101
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Corti M, Zingaro A, Dede' L, Quarteroni AM. Impact of atrial fibrillation on left atrium haemodynamics: A computational fluid dynamics study. Comput Biol Med 2022; 150:106143. [PMID: 36182758 DOI: 10.1016/j.compbiomed.2022.106143] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/30/2022] [Accepted: 09/18/2022] [Indexed: 11/28/2022]
Abstract
We analyse the haemodynamics of the left atrium, highlighting differences between healthy individuals and patients affected by atrial fibrillation. The computational study is based on patient-specific geometries of the left atria to simulate blood flow dynamics. We design a novel procedure to compute the boundary data for the 3D haemodynamic simulations, which are particularly useful in absence of data from clinical measurements. With this aim, we introduce a parametric definition of atrial displacement, and we use a closed-loop lumped parameter model of the whole cardiovascular circulation conveniently tuned on the basis of the patient's characteristics. We evaluate several fluid dynamics indicators for atrial haemodynamics, validating our numerical results in terms of clinical measurements; we investigate the impact of geometric and clinical characteristics on the risk of thrombosis. To highlight the correlation of thrombus formation with atrial fibrillation, according to medical evidence, we propose a novel indicator: age stasis. It arises from the combination of Eulerian and Lagrangian quantities. This indicator identifies regions where slow flow cannot properly rinse the chamber, accumulating stale blood particles, and creating optimal conditions for clots formation.
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Affiliation(s)
- Mattia Corti
- MOX-Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan, 20133, Italy.
| | - Alberto Zingaro
- MOX-Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan, 20133, Italy
| | - Luca Dede'
- MOX-Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan, 20133, Italy
| | - Alfio Maria Quarteroni
- MOX-Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan, 20133, Italy; Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Station 8, Av. Piccard, Lausanne, CH-1015, Switzerland (Professor Emeritus)
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102
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Guichard JB, Guasch E, Roche F, Da Costa A, Mont L. Premature atrial contractions: A predictor of atrial fibrillation and a relevant marker of atrial cardiomyopathy. Front Physiol 2022; 13:971691. [PMID: 36353376 PMCID: PMC9638131 DOI: 10.3389/fphys.2022.971691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/14/2022] [Indexed: 09/08/2023] Open
Abstract
An increased burden of premature atrial contractions (PACs) has long been considered a benign phenomenon. However, strong evidence of their involvement in the occurrence of atrial fibrillation (AF), ischemic stroke, and excess mortality suggests the need for management. The central question to be resolved is whether increased ectopic atrial rhythm is only a predictor of AF or whether it is a marker of atrial cardiomyopathy and therefore of ischemic stroke. After reviewing the pathophysiology of PACs and its impact on patient prognosis, this mini-review proposes to 1) detail the physiological and clinical elements linking PACs and AF, 2) present the evidence in favor of supraventricular ectopic activity as a marker of cardiomyopathy, and 3) outline the current limitations of this concept and the potential future clinical implications.
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Affiliation(s)
- Jean-Baptiste Guichard
- Arrhythmia Unit, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, University Hospital of Saint-Étienne, Saint-Étienne, France
- Sainbiose, DVH, Inserm U1059, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Eduard Guasch
- Arrhythmia Unit, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Frederic Roche
- Sainbiose, DVH, Inserm U1059, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Antoine Da Costa
- Department of Cardiology, University Hospital of Saint-Étienne, Saint-Étienne, France
- Sainbiose, DVH, Inserm U1059, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Lluís Mont
- Arrhythmia Unit, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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103
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Ding J, Cheng A, Li P, Yan Y, Shi Y, Xue Z, Sun S, Xu J. Cryoballoon catheter ablation or drug therapy to delay progression of atrial fibrillation: A single-center randomized trial. Front Cardiovasc Med 2022; 9:1003305. [PMID: 36337878 PMCID: PMC9627306 DOI: 10.3389/fcvm.2022.1003305] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background Delaying atrial fibrillation (AF) progression is a key goal in cardiovascular treatment. However, numbers of previously published studies on delayed AF progression are relatively limited. The purpose of this study was to determine whether a cryoballoon catheter ablation (CA) strategy could delay AF progression compared to anti-arrhythmic drug (AAD) treatment in patients with paroxysmal AF. Methods A total of 204 subjects were enrolled in the trial, including 102 in the cryoballoon CA group and 102 in the AAD group. Participants were followed up with for 36 months. The primary study endpoint was the first occurrence of persistent atrial tachyarrhythmia, while secondary endpoints included the event rates of persistent atrial tachyarrhythmia at 1 and 2 years. The primary safety endpoint was serious adverse events. Results Overall, the 36-month follow-up was completed by 154 subjects (75.5%). At 3 years, documented progression from paroxysmal AF to persistent atrial tachyarrhythmia had occurred in 2 of the 102 patients assigned to undergo cryoballoon CA [2.203% (95% confidence interval (CI), 0.554–8.537)] and in 17 of the 102 patients assigned to receive AADs [20.223% (95% CI, 13.040–30.604)] [hazard ratio (HR), 0.107; 95% CI, 0.043–0.262; P < 0.001]. Lower rates of progression in the cryoballoon CA group compared to the AAD group were already obvious at 1 year [1.053% (95% CI, 0.149–7.238) vs. 5.284% (95% CI, 2.233–12.237)] [HR, 0.193; (95% CI, 0.039–0.956; P = 0.09)] and 2 years [2.203% (95% CI, 0.554–8.537) vs. 12.430% (95% CI, 7.066–21.371)] (HR, 0.169; 95% CI, 0.057–0.501, P < 0.001). Serious adverse events occurred in 7 of the 102 patients (6.9%) in the cryoballoon CA group and 9 of the 102 patients (8.8%) in the AAD group. Conclusion Cryoballoon CA was superior to AAD therapy in preventing the occurrence of persistent atrial tachyarrhythmia in patients with paroxysmal AF who had not received prior rhythm control therapy. Serious adverse events were rare.
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104
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Fang Q, Wang J, Wei J, Long X, Wang Y, He J, Yuan X, Du J. Transcriptomic profile analysis of the left atrium in spontaneously hypertensive rats in the early stage. Front Pharmacol 2022; 13:989636. [PMID: 36324689 PMCID: PMC9620422 DOI: 10.3389/fphar.2022.989636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/28/2022] [Indexed: 11/19/2022] Open
Abstract
Left atrial remodeling, characterized by enlargement and hypertrophy of the left atrium and increased fibrosis, was accompanied by an increased incidence of atrial fibrillation. While before morphological changes at the early stage of hypertension, how overloaded hypertension influences the transcriptomic profile of the left atrium remains unclear. Therefore, RNA-sequencing was performed to define the RNA expressing profiles of left atrium in spontaneously hypertensive rats (SHRs) and normotensive Wistar-Kyoto (WKY) rats as a control group. We also compared the changes in the RNA expression profiles in SHRs treated with an angiotensin receptor blocker (ARB) and angiotensin receptor-neprilysin inhibitor (ARNI) to assess the distinct effects on the left atrium. In total, 1,558 differentially expressed genes were found in the left atrium between WKY rats and SHRs. Bioinformatics analysis showed that these mRNAs could regulate upstream pathways in atrial remodeling through atrial fibrosis, inflammation, electrical remodeling, and cardiac metabolism. The regulated transcripts detected in the left atrial tissue in both the ARB-treated and ARNI-treated groups were related to metabolism. In contrast to the ARB-treated rates, the transcripts in ARNI-treated rats were mapped to the cyclic guanosine monophosphate-protein kinase G signaling pathway.
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Affiliation(s)
- Qinghua Fang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Wang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiangjun Wei
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xianglin Long
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yao Wang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiacheng He
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin Yuan
- Department of Nephrology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jianlin Du
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Jianlin Du,
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105
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Anti-inflammatory effects of endothelin receptor blockade in left atrial tissue of spontaneously hypertensive rats. IJC HEART & VASCULATURE 2022; 42:101088. [PMID: 35879971 PMCID: PMC9307454 DOI: 10.1016/j.ijcha.2022.101088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 11/22/2022]
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106
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The Predictive Value of Epicardial Fat Tissue Volume in the Occurrence and Development of Atrial Fibrillation: A Systematic Review and Meta-Analysis. Cardiol Res Pract 2022; 2022:2090309. [PMID: 36213458 PMCID: PMC9537030 DOI: 10.1155/2022/2090309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/20/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background Atrial fibrillation (AF) is one of the most common arrhythmias in clinical practice. Although fat is currently considered to be a risk factor for AF and a pathogenic link between epicardial fat tissue (EFT) and AF has been speculated, there are currently few clinical studies and literature data domestically or abroad. Objective This study conducted a meta-analysis of observational case series studies to verify the relationship between atrial fibrillation and EFT and to strengthen the predictive value of EFT in the occurrence, development, and postablative recurrence of AF. Methods We conducted a systematic search of the literature in electronic databases until December 2021 and supplemented this through manual searches of individual studies, reviewed articles, and reference lists in conference proceedings. This study conducted a meta-analysis to compare the differences between different populations, such as healthy participants and AF patients, healthy subjects and AF subtype cases, and paroxysmal and persistent AF with AF recurrence and without AF recurrence after ablation. Results Following the retrieval of 828 articles, only 22 articles were selected as research results. Accordingly, the meta-analysis results show that the volume of EFT in AF is greater than that in healthy subjects (MD = 39.34 ml, 95% CI = 27.11, 51.58); persistent AF is greater than paroxysmal AF (MD = 14.37 ml, 95% CI = 7.46, 21.27); and recurrence after ablation is greater than without recurrence (MD = 14.37 ml, 95% CI = 7.46, 21.27). Conclusion The results of this study further confirm the connection between EFT and AF and that EFT has a certain predictive value for the occurrence and development of AF.
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107
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The Complex Relation between Atrial Cardiomyopathy and Thrombogenesis. Cells 2022; 11:cells11192963. [PMID: 36230924 PMCID: PMC9563762 DOI: 10.3390/cells11192963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
Heart disease, as well as systemic metabolic alterations, can leave a ‘fingerprint’ of structural and functional changes in the atrial myocardium, leading to the onset of atrial cardiomyopathy. As demonstrated in various animal models, some of these changes, such as fibrosis, cardiomyocyte hypertrophy and fatty infiltration, can increase vulnerability to atrial fibrillation (AF), the most relevant manifestation of atrial cardiomyopathy in clinical practice. Atrial cardiomyopathy accompanying AF is associated with thromboembolic events, such as stroke. The interaction between AF and stroke appears to be far more complicated than initially believed. AF and stroke share many risk factors whose underlying pathological processes can reinforce the development and progression of both cardiovascular conditions. In this review, we summarize the main mechanisms by which atrial cardiomyopathy, preceding AF, supports thrombogenic events within the atrial cavity and myocardial interstitial space. Moreover, we report the pleiotropic effects of activated coagulation factors on atrial remodeling, which may aggravate atrial cardiomyopathy. Finally, we address the complex association between AF and stroke, which can be explained by a multidirectional causal relation between atrial cardiomyopathy and hypercoagulability.
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108
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Cellular heterogeneity and repolarisation across the atria: an in silico study. Med Biol Eng Comput 2022; 60:3153-3168. [PMID: 36104609 PMCID: PMC9537222 DOI: 10.1007/s11517-022-02640-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/28/2022] [Indexed: 11/08/2022]
Abstract
Mechanisms of atrial fibrillation and the susceptibility to reentries can be impacted by the repolarization across the atria. Studies into atrial fibrillation ignore cell-to-cell heterogeneity due to electrotonic coupling. Recent studies show that cellular variability may have a larger impact on electrophysiological behaviour than assumed. This paper aims to determine the impact of cellular heterogeneity on the repolarization phase across the AF remodelled atria. Using a population of models approach, 10 anatomically identical atrial models were created to include cellular heterogeneity. Atrial models were compared with an equivalent homogenous model. Activation, APD90, and repolarization maps were used to compare models. The impact of electrotonic coupling in the tissue was determined through a comparison of RMP, APD20, APD50, APD90, and triangulation between regional atrial tissue and the single cell populations. After calibration, cellular heterogeneity does not impact atrial depolarization. Repolarization patterns were significantly impacted by cellular heterogeneity, with the APD90 across the LA increasing due to heterogeneity and the reverse occurring in the RA. Electrotonic coupling caused a reduction in variability across all biomarkers but did not fully remove variability. Electrotonic coupling resulted in an increase in APD20 and APD50, and reduced triangulation compared to isolated cell populations. Heterogeneity also caused a reduction in triangulation compared with regionally homogeneous atria.
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109
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Kawczynski MJ, Van De Walle S, Maesen B, Isaacs A, Zeemering S, Hermans B, Vernooy K, Maessen JG, Schotten U, Bidar E. Preoperative P-wave parameters and risk of atrial fibrillation after cardiac surgery: a meta-analysis of 20 201 patients. Interact Cardiovasc Thorac Surg 2022; 35:6673150. [PMID: 35993895 PMCID: PMC9492265 DOI: 10.1093/icvts/ivac220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/19/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
To evaluate the role of P-wave parameters, as defined on preprocedural electrocardiography (ECG), in predicting atrial fibrillation after cardiac surgery [postoperative atrial fibrillation (POAF)].
METHODS
PubMed, Cochrane library and Embase were searched for studies reporting on P-wave parameters and risk of POAF. Meta-analysis of P-wave parameters reported by at least 5 different publications was performed. In case of receiver operator characteristics (ROC-curve) analysis in the original publications, an ROC meta-analysis was performed to summarize the sensitivity and specificity.
RESULTS
Thirty-two publications, with a total of 20 201 patients, contributed to the meta-analysis. Increased P-wave duration, measured on conventional 12-lead ECG (22 studies, Cohen’s d = 0.4, 95% confidence interval: 0.3–0.5, P < 0.0001) and signal-averaged ECG (12 studies, Cohen’s d = 0.8, 95% confidence interval: 0.5–1.2, P < 0.0001), was a predictor of POAF independently from left atrial size. ROC meta-analysis for signal-averaged ECG P-wave duration showed an overall sensitivity of 72% (95% confidence interval: 65–78%) and specificity of 68% (95% confidence interval: 58–77%). Summary ROC curve had a moderate discriminative power with an area under the curve of 0.76. There was substantial heterogeneity in the meta-analyses for P-wave dispersion and PR-interval.
CONCLUSIONS
This meta-analysis shows that increased P-wave duration, measured on conventional 12-lead ECG and signal-averaged ECG, predicted POAF in patients undergoing cardiac surgery.
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Affiliation(s)
- Michal J Kawczynski
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre , Maastricht, Netherlands
- Department of Physiology, Maastricht University , Maastricht, Netherlands
| | - Sophie Van De Walle
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre , Maastricht, Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre , Maastricht, Netherlands
- Department of Physiology, Maastricht University , Maastricht, Netherlands
| | - Aaron Isaacs
- Department of Physiology, Maastricht University , Maastricht, Netherlands
| | - Stef Zeemering
- Department of Physiology, Maastricht University , Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM) , Maastricht, Netherlands
| | - Ben Hermans
- Department of Physiology, Maastricht University , Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM) , Maastricht, Netherlands
| | - Kevin Vernooy
- Cardiovascular Research Institute Maastricht (CARIM) , Maastricht, Netherlands
- Department of Cardiology, Heart and Vascular Centre, Maastricht University Medical Centre , Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre , Maastricht, Netherlands
- Department of Physiology, Maastricht University , Maastricht, Netherlands
| | - Ulrich Schotten
- Department of Physiology, Maastricht University , Maastricht, Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre , Maastricht, Netherlands
- Department of Physiology, Maastricht University , Maastricht, Netherlands
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MANFRIN M, MUGNAI G, CHIERCHIA GB, de ASMUNDIS C, BILATO C, RAUHE W. Left atrial hypertension invasively measured during pulmonary vein isolation predicts atrial fibrillation recurrence. Minerva Cardiol Angiol 2022; 70:529-536. [DOI: 10.23736/s2724-5683.20.05418-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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111
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Ravarotto V, Bertoldi G, Stefanelli LF, Nalesso F, Calò LA. Pathomechanism of oxidative stress in cardiovascularrenal remodeling and therapeutic strategies. Kidney Res Clin Pract 2022; 41:533-544. [PMID: 36239057 PMCID: PMC9576462 DOI: 10.23876/j.krcp.22.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 11/15/2023] Open
Abstract
The high prevalence of cardiovascular disease in patients with chronic kidney disease indicates significant interactions between pathogenic pathways operating in the kidney and heart. These interactions involve all cell types (endothelial cells, smooth muscle cells, macrophages, and others), components of the vasculature, glomeruli, and heart that are susceptible to oxidative damage and structural alterations. A vicious cycle occurs whereby harmful factors such as reactive oxygen species and inflammation damage of vascular structures that themselves become sources of additional dangerous/toxic components released into the local environment. The evidence of this vicious cycle in chronic kidney disease should therefore lead to add other factors to both traditional and nontraditional risk factors. This review will examine the processes occurring during progressive kidney dysfunction with regard to vascular injury, renal remodeling, cardiac hypertrophy, and the transversal role of oxidative stress in the development of these complications.
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Affiliation(s)
- Verdiana Ravarotto
- Division of Nephrology, Dialysis and Transplantation, Department of Medicine (DIMED), School of Medicine, University of Padova, Padova, Italy
| | - Giovanni Bertoldi
- Division of Nephrology, Dialysis and Transplantation, Department of Medicine (DIMED), School of Medicine, University of Padova, Padova, Italy
| | - Lucia Federica Stefanelli
- Division of Nephrology, Dialysis and Transplantation, Department of Medicine (DIMED), School of Medicine, University of Padova, Padova, Italy
| | - Federico Nalesso
- Division of Nephrology, Dialysis and Transplantation, Department of Medicine (DIMED), School of Medicine, University of Padova, Padova, Italy
| | - Lorenzo A. Calò
- Division of Nephrology, Dialysis and Transplantation, Department of Medicine (DIMED), School of Medicine, University of Padova, Padova, Italy
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112
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Shah SP, Sah RP, Panthi S, Shah RK, Acharya R, Neupane D, Puri R, Poudel S, Basnet LB. Atrial Fibrillation among Patients Admitted to the Department of Internal Medicine in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:756-760. [PMID: 36705122 PMCID: PMC9794939 DOI: 10.31729/jnma.7858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Atrial fibrillation is one of the commonest arrhythmias with an overall prevalence estimated to be 0.4-1% in the general population. The objective of this study was to find out the prevalence of atrial fibrillation among patients admitted to the Department of Internal Medicine in a tertiary care centre. METHODS A descriptive cross-sectional study was conducted among patients admitted to the Department of Internal Medicine of a tertiary care centre from 01 March 2021 to 01 March 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: IRC-478/2021). Convenience sampling method was used. Data were collected from the hospital records using a semi-structured study proforma including demography, clinical presentation, laboratory investigations, electrocardiogram, 2-dimension echocardiography, and CHA2DS2VASc score. Point estimate and 95% Confidence Interval were calculated. RESULTS Among 27,980 patients, atrial fibrillation was found in 185 (0.66%) (0.58-0.77, 95% Confidence Interval). Among them 66 (35.67%) were in the age group of 61-70 years and 97 (52.43%) were females. Dyspnea was present in 149 (80.54%), palpitation in 137 (74.05%) and pedal edema in 117 (63.27%). Valvular atrial fibrillation was seen in 101 (54.59%) and non-valvular atrial fibrillation was seen in 84 (45.41%) patients. CONCLUSIONS The prevalence of atrial fibrillation was found to be similar when compared to other studies conducted in similar settings.
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Affiliation(s)
- Surendra Prasad Shah
- Department of Internal Medicine, Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal,Correspondence: Dr Surendra Prasad Shah, Department of Internal Medicine, Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal. , Phone: +977-9860101376
| | - Ram Pratap Sah
- Department of Internal Medicine, Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal
| | - Sagar Panthi
- Department of Internal Medicine, Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal
| | - Rakesh Kumar Shah
- Department of Internal Medicine, Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal
| | - Rochana Acharya
- B. P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
| | - Durga Neupane
- B. P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
| | - Reecha Puri
- Manmohan Memorial Institute of Health Sciences, Maharajgunj, Kathmandu, Nepal
| | - Sulaksha Poudel
- Curative Service Division, Department of Health Services, Teku, Kathmandu, Nepal
| | - Lila Bahadur Basnet
- Curative Service Division, Department of Health Services, Teku, Kathmandu, Nepal
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113
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Cao S, Han C, Xuan C, Li X, Wen J, Xu D. Effects of cGMP/Akt/GSK-3β signaling pathway on atrial natriuretic peptide secretion in rabbits with rapid atrial pacing. Front Physiol 2022; 13:861981. [PMID: 36060704 PMCID: PMC9437264 DOI: 10.3389/fphys.2022.861981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Atrial natriuretic peptide (ANP) plays a pivotal role in the regulation of the cardiovascular system. The ANP level increases during atrial fibrillation (AF), suggesting that AF may provoke ANP secretion, but its potential mechanism is still unclear. In the present study, the potential mechanisms of rapid atrial pacing (RAP) regulating ANP secretion was explored. Rabbits were subjected to burst RAP, ANP secretion increased whereas cyclic guanosine monophosphate (cGMP) concentrations decreased during RAP. The p-Akt and p-GSK-3β levels decreased in atrial tissues. Natriuretic peptide receptor A (NPR-A) protein and particulate guanylate cyclase (PGC) activity were detected. The sensitivity of NPR-A to ANP decreased, leading to the decrease of PGC activity. Also, the isolated atrial perfusion system were made in the rabbit model, cGMP was shown to inhibit ANP secretion, and the Akt inhibitor LY294002 (LY) and GSK-3β inhibitor SB216763 (SB) attenuated the inhibitory effects of cGMP on ANP secretion and enhanced the inhibitory effects of cGMP on atrial dynamics. In conclusion, NPR-A interacts with ANP to regulate PGC expression, and influence the expression of cGMP during RAP, which involves in the Akt/GSK-3β signaling pathway. From the aforementioned points we conclude that cGMP regulates ANP secretion by the Akt/GSK-3β signaling pathway during atrial pacing.
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Affiliation(s)
- Shuxia Cao
- Center of Morphological Experiment, Medical College of Yanbian University, Jilin, China
| | - Chengyong Han
- Center of Morphological Experiment, Medical College of Yanbian University, Jilin, China
| | - Chunhua Xuan
- Department of Cardiology, Affiliated Hospital of Yanbian University, Jilin, China
| | - Xiangdan Li
- Center of Morphological Experiment, Medical College of Yanbian University, Jilin, China
| | - Jing Wen
- Key Laboratory of Medical Electrophysiology, Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
- *Correspondence: Jing Wen, ; Dongyuan Xu,
| | - Dongyuan Xu
- Center of Morphological Experiment, Medical College of Yanbian University, Jilin, China
- *Correspondence: Jing Wen, ; Dongyuan Xu,
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Yue H, Liang W, Zhan Y, Zhang Z, Qin X, Bian L, He K, Wu Z. Colchicine: Emerging therapeutic effects on atrial fibrillation by alleviating myocardial fibrosis in a rat model. Biomed Pharmacother 2022; 154:113573. [PMID: 35987161 DOI: 10.1016/j.biopha.2022.113573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/07/2022] [Accepted: 08/15/2022] [Indexed: 11/19/2022] Open
Abstract
Although many research have found that colchicine has general therapeutic effect in cardiovascular disease, the therapeutic mechanism in atrial fibrillation has not been clearly studied. To explore whether colchicine plays a role in the treatment of AF by reducing myocardial fibrosis, we performed a series of studies. Rat models of AF were induced by Ach-CaCl2 to assess the therapeutic effect of colchicine at doses of 0.8 mg/kg on the duration of AF rhythm, degree of myocardial fibrosis, and secretion of inflammatory factors in the serum. RNA-Seq was also performed to elucidate the possible mechanisms by which colchicine might reduce the alleviation of myocardial fibrosis associated with AF. These studies showed that colchicine reduced the duration of AF and the degree of fibrosis in the left atrium and that it significantly reduced the secretion of TGFβ1, activin A, collagen I, and collagen III. These results suggest that colchicine may reduce myocardial fibrosis by (1) inhibiting the TGFβ1/ALK5 and activin A/ALK4 fibrosis pathways; (2) inhibiting the activation, phenotypic transformation, and apoptosis resistance of myocardial fibroblasts; and (3) reducing the synthesis of inflammatory factors and collagen.
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Affiliation(s)
- Honghua Yue
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Weitao Liang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yujia Zhan
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Zheng Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoli Qin
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Longrong Bian
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Kang He
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China.
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115
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Goette A, Borof K, Breithardt G, Camm AJ, Crijns HJGM, Kuck KH, Wegscheider K, Kirchhof P. Presenting Pattern of Atrial Fibrillation and Outcomes of Early Rhythm Control Therapy. J Am Coll Cardiol 2022; 80:283-295. [PMID: 35863844 DOI: 10.1016/j.jacc.2022.04.058] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Whether atrial fibrillation (AF) pattern or timing of AF therapy modifies the effectiveness of early rhythm control (ERC) is not known. OBJECTIVES This study sought to compare clinical characteristics and outcomes in patients presenting with different AF patterns on ERC vs usual care. METHODS The effects of ERC were compared in first-diagnosed AF (FDAF), paroxysmal AF (paroxAF), and persistent AF (persAF) in this prespecified analysis of the EAST-AFNET 4 (Early treatment of atrial fibrillation for stroke prevention) trial. Associations between AF pattern and primary outcomes (first primary outcome: cardiovascular death, stroke, and hospitalization for heart failure and acute coronary syndrome; second primary outcome: nights spent in hospital per year) were compared over a mean follow-up of 5.1 years. Changes in health-related quality of life were assessed by the EQ-5D. RESULTS FDAF patients (n = 1,048, enrolled 7 days after diagnosing AF) were slightly older (71 years of age, 48.0% female) than patients with paroxAF (n = 994, 70 years of age, 50.0% female) and persAF (n = 743, 70 years of age, 38.0% female). ERC reduced the primary outcome in all 3 AF patterns. Hospitalizations for acute coronary syndrome were highest in FDAF (incidence rate ratio [IRR]: 1.50; 95% CI: 0.83-2.69; P for interaction = 0.032) compared with paroxAF (IRR: 0.64; 95% CI: 0.32-1.25) and persAF (IRR: 0.50; 95% CI: 0.25-1.00). FDAF patients spent more nights in hospital (IRR: 1.38; 95% CI: 1.12-1.70; P for interaction = 0.004) than paroxAF (IRR: 0.84; 95% CI: 0.67-1.03), and persAF (IRR: 1.02; 95% CI: 0.80-1.30) patients. ERC improved health-related quality of life (EQ-5D score) in patients with paroxAF and persAF but not in patients with FDAF (P = 0.019). CONCLUSIONS ERC reduces the first primary composite outcome in all AF patterns. Patients with FDAF are at high risk for hospitalization and acute coronary syndrome, particularly on ERC. (Early treatment of atrial fibrillation for stroke prevention trial; ISRCTN04708680; Early Treatment of Atrial Fibrillation for Stroke Prevention Trial [EAST]; NCT01288352; Early treatment of Atrial fibrillation for Stroke prevention Trial [EAST]; EudraCT2010-021258-20).
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Affiliation(s)
- Andreas Goette
- Department of Cardiology and Intensive Care Medicine, St. Vincenz Hospital, Paderborn, Germany; AFNET e.V., Münster, Germany.
| | - Katrin Borof
- AFNET e.V., Münster, Germany; Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Günter Breithardt
- AFNET e.V., Münster, Germany; Department of Cardiology and Angiology, University Hospital Münster, Münster, Germany
| | - A John Camm
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London, London, United Kingdom
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | | | - Karl Wegscheider
- Institute for Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
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116
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Karamichalakis N, Kolovos V, Paraskevaidis I, Tsougos E. A New Hope: Sodium-Glucose Cotransporter-2 Inhibition to Prevent Atrial Fibrillation. J Cardiovasc Dev Dis 2022; 9:jcdd9080236. [PMID: 35893226 PMCID: PMC9331782 DOI: 10.3390/jcdd9080236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/17/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
Atrial arrhythmias are common in patients with diabetes mellitus (DM), and despite recent advances in pharmaceutical and invasive treatments, atrial fibrillation (AF) and atrial flutter (AFl) are still associated with substantial mortality and morbidity. Clinical trial data imply a protective effect of sodium-glucose cotransporter-2 inhibitors (SGLT2is) on the occurrence of AF and AFl. This review summarizes the state of knowledge regarding DM-mediated mechanisms responsible for AF genesis and recurrence but also discusses the recent data from experimental studies, published trials and metanalyses.
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117
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Conte M, Petraglia L, Cabaro S, Valerio V, Poggio P, Pilato E, Attena E, Russo V, Ferro A, Formisano P, Leosco D, Parisi V. Epicardial Adipose Tissue and Cardiac Arrhythmias: Focus on Atrial Fibrillation. Front Cardiovasc Med 2022; 9:932262. [PMID: 35845044 PMCID: PMC9280076 DOI: 10.3389/fcvm.2022.932262] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/13/2022] [Indexed: 01/02/2023] Open
Abstract
Atrial Fibrillation (AF) is the most frequent cardiac arrhythmia and its prevalence increases with age. AF is strongly associated with an increased risk of stroke, heart failure and cardiovascular mortality. Among the risk factors associated with AF onset and severity, obesity and inflammation play a prominent role. Numerous recent evidence suggested a role of epicardial adipose tissue (EAT), the visceral fat depot of the heart, in the development of AF. Several potential arrhythmogenic mechanisms have been attributed to EAT, including myocardial inflammation, fibrosis, oxidative stress, and fat infiltration. EAT is a local source of inflammatory mediators which potentially contribute to atrial collagen deposition and fibrosis, the anatomical substrate for AF. Moreover, the close proximity between EAT and myocardium allows the EAT to penetrate and generate atrial myocardium fat infiltrates that can alter atrial electrophysiological properties. These observations support the hypothesis of a strong implication of EAT in structural and electrical atrial remodeling, which underlies AF onset and burden. The measure of EAT, through different imaging methods, such as echocardiography, computed tomography and cardiac magnetic resonance, has been proposed as a useful prognostic tool to predict the presence, severity and recurrence of AF. Furthermore, EAT is increasingly emerging as a promising potential therapeutic target. This review aims to summarize the recent evidence exploring the potential role of EAT in the pathogenesis of AF, the main mechanisms by which EAT can promote structural and electrical atrial remodeling and the potential therapeutic strategies targeting the cardiac visceral fat.
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Affiliation(s)
- Maddalena Conte
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.,Casa di Cura San Michele, Maddaloni, Italy
| | - Laura Petraglia
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Serena Cabaro
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Emanuele Pilato
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Emilio Attena
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Vincenzo Russo
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" - Monaldi and Cotugno Hospital, Naples, Italy
| | - Adele Ferro
- Institute of Biostructure and Bioimaging, Consiglio Nazionale delle Ricerche, Naples, Italy
| | - Pietro Formisano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Dario Leosco
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Valentina Parisi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
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118
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Osorio D, Vraka A, Quesada A, Hornero F, Alcaraz R, Rieta JJ. An Efficient Hybrid Methodology for Local Activation Waves Detection under Complex Fractionated Atrial Electrograms of Atrial Fibrillation. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22145345. [PMID: 35891025 PMCID: PMC9316244 DOI: 10.3390/s22145345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/06/2022] [Accepted: 07/15/2022] [Indexed: 05/04/2023]
Abstract
Local activation waves (LAWs) detection in complex fractionated atrial electrograms (CFAEs) during catheter ablation (CA) of atrial fibrillation (AF), the commonest cardiac arrhythmia, is a complicated task due to their extreme variability and heterogeneity in amplitude and morphology. There are few published works on reliable LAWs detectors, which are efficient for regular or low fractionated bipolar electrograms (EGMs) but lack satisfactory results when CFAEs are analyzed. The aim of the present work is the development of a novel optimized method for LAWs detection in CFAEs in order to assist cardiac mapping and catheter ablation (CA) guidance. The database consists of 119 bipolar EGMs classified by AF types according to Wells' classification. The proposed method introduces an alternative Botteron's preprocessing technique targeting the slow and small-ampitude activations. The lower band-pass filter cut-off frequency is modified to 20 Hz, and a hyperbolic tangent function is applied over CFAEs. Detection is firstly performed through an amplitude-based threshold and an escalating cycle-length (CL) analysis. Activation time is calculated at each LAW's barycenter. Analysis is applied in five-second overlapping segments. LAWs were manually annotated by two experts and compared with algorithm-annotated LAWs. AF types I and II showed 100% accuracy and sensitivity. AF type III showed 92.77% accuracy and 95.30% sensitivity. The results of this study highlight the efficiency of the developed method in precisely detecting LAWs in CFAEs. Hence, it could be implemented on real-time mapping devices and used during CA, providing robust detection results regardless of the fractionation degree of the analyzed recordings.
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Affiliation(s)
- Diego Osorio
- BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, Spain; (D.O.); (A.V.)
| | - Aikaterini Vraka
- BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, Spain; (D.O.); (A.V.)
| | - Aurelio Quesada
- Arrhythmia Unit, Cardiology Department, General University Hospital Consortium of Valencia, 46014 Valencia, Spain;
| | - Fernando Hornero
- Cardiovascular Surgery Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Raúl Alcaraz
- Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha, 16071 Cuenca, Spain;
| | - José J. Rieta
- BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, Spain; (D.O.); (A.V.)
- Correspondence:
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119
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Sertcakacilar G, Yildiz GO. Association between Anemia and New-Onset Atrial Fibrillation in Critically Ill Patients in the Intensive Care Unit: A Retrospective Cohort Analysis. Clin Pract 2022; 12:533-544. [PMID: 35892443 PMCID: PMC9326761 DOI: 10.3390/clinpract12040057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/05/2022] [Accepted: 07/09/2022] [Indexed: 01/28/2023] Open
Abstract
New-onset atrial fibrillation (NOAF) is one of the leading causes of morbidity and mortality, especially in older patients in the intensive care unit (ICU). Although many comorbidities are associated with NOAF, the effect of anemia on the onset of atrial fibrillation is still unknown. This study aimed to test the hypothesis that anemia is associated with an increased risk of developing NOAF in critically ill patients in intensive care. We performed a retrospective analysis of critically ill patients who underwent routine hemoglobin and electrocardiography monitoring in the ICU. Receiver operating characteristics analysis determined the hemoglobin (Hb) value that triggered NOAF formation. Bivariate correlation was used to determine the relationship between anemia and NOAF. The incidence of NOAF was 9.9% in the total population, and 12.8% in the patient group with anemia. Analysis of 1931 patients revealed a negative association between anemia and the development of NOAF in the ICU. The stimulatory Hb cut-off value for the formation of NOAF was determined as 9.64 g/dL. Anemia is associated with the development of NOAF in critically ill patients in intensive care.
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Affiliation(s)
- Gokhan Sertcakacilar
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Anesthesiology and Reanimation, University of Health Science, Bakırköy Dr. Sadi Konuk Education and Research Hospital, 34147 Istanbul, Turkey;
- Correspondence:
| | - Gunes Ozlem Yildiz
- Department of Anesthesiology and Reanimation, University of Health Science, Bakırköy Dr. Sadi Konuk Education and Research Hospital, 34147 Istanbul, Turkey;
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120
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Wang S, Zhang J, Hao S, Zhu L, Ning Z, Zhao Z. Percutaneous Retrieval of Left Atrial Appendage Closure Devices in Patients With Atrial Fibrillation: A Case Report. Front Cardiovasc Med 2022; 9:905344. [PMID: 35872919 PMCID: PMC9301371 DOI: 10.3389/fcvm.2022.905344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Left atrial appendage closure (LAAC) devices can be inadvertently released into unfavorable locations, which may allow them to migrate to a different position within the left atrial appendage or embolize from the heart into the aorta. In such instances, it can be challenging to remove the LAAC device. Here, we present two cases in which patients with atrial fibrillation experienced LAAC device exposure at an inappropriate site because of interventional operator error and device mismatch: (a) the LAAC device was dislodged into the aortic arch and retrieved percutaneously from the femoral artery route, and (b) in the left atrium, which was dislodged into the left atrium and retrieved via atrial transseptal puncture of the femoral vein.
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Affiliation(s)
- Saihua Wang
- Department of Cardiology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Juhua Zhang
- Department of Social Medicine and Health Career Management, School of Public Administration, Fudan University, Shanghai, China
| | - Shuwen Hao
- Department of Cardiology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Luoning Zhu
- Department of Cardiology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Zhongping Ning
- Department of Cardiology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
- *Correspondence: Zhongping Ning,
| | - Zhihong Zhao
- Department of Cardiology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
- Zhihong Zhao,
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121
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Cunha PS, Laranjo S, Heijman J, Oliveira MM. The Atrium in Atrial Fibrillation - A Clinical Review on How to Manage Atrial Fibrotic Substrates. Front Cardiovasc Med 2022; 9:879984. [PMID: 35859594 PMCID: PMC9289204 DOI: 10.3389/fcvm.2022.879984] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/03/2022] [Indexed: 12/27/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia in the population and is associated with a significant clinical and economic burden. Rigorous assessment of the presence and degree of an atrial arrhythmic substrate is essential for determining treatment options, predicting long-term success after catheter ablation, and as a substrate critical in the pathophysiology of atrial thrombogenesis. Catheter ablation of AF has developed into an essential rhythm-control strategy. Nowadays is one of the most common cardiac ablation procedures performed worldwide, with its success inversely related to the extent of atrial structural disease. Although atrial substrate evaluation remains complex, several diagnostic resources allow for a more comprehensive assessment and quantification of the extent of left atrial structural remodeling and the presence of atrial fibrosis. In this review, we summarize the current knowledge on the pathophysiology, etiology, and electrophysiological aspects of atrial substrates promoting the development of AF. We also describe the risk factors for its development and how to diagnose its presence using imaging, electrocardiograms, and electroanatomic voltage mapping. Finally, we discuss recent data regarding fibrosis biomarkers that could help diagnose atrial fibrotic substrates.
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Affiliation(s)
- Pedro Silva Cunha
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Center, Lisbon, Portugal
- Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Sérgio Laranjo
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Center, Lisbon, Portugal
- Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Jordi Heijman
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Mário Martins Oliveira
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Center, Lisbon, Portugal
- Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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122
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Angiotensin II Mediates Cardiomyocyte Hypertrophy in Atrial Cardiomyopathy via Epigenetic Transcriptional Regulation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:6312100. [PMID: 35756425 PMCID: PMC9232324 DOI: 10.1155/2022/6312100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 12/02/2022]
Abstract
Aims European Heart Rhythm Association established an expert consensus to define, characterize, and classify atrial cardiomyopathy into four subgroups based on their histopathological features. The predominant pathological feature of classes I and III is the hypertrophy of atrial cardiomyocytes. Here, we aim to investigate the mechanism of epigenetic transcriptional regulation of cardiomyocyte hypertrophy in atrial cardiomyopathy. Methods and Results Compared with that of sinus rhythm control individuals, the myocardium of patients with atrial fibrillation exhibited increased levels of angiotensin II (AngII), chromatin-bound myocyte enhancer factor 2 (MEF2), acetylated histone H4 (H4ac), and H3K27ac; upregulation of hypertrophy-related genes; and decreased levels of histone deacetylase (HDAC) 4 and HDAC5 bound to the promoters of hypertrophy-related genes. Furthermore, incubation of atrial cardiomyocytes with AngII increased their cross-sectional area and improved the expression of hypertrophy-related genes. AngII also promoted the phosphorylation of HDAC4 and HDAC5 and induced their nuclear export. RNA sequencing analyses revealed that AngII significantly upregulated genes associated with cardiac hypertrophy. Chromatin immunoprecipitation showed that this correlated with increased levels of chromatin-bound MEF2, H4ac, and H3K27ac and decreased HDAC4 and HDAC5 enrichment in the promoters of hypertrophy-related genes. Moreover, these AngII-induced prohypertrophic effects could be partially reverted by treatment with the AngII receptor blocker losartan. Conclusions AngII had a prohypertrophic effect on atrial cardiomyopathy which was epigenetic-dependent. Patients with atrial fibrillation manifest an increased susceptibility to hypertrophy and exhibit epigenetic characteristics that are permissive for the transcription of hypertrophy-related genes. AngII induces histone acetylation via the cytoplasmic-nuclear shuttling of HDACs, which constitutes a novel mechanism of atrial hypertrophy regulation and might provide a promising therapeutic strategy for atrial cardiomyopathy.
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123
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Pilz PM, Ward JE, Chang WT, Kiss A, Bateh E, Jha A, Fisch S, Podesser BK, Liao R. Large and Small Animal Models of Heart Failure With Reduced Ejection Fraction. Circ Res 2022; 130:1888-1905. [PMID: 35679365 DOI: 10.1161/circresaha.122.320246] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Heart failure (HF) describes a heterogenous complex spectrum of pathological conditions that results in structural and functional remodeling leading to subsequent impairment of cardiac function, including either systolic dysfunction, diastolic dysfunction, or both. Several factors chronically lead to HF, including cardiac volume and pressure overload that may result from hypertension, valvular lesions, acute, or chronic ischemic injuries. Major forms of HF include hypertrophic, dilated, and restrictive cardiomyopathy. The severity of cardiomyopathy can be impacted by other comorbidities such as diabetes or obesity and external stress factors. Age is another major contributor, and the number of patients with HF is rising worldwide in part due to an increase in the aged population. HF can occur with reduced ejection fraction (HF with reduced ejection fraction), that is, the overall cardiac function is compromised, and typically the left ventricular ejection fraction is lower than 40%. In some cases of HF, the ejection fraction is preserved (HF with preserved ejection fraction). Animal models play a critical role in facilitating the understanding of molecular mechanisms of how hearts fail. This review aims to summarize and describe the strengths, limitations, and outcomes of both small and large animal models of HF with reduced ejection fraction that are currently used in basic and translational research. The driving defect is a failure of the heart to adequately supply the tissues with blood due to impaired filling or pumping. An accurate model of HF with reduced ejection fraction would encompass the symptoms (fatigue, dyspnea, exercise intolerance, and edema) along with the pathology (collagen fibrosis, ventricular hypertrophy) and ultimately exhibit a decrease in cardiac output. Although countless experimental studies have been published, no model completely recapitulates the full human disease. Therefore, it is critical to evaluate the strength and weakness of each animal model to allow better selection of what animal models to use to address the scientific question proposed.
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Affiliation(s)
- Patrick M Pilz
- Stanford Cardiovascular Institute, Stanford University School of Medicine, CA (P.M.P., E.B., R.L.).,Ludwig Boltzmann Institute at the Center for Biomedical Research, Medical University of Vienna, Austria (P.M.P., A.K., B.K.P.)
| | - Jennifer E Ward
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, MA (J.E.W., S.F., R.L.)
| | - Wei-Ting Chang
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Taiwan (W.-T.C.).,Department of Cardiology, Chi-Mei Medical Center, Taiwan (W.-T.C.)
| | - Attila Kiss
- Ludwig Boltzmann Institute at the Center for Biomedical Research, Medical University of Vienna, Austria (P.M.P., A.K., B.K.P.)
| | - Edward Bateh
- Stanford Cardiovascular Institute, Stanford University School of Medicine, CA (P.M.P., E.B., R.L.)
| | - Alokkumar Jha
- Stanford Cardiovascular Institute, Stanford University School of Medicine, CA (P.M.P., E.B., R.L.)
| | - Sudeshna Fisch
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, MA (J.E.W., S.F., R.L.)
| | - Bruno K Podesser
- Ludwig Boltzmann Institute at the Center for Biomedical Research, Medical University of Vienna, Austria (P.M.P., A.K., B.K.P.)
| | - Ronglih Liao
- Stanford Cardiovascular Institute, Stanford University School of Medicine, CA (P.M.P., E.B., R.L.).,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, MA (J.E.W., S.F., R.L.)
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Camm AJ, Naccarelli GV, Mittal S, Crijns HJGM, Hohnloser SH, Ma CS, Natale A, Turakhia MP, Kirchhof P. The Increasing Role of Rhythm Control in Patients With Atrial Fibrillation: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:1932-1948. [PMID: 35550691 DOI: 10.1016/j.jacc.2022.03.337] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 12/16/2022]
Abstract
The considerable mortality and morbidity associated with atrial fibrillation (AF) pose a substantial burden on patients and health care services. Although the management of AF historically focused on decreasing AF recurrence, it evolved over time in favor of rate control. Recently, more emphasis has been placed on reducing adverse cardiovascular outcomes using rhythm control, generally by using safe and effective rhythm-control therapies (typically antiarrhythmic drugs and/or AF ablation). Evidence increasingly supports early rhythm control in patients with AF that has not become long-standing, but current clinical practice and guidelines do not yet fully reflect this change. Early rhythm control may effectively reduce irreversible atrial remodeling and prevent AF-related deaths, heart failure, and strokes in high-risk patients. It has the potential to halt progression and potentially save patients from years of symptomatic AF; therefore, it should be offered more widely.
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Affiliation(s)
- A John Camm
- Cardiovascular Clinical Academic Group, St George's University of London, London, United Kingdom.
| | - Gerald V Naccarelli
- Penn State Heart and Vascular Institute, Penn State University, Hershey, Pennsylvania, USA
| | - Suneet Mittal
- Snyder Center for Comprehensive Atrial Fibrillation and Department of Cardiology, Valley Health System, Ridgewood, New Jersey, USA
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre (MUMC) and Cardiovascular Research Institute (CARIM), Maastricht, the Netherlands
| | | | - Chang-Sheng Ma
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | - Mintu P Turakhia
- Center for Digital Health and Department of Medicine, Stanford University, Stanford, California, USA
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany; Atrial Fibrillation Network (AFNET), Münster, Germany; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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Ahmad M, Reddy S, Barkhane Z, Elmadi J, Satish Kumar L, Pugalenthi LS. Hyperthyroidism and the Risk of Cardiac Arrhythmias: A Narrative Review. Cureus 2022; 14:e24378. [PMID: 35619859 PMCID: PMC9126437 DOI: 10.7759/cureus.24378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/05/2022] Open
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Emerging Antiarrhythmic Drugs for Atrial Fibrillation. Int J Mol Sci 2022; 23:ijms23084096. [PMID: 35456912 PMCID: PMC9029767 DOI: 10.3390/ijms23084096] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF), the most common cardiac arrhythmia worldwide, is driven by complex mechanisms that differ between subgroups of patients. This complexity is apparent from the different forms in which AF presents itself (post-operative, paroxysmal and persistent), each with heterogeneous patterns and variable progression. Our current understanding of the mechanisms responsible for initiation, maintenance and progression of the different forms of AF has increased significantly in recent years. Nevertheless, antiarrhythmic drugs for the management of AF have not been developed based on the underlying arrhythmia mechanisms and none of the currently used drugs were specifically developed to target AF. With the increased knowledge on the mechanisms underlying different forms of AF, new opportunities for developing more effective and safer AF therapies are emerging. In this review, we provide an overview of potential novel antiarrhythmic approaches based on the underlying mechanisms of AF, focusing both on the development of novel antiarrhythmic agents and on the possibility of repurposing already marketed drugs. In addition, we discuss the opportunity of targeting some of the key players involved in the underlying AF mechanisms, such as ryanodine receptor type-2 (RyR2) channels and atrial-selective K+-currents (IK2P and ISK) for antiarrhythmic therapy. In addition, we highlight the opportunities for targeting components of inflammatory signaling (e.g., the NLRP3-inflammasome) and upstream mechanisms targeting fibroblast function to prevent structural remodeling and progression of AF. Finally, we critically appraise emerging antiarrhythmic drug principles and future directions for antiarrhythmic drug development, as well as their potential for improving AF management.
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127
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Liu FZ, Zaman JAB, Ehdaie A, Xue YM, Cingolani E, Bresee C, Chugh SS, Wu SL, Shehata M, Wang X. Atrial Fibrillation Mechanisms Before and After Pulmonary Vein Isolation Characterized by Non-Contact Charge Density Mapping. Heart Rhythm 2022; 19:1423-1432. [PMID: 35381379 DOI: 10.1016/j.hrthm.2022.03.1232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 03/21/2022] [Accepted: 03/26/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The interaction of pulmonary vein and putative non-pulmonary triggers of atrial fibrillation (AF) remains unclear, and has yet to translate into patient tailored ablation strategies. OBJECTIVE To use non-contact mapping to detail the global conduction patterns in paroxysmal and persistent AF and how they are modified during pulmonary vein ablation. METHODS 40 patients at atrial fibrillation ablation underwent mapping using a non-contact catheter (AcQMap, Acutus Medical Inc) before and after pulmonary vein isolation (PVI). Propagation history maps were analysed post-procedure for each patient to categorise conduction patterns into Focal, Organised reentrant and Disorganized patterns. RESULTS Activation patterns identified by using a non-contact mapping system can be sub-classified from three main patterns into subtypes (MacroReentrant and LocalisedReentrant subtypes, Disorganized 1 and Disorganized 2 subtypes). Persistent AF demonstrated more D-Patterns, and less O-Patterns and F-Patterns than paroxysmal AF. In addition, PAF patients inducible after PVI demonstrated a greater number and higher prevalence of MR subtypes than those non-inducible. PVs remained the critical region and included almost one third of all patterns across any AF-types. PVI was effective to eliminate PV-related functional phenotypes, and impacted on recurrence with other patterns. CONCLUSION Activation patterns identified using AcQMap can be classified into three main patterns (F-Patterns, O-Patterns and D-Patterns) as well as subtypes (MR and LR subtype, D1 and D2 subtype). PerAF was different from PAF in demonstrating a greater region number and prevalence of D-Patterns, but lower region number and prevalence of O-Patterns and F-Patterns.
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Affiliation(s)
- Fang-Zhou Liu
- Guandong Medical College, Guanzhou, China; Cedars Sinai Heart Institute, Los Angeles, CA USA
| | - Junaid A B Zaman
- Cedars Sinai Heart Institute, Los Angeles, CA USA; Keck Medicine of USC, Los Angeles, CA USA
| | | | - Yu-Mei Xue
- Guandong Medical College, Guanzhou, China
| | | | | | | | - Shu-Lin Wu
- Guandong Medical College, Guanzhou, China
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Lawrence MJ, Evans V, Whitley J, Pillai S, Williams PR, Coulson J, Krishnan M, Slade P, Power K, Morris RHK, Evans PA. The effects of apixaban on clot characteristics in atrial fibrillation: A novel pharmacodynamic biomarker. Pharmacol Res Perspect 2022; 10:e00937. [PMID: 35338612 PMCID: PMC8956932 DOI: 10.1002/prp2.937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 01/09/2023] Open
Abstract
Atrial fibrillation (AF) is a major risk factor for stroke. We aim to characterize AF patients and the effects of apixaban therapy in terms of clot microstructure using gel point analysis, a novel biomarker. Seventy-eight patients were included in the study, 50 Stroke with AF (AF-S), and 28 AF without stroke (AF). Pre- and post-anticoagulation samples were collected: gel point (GP) analysis was performed to obtain (i) TGP (the time taken to reach the GP or the clot formation time) and (ii) df , the fractal dimension of the clot, a quantification of clot fibrin microstructure at the GP. At baseline, the AF-S group had a df = 1.70 (±0.05) and TGP = 306 (±73 s). The AF group had a df = 1.70 ± 0.05 and TGP = 346 ± 78 s, showing a significantly shortened TGP in the stroke group (p = .008). For both groups, apixaban significantly prolonged TGP, p = .005, but resulted in no change in df. Apixaban prolonged clotting time while having no significant impact on the blood's ability to form stable clots (no change in df ). This indicates that apixaban provides protection from the formation of thrombi by reducing clotting kinetics.
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Affiliation(s)
- Matthew J Lawrence
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board, Swansea, UK.,Medical School, Swansea University, Swansea, UK
| | - Vanessa Evans
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board, Swansea, UK.,Medical School, Swansea University, Swansea, UK
| | - Janet Whitley
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board, Swansea, UK.,Medical School, Swansea University, Swansea, UK
| | - Suresh Pillai
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board, Swansea, UK.,Medical School, Swansea University, Swansea, UK
| | | | | | - Manju Krishnan
- Stroke Unit, Swansea Bay University Health Board, Swansea, UK
| | - Peter Slade
- Stroke Unit, Swansea Bay University Health Board, Swansea, UK
| | - Kieron Power
- Pharmacy Department, Swansea Bay University Health Board, Swansea, UK
| | - Roger H K Morris
- School of Applied Science, Cardiff Metropolitan University, Cardiff, UK
| | - Phillip A Evans
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board, Swansea, UK.,Medical School, Swansea University, Swansea, UK
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Power DA, Lampert J, Camaj A, Bienstock SW, Kocovic N, Bayes-Genis A, Miller MA, Bayés-de-Luna A, Fuster V. Cardiovascular Complications of Interatrial Conduction Block: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:1199-1211. [PMID: 35331415 DOI: 10.1016/j.jacc.2022.01.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/25/2022] [Indexed: 12/11/2022]
Abstract
Interatrial block (IAB) is an electrocardiographic pattern describing the conduction delay between the right and left atria. IAB is classified into 3 degrees of block that correspond to decreasing conduction in the region of Bachmann's bundle. Although initially considered benign in nature, specific subsets of IAB have been associated with atrial arrhythmias, elevated thromboembolic stroke risk, cognitive impairment, and mortality. As the pathophysiologic relationships between IAB and stroke are reinforced, investigation has now turned to the potential benefit of early detection, atrial imaging, cardiovascular risk factor modification, antiarrhythmic pharmacotherapy, and stroke prevention with oral anticoagulation. This review provides a contemporary overview of the epidemiology, pathophysiology, diagnosis, and management of IAB, with a focus on future directions.
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Affiliation(s)
- David A Power
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Joshua Lampert
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anton Camaj
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Solomon W Bienstock
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nikola Kocovic
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitario Germans Trias I Pujol, Badalona, Spain
| | - Marc A Miller
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Antoni Bayés-de-Luna
- Cardiovascular Research Foundation, Cardiovascular ICCC-Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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130
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Maesen B, Verheule S, Zeemering S, La Meir M, Nijs J, Lumeij S, Lau DH, Granier M, Crijns HJ, Maessen JG, Dhein S, Schotten U. Endomysial fibrosis, rather than overall connective tissue content, is the main determinant of conduction disturbances in human atrial fibrillation. Europace 2022; 24:1015-1024. [PMID: 35348667 PMCID: PMC9282911 DOI: 10.1093/europace/euac026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/15/2022] [Indexed: 12/20/2022] Open
Abstract
Aims Although in persistent atrial fibrillation (AF) a complex AF substrate characterized by a high incidence of conduction block has been reported, relatively little is known about AF complexity in paroxysmal AF (pAF). Also, the relative contribution of various aspects of structural alterations to conduction disturbances is not clear. In particular, the contribution of endomysial fibrosis to conduction disturbances during progression of AF has not been studied yet. Methods and results During cardiac surgery, epicardial high-density mapping was performed in patients with acutely induced (aAF, n = 11), pAF (n = 12), and longstanding persistent AF (persAF, n = 9) on the right atrial (RA) wall, the posterior left atrial wall (pLA) and the LA appendage (LAA). In RA appendages, overall and endomysial (myocyte-to-myocyte distances) fibrosis and connexin 43 (Cx43) distribution were quantified. Unipolar AF electrogram analysis showed a more complex pattern with a larger number of narrower waves, more breakthroughs and a higher fractionation index (FI) in persAF compared with aAF and pAF, with no differences between aAF and pAF. The FI was consistently higher at the pLA compared with the RA. Structurally, Cx43 lateralization increased with AF progression (aAF = 7.5 ± 8.9%, pAF = 24.7 ± 11.1%, persAF = 35.1 ± 11.4%, P < 0.001). Endomysial but not overall fibrosis correlated with AF complexity (r = 0.57, P = 0.001; r = 0.23, P = 0.20; respectively). Conclusions Atrial fibrillation complexity is highly variable in patients with pAF, but not significantly higher than in patients with acutely induced AF, while in patients with persistent AF complexity is higher. Among the structural alterations studied, endomysial fibrosis, but not overall fibrosis, is the strongest determinant of AF complexity.
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Affiliation(s)
- Bart Maesen
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Sander Verheule
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Physiology, Maastricht University, Universiteitssingel 50, PO Box 616, 6200MD Maastricht, The Netherlands
| | - Stef Zeemering
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Physiology, Maastricht University, Universiteitssingel 50, PO Box 616, 6200MD Maastricht, The Netherlands
| | - Mark La Meir
- Department of Cardiac Surgery, UZ Brussels, Brussels, Belgium
| | - Jan Nijs
- Department of Cardiac Surgery, UZ Brussels, Brussels, Belgium
| | - Stijn Lumeij
- Department of Physiology, Maastricht University, Universiteitssingel 50, PO Box 616, 6200MD Maastricht, The Netherlands
| | - Dennis H Lau
- Department of Physiology, Maastricht University, Universiteitssingel 50, PO Box 616, 6200MD Maastricht, The Netherlands
| | - Mathieu Granier
- Department of Physiology, Maastricht University, Universiteitssingel 50, PO Box 616, 6200MD Maastricht, The Netherlands
| | - Harry Jgm Crijns
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jos G Maessen
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Stefan Dhein
- Department of Cardiac Surgery, Clinic for Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Ulrich Schotten
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Physiology, Maastricht University, Universiteitssingel 50, PO Box 616, 6200MD Maastricht, The Netherlands
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131
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Ono K, Iwasaki YK, Akao M, Ikeda T, Ishii K, Inden Y, Kusano K, Kobayashi Y, Koretsune Y, Sasano T, Sumitomo N, Takahashi N, Niwano S, Hagiwara N, Hisatome I, Furukawa T, Honjo H, Maruyama T, Murakawa Y, Yasaka M, Watanabe E, Aiba T, Amino M, Itoh H, Ogawa H, Okumura Y, Aoki-Kamiya C, Kishihara J, Kodani E, Komatsu T, Sakamoto Y, Satomi K, Shiga T, Shinohara T, Suzuki A, Suzuki S, Sekiguchi Y, Nagase S, Hayami N, Harada M, Fujino T, Makiyama T, Maruyama M, Miake J, Muraji S, Murata H, Morita N, Yokoshiki H, Yoshioka K, Yodogawa K, Inoue H, Okumura K, Kimura T, Tsutsui H, Shimizu W. JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias. Circ J 2022; 86:1790-1924. [DOI: 10.1253/circj.cj-20-1212] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Yu-ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Masaharu Akao
- Department of Cardiovascular Medicine, National Hospital Organization Kyoto Medical Center
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Kuniaki Ishii
- Department of Pharmacology, Yamagata University Faculty of Medicine
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshinori Kobayashi
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | | | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | | | - Tetsushi Furukawa
- Department of Bio-information Pharmacology, Medical Research Institute, Tokyo Medical and Dental University
| | - Haruo Honjo
- Research Institute of Environmental Medicine, Nagoya University
| | - Toru Maruyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
| | - Yuji Murakawa
- The 4th Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi Hospital
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mari Amino
- Department of Cardiovascular Medicine, Tokai University School of Medicine
| | - Hideki Itoh
- Division of Patient Safety, Hiroshima University Hospital
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organisation Kyoto Medical Center
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Chizuko Aoki-Kamiya
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Eitaro Kodani
- Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Takashi Komatsu
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine
| | | | | | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Yukio Sekiguchi
- Department of Cardiology, National Hospital Organization Kasumigaura Medical Center
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Noriyuki Hayami
- Department of Fourth Internal Medicine, Teikyo University Mizonokuchi Hospital
| | | | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University, Faculty of Medicine
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashi Kosugi Hospital
| | - Junichiro Miake
- Department of Pharmacology, Tottori University Faculty of Medicine
| | - Shota Muraji
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | | | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Sapporo City General Hospital
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
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132
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Left atrial thrombus and smoke resolution in patients with atrial fibrillation under chronic oral anticoagulation. J Interv Card Electrophysiol 2022; 64:773-781. [DOI: 10.1007/s10840-022-01169-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
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133
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Paroxysmal Atrial Fibrillation in Horses: Pathophysiology, Diagnostics and Clinical Aspects. Animals (Basel) 2022; 12:ani12060698. [PMID: 35327097 PMCID: PMC8944606 DOI: 10.3390/ani12060698] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 02/07/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in horses causing poor performance. As in humans, the condition can be intermittent in nature, known as paroxysmal atrial fibrillation (pAF). This review covers the literature relating to pAF in horses and includes references to the human literature to compare pathophysiology, clinical presentation, diagnostic tools and treatment. The arrhythmia is diagnosed by auscultation and electrocardiography (ECG), and clinical signs can vary from sudden loss of racing performance to reduced fitness or no signs at all. If left untreated, pAF may promote electrical, functional and structural remodeling of the myocardium, thus creating a substrate that is able to maintain the arrhythmia, which over time may progress into permanent AF. Long-term ECG monitoring is essential for diagnosing the condition and fully understanding the duration and frequency of pAF episodes. The potential to adapt human cardiac monitoring systems and computational ECG analysis is therefore of interest and may benefit future diagnostic tools in equine medicine.
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134
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Zink MD, Laureanti R, Hermans BJM, Pison L, Verheule S, Philippens S, Pluymaekers N, Vroomen M, Hermans A, van Hunnik A, Crijns HJGM, Vernooy K, Linz D, Mainardi L, Auricchio A, Zeemering S, Schotten U. Extended ECG Improves Classification of Paroxysmal and Persistent Atrial Fibrillation Based on P- and f-Waves. Front Physiol 2022; 13:779826. [PMID: 35309059 PMCID: PMC8931504 DOI: 10.3389/fphys.2022.779826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/25/2022] [Indexed: 12/12/2022] Open
Abstract
Background The standard 12-lead ECG has been shown to be of value in characterizing atrial conduction properties. The added value of extended ECG recordings (longer recordings from more sites) has not been systematically explored yet. Objective The aim of this study is to employ an extended ECG to identify characteristics of atrial electrical activity related to paroxysmal vs. persistent atrial fibrillation (AF). Methods In 247 participants scheduled for AF ablation, an extended ECG was recorded (12 standard plus 3 additional leads, 5 min recording, no filtering). For patients presenting in sinus rhythm (SR), the signal-averaged P-wave and the spatiotemporal P-wave variability was analyzed. For patients presenting in AF, f-wave properties in the QRST (the amplitude complex of the ventricular electrical activity: Q-, R-, S-, and T-wave)-canceled ECG were determined. Results Significant differences between paroxysmal (N = 152) and persistent patients with AF (N = 95) were found in several P-wave and f-wave parameters, including parameters that can only be calculated from an extended ECG. Furthermore, a moderate, but significant correlation was found between echocardiographic parameters and P-wave and f-wave parameters. There was a moderate correlation of left atrial (LA) diameter with P-wave energy duration (r = 0.317, p < 0.001) and f-wave amplitude in lead A3 (r = -0.389, p = 0.002). The AF-type classification performance significantly improved when parameters calculated from the extended ECG were taken into account [area under the curve (AUC) = 0.58, interquartile range (IQR) 0.50-0.64 for standard ECG parameters only vs. AUC = 0.76, IQR 0.70-0.80 for extended ECG parameters, p < 0.001]. Conclusion The P- and f-wave analysis of extended ECG configurations identified specific ECG features allowing improved classification of paroxysmal vs. persistent AF. The extended ECG significantly improved AF-type classification in our analyzed data as compared to a standard 10-s 12-lead ECG. Whether this can result in a better clinical AF type classification warrants further prospective study.
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Affiliation(s)
- Matthias Daniel Zink
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology and Vascular Medicine, Aachen, Germany
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Rita Laureanti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Center for Computational Modeling in Cardiology, Lugano, Switzerland
| | - Ben J. M. Hermans
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Laurent Pison
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
- Ziekenhuis Oost Limburg, Genk, Belgium
| | - Sander Verheule
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Suzanne Philippens
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Nikki Pluymaekers
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Mindy Vroomen
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Astrid Hermans
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Arne van Hunnik
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Harry J. G. M. Crijns
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Kevin Vernooy
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Dominik Linz
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Luca Mainardi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Angelo Auricchio
- Center for Computational Modeling in Cardiology, Lugano, Switzerland
- Instituto Cardiocentro Ticino, Lugano, Switzerland
| | - Stef Zeemering
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Ulrich Schotten
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
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Baysal E, Okşul M, Burak C, Yalin K, Soysal AU, Yalman H, Bozyel S, Guler TE, Tanboga HI, Aksu T. Decreasing time between first diagnosis of paroxysmal atrial fibrillation and cryoballoon ablation positively affects long-term consequences. J Interv Card Electrophysiol 2022; 65:365-372. [DOI: 10.1007/s10840-022-01167-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/22/2022] [Indexed: 12/17/2022]
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Shah V, Shah J. Restoring Ravaged Heart: Molecular Mechanisms and Clinical Application of miRNA in Heart Regeneration. Front Cardiovasc Med 2022; 9:835138. [PMID: 35224063 PMCID: PMC8866653 DOI: 10.3389/fcvm.2022.835138] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/17/2022] [Indexed: 11/28/2022] Open
Abstract
Human heart development is a complex and tightly regulated process, conserving proliferation, and multipotency of embryonic cardiovascular progenitors. At terminal stage, progenitor cell type gets suppressed for terminal differentiation and maturation. In the human heart, most cardiomyocytes are terminally differentiated and so have limited proliferation capacity. MicroRNAs (miRNAs) are non-coding single-stranded RNA that regulate gene expression and mRNA silencing at the post-transcriptional level. These miRNAs play a crucial role in numerous biological events, including cardiac development, and cardiomyocyte proliferation. Several cardiac cells specific miRNAs have been discovered. Inhibition or overexpression of these miRNAs could induce cardiac regeneration, cardiac stem cell proliferation and cardiomyocyte proliferation. Clinical application of miRNAs extends to heart failure, wherein the cell cycle arrest of terminally differentiated cardiac cells inhibits the heart regeneration. The regenerative capacity of the myocardium can be enhanced by cardiomyocyte specific miRNAs controlling the cell cycle. In this review, we focus on cardiac-specific miRNAs involved in cardiac regeneration and cardiomyocyte proliferation, and their potential as a new clinical therapy for heart regeneration.
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Xie L, Huang G, Gao M, Huang J, Li H, Xia H, Xiang X, Wu S, Ruan Y. Identification of Atrial Fibrillation-Related lncRNA Based on Bioinformatic Analysis. DISEASE MARKERS 2022; 2022:8307975. [PMID: 35154514 PMCID: PMC8837454 DOI: 10.1155/2022/8307975] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/18/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia in the world. Long noncoding RNA (lncRNA) has been found to play an important role in cardiovascular diseases including heart failure, myocardial infarction, and atherosclerosis. However, the role of lncRNA in AF has rarely been studied. The purpose of this study is to identify the expression profile of lncRNA in AF patients, explore the function of lncRNA in AF, and provide a potential scientific basis for the treatment of AF in the future. METHODS The lncRNA and mRNA expression profiles were obtained from the atrial appendage samples of GSE31821, GSE411774, GSE79768, and GSE115574 in the Gene Expression Omnibus (GEO) database. Functional analysis was performed via Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Gene Set Variation Analysis (GSVA). The "CIBERSORT" R kit was used to analyze 22 immune cell infiltrates in AF and sinus rhythm (SR) patients. The "CORRPLOT" R package was used to analyze the immune correlation between lncRNA and immune cells. RESULTS A total of 6 differentially expressed lncRNAs and 45 differentially expressed mRNAs were identified in the AF and SR groups. GO, KEGG, and GSVA results showed that abnormally expressed lncRNAs were involved in signaling pathways related to the atrium, including the Toll-like receptor signaling pathway and calcium signaling pathway. Immune cell infiltration analysis revealed that native B cells, follicular helper T cells, and resting dendritic cells may be involved in the AF process. In addition, LINC00844 was negatively correlated with resting dendritic cells. CONCLUSION The expression profile of lncRNA in AF patients was different from that in normal controls. The physiological functions of these differentially expressed lncRNAs may be related to the pathogenesis of AF, which provide a scientific basis for the prognosis and treatment of patients with AF.
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Affiliation(s)
- Liangzhen Xie
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - GuanShen Huang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Mingjian Gao
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Jianming Huang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Hai Li
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Hao Xia
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Xiuting Xiang
- Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong 518000, China
| | - Saizhu Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Yunjun Ruan
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
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van der Heijden CA, Verheule S, Olsthoorn JR, Mihl C, Poulina L, van Kuijk SM, Heuts S, Maessen JG, Bidar E, Maesen B. Postoperative atrial fibrillation and atrial epicardial fat: Is there a link? IJC HEART & VASCULATURE 2022; 39:100976. [PMID: 35402690 PMCID: PMC8984634 DOI: 10.1016/j.ijcha.2022.100976] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 11/24/2022]
Abstract
Detailed local EAT analysis does not differ between POAF and non-POAF. General rather than local effects of EAT play a role in the onset of early POAF. The dominance of surgical induced factors may obscure the potential role of EAT.
Background Atrial Epicardial Adipose Tissue (EAT) is presumably involved in the pathogenesis of atrial fibrillation (AF). The transient nature of postoperative AF (POAF) suggests that surgery-induced triggers provoke an unmasking of a pre-existent AF substrate. The aim is to investigate the association between the volume of EAT and the occurrence of POAF. We hypothesise that the likelihood of developing POAF is higher in patients with high compared to low left atrial (LA) EAT volumes. Methods Quantification of LA EAT based on the Hounsfield Units using custom made software was performed on pre-operative coronary computed tomography angiography scans of patients who underwent cardiac surgery between 2009 and 2019. Patients with mitral valve disease were excluded. Results A total of 83 patients were included in this study (CABG = 34, aortic valve = 33, aorta ascendens n = 7, combination n = 9), of which 43 patients developed POAF. The EAT percentage in the LA wall nor indexed EAT volumes differed between patients with POAF and with sinus rhythm (all P > 0.05). In multivariable analysis, age and LA volume index (LAVI) were the only independent predictors for early POAF (OR: 1.076 and 1.056, respectively). Conclusions As expected, advanced age and LAVI were independent predictors of POAF. However, the amount of local EAT was not associated with the occurrence of AF after cardiac surgery. This suggests that the role of EAT in POAF is rather limited, or that the association of EAT in the early phase of POAF is obscured by the dominance of surgical-induced triggers.
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Kotb A, Chin SH, Ng GA. Recent advances in the tools available for atrial fibrillation ablation. Expert Rev Med Devices 2022; 19:141-154. [PMID: 35188431 DOI: 10.1080/17434440.2022.2038564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/02/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the commonest arrhythmia in clinical practice with significant detrimental health impacts. Much effort has been spent in mapping AF, determine its triggers and drivers, and how to develop tools to eliminate these triggers. AREAS COVERED In this state of-the-art review article, we aim to highlight the recent techniques in catheter-based management of Atrial Fibrillation; including new advancements either in the catheter design or the software used. This includes a comprehensive summary of the most recent tools used in AF mapping and subsequent ablation. EXPERT OPINION Electrical isolation of the pulmonary veins has been developed and established as the cornerstone in AF ablation with good results in patients with paroxysmal AF (PAF) whilst new ablation tools are aimed at streamlining the procedure. However, the quest for persistent AF (PeAF) remains. The future of AF ablation, we believe, lies in identifying AF drivers by means of the new developing mapping tools and altering their electrical properties in a safe, reproducible, and effective manner.
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Affiliation(s)
- Ahmed Kotb
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Shui Hao Chin
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - G Andre Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
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Clinical characteristics and prognostic factors of atrial fibrillation at a tertiary center of Pakistan - From a South-Asian perspective - A cross-sectional study. Ann Med Surg (Lond) 2022; 73:103128. [PMID: 35003722 PMCID: PMC8718836 DOI: 10.1016/j.amsu.2021.103128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background There is lack of large data from South-Asian region on atrial fibrillation and it is imperative that clinical presentation, prognostic factors, management pursued, and outcomes are known for this part of the world. Once collective evidence for the region is known, region-specific guidelines can be laid forward. Objectives To evaluate clinical characteristics and prognostic factors of atrial fibrillation at a tertiary care center of Pakistan. Methods This was a retrospective study conducted at a tertiary care center of Pakistan. Period of study ranged from July–December 2018. All hospitalized patients who were admitted with atrial fibrillation as a primary or associated diagnosis were enrolled. Results A total of 636 patients were enrolled. The mean age was 68.5 ± 12 years and 49.5% (315) were male. 90.6% of the patients were admitted via emergency room. Majority (59.9%) had previously known AF and 40% developed new-onset AF during the hospital stay. Hypertension was the most common co-morbid condition (85.4%) followed by Diabetes Mellitus (40.1%). At least 9% had rheumatic heart disease. The median CHA2DS2VASc and HASBLED scores were 4 and 2 respectively. More than one-third of patients had sepsis as a primary diagnosis (36.8%). The in-hospital mortality of patients with atrial fibrillation was 6.7%. Patients with new-onset AF had higher mortality. Sepsis and stroke were independently associated with a higher mortality. There was no significant difference in median CHA2DS2VASc and HASBLED scores for patients with new-onset and previously known AF. On discharge, 83% of the eligible patients received oral anticoagulation. Conclusion There was higher prevalence of chronic co-morbid conditions in the studied population leading to a higher CHA2DS2VASC Score. Sepsis and stroke were independently associated with higher in-hospital mortality. Sepsis and stroke are independently associated with higher in-hospital mortality in patients with atrial fibrillation. There is higher prevalence of chronic co-morbid conditions in the studied population. Hypertension is the most common co-morbid condition associated with atrial fibrillation.
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141
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Chen L, Chen JQ, Zou T, Chen Q, Lian LH, Yang ZP, Wu MQ, Lin YZ, Peng YM, Lin W, Liao XW, Huang QL, Zhang JC. Efficacy of extended antrum ablation based on substrate mapping plus pulmonary vein isolation in the treatment of atrial fibrillation. Rev Port Cardiol 2022; 41:17-26. [DOI: 10.1016/j.repc.2021.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
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142
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Adili A, Zhu X, Cao H, Tang X, Wang Y, Wang J, Shi J, Zhou Q, Wang D. Atrial Fibrillation Underlies Cardiomyocyte Senescence and Contributes to Deleterious Atrial Remodeling during Disease Progression. Aging Dis 2022; 13:298-312. [PMID: 35111375 PMCID: PMC8782549 DOI: 10.14336/ad.2021.0619] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/19/2021] [Indexed: 11/01/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Qing Zhou
- Correspondence should be addressed to: Dr. Qing Zhou (), Dr. Dongjin Wang (), The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Dongjin Wang
- Correspondence should be addressed to: Dr. Qing Zhou (), Dr. Dongjin Wang (), The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
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143
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Cardiac fibrosis and atrial fibrillation. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Cardiac fibrosis is characterized by the imbalance of production and degradation of the extracellular matrix. The result of this process is an accumulation of scar tissue, which is associated with many pathological processes such as excessive mechanical stress on the heart, inflammation, ischemia, oxidative stress, or excessive neurohormonal activation. Fibrotic response results in damaged heart architecture and dysfunction of the heart. Cardiac fibrosis leads to increased stiffness of the left ventricle and arteries, promotes disorders of contraction and relaxation of the heart, disrupts electrophysiology of heart cells, and induces arrhythmias.
Atrial fibrillation is one of the most common arrhythmias. It is associated with a deterioration in the quality of life and more frequent use of medical assistance. It is also an instantaneous risk factor for many diseases, including stroke. The underlying cause of this arrhythmia is electrical and structural remodeling induced by cardiac fibrosis. Therefore, much attention is paid to the search for biochemical markers that would allow non-invasive determination of the degree of this fibrosis.
The promising markers include galectin-3, human epididymis protein 4 (HE4), serum soluble ST2, and adipose triglyceride lipase (ATGL). Studies have shown that plasma concentrations of these substances reflect the degree of myocardial fibrosis and are indirectly associated with AF.
There are high hopes for the use of these markers in patients undergoing arrhythmia ablation. More research is needed to confirm that these markers can be used to estimate the chance of maintaining sinus rhythm in patients after ablation.
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144
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von Bibra C, Shibamiya A, Geertz B, Querdel E, Köhne M, Stuedemann T, Starbatty J, Schmidt FN, Hansen A, Hiebl B, Eschenhagen T, Weinberger F. Human engineered heart tissue transplantation in a guinea pig chronic injury model. J Mol Cell Cardiol 2022; 166:1-10. [DOI: 10.1016/j.yjmcc.2022.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
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Selejan SR, Linz D, Mauz M, Hohl M, Huynh AKD, Speer T, Wintrich J, Kazakov A, Werner C, Mahfoud F, Böhm M. Renal denervation reduces atrial remodeling in hypertensive rats with metabolic syndrome. Basic Res Cardiol 2022; 117:36. [PMID: 35834066 PMCID: PMC9283368 DOI: 10.1007/s00395-022-00943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 01/31/2023]
Abstract
Atrial fibrillation (AF) is highly prevalent in hypertensive patients with metabolic syndrome and is related to inflammation and activation of the sympathoadrenergic system. The multi-ligand Receptor-for-Advanced-Glycation-End-products (RAGE) activates inflammation-associated tissue remodeling and is regulated by the sympathetic nervous system. Its counterpart, soluble RAGE (sRAGE), serves as anti-inflammatory decoy receptor with protective properties. We investigated the effect of sympathetic modulation by renal denervation (RDN) on atrial remodeling, RAGE/sRAGE and RAGE ligands in metabolic syndrome. RDN was performed in spontaneously hypertensive obese rats (SHRob) with metabolic syndrome compared with lean spontaneously hypertensive rats (SHR) and with normotensive non-obese control rats. Blood pressure and heart rate were measured by telemetry. The animals were killed 12 weeks after RDN. Left atrial (LA) and right atrial (RA) remodeling was assessed by histological analysis and collagen types. Sympathetic innervation was measured by tyrosine hydroxylase staining of atrial nerve fibers, RAGE/sRAGE, RAGE ligands, cytokine expressions and inflammatory infiltrates were analyzed by Western blot and immunofluorescence staining. LA sympathetic nerve fiber density was higher in SHRob (+44%) versus controls and reduced after RDN (-64% versus SHRob). RAGE was increased (+718%) and sRAGE decreased (- 62%) in SHRob as compared with controls. RDN reduced RAGE expression (- 61% versus SHRob), significantly increased sRAGE levels (+162%) and induced a significant decrease in RAGE ligand levels in SHRob (- 57% CML and - 51% HMGB1) with reduced pro-inflammatory NFkB activation (- 96%), IL-6 production (- 55%) and reduced inflammatory infiltrates. This led to a reduction in atrial fibrosis (- 33%), collagen type I content (- 72%), accompanied by reduced LA myocyte hypertrophy (- 21%). Transfection experiments on H9C2 cardiomyoblasts demonstrated that RAGE is directly involved in fibrosis formation by influencing cellular production of collagen type I. In conclusion, suppression of renal sympathetic nerve activity by RDN prevents atrial remodeling in metabolic syndrome by reducing atrial sympathetic innervation and by modulating RAGE/sRAGE balance and reducing pro-inflammatory and pro-fibrotic RAGE ligands, which provides a potential therapeutic mechanism to reduce the development of AF.
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Affiliation(s)
- Simina-Ramona Selejan
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Dominik Linz
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Muriel Mauz
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Mathias Hohl
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Anh Khoa Dennis Huynh
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Thimoteus Speer
- Klinik für Innere Medizin IV (Nephrologie und Hochdruckkrankheiten), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar, Germany
| | - Jan Wintrich
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Andrey Kazakov
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Christian Werner
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
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Cheng J, Zou Q, Zhao Y. ECG signal classification based on deep CNN and BiLSTM. BMC Med Inform Decis Mak 2021; 21:365. [PMID: 34963455 PMCID: PMC8715576 DOI: 10.1186/s12911-021-01736-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background Currently, cardiovascular disease has become a major disease endangering human health, and the number of such patients is growing. Electrocardiogram (ECG) is an important basis for {medical doctors to diagnose the cardiovascular disease, which can truly reflect the health of the heart. In this context, the contradiction between the lack of medical resources and the surge in the number of patients has become increasingly prominent. The use of computer-aided diagnosis of cardiovascular disease has become particularly important, so the study of ECG automatic classification method has a strong practical significance. Methods This article proposes a new method for automatic identification and classification of ECG.We have developed a dense heart rhythm network that combines a 24-layer Deep Convolutional Neural Network (DCNN) and Bidirectional Long Short-Term Memory (BiLSTM) to deeply mine the hierarchical and time-sensitive features of ECG data. Three different sizes of convolution kernels (32, 64 and 128) are used to mine the detailed features of the ECG signal, and the original ECG is filtered using a combination of wavelet transform and median filtering to eliminate the influence of noise on the signal. A new loss function is proposed to control the fluctuation of loss during the training process, and convergence mapping of the tan function in the range of 0–1 is employed to better reflect the model training loss and correct the optimization direction in time. Results We applied the dataset provided by the 2017 PhysioNet/CINC challenge for verification. The experiment adopted ten-fold cross validation,and obtained an accuracy rate of 89.3\documentclass[12pt]{minimal}
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\begin{document}$$\%$$\end{document}% and an F1 score of 0.891. Conclusions This article proposes its own method in the aspects of ECG data preprocessing, feature extraction and loss function design. Compared with the existing methods, this method improves the accuracy of automatic ECG classification and is helpful for clinical diagnosis and self-monitoring of atrial fibrillation.
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Affiliation(s)
- Jinyong Cheng
- School of Computer Science and Technology, Qilu University of Technology (Shandong Academy of Sciences), Jinan, China
| | - Qingxu Zou
- School of Computer Science and Technology, Qilu University of Technology (Shandong Academy of Sciences), Jinan, China
| | - Yunxiang Zhao
- School of Computer Science and Technology, Qilu University of Technology (Shandong Academy of Sciences), Jinan, China.
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147
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Yugo D, Chen YY, Lin YJ, Chien KL, Chang SL, Lo LW, Hu YF, Chao TF, Chung FP, Liao JN, Chang TY, Lin CY, Tuan TC, Kuo L, Wu CI, Liu CM, Liu SH, Li CH, Hsieh YC, Chen SA. Long-term mortality and cardiovascular outcomes in patients with atrial flutter after catheter ablation. Europace 2021; 24:970-978. [PMID: 34939091 DOI: 10.1093/europace/euab308] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/01/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS For patients with typical and atypical atrial flutter (AFL) but without history of atrial fibrillation (AF), the long-term cardiovascular (CV) outcomes after catheter ablation for AFL remain unclear. We compared the long-term all-cause mortality and CV outcomes in patients with AFL receiving catheter ablation compared with the results with medical therapy. METHODS AND RESULTS Atrial flutter patients receiving catheter ablation for typical AFL were identified using the Health Insurance Database, and constituted the 'AFL ablation group'. Patients with typical and atypical AFL but without ablation (AFL without ablation group) were propensity matched to the AFL ablation group. Patients with prior AF diagnosis were excluded. Primary outcomes included all-cause and CV mortality, heart failure (HF) hospitalization, and stroke. The multivariable cox hazards regression model was used to evaluate the hazard ratio (HR) for study outcomes. A total of 3784 AFL patients (1892 patients in each group) was studied. Their mean follow-up durations were 7.85 ± 2.57 years (AFL without ablation group) and 8.31 ± 4.53 years (AFL ablation group). Atrial flutter with ablation patients had lower risks of all-cause mortality (HR: 0.68, P < 0.001), CV deaths (HR: 0.78, P = 0.001), HF hospitalization (HR: 0.84, P = 0.01), and stroke (HR: 0.80, P = 0.01). CONCLUSIONS Catheter ablation for AFL in patients without prior AF was associated with lower risks of all-cause mortality and CV events compared with AFL patients without ablation during long-term follow-ups.
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Affiliation(s)
- Dony Yugo
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa.,Cardiovascular Department, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Yun-Yu Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa.,Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa.,Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei and Hsinchu, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa.,Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei and Hsinchu, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa.,Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei and Hsinchu, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa.,Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei and Hsinchu, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa.,Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei and Hsinchu, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa.,Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei and Hsinchu, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa.,Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei and Hsinchu, Taiwan
| | - Ting-Yung Chang
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa.,Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei and Hsinchu, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa.,Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei and Hsinchu, Taiwan
| | - Ta-Chuan Tuan
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa
| | - Ling Kuo
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa
| | - Cheng-I Wu
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa.,Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei and Hsinchu, Taiwan
| | - Chih-Min Liu
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa.,Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei and Hsinchu, Taiwan
| | - Shin-Huei Liu
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa
| | - Cheng-Hung Li
- Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei and Hsinchu, Taiwan.,Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Cheng Hsieh
- Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei and Hsinchu, Taiwan.,Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa.,Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei and Hsinchu, Taiwan.,Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
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148
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Miao Y, Xu M, Yang L, Zhang C, Liu H, Shao X. Investigating the association between P wave duration and atrial fibrillation recurrence after radiofrequency ablation in early persistent atrial fibrillation patients. Int J Cardiol 2021; 351:48-54. [PMID: 34954277 DOI: 10.1016/j.ijcard.2021.12.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/11/2021] [Accepted: 12/20/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the present study, we aimed to explore the association between P wave duration, as the measured time from the start point of the P wave to the end point, and atrial fibrillation recurrence after transcatheter radiofrequency ablation in patients with early persistent atrial fibrillation. METHODS Patients with early persistent atrial fibrillation who underwent the first radiofrequency ablation procedure were retrospectively analyzed. The electrocardiographic, echocardiographic and clinical data of the enrolled patients before and after operation were collected and recorded. After adjusting confounding factors and performing stratified analysis, the association between the P wave duration and the atrial fibrillation recurrence of patients with early persistent atrial fibrillation after radiofrequency ablation was explored. RESULTS The proportions of atrial fibrillation recurrence of the low, medium, and high P wave duration groups were 6.4%, 19.7%, and 47.0%, respectively. After potential confounding factors were adjusted, the risk of atrial fibrillation recurrence gradually increased with the increase of P wave duration (odds ratio: 1.093, 95% confidence interval: 1.063-1.124, p < 0.001). This trend was statistically significant (odds ratio: 1.099, 95% confidence interval: 1.052-1.149, p < 0.001), especially in comparison of high vs. low (odds ratio: 16.99, 95% confidence interval: 4.75-60.78, p < 0.001). Curve fitting showed that there was a linear and positive association between the P wave duration and the risk of atrial fibrillation recurrence. This association was consistent in different subgroups based on gender, drinking, history of smoking, hypertension, diabetes mellitus, peripheral artery disease, stroke or transient ischemia attack, hyperlipidemia, heart failure, and heart rate, suggesting that there was no significant interaction between different grouping parameters and the association (p for interaction range = 0.217-0.965). CONCLUSIONS In patients with early persistent atrial fibrillation who underwent radiofrequency ablation procedure for the first time and converted to sinus rhythm, the P wave duration within 72 h after the procedure was independently associated with the risk of atrial fibrillation recurrence, and such association was linear and positive.
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Affiliation(s)
- Yuxia Miao
- Department of Cardiovascular Division of The Third Affiliated Hospital of Soochow University, Chang Zhou City 213000, Jiangsu Province, China
| | - Min Xu
- Department of Cardiovascular Division of The Third Affiliated Hospital of Soochow University, Chang Zhou City 213000, Jiangsu Province, China.
| | - Ling Yang
- Department of Cardiovascular Division of The Third Affiliated Hospital of Soochow University, Chang Zhou City 213000, Jiangsu Province, China.
| | - Chunxu Zhang
- Department of Cardiovascular Division of Changzhou Municipal Hospital of Traditional Chinese Medicine, Chang Zhou City 213000, Jiangsu Province, China
| | - Huannian Liu
- Department of Cardiovascular Division of Changzhou Cancer Hospital Affiliated to Soochow University, Chang Zhou City 213000, Jiangsu Province, China.
| | - Xiaoliang Shao
- Department of Nuclear Medicine of The Third Affiliated Hospital of Soochow University, Chang Zhou City 213000, Jiangsu Province, China
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149
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Roney CH, Sillett C, Whitaker J, Lemus JAS, Sim I, Kotadia I, O'Neill M, Williams SE, Niederer SA. Applications of multimodality imaging for left atrial catheter ablation. Eur Heart J Cardiovasc Imaging 2021; 23:31-41. [PMID: 34747450 PMCID: PMC8685603 DOI: 10.1093/ehjci/jeab205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Atrial arrhythmias, including atrial fibrillation and atrial flutter, may be treated through catheter ablation. The process of atrial arrhythmia catheter ablation, which includes patient selection, pre-procedural planning, intra-procedural guidance, and post-procedural assessment, is typically characterized by the use of several imaging modalities to sequentially inform key clinical decisions. Increasingly, advanced imaging modalities are processed via specialized image analysis techniques and combined with intra-procedural electrical measurements to inform treatment approaches. Here, we review the use of multimodality imaging for left atrial ablation procedures. The article first outlines how imaging modalities are routinely used in the peri-ablation period. We then describe how advanced imaging techniques may inform patient selection for ablation and ablation targets themselves. Ongoing research directions for improving catheter ablation outcomes by using imaging combined with advanced analyses for personalization of ablation targets are discussed, together with approaches for their integration in the standard clinical environment. Finally, we describe future research areas with the potential to improve catheter ablation outcomes.
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Affiliation(s)
- Caroline H Roney
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Charles Sillett
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | | | - Iain Sim
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Irum Kotadia
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Mark O'Neill
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Steven E Williams
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
- Centre for Cardiovascular Science, The University of Edinburgh, Scotland, UK
| | - Steven A Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
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150
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Li L, Hu Z, Xiong Y, Yao Y. Device-Based Sympathetic Nerve Regulation for Cardiovascular Diseases. Front Cardiovasc Med 2021; 8:803984. [PMID: 34957267 PMCID: PMC8695731 DOI: 10.3389/fcvm.2021.803984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/22/2021] [Indexed: 12/05/2022] Open
Abstract
Sympathetic overactivation plays an important role in promoting a variety of pathophysiological processes in cardiovascular diseases (CVDs), including ventricular remodeling, vascular endothelial injury and atherosclerotic plaque progression. Device-based sympathetic nerve (SN) regulation offers a new therapeutic option for some CVDs. Renal denervation (RDN) is the most well-documented method of device-based SN regulation in clinical studies, and several large-scale randomized controlled trials have confirmed its value in patients with resistant hypertension, and some studies have also found RDN to be effective in the control of heart failure and arrhythmias. Pulmonary artery denervation (PADN) has been clinically shown to be effective in controlling pulmonary hypertension. Hepatic artery denervation (HADN) and splenic artery denervation (SADN) are relatively novel approaches that hold promise for a role in cardiovascular metabolic and inflammatory-immune related diseases, and their first-in-man studies are ongoing. In addition, baroreflex activation, spinal cord stimulation and other device-based therapies also show favorable outcomes. This review summarizes the pathophysiological rationale and the latest clinical evidence for device-based therapies for some CVDs.
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Affiliation(s)
| | | | | | - Yan Yao
- National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China
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