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Shariat MH, Neira V, Redfearn DP. Sequential Intracardiac Activation Time Mapping of Arrhythmias Without Fiducial Time References. IEEE Trans Biomed Eng 2024; 71:1478-1487. [PMID: 38060362 DOI: 10.1109/tbme.2023.3340524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Sequential local activation time (LAT) mapping of intracardiac electrograms' activations requires a stable reference signal to align recording phases. OBJECTIVE This work's purpose is to develop an LAT mapping approach that does not rely on a time-alignment reference (TAR). METHODS To create an LAT map in absence of TAR (TARLess), the coordinates and LATs of recording electrodes are collected sequentially; a bank of candidate functions (CFs) is constructed that contains constant binary level CFs and non-linear functions of recording points' coordinates. Finally, a subset of CFs is linearly combined to create an activation time function with output matching electrodes' LATs. Synthetic and clinical data were deployed to validate TARLess. A simple two-dimensional computer model was used to create 30 different wavefront collision scenarios in a region with spatial conduction heterogeneities. Furthermore, sequential recordings were collected from seven atrial fibrillation patients during stimulation from one or two sites, after sinus rhythm was achieved post catheter ablation. RESULTS We showed that TARLess maps are similar to the one that uses TAR; for the 20 clinical maps, the mean absolute difference between measured LAT with the TAR and TARLess approach was 5.2 ±2.0 milliseconds. CONCLUSION We developed a novel method to create an LAT map of sequential recordings without using any TAR and showed that it can create accurate maps even during the collision of multiple wavefronts. SIGNIFICANCE TARLess mapping does not require a reference catheter which could lead to reduction in ablation procedure duration, cost, and potential complications.
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Fox SR, Toomu A, Gu K, Kang J, Sung K, Han FT, Hoffmayer KS, Hsu JC, Raissi F, Feld GK, McCulloch AD, Ho G, Krummen DE. Impact of artificial intelligence arrhythmia mapping on time to first ablation, procedure duration, and fluoroscopy use. J Cardiovasc Electrophysiol 2024; 35:916-928. [PMID: 38439119 DOI: 10.1111/jce.16237] [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: 08/14/2023] [Revised: 02/04/2024] [Accepted: 02/22/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Artificial intelligence (AI) ECG arrhythmia mapping provides arrhythmia source localization using 12-lead ECG data; whether this information impacts procedural efficiency is unknown. We performed a retrospective, case-control study to evaluate the hypothesis that AI ECG mapping may reduce time to ablation, procedural duration, and fluoroscopy. MATERIALS AND METHODS Cases in which system output was used were retrospectively enrolled according to IRB-approved protocols at each site. Matched control cases were enrolled in reverse chronological order beginning on the last day for which the technology was unavailable. Controls were matched based upon physician, institution, arrhythmia, and a predetermined complexity rating. Procedural metrics, fluoroscopy data, and clinical outcomes were assessed from time-stamped medical records. RESULTS The study group consisted of 28 patients (age 65 ± 11 years, 46% female, left atrial dimension 4.1 ± 0.9 cm, LVEF 50 ± 18%) and was similar to 28 controls. The most common arrhythmia types were atrial fibrillation (n = 10), premature ventricular complexes (n = 8), and ventricular tachycardia (n = 6). Use of the system was associated with a 19.0% reduction in time to ablation (133 ± 48 vs. 165 ± 49 min, p = 0.02), a 22.6% reduction in procedure duration (233 ± 51 vs. 301 ± 83 min, p < 0.001), and a 43.7% reduction in fluoroscopy (18.7 ± 13.3 vs. 33.2 ± 18.0 min, p < 0.001) versus controls. At 6 months follow-up, arrhythmia-free survival was 73.5% in the study group and 63.3% in the control group (p = 0.56). CONCLUSION Use of forward-solution AI ECG mapping is associated with reductions in time to first ablation, procedure duration, and fluoroscopy without an adverse impact on procedure outcomes or complications.
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Affiliation(s)
- Sutton R Fox
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Avinash Toomu
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Kelly Gu
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Jessica Kang
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Kevin Sung
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Frederick T Han
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Kurt S Hoffmayer
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Jonathan C Hsu
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Farshad Raissi
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Gregory K Feld
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Andrew D McCulloch
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Biomedical Engineering, University of California San Diego, La Jolla, California, USA
| | - Gordon Ho
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - David E Krummen
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
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Shin H, Baek JS, Kim MJ, Cha S, Yu JJ. Pacemaker-Related Factors and Outcomes of Fontan Patients - Impact of Paced QRS Duration. Circ J 2024; 88:642-648. [PMID: 38267052 DOI: 10.1253/circj.cj-23-0491] [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: 01/26/2024]
Abstract
BACKGROUND Permanent pacemaker (PPM) implantation has been identified as a risk factor for morbidity and mortality after Fontan operation. This study investigated the factors associated with outcomes in patients with Fontan physiology who underwent PPM implantation.Methods and Results: We retrospectively reviewed 508 patients who underwent Fontan surgery at Asan Medical Center between September 1992 and August 2022. Of these patients, 37 (7.3%) received PPM implantation. Five patients were excluded, leaving 32 patients, of whom 11 were categorized into the poor outcome group. Poor outcomes comprised death, heart transplantation, and "Fontan failure". Clinical, Fontan procedure-related, and PPM-related factors were compared between the poor and good outcome groups. Ventricular morphology, Fontan procedure-associated factors, pacing mode, high ventricular pacing rate, and time from first arrhythmia to PPM implantation did not differ significantly between the 2 groups. However, the poor outcome group exhibited a significantly longer mean paced QRS duration (P=0.044). Receiver operating characteristic curve analysis revealed a paced QRS duration cut-off value of 153 ms with an area under the curve of 0.73 (P=0.035). CONCLUSIONS A longer paced QRS duration was associated with poor outcomes, indicating its potential to predict adverse outcomes among Fontan patients.
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Affiliation(s)
- Hyewon Shin
- Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine
| | - Jae Suk Baek
- Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine
| | - Mi Jin Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine
| | - Seulgi Cha
- Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine
| | - Jeong Jin Yu
- Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine
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Sattar S, Mumtaz R, Qadir M, Mumtaz S, Khan MA, De Waele T, De Poorter E, Moerman I, Shahid A. Cardiac Arrhythmia Classification Using Advanced Deep Learning Techniques on Digitized ECG Datasets. Sensors (Basel) 2024; 24:2484. [PMID: 38676101 DOI: 10.3390/s24082484] [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: 02/27/2024] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
ECG classification or heartbeat classification is an extremely valuable tool in cardiology. Deep learning-based techniques for the analysis of ECG signals assist human experts in the timely diagnosis of cardiac diseases and help save precious lives. This research aims at digitizing a dataset of images of ECG records into time series signals and then applying deep learning (DL) techniques on the digitized dataset. State-of-the-art DL techniques are proposed for the classification of the ECG signals into different cardiac classes. Multiple DL models, including a convolutional neural network (CNN), a long short-term memory (LSTM) network, and a self-supervised learning (SSL)-based model using autoencoders are explored and compared in this study. The models are trained on the dataset generated from ECG plots of patients from various healthcare institutes in Pakistan. First, the ECG images are digitized, segmenting the lead II heartbeats, and then the digitized signals are passed to the proposed deep learning models for classification. Among the different DL models used in this study, the proposed CNN model achieves the highest accuracy of ∼92%. The proposed model is highly accurate and provides fast inference for real-time and direct monitoring of ECG signals that are captured from the electrodes (sensors) placed on different parts of the body. Using the digitized form of ECG signals instead of images for the classification of cardiac arrhythmia allows cardiologists to utilize DL models directly on ECG signals from an ECG machine for the real-time and accurate monitoring of ECGs.
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Affiliation(s)
- Shoaib Sattar
- School of Electrical Engineering and Computer Science (SEECS), National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan
| | - Rafia Mumtaz
- School of Electrical Engineering and Computer Science (SEECS), National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan
| | - Mamoon Qadir
- Federal Government Poly Clinic Hospital, Islamabad 44000, Pakistan
| | - Sadaf Mumtaz
- NUST School of Health Sciences (NSHS), National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan
| | - Muhammad Ajmal Khan
- School of Electrical Engineering and Computer Science (SEECS), National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan
| | - Timo De Waele
- IDLab, Department of Information Technology, Ghent University-IMEC, 9052 Ghent, Belgium
| | - Eli De Poorter
- IDLab, Department of Information Technology, Ghent University-IMEC, 9052 Ghent, Belgium
| | - Ingrid Moerman
- IDLab, Department of Information Technology, Ghent University-IMEC, 9052 Ghent, Belgium
| | - Adnan Shahid
- IDLab, Department of Information Technology, Ghent University-IMEC, 9052 Ghent, Belgium
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Behrmann A, Cayton J, Hayden MR, Lambert MD, Nourian Z, Nyanyo K, Godbee B, Hanft LM, Krenz M, McDonald KS, Domeier TL. Right ventricular preload and afterload challenge induces contractile dysfunction and arrhythmia in isolated hearts of dystrophin-deficient male mice. Physiol Rep 2024; 12:e16004. [PMID: 38658324 PMCID: PMC11043033 DOI: 10.14814/phy2.16004] [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: 12/04/2023] [Revised: 03/13/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024] Open
Abstract
Duchenne muscular dystrophy (DMD) is an X-linked recessive myopathy due to mutations in the dystrophin gene. Diaphragmatic weakness in DMD causes hypoventilation and elevated afterload on the right ventricle (RV). Thus, RV dysfunction in DMD develops early in disease progression. Herein, we deliver a 30-min sustained RV preload/afterload challenge to isolated hearts of wild-type (Wt) and dystrophic (Dmdmdx-4Cv) mice at both young (2-6 month) and middle-age (8-12 month) to test the hypothesis that the dystrophic RV is susceptible to dysfunction with elevated load. Young dystrophic hearts exhibited greater pressure development than wild type under baseline (Langendorff) conditions, but following RV challenge exhibited similar contractile function as wild type. Following the RV challenge, young dystrophic hearts had an increased incidence of premature ventricular contractions (PVCs) compared to wild type. Hearts of middle-aged wild-type and dystrophic mice had similar contractile function during baseline conditions. After RV challenge, hearts of middle-aged dystrophic mice had severe RV dysfunction and arrhythmias, including ventricular tachycardia. Following the RV load challenge, dystrophic hearts had greater lactate dehydrogenase (LDH) release than wild-type mice indicative of damage. Our data indicate age-dependent changes in RV function with load in dystrophin deficiency, highlighting the need to avoid sustained RV load to forestall dysfunction and arrhythmia.
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MESH Headings
- Animals
- Male
- Dystrophin/genetics
- Dystrophin/deficiency
- Mice
- Myocardial Contraction
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/genetics
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Dysfunction, Right/genetics
- Ventricular Dysfunction, Right/metabolism
- Muscular Dystrophy, Duchenne/physiopathology
- Muscular Dystrophy, Duchenne/genetics
- Muscular Dystrophy, Duchenne/complications
- Muscular Dystrophy, Duchenne/metabolism
- Mice, Inbred mdx
- Mice, Inbred C57BL
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Affiliation(s)
- Andrew Behrmann
- Medical Pharmacology and PhysiologyUniversity of MissouriColumbiaMissouriUSA
| | - Jessica Cayton
- Department of Veterinary PathobiologyUniversity of MissouriColumbiaMissouriUSA
| | - Matthew R. Hayden
- Medical Pharmacology and PhysiologyUniversity of MissouriColumbiaMissouriUSA
| | - Michelle D. Lambert
- Medical Pharmacology and PhysiologyUniversity of MissouriColumbiaMissouriUSA
| | - Zahra Nourian
- Medical Pharmacology and PhysiologyUniversity of MissouriColumbiaMissouriUSA
| | - Keith Nyanyo
- Medical Pharmacology and PhysiologyUniversity of MissouriColumbiaMissouriUSA
| | - Brooke Godbee
- Medical Pharmacology and PhysiologyUniversity of MissouriColumbiaMissouriUSA
| | - Laurin M. Hanft
- Medical Pharmacology and PhysiologyUniversity of MissouriColumbiaMissouriUSA
| | - Maike Krenz
- Medical Pharmacology and PhysiologyUniversity of MissouriColumbiaMissouriUSA
- Dalton Cardiovascular Research CenterUniversity of MissouriColumbiaMissouriUSA
| | - Kerry S. McDonald
- Medical Pharmacology and PhysiologyUniversity of MissouriColumbiaMissouriUSA
| | - Timothy L. Domeier
- Medical Pharmacology and PhysiologyUniversity of MissouriColumbiaMissouriUSA
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Perazzolo Marra M, Cecere A, Cipriani A, Migliore F, Zorzi A, De Lazzari M, Lorenzoni G, Cecchetto A, Brunetti G, Graziano F, Pittorru R, Motta R, De Conti G, Bauce B, Corrado D, Gregori D, Iliceto S. Determinants of Ventricular Arrhythmias in Mitral Valve Prolapse. JACC Clin Electrophysiol 2024; 10:670-681. [PMID: 38340116 DOI: 10.1016/j.jacep.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/04/2023] [Accepted: 12/04/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Mitral valve prolapse (MVP) may be associated with ventricular arrhythmias (VA) even in the absence of significant valvular regurgitation. Curling, mitral annulus disjunction (MAD) and myocardial fibrosis (late gadolinium enhancement [LGE]) may account for arrhythmogenesis. OBJECTIVES This study investigated the determinants of VA in patients with MVP without significant regurgitation. METHODS This study included 108 patients with MVP (66 female; median age: 48 years) without valve regurgitation. All patients underwent 12-lead electrocardiography, 12-lead 24-hour electrocardiographic Holter monitoring, exercise stress test, and cardiac magnetic resonance. Patients were divided into 2 groups (arrhythmic and no-arrhythmic MVP), according to the presence of VA with a right bundle branch block pattern. RESULTS The 62 patients (57%) with arrhythmic MVP showed: 1) higher MAD (median length: 6.0 vs 3.2 mm; P = 0.017); 2) higher prevalence of curling (79% vs 52%; P = 0.012); and 3) higher prevalence of left ventricular LGE (79% vs 52%; P = 0.012). Mediation analysis showed that curling had both a direct (P = 0.03) and indirect effect mediated by LGE (P = 0.04) on VA, whereas the association between MAD and VA was completely mediated by LGE. Patients with severe VA showed more pronounced morphofunctional alterations, in terms of MAD (7.0 vs 4.6 mm; P = 0.004) and presence and severity of curling (respectively, 91% vs 64%; P = 0.010; and 4 vs 3 mm; P = 0.004), compared to those without severe VA. CONCLUSIONS In patients with MVP the occurrence of VA with right bundle branch block morphology is the expression of more severe morphologic, mechanical, and tissue alterations. Curling has both a direct and an indirect effect on VA.
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Affiliation(s)
- Martina Perazzolo Marra
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Annagrazia Cecere
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Antonella Cecchetto
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giulia Brunetti
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesca Graziano
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Raimondo Pittorru
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Raffaella Motta
- Radiology Unit, University of Padua-Azienda Ospedaliera, Padua, Italy
| | - Giorgio De Conti
- Radiology Unit, University of Padua-Azienda Ospedaliera, Padua, Italy
| | - Barbara Bauce
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
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7
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Miller MA, Edens M, Malyshev Y. Ventricular Arrhythmias in Mitral Valve Prolapse: Disjunction, Curling and Fibrosis: A Whodunit Mystery. JACC Clin Electrophysiol 2024; 10:682-684. [PMID: 38658059 DOI: 10.1016/j.jacep.2024.02.009] [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] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Marc A Miller
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Madison Edens
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yury Malyshev
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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8
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Tastet L, Ramakrishna S, Lim LJ, Bibby D, Olgin JE, Connolly AJ, Moffatt E, Tseng ZH, Delling FN. Mechanical Dispersion Discriminates Between Arrhythmic and Nonarrhythmic Sudden Death: From the POST SCD Study. JACC Clin Electrophysiol 2024; 10:771-773. [PMID: 38363275 DOI: 10.1016/j.jacep.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/26/2023] [Accepted: 01/01/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Lionel Tastet
- University of California, San Francisco, California, USA
| | | | - Lisa J Lim
- University of California, San Francisco, California, USA
| | - Dwight Bibby
- University of California, San Francisco, California, USA
| | | | | | - Ellen Moffatt
- City and County of San Francisco, San Francisco, California, USA
| | - Zian H Tseng
- University of California, San Francisco, California, USA
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9
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Balaji S, Etheridge SP. Arrhythmias and the extracardiac conduit Fontan: promise unfulfilled? Europace 2024; 26:euae099. [PMID: 38650056 DOI: 10.1093/europace/euae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Affiliation(s)
- Seshadri Balaji
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University and Boise St. Luke's Medical Center, 600 East Jefferson Ave, Boise ID 83712, USA
| | - Susan P Etheridge
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University and Boise St. Luke's Medical Center, 600 East Jefferson Ave, Boise ID 83712, USA
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10
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Tereshchenko LG. Pulseless Electric Activity or Electromechanical Dissociation. Circ Arrhythm Electrophysiol 2024; 17:e012760. [PMID: 38318697 PMCID: PMC10922765 DOI: 10.1161/circep.124.012760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Larisa G Tereshchenko
- Departments of Quantitative Health Sciences and Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Lerner Research Institute, OH
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11
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Behr ER, Conte G, Wilde A. Is right ventricular outflow tract epicardial substrate ablation the standard of care in high-risk Brugada syndrome? Europace 2023; 26:euae020. [PMID: 38252938 PMCID: PMC10824472 DOI: 10.1093/europace/euae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Affiliation(s)
- Elijah R Behr
- Cardiovascular and Genomics Research Institute, St George’s, University of London, Cranmer Terrace, London SW17 0RE, UK
- Cardiology Care Group, St George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK
- Mayo Clinic Healthcare, London W1B 1PT, UK
| | - Giulio Conte
- Electrophysiology Unit, Department of Cardiology, Fondazione Cardiocentro Ticino, via Tesserete 48, Lugano, Switzerland
| | - Arthur Wilde
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
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12
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Dusi V, Vaseghi M. Neuronal sympathetic block for ventricular arrhythmias: one size may not fit all. Europace 2023; 25:euad314. [PMID: 37889145 PMCID: PMC10637298 DOI: 10.1093/europace/euad314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 10/28/2023] Open
Affiliation(s)
- Veronica Dusi
- Division of Cardiology, Department of Medical Sciences, University of Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Marmar Vaseghi
- Division of Cardiology, Department of Medicine, UCLA Cardiac Arrhythmia Center, Los Angeles, CA, USA
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13
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Wang Y, Li Q, Tao B, Angelini M, Ramadoss S, Sun B, Wang P, Krokhaleva Y, Ma F, Gu Y, Espinoza A, Yamauchi K, Pellegrini M, Novitch B, Olcese R, Qu Z, Song Z, Deb A. Fibroblasts in heart scar tissue directly regulate cardiac excitability and arrhythmogenesis. Science 2023; 381:1480-1487. [PMID: 37769108 PMCID: PMC10768850 DOI: 10.1126/science.adh9925] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/11/2023] [Indexed: 09/30/2023]
Abstract
After heart injury, dead heart muscle is replaced by scar tissue. Fibroblasts can electrically couple with myocytes, and changes in fibroblast membrane potential can lead to myocyte excitability, which suggests that fibroblast-myocyte coupling in scar tissue may be responsible for arrhythmogenesis. However, the physiologic relevance of electrical coupling of myocytes and fibroblasts and its impact on cardiac excitability in vivo have never been demonstrated. We genetically engineered a mouse that expresses the optogenetic cationic channel ChR2 (H134R) exclusively in cardiac fibroblasts. After myocardial infarction, optical stimulation of scar tissue elicited organ-wide cardiac excitation and induced arrhythmias in these animals. Complementing computational modeling with experimental approaches, we showed that gap junctional and ephaptic coupling, in a synergistic yet functionally redundant manner, excited myocytes coupled to fibroblasts.
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Affiliation(s)
- Yijie Wang
- Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Cardiovascular Theme, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Molecular, Cell and Developmental Biology, University of California Los Angeles, Los Angeles, CA 90095, USA
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California Los Angeles, Los Angeles, CA 90095, USA
- Molecular Biology Institute, University of California Los Angeles, Los Angeles, CA 90095, USA
- California Nanosystems Institute, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Qihao Li
- Peng Cheng Laboratory, Shenzhen, Guangdong 518000, China
| | - Bo Tao
- Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Cardiovascular Theme, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Molecular, Cell and Developmental Biology, University of California Los Angeles, Los Angeles, CA 90095, USA
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California Los Angeles, Los Angeles, CA 90095, USA
- Molecular Biology Institute, University of California Los Angeles, Los Angeles, CA 90095, USA
- California Nanosystems Institute, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Marina Angelini
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Sivakumar Ramadoss
- Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Cardiovascular Theme, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Molecular, Cell and Developmental Biology, University of California Los Angeles, Los Angeles, CA 90095, USA
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California Los Angeles, Los Angeles, CA 90095, USA
- Molecular Biology Institute, University of California Los Angeles, Los Angeles, CA 90095, USA
- California Nanosystems Institute, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Baiming Sun
- Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Cardiovascular Theme, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Molecular, Cell and Developmental Biology, University of California Los Angeles, Los Angeles, CA 90095, USA
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California Los Angeles, Los Angeles, CA 90095, USA
- Molecular Biology Institute, University of California Los Angeles, Los Angeles, CA 90095, USA
- California Nanosystems Institute, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Ping Wang
- Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Cardiovascular Theme, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Molecular, Cell and Developmental Biology, University of California Los Angeles, Los Angeles, CA 90095, USA
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California Los Angeles, Los Angeles, CA 90095, USA
- Molecular Biology Institute, University of California Los Angeles, Los Angeles, CA 90095, USA
- California Nanosystems Institute, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Yuliya Krokhaleva
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Feiyang Ma
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Yiqian Gu
- Department of Molecular, Cell and Developmental Biology, University of California Los Angeles, Los Angeles, CA 90095, USA
- Institute for Quantitative and Computational Biosciences–The Collaboratory, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Alejandro Espinoza
- Department of Molecular, Cell and Developmental Biology, University of California Los Angeles, Los Angeles, CA 90095, USA
- Institute for Quantitative and Computational Biosciences–The Collaboratory, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Ken Yamauchi
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Neurobiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Matteo Pellegrini
- Department of Molecular, Cell and Developmental Biology, University of California Los Angeles, Los Angeles, CA 90095, USA
- Institute for Quantitative and Computational Biosciences–The Collaboratory, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Bennett Novitch
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Neurobiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Riccardo Olcese
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Physiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Zhilin Qu
- Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Zhen Song
- Peng Cheng Laboratory, Shenzhen, Guangdong 518000, China
| | - Arjun Deb
- Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Cardiovascular Theme, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Molecular, Cell and Developmental Biology, University of California Los Angeles, Los Angeles, CA 90095, USA
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California Los Angeles, Los Angeles, CA 90095, USA
- Molecular Biology Institute, University of California Los Angeles, Los Angeles, CA 90095, USA
- California Nanosystems Institute, University of California Los Angeles, Los Angeles, CA 90095, USA
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14
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Pham BT, Le PT, Tai TC, Hsu YC, Li YH, Wang JC. Electrocardiogram Heartbeat Classification for Arrhythmias and Myocardial Infarction. Sensors (Basel) 2023; 23:2993. [PMID: 36991703 PMCID: PMC10051525 DOI: 10.3390/s23062993] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 06/19/2023]
Abstract
An electrocardiogram (ECG) is a basic and quick test for evaluating cardiac disorders and is crucial for remote patient monitoring equipment. An accurate ECG signal classification is critical for real-time measurement, analysis, archiving, and transmission of clinical data. Numerous studies have focused on accurate heartbeat classification, and deep neural networks have been suggested for better accuracy and simplicity. We investigated a new model for ECG heartbeat classification and found that it surpasses state-of-the-art models, achieving remarkable accuracy scores of 98.5% on the Physionet MIT-BIH dataset and 98.28% on the PTB database. Furthermore, our model achieves an impressive F1-score of approximately 86.71%, outperforming other models, such as MINA, CRNN, and EXpertRF on the PhysioNet Challenge 2017 dataset.
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Affiliation(s)
- Bach-Tung Pham
- Department of Computer Science and Information Engineering, National Central University, Taoyuan City 320317, Taiwan
| | - Phuong Thi Le
- Department of Computer Science and Information Engineering, National Central University, Taoyuan City 320317, Taiwan
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan City 320317, Taiwan
| | - Tzu-Chiang Tai
- Department of Computer Science and Information Engineering, Providence University, Taichung City 43301, Taiwan
| | - Yi-Chiung Hsu
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan City 320317, Taiwan
| | - Yung-Hui Li
- AI Research Center, Hon Hai Research Institute, New Taipei City 236, Taiwan
| | - Jia-Ching Wang
- Department of Computer Science and Information Engineering, National Central University, Taoyuan City 320317, Taiwan
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15
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O'Shea C, Winter J, Kabir SN, O'Reilly M, Wells SP, Baines O, Sommerfeld LC, Correia J, Lei M, Kirchhof P, Holmes AP, Fabritz L, Rajpoot K, Pavlovic D. High resolution optical mapping of cardiac electrophysiology in pre-clinical models. Sci Data 2022; 9:135. [PMID: 35361792 PMCID: PMC8971487 DOI: 10.1038/s41597-022-01253-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/07/2022] [Indexed: 11/08/2022] Open
Abstract
Optical mapping of animal models is a widely used technique in pre-clinical cardiac research. It has several advantages over other methods, including higher spatial resolution, contactless recording and direct visualisation of action potentials and calcium transients. Optical mapping enables simultaneous study of action potential and calcium transient morphology, conduction dynamics, regional heterogeneity, restitution and arrhythmogenesis. In this dataset, we have optically mapped Langendorff perfused isolated whole hearts (mouse and guinea pig) and superfused isolated atria (mouse). Raw datasets (consisting of over 400 files) can be combined with open-source software for processing and analysis. We have generated a comprehensive post-processed dataset characterising the baseline cardiac electrophysiology in these widely used pre-clinical models. This dataset also provides reference information detailing the effect of heart rate, clinically used anti-arrhythmic drugs, ischaemia-reperfusion and sympathetic nervous stimulation on cardiac electrophysiology. The effects of these interventions can be studied in a global or regional manner, enabling new insights into the prevention and initiation of arrhythmia.
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Affiliation(s)
- Christopher O'Shea
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
| | - James Winter
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - S Nashitha Kabir
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Molly O'Reilly
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Simon P Wells
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Olivia Baines
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Laura C Sommerfeld
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- University Center of Cardiovascular Science, UKE, Hamburg, Germany
| | - Joao Correia
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Ming Lei
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, University Heart and Vascular Centre, University Medical Center Hamburg-Eppendorf, Germany and German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lubeck, Lubeck, Germany
- University Center of Cardiovascular Science, UKE, Hamburg, Germany
| | - Andrew P Holmes
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, University Heart and Vascular Centre, University Medical Center Hamburg-Eppendorf, Germany and German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lubeck, Lubeck, Germany
- University Center of Cardiovascular Science, UKE, Hamburg, Germany
| | - Kashif Rajpoot
- School of Computer Science, University of Birmingham, Birmingham, UK
| | - Davor Pavlovic
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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16
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Nguyen HX, Wu T, Needs D, Zhang H, Perelli RM, DeLuca S, Yang R, Pan M, Landstrom AP, Henriquez C, Bursac N. Engineered bacterial voltage-gated sodium channel platform for cardiac gene therapy. Nat Commun 2022; 13:620. [PMID: 35110560 PMCID: PMC8810800 DOI: 10.1038/s41467-022-28251-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/11/2022] [Indexed: 12/19/2022] Open
Abstract
Therapies for cardiac arrhythmias could greatly benefit from approaches to enhance electrical excitability and action potential conduction in the heart by stably overexpressing mammalian voltage-gated sodium channels. However, the large size of these channels precludes their incorporation into therapeutic viral vectors. Here, we report a platform utilizing small-size, codon-optimized engineered prokaryotic sodium channels (BacNav) driven by muscle-specific promoters that significantly enhance excitability and conduction in rat and human cardiomyocytes in vitro and adult cardiac tissues from multiple species in silico. We also show that the expression of BacNav significantly reduces occurrence of conduction block and reentrant arrhythmias in fibrotic cardiac cultures. Moreover, functional BacNav channels are stably expressed in healthy mouse hearts six weeks following intravenous injection of self-complementary adeno-associated virus (scAAV) without causing any adverse effects on cardiac electrophysiology. The large diversity of prokaryotic sodium channels and experimental-computational platform reported in this study should facilitate the development and evaluation of BacNav-based gene therapies for cardiac conduction disorders.
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Affiliation(s)
- Hung X Nguyen
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Tianyu Wu
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Daniel Needs
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Hengtao Zhang
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Robin M Perelli
- Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Department of Cell Biology, Duke University School of Medicine, Durham, NC, USA
| | - Sophia DeLuca
- Department of Cell Biology, Duke University School of Medicine, Durham, NC, USA
| | - Rachel Yang
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Michael Pan
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Andrew P Landstrom
- Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Department of Cell Biology, Duke University School of Medicine, Durham, NC, USA
| | - Craig Henriquez
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Nenad Bursac
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
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17
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Macías Á, Díaz-Larrosa JJ, Blanco Y, Fanjul V, González-Gómez C, Gonzalo P, Andrés-Manzano MJ, da Rocha AM, Ponce-Balbuena D, Allan A, Filgueiras-Rama D, Jalife J, Andrés V. Paclitaxel mitigates structural alterations and cardiac conduction system defects in a mouse model of Hutchinson-Gilford progeria syndrome. Cardiovasc Res 2022; 118:503-516. [PMID: 33624748 PMCID: PMC8803078 DOI: 10.1093/cvr/cvab055] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/11/2020] [Accepted: 02/09/2021] [Indexed: 12/12/2022] Open
Abstract
AIMS Hutchinson-Gilford progeria syndrome (HGPS) is an ultrarare laminopathy caused by expression of progerin, a lamin A variant, also present at low levels in non-HGPS individuals. HGPS patients age and die prematurely, predominantly from cardiovascular complications. Progerin-induced cardiac repolarization defects have been described previously, although the underlying mechanisms are unknown. METHODS AND RESULTS We conducted studies in heart tissue from progerin-expressing LmnaG609G/G609G (G609G) mice, including microscopy, intracellular calcium dynamics, patch-clamping, in vivo magnetic resonance imaging, and electrocardiography. G609G mouse cardiomyocytes showed tubulin-cytoskeleton disorganization, t-tubular system disruption, sarcomere shortening, altered excitation-contraction coupling, and reductions in ventricular thickening and cardiac index. G609G mice exhibited severe bradycardia, and significant alterations of atrio-ventricular conduction and repolarization. Most importantly, 50% of G609G mice had altered heart rate variability, and sinoatrial block, both significant signs of premature cardiac aging. G609G cardiomyocytes had electrophysiological alterations, which resulted in an elevated action potential plateau and early afterdepolarization bursting, reflecting slower sodium current inactivation and long Ca+2 transient duration, which may also help explain the mild QT prolongation in some HGPS patients. Chronic treatment with low-dose paclitaxel ameliorated structural and functional alterations in G609G hearts. CONCLUSIONS Our results demonstrate that tubulin-cytoskeleton disorganization in progerin-expressing cardiomyocytes causes structural, cardiac conduction, and excitation-contraction coupling defects, all of which can be partially corrected by chronic treatment with low dose paclitaxel.
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MESH Headings
- Action Potentials/drug effects
- Animals
- Anti-Arrhythmia Agents/pharmacology
- Arrhythmias, Cardiac/drug therapy
- Arrhythmias, Cardiac/genetics
- Arrhythmias, Cardiac/metabolism
- Arrhythmias, Cardiac/physiopathology
- Cytoskeleton/drug effects
- Cytoskeleton/metabolism
- Cytoskeleton/pathology
- Disease Models, Animal
- Excitation Contraction Coupling/drug effects
- Female
- Genetic Predisposition to Disease
- Heart Conduction System/drug effects
- Heart Conduction System/metabolism
- Heart Conduction System/physiopathology
- Heart Rate/drug effects
- Lamin Type A/genetics
- Lamin Type A/metabolism
- Male
- Mice, Mutant Strains
- Mutation
- Myocytes, Cardiac/drug effects
- Myocytes, Cardiac/metabolism
- Myocytes, Cardiac/pathology
- Paclitaxel/pharmacology
- Progeria/drug therapy
- Progeria/genetics
- Progeria/metabolism
- Progeria/physiopathology
- Refractory Period, Electrophysiological/drug effects
- Swine
- Swine, Miniature
- Tubulin/metabolism
- Mice
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Affiliation(s)
- Álvaro Macías
- Vascular Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
| | - J Jaime Díaz-Larrosa
- Vascular Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
| | - Yaazan Blanco
- Vascular Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
| | - Víctor Fanjul
- Vascular Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
| | - Cristina González-Gómez
- Vascular Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
- CIBER en Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Pilar Gonzalo
- Vascular Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
| | - María Jesús Andrés-Manzano
- Vascular Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
- CIBER en Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Andre Monteiro da Rocha
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI 48109-2800, USA
| | - Daniela Ponce-Balbuena
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI 48109-2800, USA
| | - Andrew Allan
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI 48109-2800, USA
| | - David Filgueiras-Rama
- CIBER en Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
- Department of Cardiology, Cardiac Electrophysiology Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain
- Myocardial, Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
| | - José Jalife
- CIBER en Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI 48109-2800, USA
- Myocardial, Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
| | - Vicente Andrés
- Vascular Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
- CIBER en Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
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18
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Blake P. Heart Rhythm Society membership value proposition. Heart Rhythm 2022; 19:2. [PMID: 34996585 DOI: 10.1016/j.hrthm.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/18/2022]
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19
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Strauss B, Bisserier M, Obus E, Katz MG, Fargnoli A, Cacheux M, Akar JG, Hummel JP, Hadri L, Sassi Y, Akar FG. Right predominant electrical remodeling in a pure model of pulmonary hypertension promotes reentrant arrhythmias. Heart Rhythm 2022; 19:113-124. [PMID: 34563688 PMCID: PMC8742785 DOI: 10.1016/j.hrthm.2021.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/30/2020] [Revised: 09/08/2021] [Accepted: 09/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Electrophysiological (EP) properties have been studied mainly in the monocrotaline model of pulmonary arterial hypertension (PAH). Findings are confounded by major extrapulmonary toxicities, which preclude the ability to draw definitive conclusions regarding the role of PAH per se in EP remodeling. OBJECTIVE The purpose of this study was to investigate the EP substrate and arrhythmic vulnerability of a new model of PAH that avoids extracardiopulmonary toxicities. METHODS Sprague-Dawley rats underwent left pneumonectomy (Pn) followed by injection of the vascular endothelial growth factor inhibitor Sugen-5416 (Su/Pn). Five weeks later, cardiac magnetic resonance imaging was performed in vivo, optical action potential (AP) mapping ex vivo, and molecular analyses in vitro. RESULTS Su/Pn rats exhibited right ventricular (RV) hypertrophy and were highly prone to pacing-induced ventricular tachycardia/fibrillation (VT/VF). Underlying this susceptibility was disproportionate RV-sided prolongation of AP duration, which promoted formation of right-sided AP alternans at physiological rates. While propagation was impaired at all rates in Su/Pn rats, the extent of conduction slowing was most severe immediately before the emergence of interventricular lines of block and onset of VT/VF. Measurement of the cardiac wavelength revealed a decrease in Su/Pn relative to control. Nav1.5 and total connexin 43 expression was not altered, while connexin 43 phosphorylation was decreased in PAH. Col1a1 and Col3a1 transcripts were upregulated coinciding with myocardial fibrosis. Once generated, VT/VF was sustained by multiple reentrant circuits with a lower frequency of RV activation due to wavebreak formation. CONCLUSION In this pure model of PAH, we document RV-predominant remodeling that promotes multiwavelet reentry underlying VT. The Su/Pn model represents a severe form of PAH that allows the study of EP properties without the confounding influence of extrapulmonary toxicity.
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Affiliation(s)
- Benjamin Strauss
- Electro-biology & Arrhythmia Therapeutics Laboratory, Cardiovascular Research Center, Yale University
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai
| | - Malik Bisserier
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai
| | - Emerson Obus
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai
| | - Michael G. Katz
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai
| | - Anthony Fargnoli
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai
| | - Marine Cacheux
- Electro-biology & Arrhythmia Therapeutics Laboratory, Cardiovascular Research Center, Yale University
| | - Joseph G. Akar
- Electro-biology & Arrhythmia Therapeutics Laboratory, Cardiovascular Research Center, Yale University
| | - James P Hummel
- Electro-biology & Arrhythmia Therapeutics Laboratory, Cardiovascular Research Center, Yale University
| | - Lahouaria Hadri
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai
| | - Yassine Sassi
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai
- Center for Vascular and Heart Research, Fralin Biomedical research Institute at Virginia Tech Carilion
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University
| | - Fadi G. Akar
- Electro-biology & Arrhythmia Therapeutics Laboratory, Cardiovascular Research Center, Yale University
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20
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Kim JS, Choi SW, Park YG, Kim SJ, Choi CH, Cha MJ, Chang JH. Impact of High-Dose Irradiation on Human iPSC-Derived Cardiomyocytes Using Multi-Electrode Arrays: Implications for the Antiarrhythmic Effects of Cardiac Radioablation. Int J Mol Sci 2021; 23:ijms23010351. [PMID: 35008778 PMCID: PMC8745341 DOI: 10.3390/ijms23010351] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 12/19/2022] Open
Abstract
Cardiac radioablation is emerging as an alternative option for refractory ventricular arrhythmias. However, the immediate acute effect of high-dose irradiation on human cardiomyocytes remains poorly known. We measured the electrical activities of human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) upon irradiation with 0, 20, 25, 30, 40, and 50 Gy using a multi-electrode array, and cardiomyocyte function gene levels were evaluated. iPSC-CMs showed to recover their electrophysiological activities (total active electrode, spike amplitude and slope, and corrected field potential duration) within 3–6 h from the acute effects of high-dose irradiation. The beat rate immediately increased until 3 h after irradiation, but it steadily decreased afterward. Conduction velocity slowed in cells irradiated with ≥25 Gy until 6–12 h and recovered within 24 h; notably, 20 and 25 Gy-treated groups showed subsequent continuous increase. At day 7 post-irradiation, except for cTnT, cardiomyocyte function gene levels increased with increasing irradiation dose, but uniquely peaked at 25–30 Gy. Altogether, high-dose irradiation immediately and reversibly modifies the electrical conduction of cardiomyocytes. Thus, compensatory mechanisms at the cellular level may be activated after the high-dose irradiation acute effects, thereby, contributing to the immediate antiarrhythmic outcome of cardiac radioablation for refractory ventricular arrhythmias.
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Affiliation(s)
- Jae Sik Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul 03080, Korea; (J.S.K.); (C.H.C.)
- Department of Radiation Oncology, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Seong Woo Choi
- Department of Physiology, Dongguk University College of Medicine, Gyeongju 38066, Korea;
| | - Yun-Gwi Park
- Stem Cell Research Institute, T&R Biofab Co., Ltd., Siheung 15073, Korea;
| | - Sung Joon Kim
- Department of Physiology & Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Chang Heon Choi
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul 03080, Korea; (J.S.K.); (C.H.C.)
- Department of Radiation Oncology, Seoul National University Hospital, Seoul 03080, Korea
| | - Myung-Jin Cha
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
- Correspondence: (M.-J.C.); (J.H.C.); Tel.: +82-2-3010-3321 (M.-J.C.); +82-2-2072-4940 (J.H.C.)
| | - Ji Hyun Chang
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul 03080, Korea; (J.S.K.); (C.H.C.)
- Department of Radiation Oncology, Seoul National University Hospital, Seoul 03080, Korea
- Correspondence: (M.-J.C.); (J.H.C.); Tel.: +82-2-3010-3321 (M.-J.C.); +82-2-2072-4940 (J.H.C.)
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21
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El‐Battrawy I, Lan H, Cyganek L, Maywald L, Zhong R, Zhang F, Xu Q, Lee J, Duperrex E, Hierlemann A, Saguner AM, Duru F, Kovacs B, Huang M, Liao Z, Albers S, Müller J, Dinkel H, Rose L, Hohn A, Yang Z, Qiao L, Li Y, Lang S, Kleinsorge M, Mügge A, Aweimer A, Fan X, Diecke S, Akin I, Li G, Zhou X. Deciphering the pathogenic role of a variant with uncertain significance for short QT and Brugada syndromes using gene-edited human-induced pluripotent stem cell-derived cardiomyocytes and preclinical drug screening. Clin Transl Med 2021; 11:e646. [PMID: 34954893 PMCID: PMC8710296 DOI: 10.1002/ctm2.646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/24/2021] [Accepted: 10/30/2021] [Indexed: 12/22/2022] Open
Affiliation(s)
- Ibrahim El‐Battrawy
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
- Department of Cardiology and AngiologyBergmannsheil Bochum, Medical Clinic IIRuhr UniversityBochumGermany
| | - Huan Lan
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan ProvinceInstitute of Cardiovascular Research, Southwest Medical UniversityLuzhouChina
| | - Lukas Cyganek
- Stem Cell Unit, Clinic for Cardiology and PneumologyUniversity Medical Center GöttingenGöttingenGermany
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
| | - Lasse Maywald
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
| | - Rujia Zhong
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Feng Zhang
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Qiang Xu
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Jihyun Lee
- Department of Biosystems Science and EngineeringBioengineering LaboratoryBaselSwitzerland
| | - Eliane Duperrex
- Department of Biosystems Science and EngineeringBioengineering LaboratoryBaselSwitzerland
| | - Andreas Hierlemann
- Department of Biosystems Science and EngineeringBioengineering LaboratoryBaselSwitzerland
| | - Ardan M. Saguner
- Department of CardiologyElectrophysiology DivisionUniversity Heart Center ZurichZurichSwitzerland
| | - Firat Duru
- Department of CardiologyElectrophysiology DivisionUniversity Heart Center ZurichZurichSwitzerland
| | - Boldizsar Kovacs
- Department of CardiologyElectrophysiology DivisionUniversity Heart Center ZurichZurichSwitzerland
| | - Mengying Huang
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Zhenxing Liao
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Sebastian Albers
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
| | - Jonas Müller
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
| | - Hendrik Dinkel
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
| | - Lena Rose
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Alyssa Hohn
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Zhen Yang
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Lin Qiao
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Yingrui Li
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Siegfried Lang
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
| | - Mandy Kleinsorge
- Stem Cell Unit, Clinic for Cardiology and PneumologyUniversity Medical Center GöttingenGöttingenGermany
- Department of CardiologyElectrophysiology DivisionUniversity Heart Center ZurichZurichSwitzerland
| | - Andreas Mügge
- Department of Cardiology and AngiologyBergmannsheil Bochum, Medical Clinic IIRuhr UniversityBochumGermany
| | - Assem Aweimer
- Department of Cardiology and AngiologyBergmannsheil Bochum, Medical Clinic IIRuhr UniversityBochumGermany
| | - Xuehui Fan
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | | | - Ibrahim Akin
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
| | - Guang Li
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan ProvinceInstitute of Cardiovascular Research, Southwest Medical UniversityLuzhouChina
| | - Xiaobo Zhou
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan ProvinceInstitute of Cardiovascular Research, Southwest Medical UniversityLuzhouChina
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
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22
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Ravens U, Gomez AM, Heijman J, Remme CA, Dobrev D, Smith G, Volders PGA, Cerbai E, Eisner DA, Casadei B, Zaza A, Richard S, Mugelli A, Vassort G, Brown HF, Sipido KR. Edward Carmeliet (1930-2021)-channelling scientific curiosity: a tribute from the ESC Working Group on Cardiac Cellular Electrophysiology†. Cardiovasc Res 2021; 117:e171-e173. [PMID: 34850866 DOI: 10.1093/cvr/cvab333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ursula Ravens
- Institute of Experimental Cardiovascular Medicine, Freiburg, Germany
| | - Ana M Gomez
- Inserm UMR-S 1180, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Jordi Heijman
- CARIM, Maastricht University, Maastricht, The Netherlands
| | - Carol Ann Remme
- Department of Experimental Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Dobromir Dobrev
- Institute of Pharmacology, University Duisburg-Essen, Duisburg, Germany
| | - Godfrey Smith
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Paul G A Volders
- CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Elisabetta Cerbai
- Department Neurofarba, Università degli Studi Firenze, Florence, Italy
| | - David A Eisner
- Cardiac Physiology, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Barbara Casadei
- Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Antonio Zaza
- Department of Biotechnology and Biosciences, Università degli Studi di Milano Bicocca, Milan, Italy
| | - Sylvain Richard
- Inserm U1046, CNRS UMR 9214, Université de Montpellier, Montpellier, France
| | | | - Guy Vassort
- Université de Montpellier, Montpellier, France
| | - Hilary F Brown
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Karin R Sipido
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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23
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Hegyi B, Ko CY, Bossuyt J, Bers DM. Two-hit mechanism of cardiac arrhythmias in diabetic hyperglycaemia: reduced repolarization reserve, neurohormonal stimulation, and heart failure exacerbate susceptibility. Cardiovasc Res 2021; 117:2781-2793. [PMID: 33483728 PMCID: PMC8683706 DOI: 10.1093/cvr/cvab006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 08/31/2020] [Accepted: 01/10/2021] [Indexed: 12/11/2022] Open
Abstract
AIMS Diabetic hyperglycaemia is associated with increased arrhythmia risk. We aimed to investigate whether hyperglycaemia alone can be accountable for arrhythmias or whether it requires the presence of additional pathological factors. METHODS AND RESULTS Action potentials (APs) and arrhythmogenic spontaneous diastolic activities were measured in isolated murine ventricular, rabbit atrial, and ventricular myocytes acutely exposed to high glucose. Acute hyperglycaemia increased the short-term variability (STV) of action potential duration (APD), enhanced delayed afterdepolarizations, and the inducibility of APD alternans during tachypacing in both murine and rabbit atrial and ventricular myocytes. Hyperglycaemia also prolonged APD in mice and rabbit atrial cells but not in rabbit ventricular myocytes. However, rabbit ventricular APD was more strongly depressed by block of late Na+ current (INaL) during hyperglycaemia, consistent with elevated INaL in hyperglycaemia. All the above proarrhythmic glucose effects were Ca2+-dependent and abolished by CaMKII inhibition. Importantly, when the repolarization reserve was reduced by pharmacological inhibition of K+ channels (either Ito, IKr, IKs, or IK1) or hypokalaemia, acute hyperglycaemia further prolonged APD and further increased STV and alternans in rabbit ventricular myocytes. Likewise, when rabbit ventricular myocytes were pretreated with isoproterenol or angiotensin II, hyperglycaemia significantly prolonged APD, increased STV and promoted alternans. Moreover, acute hyperglycaemia markedly prolonged APD and further enhanced STV in failing rabbit ventricular myocytes. CONCLUSION We conclude that even though hyperglycaemia alone can enhance cellular proarrhythmic mechanisms, a second hit which reduces the repolarization reserve or stimulates G protein-coupled receptor signalling greatly exacerbates cardiac arrhythmogenesis in diabetic hyperglycaemia.
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Affiliation(s)
- Bence Hegyi
- Department of Pharmacology, University of California, Davis, 451 Health Sciences Drive, CA 95616, USA
| | - Christopher Y Ko
- Department of Pharmacology, University of California, Davis, 451 Health Sciences Drive, CA 95616, USA
| | - Julie Bossuyt
- Department of Pharmacology, University of California, Davis, 451 Health Sciences Drive, CA 95616, USA
| | - Donald M Bers
- Department of Pharmacology, University of California, Davis, 451 Health Sciences Drive, CA 95616, USA
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24
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He S, Kou K, O'Shea C, Chen T, Mu-U-Min R, Dong R, Ren H, Zhou X, Fan Z, Tan X, Pavlovic D, Ou X, Lei M. A dataset of dual calcium and voltage optical mapping in healthy and hypertrophied murine hearts. Sci Data 2021; 8:314. [PMID: 34916511 PMCID: PMC8677726 DOI: 10.1038/s41597-021-01085-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 11/01/2021] [Indexed: 11/18/2022] Open
Abstract
Pathological hypertrophy underlies sudden cardiac death due to its high incidence of occurrence of ventricular arrhythmias. The alteration of transmural electrophysiological properties in hypertrophic cardiac murine tissue has never been explored previously. In this dataset, we have for the first time conducted high-throughput simultaneous optical imaging of transmembrane potential and calcium transients (CaT) throughout the entire hypertrophic murine hearts at high temporal and spatial resolution. Using ElectroMap, we have conducted multiple parameters analysis including action potential duration/calcium transient duration, conduction velocity, alternans and diastolic interval. Voltage-calcium latency was measured as time difference between action potential and CaT peak. The dataset therefore provides the first high spatial resolution transmural electrophysiological profiling of the murine heart, allowing interrogation of mechanisms driving ventricular arrhythmias associated with pathological hypertrophy. The dataset allows for further reuse and detailed analyses of geometrical, topological and functional analyses and reconstruction of 2-dimensional and 3-dimentional models.
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Affiliation(s)
- Shicheng He
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
- Department of Cardiovascular Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Kun Kou
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
- Department of Cardiovascular Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Christopher O'Shea
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Tangting Chen
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Razik Mu-U-Min
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Ruirui Dong
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Huiying Ren
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
- Department of Cardiovascular Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaolin Zhou
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Zhongcai Fan
- Department of Cardiovascular Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaoqiu Tan
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
- Department of Cardiovascular Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Davor Pavlovic
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Xianhong Ou
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China.
- Department of Cardiovascular Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Ming Lei
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China.
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom.
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25
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Chung MK, Fagerlin A, Wang PJ, Ajayi TB, Allen LA, Baykaner T, Benjamin EJ, Branda M, Cavanaugh KL, Chen LY, Crossley GH, Delaney RK, Eckhardt LL, Grady KL, Hargraves IG, Hills MT, Kalscheur MM, Kramer DB, Kunneman M, Lampert R, Langford AT, Lewis KB, Lu Y, Mandrola JM, Martinez K, Matlock DD, McCarthy SR, Montori VM, Noseworthy PA, Orland KM, Ozanne E, Passman R, Pundi K, Roden DM, Saarel EV, Schmidt MM, Sears SF, Stacey D, Stafford RS, Steinberg BA, Wass SY, Wright JM. Shared Decision Making in Cardiac Electrophysiology Procedures and Arrhythmia Management. Circ Arrhythm Electrophysiol 2021; 14:e007958. [PMID: 34865518 PMCID: PMC8692382 DOI: 10.1161/circep.121.007958] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Shared decision making (SDM) has been advocated to improve patient care, patient decision acceptance, patient-provider communication, patient motivation, adherence, and patient reported outcomes. Documentation of SDM is endorsed in several society guidelines and is a condition of reimbursement for selected cardiovascular and cardiac arrhythmia procedures. However, many clinicians argue that SDM already occurs with clinical encounter discussions or the process of obtaining informed consent and note the additional imposed workload of using and documenting decision aids without validated tools or evidence that they improve clinical outcomes. In reality, SDM is a process and can be done without decision tools, although the process may be variable. Also, SDM advocates counter that the low-risk process of SDM need not be held to the high bar of demonstrating clinical benefit and that increasing the quality of decision making should be sufficient. Our review leverages a multidisciplinary group of experts in cardiology, cardiac electrophysiology, epidemiology, and SDM, as well as a patient advocate. Our goal is to examine and assess SDM methodology, tools, and available evidence on outcomes in patients with heart rhythm disorders to help determine the value of SDM, assess its possible impact on electrophysiological procedures and cardiac arrhythmia management, better inform regulatory requirements, and identify gaps in knowledge and future needs.
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Affiliation(s)
| | - Angela Fagerlin
- University of Utah, Salt Lake City, UT
- Salt Lake City Veterans Affairs Informatics Decision-Enhancement and Analytic Sciences Center for Innovation, Salt Lake City, UT
| | | | | | | | | | | | - Megan Branda
- University of Colorado, Aurora, CO
- Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | | | | | | | - Marleen Kunneman
- Mayo Clinic, Rochester, MN
- Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | - Ying Lu
- Stanford University, Stanford, CA
| | | | | | | | | | | | | | | | | | | | | | - Dan M. Roden
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | | | | - Sojin Youn Wass
- Cleveland Clinic, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
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26
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De Nittis P, Efthymiou S, Sarre A, Guex N, Chrast J, Putoux A, Sultan T, Raza Alvi J, Ur Rahman Z, Zafar F, Rana N, Rahman F, Anwar N, Maqbool S, Zaki MS, Gleeson JG, Murphy D, Galehdari H, Shariati G, Mazaheri N, Sedaghat A, Lesca G, Chatron N, Salpietro V, Christoforou M, Houlden H, Simonds WF, Pedrazzini T, Maroofian R, Reymond A. Inhibition of G-protein signalling in cardiac dysfunction of intellectual developmental disorder with cardiac arrhythmia (IDDCA) syndrome. J Med Genet 2021; 58:815-831. [PMID: 33172956 PMCID: PMC8639930 DOI: 10.1136/jmedgenet-2020-107015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/30/2020] [Accepted: 09/04/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pathogenic variants of GNB5 encoding the β5 subunit of the guanine nucleotide-binding protein cause IDDCA syndrome, an autosomal recessive neurodevelopmental disorder associated with cognitive disability and cardiac arrhythmia, particularly severe bradycardia. METHODS We used echocardiography and telemetric ECG recordings to investigate consequences of Gnb5 loss in mouse. RESULTS We delineated a key role of Gnb5 in heart sinus conduction and showed that Gnb5-inhibitory signalling is essential for parasympathetic control of heart rate (HR) and maintenance of the sympathovagal balance. Gnb5-/- mice were smaller and had a smaller heart than Gnb5+/+ and Gnb5+/- , but exhibited better cardiac function. Lower autonomic nervous system modulation through diminished parasympathetic control and greater sympathetic regulation resulted in a higher baseline HR in Gnb5-/- mice. In contrast, Gnb5-/- mice exhibited profound bradycardia on treatment with carbachol, while sympathetic modulation of the cardiac stimulation was not altered. Concordantly, transcriptome study pinpointed altered expression of genes involved in cardiac muscle contractility in atria and ventricles of knocked-out mice. Homozygous Gnb5 loss resulted in significantly higher frequencies of sinus arrhythmias. Moreover, we described 13 affected individuals, increasing the IDDCA cohort to 44 patients. CONCLUSIONS Our data demonstrate that loss of negative regulation of the inhibitory G-protein signalling causes HR perturbations in Gnb5-/- mice, an effect mainly driven by impaired parasympathetic activity. We anticipate that unravelling the mechanism of Gnb5 signalling in the autonomic control of the heart will pave the way for future drug screening.
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Affiliation(s)
| | - Stephanie Efthymiou
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, UK
| | - Alexandre Sarre
- Cardiovascular Assessment Facility, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Guex
- Bioinformatics Competence Center, University of Lausanne, Lausanne, Switzerland
| | - Jacqueline Chrast
- Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
| | - Audrey Putoux
- Service de Génétique, Hopital Femme Mere Enfant, Bron, France
| | - Tipu Sultan
- Department of Pediatric Neurology, The Children's Hospital and Institute of Child Health, Lahore, Pakistan
| | - Javeria Raza Alvi
- Department of Pediatric Neurology, The Children's Hospital and Institute of Child Health, Lahore, Pakistan
| | - Zia Ur Rahman
- Department of Pediatric Neurology, The Children's Hospital and Institute of Child Health, Lahore, Pakistan
| | - Faisal Zafar
- Department of Paediatric Neurology, Children's Hospital and Institute of Child Health, Multan, Pakistan
| | - Nuzhat Rana
- Department of Paediatric Neurology, Children's Hospital and Institute of Child Health, Multan, Pakistan
| | - Fatima Rahman
- Department of Developmental-Behavioural Paediatrics, The Children's Hospital and Institute of Child Health, Lahore, Pakistan
| | - Najwa Anwar
- Department of Developmental-Behavioural Paediatrics, The Children's Hospital and Institute of Child Health, Lahore, Pakistan
| | - Shazia Maqbool
- Department of Developmental-Behavioural Paediatrics, The Children's Hospital and Institute of Child Health, Lahore, Pakistan
| | - Maha S Zaki
- Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - Joseph G Gleeson
- Department of Neuroscience and Pediatrics, Howard Hughes Medical Institute, La Jolla, California, USA
| | - David Murphy
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, UK
| | - Hamid Galehdari
- Department of Genetics, Faculty of Science, Shahid Chamran University of Ahvaz, Ahwaz, Iran (the Islamic Republic of)
| | - Gholamreza Shariati
- Department of Medical Genetics, Faculty of Medicine, Ahvaz Jondishapour University of Medical Sciences, Ahvaz, Iran (the Islamic Republic of)
| | - Neda Mazaheri
- Department of Genetics, Faculty of Science, Shahid Chamran University of Ahvaz, Ahwaz, Iran (the Islamic Republic of)
| | - Alireza Sedaghat
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of medical Sciences, Ahvaz, Iran (the Islamic Republic of)
| | - Gaetan Lesca
- Service de Genetique, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Chatron
- Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
- Service de Genetique, Hospices Civils de Lyon, Lyon, France
| | - Vincenzo Salpietro
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, UK
| | - Marilena Christoforou
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, UK
| | - Henry Houlden
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, UK
| | - William F Simonds
- Metabolic Diseases Branch/NIDDK, National Institutes of Health, Bethesda, MD, USA
| | - Thierry Pedrazzini
- Experimental Cardiology Unit, Department of Cardiovascular Medicine, University of Lausanne, Lausanne, Switzerland
| | - Reza Maroofian
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, UK
| | - Alexandre Reymond
- Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
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27
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Gong Y, Yang L, Tang J, Zheng J, Witman N, Jakob P, Tan Y, Liu M, Chen Y, Wang H, Fu W, Wang W. Yohimbine Directly Induces Cardiotoxicity on Human-Induced Pluripotent Stem Cell-Derived Cardiomyocytes. Cardiovasc Toxicol 2021; 22:141-151. [PMID: 34817810 DOI: 10.1007/s12012-021-09709-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/12/2021] [Indexed: 11/26/2022]
Abstract
Yohimbine is a highly selective and potent α2-adrenoceptor antagonist, which is usually treated as an adjunction for impotence, as well for weight loss and natural bodybuilding aids. However, it was recently reported that Yohimbine causes myocardial injury and controversial results were reported in the setting of cardiac diseases. Here, we used human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) as a model system to explore electrophysiologic characterization after exposure to Yohimbine. HiPSC-CMs were differentiated by employment of inhibitory Wnt compounds. For analysis of electrophysiological properties, conventional whole-cell patch-clamp recording was used. Specifically, spontaneous action potentials, pacemaker currents (If), sodium (Na+) channel (INa), and calcium (Ca++) channel currents (ICa) were assessed in hiPSC-CMs after exposure to Yohimbine. HiPSC-CMs expressed sarcomeric-α-actinin and MLC2V proteins, as well as exhibited ventricular-like spontaneous action potential waveform. Yohimbine inhibited frequency of hiPSC-CMs spontaneous action potentials and significantly prolonged action potential duration in a dose-dependent manner. In addition, rest potential, threshold potential, amplitude, and maximal diastolic potential were decreased, whereas APD50/APD90 was prolonged. Yohimbine inhibited the amplitude of INa in low doses (IC50 = 14.2 μM, n = 5) and inhibited ICa in high doses (IC50 = 139.7 μM, n = 5). Whereas Yohimbine did not affect the activation curves, treatment resulted in left shifts in inactivation curves of both Na+ and Ca++ channels. Here, we show that Yohimbine induces direct cardiotoxic effects on spontaneous action potentials of INa and ICa in hiPSC-CMs. Importantly, these effects were not mediated by α2-adrenoceptor signaling. Our results strongly suggest that Yohimbine directly and negatively affects electrophysiological properties of human cardiomyocytes. These findings are highly relevant for potential application of Yohimbine in patients with atrioventricular conduction disorder.
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Affiliation(s)
- Yiqi Gong
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
| | - Li Yang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jun Tang
- Department of Anesthesiology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 200240, China
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Nevin Witman
- Department of Cell and Molecular Biology, Karolinska Institute, 17177, Stockholm, Sweden
| | - Philipp Jakob
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
| | - Yao Tan
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China
| | - Minglu Liu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China
| | - Ying Chen
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China
| | - Huijing Wang
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Wei Fu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China.
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
- Shanghai Key Laboratory of Tissue Engineering, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China.
| | - Wei Wang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China.
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Abstract
Chronic heart failure is a clinical syndrome with multiple etiologies, associated with significant morbidity and mortality. Cardiac arrhythmias, including ventricular tachyarrhythmias and atrial fibrillation, are common in heart failure. A number of cardiac diseases including heart failure alter the expression and regulation of ion channels and transporters leading to arrhythmogenic electrical remodeling. Myocardial hypertrophy, fibrosis and scar formation are key elements of arrhythmogenic structural remodeling in heart failure. In this article, the mechanisms responsible for increased arrhythmia susceptibility as well as the underlying changes in ion channel, transporter expression and function as well as alterations in calcium handling in heart failure are discussed. Understanding the mechanisms of arrhythmogenic remodeling is key to improving arrhythmia management and the prevention of sudden cardiac death in patients with heart failure.
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Affiliation(s)
- Zoltán Husti
- Department of Pharmacology and Pharmacotherapy, University of Szeged, 6720 Szeged, Hungary; (Z.H.); (A.V.)
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, 6720 Szeged, Hungary
| | - András Varró
- Department of Pharmacology and Pharmacotherapy, University of Szeged, 6720 Szeged, Hungary; (Z.H.); (A.V.)
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, 6720 Szeged, Hungary
- ELKH-SZTE Research Group for Cardiovascular Pharmacology, Eötvös Loránd Research Network, 6720 Szeged, Hungary
| | - István Baczkó
- Department of Pharmacology and Pharmacotherapy, University of Szeged, 6720 Szeged, Hungary; (Z.H.); (A.V.)
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, 6720 Szeged, Hungary
- Correspondence:
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29
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Takase B, Higashimura Y, Asahina H, Ishihara M, Sakai H. Liposome-encapsulated hemoglobin (HbV) transfusion rescues rats undergoing progressive lethal 85% hemorrhage as a result of an anti-arrhythmogenic effect on the myocardium. Artif Organs 2021; 45:1391-1404. [PMID: 34219238 DOI: 10.1111/aor.14033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/04/2021] [Accepted: 06/28/2021] [Indexed: 12/28/2022]
Abstract
Liposome-encapsulated hemoglobin vesicles (HbV) can serve as a blood substitute with oxygen-carrying capacity comparable to that of human blood and lethal hemorrhage is associated with lethal arrhythmias. To investigate the resuscitation effect of HbV on lethal hemorrhage and anti-arrhythmogenesis, we performed optical mapping analysis (OMP) and electrophysiological study (EPS) in graded blood exchange (85% blood loss) in the rat model. We also measured cardiac autonomic activity, as assessed by heart rate variability (HRV), and changes in plasma norepinephrine and left ventricle ejection fraction (LVEF) by echocardiography. Pathological study on Connexin43 was performed. A 5% albumin (ALB group), washed rat erythrocytes (wRBC group), and HbV (HbV group) were used as a resuscitation fluid. The survival effects over 24 hours were examined. All rats died in the ALB group, whereas almost all survived for 24-hours period in wRBC and HbV groups. OMP showed impaired action potential duration dispersion (APDd) in the ALB group, whereas normal APDs in HbV and wRBC groups. Lethal arrhythmias were induced by EPS in the ALB group, but not in wRBC and HbV groups. HRV indices, LVEF, Connexin43 were preserved in HbV and wRBC groups. Lethal hemorrhage causes lethal arrhythmias in the presence of impaired APDd. HbV acutely rescues lethal hemorrhage by preventing lethal arrhythmias and preserving arrhythmogenic factors.
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Affiliation(s)
- Bonpei Takase
- Department of Intensive Care Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Yuko Higashimura
- Department of Intensive Care Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Haruka Asahina
- Department of Critical Care Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Masayuki Ishihara
- Division of Biomedical Engineering, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Hiromi Sakai
- Department of Chemistry, School of Medicine, Nara Medical University, Kashihara, Japan
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30
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Abstract
The ongoing coronavirus infection-2019 (COVID-19) global pandemic has had devastating impacts on the global population since 2019. Cardiac complications are a well-documented sequala of COVID-19, with exposed patients experiencing complications such as myocardial infarction, myocarditis, and arrythmias. This article aims to review prominent literature regarding COVID-19 and its link with arrhythmias, as well as to discuss some of the possible mechanisms by which arrhythmogenesis may occur in patients with COVID-19.
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Affiliation(s)
- John N. Varkey
- From theDepartment of Medicine, Stony Brook University, Stony Brook, NY
| | - William H. Frishman
- Departments of Medicine and Cardiology, New York Medical College/Westchester Medical Center, Valhalla, NY
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31
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Liu C, Yao L, Zhang L, Lin Y. Effect of metoprolol tartrate tablets and recombinant human B-type natriuretic peptide on the sudden cardiac death and malignant arrhythmias in patients with acute myocardial infarction and heart failure. Pak J Pharm Sci 2021; 34:2473-2478. [PMID: 35039262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
To explore the effect of metoprolol tartrate tablets and recombinant human natriuretic peptide B (NPPB) on sudden cardiac death and malignant arrhythmias in patients with acute myocardial infarction and patients with heart failure (AMI-HF). A total of 105 AMI-HF patients treatedfrom January 2020 and June 2021 were enrolled and divided into Group I (n=53) and Group II (n=52). Both groups received conventional treatment, and Group II was additionally treated with metoprolol tartrate tablets and NPPB. The clinical observation indicators of the two groups of patients were compared. Group II had better left ventricular end diastolic diameter (LVEDd), left ventricular end systolic diameter (LVESD) and left ventricular ejection fraction (LVEF) (p<0.05). The standard deviation of NN (R-R) interval (SDNN), mean NN (R-R), root mean square of continuous difference (RMSSD) and the percentage of difference between adjacent RR intervals >50ms (pNN50) increased after treatment, with more increase in the Group II (p<0.05). Group II obtained significantly lower levels of B type natriuretic peptide (BNP),N terminal pro B type natriuretic peptide (NT-ProBNP), interleukin (IL)-6 and hs-CRP in contrast to Group I (p<0.05). Markedly higher total response rates were observed in Group II (p<0.05). The combination of metoprolol tartrate tablets and NPPB is effective in treating AMI-HF.
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MESH Headings
- Adrenergic beta-1 Receptor Antagonists/adverse effects
- Adrenergic beta-1 Receptor Antagonists/therapeutic use
- Aged
- Anti-Arrhythmia Agents/adverse effects
- Anti-Arrhythmia Agents/therapeutic use
- Arrhythmias, Cardiac/blood
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/prevention & control
- Biomarkers/blood
- C-Reactive Protein/metabolism
- Death, Sudden, Cardiac/prevention & control
- Drug Therapy, Combination
- Female
- Heart Failure/blood
- Heart Failure/drug therapy
- Heart Failure/mortality
- Heart Failure/physiopathology
- Humans
- Interleukin-6/blood
- Male
- Metoprolol/adverse effects
- Metoprolol/therapeutic use
- Middle Aged
- Myocardial Infarction/blood
- Myocardial Infarction/drug therapy
- Myocardial Infarction/mortality
- Myocardial Infarction/physiopathology
- Natriuretic Peptide, Brain/adverse effects
- Natriuretic Peptide, Brain/blood
- Natriuretic Peptide, Brain/therapeutic use
- Peptide Fragments/blood
- Recombinant Proteins/therapeutic use
- Recovery of Function
- Retrospective Studies
- Stroke Volume/drug effects
- Time Factors
- Treatment Outcome
- Ventricular Function, Left/drug effects
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Affiliation(s)
- Chenjie Liu
- Medical Examination Center, Cangzhou Central Hospital, Cangzhou, China
| | - Li Yao
- Department VI of Cardiovascular Medicine, Cangzhou Central Hospital, Cangzhou, China
| | - Li Zhang
- CT Scan Room, Cangzhou Central Hospital, Cangzhou, China
| | - Yu Lin
- Catheterization Room, Cangzhou Central Hospital, Cangzhou, China
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32
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Han B, Trew ML, Zgierski-Johnston CM. Cardiac Conduction Velocity, Remodeling and Arrhythmogenesis. Cells 2021; 10:cells10112923. [PMID: 34831145 PMCID: PMC8616078 DOI: 10.3390/cells10112923] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/14/2021] [Accepted: 10/22/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiac electrophysiological disorders, in particular arrhythmias, are a key cause of morbidity and mortality throughout the world. There are two basic requirements for arrhythmogenesis: an underlying substrate and a trigger. Altered conduction velocity (CV) provides a key substrate for arrhythmogenesis, with slowed CV increasing the probability of re-entrant arrhythmias by reducing the length scale over which re-entry can occur. In this review, we examine methods to measure cardiac CV in vivo and ex vivo, discuss underlying determinants of CV, and address how pathological variations alter CV, potentially increasing arrhythmogenic risk. Finally, we will highlight future directions both for methodologies to measure CV and for possible treatments to restore normal CV.
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Affiliation(s)
- Bo Han
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen, 79110 Freiburg im Breisgau, Germany;
- Faculty of Medicine, University of Freiburg, 79110 Freiburg im Breisgau, Germany
- Spemann Graduate School of Biology and Medicine (SGBM), University of Freiburg, 79104 Freiburg im Breisgau, Germany
- Department of Cardiovascular Surgery, The Fourth People’s Hospital of Jinan, 250031 Jinan, China
| | - Mark L. Trew
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand;
| | - Callum M. Zgierski-Johnston
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen, 79110 Freiburg im Breisgau, Germany;
- Faculty of Medicine, University of Freiburg, 79110 Freiburg im Breisgau, Germany
- Correspondence:
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33
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Escobar-Lopez L, Ochoa JP, Mirelis JG, Espinosa MÁ, Navarro M, Gallego-Delgado M, Barriales-Villa R, Robles-Mezcua A, Basurte-Elorz MT, Gutiérrez García-Moreno L, Climent V, Jiménez-Jaimez J, Mogollón-Jiménez MV, Lopez J, Peña-Peña ML, García-Álvarez A, Brion M, Ripoll-Vera T, Palomino-Doza J, Tirón C, Idiazabal U, Brögger MN, García-Hernández S, Restrepo-Córdoba MA, Gonzalez-Lopez E, Méndez I, Sabater M, Villacorta E, Larrañaga-Moreira JM, Abecia A, Fernández AI, García-Pinilla JM, Rodríguez-Palomares JF, Gimeno-Blanes JR, Bayes-Genis A, Lara-Pezzi E, Domínguez F, Garcia-Pavia P. Association of Genetic Variants With Outcomes in Patients With Nonischemic Dilated Cardiomyopathy. J Am Coll Cardiol 2021; 78:1682-1699. [PMID: 34674813 DOI: 10.1016/j.jacc.2021.08.039] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [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: 05/17/2021] [Revised: 06/29/2021] [Accepted: 08/11/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The clinical relevance of genetic variants in nonischemic dilated cardiomyopathy (DCM) is unsettled. OBJECTIVES The study sought to assess the prognostic impact of disease-causing genetic variants in DCM. METHODS Baseline and longitudinal clinical data from 1,005 genotyped DCM probands were retrospectively collected at 20 centers. A total of 372 (37%) patients had pathogenic or likely pathogenic variants (genotype positive) and 633 (63%) were genotype negative. The primary endpoint was a composite of major adverse cardiovascular events. Secondary endpoints were end-stage heart failure (ESHF), malignant ventricular arrhythmia (MVA), and left ventricular reverse remodeling (LVRR). RESULTS After a median follow-up of 4.04 years (interquartile range: 1.70-7.50 years), the primary endpoint had occurred in 118 (31.7%) patients in the genotype-positive group and in 125 (19.8%) patients in the genotype-negative group (hazard ratio [HR]: 1.51; 95% confidence interval [CI]: 1.17-1.94; P = 0.001). ESHF occurred in 60 (16.1%) genotype-positive patients and in 55 (8.7%) genotype-negative patients (HR: 1.67; 95% CI: 1.16-2.41; P = 0.006). MVA occurred in 73 (19.6%) genotype-positive patients and in 77 (12.2%) genotype-negative patients (HR: 1.50; 95% CI: 1.09-2.07; P = 0.013). LVRR occurred in 39.6% in the genotype-positive group and in 46.2% in the genotype-negative group (P = 0.047). Among individuals with baseline left ventricular ejection fraction ≤35%, genotype-positive patients exhibited more major adverse cardiovascular events, ESHF, and MVA than their genotype-negative peers (all P < 0.02). LVRR and clinical outcomes varied depending on the underlying affected gene. CONCLUSIONS In this study, DCM patients with pathogenic or likely pathogenic variants had worse prognosis than genotype-negative individuals. Clinical course differed depending on the underlying affected gene.
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Affiliation(s)
- Luis Escobar-Lopez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, the Netherlands
| | - Juan Pablo Ochoa
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, the Netherlands; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Jesús G Mirelis
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, the Netherlands
| | - María Ángeles Espinosa
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marina Navarro
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, the Netherlands; Inherited Cardiac Disease Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - María Gallego-Delgado
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiac Diseases Unit, Department of Cardiology, Instituto de Investigación Biomédica de Salamanca, Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León, Salamanca, Spain
| | - Roberto Barriales-Villa
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiac Diseases Unit, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, Universidade da Coruña, A Coruña, Spain
| | - Ainhoa Robles-Mezcua
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Heart Failure and Familial Heart Diseases Unit, Cardiology Department, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | | | - Laura Gutiérrez García-Moreno
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiovascular Diseases Unit, Department of Cardiology, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vicente Climent
- Inherited Cardiovascular Diseases Unit, Department of Cardiology, Hospital General Universitario de Alicante, Institute of Health and Biomedical Research, Alicante, Spain
| | - Juan Jiménez-Jaimez
- Department of Cardiology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Javier Lopez
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Instituto de Ciencias del Corazón, Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - María Luisa Peña-Peña
- Inherited Cardiac Diseases Unit, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Ana García-Álvarez
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; August Pi i Sunyer Biomedical Research Institute, Hospital Clínic, Departament of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - María Brion
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Xenética Cardiovascular, Instituto de investigación Sanitaria de Santiago, Unidad de Cardiopatías Familiares, Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiac Diseases Unit, Cardiology Department, Hospital Universitario Son Llatzer and Institut d'Investigaciò Sanitària Illes Balears, Palma de Mallorca, Spain
| | - Julián Palomino-Doza
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiac Diseases Unit, Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Madrid, Spain
| | - Coloma Tirón
- Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Uxua Idiazabal
- Depatment of Cadiology, Clinica San Miguel, Pamplona, Spain
| | | | - Soledad García-Hernández
- Inherited Cardiac Diseases Unit, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, Universidade da Coruña, A Coruña, Spain; Department of Cardiology, Health in Code, A Coruña, Spain
| | - María Alejandra Restrepo-Córdoba
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, the Netherlands
| | - Esther Gonzalez-Lopez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, the Netherlands
| | - Irene Méndez
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Sabater
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, the Netherlands; Inherited Cardiac Disease Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Eduardo Villacorta
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiac Diseases Unit, Department of Cardiology, Instituto de Investigación Biomédica de Salamanca, Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León, Salamanca, Spain; Departament of Medicine, Facultad de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - José M Larrañaga-Moreira
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiac Diseases Unit, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, Universidade da Coruña, A Coruña, Spain
| | - Ana Abecia
- Department of Cardiology, Área del Corazón, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ana Isabel Fernández
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José M García-Pinilla
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Heart Failure and Familial Heart Diseases Unit, Cardiology Department, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - José F Rodríguez-Palomares
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiovascular Diseases Unit, Department of Cardiology, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Ramón Gimeno-Blanes
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, the Netherlands; Inherited Cardiac Disease Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Enrique Lara-Pezzi
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Fernando Domínguez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, the Netherlands; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
| | - Pablo Garcia-Pavia
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, the Netherlands; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain.
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34
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Mages C, Gampp H, Syren P, Rahm AK, André F, Frey N, Lugenbiel P, Thomas D. Electrical Ventricular Remodeling in Dilated Cardiomyopathy. Cells 2021; 10:cells10102767. [PMID: 34685747 PMCID: PMC8534398 DOI: 10.3390/cells10102767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/01/2021] [Accepted: 10/12/2021] [Indexed: 12/19/2022] Open
Abstract
Ventricular arrhythmias contribute significantly to morbidity and mortality in patients with heart failure (HF). Pathomechanisms underlying arrhythmogenicity in patients with structural heart disease and impaired cardiac function include myocardial fibrosis and the remodeling of ion channels, affecting electrophysiologic properties of ventricular cardiomyocytes. The dysregulation of ion channel expression has been associated with cardiomyopathy and with the development of arrhythmias. However, the underlying molecular signaling pathways are increasingly recognized. This review summarizes clinical and cellular electrophysiologic characteristics observed in dilated cardiomyopathy (DCM) with ionic and structural alterations at the ventricular level. Furthermore, potential translational strategies and therapeutic options are highlighted.
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Affiliation(s)
- Christine Mages
- Department of Cardiology, Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (C.M.); (H.G.); (P.S.); (A.-K.R.); (F.A.); (N.F.); (P.L.)
- Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Heike Gampp
- Department of Cardiology, Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (C.M.); (H.G.); (P.S.); (A.-K.R.); (F.A.); (N.F.); (P.L.)
- Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Pascal Syren
- Department of Cardiology, Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (C.M.); (H.G.); (P.S.); (A.-K.R.); (F.A.); (N.F.); (P.L.)
- Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Ann-Kathrin Rahm
- Department of Cardiology, Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (C.M.); (H.G.); (P.S.); (A.-K.R.); (F.A.); (N.F.); (P.L.)
- Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Florian André
- Department of Cardiology, Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (C.M.); (H.G.); (P.S.); (A.-K.R.); (F.A.); (N.F.); (P.L.)
- Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (C.M.); (H.G.); (P.S.); (A.-K.R.); (F.A.); (N.F.); (P.L.)
- Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Patrick Lugenbiel
- Department of Cardiology, Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (C.M.); (H.G.); (P.S.); (A.-K.R.); (F.A.); (N.F.); (P.L.)
- Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Dierk Thomas
- Department of Cardiology, Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (C.M.); (H.G.); (P.S.); (A.-K.R.); (F.A.); (N.F.); (P.L.)
- Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-568855; Fax: +49-6221-565514
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Zagidullin NS, Motloch LJ, Musin TI, Bagmanova ZA, Lakman IA, Tyurin AV, Gumerov RM, Enikeev D, Cai B, Gareeva DF, Davtyan PA, Gareev DA, Talipova HM, Badykov MR, Jirak P, Kopp K, Hoppe UC, Pistulli R, Pavlov VN. J-waves in acute COVID-19: A novel disease characteristic and predictor of mortality? PLoS One 2021; 16:e0257982. [PMID: 34648510 PMCID: PMC8516278 DOI: 10.1371/journal.pone.0257982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022] Open
Abstract
Background J-waves represent a common finding in routine ECGs (5–6%) and are closely linked to ventricular tachycardias. While arrhythmias and non-specific ECG alterations are a frequent finding in COVID-19, an analysis of J-wave incidence in acute COVID-19 is lacking. Methods A total of 386 patients consecutively, hospitalized due to acute COVID-19 pneumonia were included in this retrospective analysis. Admission ECGs were analyzed, screened for J-waves and correlated to clinical characteristics and 28-day mortality. Results J-waves were present in 12.2% of patients. Factors associated with the presence of J-waves were old age, female sex, a history of stroke and/or heart failure, high CRP levels as well as a high BMI. Mortality rates were significantly higher in patients with J-waves in the admission ECG compared to the non-J-wave cohort (J-wave: 14.9% vs. non-J-wave 3.8%, p = 0.001). After adjusting for confounders using a multivariable cox regression model, the incidence of J-waves was an independent predictor of mortality at 28-days (OR 2.76 95% CI: 1.15–6.63; p = 0.023). J-waves disappeared or declined in 36.4% of COVID-19 survivors with available ECGs for 6–8 months follow-up. Conclusion J-waves are frequently and often transiently found in the admission ECG of patients hospitalized with acute COVID-19. Furthermore, they seem to be an independent predictor of 28-day mortality.
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Affiliation(s)
- Naufal Shamilevich Zagidullin
- Department of Internal Medicine I, Bashkir State Medical University, Ufa, Russian Federation
- Department of Biomedical Engineering of Ufa State Aviation Technical University, Ufa, Russian Federation
- * E-mail:
| | - Lukas J. Motloch
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Timur Ilgamovich Musin
- Department of Internal Medicine I, Bashkir State Medical University, Ufa, Russian Federation
| | | | - Irina Alexandrovna Lakman
- Department of Biomedical Engineering of Ufa State Aviation Technical University, Ufa, Russian Federation
- Department of Economics, Finance and Business, Bashkir State University, Ufa, Russian Federation
| | | | | | - Dinar Enikeev
- Department of Biomedical Engineering of Ufa State Aviation Technical University, Ufa, Russian Federation
| | - Benzhi Cai
- Department of Pharmacy at The Second Affiliated Hospital, and Department of Pharmacology (The Key Laboratory of Cardiovascular Medicine Research, Ministry of Education) at College of Pharmacy, Harbin Medical University, Harbin, China
| | | | | | - Damir Aidarovich Gareev
- Department of Internal Medicine I, Bashkir State Medical University, Ufa, Russian Federation
| | | | | | - Peter Jirak
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Kristen Kopp
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Uta C. Hoppe
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Rudin Pistulli
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Münster, Germany
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Palacio LC, Pachajoa DC, Durango-Giraldo G, Zapata-Hernandez C, Ugarte JP, Saiz J, Buitrago-Sierra R, Tobón C. Atrial proarrhythmic effect of lead as one of the PM10 metal components of air pollution. An in-silico study. PLoS One 2021; 16:e0258313. [PMID: 34637464 PMCID: PMC8509962 DOI: 10.1371/journal.pone.0258313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Abstract
Particulate matter (PM) is considered the most severe environmental pollution problem due to its serious effects on human health associated with an increased risk of cardiovascular morbidity and mortality. In this work, a physicochemical characterization of PM10 from the city of Medellin was developed. The results evince that lead (Pb) is one of the most abundant elements since it is present in all analyzed samples. Therefore, Pb was chosen to perform an in-silico study to assess its effects on atrial arrhythmias generation. For this purpose, we developed a model representing the Pb2+ blocking effect on the L-type calcium channel. This formulation was incorporated in a human atrial cell mathematical model and in 2D and 3D models of human atria. The simulations showed a proarrhythmic effect at high Pb2+ concentrations, through shortening of action potential duration inducing the generation of reentrant activity and atrial flutter. The results contribute to the knowledge about the cardiac physiopathological processes, triggered by lead as one of the main PM10 metal components of air pollution, that yields the generation of arrhythmias.
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Affiliation(s)
| | | | | | | | - Juan P. Ugarte
- GIMSC, Universidad de San Buenaventura, Medellín, Colombia
| | - Javier Saiz
- CIB, Universitat Politècnica de València, Valencia, Spain
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Wang P, He T, Zheng R, Sun Y, Qiu R, Zhang X, Xing Y, Shang H. Applying cooperative module pair analysis to uncover compatibility mechanism of Fangjis: An example of Wenxin Keli decoction. J Ethnopharmacol 2021; 278:114214. [PMID: 34033900 DOI: 10.1016/j.jep.2021.114214] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/10/2021] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Fangji is an ancient combinatorial formula. The compatibility mechanisms that how component herbs of Fangji work cooperatively to achieve the executive framework remain unexplored. AIM OF THE STUDY Toexplore compatibility mechanism and systematical effects of Fangjis by taking Wenxin Keli decoction (WXKL), a classical Fangji constituted by Codonopsis Radix, PolygonatiRhizoma, Notoginseng Radix Et Rhizoma, Ambrum, and Nardostachyos Radix Et Rhizoma., as example. MAIN METHODS Here, we employed bioinformatics approach, including cluster analysis, cooperative module pair analysis, primary module identification, and proximity examination among target profile of herbs, to investigate compatibility characterization and anti-arrhythmia mechanism of WXKL. Finally, core mechanisms of WXKL were validatedby in vivo experiments. RESULTS As a result, we identified 695 putative target proteins and 27 clusters (W-modules) inWXKL target network (W-network), in which W-module 1, 2, 4, 8, 10 were primary modules. The cooperative module pairs were W-module 2 and 4, W-module 2 and 8, and W-module 2 and 1, all of which existed in Codonopsis Radix- or Notoginseng Radix Et Rhizoma.-condition. And Nardostachyos Radix Et Rhizoma only yielded cooperation between W-module 1 and 2. The proximity of herbs' target profiles of Codonopsis Radix and Notoginseng Radix Et Rhizoma were similar, and Nardostachyos Radix Et Rhizoma and Ambrum were similar. For the compatibility framework, Codonopsis Radix general regulated 70.67% targets and majority W-modules (81.48%) as sovereign herb, contributing to primary therapeutic effect, mainly involving neurohormonal regulation, vasomotor, inflammation and oxidative stress. Other herbs assisted Codonopsis Radix to enhance major outcomes through common modules, and acted as complementary roles through unique process including mitotic cell cycle, biosynthetic and catabolic process, etc. Furthermore, WXKL regulated 66.67% hub proteins of arrhythmia-network, 68.18% and 47.37% proteins in primary arrhythmia-module 1 and 2, mainly involving ion channel activity, neurohormonal regulation, and stress response processes, to constitute regulatory network focusing on cardiovascular, renal, nervous system, to reverse the pathological process of arrhythmia. In vivo experiments demonstrated WXKL can attenuate adrenergic activation induced sympathetic atrial fibrillation by inhibiting calmodulin expression (CaM) and ryanodine receptor 2 (RYR2) phosphorylation to regulate neurohormonal action. CONCLUSION This strategy provided an overarching view of anti-arrhythmia mechanism of WXKL and its internal compatibility, and may facilitate the understanding of compatibility in Fangjis from the perspectives of modern biology.
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Affiliation(s)
- Pengqian Wang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China; Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Tianmai He
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Rui Zheng
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yang Sun
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ruijin Qiu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoyu Zhang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yanwei Xing
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
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Abstract
BACKGROUND Empagliflozin is a selective sodium-glucose cotransporter 2 (SGLT2) inhibitor used to lower blood sugar in adults with type 2 diabetes. Empagliflozin also exerts cardioprotective effects independent from glucose control, but its benefits on arrhythmogenesis and sudden cardiac death are not known. The purpose of this study was to examine the effect of empagliflozin on myocardial ischemia/reperfusion-provoked cardiac arrhythmia and sudden cardiac death in vivo. METHODS Male Sprague Dawley rats were randomly assigned to sham-operated, control or empagliflozin groups. All except for the sham-operated rats were subjected to 5-min left main coronary artery ligation followed by 20-min reperfusion. A standard limb lead II electrocardiogram was continuously measured throughout the experiment. Coronary artery reperfusion-induced ventricular arrhythmogenesis and empagliflozin therapy were evaluated. The hearts were used for protein phosphorylation analysis and immunohistological assessment. RESULTS Empagliflozin did not alter baseline cardiac normal conduction activity. However, empagliflozin eliminated myocardial vulnerability to sudden cardiac death (from 69.2% mortality rate in the control group to 0% in the empagliflozin group) and reduced the susceptibility to reperfusion-induced arrhythmias post I/R injury. Empagliflozin increased phosphorylation of cardiac ERK1/2 after reperfusion injury. Furthermore, inhibition of ERK1/2 using U0126 abolished the anti-arrhythmic action of empagliflozin and ERK1/2 phosphorylation. CONCLUSIONS Pretreatment with empagliflozin protects the heart from subsequent severe lethal ventricular arrhythmia induced by myocardial ischemia and reperfusion injury. These protective benefits may occur as a consequence of activation of the ERK1/2-dependent cell-survival signaling pathway in a glucose-independent manner.
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MESH Headings
- Animals
- Arrhythmias, Cardiac/enzymology
- Arrhythmias, Cardiac/pathology
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/prevention & control
- Benzhydryl Compounds/pharmacology
- Death, Sudden, Cardiac/prevention & control
- Disease Models, Animal
- Glucosides/pharmacology
- Heart Rate/drug effects
- Male
- Mitogen-Activated Protein Kinase 1/metabolism
- Mitogen-Activated Protein Kinase 3/metabolism
- Myocardial Reperfusion Injury/drug therapy
- Myocardial Reperfusion Injury/enzymology
- Myocardial Reperfusion Injury/pathology
- Myocardial Reperfusion Injury/physiopathology
- Myocytes, Cardiac/drug effects
- Myocytes, Cardiac/enzymology
- Myocytes, Cardiac/pathology
- Phosphorylation
- Rats, Sprague-Dawley
- Signal Transduction
- Sodium-Glucose Transporter 2 Inhibitors/pharmacology
- Rats
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Affiliation(s)
- Zhaoyang Hu
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Feng Ju
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lei Du
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Geoffrey W Abbott
- Bioelectricity Laboratory, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, USA
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Hamilton S, Terentyeva R, Perger F, Hernández Orengo B, Martin B, Gorr MW, Belevych AE, Clements RT, Györke S, Terentyev D. MCU overexpression evokes disparate dose-dependent effects on mito-ROS and spontaneous Ca 2+ release in hypertrophic rat cardiomyocytes. Am J Physiol Heart Circ Physiol 2021; 321:H615-H632. [PMID: 34415186 PMCID: PMC8794228 DOI: 10.1152/ajpheart.00126.2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 03/10/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 12/11/2022]
Abstract
Cardiac dysfunction in heart failure (HF) and diabetic cardiomyopathy (DCM) is associated with aberrant intracellular Ca2+ handling and impaired mitochondrial function accompanied with reduced mitochondrial calcium concentration (mito-[Ca2+]). Pharmacological or genetic facilitation of mito-Ca2+ uptake was shown to restore Ca2+ transient amplitude in DCM and HF, improving contractility. However, recent reports suggest that pharmacological enhancement of mito-Ca2+ uptake can exacerbate ryanodine receptor-mediated spontaneous sarcoplasmic reticulum (SR) Ca2+ release in ventricular myocytes (VMs) from diseased animals, increasing propensity to stress-induced ventricular tachyarrhythmia. To test whether chronic recovery of mito-[Ca2+] restores systolic Ca2+ release without adverse effects in diastole, we overexpressed mitochondrial Ca2+ uniporter (MCU) in VMs from male rat hearts with hypertrophy induced by thoracic aortic banding (TAB). Measurement of mito-[Ca2+] using genetic probe mtRCamp1h revealed that mito-[Ca2+] in TAB VMs paced at 2 Hz under β-adrenergic stimulation is lower compared with shams. Adenoviral 2.5-fold MCU overexpression in TAB VMs fully restored mito-[Ca2+]. However, it failed to improve cytosolic Ca2+ handling and reduce proarrhythmic spontaneous Ca2+ waves. Furthermore, mitochondrial-targeted genetic probes MLS-HyPer7 and OMM-HyPer revealed a significant increase in emission of reactive oxygen species (ROS) in TAB VMs with 2.5-fold MCU overexpression. Conversely, 1.5-fold MCU overexpression in TABs, that led to partial restoration of mito-[Ca2+], reduced mitochondria-derived reactive oxygen species (mito-ROS) and spontaneous Ca2+ waves. Our findings emphasize the key role of elevated mito-ROS in disease-related proarrhythmic Ca2+ mishandling. These data establish nonlinear mito-[Ca2+]/mito-ROS relationship, whereby partial restoration of mito-[Ca2+] in diseased VMs is protective, whereas further enhancement of MCU-mediated Ca2+ uptake exacerbates damaging mito-ROS emission.NEW & NOTEWORTHY Defective intracellular Ca2+ homeostasis and aberrant mitochondrial function are common features in cardiac disease. Here, we directly compared potential benefits of mito-ROS scavenging and restoration of mito-Ca2+ uptake by overexpressing MCU in ventricular myocytes from hypertrophic rat hearts. Experiments using novel mito-ROS and Ca2+ biosensors demonstrated that mito-ROS scavenging rescued both cytosolic and mito-Ca2+ homeostasis, whereas moderate and high MCU overexpression demonstrated disparate effects on mito-ROS emission, with only a moderate increase in MCU being beneficial.
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MESH Headings
- Adrenergic beta-Agonists/pharmacology
- Animals
- Arrhythmias, Cardiac/genetics
- Arrhythmias, Cardiac/metabolism
- Arrhythmias, Cardiac/pathology
- Arrhythmias, Cardiac/physiopathology
- Biosensing Techniques
- Calcium/metabolism
- Calcium Channels/genetics
- Calcium Channels/metabolism
- Calcium Signaling/drug effects
- Cells, Cultured
- Disease Models, Animal
- Heart Rate
- Hypertrophy, Left Ventricular/genetics
- Hypertrophy, Left Ventricular/metabolism
- Hypertrophy, Left Ventricular/pathology
- Hypertrophy, Left Ventricular/physiopathology
- Male
- Microscopy, Confocal
- Mitochondria, Heart/drug effects
- Mitochondria, Heart/genetics
- Mitochondria, Heart/metabolism
- Mitochondria, Heart/pathology
- Myocardial Contraction
- Myocytes, Cardiac/drug effects
- Myocytes, Cardiac/metabolism
- Myocytes, Cardiac/pathology
- Rats, Sprague-Dawley
- Reactive Oxygen Species/metabolism
- Up-Regulation
- Ventricular Function, Left
- Ventricular Remodeling
- Rats
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Affiliation(s)
- Shanna Hamilton
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
| | - Radmila Terentyeva
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
| | - Fruzsina Perger
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
| | - Benjamín Hernández Orengo
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
| | - Benjamin Martin
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
| | - Matthew W Gorr
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
- College of Nursing, The Ohio State University, Columbus, Ohio
| | - Andriy E Belevych
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
| | - Richard T Clements
- Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, Rhode Island
| | - Sandor Györke
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
| | - Dmitry Terentyev
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
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Abstract
Each heartbeat that pumps blood throughout the body is initiated by an electrical impulse generated in the sinoatrial node (SAN). However, a number of disease conditions can hamper the ability of the SAN's pacemaker cells to generate consistent action potentials and maintain an orderly conduction path, leading to arrhythmias. For symptomatic patients, current treatments rely on implantation of an electronic pacing device. However, complications inherent to the indwelling hardware give pause to categorical use of device therapy for a subset of populations, including pediatric patients or those with temporary pacing needs. Cellular-based biological pacemakers, derived in vitro or in situ, could function as a therapeutic alternative to current electronic pacemakers. Understanding how biological pacemakers measure up to the SAN would facilitate defining and demonstrating its advantages over current treatments. In this review, we discuss recent approaches to creating biological pacemakers and delineate design criteria to guide future progress based on insights from basic biology of the SAN. We emphasize the need for long-term efficacy in vivo via maintenance of relevant proteins, source-sink balance, a niche reflective of the native SAN microenvironment, and chronotropic competence. With a focus on such criteria, combined with delivery methods tailored for disease indications, clinical implementation will be attainable.
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Affiliation(s)
- Elizabeth R Komosa
- Department of Biomedical Engineering (E.R.K., B.M.O.), University of Minnesota-Twin Cities, Minneapolis
- Stem Cell Institute (E.R.K., B.M.O.), University of Minnesota-Twin Cities, Minneapolis
| | - David W Wolfson
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta (D.W.W., H.C.C.)
| | - Michael Bressan
- Department of Cell Biology and Physiology (M.B.), University of North Carolina-Chapel Hill
- McAllister Heart Institute (M.B.), University of North Carolina-Chapel Hill
| | - Hee Cheol Cho
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta (D.W.W., H.C.C.)
- Department of Pediatrics, Emory University, Atlanta, GA (H.C.C.)
| | - Brenda M Ogle
- Department of Biomedical Engineering (E.R.K., B.M.O.), University of Minnesota-Twin Cities, Minneapolis
- Stem Cell Institute (E.R.K., B.M.O.), University of Minnesota-Twin Cities, Minneapolis
- Department of Pediatrics (B.M.O), University of Minnesota-Twin Cities, Minneapolis
- Lillehei Heart Institute (B.M.O), University of Minnesota-Twin Cities, Minneapolis
- Institute for Engineering in Medicine (B.M.O), University of Minnesota-Twin Cities, Minneapolis
- Masonic Cancer Center (B.M.O), University of Minnesota-Twin Cities, Minneapolis
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Chevalier K, Benyounes N, Obadia MA, Van Der Vynckt C, Morvan E, Tibi T, Poujois A. Cardiac involvement in Wilson disease: Review of the literature and description of three cases of sudden death. J Inherit Metab Dis 2021; 44:1099-1112. [PMID: 34286869 DOI: 10.1002/jimd.12418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/07/2022]
Abstract
Wilson disease (WD) is a rare genetic condition that results from a build-up of copper in the body. It requires life-long treatment and is mainly characterized by hepatic and neurological features. Copper accumulation has been reported to be related to the occurrence of heart disease, although little is known regarding this association. We have conducted a systematic review of the literature to document the association between WD and cardiac involvement. Thirty-two articles were retained. We also described three cases of sudden death. Cardiac manifestations in WD include cardiomyopathy (mainly left ventricular (LV) remodeling, hypertrophy, and LV diastolic dysfunction, and less frequently LV systolic dysfunction), increased levels of troponin, and/or brain natriuretic peptide, electrocardiogram (ECG) abnormalities, and rhythm or conduction abnormalities, which can be life-threatening. Dysautonomia has also been reported. The mechanism of cardiac damage in WD has not been elucidated. It may be the result of copper accumulation in the heart, and/or it could be due to a toxic effect of copper, resulting in the release of free oxygen radicals. Patients with signs and/or symptoms of cardiac involvement or who have cardiovascular risk factors should be examined by a cardiologist in addition to being assessed by their interdisciplinary treating team. Furthermore, ECG, cardiac biomarkers, echocardiography, and 24-hours or more of Holter monitoring at the diagnosis and/or during the follow-up of patients with WD need to be evaluated. Cardiac magnetic resonance imaging, although not always available, could also be a useful diagnostic tool, allowing assessment of the risk of ventricular arrhythmias and further guidance of the cardiac workup.
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Affiliation(s)
- Kevin Chevalier
- Department of Neurology, Rothschild Foundation Hospital, Paris, France
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Rothschild Foundation Hospital, Paris, France
| | - Nadia Benyounes
- Department of Cardiology, Rothschild Foundation Hospital, Paris, France
| | - Michaël Alexandre Obadia
- Department of Neurology, Rothschild Foundation Hospital, Paris, France
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Rothschild Foundation Hospital, Paris, France
| | | | - Erwan Morvan
- Department of Neurology, Rothschild Foundation Hospital, Paris, France
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Rothschild Foundation Hospital, Paris, France
| | - Thierry Tibi
- Department of Cardiology, Rothschild Foundation Hospital, Paris, France
| | - Aurélia Poujois
- Department of Neurology, Rothschild Foundation Hospital, Paris, France
- National Reference Center for Wilson's Disease and Other Copper-Related Rare Diseases, Rothschild Foundation Hospital, Paris, France
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Brisinda D, Merico B, Fenici P, Fenici R. When Manual Analysis of 12-Lead ECG Holter Plays a Critical Role in Discovering Unknown Patterns of Increased Arrhythmogenic Risk: A Case Report of a Patient Treated with Tamoxifen and Subsequent Pneumonia in COVID-19. Cardiovasc Toxicol 2021; 21:687-694. [PMID: 34018126 PMCID: PMC8136377 DOI: 10.1007/s12012-021-09659-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/07/2021] [Indexed: 12/04/2022]
Abstract
Several medicines, including cancer therapies, are known to alter the electrophysiological function of ventricular myocytes resulting in abnormal prolongation and dispersion of ventricular repolarization (quantified by multi-lead QTc measurement). This effect could be amplified by other concomitant factors (e.g., combination with other drugs affecting the QT, and/or electrolyte abnormalities, such as especially hypokalemia, hypomagnesaemia, and hypocalcemia). Usually, this condition results in higher risk of torsade de point and other life-threatening arrhythmias, related to unrecognized unpaired cardiac ventricular repolarization reserve (VRR). Being VRR a dynamic phenomenon, QT prolongation might often not be identified during the 10-s standard 12-lead ECG recording at rest, leaving the patient at increased risk for life-threatening event. We report the case of a 49-year woman, undergoing tamoxifen therapy for breast cancer, which alteration of ventricular repolarization reserve, persisting also after correction of concomitant recurrent hypokalemia, was evidenced only after manual measurements of the corrected QT (QTc) interval from selected intervals of the 12-lead ECG Holter monitoring. This otherwise missed finding was fundamental to drive the discontinuation of tamoxifen, shifting to another "safer" therapeutic option, and to avoid the use of potentially arrhythmogenic antibiotics when treating a bilateral pneumonia in recent COVID-19.
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Affiliation(s)
- Donatella Brisinda
- Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.
- Biomagnetism and Clinical Physiology International Center (BACPIC), Viale dell'Astronomia, 12, 00144, Rome, Italy.
| | - Barbara Merico
- Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Peter Fenici
- Biomagnetism and Clinical Physiology International Center (BACPIC), Viale dell'Astronomia, 12, 00144, Rome, Italy
| | - Riccardo Fenici
- Biomagnetism and Clinical Physiology International Center (BACPIC), Viale dell'Astronomia, 12, 00144, Rome, Italy
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43
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Popov SV, Mukhomedzyanov AV, Tsibulnikov SY, Khaliuli I, Oeltgen PR, Prasad NR, Maslov LN. Activation of Peripheral Opioid Kappa1 Receptor Prevents Cardiac Reperfusion Injury. Physiol Res 2021; 70:523-531. [PMID: 34062075 PMCID: PMC8820547 DOI: 10.33549/physiolres.934646] [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: 01/19/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022] Open
Abstract
The role of opioid kappa1 and kappa2 receptors in reperfusion cardiac injury was studied. Male Wistar rats were subjected to a 45-min coronary artery occlusion followed by a 120-min reperfusion. Opioid kappa receptor agonists were administered intravenously 5 min before the onset of reperfusion, while opioid receptor antagonists were given 10 min before reperfusion. The average value of the infarct size/area at risk (IS/AAR) ratio was 43 - 48% in untreated rats. Administration of the opioid kappa1 receptor agonist (-)-U-50,488 (1 mg/kg) limited the IS/AAR ratio by 42%. Administration of the opioid kappa receptor agonist ICI 199,441 (0.1 mg/kg) limited the IS/AAR ratio by 41%. The non-selective opioid kappa receptor agonist (+)-U-50,488 (1 mg/kg) with low affinity for opioid kappa receptor, the peripherally acting opioid kappa2 receptor agonist ICI 204,448 (4 mg/kg) and the selective opioid ?2 receptor agonist GR89696 (0.1 mg/kg) had no effect on the IS/AAR ratio. Pretreatment with naltrexone, the peripherally acting opioid receptor antagonist naloxone methiodide, or the selective opioid kappa2 receptor antagonist nor-binaltorphimine completely abolished the infarct-reducing effect of (-)-U-50,488 and ICI 199,441. Pretreatment with the selective opioid ? receptor antagonist TIPP[psi] and the selective opioid µ receptor antagonist CTAP did not alter the infarct reducing effect of (-)-U-50,488 and ICI 199,441. Our study is the first to demonstrate the following: (a) the activation of opioid kappa2 receptor has no effect on cardiac tolerance to reperfusion; (b) peripheral opioid kappa1 receptor stimulation prevents reperfusion cardiac injury; (c) ICI 199,441 administration resulted in an infarct-reducing effect at reperfusion; (e) bradycardia induced by opioid kappa receptor antagonists is not dependent on the occupancy of opioid kappa receptor.
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MESH Headings
- 3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cyclohexyl)-benzeneacetamide, (trans)-Isomer/administration & dosage
- 3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cyclohexyl)-benzeneacetamide, (trans)-Isomer/toxicity
- Administration, Intravenous
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/toxicity
- Animals
- Arrhythmias, Cardiac/chemically induced
- Arrhythmias, Cardiac/physiopathology
- Disease Models, Animal
- Heart Rate/drug effects
- Male
- Myocardial Infarction/metabolism
- Myocardial Infarction/pathology
- Myocardial Infarction/prevention & control
- Myocardial Reperfusion Injury/metabolism
- Myocardial Reperfusion Injury/pathology
- Myocardial Reperfusion Injury/prevention & control
- Myocytes, Cardiac/drug effects
- Myocytes, Cardiac/metabolism
- Myocytes, Cardiac/pathology
- Narcotic Antagonists/administration & dosage
- Piperazines/administration & dosage
- Pyrrolidines/administration & dosage
- Pyrrolidines/toxicity
- Rats, Wistar
- Receptors, Opioid, kappa/agonists
- Receptors, Opioid, kappa/metabolism
- Signal Transduction
- Rats
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Affiliation(s)
- S V Popov
- Laboratory of Experimental Cardiology, Cardiology Research Institute, Tomsk National Research Medical Center, the Russian Academy of Sciences, Tomsk, Russia.
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Johnson DM, Junarta J, Gerace C, Frisch DR. Usefulness of Mobile Electrocardiographic Devices to Reduce Urgent Healthcare Visits. Am J Cardiol 2021; 153:125-128. [PMID: 34229856 DOI: 10.1016/j.amjcard.2021.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/08/2021] [Accepted: 05/14/2021] [Indexed: 11/15/2022]
Abstract
Mobile electrocardiogram (mECG) devices are being used increasingly, supplying recordings to providers and providing automatic rhythm interpretation. Given the intermittent nature of certain cardiac arrhythmias, mECGs allow instant access to a recording device. In the current COVID-19 pandemic, efforts to limit in-person patient interactions and avoid overwhelming emergency and inpatient services would add value. Our goal was to evaluate whether a mECG device would reduce healthcare utilization overall, particularly those of urgent nature. We identified a cohort of KardiaMobile (AliveCor, USA) mECG users and compared their healthcare utilization 1 year prior to obtaining the device and 1 year after. One hundred and twenty-eight patients were studied (mean age 64, 47% female). Mean duration of follow-up pre-intervention was 9.8 months. One hundred and twenty-three of 128 individuals completed post-intervention follow-up. Patients were less likely to have cardiac monitors ordered (30 vs 6; p <0.01), outpatient office visits (525 vs 382; p <0.01), cardiac-specific ED visits (51 vs 30; p <0.01), arrhythmia related ED visits (45 vs 20; p <0.01), and unplanned arrhythmia admissions (34 vs 11; p <0.01) in the year after obtaining a KardiaMobile device compared to the year prior to obtaining the device. Mobile technology is available for heart rhythm monitoring and can give feedback to the user. This study showed a reduction of in-person, healthcare utilization with mECG device use. In conclusion, this strategy would be expected to decrease the risk of exposure to patients and providers and would avoid overwhelming emergency and inpatient services.
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Affiliation(s)
- Drew M Johnson
- Thomas Jefferson University Hospital, Department of Medicine, Division of Cardiology, Philadelphia, PA.
| | - Joey Junarta
- Thomas Jefferson University Hospital, Department of Medicine, Division of Cardiology, Philadelphia, PA
| | - Christopher Gerace
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Daniel R Frisch
- Thomas Jefferson University Hospital, Department of Medicine, Division of Cardiology, Philadelphia, PA
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Jæger KH, Edwards AG, Giles WR, Tveito A. A computational method for identifying an optimal combination of existing drugs to repair the action potentials of SQT1 ventricular myocytes. PLoS Comput Biol 2021; 17:e1009233. [PMID: 34383746 PMCID: PMC8360568 DOI: 10.1371/journal.pcbi.1009233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/01/2021] [Indexed: 01/26/2023] Open
Abstract
Mutations are known to cause perturbations in essential functional features of integral membrane proteins, including ion channels. Even restricted or point mutations can result in substantially changed properties of ion currents. The additive effect of these alterations for a specific ion channel can result in significantly changed properties of the action potential (AP). Both AP shortening and AP prolongation can result from known mutations, and the consequences can be life-threatening. Here, we present a computational method for identifying new drugs utilizing combinations of existing drugs. Based on the knowledge of theoretical effects of existing drugs on individual ion currents, our aim is to compute optimal combinations that can ‘repair’ the mutant AP waveforms so that the baseline AP-properties are restored. More specifically, we compute optimal, combined, drug concentrations such that the waveforms of the transmembrane potential and the cytosolic calcium concentration of the mutant cardiomyocytes (CMs) becomes as similar as possible to their wild type counterparts after the drug has been applied. In order to demonstrate the utility of this method, we address the question of computing an optimal drug for the short QT syndrome type 1 (SQT1). For the SQT1 mutation N588K, there are available data sets that describe the effect of various drugs on the mutated K+ channel. These published findings are the basis for our computational analysis which can identify optimal compounds in the sense that the AP of the mutant CMs resembles essential biomarkers of the wild type CMs. Using recently developed insights regarding electrophysiological properties among myocytes from different species, we compute optimal drug combinations for hiPSC-CMs, rabbit ventricular CMs and adult human ventricular CMs with the SQT1 mutation. Since the ‘composition’ of ion channels that form the AP is different for the three types of myocytes under consideration, so is the composition of the optimal drug. Poly-pharmacology (using multiple drugs to treat disease) has been proposed for improving cardiac anti-arrhythmic therapy for at least two decades. However, the specific arrhythmia contexts in which polytherapy is likely to be both safe and effective have remained elusive. Type 1 short QT syndrome (SQT1) is a rare form of cardiac arrhythmia that results from mutations to the human Ether-á-go-go Related Gene (hERG) potassium channel. Functionally, these mutations are remarkably consistent in that they permit the channel to open earlier during each heart beat. While hundreds of compounds are known to inhibit hERG channels, the specific effect of SQT1 mutations that allows for early channel opening also limits the ability of most of those compounds to correct SQT1 dysfunction. Here, we have applied a suite of ventricular cardiomyocyte computational models to ask whether polytherapy may offer a more effective therapeutic strategy in SQT1, and if so, what the likely characteristics of that strategy are. Our analyses suggest that simultaneous induction of late sodium current and partial hERG blockade offers a promising strategy. While no activators of late sodium current have been clinically approved, several experimental compounds are available and may provide a basis for interrogating this strategy. The method presented here can be used to compute optimal drug combinations provided that the effect of each drug on every relevant ion channel is known.
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MESH Headings
- Action Potentials/drug effects
- Amino Acid Substitution
- Animals
- Anti-Arrhythmia Agents/administration & dosage
- Arrhythmias, Cardiac/drug therapy
- Arrhythmias, Cardiac/genetics
- Arrhythmias, Cardiac/physiopathology
- Computational Biology
- Drug Combinations
- Drug Design
- Drug Therapy, Combination/methods
- ERG1 Potassium Channel/drug effects
- ERG1 Potassium Channel/genetics
- ERG1 Potassium Channel/physiology
- Heart Conduction System/abnormalities
- Heart Conduction System/physiopathology
- Heart Defects, Congenital/drug therapy
- Heart Defects, Congenital/genetics
- Heart Defects, Congenital/physiopathology
- Humans
- Induced Pluripotent Stem Cells/drug effects
- Induced Pluripotent Stem Cells/physiology
- Models, Cardiovascular
- Mutation, Missense
- Myocytes, Cardiac/drug effects
- Myocytes, Cardiac/physiology
- Rabbits
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Affiliation(s)
| | - Andrew G. Edwards
- Simula Research Laboratory, Oslo, Norway
- Department of Pharmacology, University of California, Davis, California United States of America
| | - Wayne R. Giles
- Simula Research Laboratory, Oslo, Norway
- Department of Physiology and Pharmacology, Faculty of Medicine, University of Calgary, Calgary, Canada
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Abstract
PURPOSE Myocardial healing following myocardial infarction (MI) is a complex process that is yet to be fully understood. Clinical attempts in regeneration of the injured myocardium using cardiac stem cells faced major challenges, calling for a better understanding of the processes involved at a more basic level in order to foster translation. PROCEDURES We examined the feasibility of volumetric optoacoustic tomography (VOT) in studying healing of the myocardium in different models of MI, including permanent occlusion (PO) of the left coronary artery, temporary occlusion (ischemia-reperfusion-I/R) and infarcted c-kit mutants, a genetic mouse model with impaired cardiac healing. Murine hearts were imaged at 100 Hz frame rate using 800 nm excitation wavelength, corresponding to the peak absorption of indocyanine green (ICG) in plasma and the isosbestic point of haemoglobin. RESULTS The non-invasive real-time volumetric imaging capabilities of VOT have allowed the detection of significant variations in the pulmonary transit time (PTT), a parameter affected by MI, across different murine models. Upon intravenous injection of ICG, we were able to track alterations in cardiac perfusion in I/R models, which were absent in wild-type (wt) PO or kitW/kitW-v PO mice. The wt-PO and I/R models further exhibited irregularities in their cardiac cycles. CONCLUSIONS Clear differences in the PTT, ICG perfusion and cardiac cycle patterns were identified between the different models and days post MI. Overall, the results highlight the unique capacity of VOT for multi-parametric characterization of morphological and functional changes in murine models of MI.
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Affiliation(s)
- Ivana Ivankovic
- Faculty of Medicine and Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
- Institute for Biomedical Engineering and Department of Information Technology and Electrical Engineering, ETH Zurich, Zurich, Switzerland
| | - Xosé Luís Déan-Ben
- Faculty of Medicine and Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
- Institute for Biomedical Engineering and Department of Information Technology and Electrical Engineering, ETH Zurich, Zurich, Switzerland
| | - Helena Haas
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar Technical University of Munich, Munich, Germany
| | - Melanie A Kimm
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar Technical University of Munich, Munich, Germany
| | - Moritz Wildgruber
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar Technical University of Munich, Munich, Germany
- Translational Research Imaging Center, Department of Clinical Radiology, Universitätsklinikum Münster, Munster, Germany
| | - Daniel Razansky
- Faculty of Medicine and Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland.
- Institute for Biomedical Engineering and Department of Information Technology and Electrical Engineering, ETH Zurich, Zurich, Switzerland.
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Ul Haq A, Carotenuto F, De Matteis F, Prosposito P, Francini R, Teodori L, Pasquo A, Di Nardo P. Intrinsically Conductive Polymers for Striated Cardiac Muscle Repair. Int J Mol Sci 2021; 22:8550. [PMID: 34445255 PMCID: PMC8395236 DOI: 10.3390/ijms22168550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/05/2021] [Indexed: 12/12/2022] Open
Abstract
One of the most important features of striated cardiac muscle is the excitability that turns on the excitation-contraction coupling cycle, resulting in the heart blood pumping function. The function of the heart pump may be impaired by events such as myocardial infarction, the consequence of coronary artery thrombosis due to blood clots or plaques. This results in the death of billions of cardiomyocytes, the formation of scar tissue, and consequently impaired contractility. A whole heart transplant remains the gold standard so far and the current pharmacological approaches tend to stop further myocardium deterioration, but this is not a long-term solution. Electrically conductive, scaffold-based cardiac tissue engineering provides a promising solution to repair the injured myocardium. The non-conductive component of the scaffold provides a biocompatible microenvironment to the cultured cells while the conductive component improves intercellular coupling as well as electrical signal propagation through the scar tissue when implanted at the infarcted site. The in vivo electrical coupling of the cells leads to a better regeneration of the infarcted myocardium, reducing arrhythmias, QRS/QT intervals, and scar size and promoting cardiac cell maturation. This review presents the emerging applications of intrinsically conductive polymers in cardiac tissue engineering to repair post-ischemic myocardial insult.
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Affiliation(s)
- Arsalan Ul Haq
- Dipartimento di Scienze Cliniche e Medicina Traslazionale, Università degli Studi di Roma “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy;
- CIMER—Centro di Ricerca Interdipartimentale di Medicina Rigenerativa, Università degli Studi di Roma “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (F.D.M.); (P.P.); (R.F.); (L.T.)
| | - Felicia Carotenuto
- Dipartimento di Scienze Cliniche e Medicina Traslazionale, Università degli Studi di Roma “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy;
- CIMER—Centro di Ricerca Interdipartimentale di Medicina Rigenerativa, Università degli Studi di Roma “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (F.D.M.); (P.P.); (R.F.); (L.T.)
- Department of Fusion and Technologies for Nuclear Safety and Security, Diagnostic and Metrology (FSN-TECFIS-DIM), ENEA, CR Frascati, 00044 Rome, Italy;
| | - Fabio De Matteis
- CIMER—Centro di Ricerca Interdipartimentale di Medicina Rigenerativa, Università degli Studi di Roma “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (F.D.M.); (P.P.); (R.F.); (L.T.)
- Dipartimento di Ingegneria Industriale, Università degli Studi di Roma “Tor Vergata”, Via del Politecnico, 00133 Roma, Italy
| | - Paolo Prosposito
- CIMER—Centro di Ricerca Interdipartimentale di Medicina Rigenerativa, Università degli Studi di Roma “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (F.D.M.); (P.P.); (R.F.); (L.T.)
- Dipartimento di Ingegneria Industriale, Università degli Studi di Roma “Tor Vergata”, Via del Politecnico, 00133 Roma, Italy
| | - Roberto Francini
- CIMER—Centro di Ricerca Interdipartimentale di Medicina Rigenerativa, Università degli Studi di Roma “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (F.D.M.); (P.P.); (R.F.); (L.T.)
- Dipartimento di Ingegneria Industriale, Università degli Studi di Roma “Tor Vergata”, Via del Politecnico, 00133 Roma, Italy
| | - Laura Teodori
- CIMER—Centro di Ricerca Interdipartimentale di Medicina Rigenerativa, Università degli Studi di Roma “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (F.D.M.); (P.P.); (R.F.); (L.T.)
- Department of Fusion and Technologies for Nuclear Safety and Security, Diagnostic and Metrology (FSN-TECFIS-DIM), ENEA, CR Frascati, 00044 Rome, Italy;
| | - Alessandra Pasquo
- Department of Fusion and Technologies for Nuclear Safety and Security, Diagnostic and Metrology (FSN-TECFIS-DIM), ENEA, CR Frascati, 00044 Rome, Italy;
| | - Paolo Di Nardo
- Dipartimento di Scienze Cliniche e Medicina Traslazionale, Università degli Studi di Roma “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy;
- CIMER—Centro di Ricerca Interdipartimentale di Medicina Rigenerativa, Università degli Studi di Roma “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (F.D.M.); (P.P.); (R.F.); (L.T.)
- L.L. Levshin Institute of Cluster Oncology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
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Hegyi B, Shimkunas R, Jian Z, Izu LT, Bers DM, Chen-Izu Y. Mechanoelectric coupling and arrhythmogenesis in cardiomyocytes contracting under mechanical afterload in a 3D viscoelastic hydrogel. Proc Natl Acad Sci U S A 2021; 118:e2108484118. [PMID: 34326268 PMCID: PMC8346795 DOI: 10.1073/pnas.2108484118] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The heart pumps blood against the mechanical afterload from arterial resistance, and increased afterload may alter cardiac electrophysiology and contribute to life-threatening arrhythmias. However, the cellular and molecular mechanisms underlying mechanoelectric coupling in cardiomyocytes remain unclear. We developed an innovative patch-clamp-in-gel technology to embed cardiomyocytes in a three-dimensional (3D) viscoelastic hydrogel that imposes an afterload during regular myocyte contraction. Here, we investigated how afterload affects action potentials, ionic currents, intracellular Ca2+ transients, and cell contraction of adult rabbit ventricular cardiomyocytes. We found that afterload prolonged action potential duration (APD), increased transient outward K+ current, decreased inward rectifier K+ current, and increased L-type Ca2+ current. Increased Ca2+ entry caused enhanced Ca2+ transients and contractility. Moreover, elevated afterload led to discordant alternans in APD and Ca2+ transient. Ca2+ alternans persisted under action potential clamp, indicating that the alternans was Ca2+ dependent. Furthermore, all these afterload effects were significantly attenuated by inhibiting nitric oxide synthase 1 (NOS1). Taken together, our data reveal a mechano-chemo-electrotransduction (MCET) mechanism that acutely transduces afterload through NOS1-nitric oxide signaling to modulate the action potential, Ca2+ transient, and contractility. The MCET pathway provides a feedback loop in excitation-Ca2+ signaling-contraction coupling, enabling autoregulation of contractility in cardiomyocytes in response to afterload. This MCET mechanism is integral to the individual cardiomyocyte (and thus the heart) to intrinsically enhance its contractility in response to the load against which it has to do work. While this MCET is largely compensatory for physiological load changes, it may also increase susceptibility to arrhythmias under excessive pathological loading.
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Affiliation(s)
- Bence Hegyi
- Department of Pharmacology, University of California, Davis, CA 95616
| | - Rafael Shimkunas
- Department of Pharmacology, University of California, Davis, CA 95616
- Department of Biomedical Engineering, University of California, Davis, CA 95616
| | - Zhong Jian
- Department of Pharmacology, University of California, Davis, CA 95616
| | - Leighton T Izu
- Department of Pharmacology, University of California, Davis, CA 95616
| | - Donald M Bers
- Department of Pharmacology, University of California, Davis, CA 95616
| | - Ye Chen-Izu
- Department of Pharmacology, University of California, Davis, CA 95616;
- Department of Biomedical Engineering, University of California, Davis, CA 95616
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, CA 95616
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49
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Kupchik N, Green J. A Case of Heart Palpitations and a Rapid Pulse. Am J Nurs 2021; 121:51-54. [PMID: 34819474 DOI: 10.1097/01.naj.0000767812.15304.3a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Editor's note: This article is one in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm. To see all the articles in the series, go to http://links.lww.com/AJN/A207.
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Affiliation(s)
- Nicole Kupchik
- Nicole Kupchik is an independent clinical nurse specialist at Nicole Kupchik Consulting, and Joel Green is a staff nurse at University of Washington Medical Center, both in Seattle. Kupchik also coordinates Strip Savvy . Contact author: Nicole Kupchik, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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50
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Bhaskaran A, Liang T, Niri A, Azam MA, Massé S, Asta J, Magtibay K, Lai PFH, Labos C, Ha ACT, Nanthakumar K. Multi-Axis Lead with Tetrahedral Electrode Tip for Cardiac Implantable Devices: Creative Concept for Pacing and Sensing Technology. Can J Cardiol 2021; 37:1808-1817. [PMID: 34333028 DOI: 10.1016/j.cjca.2021.07.013] [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: 05/10/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We developed a multi-axis lead (MaxLead) incorporating four electrodes arranged at the lead-tip organized in an equidistant tetrahedron. Here, we studied MaxLead performance in sensing, pacing and activation wavefront-direction analysis. METHODS Sixteen explanted animal hearts (from 7 pigs, 7 sheep and 2 rabbits) were used. Pacing threshold was tested from all axes of MaxLead from RV apex before and after simulated dislodgement. Additionally, conduction-system pacing was performed in sheep heart preparations from all axes of MaxLead. Sensing via MaxLead positioned at RV apex was tested during sinus rhythm (SR), pacing from RV and LV free-wall, and ventricular fibrillation (VF). MaxLead-enabled voltage (MaxV), defined as the largest span of the sensed electric field loop, was compared to traditional lead-tip voltage detection. RESULTS Pacing: MaxLead minimized change in pacing threshold due to lead-dislodgement (average voltage change 0.2 mV, 95% CI (-0.5, 0.9)), using multiple bipoles available for pacing. In animals with high conduction system pacing thresholds (>2mV) in one or more bipoles (3/7), acceptable thresholds (<1 mV) were demonstrated in an average of 2.5 remaining bipoles. Sensing: MaxV of SR and VF was consistently higher than the highest bipolar voltage (voltage difference averaged -0.18 mV, 95% confidence interval (CI: -0.28 to -0.07), p=0.001). Electric field loop geometry consistently differentiated ventricular activation in SR from that during pacing from RV and LV free walls. CONCLUSIONS The multi-axis MaxLead electrode showed advantages in pacing, sensing and mapping and has the potential to allow for improvements in lead/electrode technology for cardiac implanted electronic devices.
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Affiliation(s)
- Abhishek Bhaskaran
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Timothy Liang
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ahmed Niri
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Mohammed Ali Azam
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Stéphane Massé
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - John Asta
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Karl Magtibay
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Patrick F H Lai
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Andrew C T Ha
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
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