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Linz D, van Hunnik A, Hohl M, Mahfoud F, Wolf M, Neuberger HR, Casadei B, Reilly SN, Verheule S, Böhm M, Schotten U. Catheter-based renal denervation reduces atrial nerve sprouting and complexity of atrial fibrillation in goats. Circ Arrhythm Electrophysiol 2015; 8:466-74. [PMID: 25713217 DOI: 10.1161/circep.114.002453] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) leads to structural and neural remodeling in the atrium, which enhances AF complexity and perpetuation. Renal denervation (RDN) can reduce renal and whole-body sympathetic activity. Aim of this study was to determine the effect of sympathetic nervous system modulation by RDN on atrial arrhythmogenesis. METHODS AND RESULT Eighteen goats were instrumented with an atrial endocardial pacemaker lead and a burst pacemaker. Percutaneous catheter-based RDN was performed in 8 goats (RDN-AF). Ten goats undergoing a sham procedure served as control (SHAM-AF). AF was induced and maintained by burst pacing for 6 weeks. High-resolution mapping was used to record epicardial conduction patterns of the right and left atrium. RDN reduced tyrosine hydroxylase-positive sympathetic nerve staining and resulted in lower transcardiac norepinephrine levels. This was associated with reduced expression of nerve growth factor-β, indicating less atrial nerve sprouting. Atrial endomysial fibrosis content was lower and myocyte diameter was smaller in RDN-AF. Median conduction velocity was higher (75 ± 9 versus 65 ± 10 cm/s, P = 0.02), and AF cycle length was shorter in RDN-AF compared with SHAM-AF. Left atrial AF complexity (4.8 ± 0.8 fibrillation waves/AF cycle length versus 8.5 ± 0.8 waves/AF cycle length, P = 0.001) and incidence of breakthroughs (2.0 ± 0.3 versus 4.3 ± 0.5 waves/AF cycle length, P = 0.059) were lower in RDN-AF compared with SHAM-AF. Blood pressure was normal and not significantly different between the groups. CONCLUSIONS RDN reduces atrial sympathetic nerve sprouting, structural alterations, and AF complexity in goats with persistent AF, independent of changes in blood pressure.
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Affiliation(s)
- Dominik Linz
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Arne van Hunnik
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Mathias Hohl
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Felix Mahfoud
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Milan Wolf
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Hans-Ruprecht Neuberger
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Barbara Casadei
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Svetlana N Reilly
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Sander Verheule
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Michael Böhm
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Ulrich Schotten
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.).
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652
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Lau DH, Volders PGA, Kohl P, Prinzen FW, Zaza A, Kaab S, Oto A, Schotten U. Opportunities and challenges of current electrophysiology research: a plea to establish 'translational electrophysiology' curricula. Europace 2015; 17:825-33. [DOI: 10.1093/europace/euu301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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653
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Pluteanu F, Heß J, Plackic J, Nikonova Y, Preisenberger J, Bukowska A, Schotten U, Rinne A, Kienitz MC, Schäfer MKH, Weihe E, Goette A, Kockskämper J. Early subcellular Ca2+ remodelling and increased propensity for Ca2+ alternans in left atrial myocytes from hypertensive rats. Cardiovasc Res 2015; 106:87-97. [PMID: 25691541 DOI: 10.1093/cvr/cvv045] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
AIMS Hypertension is a major risk factor for atrial fibrillation. We hypothesized that arterial hypertension would alter atrial myocyte calcium (Ca2+) handling and that these alterations would serve to trigger atrial tachyarrhythmias. METHODS AND RESULTS Left atria or left atrial (LA) myocytes were isolated from spontaneously hypertensive rats (SHR) or normotensive Wistar-Kyoto (WKY) controls. Early after the onset of hypertension, at 3 months of age, there were no differences in Ca2+ transients (CaTs) or expression and phosphorylation of Ca2+ handling proteins between SHR and WKY. At 7 months of age, when left ventricular (LV) hypertrophy had progressed and markers of fibrosis were increased in left atrium, CaTs (at 1 Hz stimulation) were still unchanged. Subcellular alterations in Ca2+ handling were observed, however, in SHR atrial myocytes including (i) reduced expression of the α1C subunit of and reduced Ca2+ influx through L-type Ca2+ channels, (ii) reduced expression of ryanodine receptors with increased phosphorylation at Ser2808, (iii) decreased activity of the Na+ / Ca2+ exchanger (at unaltered intracellular Na+ concentration), and (iv) increased SR Ca2+ load with reduced fractional release. These changes were associated with an increased propensity of SHR atrial myocytes to develop frequency-dependent, arrhythmogenic Ca2+ alternans. CONCLUSIONS In SHR, hypertension induces early subcellular LA myocyte Ca2+ remodelling during compensated LV hypertrophy. In basal conditions, atrial myocyte CaTs are not changed. At increased stimulation frequency, however, SHR atrial myocytes become more prone to arrhythmogenic Ca2+ alternans, suggesting a link between hypertension, atrial Ca2+ homeostasis, and development of atrial tachyarrhythmias.
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Affiliation(s)
- Florentina Pluteanu
- Institute of Pharmacology and Clinical Pharmacy, Biochemical and Pharmacological Center (BPC) Marburg, Philipps-University Marburg, Karl-von-Frisch-Str. 1, 35032 Marburg, Germany
| | - Johannes Heß
- Institute of Pharmacology and Clinical Pharmacy, Biochemical and Pharmacological Center (BPC) Marburg, Philipps-University Marburg, Karl-von-Frisch-Str. 1, 35032 Marburg, Germany
| | - Jelena Plackic
- Institute of Pharmacology and Clinical Pharmacy, Biochemical and Pharmacological Center (BPC) Marburg, Philipps-University Marburg, Karl-von-Frisch-Str. 1, 35032 Marburg, Germany
| | - Yulia Nikonova
- Institute of Pharmacology and Clinical Pharmacy, Biochemical and Pharmacological Center (BPC) Marburg, Philipps-University Marburg, Karl-von-Frisch-Str. 1, 35032 Marburg, Germany
| | - Judit Preisenberger
- Institute of Pharmacology and Clinical Pharmacy, Biochemical and Pharmacological Center (BPC) Marburg, Philipps-University Marburg, Karl-von-Frisch-Str. 1, 35032 Marburg, Germany
| | - Alicja Bukowska
- Working Group of Molecular Electrophysiology, Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Ulrich Schotten
- Department of Physiology, Cardiovascular Research Institute Maastricht, University Maastricht, Maastricht, The Netherlands
| | - Andreas Rinne
- Institute of Physiology, Ruhr-University Bochum, Bochum, Germany
| | | | - Martin K-H Schäfer
- Institute of Anatomy and Cell Biology, Philipps-University Marburg, Marburg, Germany
| | - Eberhard Weihe
- Institute of Anatomy and Cell Biology, Philipps-University Marburg, Marburg, Germany
| | - Andreas Goette
- Working Group of Molecular Electrophysiology, Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany St. Vincenz-Hospital, Paderborn, Germany
| | - Jens Kockskämper
- Institute of Pharmacology and Clinical Pharmacy, Biochemical and Pharmacological Center (BPC) Marburg, Philipps-University Marburg, Karl-von-Frisch-Str. 1, 35032 Marburg, Germany
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654
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Ravens U. Pathophysiology and progression of atrial fibrillation: Do we have a comprehensive model? Trends Cardiovasc Med 2015; 25:485-6. [PMID: 25681991 DOI: 10.1016/j.tcm.2015.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Ursula Ravens
- Department of Pharmacology and Toxicology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.
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655
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Krul SPJ, Berger WR, Smit NW, van Amersfoorth SCM, Driessen AHG, van Boven WJ, Fiolet JWT, van Ginneken ACG, van der Wal AC, de Bakker JMT, Coronel R, de Groot JR. Atrial fibrosis and conduction slowing in the left atrial appendage of patients undergoing thoracoscopic surgical pulmonary vein isolation for atrial fibrillation. Circ Arrhythm Electrophysiol 2015; 8:288-95. [PMID: 25673630 DOI: 10.1161/circep.114.001752] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 01/27/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Atrial fibrosis is an important component of the arrhythmogenic substrate in patients with atrial fibrillation (AF). We studied the effect of interstitial fibrosis on conduction velocity (CV) in the left atrial appendage of patients with AF. METHODS AND RESULTS Thirty-five left atrial appendages were obtained during AF surgery. Preparations were superfused and stimulated at 100 beats per minute. Activation was recorded with optical mapping. Longitudinal CV (CVL), transverse CV (CVT), and activation times (> 2 mm distance) were measured. Interstitial collagen was quantified and graded qualitatively. The presence of fibroblasts and myofibroblasts was assessed immunohistochemically. Mean CVL was 0.55 ± 0.22 m/s, mean CVT was 0.25 ± 0.15 m/s, and the mean activation time was 9.31 ± 5.45 ms. The amount of fibrosis was unrelated to CV or patient characteristics. CVL was higher in left atrial appendages with thick compared with thin interstitial collagen strands (0.77 ± 0.22 versus 0.48 ± 0.19 m/s; P = 0.012), which were more frequently present in persistent patients with AF. CVT was not significantly different (P = 0.47), but activation time was 14.93 ± 4.12 versus 7.95 ± 4.12 ms in patients with thick versus thin interstitial collagen strands, respectively (P = 0.004). Fibroblasts were abundantly present and were associated with the presence of thick interstitial collagen strands (P = 0.008). Myofibroblasts were not detected in the left atrial appendage. CONCLUSIONS In patients with AF, thick interstitial collagen strands are associated with higher CVL and increased activation time. Our observations demonstrate that the severity and structure of local interstitial fibrosis is associated with atrial conduction abnormalities, presenting an arrhythmogenic substrate for atrial re-entry.
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Affiliation(s)
- Sébastien P J Krul
- From the Heart Center, Departments of Clinical and Experimental Cardiology (S.P.J.K., W.R.B., N.W.S., S.C.M.v.A., J.W.T.F., J.M.T.d.B., R.C., J.R.d.G.) and Cardiothoracic Surgery (A.H.G.D., W.J.v.B.), Departments of Anatomy, Embryology, and Physiology (A.C.G.v.G.) and Pathology (A.C.v.d.W.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.M.T.d.B.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France (R.C.)
| | - Wouter R Berger
- From the Heart Center, Departments of Clinical and Experimental Cardiology (S.P.J.K., W.R.B., N.W.S., S.C.M.v.A., J.W.T.F., J.M.T.d.B., R.C., J.R.d.G.) and Cardiothoracic Surgery (A.H.G.D., W.J.v.B.), Departments of Anatomy, Embryology, and Physiology (A.C.G.v.G.) and Pathology (A.C.v.d.W.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.M.T.d.B.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France (R.C.)
| | - Nicoline W Smit
- From the Heart Center, Departments of Clinical and Experimental Cardiology (S.P.J.K., W.R.B., N.W.S., S.C.M.v.A., J.W.T.F., J.M.T.d.B., R.C., J.R.d.G.) and Cardiothoracic Surgery (A.H.G.D., W.J.v.B.), Departments of Anatomy, Embryology, and Physiology (A.C.G.v.G.) and Pathology (A.C.v.d.W.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.M.T.d.B.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France (R.C.)
| | - Shirley C M van Amersfoorth
- From the Heart Center, Departments of Clinical and Experimental Cardiology (S.P.J.K., W.R.B., N.W.S., S.C.M.v.A., J.W.T.F., J.M.T.d.B., R.C., J.R.d.G.) and Cardiothoracic Surgery (A.H.G.D., W.J.v.B.), Departments of Anatomy, Embryology, and Physiology (A.C.G.v.G.) and Pathology (A.C.v.d.W.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.M.T.d.B.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France (R.C.)
| | - Antoine H G Driessen
- From the Heart Center, Departments of Clinical and Experimental Cardiology (S.P.J.K., W.R.B., N.W.S., S.C.M.v.A., J.W.T.F., J.M.T.d.B., R.C., J.R.d.G.) and Cardiothoracic Surgery (A.H.G.D., W.J.v.B.), Departments of Anatomy, Embryology, and Physiology (A.C.G.v.G.) and Pathology (A.C.v.d.W.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.M.T.d.B.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France (R.C.)
| | - Wim Jan van Boven
- From the Heart Center, Departments of Clinical and Experimental Cardiology (S.P.J.K., W.R.B., N.W.S., S.C.M.v.A., J.W.T.F., J.M.T.d.B., R.C., J.R.d.G.) and Cardiothoracic Surgery (A.H.G.D., W.J.v.B.), Departments of Anatomy, Embryology, and Physiology (A.C.G.v.G.) and Pathology (A.C.v.d.W.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.M.T.d.B.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France (R.C.)
| | - Jan W T Fiolet
- From the Heart Center, Departments of Clinical and Experimental Cardiology (S.P.J.K., W.R.B., N.W.S., S.C.M.v.A., J.W.T.F., J.M.T.d.B., R.C., J.R.d.G.) and Cardiothoracic Surgery (A.H.G.D., W.J.v.B.), Departments of Anatomy, Embryology, and Physiology (A.C.G.v.G.) and Pathology (A.C.v.d.W.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.M.T.d.B.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France (R.C.)
| | - Antoni C G van Ginneken
- From the Heart Center, Departments of Clinical and Experimental Cardiology (S.P.J.K., W.R.B., N.W.S., S.C.M.v.A., J.W.T.F., J.M.T.d.B., R.C., J.R.d.G.) and Cardiothoracic Surgery (A.H.G.D., W.J.v.B.), Departments of Anatomy, Embryology, and Physiology (A.C.G.v.G.) and Pathology (A.C.v.d.W.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.M.T.d.B.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France (R.C.)
| | - Allard C van der Wal
- From the Heart Center, Departments of Clinical and Experimental Cardiology (S.P.J.K., W.R.B., N.W.S., S.C.M.v.A., J.W.T.F., J.M.T.d.B., R.C., J.R.d.G.) and Cardiothoracic Surgery (A.H.G.D., W.J.v.B.), Departments of Anatomy, Embryology, and Physiology (A.C.G.v.G.) and Pathology (A.C.v.d.W.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.M.T.d.B.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France (R.C.)
| | - Jacques M T de Bakker
- From the Heart Center, Departments of Clinical and Experimental Cardiology (S.P.J.K., W.R.B., N.W.S., S.C.M.v.A., J.W.T.F., J.M.T.d.B., R.C., J.R.d.G.) and Cardiothoracic Surgery (A.H.G.D., W.J.v.B.), Departments of Anatomy, Embryology, and Physiology (A.C.G.v.G.) and Pathology (A.C.v.d.W.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.M.T.d.B.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France (R.C.)
| | - Ruben Coronel
- From the Heart Center, Departments of Clinical and Experimental Cardiology (S.P.J.K., W.R.B., N.W.S., S.C.M.v.A., J.W.T.F., J.M.T.d.B., R.C., J.R.d.G.) and Cardiothoracic Surgery (A.H.G.D., W.J.v.B.), Departments of Anatomy, Embryology, and Physiology (A.C.G.v.G.) and Pathology (A.C.v.d.W.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.M.T.d.B.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France (R.C.)
| | - Joris R de Groot
- From the Heart Center, Departments of Clinical and Experimental Cardiology (S.P.J.K., W.R.B., N.W.S., S.C.M.v.A., J.W.T.F., J.M.T.d.B., R.C., J.R.d.G.) and Cardiothoracic Surgery (A.H.G.D., W.J.v.B.), Departments of Anatomy, Embryology, and Physiology (A.C.G.v.G.) and Pathology (A.C.v.d.W.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.M.T.d.B.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France (R.C.).
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656
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Hwang M, Park J, Lee YS, Park JH, Choi SH, Shim EB, Pak HN. Fibrillation Number Based on Wavelength and Critical Mass in Patients Who Underwent Radiofrequency Catheter Ablation for Atrial Fibrillation. IEEE Trans Biomed Eng 2015; 62:673-9. [DOI: 10.1109/tbme.2014.2363669] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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657
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Hancock JM, Weatherall KL, Choisy SC, James AF, Hancox JC, Marrion NV. Selective activation of heteromeric SK channels contributes to action potential repolarization in mouse atrial myocytes. Heart Rhythm 2015; 12:1003-15. [PMID: 25620048 DOI: 10.1016/j.hrthm.2015.01.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Activation of small conductance calcium-activated potassium (SK) channels is proposed to contribute to repolarization of the action potential in atrial myocytes. This role is controversial, as these cardiac SK channels appear to exhibit an uncharacteristic pharmacology. OBJECTIVES The objectives of this study were to resolve whether activation of SK channels contributes to atrial action potential repolarization and to determine the likely subunit composition of the channel. METHODS The effect of 2 SK channel inhibitors was assessed on outward current evoked in voltage clamp and on action potential duration in perforated patch and whole-cell current clamp recording from acutely isolated mouse atrial myocytes. The presence of SK channel subunits was assessed using immunocytochemistry. RESULTS A significant component of outward current was reduced by the SK channel blockers apamin and UCL1684. Block by apamin displayed a sensitivity indicating that this current was carried by homomeric SK2 channels. Action potential duration was significantly prolonged by UCL1684, but not by apamin. This effect was accompanied by an increase in beat-to-beat variability and action potential triangulation. This pharmacology was matched by that of expressed heteromeric SK2-SK3 channels in HEK293 cells. Immunocytochemistry showed that atrial myocytes express both SK2 and SK3 channels with an overlapping expression pattern. CONCLUSION Only proposed heteromeric SK2-SK3 channels are physiologically activated to contribute to action potential repolarization, which is indicated by the difference in pharmacology of evoked outward current and prolongation of atrial action potential duration. The effect of blocking this channel on the action potential suggests that SK channel inhibition during cardiac function has the potential to be proarrhythmic.
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Affiliation(s)
- Jane M Hancock
- School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom
| | - Kate L Weatherall
- School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom
| | - Stéphanie C Choisy
- School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom
| | - Andrew F James
- School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom
| | - Jules C Hancox
- School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom
| | - Neil V Marrion
- School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom.
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658
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Yi F, Ling TY, Lu T, Wang XL, Li J, Claycomb WC, Shen WK, Lee HC. Down-regulation of the small conductance calcium-activated potassium channels in diabetic mouse atria. J Biol Chem 2015; 290:7016-26. [PMID: 25605734 DOI: 10.1074/jbc.m114.607952] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The small conductance Ca(2+)-activated K(+) (SK) channels have recently been found to be expressed in the heart, and genome-wide association studies have shown that they are implicated in atrial fibrillation. Diabetes mellitus is an independent risk factor of atrial fibrillation, but the ionic mechanism underlying this relationship remains unclear. We hypothesized that SK channel function is abnormal in diabetes mellitus, leading to altered cardiac electrophysiology. We found that in streptozotocin-induced diabetic mice, the expression of SK2 and SK3 isoforms was down-regulated by 85 and 92%, respectively, whereas that of SK1 was not changed. SK currents from isolated diabetic mouse atrial myocytes were significantly reduced compared with controls. The resting potentials of isolated atrial preparations were similar between control and diabetic mice, but action potential durations were significantly prolonged in the diabetic atria. Exposure to apamin significantly prolonged action potential durations in control but not in diabetic atria. Production of reactive oxygen species was significantly increased in diabetic atria and in high glucose-cultured HL-1 cells, whereas exposure of HL-1 cells in normal glucose culture to H2O2 reduced the expression of SK2 and SK3. Tyrosine nitration in SK2 and SK3 was significantly increased by high glucose culture, leading to accelerated channel turnover. Treatment with Tiron prevented these changes. Our results suggest that increased oxidative stress in diabetes results in SK channel-associated electrical remodeling in diabetic atria and may promote arrhythmogenesis.
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Affiliation(s)
- Fu Yi
- From the Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, Department of Cardiovascular Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Tian-You Ling
- From the Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, Department of Cardiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Tong Lu
- From the Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905
| | - Xiao-Li Wang
- From the Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905
| | - Jingchao Li
- From the Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, Department of Emergency Medicine, Henan Provincial People's Hospital, Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, Henan, China
| | - William C Claycomb
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, and
| | - Win-Kuang Shen
- Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona 85255
| | - Hon-Chi Lee
- From the Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905,
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659
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Aschar-Sobbi R, Izaddoustdar F, Korogyi AS, Wang Q, Farman GP, Yang F, Yang W, Dorian D, Simpson JA, Tuomi JM, Jones DL, Nanthakumar K, Cox B, Wehrens XHT, Dorian P, Backx PH. Increased atrial arrhythmia susceptibility induced by intense endurance exercise in mice requires TNFα. Nat Commun 2015; 6:6018. [PMID: 25598495 DOI: 10.1038/ncomms7018] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/02/2014] [Indexed: 12/13/2022] Open
Abstract
Atrial fibrillation (AF) is the most common supraventricular arrhythmia that, for unknown reasons, is linked to intense endurance exercise. Our studies reveal that 6 weeks of swimming or treadmill exercise improves heart pump function and reduces heart-rates. Exercise also increases vulnerability to AF in association with inflammation, fibrosis, increased vagal tone, slowed conduction velocity, prolonged cardiomyocyte action potentials and RyR2 phosphorylation (CamKII-dependent S2814) in the atria, without corresponding alterations in the ventricles. Microarray results suggest the involvement of the inflammatory cytokine, TNFα, in exercised-induced atrial remodelling. Accordingly, exercise induces TNFα-dependent activation of both NFκB and p38MAPK, while TNFα inhibition (with etanercept), TNFα gene ablation, or p38 inhibition, prevents atrial structural remodelling and AF vulnerability in response to exercise, without affecting the beneficial physiological changes. Our results identify TNFα as a key factor in the pathology of intense exercise-induced AF.
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Affiliation(s)
- Roozbeh Aschar-Sobbi
- 1] Department of Physiology, University of Toronto, 1 King's College Cir., Toronto, Ontario, Canada M5S1A8 [2] Department of Medicine, University of Toronto, 1 King's College Cir., Toronto, Ontario, Canada M5S1A8
| | - Farzad Izaddoustdar
- 1] Department of Physiology, University of Toronto, 1 King's College Cir., Toronto, Ontario, Canada M5S1A8 [2] Department of Medicine, University of Toronto, 1 King's College Cir., Toronto, Ontario, Canada M5S1A8
| | - Adam S Korogyi
- 1] Department of Physiology, University of Toronto, 1 King's College Cir., Toronto, Ontario, Canada M5S1A8 [2] Department of Medicine, University of Toronto, 1 King's College Cir., Toronto, Ontario, Canada M5S1A8
| | - Qiongling Wang
- Cardiovascular Research Institute, Department of Molecular Physiology and Biophysics, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030, USA
| | - Gerrie P Farman
- Department of Physiology and Biophysics, Boston University, 700 Albany St, Boston, Massachusetts 02118-2526, USA
| | - FengHua Yang
- 1] Department of Physiology, University of Toronto, 1 King's College Cir., Toronto, Ontario, Canada M5S1A8 [2] Department of Medicine, University of Toronto, 1 King's College Cir., Toronto, Ontario, Canada M5S1A8
| | - Wallace Yang
- 1] Department of Physiology, University of Toronto, 1 King's College Cir., Toronto, Ontario, Canada M5S1A8 [2] Department of Medicine, University of Toronto, 1 King's College Cir., Toronto, Ontario, Canada M5S1A8
| | - David Dorian
- Department of Physiology, University of Toronto, 1 King's College Cir., Toronto, Ontario, Canada M5S1A8
| | - Jeremy A Simpson
- Department of Human Health and Nutritional Sciences, University of Guelph, 50 Stone Road East, Guelph, Ontario, Canada N1G2W1
| | - Jari M Tuomi
- Department of Physiology and Pharmacology, Western University, Medical Science Building, London, Ontario, Canada N6A5C1
| | - Douglas L Jones
- Department of Physiology and Pharmacology, Western University, Medical Science Building, London, Ontario, Canada N6A5C1
| | - Kumaraswamy Nanthakumar
- 1] Department of Medicine, University of Toronto, 1 King's College Cir., Toronto, Ontario, Canada M5S1A8 [2] Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, 200 Elizabeth St, Toronto, Ontario, Canada M5G2C4
| | - Brian Cox
- 1] Department of Physiology, University of Toronto, 1 King's College Cir., Toronto, Ontario, Canada M5S1A8 [2] Program in Developmental and Stem Cell Biology, Hospital for Sick Children Research Institute, 555 University Ave, Toronto, Ontario, Canada M5G 1X9
| | - Xander H T Wehrens
- Cardiovascular Research Institute, Department of Molecular Physiology and Biophysics, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030, USA
| | - Paul Dorian
- 1] Department of Medicine, University of Toronto, 1 King's College Cir., Toronto, Ontario, Canada M5S1A8 [2] Division of Cardiology, St Michael's Hospital, 2300 Yonge St, Toronto, Ontario, Canada M4P1E4
| | - Peter H Backx
- 1] Department of Physiology, University of Toronto, 1 King's College Cir., Toronto, Ontario, Canada M5S1A8 [2] Department of Medicine, University of Toronto, 1 King's College Cir., Toronto, Ontario, Canada M5S1A8 [3] Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, 200 Elizabeth St, Toronto, Ontario, Canada M5G2C4 [4] Heart &Stroke Richard Lewar Centre of Excellence, University of Toronto, 1 King's College Cir., Toronto, Ontario, Canada M5S1A8
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660
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Varela M, Aslanidi OV. Role of atrial tissue substrate and electrical activation pattern in fractionation of atrial electrograms: a computational study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:1587-90. [PMID: 25570275 DOI: 10.1109/embc.2014.6943907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Complex fractionated atrial electrograms (CFAEs) are often used as a clinical marker for re-entrant drivers of atrial fibrillation. However, outcomes of clinical ablation procedures based on CFAEs are controversial and the mechanistic links between fractionation, re-entrant activity and the characteristics of the atrial substrate are not completely understood. We explore such links by simulating electrograms arising from both normal and re-entrant electrical activity in atrial tissue models. 2D and 3D tissue geometries with a range of conditions for intracellular coupling and myofiber orientation fields were studied. Electrograms were fractionated in the presence of complex atrial fiber fields and in 3D irregular geometries, due to far-field excitations. The complexity of the local electrical activity was not a strong determinant of the degree of fractionation. These results suggest that electrogram fractionation is more strongly linked to atrial substrate characteristics (including tissue geometry, fiber orientation and degree of intercelullar coupling) than to the electrical activation pattern sustaining atrial fibrillation.
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661
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Scridon A, Fouilloux-Meugnier E, Loizon E, Rome S, Julien C, Barrès C, Chevalier P. Long-standing arterial hypertension is associated with Pitx2 down-regulation in a rat model of spontaneous atrial tachyarrhythmias. Europace 2015; 17:160-5. [PMID: 24908044 DOI: 10.1093/europace/euu139] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS The timecourse of left atrial Pitx2 down-regulation in the setting of atrial tachyarrhythmias remains unknown. Accordingly, we aimed to assess the age dependency of left atrial Pitx2 expression in an experimental model of spontaneous atrial tachyarrhythmias in rats. METHODS AND RESULTS Atrial sampling was performed in three groups (n = 4 each) of young (14-week-old), adult (24-week-old), and ageing (48-week-old) spontaneously hypertensive rats (SHRs), in which we previously demonstrated the age dependency of spontaneous atrial tachyarrhythmias, and three groups (n = 4 each) of age-matched normotensive Wistar-Kyoto (WKY) rats. mRNA expression of Pitx2 was studied using real-time polymerase chain reaction. Ageing SHRs presented significantly lower left atrial Pitx2 expressions compared with age-matched WKY rats (P = 0.02), while no significant difference was observed between young or adult SHRs and age-matched WKY rats (both P > 0.05). Among SHRs, Pitx2 expressions showed a progressive, age-dependent decrease (34.9 ± 6.7 in young SHRs, 17.1 ± 3.6 in adult SHRs, and 10.7 ± 1.7 in ageing SHRs, P = 0.04) and were significantly negatively correlated with both age (Spearman r = -0.86, P < 0.01) and heart weight (Spearman r = -0.76, P < 0.01). CONCLUSION The present study suggests the presence of age-dependent left atrial Pitx2 down-regulation in SHRs. The strong negative correlation between left atrial Pitx2 expression and heart weight among SHRs may indicate a link between long-standing arterial hypertension and Pitx2-related atrial arrhythmogenicity.
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Affiliation(s)
- Alina Scridon
- Physiology Department, University of Medicine and Pharmacy of Tîrgu Mureş, Tîrgu Mureş 540139, Romania Unité de Neurocardiologie, EA 4612, Université Lyon 1, Lyon F-69008, France
| | | | | | - Sophie Rome
- Unité 1060 INSERM CarMen, Université Lyon 1, Lyon F-69008, France
| | - Claude Julien
- Unité de Neurocardiologie, EA 4612, Université Lyon 1, Lyon F-69008, France
| | - Christian Barrès
- Unité de Neurocardiologie, EA 4612, Université Lyon 1, Lyon F-69008, France
| | - Philippe Chevalier
- Unité de Neurocardiologie, EA 4612, Université Lyon 1, Lyon F-69008, France Service de Rythmologie, Hospices Civils de Lyon, Hôpital Louis Pradel, 28 Avenue du Doyen Lépine, Bron Cedex 69500, France
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662
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Bockeria LA, Filatov AA, Covalev AS. eComment. The Berglin apical stitch: a simple technique to straighten things out in atrial fibrillation surgery? Interact Cardiovasc Thorac Surg 2014; 19:686. [PMID: 25536677 DOI: 10.1093/icvts/ivu283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Leo A Bockeria
- Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
| | - Andrey A Filatov
- Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
| | - Alexey S Covalev
- Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
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663
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Deshmukh A, Barnard J, Sun H, Newton D, Castel L, Pettersson G, Johnston D, Roselli E, Gillinov AM, McCurry K, Moravec C, Smith JD, Van Wagoner DR, Chung MK. Left atrial transcriptional changes associated with atrial fibrillation susceptibility and persistence. Circ Arrhythm Electrophysiol 2014; 8:32-41. [PMID: 25523945 DOI: 10.1161/circep.114.001632] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Prior transcriptional studies of atrial fibrillation (AF) have been limited to specific transcripts, animal models, chronic AF, right atria, or small samples. We sought to characterize the left atrial transcriptome in human AF to distinguish changes related to AF susceptibility and persistence. METHODS AND RESULTS Left atrial appendages from 239 patients stratified by coronary artery disease, valve disease, and AF history (no history of AF, AF history in sinus rhythm at surgery, and AF history in AF at surgery) were selected for genome-wide mRNA microarray profiling. Transcripts were examined for differential expression with AF phenotype group. Enrichment in differentially expressed genes was examined in 3 gene set collections: a transcription factor collection, defined by shared conserved cis-regulatory motifs, a miRNA collection, defined by shared 3' untranslated region motifs, and a molecular function collection, defined by shared Gene Ontology molecular function. AF susceptibility was associated with decreased expression of the targets of CREB/ATF family, heat-shock factor 1, ATF6, SRF, and E2F1 transcription factors. Persistent AF activity was associated with decreased expression in genes and gene sets related to ion channel function consistent with reported functional changes. CONCLUSIONS AF susceptibility was associated with decreased expression of targets of several transcription factors related to inflammation, oxidation, and cellular stress responses. In contrast, changes in ion channel expression were associated with AF activity but were limited in AF susceptibility. Our results suggest that significant transcriptional remodeling marks susceptibility to AF, whereas remodeling of ion channel expression occurs later in the progression or as a consequence of AF.
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Affiliation(s)
- Amrish Deshmukh
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - John Barnard
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Han Sun
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - David Newton
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Laurie Castel
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Gosta Pettersson
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Douglas Johnston
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Eric Roselli
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - A Marc Gillinov
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Kenneth McCurry
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Christine Moravec
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Jonathan D Smith
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - David R Van Wagoner
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Mina K Chung
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.).
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Wolke C, Bukowska A, Goette A, Lendeckel U. Redox control of cardiac remodeling in atrial fibrillation. Biochim Biophys Acta Gen Subj 2014; 1850:1555-65. [PMID: 25513966 DOI: 10.1016/j.bbagen.2014.12.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/04/2014] [Accepted: 12/09/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is a potential cause of thromboembolic events. AF induces significant changes in the electrophysiological properties of atrial myocytes and causes alterations in the structure, metabolism, and function of the atrial tissue. The molecular basis for the development of structural atrial remodeling of fibrillating human atria is still not fully understood. However, increased production of reactive oxygen or nitrogen species (ROS/RNS) and the activation of specific redox-sensitive signaling pathways observed both in patients with and animal models of AF are supposed to contribute to development, progression and self-perpetuation of AF. SCOPE OF REVIEW The present review summarizes the sources and targets of ROS/RNS in the setting of AF and focuses on key redox-sensitive signaling pathways that are implicated in the pathogenesis of AF and function either to aggravate or protect from disease. MAJOR CONCLUSIONS NADPH oxidases and various mitochondrial monooxygenases are major sources of ROS during AF. Besides direct oxidative modification of e.g. ion channels and ion handling proteins that are crucially involved in action potential generation and duration, AF leads to the reversible activation of redox-sensitive signaling pathways mediated by activation of redox-regulated proteins including Nrf2, NF-κB, and CaMKII. Both processes are recognized to contribute to the formation of a substrate for AF and, thus, to increase AF inducibility and duration. GENERAL SIGNIFICANCE AF is a prevalent disease and due to the current demographic developments its socio-economic relevance will further increase. Improving our understanding of the role that ROS and redox-related (patho)-mechanisms play in the development and progression of AF may allow the development of a targeted therapy for AF that surpasses the efficacy of previous general anti-oxidative strategies. This article is part of a Special Issue entitled Redox regulation of differentiation and de-differentiation.
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Affiliation(s)
- Carmen Wolke
- Institute of Medical Biochemistry and Molecular Biology, University Medicine Greifswald, D-17487 Greifswald, Germany
| | - Alicja Bukowska
- EUTRAF Working Group: Molecular Electrophysiology, University Hospital Magdeburg, D-39120 Magdeburg, Germany
| | - Andreas Goette
- EUTRAF Working Group: Molecular Electrophysiology, University Hospital Magdeburg, D-39120 Magdeburg, Germany; Department of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital, D-33098 Paderborn, Germany
| | - Uwe Lendeckel
- Institute of Medical Biochemistry and Molecular Biology, University Medicine Greifswald, D-17487 Greifswald, Germany.
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665
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Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia, contributing to increased morbidity and reduced survival through its associations with stroke and heart failure. AF contributes to a four- to fivefold increase in the risk of stroke in the general population and is responsible for 10-15 % of all ischemic strokes. Diagnosis and treatment of AF require considerable health care resources. Current therapies to restore sinus rhythm in AF are suboptimal and are limited either by their pro-arrhythmic effects or by their procedure-related complications. These limitations have necessitated identification of newer therapeutic targets to expand the treatment options. There has been a considerable amount of research interest in investigating the mechanisms of initiation and propagation of AF. Despite extensive research focused on the pathogenesis of AF, a thorough understanding of various pathways mediating initiation and propagation of AF still remains limited. Research efforts focused on the identification of these pathways and molecular mediators have generated a great degree of interest for developing more targeted therapies. This review discusses the potential therapeutic targets and the results from experimental and clinical research investigating these targets.
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666
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Nicoara A, Holmquist F, Raggains C, Mathew JP. Anesthesia for Catheter Ablation Procedures. J Cardiothorac Vasc Anesth 2014; 28:1589-603. [DOI: 10.1053/j.jvca.2014.05.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Indexed: 11/11/2022]
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667
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Abstract
Atrial fibrillation (AF), the most common sustained arrhythmia in clinical practice, is an important contributor to cardiac morbidity and mortality. Pharmacological approaches currently available to treat patients with AF lack sufficient efficacy and are associated with potential adverse effects. Even though ablation is generally more effective than pharmacotherapy, this invasive procedure has considerable potential complications and is limited by long-term recurrences. Novel therapies based on the underlying molecular mechanisms of AF can provide useful alternatives to current treatments. MicroRNAs (miRNAs), endogenous short RNA sequences that regulate gene expression, have been implicated in the control of AF, providing novel insights into the molecular basis of the pathogenesis of AF and suggesting miRNA targeting as a potential approach for the management of this common arrhythmia. In this Review, we provide a comprehensive analysis of the current experimental evidence supporting miRNAs as important factors in AF and discuss their therapeutic implications. We first provide background information on the pathophysiology of AF and the biological determinants of miRNA synthesis and action, followed by experimental evidence for miRNA-mediated regulation of AF, and finally provide a comprehensive overview of miRNAs as potential novel therapeutic targets for AF.
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668
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Decloedt A, de Clercq D, van der Vekens N, Verheyen T, Ven S, van Loon G. Influence of detomidine on atrial fibrillation cycle length measured by intracardiac electrogram recording and by colour tissue Doppler imaging in horses. Equine Vet J 2014; 48:21-6. [DOI: 10.1111/evj.12366] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 09/18/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A. Decloedt
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - D. de Clercq
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - N. van der Vekens
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - T. Verheyen
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - S. Ven
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - G. van Loon
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
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669
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Hasun M, Gatterer E, Weidinger F. Atrial fibrillation: state of the art. Wien Klin Wochenschr 2014; 126:692-704. [PMID: 25409952 DOI: 10.1007/s00508-014-0667-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/22/2014] [Indexed: 10/24/2022]
Abstract
Atrial fibrillation (AF) is by far the most frequent heart rhythm disorder and is associated with a significantly increased risk of stroke, heart failure and death. Despite improvements in prevention and treatment, the prognosis has not changed significantly. To use new and promising pharmacological and interventional concepts for thromboembolic prophylaxis and treatment of AF, as well as prevention of recurrence, patient compliance has to be improved, physicians have to be trained and experience hast to be gained. A consistently carried 'anticoagulation pass' might be a promising piece of the puzzle.
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Affiliation(s)
- Matthias Hasun
- 2. Medizinische Abteilung, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Vienna, Austria
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670
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Trayanova NA, Boyle PM, Arevalo HJ, Zahid S. Exploring susceptibility to atrial and ventricular arrhythmias resulting from remodeling of the passive electrical properties in the heart: a simulation approach. Front Physiol 2014; 5:435. [PMID: 25429272 PMCID: PMC4228852 DOI: 10.3389/fphys.2014.00435] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/24/2014] [Indexed: 12/19/2022] Open
Abstract
Under diseased conditions, remodeling of the cardiac tissue properties (“passive properties”) takes place; these are aspects of electrophysiological behavior that are not associated with active ion transport across cell membranes. Remodeling of the passive electrophysiological properties most often results from structural remodeling, such as gap junction down-regulation and lateralization, fibrotic growth infiltrating the myocardium, or the development of an infarct scar. Such structural remodeling renders atrial or ventricular tissue as a major substrate for arrhythmias. The current review focuses on these aspects of cardiac arrhythmogenesis. Due to the inherent complexity of cardiac arrhythmias, computer simulations have provided means to elucidate interactions pertinent to this spatial scale. Here we review the current state-of-the-art in modeling atrial and ventricular arrhythmogenesis as arising from the disease-induced changes in the passive tissue properties, as well as the contributions these modeling studies have made to our understanding of the mechanisms of arrhythmias in the heart. Because of the rapid advance of structural imaging methodologies in cardiac electrophysiology, we chose to present studies that have used such imaging methodologies to construct geometrically realistic models of cardiac tissue, or the organ itself, where the regional remodeling properties of the myocardium can be represented in a realistic way. We emphasize how the acquired knowledge can be used to pave the way for clinical applications of cardiac organ modeling under the conditions of structural remodeling.
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Affiliation(s)
- Natalia A Trayanova
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University Baltimore, MD, USA
| | - Patrick M Boyle
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University Baltimore, MD, USA
| | - Hermenegild J Arevalo
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University Baltimore, MD, USA
| | - Sohail Zahid
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University Baltimore, MD, USA
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671
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Linz D, Hunnik AV, Ukena C, Mahfoud F, Ewen S, Verheule S, Böhm M, Schotten U. Effects of renal denervation on atrial arrhythmogenesis. Future Cardiol 2014; 10:813-22. [DOI: 10.2217/fca.14.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Atrial fibrillation is the most common sustained arrhythmia and is associated with significant morbidity and mortality. In addition to mechanisms such as atrial stretch and atrial remodeling, the activity of the autonomic nervous system has also been suggested to contribute to the progression from paroxysmal to persistent atrial fibrillation. Catheter-based renal denervation was introduced as a minimally invasive approach to reduce renal and whole body sympathetic activation with accompanying blood pressure reduction and left-ventricular morphological and functional improvement in drug-resistant hypertension. This review focuses on the potential effects of renal denervation on different arrhythmogenic mechanisms in the atrium and discusses potential anti-remodeling effects in atrial fibrillation patients with hypertension, heart failure and sleep apnea.
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Affiliation(s)
- Dominik Linz
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Arne van Hunnik
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Christian Ukena
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Felix Mahfoud
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Sebastian Ewen
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Sander Verheule
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Michael Böhm
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Ulrich Schotten
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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672
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Greiser M, Kerfant BG, Williams GS, Voigt N, Harks E, Dibb KM, Giese A, Meszaros J, Verheule S, Ravens U, Allessie MA, Gammie JS, van der Velden J, Lederer WJ, Dobrev D, Schotten U. Tachycardia-induced silencing of subcellular Ca2+ signaling in atrial myocytes. J Clin Invest 2014; 124:4759-72. [PMID: 25329692 PMCID: PMC4347234 DOI: 10.1172/jci70102] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 08/28/2014] [Indexed: 01/06/2023] Open
Abstract
Atrial fibrillation (AF) is characterized by sustained high atrial activation rates and arrhythmogenic cellular Ca2+ signaling instability; however, it is not clear how a high atrial rate and Ca2+ instability may be related. Here, we characterized subcellular Ca2+ signaling after 5 days of high atrial rates in a rabbit model. While some changes were similar to those in persistent AF, we identified a distinct pattern of stabilized subcellular Ca2+ signaling. Ca2+ sparks, arrhythmogenic Ca2+ waves, sarcoplasmic reticulum (SR) Ca2+ leak, and SR Ca2+ content were largely unaltered. Based on computational analysis, these findings were consistent with a higher Ca2+ leak due to PKA-dependent phosphorylation of SR Ca2+ channels (RyR2s), fewer RyR2s, and smaller RyR2 clusters in the SR. We determined that less Ca2+ release per [Ca2+]i transient, increased Ca2+ buffering strength, shortened action potentials, and reduced L-type Ca2+ current contribute to a stunning reduction of intracellular Na+ concentration following rapid atrial pacing. In both patients with AF and in our rabbit model, this silencing led to failed propagation of the [Ca2+]i signal to the myocyte center. We conclude that sustained high atrial rates alone silence Ca2+ signaling and do not produce Ca2+ signaling instability, consistent with an adaptive molecular and cellular response to atrial tachycardia.
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Affiliation(s)
- Maura Greiser
- Department of Physiology, Maastricht University, Maastricht, the Netherlands. Center for Biomedical Engineering and Technology, Laboratory of Molecular Cardiology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA. Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany. Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom. Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA. Laboratory for Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Benoît-Gilles Kerfant
- Department of Physiology, Maastricht University, Maastricht, the Netherlands. Center for Biomedical Engineering and Technology, Laboratory of Molecular Cardiology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA. Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany. Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom. Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA. Laboratory for Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - George S.B. Williams
- Department of Physiology, Maastricht University, Maastricht, the Netherlands. Center for Biomedical Engineering and Technology, Laboratory of Molecular Cardiology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA. Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany. Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom. Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA. Laboratory for Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Niels Voigt
- Department of Physiology, Maastricht University, Maastricht, the Netherlands. Center for Biomedical Engineering and Technology, Laboratory of Molecular Cardiology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA. Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany. Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom. Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA. Laboratory for Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Erik Harks
- Department of Physiology, Maastricht University, Maastricht, the Netherlands. Center for Biomedical Engineering and Technology, Laboratory of Molecular Cardiology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA. Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany. Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom. Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA. Laboratory for Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Katharine M. Dibb
- Department of Physiology, Maastricht University, Maastricht, the Netherlands. Center for Biomedical Engineering and Technology, Laboratory of Molecular Cardiology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA. Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany. Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom. Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA. Laboratory for Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Anne Giese
- Department of Physiology, Maastricht University, Maastricht, the Netherlands. Center for Biomedical Engineering and Technology, Laboratory of Molecular Cardiology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA. Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany. Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom. Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA. Laboratory for Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Janos Meszaros
- Department of Physiology, Maastricht University, Maastricht, the Netherlands. Center for Biomedical Engineering and Technology, Laboratory of Molecular Cardiology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA. Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany. Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom. Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA. Laboratory for Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Sander Verheule
- Department of Physiology, Maastricht University, Maastricht, the Netherlands. Center for Biomedical Engineering and Technology, Laboratory of Molecular Cardiology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA. Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany. Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom. Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA. Laboratory for Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Ursula Ravens
- Department of Physiology, Maastricht University, Maastricht, the Netherlands. Center for Biomedical Engineering and Technology, Laboratory of Molecular Cardiology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA. Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany. Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom. Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA. Laboratory for Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Maurits A. Allessie
- Department of Physiology, Maastricht University, Maastricht, the Netherlands. Center for Biomedical Engineering and Technology, Laboratory of Molecular Cardiology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA. Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany. Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom. Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA. Laboratory for Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - James S. Gammie
- Department of Physiology, Maastricht University, Maastricht, the Netherlands. Center for Biomedical Engineering and Technology, Laboratory of Molecular Cardiology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA. Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany. Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom. Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA. Laboratory for Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Jolanda van der Velden
- Department of Physiology, Maastricht University, Maastricht, the Netherlands. Center for Biomedical Engineering and Technology, Laboratory of Molecular Cardiology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA. Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany. Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom. Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA. Laboratory for Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - W. Jonathan Lederer
- Department of Physiology, Maastricht University, Maastricht, the Netherlands. Center for Biomedical Engineering and Technology, Laboratory of Molecular Cardiology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA. Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany. Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom. Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA. Laboratory for Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Dobromir Dobrev
- Department of Physiology, Maastricht University, Maastricht, the Netherlands. Center for Biomedical Engineering and Technology, Laboratory of Molecular Cardiology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA. Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany. Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom. Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA. Laboratory for Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Ulrich Schotten
- Department of Physiology, Maastricht University, Maastricht, the Netherlands. Center for Biomedical Engineering and Technology, Laboratory of Molecular Cardiology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA. Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany. Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom. Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA. Laboratory for Physiology, VU University Medical Center, Amsterdam, the Netherlands
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673
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Linz D, Ukena C, Wolf M, Linz B, Mahfoud F, Böhm M. Experimental Evidence Of The Role Of Renal Sympathetic Denervation For Treating Atrial Fibrillation. J Atr Fibrillation 2014; 7:1128. [PMID: 27957120 DOI: 10.4022/jafib.1128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 08/27/2014] [Accepted: 08/27/2014] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with significant morbidity and mortality. In addition to mechanisms such as atrial stretch and atrial remodeling, also the activity of the autonomic nervous system has been suggested to contribute to the progression from paroxysmal to persistent AF. Catheter-based renal denervation (RDN) was introduced as a minimally invasive approach to reduce renal and whole body sympathetic activation which may result in atrial antiarrhythmic effects under some pathophysiological conditions. This review focuses on the potential effects of RDN on different arrhythmogenic mechanisms in the atrium and discusses potential anti-remodeling effects in hypertension, heart failure, and sleep apnea.
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Affiliation(s)
- Dominik Linz
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes
| | - Christian Ukena
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes
| | - Milan Wolf
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes
| | - Benedikt Linz
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes
| | - Felix Mahfoud
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes
| | - Michael Böhm
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes
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674
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Kosiuk J, Hilbert S, Pokushalov E, Hindricks G, Steinberg JS, Bollmann A. Renal denervation for treatment of cardiac arrhythmias: state of the art and future directions. J Cardiovasc Electrophysiol 2014; 26:233-8. [PMID: 25231911 DOI: 10.1111/jce.12553] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/25/2014] [Accepted: 08/27/2014] [Indexed: 12/14/2022]
Abstract
It has now been more than a quarter of a century since modulation of the sympathetic nervous system was proposed for the treatment of cardiac arrhythmias of different origins. But it has also been some time since some of the early surgical attempts have been abandoned. With the development of ablation techniques, however, new approaches and targets have been recently introduced that have revolutionized our way of thinking about sympathetic modulation. Renal nerve ablation technology is now being successfully used for the treatment of resistant hypertension, but the indication spectrum might broaden and new therapeutic options might arise in the near future. This review focuses on the possible impact of renal sympathetic system modulation on cardiac arrhythmias, the current evidence supporting this approach, and the ongoing trials of this method in electrophysiological laboratories. We will discuss the potential roles that sympathetic modulation may play in the future.
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Affiliation(s)
- Jedrzej Kosiuk
- Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany
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675
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Krul SP, Meijborg VM, Berger WR, Linnenbank AC, Driessen AH, van Boven WJ, Wilde AA, de Bakker JM, Coronel R, de Groot JR. Disparate response of high-frequency ganglionic plexus stimulation on sinus node function and atrial propagation in patients with atrial fibrillation. Heart Rhythm 2014; 11:1743-51. [DOI: 10.1016/j.hrthm.2014.04.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Indexed: 11/29/2022]
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676
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Hsu LA, Yeh YH, Kuo CT, Chen YH, Chang GJ, Tsai FC, Chen WJ. Microsatellite polymorphism in the heme oxygenase-1 gene promoter and the risk of atrial fibrillation in Taiwanese. PLoS One 2014; 9:e108773. [PMID: 25268359 PMCID: PMC4182563 DOI: 10.1371/journal.pone.0108773] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/25/2014] [Indexed: 11/18/2022] Open
Abstract
Background Atrial fibrillation (AF) is associated with increased oxidative stress. Emerging evidence suggests that heme oxygenase-1 (HO-1) is a potent antioxidant system against various oxidative stress-related diseases. The human HO-1 promoter has a GT-repeat length polymorphism that can determine the level of gene transcription. Objective The aim of this study is to assess the role of the GT-repeat polymorphism in the promoter region of the HO-1 gene in Chinese-Taiwanese patients with AF. Methods and Results This study enrolled 200 AF patients and 240 controls, comparable for age and gender. In each subject, the length of GT-repeat polymorphism in the HO-1 promoter region was examined by polymerase chain reactions. The frequencies of long GT-repeat alleles (≧32) were significantly higher in AF patients than in controls. Multivariate analysis showed that the presence of long allele was significantly and independently associated with AF (odds ratio: 1.91, 95% CI 1.07–3.72; P = 0.028). Right atrial tissues from patients with chronic AF were investigated with immunoconfocal microscopy. Patients homozygous for shorter GT-repeat alleles exhibited greater HO-1 expression in their atria than those homozygous for longer alleles, which was reflected by less oxidative stress, myofibril degradation, and fibrosis in the atria of patients with shorter GT-repeat. In vitro, transient transfection assay in HL-1 atrial myocytes showed that the responsiveness of HO-1 transcriptional activity to tachypacing was inversely correlated with the length of the GT-repeats. Conclusion Our results suggest that the HO-1 microsatellite polymorphism may contribute to the genetic background of AF in Chinese-Taiwanese patients.
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Affiliation(s)
- Lung-An Hsu
- Cardiovascular Division, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Yung-Hsin Yeh
- Cardiovascular Division, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Chi-Tai Kuo
- Cardiovascular Division, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Ying-Hwa Chen
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, National Yang-Ming University College of Medicine, Taipei, Taiwan
- * E-mail: (YHC); (WJC)
| | - Gwo-Jyh Chang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao-Yuan, Taiwan
| | - Feng-Chun Tsai
- Division of Cardiac Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Wei-Jan Chen
- Cardiovascular Division, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
- * E-mail: (YHC); (WJC)
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677
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Virtual ablation for atrial fibrillation in personalized in-silico three-dimensional left atrial modeling: comparison with clinical catheter ablation. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 116:40-7. [PMID: 25261813 DOI: 10.1016/j.pbiomolbio.2014.09.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 09/01/2014] [Accepted: 09/05/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although catheter ablation is an effective rhythm control strategy for atrial fibrillation (AF), empirically-based ablation has a substantial recurrence rate. The purposes of this study were to develop a computational platform for patient-specific virtual AF ablation and to compare the anti-fibrillatory effects of 5 different virtual ablation protocols with empirically chosen clinical ablations. METHODS We included 20 patients with AF (65% male, 60.1 ± 10.5 years old, 80% persistent AF [PeAF]) who had undergone empirically-based catheter ablation: circumferential pulmonary vein isolation (CPVI) for paroxysmal AF (PAF) and additional posterior box lesion (L1) and anterior line (L2) for PeAF. Using patient-specific three-dimensional left atrial (LA) geometry, we generated a finite element model and tested the AF termination rate after 5 different virtual ablations: CPVI alone, CPVI + L1, CPVI + L1,2, CPVI with complex fractionated atrial electrogram (CFAE) ablation, and CFAE ablation alone. RESULTS 1. Virtual CPVI + L1,2 ablation showed the highest AF termination rate in overall patients (55%) and PeAF patients (n = 16, 62.5%). 2. The virtual AF maintenance duration was shortest in the case of virtual CPVI + L1,2 ablation in overall patients (2.19 ± 1.28 vs. 2.91 ± 1.04 s, p = 0.009) and in patients with PeAF (2.05 ± 1.23 vs. 2.93 ± 10.2 s, p = 0.004) compared with other protocols. CONCLUSION Virtual AF ablation using personalized in-silico model of LA is feasible. Virtual ablation with CPVI + L1,2 shows the highest antifibrillatory effect, concordant with the empirical ablation protocol in patients with PeAF.
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678
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Hohl M, Linz B, Böhm M, Linz D. Obstructive sleep apnea and atrial arrhythmogenesis. Curr Cardiol Rev 2014; 10:362-8. [PMID: 25004989 PMCID: PMC4101201 DOI: 10.2174/1573403x1004140707125137] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 05/22/2014] [Accepted: 05/23/2014] [Indexed: 11/22/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with relevant morbidity and mortality. Besides hypertension, valvular disease and cardiomyopathy, mainly ischemic and dilated, also other conditions like obesity, alcohol abusus, genetic factors and obstructive sleep apnea (OSA) are discussed to contribute to the progression from paroxysmal to persistent AF. The prevalence of OSA among patients with AF is 40-50%. OSA is characterized by periodic or complete cessation of effective breathing during sleep due to obstruction of the upper airways. Obstructive respiratory events result in acute intrathoracic pressure swings and profound changes in blood gases together leading to atrial stretch and acute sympatho-vagal dysbalance resulting in acute apnea related to electrophysiological and hemodynamic alterations. Additionally, repetitive obstructive events in patients with OSA may lead to sympathetic and neurohumoral activation and subsequent structural and functional changes in the atrium creating an arrhythmogenic substrate for AF in the long run. This review focuses on the acute and chronic effects of negative thoracic pressure swings, changes in blood pressure and sympatho-vagal dysbalance induced by obstructive respiratory events on atrial electrophysiology and atrial structure in patients with obstructive sleep apnea.
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Affiliation(s)
| | | | | | - Dominik Linz
- Klinik fur Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitatsklinikum des Saarlandes, Kirrberger Str. 1, Geb. 40, D-66421 Homburg/ Saar, Germany.
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679
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Francia P, Ricotta A, Balla C, Adduci C, Semprini L, Frattari A, Modestino A, Mercanti F, Sensini I, Caprinozzi M, Tocci G, Volpe M. P-wave duration in lead aVR and the risk of atrial fibrillation in hypertension. Ann Noninvasive Electrocardiol 2014; 20:167-74. [PMID: 25200638 DOI: 10.1111/anec.12197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypertension entails atrial remodeling that affect P-wave (PW) duration on electrocardiogram (ECG). PW indices (e.g., variance, dispersion, and terminal force) are associated with a higher risk for atrial fibrillation (AF), but their calculation requires multiple measurements of PW duration, limiting their use in clinical practice. We evaluated whether PW duration in specific ECG leads may identify patients with increased susceptibility to AF in a population of hypertensive patients. METHODS In a case-control study, AF and control subjects were matched for age, sex, and left atrial (LA) dimensions. PW duration was measured from digitally stored ECGs. Logistic regression was used to assess the association of PW duration and indices with AF. RESULTS We enrolled 44 hypertensive AF patients (16 paroxysmal and 28 persistent) and 44 hypertensive controls. AF and control subjects were matched for sex (males, n = 27), age (67 ± 8 years), LA diameter (40 ± 5 mm), and were comparable for left ventricular mass (45 ± 11 g/m(2.7) vs 48 ± 12 g/m(2.7) , P = 0.19), ejection fraction (58 ± 7% in both groups), and prevalence of mild valvular heart disease (7% vs 5%; P = 0.64). PW duration in lead aVR was significantly higher in AF patients as compared with controls (115 ± 18 ms vs 101 ± 14 ms; P < 0.0001) and was the best independent predictor of AF in multivariable logistic regression (PW ≥ 100 ms: RR = 3.7; 95% CI: 1.3-10.3; P = 0.02). CONCLUSIONS Simple measurement of PW duration in lead aVR allows effective identification of AF patients in a population of hypertensives. Confirmation of this finding in a larger population would provide a simple and effective risk marker of AF in hypertensive patients.
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Affiliation(s)
- Pietro Francia
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
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680
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Frendl G, Sodickson AC, Chung MK, Waldo AL, Gersh BJ, Tisdale JE, Calkins H, Aranki S, Kaneko T, Cassivi S, Smith SC, Darbar D, Wee JO, Waddell TK, Amar D, Adler D. 2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. J Thorac Cardiovasc Surg 2014; 148:e153-93. [PMID: 25129609 PMCID: PMC4454633 DOI: 10.1016/j.jtcvs.2014.06.036] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Gyorgy Frendl
- Department of Anesthesiology, Perioperative Critical Care and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
| | - Alissa C Sodickson
- Department of Anesthesiology, Perioperative Critical Care and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Mina K Chung
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Department of Molecular Cardiology, Lerner Research Institute Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University Cleveland Clinic, Cleveland, Ohio
| | - Albert L Waldo
- Division of Cardiovascular Medicine, Department of Medicine, Case Western Reserve University, Cleveland, Ohio; Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Bernard J Gersh
- Division of Cardiovascular Diseases and Internal Medicine, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minn
| | - James E Tisdale
- Department of Pharmacy Practice, College of Pharmacy, Purdue University and Indiana University School of Medicine, Indianapolis, Ind
| | - Hugh Calkins
- Department of Medicine, Cardiac Arrhythmia Service, Johns Hopkins University, Baltimore, Md
| | - Sary Aranki
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Stephen Cassivi
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minn
| | - Sidney C Smith
- Center for Heart and Vascular Care, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Dawood Darbar
- Division of Cardiovascular Medicine, Department of Medicine, Arrhythmia Service, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Jon O Wee
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Thomas K Waddell
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Amar
- Memorial Sloan-Kettering Cancer Center, Department of Anesthesiology and Critical Care Medicine, New York, NY
| | - Dale Adler
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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681
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Magnetic resonance post-contrast T1 mapping in the human atrium: Validation and impact on clinical outcome after catheter ablation for atrial fibrillation. Heart Rhythm 2014; 11:1551-9. [DOI: 10.1016/j.hrthm.2014.06.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Indexed: 11/23/2022]
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682
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Abstract
Atrial fibrillation (AF) is by far the most common sustained tachyarrhythmia, affecting 1% to 2% of the general population. AF prevalence and the total annual cost for treatment are alarming, emphasizing the need for an urgent attention to the problem. Thus, having up-to-date information on AF risk factors and appreciating how they promote maintenance of AF maintenance are essential. This article presents a simplified examination of AF risk factors, including emerging genetic risks.
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683
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Liang Z, Liu LF, Chen XP, Shi XM, Guo HY, Lin K, Guo JP, Shan ZL, Wang YT. Establishment of a model of renal impairment with mild renal insufficiency associated with atrial fibrillation in canines. PLoS One 2014; 9:e105974. [PMID: 25157494 PMCID: PMC4144969 DOI: 10.1371/journal.pone.0105974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 07/25/2014] [Indexed: 11/19/2022] Open
Abstract
Background Chronic kidney disease and occurrence of atrial fibrillation (AF) are closely related. No studies have examined whether renal impairment (RI) without severe renal dysfunction is associated with the occurrence of AF. Methods Unilateral RI with mild renal insufficiency was induced in beagles by embolization of small branches of the renal artery in the left kidney for 2 weeks using gelatin sponge granules in the model group (n = 5). The sham group (n = 5) underwent the same procedure, except for embolization. Parameters associated with RI and renal function were tested, cardiac electrophysiological parameters, blood pressure, left ventricular pressure, and AF vulnerability were investigated. The activity of the sympathetic nervous system, renin-angiotensin-aldosterone system, inflammation, and oxidative stress were measured. Histological studies associated with atrial interstitial fibrosis were performed. Results Embolization of small branches of the renal artery in the left kidney led to ischemic RI with mild renal insufficiency. The following changes occurred after embolization. Heart rate and P wave duration were increased. Blood pressure and left ventricular systolic pressure were elevated. The atrial effective refractory period and antegrade Wenckebach point were shortened. Episodes and duration of AF, as well as atrial and ventricular rate during AF were increased in the model group. Plasma levels of norepinephrine, renin, and aldosterone were increased, angiotensin II and aldosterone levels in atrial tissue were elevated, and atrial interstitial fibrosis was enhanced after 2 weeks of embolization in the model group. Conclusions We successfully established a model of RI with mild renal insufficiency in a large animal. We found that RI with mild renal insufficiency was associated with AF in this model.
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Affiliation(s)
- Zhuo Liang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Li-feng Liu
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Xin-pei Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Xiang-min Shi
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Hong-yang Guo
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Kun Lin
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jian-ping Guo
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Zhao-liang Shan
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
- * E-mail: (ZLS); (YTW)
| | - Yu-tang Wang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
- * E-mail: (ZLS); (YTW)
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684
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Yu TY, Syeda F, Holmes AP, Osborne B, Dehghani H, Brain KL, Kirchhof P, Fabritz L. An automated system using spatial oversampling for optical mapping in murine atria. Development and validation with monophasic and transmembrane action potentials. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 115:340-8. [PMID: 25130572 PMCID: PMC4210664 DOI: 10.1016/j.pbiomolbio.2014.07.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 07/24/2014] [Indexed: 12/19/2022]
Abstract
We developed and validated a new optical mapping system for quantification of electrical activation and repolarisation in murine atria. The system makes use of a novel 2nd generation complementary metal-oxide-semiconductor (CMOS) camera with deliberate oversampling to allow both assessment of electrical activation with high spatial and temporal resolution (128 × 2048 pixels) and reliable assessment of atrial murine repolarisation using post-processing of signals. Optical recordings were taken from isolated, superfused and electrically stimulated murine left atria. The system reliably describes activation sequences, identifies areas of functional block, and allows quantification of conduction velocities and vectors. Furthermore, the system records murine atrial action potentials with comparable duration to both monophasic and transmembrane action potentials in murine atria.
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Affiliation(s)
- Ting Yue Yu
- Centre for Cardiovascular Sciences, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, UK; Doctoral Training Centre for Physical Sciences of Imaging in the Biomedical Sciences (PSIBS), University of Birmingham, UK
| | - Fahima Syeda
- Centre for Cardiovascular Sciences, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Andrew P Holmes
- Centre for Cardiovascular Sciences, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Benjamin Osborne
- Centre for Cardiovascular Sciences, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Hamid Dehghani
- Doctoral Training Centre for Physical Sciences of Imaging in the Biomedical Sciences (PSIBS), University of Birmingham, UK; School of Computer Science, College of Engineering and Physical Sciences, University of Birmingham, UK
| | - Keith L Brain
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Paulus Kirchhof
- Centre for Cardiovascular Sciences, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Larissa Fabritz
- Centre for Cardiovascular Sciences, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, UK.
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685
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Yang Q, Qi X, Li Y. The preventive effect of atorvastatin on atrial fibrillation: a meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2014; 14:99. [PMID: 25117689 PMCID: PMC4135360 DOI: 10.1186/1471-2261-14-99] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 08/04/2014] [Indexed: 11/12/2022] Open
Abstract
Background A number of clinical and experimental studies have investigated the effect of atorvastatin on atrial fibrillation (AF), but the results are equivocal. This meta-analysis was performed to evaluate whether atorvastatin can reduce the risk of AF in different populations. Methods We searched PubMed, EMBASE and the Cochrane Database for all published studies that examined the effect of atorvastatin therapy on AF up to April 2014. A random effects model was used when there was substantial heterogeneity and a fixed effects model when there was negligible heterogeneity. Results Eighteen published studies including 9952 patients with sinus rhythm were identified for inclusion in the analysis. Ten studies investigated primary prevention of AF by atorvastatin in patients without AF, seven studies investigated secondary prevention of atorvastatin in patients with AF, and one study investigated mixed populations of patients. Overall, atorvastatin was associated with a decreased risk of AF (odds ratio (OR) 0.51, 95% confidence interval (CI) 0.36–0.70, P < 0.0001). However, subgroup analyses showed that in the primary prevention subgroup (OR 0.55, 95% CI 0.38–0.81, P = 0.002), atorvastatin reduced the risk of new-onset AF in patients after coronary surgery (OR 0.44, 95% CI 0.29–0.68, P = 0.0002), but had no beneficial effect in patients without coronary surgery (OR 0.97, 95% CI 0.59–1.58, P = 0.89); in the secondary prevention subgroup, atorvastatin had no beneficial effect on AF recurrence in patients with electrical cardioversion (EC) (OR 0.57, 95% CI 0.25–1.32, P = 0.19) or without EC (OR 0.38, 95% CI 0.14–1.06, P = 0.06). Conclusions This meta-analysis suggests that atorvastatin has an overall protective effect against AF. However, this preventive effect was not seen in all types of AF. Atorvastatin was significantly associated with a decreased risk of new-onset AF in patients after coronary surgery. Moreover, atorvastatin did not prove to exert a significant protective effect against the AF recurrences in both patients who had experienced sinus rhythm restoration by means of EC and those who had obtained cardioversion by means of drug therapy. Thus, further prospective studies are warranted.
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Affiliation(s)
| | - Xiaoyong Qi
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China.
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686
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Chang SH, Wu LS, Chiou MJ, Liu JR, Yu KH, Kuo CF, Wen MS, Chen WJ, Yeh YH, See LC. Association of metformin with lower atrial fibrillation risk among patients with type 2 diabetes mellitus: a population-based dynamic cohort and in vitro studies. Cardiovasc Diabetol 2014; 13:123. [PMID: 25106079 PMCID: PMC4149273 DOI: 10.1186/s12933-014-0123-x] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 08/04/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF), an inflammatory process involving arrhythmia, is associated with severe morbidity and mortality and commonly seen in patients with diabetes mellitus (DM). The effect of metformin, the most commonly used medication for patients with DM, on AF has not been investigated. The primary aim of this study was to examine whether metformin prevented the occurrence of AF in type 2 DM patients by analyzing a nationwide, population-based dynamic cohort. Additionally, we investigated the effect of metformin on tachycardia-induced myolysis and oxidative stress in atrial cells. METHODS The study population included 645,710 patients with type 2 diabetes and not using other anti-diabetic medication from a subset of the Taiwan National Health Insurance Research Database. Of these patients, those who used metformin were categorized as the user group, and the remaining were classified as the non-user group. The time-dependent Cox's proportional hazard model was used to examine the effect of metformin on AF and the status of metformin use was treated as a time-dependent covariate. HL-1 atrial cells were paced with or without metformin, and then troponin and heavy-chain-myosin were measured as markers of myolysis. RESULTS After 13 years of follow-up, 9,983 patients developed AF with an incidence rate of 1.5% (287 per 100,000 person-years). After adjusting for co-morbidities and medications, metformin independently protected the diabetic patients from new-onset AF with a hazard ratio of .81 (95% confidence interval 0.76-0.86, p < 0.0001). Metformin significantly decreased the extent of pacing-induced myolysis and the production of reactive oxygen species. CONCLUSION Metformin use was associated with a decreased risk of AF in patients with type 2 DM who were not using other anti-diabetic medication, probably via attenuation of atrial cell tachycardia-induced myolysis and oxidative stress.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yung-Hsin Yeh
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Kweishan 333, Taoyuan, Taiwan.
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687
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Barana A, Matamoros M, Dolz-Gaitón P, Pérez-Hernández M, Amorós I, Núñez M, Sacristán S, Pedraz Á, Pinto Á, Fernández-Avilés F, Tamargo J, Delpón E, Caballero R. Chronic atrial fibrillation increases microRNA-21 in human atrial myocytes decreasing L-type calcium current. Circ Arrhythm Electrophysiol 2014; 7:861-8. [PMID: 25107449 DOI: 10.1161/circep.114.001709] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Atrial fibrillation is characterized by progressive atrial structural and electrical changes (atrial remodeling) that favor arrhythmia recurrence and maintenance. Reduction of L-type Ca(2+) current (I(Ca,L)) density is a hallmark of the electrical remodeling. Alterations in atrial microRNAs could contribute to the protein changes underlying atrial fibrillation-induced atrial electrical remodeling. This study was undertaken to compare miR-21 levels in isolated myocytes from atrial appendages obtained from patients in sinus rhythm and with chronic atrial fibrillation (CAF) and to determine whether L-type Ca(2+) channel subunits are targets for miR-21. METHODS AND RESULTS Quantitative polymerase chain reaction analysis showed that miR-21 was expressed in human atrial myocytes from patients in sinus rhythm and that its expression was significantly greater in CAF myocytes. There was an inverse correlation between miR-21 and the mRNA of the α1c subunit of the calcium channel (CACNA1C) expression and I(Ca,L) density. Computational analyses predicted that CACNA1C and the mRNA of the β2 subunit of the calcium channel (CACNB2) could be potential targets for miR-21. Luciferase reporter assays demonstrated that miR-21 produced a concentration-dependent decrease in the luciferase activity in Chinese Hamster Ovary cells transfected with CACNA1C and CACNB2 3' untranslated region regions. miR-21 transfection in HL-1 cells produced changes in I(Ca,L) properties qualitatively similar to those produced by CAF (ie, a marked reduction of I(Ca,L) density and shift of the inactivation curves to more depolarized potentials). CONCLUSIONS Our results demonstrated that CAF increases miR-21 expression in enzymatically isolated human atrial myocytes. Moreover, it decreases I(Ca,L) density by downregulating Ca(2+) channel subunits expression. These results suggested that this microRNA could participate in the CAF-induced I(Ca,L) downregulation and in the action potential duration shortening that maintains the arrhythmia.
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Affiliation(s)
- Adriana Barana
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Marcos Matamoros
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Pablo Dolz-Gaitón
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Marta Pérez-Hernández
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Irene Amorós
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Mercedes Núñez
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Sandra Sacristán
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Álvaro Pedraz
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Ángel Pinto
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Francisco Fernández-Avilés
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Juan Tamargo
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Eva Delpón
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Ricardo Caballero
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
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688
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Verheule S, Eckstein J, Linz D, Maesen B, Bidar E, Gharaviri A, Schotten U. Role of endo-epicardial dissociation of electrical activity and transmural conduction in the development of persistent atrial fibrillation. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 115:173-85. [DOI: 10.1016/j.pbiomolbio.2014.07.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 07/19/2014] [Indexed: 10/25/2022]
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689
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Pagola J, González-Alujas T, Flores A, Muchada M, Rodriguez-Luna D, Seró L, Rubiera M, Boned S, Ribó M, Álvarez-Sabin J, Evangelista A, Molina CA. Left Atria Strain Is a Surrogate Marker for Detection of Atrial Fibrillation in Cryptogenic Strokes. Stroke 2014; 45:e164-6. [DOI: 10.1161/strokeaha.114.005540] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Jorge Pagola
- From the Stroke Unit, Department of Neurology (J.P., A.F., M.M., D.R.-L., L.S., M. Rubiera, S.B., M. Ribó, J.A.-S., C.A.M.) and Echocardiography Unit, Department of Cardiology (T.G.-A., A.E.), Vall d´Hebrón Hospital Research Institute, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Teresa González-Alujas
- From the Stroke Unit, Department of Neurology (J.P., A.F., M.M., D.R.-L., L.S., M. Rubiera, S.B., M. Ribó, J.A.-S., C.A.M.) and Echocardiography Unit, Department of Cardiology (T.G.-A., A.E.), Vall d´Hebrón Hospital Research Institute, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Alan Flores
- From the Stroke Unit, Department of Neurology (J.P., A.F., M.M., D.R.-L., L.S., M. Rubiera, S.B., M. Ribó, J.A.-S., C.A.M.) and Echocardiography Unit, Department of Cardiology (T.G.-A., A.E.), Vall d´Hebrón Hospital Research Institute, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Marian Muchada
- From the Stroke Unit, Department of Neurology (J.P., A.F., M.M., D.R.-L., L.S., M. Rubiera, S.B., M. Ribó, J.A.-S., C.A.M.) and Echocardiography Unit, Department of Cardiology (T.G.-A., A.E.), Vall d´Hebrón Hospital Research Institute, Universitat Autònoma Barcelona, Barcelona, Spain
| | - David Rodriguez-Luna
- From the Stroke Unit, Department of Neurology (J.P., A.F., M.M., D.R.-L., L.S., M. Rubiera, S.B., M. Ribó, J.A.-S., C.A.M.) and Echocardiography Unit, Department of Cardiology (T.G.-A., A.E.), Vall d´Hebrón Hospital Research Institute, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Laia Seró
- From the Stroke Unit, Department of Neurology (J.P., A.F., M.M., D.R.-L., L.S., M. Rubiera, S.B., M. Ribó, J.A.-S., C.A.M.) and Echocardiography Unit, Department of Cardiology (T.G.-A., A.E.), Vall d´Hebrón Hospital Research Institute, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Marta Rubiera
- From the Stroke Unit, Department of Neurology (J.P., A.F., M.M., D.R.-L., L.S., M. Rubiera, S.B., M. Ribó, J.A.-S., C.A.M.) and Echocardiography Unit, Department of Cardiology (T.G.-A., A.E.), Vall d´Hebrón Hospital Research Institute, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Sandra Boned
- From the Stroke Unit, Department of Neurology (J.P., A.F., M.M., D.R.-L., L.S., M. Rubiera, S.B., M. Ribó, J.A.-S., C.A.M.) and Echocardiography Unit, Department of Cardiology (T.G.-A., A.E.), Vall d´Hebrón Hospital Research Institute, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Marc Ribó
- From the Stroke Unit, Department of Neurology (J.P., A.F., M.M., D.R.-L., L.S., M. Rubiera, S.B., M. Ribó, J.A.-S., C.A.M.) and Echocardiography Unit, Department of Cardiology (T.G.-A., A.E.), Vall d´Hebrón Hospital Research Institute, Universitat Autònoma Barcelona, Barcelona, Spain
| | - José Álvarez-Sabin
- From the Stroke Unit, Department of Neurology (J.P., A.F., M.M., D.R.-L., L.S., M. Rubiera, S.B., M. Ribó, J.A.-S., C.A.M.) and Echocardiography Unit, Department of Cardiology (T.G.-A., A.E.), Vall d´Hebrón Hospital Research Institute, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Arturo Evangelista
- From the Stroke Unit, Department of Neurology (J.P., A.F., M.M., D.R.-L., L.S., M. Rubiera, S.B., M. Ribó, J.A.-S., C.A.M.) and Echocardiography Unit, Department of Cardiology (T.G.-A., A.E.), Vall d´Hebrón Hospital Research Institute, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Carlos A Molina
- From the Stroke Unit, Department of Neurology (J.P., A.F., M.M., D.R.-L., L.S., M. Rubiera, S.B., M. Ribó, J.A.-S., C.A.M.) and Echocardiography Unit, Department of Cardiology (T.G.-A., A.E.), Vall d´Hebrón Hospital Research Institute, Universitat Autònoma Barcelona, Barcelona, Spain
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690
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Bingen BO, Engels MC, Schalij MJ, Jangsangthong W, Neshati Z, Feola I, Ypey DL, Askar SFA, Panfilov AV, Pijnappels DA, de Vries AAF. Light-induced termination of spiral wave arrhythmias by optogenetic engineering of atrial cardiomyocytes. Cardiovasc Res 2014; 104:194-205. [PMID: 25082848 DOI: 10.1093/cvr/cvu179] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Atrial fibrillation (AF) is the most common cardiac arrhythmia and often involves reentrant electrical activation (e.g. spiral waves). Drug therapy for AF can have serious side effects including proarrhythmia, while electrical shock therapy is associated with discomfort and tissue damage. Hypothetically, forced expression and subsequent activation of light-gated cation channels in cardiomyocytes might deliver a depolarizing force sufficient for defibrillation, thereby circumventing the aforementioned drawbacks. We therefore investigated the feasibility of light-induced spiral wave termination through cardiac optogenetics. METHODS AND RESULTS Neonatal rat atrial cardiomyocyte monolayers were transduced with lentiviral vectors encoding light-activated Ca(2+)-translocating channelrhodopsin (CatCh; LV.CatCh∼eYFP↑) or eYFP (LV.eYFP↑) as control, and burst-paced to induce spiral waves rotating around functional cores. Effects of CatCh activation on reentry were investigated by optical and multi-electrode array (MEA) mapping. Western blot analyses and immunocytology confirmed transgene expression. Brief blue light pulses (10 ms/470 nm) triggered action potentials only in LV.CatCh∼eYFP↑-transduced cultures, confirming functional CatCh-mediated current. Prolonged light pulses (500 ms) resulted in reentry termination in 100% of LV.CatCh∼eYFP↑-transduced cultures (n = 31) vs. 0% of LV.eYFP↑-transduced cultures (n = 11). Here, CatCh activation caused uniform depolarization, thereby decreasing overall excitability (MEA peak-to-peak amplitude decreased 251.3 ± 217.1 vs. 9.2 ± 9.5 μV in controls). Consequently, functional coresize increased and phase singularities (PSs) drifted, leading to reentry termination by PS-PS or PS-boundary collisions. CONCLUSION This study shows that spiral waves in atrial cardiomyocyte monolayers can be terminated effectively by a light-induced depolarizing current, produced by the arrhythmogenic substrate itself, upon optogenetic engineering. These results provide proof-of-concept for shockless defibrillation.
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Affiliation(s)
- Brian O Bingen
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - Marc C Engels
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - Martin J Schalij
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - Wanchana Jangsangthong
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - Zeinab Neshati
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - Iolanda Feola
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - Dirk L Ypey
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - Saïd F A Askar
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | | | - Daniël A Pijnappels
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - Antoine A F de Vries
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
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691
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Ravelli F, Masè M, Cristoforetti A, Marini M, Disertori M. The logical operator map identifies novel candidate markers for critical sites in patients with atrial fibrillation. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 115:186-97. [PMID: 25077410 DOI: 10.1016/j.pbiomolbio.2014.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/17/2014] [Indexed: 11/28/2022]
Abstract
The identification of suitable markers for critical patterns during atrial fibrillation (AF) may be crucial to guide an effective ablation treatment. Single parameter maps, based on dominant frequency and complex fractionated electrograms, have been proposed as a tool for electrogram-guided ablation, however the specificity of these markers is debated. Experimental studies suggest that AF critical patterns may be identified on the basis of specific rate and organization features, where rapid organized and rapid fragmented activities characterize respectively localized sources and critical substrates. In this paper we introduce the logical operator map, a novel mapping tool for a point-by-point identification and localization of AF critical sites. Based on advanced signal and image processing techniques, the approach combines in a single map electrogram-derived rate and organization features with tomographic anatomical detail. The construction of the anatomically-detailed logical operator map is based on the time-domain estimation of atrial rate and organization in terms of cycle length and wave-similarity, the logical combination of these indexes to obtain suitable markers of critical sites, and the multimodal integration of electrophysiological and anatomical information by segmentation and registration techniques. Logical operator maps were constructed in 14 patients with persistent AF, showing the capability of the combined rate and organization markers to identify with high selectivity the subset of electrograms associated with localized sources and critical substrates. The precise anatomical localization of these critical sites revealed the confinement of rapid organized sources in the left atrium with organization and rate gradients towards the surrounding tissue, and the presence of rapid fragmented electrograms in proximity of the sources. By merging in a single map the most relevant electrophysiological and anatomical features of the AF process, the logical operator map may have significant clinical impact as a direct, comprehensive tool to understand arrhythmia mechanisms in the single patient and guide more conservative, step-wise ablation.
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Affiliation(s)
- Flavia Ravelli
- Department of Physics, University of Trento, Povo-Trento, Italy.
| | - Michela Masè
- Department of Physics, University of Trento, Povo-Trento, Italy
| | | | | | - Marcello Disertori
- Division of Cardiology, S. Chiara Hospital, Trento, Italy; Healthcare Research and Innovation Program, PAT-FBK, Trento, Italy
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692
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Böhm M, Linz D, Ukena C, Esler M, Mahfoud F. Renal Denervation for the Treatment of Cardiovascular High Risk-Hypertension or Beyond? Circ Res 2014; 115:400-9. [DOI: 10.1161/circresaha.115.302522] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Michael Böhm
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (M.B., D.L., C.U., F.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.E.)
| | - Dominik Linz
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (M.B., D.L., C.U., F.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.E.)
| | - Christian Ukena
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (M.B., D.L., C.U., F.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.E.)
| | - Murray Esler
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (M.B., D.L., C.U., F.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.E.)
| | - Felix Mahfoud
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (M.B., D.L., C.U., F.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.E.)
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693
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Is epicardial adipose tissue an epiphenomenon or a new player in the pathophysiology of atrial fibrillation? Arch Cardiovasc Dis 2014; 107:349-52. [PMID: 25027058 DOI: 10.1016/j.acvd.2014.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 06/12/2014] [Indexed: 11/22/2022]
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694
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Abstract
Abstract
Atrial fibrillation is the most common arrhythmia. The anesthetic considerations of endovascular ablation for the treatment of atrial fibrillation are reviewed.
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695
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Pokushalov E, Romanov A, Katritsis DG, Artyomenko S, Bayramova S, Losik D, Baranova V, Karaskov A, Steinberg JS. Renal denervation for improving outcomes of catheter ablation in patients with atrial fibrillation and hypertension: Early experience. Heart Rhythm 2014; 11:1131-8. [DOI: 10.1016/j.hrthm.2014.03.055] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Indexed: 10/25/2022]
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696
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Affiliation(s)
- Paulus Kirchhof
- University of Birmingham Center for Cardiovascular Sciences, School of Clinical and Experimental Medicine, and SWBH NHS Trust, Birmingham, UK Department of Cardiovascular Medicine, Hospital of the University of Muenster, Muenster, Germany
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697
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Trayanova NA. Mathematical approaches to understanding and imaging atrial fibrillation: significance for mechanisms and management. Circ Res 2014; 114:1516-31. [PMID: 24763468 DOI: 10.1161/circresaha.114.302240] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia in humans. The mechanisms that govern AF initiation and persistence are highly complex, of dynamic nature, and involve interactions across multiple temporal and spatial scales in the atria. This article aims to review the mathematical modeling and computer simulation approaches to understanding AF mechanisms and aiding in its management. Various atrial modeling approaches are presented, with descriptions of the methodological basis and advancements in both lower-dimensional and realistic geometry models. A review of the most significant mechanistic insights made by atrial simulations is provided. The article showcases the contributions that atrial modeling and simulation have made not only to our understanding of the pathophysiology of atrial arrhythmias, but also to the development of AF management approaches. A summary of the future developments envisioned for the field of atrial simulation and modeling is also presented. The review contends that computational models of the atria assembled with data from clinical imaging modalities that incorporate electrophysiological and structural remodeling could become a first line of screening for new AF therapies and approaches, new diagnostic developments, and new methods for arrhythmia prevention.
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Affiliation(s)
- Natalia A Trayanova
- From the Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD
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698
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Nishida K, Nattel S. Atrial fibrillation compendium: historical context and detailed translational perspective on an important clinical problem. Circ Res 2014; 114:1447-52. [PMID: 24763463 DOI: 10.1161/circresaha.114.303466] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kunihiro Nishida
- From the Second Department of Internal Medicine, University of Toyama, Toyama, Japan (K.N.); Department of Medicine, Montreal Heart Institute, and Université de Montréal, Montreal, Quebec, Canada (S.N.); and Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada (S.N.)
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699
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Andrade J, Khairy P, Dobrev D, Nattel S. The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms. Circ Res 2014; 114:1453-68. [PMID: 24763464 DOI: 10.1161/circresaha.114.303211] [Citation(s) in RCA: 825] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia (estimated lifetime risk, 22%-26%). The aim of this article is to review the clinical epidemiological features of AF and to relate them to underlying mechanisms. Long-established risk factors for AF include aging, male sex, hypertension, valve disease, left ventricular dysfunction, obesity, and alcohol consumption. Emerging risk factors include prehypertension, increased pulse pressure, obstructive sleep apnea, high-level physical training, diastolic dysfunction, predisposing gene variants, hypertrophic cardiomyopathy, and congenital heart disease. Potential risk factors are coronary artery disease, kidney disease, systemic inflammation, pericardial fat, and tobacco use. AF has substantial population health consequences, including impaired quality of life, increased hospitalization rates, stroke occurrence, and increased medical costs. The pathophysiology of AF centers around 4 general types of disturbances that promote ectopic firing and reentrant mechanisms, and include the following: (1) ion channel dysfunction, (2) Ca(2+)-handling abnormalities, (3) structural remodeling, and (4) autonomic neural dysregulation. Aging, hypertension, valve disease, heart failure, myocardial infarction, obesity, smoking, diabetes mellitus, thyroid dysfunction, and endurance exercise training all cause structural remodeling. Heart failure and prior atrial infarction also cause Ca(2+)-handling abnormalities that lead to focal ectopic firing via delayed afterdepolarizations/triggered activity. Neural dysregulation is central to atrial arrhythmogenesis associated with endurance exercise training and occlusive coronary artery disease. Monogenic causes of AF typically promote the arrhythmia via ion channel dysfunction, but the mechanisms of the more common polygenic risk factors are still poorly understood and under intense investigation. Better recognition of the clinical epidemiology of AF, as well as an improved appreciation of the underlying mechanisms, is needed to develop improved methods for AF prevention and management.
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Affiliation(s)
- Jason Andrade
- From Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada (J.A., P.K., S.N.); Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.A.); and Faculty of Medicine, Institute of Pharmacology, University Duisburg-Essen, Essen, Germany (D.D.)
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700
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Boudoulas KD, Paraskevaidis IA, Boudoulas H, Triposkiadis FK. The Left Atrium: From the Research Laboratory to the Clinic. Cardiology 2014; 129:1-17. [DOI: 10.1159/000360935] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 02/27/2014] [Indexed: 11/19/2022]
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