardiomyopathy, and/or CHD and phenotypic subtypes of CHD comprising conotruncal defects, heterotaxy, left ventricular outflow tract obstruction, septal defects, and "other" heart defects. We found a significant increase in the frequency of positive findings for patients who underwent genome sequencing compared to exome sequencing and for syndromic cardiac defects compared to isolated cardiac defects. We also found significantly higher diagnostic rates for patients who presented with isolated cardiomyopathy compared to isolated CHD. For patients with syndromic presentations who underwent genome sequencing, there were significant differences in the numbers of positive diagnoses for phenotypic subcategories of CHD, ranging from 31.7% for septal defects to 60% for "other". Despite variation in the diagnostic yield at each site, our results support genetic testing in pediatric patients with syndromic and isolated cardiovascular issues and in all subtypes of CHD.
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Affiliation(s)
- Anne M Slavotinek
- Division of Medical Genetics, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA; Division of Human Genetics, Cincinnati Children's Hospital, Cincinnati, OH, USA; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | - Michelle L Thompson
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA; Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Lisa J Martin
- Division of Human Genetics, Cincinnati Children's Hospital, Cincinnati, OH, USA; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Bruce D Gelb
- Mindich Child Health and Development Institute and Departments of Pediatrics and Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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24
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Kanade PP, Oyunbaatar NE, Kim J, Lee BK, Kim ES, Lee DW. Cardiotoxicity Assessment through a Polymer-Based Cantilever Platform: An Integrated Electro-Mechanical Screening Approach. Small 2024:e2311274. [PMID: 38511575 DOI: 10.1002/smll.202311274] [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] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/08/2024] [Indexed: 03/22/2024]
Abstract
Preclinical drug screening for cardiac toxicity has traditionally relied on observing changes in cardiomyocytes' electrical activity, primarily through invasive patch clamp techniques or non-invasive microelectrode arrays (MEA). However, relying solely on field potential duration (FPD) measurements for electrophysiological assessment can miss the full spectrum of drug-induced toxicity, as different drugs affect cardiomyocytes through various mechanisms. A more comprehensive approach, combining field potential and contractility measurements, is essential for accurate toxicity profiling, particularly for drugs targeting contractile proteins without affecting electrophysiology. However, previously proposed platform has significant limitations in terms of simultaneous measurement. The novel platform addresses these issues, offering enhanced, non-invasive evaluation of drug-induced cardiotoxicity. It features eight cantilevers with patterned strain sensors and MEA, enabling real-time monitoring of both cardiomyocyte contraction force and field potential. This system can detect minimum cardiac contraction force of ≈2 µN and field potential signals with 50 µm MEA diameter, using the same cardiomyocytes in measurements of two parameters. Testing with six drugs of varied mechanisms of action, the platform successfully identifies these mechanisms and accurately assesses toxicity profiles, including drugs not inhibiting potassium channels. This innovative approach presents a comprehensive, non-invasive method for cardiac function assessment, poised to revolutionize preclinical cardiotoxicity screening.
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Affiliation(s)
- Pooja P Kanade
- School of Mechanical Engineering, Chonnam National University, Gwangju, 61186, South Korea
- Advanced Medical Device Research Center for Cardiovascular Disease, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Nomin-Erdene Oyunbaatar
- School of Mechanical Engineering, Chonnam National University, Gwangju, 61186, South Korea
- Advanced Medical Device Research Center for Cardiovascular Disease, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Jongyun Kim
- School of Mechanical Engineering, Chonnam National University, Gwangju, 61186, South Korea
- Advanced Medical Device Research Center for Cardiovascular Disease, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Bong-Kee Lee
- School of Mechanical Engineering, Chonnam National University, Gwangju, 61186, South Korea
| | - Eung-Sam Kim
- Department of Biological Sciences, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Dong-Weon Lee
- School of Mechanical Engineering, Chonnam National University, Gwangju, 61186, South Korea
- Advanced Medical Device Research Center for Cardiovascular Disease, Chonnam National University, Gwangju, 61186, Republic of Korea
- Center for Next-Generation Sensor Research and Development, Chonnam National University, Gwangju, 61186, Republic of Korea
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25
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Zhu W, Yuan H, Lv J. Advancements in the diagnosis and management of premature ventricular contractions in pediatric patients. Front Pediatr 2024; 12:1373772. [PMID: 38571703 PMCID: PMC10987820 DOI: 10.3389/fped.2024.1373772] [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: 01/20/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
Background Premature ventricular contractions (PVCs) are relatively common arrhythmias in the pediatric population, with implications that range from benign to potentially life-threatening. The management of PVCs in children poses unique challenges, and recent advancements in diagnostic and therapeutic options call for a comprehensive review of current practices. Methods This review synthesizes the latest literature on pediatric PVCs, focusing on publications from the past decade. We evaluate studies addressing the epidemiology, pathophysiology, diagnosis, and treatment of PVCs in children, including pharmacological, non-pharmacological, and invasive strategies. Results The review identifies key advancements in the non-invasive detection of PVCs, the growing understanding of their genetic underpinnings, and the evolving landscape of management options. We discuss the clinical decision-making process, considering the variable significance of PVCs in different pediatric patient subgroups, and highlight the importance of individualized care. Current guidelines and consensus statements are examined, and areas of controversy or limited evidence are identified. Conclusions Our review underscores the need for a nuanced approach to PVCs in children, integrating the latest diagnostic techniques with a tailored therapeutic strategy. We call for further research into long-term outcomes and the development of risk stratification tools to guide treatment. The potential of emerging technologies and the importance of multidisciplinary care are also emphasized to improve prognoses for pediatric patients with PVCs.
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Affiliation(s)
- Wenjing Zhu
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Clinical Research Center for Children's Health and Disease Office, Jinan, Shandong, China
| | - Hui Yuan
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Clinical Research Center for Children's Health and Disease Office, Jinan, Shandong, China
| | - Jianli Lv
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Clinical Research Center for Children's Health and Disease Office, Jinan, Shandong, China
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26
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Li W, Cheng X, Zhu G, Hu Y, Wang Y, Niu Y, Li H, Aierken A, Li J, Feng L, Liu G. A review of chemotherapeutic drugs-induced arrhythmia and potential intervention with traditional Chinese medicines. Front Pharmacol 2024; 15:1340855. [PMID: 38572424 PMCID: PMC10987752 DOI: 10.3389/fphar.2024.1340855] [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: 11/19/2023] [Accepted: 03/05/2024] [Indexed: 04/05/2024] Open
Abstract
Significant advances in chemotherapy drugs have reduced mortality in patients with malignant tumors. However, chemotherapy-related cardiotoxicity increases the morbidity and mortality of patients, and has become the second leading cause of death after tumor recurrence, which has received more and more attention in recent years. Arrhythmia is one of the common types of chemotherapy-induced cardiotoxicity, and has become a new risk related to chemotherapy treatment, which seriously affects the therapeutic outcome in patients. Traditional Chinese medicine has experienced thousands of years of clinical practice in China, and has accumulated a wealth of medical theories and treatment formulas, which has unique advantages in the prevention and treatment of malignant diseases. Traditional Chinese medicine may reduce the arrhythmic toxicity caused by chemotherapy without affecting the anti-cancer effect. This paper mainly discussed the types and pathogenesis of secondary chemotherapeutic drug-induced arrhythmia (CDIA), and summarized the studies on Chinese medicine compounds, Chinese medicine Combination Formula and Chinese medicine injection that may be beneficial in intervention with secondary CDIA including atrial fibrillation, ventricular arrhythmia and sinus bradycardia, in order to provide reference for clinical prevention and treatment of chemotherapy-induced arrhythmias.
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Affiliation(s)
- Weina Li
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaozhen Cheng
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guanghui Zhu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ying Hu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine (National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion), Tianjin, China
| | - Yunhan Wang
- Henan Province Hospital of Traditional Chinese Medicine (The Second Affiliated Hospital of Henan University of Traditional Chinese Medicine), Zhengzhou, Henan, China
| | - Yueyue Niu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hongping Li
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Aikeremu Aierken
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jie Li
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ling Feng
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guifang Liu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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27
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Lee SH, Kim S, Sohn JT. Lipid emulsion treatment for local anesthetic systemic toxicity in pediatric patients: A systematic review. Medicine (Baltimore) 2024; 103:e37534. [PMID: 38489714 PMCID: PMC10939516 DOI: 10.1097/md.0000000000037534] [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: 12/08/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Local anesthetic systemic toxicity (LAST) is rare, but fatal; the current widely used treatment is lipid emulsion (LE). The goal of this study was to analyze and review case reports on LE treatment for LAST in pediatric patients. METHODS We performed a systematic review using case reports on LE treatment for LAST in pediatric patients, searching PubMed and Scopus databases to March 2023 using the following keywords: ("local anesthetic toxicity" OR "local anesthetic systemic toxicity" OR LAST") AND ("newborn" OR "infant" OR "child" OR "children" OR "adolescent" OR "pediatric") AND ("lipid emulsion" OR "Intralipid"). RESULTS Our search yielded 21 cases, revealing that nearly 43% patients with LAST were less than 1 year old, and most cases were caused by bupivacaine (approximately 67% cases). "Inadvertent intravascular injection" by anesthesiologists and "overdose of local anesthetics" mainly by surgeons were responsible for 52% and 24% cases of LAST, respectively. LAST occurred in the awake state (52%) and under general anesthesia (48%), mainly causing seizures and arrhythmia, respectively. Approximately 55% of patients received LE treatment in <10 minutes after LAST, mainly improving cardiovascular symptoms. A 20% LE (1.5 mL/kg) dose followed by 0.25 mL/kg/minutes dose was frequently used. LE and anticonvulsants were mainly used in the awake state, whereas LE with or without vasopressors was mainly used under general anesthesia. LE treatment led to full recovery from LAST in 20 cases; however, 1 patient died due to underlying disease. CONCLUSION Consequently, our findings reveal that LE is effective in treating pediatric LAST.
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Affiliation(s)
- Soo Hee Lee
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Changwon Hospital 11, Gyeongsangnam-do, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University College of Medicine, Gyeongsangnam-do, Republic of Korea
- Institute of Medical Science, Gyeongsang National University, Jinju-si, Republic of Korea
| | - Sunmin Kim
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Gyeongsangnam-do, Republic of Korea
| | - Ju-Tae Sohn
- Institute of Medical Science, Gyeongsang National University, Jinju-si, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Gyeongsangnam-do, Republic of Korea
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28
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Franco-Riveros VB, Pividori SM, Martin TI, Nicora FE, Lallana MC, Pontecorvo AA, Flores JC, Tubbs RS, Boezaart AP, Reina MA, Buchholz B. Anatomical study with clinical significance of communicating and visceral branching of the cervical and upper thoracic sympathetic trunk. Clin Anat 2024. [PMID: 38469730 DOI: 10.1002/ca.24149] [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: 02/06/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
Current advances in the management of the autonomic nervous system in various cardiovascular diseases, and in treatments for pain or sympathetic disturbances in the head, neck, or upper limbs, necessitate a thorough understanding of the anatomy of the cervicothoracic sympathetic trunk. Our objective was to enhance our understanding of the origin and distribution of communicating branches and visceral cervicothoracic sympathetic nerves in human fetuses. This was achieved through a comprehensive topographic systematization of the branching patterns observed in the cervical and upper thoracic ganglia, along with the distribution of communicating branches to each cervical spinal nerve. We conducted detailed sub-macroscopic dissections of the cervical and thoracic regions in 20 human fetuses (40 sides). The superior and cervicothoracic ganglia were identified as the cervical sympathetic ganglia that provided the most communicating branches on both sides. The middle and accessory cervical ganglia contributed the fewest branches, with no significant differences between the right and left sides. The cervicothoracic ganglion supplied sympathetic branches to the greatest number of spinal nerves, spanning from C5 to T2 . The distribution of communicating branches to spinal nerves was non-uniform. Notably, C3 , C4 , and C5 received the fewest branches, and more than half of the specimens showed no sympathetic connections. C1 and C2 received sympathetic connections exclusively from the superior ganglion. Spinal nerves that received more branches often did so from multiple ganglia. The vertebral nerve provided deep communicating branches primarily to C6 , with lesser contributions to C7 , C5 , and C8 . The vagus nerve stood out as the cranial nerve with the most direct sympathetic connections. The autonomic branching pattern and connections of the cervicothoracic sympathetic trunk are significantly variable in the fetus. A comprehensive understanding of the anatomy of the cervical and upper thoracic sympathetic trunk and its branches is valuable during autonomic interventions and neuromodulation. This knowledge is particularly relevant for addressing various autonomic cardiac diseases and for treating pain and vascular dysfunction in the head, neck, and upper limbs.
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Affiliation(s)
- Verena B Franco-Riveros
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
- School of Medicine, Department of Pathology, Institute of Cardiovascular Physiopathology (INFICA), Buenos Aires University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Institute of Biochemistry and Molecular Medicine (IBIMOL), Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | - Sofía M Pividori
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
- Diagnostic Imaging Department, Hospital Británico, Buenos Aires, Argentina
| | - Tomás I Martin
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
| | - Florencia E Nicora
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
| | - María Cecilia Lallana
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
| | - Agustina A Pontecorvo
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
| | - Juan Carlos Flores
- Postgraduate Universitary Training at Interventional Procedures for Chronic Refractory Pain, CAIDBA Comprehensive Pain Center Foundation; and La Plata University School of Medical Sciences, La Plata, Buenos Aires, Argentina
| | - Richard Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Anatomical Sciences, St. George's University, St. George's, West Indies
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
- Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - André P Boezaart
- Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
- Lumina Health Pain Medicine Collaborative, Surrey, UK
| | - Miguel A Reina
- Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
- School of Medicine, CEU-San-Pablo University, Madrid, Spain
- Department of Anesthesiology, Madrid-Montepríncipe University Hospital, Madrid, Spain
| | - Bruno Buchholz
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
- School of Medicine, Department of Pathology, Institute of Cardiovascular Physiopathology (INFICA), Buenos Aires University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Institute of Biochemistry and Molecular Medicine (IBIMOL), Buenos Aires University School of Medicine, Buenos Aires, Argentina
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Angom RS, Joshi A, Patowary A, Sivadas A, Ramasamy S, K. V. S, Kaushik K, Sabharwal A, Lalwani MK, K. S, Singh N, Scaria V, Sivasubbu S. Forward genetic screen using a gene-breaking trap approach identifies a novel role of grin2bb-associated RNA transcript ( grin2bbART) in zebrafish heart function. Front Cell Dev Biol 2024; 12:1339292. [PMID: 38533084 PMCID: PMC10964321 DOI: 10.3389/fcell.2024.1339292] [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: 11/15/2023] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
LncRNA-based control affects cardiac pathophysiologies like myocardial infarction, coronary artery disease, hypertrophy, and myotonic muscular dystrophy. This study used a gene-break transposon (GBT) to screen zebrafish (Danio rerio) for insertional mutagenesis. We identified three insertional mutants where the GBT captured a cardiac gene. One of the adult viable GBT mutants had bradycardia (heart arrhythmia) and enlarged cardiac chambers or hypertrophy; we named it "bigheart." Bigheart mutant insertion maps to grin2bb or N-methyl D-aspartate receptor (NMDAR2B) gene intron 2 in reverse orientation. Rapid amplification of adjacent cDNA ends analysis suggested a new insertion site transcript in the intron 2 of grin2bb. Analysis of the RNA sequencing of wild-type zebrafish heart chambers revealed a possible new transcript at the insertion site. As this putative lncRNA transcript satisfies the canonical signatures, we called this transcript grin2bb associated RNA transcript (grin2bbART). Using in situ hybridization, we confirmed localized grin2bbART expression in the heart, central nervous system, and muscles in the developing embryos and wild-type adult zebrafish atrium and bulbus arteriosus. The bigheart mutant had reduced Grin2bbART expression. We showed that bigheart gene trap insertion excision reversed cardiac-specific arrhythmia and atrial hypertrophy and restored grin2bbART expression. Morpholino-mediated antisense downregulation of grin2bbART in wild-type zebrafish embryos mimicked bigheart mutants; this suggests grin2bbART is linked to bigheart. Cardiovascular tissues use Grin2bb as a calcium-permeable ion channel. Calcium imaging experiments performed on bigheart mutants indicated calcium mishandling in the heart. The bigheart cardiac transcriptome showed differential expression of calcium homeostasis, cardiac remodeling, and contraction genes. Western blot analysis highlighted Camk2d1 and Hdac1 overexpression. We propose that altered calcium activity due to disruption of grin2bbART, a putative lncRNA in bigheart, altered the Camk2d-Hdac pathway, causing heart arrhythmia and hypertrophy in zebrafish.
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Affiliation(s)
- Ramcharan Singh Angom
- Genomics and Molecular Medicine, CSIR Institute of Genomics and Integrative Biology, Delhi, India
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, Jacksonville, FL, United States
| | - Adita Joshi
- Genomics and Molecular Medicine, CSIR Institute of Genomics and Integrative Biology, Delhi, India
| | - Ashok Patowary
- Genomics and Molecular Medicine, CSIR Institute of Genomics and Integrative Biology, Delhi, India
| | - Ambily Sivadas
- GN Ramachandran Knowledge Center for Genome Informatics, Council of Scientific and Industrial Research, Institute of Genomics and Integrative Biology, Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Soundhar Ramasamy
- Genomics and Molecular Medicine, CSIR Institute of Genomics and Integrative Biology, Delhi, India
| | - Shamsudheen K. V.
- Genomics and Molecular Medicine, CSIR Institute of Genomics and Integrative Biology, Delhi, India
- GN Ramachandran Knowledge Center for Genome Informatics, Council of Scientific and Industrial Research, Institute of Genomics and Integrative Biology, Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Kriti Kaushik
- Genomics and Molecular Medicine, CSIR Institute of Genomics and Integrative Biology, Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Ankit Sabharwal
- Genomics and Molecular Medicine, CSIR Institute of Genomics and Integrative Biology, Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Mukesh Kumar Lalwani
- Genomics and Molecular Medicine, CSIR Institute of Genomics and Integrative Biology, Delhi, India
| | - Subburaj K.
- Genomics and Molecular Medicine, CSIR Institute of Genomics and Integrative Biology, Delhi, India
| | - Naresh Singh
- Genomics and Molecular Medicine, CSIR Institute of Genomics and Integrative Biology, Delhi, India
| | - Vinod Scaria
- Genomics and Molecular Medicine, CSIR Institute of Genomics and Integrative Biology, Delhi, India
- GN Ramachandran Knowledge Center for Genome Informatics, Council of Scientific and Industrial Research, Institute of Genomics and Integrative Biology, Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Sridhar Sivasubbu
- Genomics and Molecular Medicine, CSIR Institute of Genomics and Integrative Biology, Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
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30
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Hossri C, Araujo F, Baldi B, Otterstetter R, Uemoto V, Carvalho C, Mastrocola L, Albuquerque A. Association among cardiopulmonary and metabolic rehabilitation, arrhythmias, and myocardial ischemia responses of patients with HFpEF or HFmrEF. Braz J Med Biol Res 2024; 57:e13174. [PMID: 38451608 PMCID: PMC10913385 DOI: 10.1590/1414-431x2024e13174] [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: 10/28/2023] [Accepted: 02/01/2024] [Indexed: 03/08/2024] Open
Abstract
There's limited evidence of the potential benefits of cardiopulmonary and metabolic rehabilitation (CPMR) in patients with heart failure with preserved ejection fraction (HFpEF) or mildly reduced ejection fraction (HFmrEF) and coronary artery disease (CAD). The aim of this study was to investigate the impact of CPMR on the myocardial ischemia response (MIR), exercise-induced arrhythmias (EIA), New York Heart Association (NYHA) functional class, heart rate recovery (HRR), Borg CR10 perceived symptoms, and the SF-36 physical and mental health summary scores. A prospective cohort study was conducted with 106 patients undergoing 12 weeks of CPMR who completed two exercise tests pre- and post-CPMR: 1) maximum incremental test (CPX) and 2) submaximal constant load test (SUB). After CPMR, the effects on MIR, EIA, NYHA functional class, and HRR during both tests were analyzed. There was a significant change in NYHA functional classes after CPMR, with 96% of the patients in class I (vs 62% pre-CPMR, P<0.0001), 4% in class II (vs 32%), and none in class III (vs 6%). There was a significant reduction in the frequency of EIA (P<0.05) and MIR (P<0.001) and a significantly improved performance on both CPX and SUB tests (P<0.0001). Lastly, there was significant progress in the recovery metrics like HRR (P<0.0001), the Borg CR10 (P<0.0001), and the SF-36 summary scores (P<0.0001). The CPMR resulted in a significant decrease in EIA, delayed ischemia threshold in CPX and SUB tests, increased functional capacity, and improved quality of life.
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Affiliation(s)
- C.A.C. Hossri
- Hospital do Coração, Associação Beneficente Síria, São Paulo, SP, Brasil
- Pneumologia-Incor, Instituto do Coração, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - B.G. Baldi
- Hospital do Coração, Associação Beneficente Síria, São Paulo, SP, Brasil
- Pneumologia-Incor, Instituto do Coração, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R. Otterstetter
- School of Exercise and Nutrition Sciences, University of Akron, Akron, OH, USA
| | - V.R. Uemoto
- Setor da Bioengenharia, Instituto Dante Pazzanese, São Paulo, SP, Brasil
| | - C.R.R. Carvalho
- Hospital do Coração, Associação Beneficente Síria, São Paulo, SP, Brasil
- Pneumologia-Incor, Instituto do Coração, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L.E. Mastrocola
- Hospital do Coração, Associação Beneficente Síria, São Paulo, SP, Brasil
| | - A.L.P. Albuquerque
- Hospital do Coração, Associação Beneficente Síria, São Paulo, SP, Brasil
- Pneumologia-Incor, Instituto do Coração, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Arıcı S, Akalın F, Geckinli BB. A case of Carvajal syndrome presenting with dilated cardiomyopathy. Cardiol Young 2024:1-3. [PMID: 38433550 DOI: 10.1017/s1047951124000222] [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] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Carvajal syndrome is a very rare autosomal recessive cardiocutaneous disorder caused by a desmosomal mutation in exon 24 of the desmoplakin gene. It manifests with woolly hair, epidermolytic palmoplantar keratoderma, and arrhythmogenic right ventricular cardiomyopathy. We herein present a patient with heart failure and dilated cardiomyopathy who was diagnosed with Carvajal syndrome because of dermatologic manifestations. CASE PRESENTATION A seven-year-old girl was referred to our clinic due to decompensated heart failure and clinical deterioration. The patient had severe weakness, tachycardia, and tachypnea. She had a complaint of getting tired quickly for three weeks, and she had shortness of breath and abdominal pain for the last two days. She had hepatomegaly and woolly hair. Mild keratoderma was present on the soles of her feet. Echocardiography demonstrated biventricular dilatation, significantly impaired left ventricular systolic function (ejection fraction 22%), and moderate to severe mitral and tricuspid regurgitation. Molecular genetic evaluation was performed because of cutaneous and cardiac findings, which demonstrated a desmoplakin gene mutation. Homozygous mutation c.4297C > T (p.Gln1433*) was identified in desmoplakin gene, and the diagnosis of Carvajal syndrome was confirmed. CONCLUSIONS Syndromic types of arrhythmogenic right ventricular cardiomyopathy such as Carvajal syndrome are rare diseases. Awareness about cutaneous manifestations and genetic evaluation would help diagnosis and prevention of sudden death. Genetic counselling is needed in familial cases.
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Affiliation(s)
- Sule Arıcı
- Pediatric Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Figen Akalın
- Pediatric Cardiology, Marmara University School of Medicine, Istanbul, Turkey
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Coyle C, Kanella I, Mann I, Qureshi N, Linton NWF, Kanagaratnam P. RETRO-mapping: A novel algorithm automating wavefront categorization using activation mapping during persistent atrial fibrillation demonstrates a reduction in wavefront collisions following pulmonary vein isolation. J Cardiovasc Electrophysiol 2024; 35:557-568. [PMID: 37870146 DOI: 10.1111/jce.16116] [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: 08/19/2023] [Revised: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Abstract
RETRO-mapping was developed to automate activation mapping of atrial fibrillation (AF). We used the algorithm to study the effect of pulmonary vein isolation (PVI) on the frequency of focal, planar, and colliding wavefronts in persistent AF. An AFocusII catheter was placed on the left atrial endocardium to record 3 s of AF at six sites pre and post-PVI in patients undergoing wide circumferential PVI for persistent AF. RETRO-mapping analyzed each segment in 2 ms time windows for evidence of focal, planar, and colliding waveforms and the automated categorizations manually validated. Ten patients were recruited. A total of 360 s of data in 120 segments of 3 s from 60 left atrial locations were analyzed. RETRO-map was highly effective at identifying focal waves and collisions during AF. PVI significantly reduced collision frequency but not focal and planar activation frequency. However, there was a significant reduction in the dispersion of activation directions. Larger studies may help determine factors associated with successful clinical outcome.
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Affiliation(s)
| | | | | | - Norman Qureshi
- Imperial College, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Nick W F Linton
- Imperial College, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Prapa Kanagaratnam
- Imperial College, London, UK
- Imperial College Healthcare NHS Trust, London, UK
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Colman MA, Varela M, MacLeod RS, Hancox JC, Aslanidi OV. Interactions between calcium-induced arrhythmia triggers and the electrophysiological-anatomical substrate underlying the induction of atrial fibrillation. J Physiol 2024; 602:835-853. [PMID: 38372694 DOI: 10.1113/jp285740] [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: 09/28/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and is sustained by spontaneous focal excitations and re-entry. Spontaneous electrical firing in the pulmonary vein (PV) sleeves is implicated in AF generation. The aim of this simulation study was to identify the mechanisms determining the localisation of AF triggers in the PVs and their contribution to the genesis of AF. A novel biophysical model of the canine atria was used that integrates stochastic, spontaneous subcellular Ca2+ release events (SCRE) with regional electrophysiological heterogeneity in ionic properties and a detailed three-dimensional model of atrial anatomy, microarchitecture and patchy fibrosis. Simulations highlighted the importance of the smaller inward rectifier potassium current (IK1 ) in PV cells compared to the surrounding atria, which enabled SCRE more readily to result in delayed-afterdepolarisations that induced triggered activity. There was a leftward shift in the dependence of the probability of triggered activity on sarcoplasmic reticulum Ca2+ load. This feature was accentuated in 3D tissue compared to single cells (Δ half-maximal [Ca2+ ]SR = 58 μM vs. 22 μM). In 3D atria incorporating electrical heterogeneity, excitations preferentially emerged from the PV region. These triggered focal excitations resulted in transient re-entry in the left atrium. Addition of fibrotic patches promoted localised emergence of focal excitations and wavebreaks that had a more substantial impact on generating AF-like patterns than the PVs. Thus, a reduced IK1 , less negative resting membrane potential, and fibrosis-induced changes of the electrotonic load all contribute to the emergence of complex excitation patterns from spontaneous focal triggers. KEY POINTS: Focal excitations in the atria are most commonly associated with the pulmonary veins, but the mechanisms for this localisation are yet to be elucidated. We applied a multi-scale computational modelling approach to elucidate the mechanisms underlying such localisations. Myocytes in the pulmonary vein region of the atria have a less negative resting membrane potential and reduced time-independent potassium current; we demonstrate that both of these factors promote triggered activity in single cells and tissues. The less negative resting membrane potential also contributes to heterogeneous inactivation of the fast sodium current, which can enable re-entrant-like excitation patterns to emerge without traditional conduction block.
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Affiliation(s)
- Michael A Colman
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Marta Varela
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Rob S MacLeod
- The Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - Jules C Hancox
- School of Physiology, Pharmacology & Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, UK
| | - Oleg V Aslanidi
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
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Yu L, Liu Y, Feng Y. Cardiac arrhythmia in COVID-19 patients. Ann Noninvasive Electrocardiol 2024; 29:e13105. [PMID: 38339786 PMCID: PMC10858328 DOI: 10.1111/anec.13105] [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: 09/30/2023] [Revised: 11/07/2023] [Accepted: 12/24/2023] [Indexed: 02/12/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) was first introduced in December 2019, which is known as severe acute respiratory syndrome caused by coronavirus-2 (SARS-CoV-2) that is a serious and life-threatening disease. Although pneumonia is the most common manifestation of COVID-19 and was initially introduced as a respiratory infection, in fact, the infection of COVID-19 is a subset of complications and damage to various organs. There are several reports of cardiac involvement with COVID-19. A wide range of cardiac complications may occur following COVID-19 infection, including systolic heart failure, myocarditis, pericarditis, atrial and ventricular arrhythmias, and thromboembolic events. There are various hypotheses about the pathophysiology of cardiovascular involvement by this virus. At the top of these hypotheses is the release of cytokines to the heart. Although there are other assumptions, considering that one of the causes of death in patients with COVID-19 is arrhythmia. It is necessary to know correctly about its pathophysiology and etiology. Therefore, in this study, we have reviewed the articles of recent years in the field of pathophysiology and etiology of arrhythmia in patients with COVID-19 infection. The purpose of this study was to provide a basis for a correct and more comprehensive understanding of the pathogenesis of arrhythmia in patients with COVID-19 infection.
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Affiliation(s)
- Lei Yu
- Department of CardiologyJinan Third People's HospitalJinanChina
| | - Ying Liu
- Department of CardiologyShandong Second Provincial General HospitalJinanChina
| | - Yanjing Feng
- Department of CardiologyShandong Second Provincial General HospitalJinanChina
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35
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Cosyns B, Haugaa KH. Multiparametric Approach to Asymptomatic Aortic Stenosis: New Surrogate Markers Are Welcome. JACC Cardiovasc Imaging 2024; 17:246-247. [PMID: 38032589 DOI: 10.1016/j.jcmg.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Bernard Cosyns
- Center for Cardiovascular Disorders, Department of Cardiology, University Hospital Brussels, Free University of Brussels, Brussels, Belgium.
| | - Kristina H Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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36
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Hegemann N, Barth L, Döring Y, Voigt N, Grune J. Implications for neutrophils in cardiac arrhythmias. Am J Physiol Heart Circ Physiol 2024; 326:H441-H458. [PMID: 38099844 DOI: 10.1152/ajpheart.00590.2023] [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: 09/22/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 02/03/2024]
Abstract
Cardiac arrhythmias commonly occur as a result of aberrant electrical impulse formation or conduction in the myocardium. Frequently discussed triggers include underlying heart diseases such as myocardial ischemia, electrolyte imbalances, or genetic anomalies of ion channels involved in the tightly regulated cardiac action potential. Recently, the role of innate immune cells in the onset of arrhythmic events has been highlighted in numerous studies, correlating leukocyte expansion in the myocardium to increased arrhythmic burden. Here, we aim to call attention to the role of neutrophils in the pathogenesis of cardiac arrhythmias and their expansion during myocardial ischemia and infectious disease manifestation. In addition, we will elucidate molecular mechanisms associated with neutrophil activation and discuss their involvement as direct mediators of arrhythmogenicity.
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Affiliation(s)
- Niklas Hegemann
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Lukas Barth
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Yannic Döring
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Niels Voigt
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
- Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Göttingen, Germany
| | - Jana Grune
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
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37
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Li D, Fang Z, Liu M, Li H, Zhang H, Li H, Liu Y, Jiang W. Predictors and mortality of new onset postoperative atrial fibrillation after STAAD surgery: a retrospective cohort study. Int J Surg 2024; 110:1620-1626. [PMID: 38052020 PMCID: PMC10942241 DOI: 10.1097/js9.0000000000000996] [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: 09/05/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Data on new onset postoperative atrial fibrillation (POAF) after Stanford type A dissection (STAAD) surgery was limited. This study aimed to detect the risk factors for developing POAF after STAAD procedures and the association between POAF and in-hospital mortality. METHODS A total of 1354 patients who underwent surgical treatment for STAAD in Beijing Anzhen hospital were enrolled in this single-center retrospective study from January 2015 to October 2020. POAF were defined as atrial fibrillation/flutter requiring treatment after surgery procedure. Logistic model was conducted to detect the predictors of POAF, and inverse probability of treatment weighting (IPTW) and subgroup analysis were used to compare the mortality of POAF and non-POAF groups. RESULTS There were 176 patients (13.0%) diagnosed with POAF according to the definition. Multivariate logistics analyses revealed that advanced age [odds ratio (OR), 1.07; 95% CI: 1.05-1.08; P <0.001)], creatinine (OR, 1.00; 95% CI: 1.00-1.01; P =0.001) and cross-clamp time (OR, 1.00; 95% CI: 1.00-1.01; P =0.021) were independent risk factors of developing POAF in STAAD patients. POAF patients were associated with significantly higher in-hospital mortality compared with non-POAF patients (6.5 vs. 19.9%, OR, 3.60; 95% CI: 2.30-5.54; P <0.001), IPTW and subgroup analysis had reached consistent conclusions. CONCLUSIONS The incidence of POAF was 13.0% after STAAD surgery, advanced age, creatinine, and cross-clamp time were independent risk factors of developing POAF in STAAD patients. POAF is associated with increased mortality after STAAD procedures.
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Affiliation(s)
- Dongjie Li
- Department of Cardiac Surgery
- Beijing Lab for Cardiovascular Precision Medicine, Beijing
| | - Zhou Fang
- Department of Cardiac Surgery
- Beijing Lab for Cardiovascular Precision Medicine, Beijing
| | - Maomao Liu
- Center for Cardiac Intensive, Beijing Anzhen Hospital
| | - Haibin Li
- Department of Cardiac Surgery, Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University
- Beijing Lab for Cardiovascular Precision Medicine, Beijing
| | - Hongjia Zhang
- Department of Cardiac Surgery
- Beijing Lab for Cardiovascular Precision Medicine, Beijing
| | - Haiyang Li
- Department of Cardiac Surgery
- Beijing Lab for Cardiovascular Precision Medicine, Beijing
| | - Yuyong Liu
- Department of Cardiac Surgery
- Beijing Lab for Cardiovascular Precision Medicine, Beijing
- The First Affiliated Hospital of Anhui Medical University, Hefei 230022, People’s Republic of China
| | - Wenjian Jiang
- Department of Cardiac Surgery
- Beijing Lab for Cardiovascular Precision Medicine, Beijing
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Pilia E, Silvetti S, Bohane SM, Pusceddu E, Belletti A. Safety of Levosimendan in Pediatric Patients: An Up-to-Date Systematic Review. J Cardiothorac Vasc Anesth 2024; 38:820-828. [PMID: 38135567 DOI: 10.1053/j.jvca.2023.11.020] [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: 09/16/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The potential risks associated with the use of levosimendan in the pediatric population has not been systematically evaluated. This study aimed to review the available evidence regarding the safety of this treatment. METHODS Bio Med Central, PubMed, Embase, and the Cochrane Central Register of clinical trials were searched for studies describing levosimendan administration in the pediatric population in any setting. Relevant studies were independently screened, selected, and their data extracted by two investigators. The authors excluded: reviews, meta-analyses, as well as basic research and trials involving patients >18 years old. The primary outcome was the number and the type of adverse side effects reported during levosimendan administration. RESULTS The updated systematic review included 48 studies, enrolling a total of 1,271 pediatric patients who received levosimendan as treatment (790 patients in the 11 studies that reported side effects). The primary adverse effects of levosimendan administration were hypotension and cardiac arrhythmias, particularly tachycardia. Hypotension occurred in approximately 28.9% of patients, while arrhythmia occurred in about 12.3% of patients. Meta analysis of RCTs revealed a rate of all-cause mortality of 2.0% (8 out of 385) in the levosimendan group compared to 3.9% (15 out of 378) in the control group (dobutamine, milrinone or placebo) (risk ratio [RR] = 0.55; 95% confidence interval [CI] = 0.25-1.21; P = 0.14; I2 = 0%) CONCLUSIONS: Hypotension and cardiac arrhythmia are the most reported side effects of levosimendan in pediatric patients. However, adverse events remain underreported, especially in randomized trials.
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Affiliation(s)
- Eros Pilia
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; ARNAS G. Brotzu, Anesthesia and Intensive Care Unit, Liver Transplantation Center, Cagliari, Italy
| | - Simona Silvetti
- Dipartimento di Cardioanestesia e Terapia Intensiva, Ospedale Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova, Italy
| | - Shai Marc Bohane
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pusceddu
- ARNAS G. Brotzu, Anesthesia and Intensive Care Unit, Liver Transplantation Center, Cagliari, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Bukhari S, Khan SZ, Ghoweba M, Khan B, Bashir Z. Arrhythmias and Device Therapies in Cardiac Amyloidosis. J Clin Med 2024; 13:1300. [PMID: 38592132 PMCID: PMC10932014 DOI: 10.3390/jcm13051300] [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: 01/13/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
Cardiac amyloidosis is caused by amyloid fibrils that deposit in the myocardial interstitium, causing restrictive cardiomyopathy and eventually death. The electromechanical, inflammatory, and autonomic changes due to amyloid deposition result in arrhythmias. Atrial fibrillation is by far the most common arrhythmia. The rate control strategy is generally poorly tolerated due to restrictive filling physiology and heart rate dependance, favoring adoption of the rhythm control strategy. Anticoagulation for stroke prophylaxis is warranted, irrespective of CHA2DS2-VASc score in patients with a favorable bleeding profile; data on left appendage closure devices are still insufficient. Ventricular arrhythmias are also not uncommon, and the role of implantable cardioverter-defibrillator in cardiac amyloidosis is controversial. There is no evidence of improvement in outcomes when used for primary prevention in these patients. Bradyarrhythmia is most commonly associated with sudden cardiac death in cardiac amyloidosis. Pacemaker implantation can help provide symptomatic relief but does not confer mortality benefit.
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Affiliation(s)
- Syed Bukhari
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.Z.K.); (M.G.)
| | - Syed Zamrak Khan
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.Z.K.); (M.G.)
| | - Mohamed Ghoweba
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.Z.K.); (M.G.)
| | - Bilal Khan
- Department of Hospital Medicine, Temple University-Jeanes Campus, Philadelphia, PA 19111, USA;
| | - Zubair Bashir
- Department of Hospital Medicine, Alpert Medical School of Brown University, Providence, RI 02903, USA;
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Ibrahim L, Buschmann E, van Loon G, Cornillie P. Morphological evidence of a potential arrhythmogenic substrate in the caudal and cranial vena cava in horses. Equine Vet J 2024. [PMID: 38391272 DOI: 10.1111/evj.14075] [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: 11/06/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Three-dimensional electro-anatomical mapping, previously performed in horses with atrial arrhythmias, has demonstrated the medial region of the caudal vena cava (CaVC), 1-8 cm caudal to the fossa ovalis, as an anatomical predilection site for atrial tachycardia associated with areas of slow conduction and conduction block. Slow conduction has also been recorded in the cranial vena cava (CrVC). OBJECTIVES To investigate the morphological characteristics of the myocardial sleeves (MS) in the CaVC and CrVC, in order to identify a potential substrate of right sided atrial arrhythmias. STUDY DESIGN Cross sectional. METHODS Post-mortem dissection of 37 hearts from adult warmblood horses without known cardiovascular disease. Macroscopic examination of the myocardial distribution, evaluated the MS area, length, width, and shape in the CaVC and the CrVC. At least 2 samples from each vena cava MS were histologically examined using Masson's trichrome staining. RESULTS Myocardial sleeves into the medial CaVC and into the CrVC were observed in all horses and showed variations in distribution, shape, and size between horses. Their mean ± standard deviation length from the limbus into the CaVC reached 5.7 ± 1.0 cm (maximum 8.3 cm), and from the azygos vein into the CrVC 5.3 ± 1.6 cm (maximum 8.6 cm). Myocardium-free islands were observed in the CaVC and CrVC in 30% and 6% of horses, respectively. Histologically, MS showed a non-uniform myocardial fibre arrangement, with presence of fibroadipose tissue, features known to result in slow conduction and pro-arrhythmia. MAIN LIMITATIONS Study only included horses without history of atrial arrhythmia. CONCLUSIONS Myocardial sleeves are present in both CaVC and CrVC, showing anatomical variations between horses. Tissue characteristics known to favour re-entry were identified indicating that these venae cavae MS are a potential substrate for atrial tachyarrhythmias and a target for treatment by ablation.
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Affiliation(s)
- Lara Ibrahim
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Eva Buschmann
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Gunther van Loon
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Pieter Cornillie
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
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Wolfes J, Uphoff J, Kemena S, Wegner F, Rath B, Eckardt L, Frommeyer G, Ellermann C. Divergent electrophysiologic action of dapagliflozin and empagliflozin on ventricular and atrial tachy arrhythmias in isolated rabbit hearts. Front Cardiovasc Med 2024; 11:1369250. [PMID: 38455723 PMCID: PMC10918010 DOI: 10.3389/fcvm.2024.1369250] [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: 01/11/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Abstract
Background The use of SGLT-2 inhibitors has revolutionized heart failure therapy. Evidence suggests a reduced incidence of ventricular and atrial arrhythmias in patients with dapagliflozin or empagliflozin treatment. It is unclear to what extent the reduced arrhythmia burden is due to direct effects of the SGLT2 inhibitors or is solely a marker of improved cardiac function. Methods One hundred five rabbit hearts were allocated to eight groups and retrogradely perfused, employing a Langendorff setup. Action potential duration at 90% of repolarization (APD90), QT intervals, effective refractory periods, conduction velocity, and dispersion of repolarization were obtained with monophasic action potential catheters. A model for tachyarrhythmias was established with the IKr blocker erythromycin for QT prolongation associated proarrhythmia as well as the potassium channel opener pinacidil for a short-QT model. An atrial fibrillation (AF) model was created with isoproterenol and acetylcholine. With increasing concentrations of both SGLT2 inhibitors, reductions in QT intervals and APD90 were observed, accompanied by a slight increase in ventricular arrhythmia episodes. During drug-induced proarrhythmia, empagliflozin succeeded in decreasing QT intervals, APD90, and VT burden whereas dapagliflozin demonstrated no significant effects. In the presence of pinacidil induced arrhythmogenicity, neither SGLT2 inhibitor had a significant impact on cardiac electrophysiology. In the AF setting, perfusion with dapagliflozin showed significant suppression of AF in the course of restitution of electrophysiological parameters whereas empagliflozin showed no significant effect on atrial fibrillation incidence. Conclusion In this model, empagliflozin and dapagliflozin demonstrated opposite antiarrhythmic properties. Empagliflozin reduced ventricular tachyarrhythmias whereas dapagliflozin showed effective suppression of atrial arrhythmias.
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Affiliation(s)
- Julian Wolfes
- Department of Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
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Vitali F, De Raffele M, Malagù M, Balla C, Azzolini G, Gibiino F, Boccadoro A, Micillo M, Bertini M. Comparative Study of Lesions Obtained through Radiofrequency between the Irrigated Ablation Catheter with a Flexible Tip and the Non-Irrigated Catheter in Ex Vivo Porcine Hearts. Biology (Basel) 2024; 13:132. [PMID: 38392350 PMCID: PMC10886553 DOI: 10.3390/biology13020132] [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] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND At the same conditions of delivered power and contact force, open-irrigated radiofrequency ablation catheters are believed to create deeper lesions, while non-irrigated ones produce shallower lesions. This ex vivo study aims to directly compare the lesion dimensions and characteristics of an irrigated ablation catheter with a flexible tip and a non-irrigated solid-tip catheter. METHODS Radiofrequency lesions were induced on porcine myocardial slabs using both open-tip irrigated and non-irrigated standard 4 mm catheters at three power settings (20 W, 30 W, and 40 W), maintaining a fixed contact force of 10 gr. A lesion assessment was conducted including the lesion depth, depth at the maximum diameter, and lesion surface diameters, with the subsequent calculation of the lesion volume and area being undertaken. RESULTS Irrigated catheters produced lesions with significantly higher superficial widths at all power levels (3.8 vs. 4.4 mm at 20 W; 3.9 mm vs. 4.4 mm at 30 W; 3.8 mm vs. 4.5 mm at 40 W; p = 0.001, p = 0.019, p = 0.003, respectively). Non-irrigated catheters resulted in significantly higher superficial areas at all power levels (23 mm2 vs. 18 mm2 at 20 W; 25 mm2 vs. 19 mm2 at 30 W; 26 mm2 vs. 19 mm2 at 40 W; p = 0.001, p = 0.005, p = 0.001, respectively). Irrigated catheters showed significantly higher values of lesion maximum depth at 40 W (4.6 mm vs. 5.5 mm; p = 0.007), while non-irrigated catheters had a significantly higher calculated volume at 20 W (202 µL vs. 134 µL; p = 0.002). CONCLUSIONS Radiofrequency ablation using an irrigated catheter with a flexible tip has the potential to generate smaller superficial lesion areas compared with those obtained using a non-irrigated catheter.
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Affiliation(s)
- Francesco Vitali
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Martina De Raffele
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Michele Malagù
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Cristina Balla
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Giorgia Azzolini
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Federico Gibiino
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Alberto Boccadoro
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Marco Micillo
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Matteo Bertini
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
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Reisqs JB, Qu YS, Boutjdir M. Ion channel trafficking implications in heart failure. Front Cardiovasc Med 2024; 11:1351496. [PMID: 38420267 PMCID: PMC10899472 DOI: 10.3389/fcvm.2024.1351496] [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: 12/06/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Heart failure (HF) is recognized as an epidemic in the contemporary world, impacting around 1%-2% of the adult population and affecting around 6 million Americans. HF remains a major cause of mortality, morbidity, and poor quality of life. Several therapies are used to treat HF and improve the survival of patients; however, despite these substantial improvements in treating HF, the incidence of HF is increasing rapidly, posing a significant burden to human health. The total cost of care for HF is USD 69.8 billion in 2023, warranting a better understanding of the mechanisms involved in HF. Among the most serious manifestations associated with HF is arrhythmia due to the electrophysiological changes within the cardiomyocyte. Among these electrophysiological changes, disruptions in sodium and potassium currents' function and trafficking, as well as calcium handling, all of which impact arrhythmia in HF. The mechanisms responsible for the trafficking, anchoring, organization, and recycling of ion channels at the plasma membrane seem to be significant contributors to ion channels dysfunction in HF. Variants, microtubule alterations, or disturbances of anchoring proteins lead to ion channel trafficking defects and the alteration of the cardiomyocyte's electrophysiology. Understanding the mechanisms of ion channels trafficking could provide new therapeutic approaches for the treatment of HF. This review provides an overview of the recent advances in ion channel trafficking in HF.
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Affiliation(s)
- Jean-Baptiste Reisqs
- Cardiovascular Research Program, VA New York Harbor Healthcare System, New York, NY, United States
| | - Yongxia Sarah Qu
- Cardiovascular Research Program, VA New York Harbor Healthcare System, New York, NY, United States
- Department of Cardiology, New York Presbyterian Brooklyn Methodist Hospital, New York, NY, United States
| | - Mohamed Boutjdir
- Cardiovascular Research Program, VA New York Harbor Healthcare System, New York, NY, United States
- Department of Medicine, Cell Biology and Pharmacology, State University of New York Downstate Health Sciences University, New York, NY, United States
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
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Barajas-Martinez H, Shehata M, Liu Y. Editorial: Arrhythmias in women. Front Cardiovasc Med 2024; 11:1348878. [PMID: 38414920 PMCID: PMC10896896 DOI: 10.3389/fcvm.2024.1348878] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/05/2024] [Indexed: 02/29/2024] Open
Affiliation(s)
- Hector Barajas-Martinez
- Lankenau Institute for Medical Research, Lankenau Heart Institute, Wynnwood, PA, United States
| | - Michael Shehata
- Cedars Sinai Heart Institute, Los Angeles, CA, United States
| | - Yang Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
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Imamura T. Clinical Implications of Ivabradine in the Contemporary Era. Medicina (Kaunas) 2024; 60:303. [PMID: 38399590 PMCID: PMC10890219 DOI: 10.3390/medicina60020303] [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] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
Ivabradine is a recently introduced inhibitor of the If ion channel, which exhibits the capacity to reduce heart rate while preserving hemodynamic stability. At present, ivabradine finds its clinical indication in patients suffering from heart failure with reduced ejection fraction and maintaining a relative sinus rhythm refractory to beta-blockers. To optimize heart rate control, it is recommended to pursue an aggressive up-titration of ivabradine. This approach may ameliorate tachycardia-induced hypotension by incrementally enhancing cardiac output and allow further up-titration of agents aimed at ameliorating heart failure, such as beta-blockers. Both the modulation of heart rate itself and the up-titration of agents targeting heart failure lead to cardiac reverse remodeling, consequently culminating in a subsequent reduction in mortality and morbidity. A novel overlap theory that our team proposed recently has emerged in recent times. Under trans-mitral Doppler echocardiography, the E-wave and A-wave closely juxtapose one another without any overlapping at the optimal heart rate. Employing echocardiography-guided ivabradine for heart-rate modulation to minimize the overlap between the E-wave and A-wave appears to confer substantial benefits to patients with heart failure. This approach facilitates superior cardiac reverse remodeling and yields more favorable clinical outcomes when compared to those patients who do not receive echocardiography-guided care. The next pertinent issue revolves around the potential expansion of ivabradine's clinical indications to encompass a broader spectrum of diseases. It is imperative to acknowledge that ivabradine may not yield clinically significant benefits in patients afflicted by heart failure with preserved ejection fraction, acute heart failure, sepsis, or stable angina. An important fact yet to be explored is the clinical applicability of ivabradine in patients with atrial fibrillation, a concern that beckons future investigation. In this review, the concept of overlap theory it introduced, along with its application to expand the indication of ivabradine and the overlap theory-guided optimal ivabradine therapy.
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Affiliation(s)
- Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-8555, Japan
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Załucka L, Świerżyńska E, Orczykowski M, Dutkowski K, Szymański J, Kuriata J, Dąbrowski R, Kołsut P, Szumowski Ł, Sterliński M. Ventricular Arrhythmias in Left Ventricular Assist Device Patients-Current Diagnostic and Therapeutic Considerations. Sensors (Basel) 2024; 24:1124. [PMID: 38400282 PMCID: PMC10893394 DOI: 10.3390/s24041124] [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] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/18/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024]
Abstract
Left ventricular assist devices (LVAD) are used in the treatment of advanced left ventricular heart failure. LVAD can serve as a bridge to orthotopic heart transplantation or as a destination therapy in cases where orthotopic heart transplantation is contraindicated. Ventricular arrhythmias are frequently observed in patients with LVAD. This problem is further compounded as a result of diagnostic difficulties arising from presently available electrocardiographic methods. Due to artifacts from LVAD-generated electromagnetic fields, it can be challenging to assess the origin of arrhythmias in standard ECG tracings. In this article, we will review and discuss common mechanisms, diagnostics methods, and therapeutic strategies for ventricular arrhythmia treatment, as well as numerous problems we face in LVAD implant patients.
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Affiliation(s)
- Laura Załucka
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Ewa Świerżyńska
- 1st Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
- Doctoral School, Medical University of Warsaw, 61 Zwirki I Wigury Street, 02-091 Warsaw, Poland
| | - Michał Orczykowski
- 1st Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
| | - Krzysztof Dutkowski
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Jarosław Szymański
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Jarosław Kuriata
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Rafał Dąbrowski
- Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
| | - Piotr Kołsut
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Łukasz Szumowski
- 1st Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
| | - Maciej Sterliński
- 1st Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
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Brown AP, Friedrichs GS, Tang HM, Traebert M, Weber V, Yao N, Yan GX. Electrophysiological Changes in the Rabbit Ventricular Wedge and Human-Induced Pluripotent Stem-Cell Derived (IPSC) Cardiomyocytes Translate to Severe Arrhythmia Observed in a Canine Toxicology Study, Not Predicted by Standard In Vitro Ion Channel Assays. Int J Toxicol 2024:10915818241230900. [PMID: 38327194 DOI: 10.1177/10915818241230900] [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] [Indexed: 02/09/2024]
Abstract
During drug discovery, small molecules are typically assayed in vitro for secondary pharmacology effects, which include ion channels relevant to cardiac electrophysiology. Compound A was an irreversible inhibitor of myeloperoxidase investigated for the treatment of peripheral artery disease. Oral doses in dogs at ≥5 mg/kg resulted in cardiac arrhythmias in a dose-dependent manner (at Cmax, free ≥1.53 μM) that progressed in severity with time. Nevertheless, a panel of 13 different cardiac ion channel (K, Na, and Ca) assays, including hERG, failed to identify pharmacologic risks of the molecule. Compound A and a related Compound B were evaluated for electrophysiological effects in the isolated rabbit ventricular wedge assay. Compounds A and B prolonged QT and Tp-e intervals at ≥1 and ≥.3 μM, respectively, and both prolonged QRS at ≥5 μM. Compound A produced early after depolarizations and premature ventricular complexes at ≥5 μM. These data indicate both compounds may be modulating hERG (Ikr) and Nav1.5 ion channels. In human IPSC cardiomyocytes, Compounds A and B prolonged field potential duration at ≥3 μM and induced cellular dysrhythmia at ≥10 and ≥3 μM, respectively. In a rat toxicology study, heart tissue: plasma concentration ratios for Compound A were ≥19X at 24 hours post-dose, indicating significant tissue distribution. In conclusion, in vitro ion channel assays may not always identify cardiovascular electrophysiological risks observed in vivo, which can be affected by tissue drug distribution. Risk for arrhythmia may increase with a "trappable" ion channel inhibitor, particularly if cardiac tissue drug levels achieve a critical threshold for pharmacologic effects.
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Affiliation(s)
- Alan P Brown
- Novartis Biomedical Research, Cambridge, MA, USA
| | | | | | | | | | - Nancy Yao
- Novartis Biomedical Research, East Hanover, NJ, USA
| | - Gan-Xin Yan
- Lankenau Institute for Medical Research, Wynnewood, PA, USA
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Kumar V, Ilkhanoff L. Anticoagulants for atrial fibrillation: from warfarin and DOACs to the promise of factor XI inhibitors. Front Cardiovasc Med 2024; 11:1352734. [PMID: 38374994 PMCID: PMC10875050 DOI: 10.3389/fcvm.2024.1352734] [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: 12/08/2023] [Accepted: 01/16/2024] [Indexed: 02/21/2024] Open
Abstract
Anticoagulation is the mainstay of stroke prevention in appropriate patients with atrial fibrillation. Due to advances in pharmacotherapy the anticoagulants used for this purpose have evolved significantly over the past decades with the aim of optimizing effectiveness while minimizing bleeding risks. Though significant improvements have been made toward this goal, bleeding risk remains the major concern with these therapies. An investigational class of agents which inhibit Factor XI have shown promise in pre-clinical and early clinical trials to significantly minimize bleeding while maintaining efficacy against stroke and systemic embolism. This mini-review will discuss anticoagulants currently used for stroke prevention in patients with atrial fibrillation including warfarin and direct oral anticoagulants. We will also review the mechanism of action and data from early clinical trials for Factor XI inhibitors and discuss their potential advantages and shortcomings.
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Affiliation(s)
| | - Leonard Ilkhanoff
- Electrophysiology Section, INOVA Fairfax Hospital, INOVA Schar Heart and Vascular Institute, Falls Church, VA, United States
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Vašků A, Novotný T, Špinar J. Polymorphic Variants of SCN5A Gene (rs41312433 and rs1805124) Associated with Coronary Artery Affliction in Patients with Severe Arrhythmias. Genes (Basel) 2024; 15:200. [PMID: 38397190 PMCID: PMC10887539 DOI: 10.3390/genes15020200] [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: 12/19/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
Several mutations in this gene for the α subunit of the cardiac sodium channel have been identified in a heterogeneous subset of cardiac rhythm syndromes, including Brugada syndrome, progressive cardiac conduction defect, sick sinus node syndrome, atrial fibrillation and dilated cardiomyopathy. The aim of our study was to associate some SCN5A polymorphic variants directly with confirmed coronary stenoses in patients with non-LQTS ventricular fibrillation/flutter treated by an implantable cardioverter defibrillator. MATERIALS AND METHODS A group of 32 unrelated individuals, aged 63 ± 12 years, was included in the study. All the patients were examined, diagnosed and treated with an implantable cardioverter defibrillator at the Department of Internal Cardiology Medicine, Faculty Hospital Brno. The control group included 87 persons of similar age without afflicted coronary circulation, which was confirmed coronagraphically. Genomic DNA was extracted from samples of peripheral blood according to the standard protocol. Two SCN5A polymorphisms-IVS9-3C/A (rs41312433) and A1673G (rs1805124, H558R)-were examined in association with coronary artery stenosis in the patients. RESULTS In the case-control study, no significant differences in genotype distribution/allelic frequencies were observed for IVS9-3c>a and A1673G gene polymorphisms between patients with severe arrhythmias and healthy persons. The distribution of SCN5A double genotypes was not significantly different among different types of arrhythmias according to their ejection fraction in arrhythmic patients (p = 0.396). The ventricular arrhythmias with an ejection fraction below 40% were found to be 10.67 times more frequent in patients with multiple coronary stenosis with clinically valid sensitivity, specificity and power tests. In the genotype-phenotype study, we observed a significant association of both SCN5A polymorphisms with the stenosis of coronary vessels in the patients with severe arrhythmia. The double genotype of polymorphisms IVS9-3C/A together with A1673G (CCAA) as well as their simple genotypes were associated with significant multiple stenosis of coronary arteries (MVS) with high sensitivity and specificity (p = 0.05; OR = 5 (95% CI 0.99-23.34); sensitivity 0.70; specificity 0.682; power test 0.359) Moreover, when a concrete stenotic coronary artery was associated with SCN5A genotypes, the CCAA double genotype was observed to be five times more frequent in patients with significant stenosis in the right coronary artery (RCA) compared to those without affliction of this coronary artery (p = 0.05; OR = 5 (95% CI 0.99-23.34); sensitivity 0.682; specificity 0.700; power test 0.359). The CCAA genotype was also more frequent in patients without RCA affliction with MVS (p = 0.008); in patients with ACD affliction but without MVS (p = 0.008); and in patients with both ACD affliction and MVS compared to those without ACD affliction and MVS (p = 0.005). CONCLUSIONS Our study presents a highly sensitive and specific association of two polymorphisms in SCN5A with significant coronary artery stenoses in patients with potentially fatal ventricular arrhythmias. At the same time, these polymorphisms were not associated with arrhythmias themselves. Thus, SCN5A gene polymorphic variants may form a part of germ cell gene predisposition to ischemia.
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Affiliation(s)
- Anna Vašků
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
| | - Tomáš Novotný
- Department of Internal Medicine and Cardiology, University Hospital Brno, Masaryk University, 62500 Brno, Czech Republic;
| | - Jindřich Špinar
- First Department of Internal Medicine—Cardioangiology, St. Anne’s University Hospital, Faculty of Medicine, Masaryk University, 60200 Brno, Czech Republic;
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Badura K, Buławska D, Dąbek B, Witkowska A, Lisińska W, Radzioch E, Skwira S, Młynarska E, Rysz J, Franczyk B. Primary Electrical Heart Disease-Principles of Pathophysiology and Genetics. Int J Mol Sci 2024; 25:1826. [PMID: 38339103 PMCID: PMC10855675 DOI: 10.3390/ijms25031826] [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: 12/29/2023] [Revised: 01/27/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Primary electrical heart diseases, often considered channelopathies, are inherited genetic abnormalities of cardiomyocyte electrical behavior carrying the risk of malignant arrhythmias leading to sudden cardiac death (SCD). Approximately 54% of sudden, unexpected deaths in individuals under the age of 35 do not exhibit signs of structural heart disease during autopsy, suggesting the potential significance of channelopathies in this group of age. Channelopathies constitute a highly heterogenous group comprising various diseases such as long QT syndrome (LQTS), short QT syndrome (SQTS), idiopathic ventricular fibrillation (IVF), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and early repolarization syndromes (ERS). Although new advances in the diagnostic process of channelopathies have been made, the link between a disease and sudden cardiac death remains not fully explained. Evolving data in electrophysiology and genetic testing suggest previously described diseases as complex with multiple underlying genes and a high variety of factors associated with SCD in channelopathies. This review summarizes available, well-established information about channelopathy pathogenesis, genetic basics, and molecular aspects relative to principles of the pathophysiology of arrhythmia. In addition, general information about diagnostic approaches and management is presented. Analyzing principles of channelopathies and their underlying causes improves the understanding of genetic and molecular basics that may assist general research and improve SCD prevention.
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Affiliation(s)
- Krzysztof Badura
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Dominika Buławska
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Bartłomiej Dąbek
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Alicja Witkowska
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Wiktoria Lisińska
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Ewa Radzioch
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Sylwia Skwira
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Ewelina Młynarska
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
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