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Vandecasteele T, Cornillie P, Vandevelde K, Logothetidou A, Couck L, van Loon G, Van den Broeck W. Presence of Ganglia and Telocytes in Proximity to Myocardial Sleeve Tissue in the Porcine Pulmonary Veins Wall. Anat Histol Embryol 2017; 46:325-333. [DOI: 10.1111/ahe.12273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/22/2017] [Indexed: 12/31/2022]
Affiliation(s)
- T. Vandecasteele
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - P. Cornillie
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - K. Vandevelde
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - A. Logothetidou
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - L. Couck
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - G. van Loon
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - W. Van den Broeck
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
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Association of SCN10A Polymorphisms with the Recurrence of Atrial Fibrillation after Catheter Ablation in a Chinese Han Population. Sci Rep 2017; 7:44003. [PMID: 28281580 PMCID: PMC5345091 DOI: 10.1038/srep44003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 02/02/2017] [Indexed: 11/08/2022] Open
Abstract
The nonsynonymous SCN10A single nucleotide polymorphism (SNP) rs6795970 has been reported to associate with PR interval and atrial fibrillation (AF) and in strong linkage disequilibrium (LD) with the AF-associated SNP rs6800541. In this study, we investigated whether rs6795970 polymorphisms are associated with AF recurrence after catheter ablation. A total of 502 consecutive patients with AF who underwent catheter ablation were included. AF recurrence was defined as a documented episode of any atrial arrhythmias lasting ≥30 s after a blanking period of 3 months. AF recurrence was observed between 3 and 12 months after catheter ablation in 24.5% of the patients. There was a significant difference in the allele distribution (p = 7.86 × 10−5) and genotype distribution (p = 1.42 × 10−5) of rs6795970 between the AF recurrence and no recurrence groups. In a multivariate analysis, we identified the following independent predictors of AF recurrence: the rs6795970 genotypes in an additive model (OR 0.36, 95%CI 0.22~0.60, p = 7.04 × 10−5), a history of AF ≥36 months (OR 3.57, 95%CI 2.26~5.63, p = 4.33 × 10−8) and left atrial diameter (LAD) ≥40 mm (OR 1.85, 95%CI 1.08~3.19, p = 0.026). These data suggest that genetic variation in SCN10A may play an important role in predicting AF recurrence after catheter ablation in the Chinese Han population.
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Abstract
Strategies and technology related to catheter ablation for atrial fibrillation (AF) continue to advance since its inception nearly 20 years ago. Broader selections of patients are now offered ablation with a similar level of procedural outcome and safety standards. It is hoped that improved understanding of the pathophysiologic processes of the initiation and maintenance of AF will refine target selection during ablation and improve long-term procedural efficacy, particularly in patients with persistent and long-standing persistent AF.
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Affiliation(s)
- Rakesh Latchamsetty
- Department of Electrophysiology, University of Michigan Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5853, USA.
| | - Fred Morady
- Department of Electrophysiology, University of Michigan Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5853, USA
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Abstract
Ganglionated plexi (GP), consisting of conglomerations of autonomic ganglia on the epicardial surface of the heart, have been shown to play a significant role in different arrhythmias, including atrial fibrillation. GP ablation has become an adjunctive procedure in the treatment of atrial fibrillation, while it has been used successfully in preliminary studies in vasovagal syncope. This review will present the current data on the physiology and clinical applications of GP ablation in the treatment of atrial fibrillation and other diseases.
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Affiliation(s)
- Stavros Stavrakis
- University of Oklahoma Health Sciences Center,Oklahoma City, Oklahoma, USA
| | - Sunny Po
- University of Oklahoma Health Sciences Center,Oklahoma City, Oklahoma, USA
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Chen X, Yu L, Shi S, Jiang H, Huang C, Desai M, Li Y, Barajas-Martinez H, Hu D. Neuronal Nav1.8 Channels as a Novel Therapeutic Target of Acute Atrial Fibrillation Prevention. J Am Heart Assoc 2016; 5:e004050. [PMID: 27806967 PMCID: PMC5210368 DOI: 10.1161/jaha.116.004050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/27/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Ganglionated plexus have been developed as additional ablation targets to improve the outcome of atrial fibrillation (AF) besides pulmonary vein isolation. Recent studies implicated an intimate relationship between neuronal sodium channel Nav1.8 (encoded by SCN10A) and AF. The underlying mechanism between Nav1.8 and AF remains unclear. This study aimed to determine the role of Nav1.8 in cardiac electrophysiology in an acute AF model and explore possible therapeutic targets. METHODS AND RESULTS Immunohistochemical study was used on canine cardiac ganglionated plexus. Both Nav1.5 and Nav1.8 were expressed in ganglionated plexus with canonical neuronal markers. Sixteen canines were randomly administered either saline or the Nav1.8 blocker A-803467. Electrophysiological study was compared between the 2 groups before and after 6-hour rapid atrial pacing. Compared with the control group, administration of A-803467 decreased the incidence of AF (87.5% versus 25.0%, P<0.05), shortened AF duration, and prolonged AF cycle length. A-803467 also significantly suppressed the decrease in the effective refractory period and the increase in effective refractory period dispersion and cumulative window of vulnerability caused by rapid atrial pacing in all recording sites. Patch clamp study was performed under 100 nmol/L A-803467 in TSA201 cells cotransfected with SCN10A-WT, SCN5A-WT, and SCN3B-WT. INa,P was reduced by 45.34% at -35 mV, and INa,L by 68.57% at -20 mV. Evident fast inactivation, slow recovery, and use-dependent block were also discovered after applying the drug. CONCLUSIONS Our study demonstrates that Nav1.8 could exert its effect on electrophysiological characteristics through cardiac ganglionated plexus. It indicates that Nav1.8 is a novel target in understanding cardiac electrophysiology and SCN10A-related arrhythmias.
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Affiliation(s)
- XiaoMeng Chen
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - LiLei Yu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China
| | - ShaoBo Shi
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hong Jiang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China
| | - CongXin Huang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China
| | | | - YiGang Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | | | - Dan Hu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China
- Masonic Medical Research Laboratory, Utica, NY
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56
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Low-level carotid baroreflex stimulation suppresses atrial fibrillation by inhibiting left stellate ganglion activity in an acute canine model. Heart Rhythm 2016; 13:2203-2212. [DOI: 10.1016/j.hrthm.2016.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Indexed: 11/17/2022]
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Qin M, Liu X, Wu SH, Zhang XD. Atrial Substrate Modification in Atrial Fibrillation: Targeting GP or CFAE? Evidence from Meta-Analysis of Clinical Trials. PLoS One 2016; 11:e0164989. [PMID: 27764185 PMCID: PMC5072654 DOI: 10.1371/journal.pone.0164989] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 10/04/2016] [Indexed: 11/19/2022] Open
Abstract
Several clinically relevant outcomes post atrial substrate modification in patients with atrial fibrillation (AF) have not been systematically analyzed among published studies on adjunctive cardiac ganglionated plexi (GP) or complex fractionated atrial electograms (CFAE) ablation vs. pulmonary vein isolation (PVI) alone. Out of 176 reports identified, the present meta-analysis included 14 randomized and non-randomized controlled trials (1613 patients) meeting inclusion criteria. Addition of GP ablation to PVI significantly increased freedom from atrial tachyarrhythmia in short- (OR: 1.72; P = 0.003) and long-term (OR: 2.0, P = 0.0006) follow-up, while adjunctive CFAE ablation did not after one or repeat procedure (P<0.05). The percentage of atrial tachycardia or atrial flutter (AT/AFL) after one procedure was higher for CFAE than GP ablation. In sub-analysis of non-paroxysmal AF, relative to PVI alone, adjunctive GP but not CFAE ablation significantly increased sinus rhythm maintenance (OR: 1.88, P = 0.01; and OR:1.24, P = 0.18, respectively). Meta regression analysis of the 14 studies indicated that sample size was significant source of heterogeneity either in outcomes after one or repeat procedure. In conclusion, in patients with AF, adjunctive GP but not CFAE ablation appeared to significantly add to the beneficial effects on sinus rhythm maintenance of PVI ablation alone; and CFAE ablation was associated with higher incidence of subsequent AT/AFL.
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Affiliation(s)
- Mu Qin
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200030, China
| | - Xu Liu
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200030, China
- * E-mail:
| | - Shao-Hui Wu
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200030, China
| | - Xiao-Dong Zhang
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200030, China
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Jiang RH, Hu GS, Liu Q, Sheng X, Sun YX, Yu LU, Zhang P, Zhang ZW, Chen SQ, Ye Y, Zhu J, Fu GS, Jiang CY. Impact of Anatomically Guided Ganglionated Plexus Ablation on Electrical Firing from Isolated Pulmonary Veins. Pacing Clin Electrophysiol 2016; 39:1351-1358. [PMID: 27723101 DOI: 10.1111/pace.12957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/04/2016] [Accepted: 09/20/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The mechanisms underlying atrial fibrillation (AF) initiation and pulmonary vein isolation (PVI) effectiveness remain unclear. Ganglionated plexus (GPs) have been implicated in AF initiation and maintenance. In this study, we evaluated the impact of GP ablation in patients with pulmonary vein (PV) firing after PVI. METHODS Patients with drug-refractory paroxysmal AF undergoing radiofrequency catheter ablation therapy with PVI were screened. Among 840 cases over a 3.75-year period, 12 cases were identified with persistent PV firing (left = 4 and right = 8) after PVI was achieved and left atrial sinus rhythm restored. Adjacent GP ablation was performed anatomically and followed if necessary by additional PV ablation. RESULTS In eight patients, PV firing was terminated during GP ablation outside of the circumferential ablation line. In one patient, additional PV ablation resulted in cessation of PV firing and in the remaining three patients, firing could not be terminated by GP ablation or additional PVI. CONCLUSION GP ablation outside of wide antral circumferential line frequently results in the cessation of rapid firing from electrically isolated PVs. These observations suggest that interactions between left atrium and PV beyond electrical conduction warrant consideration in AF mechanisms.
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Affiliation(s)
- Ru-Hong Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Gen-Sheng Hu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Cardiology, The First People's Hospital of Wuhu City, Anhui, China
| | - Qiang Liu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xia Sheng
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ya-Xun Sun
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - L U Yu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Pei Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zu-Wen Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shi-Quan Chen
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yang Ye
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Zhu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guo-Sheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chen-Yang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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59
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Michaud GF, Kumar S. Surgical Ganglionic Plexus Ablation in Atrial Fibrillation. J Am Coll Cardiol 2016; 68:1166-1168. [DOI: 10.1016/j.jacc.2016.07.731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
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SHARMA PARIKSHITS, KASIRAJAN VIGNESHWAR, ELLENBOGEN KENNETHA, KONERU JAYANTHIN. Interconnections between Left Atrial Ganglionic Plexi: Insights from Minimally Invasive Maze Procedures and Their Outcomes. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:427-33. [DOI: 10.1111/pace.12823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 01/17/2016] [Accepted: 01/19/2016] [Indexed: 12/01/2022]
Affiliation(s)
- PARIKSHIT S. SHARMA
- Division of Cardiology; Virginia Commonwealth University Medical Center; Richmond Virginia
| | - VIGNESHWAR KASIRAJAN
- Division of Cardiology; Virginia Commonwealth University Medical Center; Richmond Virginia
| | - KENNETH A. ELLENBOGEN
- Division of Cardiology; Virginia Commonwealth University Medical Center; Richmond Virginia
| | - JAYANTHI N. KONERU
- Division of Cardiology; Virginia Commonwealth University Medical Center; Richmond Virginia
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Madhavan M, Venkatachalam KL, Swale MJ, Desimone CV, Gard JJ, Johnson SB, Suddendorf SH, Mikell SB, Ladewig DJ, Nosbush TG, Danielsen AJ, Knudson M, Asirvatham SJ. Novel Percutaneous Epicardial Autonomic Modulation in the Canine for Atrial Fibrillation: Results of an Efficacy and Safety Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:407-17. [PMID: 26854009 DOI: 10.1111/pace.12824] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/24/2015] [Accepted: 01/28/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Endocardial ablation of atrial ganglionated plexi (GP) has been described for treatment of atrial fibrillation (AF). Our objective in this study was to develop percutaneous epicardial GP ablation in a canine model using novel energy sources and catheters. METHODS Phase 1: The efficacy of several modalities to ablate the GP was tested in an open chest canine model (n = 10). Phase 2: Percutaneous epicardial ablation of GP was done in six dogs using the most efficacious modality identified in phase 1 using two novel catheters. RESULTS Phase 1: Direct current (DC) in varying doses (blocking [7-12 μA], electroporation [300-500 μA], ablation [3,000-7,500 μA]), radiofrequency ablation (25-50 W), ultrasound (1.5 MHz), and alcohol (2-5 mL) injection were successful at 0/8, 4/12, 5/7, 3/8, 1/5, and 5/7 GP sites. DC (500-5,000 μA) along with alcohol irrigation was tested in phase 2. Phase 2: Percutaneous epicardial ablation of the right atrium, oblique sinus, vein of Marshall, and transverse sinus GP was successful in 5/6 dogs. One dog died of ventricular fibrillation during DC ablation at 5,000 μA. Programmed stimulation induced AF in six dogs, preablation and no atrial arrhythmia in three, flutter in one, and AF in one postablation. Heart rate, blood pressure, effective atrial refractory period, and local atrial electrogram amplitude did not change significantly postablation. Microscopic examination showed elimination of GP, and minimal injury to atrial myocardium. CONCLUSION Percutaneous epicardial ablation of GP using DC and novel catheters is safe and feasible and may be used as an adjunct to pulmonary vein isolation in the treatment of AF in order to minimize additional atrial myocardial ablation.
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Affiliation(s)
- Malini Madhavan
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - K L Venkatachalam
- Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Jacksonville, Florida.,Department of Surgical Research, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Susan B Johnson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Scott H Suddendorf
- Department of Research Administrative Services, Mayo Clinic, Rochester, Minnesota
| | - Susan B Mikell
- Department of Research Administrative Services, Mayo Clinic, Rochester, Minnesota
| | - Dorothy J Ladewig
- Department of Research Administrative Services, Mayo Clinic, Rochester, Minnesota
| | | | | | - Mark Knudson
- Mayo Clinic, Rochester, Minnesota.,EnteroMedics, Inc, St. Paul, Minnesota
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Ghanbari H, Oral H. Atrial Fibrillation Ablation Strategy: "Ready Made" or "Tailored"? Card Electrophysiol Clin 2016; 4:353-61. [PMID: 26939955 DOI: 10.1016/j.ccep.2012.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia leading to hospital admissions. Catheter ablation has evolved as an effective treatment strategy; however, ablation strategies continue to evolve due to the complex and multifactorial nature of atrial fibrillation. A standardized and primarily anatomical approach may not be sufficient to eliminate all mechanisms of atrial fibrillation. A tailored ablation strategy can target specific triggers and drivers of atrial fibrillation; however, it is limited by the accuracy and sensitivity of the methods used in identifying specific mechanisms of atrial fibrillation.
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Affiliation(s)
- Hamid Ghanbari
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
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63
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Singhal R, Lo LW, Lin YJL, Chang SL, Hu YF, Chao TF, Chung FP, Chiou CW, Tsao HM, Chen SA. Intrinsic Cardiac Autonomic Ganglionated Plexi within Epicardial Fats Modulate the Atrial Substrate Remodeling: Experiences with Atrial Fibrillation Patients Receiving Catheter Ablation. ACTA CARDIOLOGICA SINICA 2016; 32:174-84. [PMID: 27122948 PMCID: PMC4816916 DOI: 10.6515/acs20150427a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 04/27/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND A recent study reported the close relationship between high dominant frequent (DF) sites [atrial fibrillation (AF) nest] and the intrinsic cardiac autonomic nervous system. The aim of this study was to investigate the correlation between the regional distribution of epicardial fat and the properties of the biatrial substrates in AF patients. METHODS We studied 32 patients with paroxysmal (n = 23) and persistent (n = 9) AF. The epicardial fat volume around the left atrium (LA) was evaluated using 64-slice multidetector computed tomography and the topographic distribution of the fat volume was assessed. The biatrial DFs, voltages, and total activation times (TATs) were obtained during sinus rhythm. RESULTS Out of the 8 divided LA regions, a significant linear correlation existed between the LA fat and mean DF values in the right upper anterior LA, left upper anterior LA, right lower anterior LA, right upper posterior LA, left upper posterior LA, and left lower posterior LA. There was no significant correlation between the regional LA fat distribution and regional LA peak-to-peak bipolar voltage and TAT. During a mean follow-up of 17 ± 8 months, 22 of the 32 (69%) patients were free of AF. In the multivariate analysis, only the mean LA DF was found to be a significant predictor of recurrence. CONCLUSIONS There was a close association between the regional distribution of the LA epicardial fat and the atrial substrate manifesting high frequency during sinus rhythm (AF nest). Those nests were related to ablation outcome. Hence, epicardial fat may play a significant role in atrial substrate remodeling and thereby in the pathogenesis and maintenance of AF. KEY WORDS Atrial fibrillation • Dominant frequency • Epicardial fat • Nest • Recurrence.
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Affiliation(s)
- Rahul Singhal
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Yenn-Jiang Lin Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Cheun-Wang Chiou
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Hsuan-Ming Tsao
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei
- National Yang-Ming University Hospital, ILan, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei
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Lappe JM, Cutler MJ, Day JD, Bunch TJ. Ablation for Persistent Atrial Fibrillation—Is There a Role for More Than PVI? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:15. [DOI: 10.1007/s11936-016-0437-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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A case of paroxysmal atrial fibrillation with a non-pulmonary vein trigger identified by intravenous adenosine triphosphate infusion. J Arrhythm 2015; 31:318-22. [PMID: 26550091 DOI: 10.1016/j.joa.2015.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 01/16/2015] [Accepted: 03/13/2015] [Indexed: 11/20/2022] Open
Abstract
A 54-year-old woman was referred to our institution with frequent chest discomfort and was diagnosed with drug-refractory paroxysmal atrial fibrillation. Radiofrequency catheter ablation (RFCA) was performed using a three-dimensional electroanatomic mapping system. After completion of left and right circumferential pulmonary vein isolation (CPVI), an intravenous bolus of adenosine triphosphate (ATP, 20 mg) was administered to evaluate the electric reconduction between the pulmonary vein (PV) and left atrium (LA). Although no PV-LA reconduction was observed, atrial fibrillation (AF) was reproducibly induced. As the duration of AF was very short (<20 s), no further RFCA to the LA was performed. One month later, the patient presented with frequent atrial tachyarrhythmias (ATs), and RFCA was repeated. Although no electric reconduction was observed in the left- or right-sided PVs, incessant ATs and AF were induced after an intravenous bolus administration of ATP. The earliest atrial activation site initiating ATs was consistently identified from electrodes positioned in the superior vena cava (SVC), and both ATs and AF were no longer inducible after electric isolation of the SVC. ATP-induced PV/non-PV ectopy may be a marker of increased susceptibility to autonomic triggers of AF and could potentially predict recurrent AF after CPVI.
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Cheng H, Dai YY, Jiang RH, Liu Q, Sun YX, Lin JW, Zhang ZW, Chen SQ, Zhu J, Sheng X, Jiang CY. Non-pulmonary vein foci induced before and after pulmonary vein isolation in patients undergoing ablation therapy for paroxysmal atrial fibrillation: incidence and clinical outcome. J Zhejiang Univ Sci B 2015; 15:915-22. [PMID: 25294381 DOI: 10.1631/jzus.b1400146] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the incidence and clinical outcome of adenosine triphosphate (ATP) plus isoproterenol (ISP)-induced non-pulmonary vein (PV) foci before and after circumferential PV isolation (CPVI) during index ablation in patients with paroxysmal atrial fibrillation (PAF). METHODS In 80 consecutive patients undergoing catheter ablation for drug-refractory, symptomatic PAF at our hospital from April 2010 to January 2011, atrial fibrillation (AF) was provoked with ATP (20 mg) and ISP (20 µg/min) administration before and after CPVI. The spontaneous initiation of AF was mapped and recorded. RESULTS Before ablation, AF mostly originating from PVs (PV vs. non-PV, 36/70 vs. 3/70; P<0.01) was induced in 39 patients with sinus rhythm. CPVI significantly suppressed AF inducibility; however, more non-PV foci were provoked (post-CPVI vs. pre-CPVI, 13/76 vs. 3/70; P=0.016). Patients with pre- and post-CPVI induced AF (n=49) were divided according to non-PV foci being induced (group N, n=17) or not (group P, n=32). After mean (19.2±8.2) months follow-up, 88.2% (15/17) and 65.6% (21/32) of patients in groups N and P, respectively, were free from AF recurrence (P=0.088). CONCLUSIONS ATP+ISP administration effectively provokes non-PV foci, especially after CPVI in PAF patients. Although in this study difference did not achieve statistical significance, supplementary ablation targeting non-PV foci might benefit clinical outcome.
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Affiliation(s)
- Hui Cheng
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China; Department of Cardiology, the First People's Hospital of Xiaoshan, Hangzhou 311200, China
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Abstract
Autonomic dysfunction has been associated with paroxysmal atrial fibrillation (PAF). The head-up tilt test (HUTT) is an important diagnostic tool for autonomic dysfunction. The aim of this study was to examine atrial fibrillation recurrence after RFCA by performing HUTT. A total of 488 consecutive patients with PAF who underwent RFCA were prospectively enrolled. HUTT was positive in 154 (31.6%) patients after a mean follow-up of 22.7 ± 3.5 months, and 163 (33.4%) had a recurrence. HUTT positive was significantly higher in PAF patients with recurrence compared to those without (68 (41.7%) versus 86 (26.5%), P < 0.001). Multivariate Cox regression analysis revealed that HUTT positive (HR: 1.96; 95% CI: 1.49-2.48, P < 0.001), left atrial diameter (HR: 1.77; 95%CI: 1.15-2.11, P = 0.004), AF duration (HR: 1.27; 95%CI: 0.98-1.83, P = 0.014), and sleep apnea (HR: 1.02; 95%CI: 0.81-1.53, P = 0.032) were independent predictors of clinical recurrence after RFCA. The success rate of ablation was 70.4% in patients in the HUTT negative group compared with 58.4% in patients in the HUTT positive group (log-rank P = 0.006). Patients with a positive headup tilt test were at an increased risk of AF recurrence after catheter ablation. Our results suggest that HUTT was a significant predictor for AF recurrence after catheter ablation for PAF.
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Affiliation(s)
- Jinyi Xu
- Department of Heart Function, Henan Province People's Hospital & The People's Hospital of Zhengzhou University
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69
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Wang X, Zhang M, Zhang Y, Xie X, Wang W, Li Z, Gao M, Wang Z, Hou Y. Long-Term Effects of Ganglionated Plexi Ablation on Electrophysiological Characteristics and Neuron Remodeling in Target Atrial Tissues in a Canine Model. Circ Arrhythm Electrophysiol 2015; 8:1276-83. [PMID: 26078277 DOI: 10.1161/circep.114.002554] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 06/03/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The long-term effects of ganglionated plexi ablation on electrophysiological characteristics and neuron remodeling in target atrial tissues remain unclear. METHODS AND RESULTS Dogs in group 1 (control, n=8) were not subjected to ganglionated plexi ablation and observed for 1 month, and dogs in groups 2 to 4 (ablation groups, n=8 each) underwent ablation of the right-sided ganglionated plexi and observed for 1, 6, and 12 months, respectively. Atrial electrophysiological characteristics were examined before ablation, immediately and continuously after ablation. Target atrial tissues were subjected to immunohistochemical staining and Western blot analysis. Atrial effective refractory period was significantly prolonged immediately after ablation (P<0.001), and persisted for 1 month (P<0.05). Nerve densities decreased 1 month after ablation (P<0.001). These parameters reverted to preablation levels after 6 and 12 months. In the ablation groups, atrial fibrillation was induced in 5 of 8 dogs after 1 month and in all animals after 6 and 12 months. Atrial fibrillation was not observed in the control group and in the experimental groups immediately after ablation. Moreover, the expression of the growth-associated protein 43 was upregulated after ablation. CONCLUSIONS Ganglionated plexi ablation effectively prolonged atrial effective refractory period for a short period, but the long-term effects on atrial effective refractory period and the suppression of atrial fibrillation induction were not persistent. Targeted atrial neuron remodeling may be an important mechanism underlying the observed electrophysiological changes.
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Affiliation(s)
- Ximin Wang
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Ming Zhang
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Yujiao Zhang
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Xinxing Xie
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Weizong Wang
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zhan Li
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Mei Gao
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zhongsu Wang
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Yinglong Hou
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.
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70
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Galloway A, Li H, Vanderlinde-Wood M, Khan M, Benbrook A, Liles C, Zillner C, Rao V, Cunningham MW, Yu X, Kem DC. Activating autoantibodies to the β1/2-adrenergic and M2 muscarinic receptors associate with atrial tachyarrhythmias in patients with hyperthyroidism. Endocrine 2015; 49:457-63. [PMID: 25500789 PMCID: PMC5810549 DOI: 10.1007/s12020-014-0495-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Abstract
We have previously demonstrated that activating autoantibodies to β1-adrenergic receptor (β1AR) and M2 muscarinic receptor (M2R) facilitate atrial fibrillation (AF) in patients with Graves' disease (GD). The objectives of this expanded study were to examine the prevalence of β1AR, β2AR, and M2R autoantibodies in hyperthyroidism subjects. Sera from 81 patients including 31 with GD and AF, 36 with GD and sinus rhythm, 9 with toxic multinodular goiter, 5 with subacute thyroiditis, and 10 control subjects were examined for these autoantibodies by ELISA. Sera from 20 ELISA-positive GD subjects, 10 with AF and 10 with sinus rhythm, were assayed for autoantibody bioactivity using cell-based bioassays. In patients with GD and AF, 45, 65, and 77 % were ELISA positive for β1AR, M2R, and β2AR autoantibodies, respectively. In patients with GD and sinus rhythm, 17, 39, and 75 % were ELISA positive for β1AR, M2R, and β2AR autoantibodies, respectively. β1AR and M2R autoantibodies were co-present in 39 % of patients with GD and AF compared to 14 % in GD with sinus rhythm (p = 0.026). Patients with toxic multinodular goiter or subacute thyroiditis had a low prevalence of autoantibodies. The mean β1AR and M2R autoantibody activity was elevated in both GD groups but higher in those with AF than those with sinus rhythm. β2AR autoantibody activity was also increased in both groups. In conclusion, β1AR, β2AR, and M2R autoantibodies were elevated in GD. β1AR and M2R autoantibodies appear to be related to concurrent AF, while β2AR autoantibodies were equally prevalent in those with a sinus tachycardia and those with AF.
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Affiliation(s)
- Allison Galloway
- Endocrinology and the Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center and Veterans Affairs Medical Center, Oklahoma City, OK, 73104, USA
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71
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Obesity and atrial fibrillation: A comprehensive review of the pathophysiological mechanisms and links. J Cardiol 2015; 66:361-9. [PMID: 25959929 DOI: 10.1016/j.jjcc.2015.04.002] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 03/15/2015] [Accepted: 04/02/2015] [Indexed: 12/15/2022]
Abstract
Obesity is a worldwide health problem with epidemic proportions that has been associated with atrial fibrillation (AF). Even though the underlying pathophysiological mechanisms have not been completely elucidated, several experimental and clinical studies implicate obesity in the initiation and perpetuation of AF. Of note, hypertension, diabetes mellitus, metabolic syndrome, coronary artery disease, and obstructive sleep apnea, represent clinical correlates between obesity and AF. In addition, ventricular adaptation, diastolic dysfunction, and epicardial adipose tissue appear to be implicated in atrial electrical and structural remodeling, thereby promoting the arrhythmia in obese subjects. The present article provides a concise overview of the association between obesity and AF, and highlights the underlying pathophysiological mechanisms.
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72
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Krummen DE, Hebsur S, Salcedo J, Narayan SM, Lalani GG, Schricker AA. Mechanisms Underlying AF: Triggers, Rotors, Other? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:371. [PMID: 25778423 DOI: 10.1007/s11936-015-0371-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OPINION STATEMENT There is ongoing debate regarding the precise mechanisms underlying atrial fibrillation (AF). An improved understanding of these mechanisms is urgently needed to improve interventional strategies to suppress and eliminate AF, since the success of current strategies is suboptimal. At present, guidelines for AF ablation focus on pulmonary vein (PV) isolation for the prevention of arrhythmia. Additional targets are presently unclear, and include additional linear ablation and electrogram-guided substrate modification, without clear mechanistic relevance. PV and non-PV triggers are likely central in the first few seconds of AF initiation. Rapid activation from such triggers interacts with transitional mechanisms including conduction velocity slowing, action potential duration (APD) alternans, and steep APD restitution to cause conduction block and initiate functional reentry. However, complete suppression of potential triggers has proven elusive, and the intra-procedural mapping and targeting of transitional mechanisms has not been reported. A growing body of research implicates electrical rotors and focal sources as central mechanisms for the maintenance of AF. In several recent series, they were observed in nearly all patients with sustained arrhythmia. Ablation of rotor and focal source sites, prior to pulmonary vein isolation, substantially modulated atrial fibrillation in a high proportion of patients, and improved ablation outcomes versus pulmonary vein isolation alone. These results have subsequently been confirmed in multicenter series, and the improved outcomes have been found to persist to a mean follow-up of 3 years. Recently, rotors have been observed by multiple groups using diverse technologies. These findings represent a paradigm shift in AF, focusing on sustaining mechanisms, as is currently done with other arrhythmias such as atrioventricular node reentrant tachycardia. Studies are currently underway to assess the optimal strategy for the application of rotor-based ablation in AF management, including clinical trials on the relative efficacy of rotor-only ablation versus PVI-only ablation, which will inform future practice guidelines.
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Affiliation(s)
- David E Krummen
- University of California San Diego and VA San Diego Healthcare System, 3350 La Jolla Village Drive, Cardiology Section 111A, San Diego, CA, 92161, USA,
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73
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Stavrakis S, Nakagawa H, Po SS, Scherlag BJ, Lazzara R, Jackman WM. The role of the autonomic ganglia in atrial fibrillation. JACC Clin Electrophysiol 2015; 1:1-13. [PMID: 26301262 DOI: 10.1016/j.jacep.2015.01.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Recent experimental and clinical studies have shown that the epicardial autonomic ganglia play an important role in the initiation and maintenance of atrial fibrillation (AF). In this review, we present the current data on the role of the autonomic ganglia in the pathogenesis of AF and discuss potential therapeutic implications. Experimental studies have demonstrated that acute autonomic remodeling may play a crucial role in AF maintenance in the very early stages. The benefit of adding ablation of the autonomic ganglia to the standard pulmonary vein (PV) isolation procedure for patients with paroxysmal AF is supported by both experimental and clinical data. The interruption of axons from these hyperactive autonomic ganglia to the PV myocardial sleeves may be an important factor in the success of PV isolation procedures. The vagus nerve exerts an inhibitory control over the autonomic ganglia and attenuation or loss of this control may allow these ganglia to become hyperactive. Autonomic neuromodulation using low-level vagus nerve stimulation inhibits the activity of the autonomic ganglia and reverses acute electrical atrial remodeling during rapid atrial pacing and may provide an alternative non-ablative approach for the treatment of AF, especially in the early stages. This notion is supported by a preliminary human study. Further studies are warranted to confirm these findings.
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Affiliation(s)
- Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Sunny S Po
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Benjamin J Scherlag
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Ralph Lazzara
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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74
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Krummen DE, Swarup V, Narayan SM. The role of rotors in atrial fibrillation. J Thorac Dis 2015; 7:142-51. [PMID: 25713729 DOI: 10.3978/j.issn.2072-1439.2014.11.15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/23/2014] [Indexed: 11/14/2022]
Abstract
Despite significant advances in our understanding of atrial fibrillation (AF) mechanisms in the last 15 years, ablation outcomes remain suboptimal. A potential reason is that many ablation techniques focus on anatomic, rather than patient-specific functional targets for ablation. Panoramic contact mapping, incorporating phase analysis, repolarization and conduction dynamics, and oscillations in AF rate, overcomes many prior difficulties with mapping AF. This approach provides evidence that the mechanisms sustaining human AF are deterministic, largely due to stable electrical rotors and focal sources in either atrium. Ablation of such sources (Focal Impulse and Rotor Modulation: FIRM ablation) has been shown to improve ablation outcome compared with conventional ablation alone; independent laboratories directly targeting stable rotors have shown similar results. Clinical trials examining the role of stand-alone FIRM ablation are in progress. Looking forward, translating insights from patient-specific mapping to evidence-based guidelines and clinical practice is the next challenge in improving patient outcomes in AF management.
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Affiliation(s)
- David E Krummen
- 1 Department of Medicine/Cardiology, University of California San Diego Medical Center, San Diego, CA and VA San Diego Healthcare System, San Diego, CA 92161, USA ; 2 Arizona Heart Hospital, Phoenix, AZ, USA ; 3 Stanford University, Palo Alto, CA, USA
| | - Vijay Swarup
- 1 Department of Medicine/Cardiology, University of California San Diego Medical Center, San Diego, CA and VA San Diego Healthcare System, San Diego, CA 92161, USA ; 2 Arizona Heart Hospital, Phoenix, AZ, USA ; 3 Stanford University, Palo Alto, CA, USA
| | - Sanjiv M Narayan
- 1 Department of Medicine/Cardiology, University of California San Diego Medical Center, San Diego, CA and VA San Diego Healthcare System, San Diego, CA 92161, USA ; 2 Arizona Heart Hospital, Phoenix, AZ, USA ; 3 Stanford University, Palo Alto, CA, USA
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75
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Kurotobi T, Shimada Y, Kino N, Ito K, Tonomura D, Yano K, Tanaka C, Yoshida M, Tsuchida T, Fukumoto H. Features of intrinsic ganglionated plexi in both atria after extensive pulmonary isolation and their clinical significance after catheter ablation in patients with atrial fibrillation. Heart Rhythm 2014; 12:470-476. [PMID: 25433142 DOI: 10.1016/j.hrthm.2014.11.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The features of intrinsic ganglionated plexi (GP) in both atria after extensive pulmonary vein isolation (PVI) and their clinical implications have not been clarified in patients with atrial fibrillation (AF). OBJECTIVE The purpose of this study was to assess the features of GP response after extensive PVI and to evaluate the relationship between GP responses and subsequent AF episodes. METHODS The study population consisted of 216 consecutive AF patients (104 persistent AF) who underwent an initial ablation. We searched for the GP sites in both atria after an extensive PVI. RESULTS GP responses were determined in 186 of 216 patients (85.6%). In the left atrium, GP responses were observed around the right inferior GP in 116 of 216 patients (53.7%) and around the left inferior GP in 57 of 216 (26.4%). In the right atrium, GP responses were observed around the posteroseptal area: inside the CS in 64 of 216 patients (29.6%), at the CS ostium in 150 of 216 (69.4%), and in the lower right atrium in 45 of 216 (20.8%). The presence of a positive GP response was an independent risk factor for AF recurrence (hazard ratio 4.04, confidence interval 1.48-11.0) in patients with paroxysmal, but not persistent, AF. The incidence of recurrent atrial tachyarrhythmias in patients with paroxysmal AF with a positive GP response was 51% vs 8% in those without a GP response (P = .002). CONCLUSION The presence of GP responses after extensive PVI was significantly associated with increased AF recurrence after ablation in patients with paroxysmal AF.
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Affiliation(s)
| | | | - Naoto Kino
- Cardiovascular Division, Shiroyama Hospital, Osaka, Japan
| | - Kazato Ito
- Cardiovascular Division, Shiroyama Hospital, Osaka, Japan
| | | | - Kentaro Yano
- Cardiovascular Division, Shiroyama Hospital, Osaka, Japan
| | - Chiharu Tanaka
- Cardiovascular Division, Shiroyama Hospital, Osaka, Japan
| | | | - Takao Tsuchida
- Cardiovascular Division, Shiroyama Hospital, Osaka, Japan
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76
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77
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Vincenti A, Passini E, Fabbrini P, Luise MC, Severi S, Genovesi S. Recurrent intradialytic paroxysmal atrial fibrillation: hypotheses on onset mechanisms based on clinical data and computational analysis. Europace 2014; 16:396-404. [PMID: 24569894 DOI: 10.1093/europace/eut346] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Atrial fibrillation (AF) incidence is high in end-stage renal disease (ESRD) patients, and haemodialysis (HD) session may induce paroxysmal AF episodes. Structural atrium remodelling is common in ESRD patients, moreover, HD session induces rapid plasma electrolytes and blood volume changes, possibly favouring arrhythmia onset. Therefore, HD session represents a unique model to study in vivo the mechanisms potentially inducing paroxysmal AF episodes. Here, we present the case report of a patient in which HD regularly induced paroxysmal AF. In four consecutive sessions, heart rate variability analysis showed a progressive reduction of low/high frequency ratio before the AF onset, suggesting a relative increase in vagal activity. Moreover, all AF episodes were preceded by a great increase of supraventricular ectopic beats. We applied computational modelling of cardiac cellular electrophysiology to these clinical findings, using plasma electrolyte concentrations and heart rate to simulate patient conditions at the beginning of HD session (pre-HD) and right before the AF onset (pre-AF), in a human atrial action potential model. Simulation results provided evidence of a slower depolarization and a shortened refractory period in pre-AF vs. pre-HD, and these effects were enhanced when adding acetylcholine effect. Paroxysmal AF episodes are induced by the presence of a trigger that acts upon a favourable substrate on the background of autonomic nervous system changes and in the described case report all these three elements were present. Starting from these findings, here we review the possible mechanisms leading to intradialytic AF onset.
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Affiliation(s)
- Antonio Vincenti
- Electrophysiology and Cardiac Pacing Unit, San Gerardo Hospital, 20900 Monza, Italy
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78
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Affiliation(s)
- Benjamin J Scherlag
- From the Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City.
| | - Warren M Jackman
- From the Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City
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79
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Jiang Md CY, Jiang Ms RH. Improvements In AF Ablation Outcome Will Be Based More On Technological Advancement Versus Mechanistic Understanding. J Atr Fibrillation 2014; 7:1120. [PMID: 27957107 DOI: 10.4022/jafib.1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 07/22/2014] [Accepted: 07/22/2014] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) is one of the most common cardiac arrhythmias. Catheter ablation has proven more effective than antiarrhythmic drugs in preventing clinical recurrence of AF, however long-term outcome remains unsatisfactory. Ablation strategies have evolved based on progress in mechanistic understanding, and technologies have advanced continuously. This article reviews current mechanistic concepts and technological advancements in AF treatment, and summarizes their impact on improvement of AF ablation outcome.
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Affiliation(s)
- Chen-Yang Jiang Md
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ru-Hong Jiang Ms
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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80
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Perkiömäki J, Ukkola O, Kiviniemi A, Tulppo M, Ylitalo A, Kesäniemi YA, Huikuri H. Heart rate variability findings as a predictor of atrial fibrillation in middle-aged population. J Cardiovasc Electrophysiol 2014; 25:719-24. [PMID: 24602026 DOI: 10.1111/jce.12402] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 02/20/2014] [Accepted: 02/21/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Autonomic nervous system modifies atrial electrophysiologic properties and arrhythmia vulnerability. METHODS Heart rate (HR) variability, an indicator of cardiac autonomic regulation, was measured in 784 subjects (mean age 51 ± 6 years; 54% males) from a standardized 45-minute period in a study population (n = 1,045), which consisted of randomly selected hypertensive and age- and sex-matched control subjects at the time of recruitment in 1991-1992 (the OPERA study). RESULTS During a mean follow-up of 16.5 ± 3.5 years, 76 subjects (9.7%) had developed symptomatic atrial fibrillation (AF), needing hospitalization. HR did not predict the occurrence of AF. Among the various spectral and time-domain HR variability indexes, only the low-frequency (LF) spectral component independently predicted AF. In the Cox regression analysis, the hazard ratio of reduced HR corrected LF (LFccv ≤ 1.59%, optimal cutoff from the ROC curve) in predicting the AF was 3.28 (95% CI: 2.06-5.24; P < 0.001). In the multiple Cox regression model, including LFccv and other predictors of AF, such as age, gender, hypertension, history of coronary artery disease, systolic and diastolic blood pressure, body mass index, β-blocking, angiotensin converting enzyme inhibitor and aspirin medication, left atrial size, left ventricular mass index, and left ventricular size obtained by echocardiography, only LFccv (hazard ratio 2.81; 95% CI: 1.64-4.81; P < 0.001), age (P = 0.006), and systolic blood pressure (P = 0.02) remained as significant predictors of AF. CONCLUSIONS Impaired LF oscillation of HR predicts new-onset AF in a middle-aged population emphasizing the important role of autonomic nervous system in the genesis of symptomatic AF.
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Affiliation(s)
- Juha Perkiömäki
- Medical Research Center, University Hospital of Oulu, University of Oulu, Oulu, Finland
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81
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The Propensity for Inducing Atrial Fibrillation: A Comparative Study on Old versus Young Rabbits. J Aging Res 2014; 2014:684918. [PMID: 24719763 PMCID: PMC3955625 DOI: 10.1155/2014/684918] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 01/21/2014] [Indexed: 11/17/2022] Open
Abstract
It is well established that atrial fibrillation (AF) is far more common in elderly humans. Autonomic activation is thought to be an operative mechanism for AF propensity. The aim of the study was to investigate the impact of age on atrial tachyarrhythmia induction in a rabbit model. Six old (aged 4-6 years) and 9 young (aged 3-4 months) New Zealand white rabbits were subjected to a catheter-based electrophysiological study. Atrial tachyarrhythmia susceptibility was tested by burst pacing before and after infusion of increasing concentrations of acetylcholine. Both young and old rabbits were in normal sinus rhythm at the beginning of the infusion/burst pacing protocol. The old rabbits had faster heart rates and a marked increase in atrial tachyarrhythmias compared to the young rabbits. Nonsustained and sustained AF events were more frequent in the old rabbits. No significant fibrosis was observed in the atria of either young or old rabbits. In conclusion, the old rabbits have a greater propensity for induction of AF. The significantly faster heart rates in the old rabbits suggest that dominant sympathetic activity may play an important role in the propensity for AF in this group.
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82
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Atrial fibrillation: A progressive atrial myopathy or a distinct disease? Int J Cardiol 2014; 171:126-33. [DOI: 10.1016/j.ijcard.2013.12.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 10/09/2013] [Accepted: 12/10/2013] [Indexed: 02/06/2023]
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83
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Qi B, Wei Y, Chen S, Zhou G, Li H, Xu J, Ding Y, Lu X, Zhao L, Zhang F, Chen G, Zhao J, Liu S. Nav1.8 channels in ganglionated plexi modulate atrial fibrillation inducibility. Cardiovasc Res 2014; 102:480-6. [PMID: 24419303 DOI: 10.1093/cvr/cvu005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Emerging evidences indicate that SCN10A/NaV1.8 is associated with cardiac conduction and atrial fibrillation, but the exact role of NaV1.8 in cardiac electrophysiology remains poorly understood. The present study was designed to investigate the effects of blocking NaV1.8 channels in cardiac ganglionated plexi (GP) on modulating cardiac conduction and atrial fibrillation inducibility in the canine model. METHODS AND RESULTS Thirteen mongrel dogs were randomly enrolled. Right cervical vagus nerve stimulation (VNS) was applied to determine its effects on the sinus rate, ventricular rate during atrial fibrillation, PR interval, atrial effective refractory period, and the cumulative window of vulnerability. The NaV1.8 blocker A-803467 (1 μmol/0.5 mL per GP, n = 7) or 5% DMSO/95% polyethylene glycol (0.5 mL per GP, n = 6, control) was injected into the anterior right GP and the inferior right GP. The effects of VNS on the sinus rate, ventricular rate, PR interval, atrial effective refractory period, and the cumulative window of vulnerability were significantly eliminated at 10, 35, and 90 min after A-803467 injection. In separate experiments (n = 8), A-803467 blunted the slowing of sinus rate with increasing stimulation voltage of the anterior right GP at 10 min after local injection. CONCLUSIONS Blockade of NaV1.8 channels suppresses the effects of VNS on cardiac conduction and atrial fibrillation inducibility, most likely by inhibiting the neural activity of the cardiac GP.
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Affiliation(s)
- Baozhen Qi
- Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, NO 100, Haining Road, Hongkou District, Shanghai 200080, China
| | - Yong Wei
- Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, NO 100, Haining Road, Hongkou District, Shanghai 200080, China
| | - Songwen Chen
- Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, NO 100, Haining Road, Hongkou District, Shanghai 200080, China
| | - Genqing Zhou
- Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, NO 100, Haining Road, Hongkou District, Shanghai 200080, China
| | - Hongli Li
- Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, NO 100, Haining Road, Hongkou District, Shanghai 200080, China
| | - Juan Xu
- Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, NO 100, Haining Road, Hongkou District, Shanghai 200080, China
| | - Yu Ding
- Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, NO 100, Haining Road, Hongkou District, Shanghai 200080, China
| | - Xiaofeng Lu
- Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, NO 100, Haining Road, Hongkou District, Shanghai 200080, China
| | - Liqun Zhao
- Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, NO 100, Haining Road, Hongkou District, Shanghai 200080, China
| | - Feng Zhang
- Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, NO 100, Haining Road, Hongkou District, Shanghai 200080, China
| | - Gang Chen
- Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, NO 100, Haining Road, Hongkou District, Shanghai 200080, China
| | - Jing Zhao
- Wolfson Institute for Biomedical Research, University College London, Wing3.1, Cruciform Building, Gower Street, London WC1E 6BT, UK
| | - Shaowen Liu
- Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, NO 100, Haining Road, Hongkou District, Shanghai 200080, China
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84
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Cheung JW, Lin FS, Ip JE, Bender SR, Siddiqi FK, Liu CF, Thomas G, Markowitz SM, Lerman BB. Adenosine-induced pulmonary vein ectopy as a predictor of recurrent atrial fibrillation after pulmonary vein isolation. Circ Arrhythm Electrophysiol 2013; 6:1066-73. [PMID: 24243786 DOI: 10.1161/circep.113.000796] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adenosine can unmask dormant pulmonary vein (PV) conduction after PV isolation. Adenosine can also induce ectopy in electrically silent PVs after isolation, possibly via activation of autonomic triggers. We sought to identify the implications of adenosine-induced PV ectopy for atrial fibrillation (AF) recurrence after PV isolation. METHODS AND RESULTS A total of 152 patients (age, 60±11 years; 63% paroxysmal AF) undergoing PV isolation for AF were studied. After each PV was isolated, adenosine was administered and the presence of adenosine-induced PV reconnection and PV ectopy were recorded. Dormant conduction was targeted with additional ablation. Adenosine-induced PV ectopy was seen in 45 (30%) patients, and dormant conduction was seen in 44 (29%) patients. After a median follow-up of 374 days, 48 (32%) patients had recurrent AF after a single ablation procedure. Rates of freedom from AF among patients with adenosine-induced PV ectopy were significantly lower than patients without adenosine-induced PV ectopy (63% versus 76% at 1 year; log rank, 0.014). Rates of freedom from AF among patients with dormant conduction were also lower than patients without dormant conduction (64% versus 76% at 1 year; log rank, 0.062). With multivariate analysis, adenosine-induced PV ectopy was found to be the only independent predictor of AF after PV isolation (hazard ratio, 1.90; 95% confidence interval, 1.06-3.40; P=0.032). CONCLUSIONS Adenosine-induced PV ectopy is a predictor of recurrent AF after PV isolation and may be a marker of increased susceptibility to autonomic triggers of AF.
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Affiliation(s)
- Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY
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85
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JIANG RUHONG, JIANG CHENYANG, SHENG XIA, ZHANG ZUWEN, SUN YAXUN, LIU QIANG, FU GUOSHENG, PO SUNNYS. Marked Suppression of Pulmonary Vein Firing After Circumferential Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation: Is Pulmonary Vein Firing an Epiphenomenon? J Cardiovasc Electrophysiol 2013; 25:111-8. [DOI: 10.1111/jce.12288] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/17/2013] [Accepted: 09/03/2013] [Indexed: 11/28/2022]
Affiliation(s)
- RU-HONG JIANG
- Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University; Hangzhou China
| | - CHEN-YANG JIANG
- Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University; Hangzhou China
| | - XIA SHENG
- Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University; Hangzhou China
| | - ZU-WEN ZHANG
- Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University; Hangzhou China
| | - YA-XUN SUN
- Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University; Hangzhou China
| | - QIANG LIU
- Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University; Hangzhou China
| | - GUO-SHENG FU
- Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University; Hangzhou China
| | - SUNNY S. PO
- Department of Medicine and Heart Rhythm Institute; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma USA
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86
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The impact of vagotonic, adrenergic, and random type of paroxysmal atrial fibrillation on left atrial ablation outcomes. Int J Cardiol 2013; 168:4015-8. [DOI: 10.1016/j.ijcard.2013.06.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 05/09/2013] [Accepted: 06/30/2013] [Indexed: 11/20/2022]
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87
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ZHOU QINA, ZHANG LING, WANG KUN, XU XIAOXIA, JI MENG, ZHANG FENG, WANG HONGLI, HOU YUEMEI. Effect of Interconnection between Cervical Vagus Trunk, Epicardial Fat Pad on Sinus Node Function, and Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:356-63. [PMID: 24111726 DOI: 10.1111/pace.12265] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 07/05/2013] [Accepted: 08/12/2013] [Indexed: 11/29/2022]
Affiliation(s)
- QINA ZHOU
- Cardiovascular Center; The First Affiliated Hospital of Xinjiang Medical University; Urumqi P. R. China
| | - LING ZHANG
- Cardiovascular Center; The First Affiliated Hospital of Xinjiang Medical University; Urumqi P. R. China
| | - KUN WANG
- Cardiovascular Center; The First Affiliated Hospital of Xinjiang Medical University; Urumqi P. R. China
| | - XIAOXIA XU
- Cardiovascular Center; The First Affiliated Hospital of Xinjiang Medical University; Urumqi P. R. China
| | - MENG JI
- Cardiovascular Center; The First Affiliated Hospital of Xinjiang Medical University; Urumqi P. R. China
| | - FENG ZHANG
- Cardiovascular Center; The First Affiliated Hospital of Xinjiang Medical University; Urumqi P. R. China
| | - HONGLI WANG
- Cardiovascular Center; The First Affiliated Hospital of Xinjiang Medical University; Urumqi P. R. China
| | - YUEMEI HOU
- Department of Cardiovascular Diseases; The Sixth People's Hospital (Southern) affiliated to Shanghai Jiaotong University; Shanghai P. R. China
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88
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Shen X, Scherlag BJ, He B, Sun J, Mei G, Po SS. The Role of the Atrial Neural Network In Atrial Fibrillation: The Metastatic Progression Hypothesis. J Atr Fibrillation 2013; 6:882. [PMID: 28496879 DOI: 10.4022/jafib.882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/08/2013] [Accepted: 08/08/2013] [Indexed: 11/10/2022]
Abstract
With the advent of catheter ablation of atrial fibrillation (AF) there has been acceleration in our understanding of the mechanisms underlying the etiology of this common clinical arrhythmia. In this regard, the role of the intrinsic cardiac autonomic nervous system in the initiation and maintenance of AF began to receive attention in numerous experimental and clinical investigations. Up to now, the focus has been on the large ganglionated plexi (GP) which are located in the posterior left atrium mainly at the pulmonary vein-atrial junctions. As long term outcomes have been reported and single procedures have indicated diminished success rates particularly for persistent/long standing persistent AF, emphasis has begun to shift away from the pulmonary vein isolation (PVI) alone as well as GP ablation with or without PVI. An understanding of the atrial substrate represented by the extensions of the intrinsic cardiac autonomic system constituting the atrial neural network is beginning to evolve. In this review, the contribution of the intrinsic cardiac autonomic nervous system to the etiology of AF is addressed, particularly in regard to the greater prevalence of AF in the elderly. In addition, we emphasize the involvement of the atrial neural network in the "metastatic" progression of paroxysmal to persistent and long standing persistent forms of AF.
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Affiliation(s)
- X Shen
- Department of Cardiology, Sir Run Run Shaw Hospital, 3 Qing Chun Road East, Hangzhou, Zhejiang Province, China,310016
| | - B J Scherlag
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center,Oklahoma City, OK
| | - B He
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center,Oklahoma City, OK
| | - J Sun
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center,Oklahoma City, OK
| | - G Mei
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center,Oklahoma City, OK
| | - S S Po
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center,Oklahoma City, OK
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89
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Denervation as a common mechanism underlying different pulmonary vein isolation strategies for paroxysmal atrial fibrillation: evidenced by heart rate variability after ablation. ScientificWorldJournal 2013; 2013:569564. [PMID: 24058286 PMCID: PMC3766572 DOI: 10.1155/2013/569564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 07/19/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUNDS Segmental and circumferential pulmonary vein isolations (SPVI and CPVI) have been demonstrated to be effective therapies for paroxysmal atrial fibrillation (PAF). PVI is well established as the endpoint of different ablation techniques, whereas it may not completely account for the long-term success. METHODS 181 drug-refractory symptomatic PAF patients were referred for segmental or circumferential PVI (SPVI = 67; CPVI = 114). Heart rate variability (HRV) was assessed before and after the final ablation. RESULTS After following up for 62.23 ± 12.75 months, patients underwent 1.41 ± 0.68 procedures in average, and the success rates in SPVI and CPVI groups were comparable. 119 patients were free from AF recurrence (SPVI-S, n = 43; CPVI-S, n = 76). 56 patients had recurrent episodes (SPVI-R, n = 21; CPVI-R, n = 35). Either ablation technique decreased HRV significantly. Postablation SDNN and rMSSD were significantly lower in SPVI-S and CPVI-S subgroups than in SPVI-R and CPVI-R subgroups (SPVI-S versus SPVI-R: SDNN 91.8 ± 32.6 versus 111.5 ± 36.2 ms, rMSSD 47.4 ± 32.3 versus 55.2 ± 35.2 ms; CPVI-S versus CPVI-R: SDNN 83.0 ± 35.6 versus 101.0 ± 40.7 ms, rMSSD 41.1 ± 22.9 versus 59.2 ± 44.8 ms; all P < 0.05). Attenuation of SDNN and rMSSD remained for 12 months in SPVI-S and CPVI-S subgroups, whereas it recovered earlier in SPVI-R and CPVI-R subgroups. Multivariate logistic regression analysis identified SDNN as the only predictor of long-term success. CONCLUSIONS Beyond PVI, denervation may be a common mechanism underlying different ablation strategies for PAF.
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90
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Liu Y, Scherlag BJ, Fan Y, Mao J, Hepler E, Varma V, Male S, Xia W, Huang H, Po SS. Experimental model of focal atrial tachycardia: clinical correlates. J Cardiovasc Electrophysiol 2013; 24:909-13. [PMID: 23621576 DOI: 10.1111/jce.12160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 02/26/2013] [Accepted: 03/06/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The mechanisms underlying focal atrial tachycardia (AT) are unclear. METHODS In 14 pentobarbital anesthetized dogs, a right thoracotomy allowed electrical stimulation (ES) of the anterior right ganglionated plexi (ARGP). After ES was applied to the ARGP at baseline, atropine, 1 mg/cc, was injected into the ARGP and repeat stimulation applied. After a left thoracotomy (n = 8), a similar procedure was followed by atropine injected into the superior left (SL) GP. RESULTS ES (0.6-3.2 V) applied to the ARGP and SLGP caused an average reduction in sinus rate from 151 ± 14/min to 60 ± 11/min. At ≥4.5 V atrial fibrillation (AF) was induced (duration 48 ± 14 seconds). After injection of atropine into the ARGP or SLGP, ES applied to these GP induced no slowing of the sinus rate. Runs of AT were induced at an average voltage of 10 ± 2 V in 14 experiments (duration ≥4 minutes). AT was localized by ice mapping or by 3D noncontact mapping to the crista terminalis (n = 6), AV junction (n = 2) or a focal site at the left superior pulmonary vein (6). In AT lasting <4 minutes (n = 2), epinephrine injected into the GP significantly increased the AT duration. In 4/4 experiments, sustained AT could be terminated by intravenous esmolol. CONCLUSIONS Atropine injected into the ARGP or SLGP promotes ES-induced AT whose duration is increased by adrenergic agonists and terminated by beta blockade. Presumably cholinergic blockade and accentuated release of adrenergic neurotransmitters provide the AT mechanism. The induced AT was found to be localized at sites similar to those reported clinically.
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Affiliation(s)
- Yu Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
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91
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Raviele A, Natale A, Calkins H, Camm JA, Cappato R, Ann Chen S, Connolly SJ, Damiano R, DE Ponti R, Edgerton JR, Haïssaguerre M, Hindricks G, Ho SY, Jalife J, Kirchhof P, Kottkamp H, Kuck KH, Marchlinski FE, Packer DL, Pappone C, Prystowsky E, Reddy VK, Themistoclakis S, Verma A, Wilber DJ, Willems S. Venice Chart international consensus document on atrial fibrillation ablation: 2011 update. J Cardiovasc Electrophysiol 2013; 23:890-923. [PMID: 22953789 DOI: 10.1111/j.1540-8167.2012.02381.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Antonio Raviele
- Cardiovascular Department, Arrhythmia Center and Center for Atrial Fibrillation, Dell'Angelo Hospital, Venice-Mestre, Italy.
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Gelsomino S, Corradi D, Lorusso R, Parise O, Callegari S, Macchi E, Maessen J, La Meir M. Anatomical basis of minimally invasive epicardial ablation of atrial fibrillation. Eur J Cardiothorac Surg 2012; 43:673-82. [PMID: 23111561 DOI: 10.1093/ejcts/ezs550] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sandro Gelsomino
- Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
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93
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LIU YU, SCHERLAG BENJAMINJ, FAN YOUQI, VARMA VANDANA, MALE SHAILESH, CHAUDHRY MUHAMMADA, HUANG CONGXIN, PO SUNNYS. Inducibility of Atrial Fibrillation After GP Ablations and “Autonomic Blockade”: Evidence for the Pathophysiological Role of the Nonadrenergic and Noncholinergic Neurotransmitters. J Cardiovasc Electrophysiol 2012; 24:188-95. [DOI: 10.1111/j.1540-8167.2012.02449.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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94
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Differential Effects of Adenosine on Pulmonary Vein Ectopy After Pulmonary Vein Isolation. Circ Arrhythm Electrophysiol 2012; 5:659-66. [DOI: 10.1161/circep.112.971945] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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95
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2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. J Interv Card Electrophysiol 2012; 33:171-257. [PMID: 22382715 DOI: 10.1007/s10840-012-9672-7] [Citation(s) in RCA: 256] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This is a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation, developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology and the European Cardiac Arrhythmia Society (ECAS), and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). This is endorsed by the governing bodies of the ACC Foundation, the AHA, the ECAS, the EHRA, the STS, the APHRS, and the HRS.
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96
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Kuz'min VS, Rozenshtraukh LV. The effects of isoproterenol and barium on automatic activity in the myocardium of the rat pulmonary veins. DOKLADY BIOLOGICAL SCIENCES : PROCEEDINGS OF THE ACADEMY OF SCIENCES OF THE USSR, BIOLOGICAL SCIENCES SECTIONS 2012; 444:153-6. [PMID: 22760613 DOI: 10.1134/s0012496612030131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Indexed: 11/23/2022]
Affiliation(s)
- V S Kuz'min
- Institute of Experimental Cardiology, Moscow, Russia
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97
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He B, Scherlag BJ, Nakagawa H, Lazzara R, Po SS. The intrinsic autonomic nervous system in atrial fibrillation: a review. ISRN CARDIOLOGY 2012; 2012:490674. [PMID: 22778995 PMCID: PMC3385664 DOI: 10.5402/2012/490674] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 04/22/2012] [Indexed: 11/23/2022]
Abstract
The procedure of catheter ablation for the treatment of drug resistant atrial fibrillation (AF) has evolved but still relies on lesion sets intended to isolate areas of focal firing, mainly the myocardial sleeves of the pulmonary veins (PVs), from the rest of the atria. However the success rates for this procedure have varied inversely with the type of AF. At best success rates have been 20 to 30% below that of other catheter ablation procedures for Wolff-Parkinson-White syndrome, atrioventricular junctional re-entrant tachycardia and atrial flutter. Basic and clinical evidence has emerged suggesting a critical role of the ganglionated plexi (GP) at the PV-atrial junctions in the initiation and maintenance of the focal form of AF. At present the highest success rates have been obtained with the combination of PV isolation and GP ablation both as catheter ablation or minimally invasive surgical procedures. Various lines of evidence from earlier and more recent reports provide that both neurally based and myocardially based forms of AF can separately dominate or coexist within the context of atrial remodeling. Future studies are focusing on non-pharmacological, non-ablative approaches for the prevention and treatment of AF in order to avoid the substantive complications of both these regimens.
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Affiliation(s)
- Bo He
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan, Hubei 430060, China
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98
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The atrial neural network as a substrate for atrial fibrillation. J Interv Card Electrophysiol 2012; 35:3-9. [DOI: 10.1007/s10840-012-9692-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 04/24/2012] [Indexed: 10/28/2022]
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Abstract
PURPOSE OF REVIEW The autonomic nerve system is a potentially potent modulator of the initiation and perpetuation of atrial fibrillation. This review will briefly summarize the neural mechanisms of atrial fibrillation. RECENT FINDINGS Complex interactions exist between the sympathetic and parasympathetic nervous system on the atrial electrophysiologic properties. Direct autonomic recordings in canine models demonstrated simultaneous sympathovagal discharges are the most common triggers of paroxysmal atrial tachycardia and paroxysmal atrial fibrillation. Also, intrinsic cardiac autonomic nerve can serve as a sole triggering factor for the initiation of atrial fibrillation. Modulation of autonomic nervous system (ANS) by electrical stimulation has been tried as a treatment strategy clinically and experimentally. Recent studies showed that autonomic nervous system modulation can suppress the stellate ganglion nerve activity and reduce the incidence of paroxysmal atrial tachyarrhythmias in ambulatory dogs. SUMMARY The autonomic nerve system influences the initiation and perpetuation of atrial fibrillation. Scientific advances toward a better understanding of the complex interrelationships of the various components of the ANS will hopefully lead to improvement of treatments for this common arrhythmia.
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100
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Stavrakis S, Scherlag BJ, Fan Y, Liu Y, Liu Q, Mao J, Cai H, Lazzara R, Po SS. Antiarrhythmic effects of vasostatin-1 in a canine model of atrial fibrillation. J Cardiovasc Electrophysiol 2012; 23:771-7. [PMID: 22487376 DOI: 10.1111/j.1540-8167.2012.02317.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND We examined the antiarrhythmic effects of vasostatin-1, a recently identified cardioregulatory peptide, in canine models of atrial fibrillation (AF). METHODS AND RESULTS In 13 pentobarbital-anesthetized dogs bilateral thoracotomies allowed the attachment of multielectrode catheters to superior and inferior pulmonary veins and atrial appendages (AA). Rapid atrial pacing (RAP) was maintained for 6 hours. Each hour, programmed stimulation was performed to determine the window of vulnerability (WOV), a measure of AF inducibility, at all sites. During the last 3 hours, vasostatin-1, 33 nM, was injected into the anterior right (AR) ganglionated plexus (GP) and inferior right (IR) GP every 30 minutes (n = 6). Seven dogs underwent 6 hours of RAP only (controls). At baseline, acetylcholine, 100 mM, was applied on the right AA and AF duration was recorded before and after injection of vasostatin-1, 33 nM, into the ARGP and IRGP. In separate experiments (n = 8), voltage-sinus rate response curves (surrogate for GP function) were constructed by applying high-frequency stimulation to the ARGP with incremental voltages with or without vasostatin-1. Vasostatin-1 significantly decreased the duration of acetylcholine-induced AF (11.0 ± 4.1 vs 5.5 ± 2.6 min, P = 0.02). The cumulative WOV (the sum of individual WOVs) significantly increased (P < 0.0001) during the first 3 hours and decreased toward baseline in the presence of vasostatin-1 (P < 0.0001). Cumulative WOV in controls steadily increased. Vasostatin-1 blunted the slowing of sinus rate with increasing stimulation voltage of ARGP. CONCLUSIONS Vasostatin-1 suppresses AF inducibility, likely by inhibiting GP function. These data may provide new insights into the role of peptide neuromodulators for AF therapy.
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Affiliation(s)
- Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
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