101
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Dai Z, Huang C, Zhao Q, Zhang S, Zhao H, Zhang Y, Qian Y, Tang Y. Effects of extrinsic cardiac nerve stimulation on atrial fibrillation inducibility: The regulatory role of the spinal cord. J Cardiovasc Electrophysiol 2017; 28:819-827. [PMID: 28422349 DOI: 10.1111/jce.13217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 03/15/2017] [Accepted: 04/03/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate the effect of the mutual regulation of the extrinsic cardiac nerves on atrial electrophysiology and atrial fibrillation (AF) vulnerability. METHODS AND RESULTS Fourteen dogs were randomly divided into two groups: spinal cord stimulation (SCS) group (n = 7) and spinal cord block (SCB) group (n = 7). SCS was performed with 90% of the threshold voltage stimulating the T1 -T2 spinal level, while SCB was performed by injecting 2% lidocaine into the epidural space at the T2-3 level. The effective refractory period (ERP), ERP dispersion, and AF inducibility were measured during atrial pacing combined with different extrinsic cardiac nerve stimulation. ERPs were decreased in the atrium and pulmonary veins and ERP dispersion was increased from baseline during left cervical vagus nerve stimulation (VNS) or left stellate ganglion stimulation (SGS) in the two groups. When combined with SCS, VNS resulted in diminished ERPs at all recording sites, longer ERP dispersion and more episodes of AF than were observed during VNS, whereas ERPs were greater and correspondingly fewer episodes of AF occurred during SCS combined with SGS than SGS. In the SCB group, ERPs were shortened, ERP dispersion was lengthened, and episodes of AF were increased during SGS after SCB. SCS enhanced the activity of the left vagus nerve but attenuated the left stellate ganglion and superior left ganglionated plexus. CONCLUSION SCS modulates extrinsic and intrinsic cardiac nerve activity among the vagus nerve, stellate ganglion, and ganglionated plexus. SCS facilitates the effect of VNS and attenuates the effect of SGS on atrial electrophysiology.
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Affiliation(s)
- Zixuan Dai
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, PR China.,Hubei Key Laboratory of Cardiology, Wuhan, PR China
| | - Congxin Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, PR China.,Hubei Key Laboratory of Cardiology, Wuhan, PR China
| | - Qingyan Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, PR China.,Hubei Key Laboratory of Cardiology, Wuhan, PR China
| | - Shujuan Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, PR China.,Hubei Key Laboratory of Cardiology, Wuhan, PR China
| | - Hongyi Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, PR China.,Hubei Key Laboratory of Cardiology, Wuhan, PR China
| | - Youjing Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, PR China.,Hubei Key Laboratory of Cardiology, Wuhan, PR China
| | - Yongsheng Qian
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, PR China.,Hubei Key Laboratory of Cardiology, Wuhan, PR China
| | - Yanhong Tang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, PR China.,Hubei Key Laboratory of Cardiology, Wuhan, PR China
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102
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The role of the autonomic nervous system in arrhythmias and sudden cardiac death. Auton Neurosci 2017; 205:1-11. [PMID: 28392310 DOI: 10.1016/j.autneu.2017.03.005] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 03/11/2017] [Accepted: 03/28/2017] [Indexed: 12/16/2022]
Abstract
The autonomic nervous system (ANS) is complex and plays an important role in cardiac arrhythmia pathogenesis. A deeper understanding of the anatomy and development of the ANS has shed light on its involvement in cardiac arrhythmias. Alterations in levels of Sema-3a and NGF, both growth factors involved in innervation patterning during development of the ANS, leads to cardiac arrhythmias. Dysregulation of the ANS, including polymorphisms in genes involved in ANS development, have been implicated in sudden infant death syndrome. Disruptions in the sympathetic and/or parasympathetic systems of the ANS can lead to cardiac arrhythmias and can vary depending on the type of arrhythmia. Simultaneous stimulation of both the sympathetic and parasympathetic systems is thought to lead to atrial fibrillation whereas increased sympathetic stimulation is thought to lead to ventricular fibrillation or ventricular tachycardia. In inherited arrhythmia syndromes, such as Long QT and Catecholaminergic Polymorphic Ventricular Tachycardia, sympathetic system stimulation is thought to lead to ventricular tachycardia, subsequent arrhythmias, and in severe cases, cardiac death. On the other hand, arrhythmic events in Brugada Syndrome have been associated with periods of high parasympathetic tone. Increasing evidence suggests that modulation of the ANS as a therapeutic strategy in the treatment of cardiac arrhythmias is safe and effective. Further studies investigating the involvement of the ANS in arrhythmia pathogenesis and its modulation for the treatment of cardiac arrhythmias is warranted.
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103
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Uradu A, Wan J, Doytchinova A, Wright KC, Lin AYT, Chen LS, Shen C, Lin SF, Everett TH, Chen PS. Skin sympathetic nerve activity precedes the onset and termination of paroxysmal atrial tachycardia and fibrillation. Heart Rhythm 2017; 14:964-971. [PMID: 28347833 DOI: 10.1016/j.hrthm.2017.03.030] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Skin sympathetic nerve activity (SKNA) is useful for estimating sympathetic tone in humans. OBJECTIVE The purpose of this study was to test the hypotheses that (1) increased SKNA is associated with the onset and termination of paroxysmal atrial tachycardia (AT) and atrial fibrillation (AF) and (2) sinoatrial node response to SKNA is reduced in patients with more frequent AT or AF episodes. METHODS SKNA and electrocardiogram were recorded in 11 patients (4 men and 7 women; average age 66 ± 10 years), including 3 patients with AT (11 ± 18 episodes per patient) and 8 patients with AF (24 ± 26 episodes per patient). RESULTS The average SKNA (aSKNA) 10 seconds before AT onset was 1.07 ± 0.10 μV and 10 seconds after termination was 1.27 ± 0.10 μV; both were significantly (P = .032 and P < .0001) higher than that during sinus rhythm (0.97 ± 0.09 μV). The aSKNA 10 seconds before AF onset was 1.34 ± 0.07 μV and 10 seconds after termination was 1.31 ± 0.07 μV; both were significantly (P < .0001) higher than that during sinus rhythm (1.04 ± 0.07 μV). The aSKNA before onset (P < .0001) and after termination (P = .0011) was higher in AF than in AT. The sinus rate correlated (P < .0001) with aSKNA in each patient (average r = 0.74; 95% confidence interval 0.65-0.84). The r value in each patient negatively correlated with the number of AT and AF episodes (r = -0.6493; 95% confidence interval -0.8990 to -0.08073; P = .0306). CONCLUSION Increased SKNA was observed both at the onset and termination of AT and AF. Patients with more frequent AT and AF episodes had a weak correlation between sinus rate and aSKNA, suggesting sinoatrial node remodeling by tachycardia.
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Affiliation(s)
- Andrea Uradu
- Division of Cardiology, Department of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | - Juyi Wan
- Division of Cardiology, Department of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana; Department of Cardiothoracic Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Anisiia Doytchinova
- Division of Cardiology, Department of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | - Keith C Wright
- Division of Cardiology, Department of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | - Andrew Y T Lin
- Division of Cardiology, Department of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | - Lan S Chen
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Changyu Shen
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Shien-Fong Lin
- Institute of Biomedical Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Thomas H Everett
- Division of Cardiology, Department of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | - Peng-Sheng Chen
- Division of Cardiology, Department of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana.
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104
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Zhao HY, Zhang SD, Zhang K, Wang X, Zhao QY, Zhang SJ, Dai ZX, Qian YS, Zhang YJ, Wei HT, Tang YH, Huang CX. Effect of Shensong Yangxin on the Progression of Paroxysmal Atrial Fibrillation is Correlated with Regulation of Autonomic Nerve Activity. Chin Med J (Engl) 2017; 130:171-178. [PMID: 28091409 PMCID: PMC5282674 DOI: 10.4103/0366-6999.197997] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Shensong Yangxin (SSYX), a traditional Chinese herbal medicine, has long been used clinically to treat arrhythmias in China. However, the mechanism of SSYX on atrial fibrillation (AF) is unknown. In this study, we tested the hypothesis that the effect of SSYX on the progression of paroxysmal AF is correlated with the regulation of autonomic nerve activity. METHODS Eighteen mongrel dogs were randomly divided into control group (n = 6), pacing group (n = 6), and pacing + SSYX group (n = 6). The control group was implanted with pacemakers without pacing; the pacing group was implanted with pacemakers with long-term intermittent atrial pacing; the pacing + SSYX group underwent long-term intermittent atrial pacing and SSYX oral administration. RESULTS Compared to the pacing group, the parameters of heart rate variability were lower after 8 weeks in the pacing + SSYX group (low-frequency [LF] component: 20.85 ± 3.14 vs. 15.3 ± 1.89 ms 2 , P = 0.004; LF component/high-frequency component: 1.34 ± 0.33 vs. 0.77 ± 0.15, P < 0.001). The atrial effective refractory period (AERP) was shorter and the dispersion of the AERP was higher after 8 weeks in the pacing group, while the changes were suppressed by SSYX intake. The dogs in the pacing group had more episodes and longer durations of AF than that in the pacing + SSYX group. SSYX markedly inhibited the increase in sympathetic nerves and upregulation of tumor necrosis factor-alpha and interleukin-6 expression in the pacing + SSYX group. Furthermore, SSYX suppressed the decrease of acetylcholine and α7 nicotinic acetylcholine receptor protein induced by long-term intermittent atrial pacing. CONCLUSIONS SSYX substantially prevents atrial electrical remodeling and the progression of AF. These effects of SSYX may have association with regulating the imbalance of autonomic nerve activity and the cholinergic anti-inflammatory pathway.
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Affiliation(s)
- Hong-Yi Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060; Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060; Hubei Key Laboratory of Cardiology, Wuhan, Hubei 430060, China
| | - Shu-Di Zhang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Kai Zhang
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550000, China
| | - Xi Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060; Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060; Hubei Key Laboratory of Cardiology, Wuhan, Hubei 430060, China
| | - Qing-Yan Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060; Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060; Hubei Key Laboratory of Cardiology, Wuhan, Hubei 430060, China
| | - Shu-Juan Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060; Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060; Hubei Key Laboratory of Cardiology, Wuhan, Hubei 430060, China
| | - Zi-Xuan Dai
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060; Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060; Hubei Key Laboratory of Cardiology, Wuhan, Hubei 430060, China
| | - Yong-Sheng Qian
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060; Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060; Hubei Key Laboratory of Cardiology, Wuhan, Hubei 430060, China
| | - You-Jing Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060; Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060; Hubei Key Laboratory of Cardiology, Wuhan, Hubei 430060, China
| | - Hao-Tian Wei
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060; Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060; Hubei Key Laboratory of Cardiology, Wuhan, Hubei 430060, China
| | - Yan-Hong Tang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060; Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060; Hubei Key Laboratory of Cardiology, Wuhan, Hubei 430060, China
| | - Cong-Xin Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060; Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060; Hubei Key Laboratory of Cardiology, Wuhan, Hubei 430060, China
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105
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Tsai WC, Chan YH, Chinda K, Chen Z, Patel J, Shen C, Zhao Y, Jiang Z, Yuan Y, Ye M, Chen LS, Riley AA, Persohn SA, Territo PR, Everett TH, Lin SF, Vinters HV, Fishbein MC, Chen PS. Effects of renal sympathetic denervation on the stellate ganglion and brain stem in dogs. Heart Rhythm 2017; 14:255-262. [PMID: 27720832 PMCID: PMC5250538 DOI: 10.1016/j.hrthm.2016.10.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Renal sympathetic denervation (RD) is a promising method of neuromodulation for the management of cardiac arrhythmia. OBJECTIVE We tested the hypothesis that RD is antiarrhythmic in ambulatory dogs because it reduces the stellate ganglion nerve activity (SGNA) by remodeling the stellate ganglion (SG) and brain stem. METHODS We implanted a radiotransmitter to record SGNA and electrocardiogram in 9 ambulatory dogs for 2 weeks, followed by a second surgery for RD and 2 months SGNA recording. Cell death was probed by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. RESULTS Integrated SGNA at baseline and 1 and 2 months after RD were 14.0 ± 4.0, 9.3 ± 2.8, and 9.6 ± 2.0 μV, respectively (P = .042). The SG from RD but not normal control dogs (n = 5) showed confluent damage. An average of 41% ± 10% and 40% ± 16% of ganglion cells in the left and right SG, respectively, were TUNEL positive in RD dogs compared with 0% in controls dogs (P = .005 for both). The left and right SG from RD dogs had more tyrosine hydroxylase-negative ganglion cells than did the left SG of control dogs (P = .028 and P = .047, respectively). Extensive TUNEL-positive neurons and glial cells were also noted in the medulla, associated with strongly positive glial fibrillary acidic protein staining. The distribution was heterogeneous, with more cell death in the medial than lateral aspects of the medulla. CONCLUSION Bilateral RD caused significant central and peripheral sympathetic nerve remodeling and reduced SGNA in ambulatory dogs. These findings may in part explain the antiarrhythmic effects of RD.
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Affiliation(s)
- Wei-Chung Tsai
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Hsin Chan
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Kroekkiat Chinda
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Physiology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
| | - Zhenhui Chen
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jheel Patel
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Changyu Shen
- Department of Biostatistics, Indiana University School of Medicine and the Fairbanks School of Public Health, Indianapolis, Indiana
| | - Ye Zhao
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiac Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhaolei Jiang
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuan Yuan
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Michael Ye
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Amanda A Riley
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Scott A Persohn
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Paul R Territo
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas H Everett
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Shien-Fong Lin
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan
| | - Harry V Vinters
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Peng-Sheng Chen
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
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106
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Piña PG, Chicos AB. Early Cardioversion in Atrial Fibrillation: Earlier Is Better, but Not Always and (Maybe) Not Immediately. Curr Atheroscler Rep 2017; 19:3. [PMID: 28108860 DOI: 10.1007/s11883-017-0638-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia in humans. One of its important features is the tendency to become more persistent over time, even in the absence of underlying progressive heart disease. Conversion and maintenance of sinus rhythm by pharmacological or electrical methods become increasingly difficult the longer the arrhythmia persists. Electrical, mechanical, structural, and autonomic remodeling processes have been implicated in the mechanisms of AF initiation, perpetuation, and progression. Prevention or reversal of these remodeling processes can halt the progression of the disease. Cardioversion is a powerful tool and rhythm control is a widely used strategy in the management of AF. However, important questions remain unanswered regarding not only if, but also when to perform cardioversion. There are observations from past trials and clinical situations that support attempting to restore sinus rhythm, but further prospective randomized clinical trials are needed. Optimal timing of cardioversion remains somewhat uncertain, but it appears to be some time after the first few hours and before the first few months: the earlier, the better, but not always, and maybe not immediately, and it has to be tailored to the clinical situation and its many variables. This review is intended to summarize the evidence supporting early intervention for the prevention of remodeling in patients with AF.
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Affiliation(s)
- Paloma G Piña
- Clinical Cardiac Electrophysiology, Bluhm Cardiovascular Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Alexandru B Chicos
- Clinical Cardiac Electrophysiology, Bluhm Cardiovascular Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA.
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107
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Brunetti ND, Ieva R, Correale M, De Gennaro L, Santoro F, Di Biase M. Tako-Tsubo cardiomyopathy complicated by paroxysmal supraventricular tachycardia. J Cardiovasc Med (Hagerstown) 2017; 17 Suppl 2:e264-e265. [PMID: 28079764 DOI: 10.2459/jcm.0b013e3283638e6d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: We report a case of paroxysmal supraventricular tachycardia complicating Tako-Tsubo cardiomyopathy. We hypothesize that increased adrenergic tone supposedly underlying transient apical ballooning syndrome may facilitate the onset of paroxysmal supraventricular tachycardias in predisposed patients.
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108
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Sabbag A, Berkovitch A, Sidi Y, Kivity S, Ben Zekry S, Beinart R, Segev S, Glikson M, Goldenberg I, Maor E. Poor Heart Rate Recovery Is Associated With the Development of New-Onset Atrial Fibrillation in Middle-Aged Adults. Mayo Clin Proc 2016; 91:1769-1777. [PMID: 28126153 DOI: 10.1016/j.mayocp.2016.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the association between heart rate recovery (HRR) and new-onset atrial fibrillation (AF) in middle-aged adults. PATIENTS AND METHODS Heart rate recovery was calculated using the exercise stress test in 15,729 apparently healthy self-referred men and women who attended periodic health screening examinations between January 2000, and December 2015. All participants completed the maximal exercise stress test according to the Bruce protocol and were followed clinically on a yearly basis for a median of 6.4±4 years. The primary end point was new-onset AF. Participants were grouped according to HRR at 5 minutes, dichotomized at the median value (<73 beats/min). RESULTS Participants with low HRR were older, were more commonly men, had a higher rate of comorbidities, and were less fit. Kaplan-Meier survival analysis revealed that the cumulative probability of AF at 6 years was higher in participants with low HRR (2.1%) than in those with high HRR (0.6%) (log-rank, P<.001). Older age, male sex, obesity resting heart rate, and ischemic heart disease were all associated with increased AF risk in a univariate Cox regression model (P<.05 for all). Multivariate Cox regression analysis revealed that low HRR was independently associated with increased AF risk (hazard ratio, 1.92; 95% CI, 1.3-2.8; P<.001) after adjustment for multiple confounders. CONCLUSION Lower HRR is independently associated with the development of new-onset AF during long-term follow-up in middle-aged adults.
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Affiliation(s)
- Avi Sabbag
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Berkovitch
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yechezkel Sidi
- Departments of Internal Medicine A and C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shaye Kivity
- Departments of Internal Medicine A and C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sagit Ben Zekry
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Beinart
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Segev
- Institute for Medical Screening, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Michael Glikson
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Goldenberg
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Maor
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Pinchas Borenstein Talpiot Medical Leadership Program, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
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109
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Sposato LA, Cohen G, Wardlaw JM, Sandercock P, Lindley RI, Hachinski V, von Kummer R, von Heijne A, Bradey N, Peeters A, Cala L, Adami A, Morris Z, Farrall A, Potter G. Effect of Right Insular Involvement on Death and Functional Outcome After Acute Ischemic Stroke in the IST-3 Trial (Third International Stroke Trial). Stroke 2016; 47:2959-2965. [DOI: 10.1161/strokeaha.116.014928] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 08/25/2016] [Accepted: 10/05/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
In patients with acute ischemic stroke, whether involvement of the insular cortex influences outcome is controversial. Much of the apparent adverse outcome may relate to such strokes usually being severe. We examined the influence of right and left insular involvement on stroke outcomes among patients from the IST-3 study (Third International Stroke Trial) who had visible ischemic stroke on neuroimaging.
Methods—
We used multiple logistic regression to compare outcomes of left versus right insular and noninsular strokes across strata of stroke severity, on death, proportion dead or dependent, and level of disability (ordinalized Oxford Handicap Score) at 6 months, with adjustment for the effects of age, lesion size, and presence of atrial fibrillation.
Results—
Of 3035 patients recruited, 2099 had visible ischemic strokes limited to a single hemisphere on computed tomography/magnetic resonance scans. Of these, 566 and 714 had infarction of right and left insula. Six months after randomization, right insular involvement was associated with increased odds of death when compared with noninsular strokes on the left side (adjusted odds ratio, 1.83; 95% confidence interval, 1.33−2.52), whereas the adjusted odds ratio comparing mortality after insular versus noninsular strokes on the left side was not significant. Among mild/moderate strokes, outcomes for right insular involvement were worse than for left insular, but among more severe strokes, the difference in outcomes was less substantial.
Conclusions—
We found an association between right insular involvement and higher odds of death and worse functional outcome. The difference between right- and left-sided insular lesions on outcomes seemed to be most evident for mild/moderate strokes.
Clinical Trial Registration—
URL:
http://www.isrctn.com
. Unique identifier: ISRCTN25765518.
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Affiliation(s)
- Luciano A. Sposato
- From the Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University (L.A.S., V.H.), and Stroke, Dementia & Heart Disease Laboratory (L.A.S.), Ontario, Canada; Centre for Clinical Brain Sciences, University of Edinburgh, Scotland (G.C., J.M.W., P.S.); and George Institute for Global Health and Discipline of Medicine, University of Sydney, New South Wales, Australia (R.I.L.)
| | - Geoffrey Cohen
- From the Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University (L.A.S., V.H.), and Stroke, Dementia & Heart Disease Laboratory (L.A.S.), Ontario, Canada; Centre for Clinical Brain Sciences, University of Edinburgh, Scotland (G.C., J.M.W., P.S.); and George Institute for Global Health and Discipline of Medicine, University of Sydney, New South Wales, Australia (R.I.L.)
| | - Joanna M. Wardlaw
- From the Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University (L.A.S., V.H.), and Stroke, Dementia & Heart Disease Laboratory (L.A.S.), Ontario, Canada; Centre for Clinical Brain Sciences, University of Edinburgh, Scotland (G.C., J.M.W., P.S.); and George Institute for Global Health and Discipline of Medicine, University of Sydney, New South Wales, Australia (R.I.L.)
| | - Peter Sandercock
- From the Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University (L.A.S., V.H.), and Stroke, Dementia & Heart Disease Laboratory (L.A.S.), Ontario, Canada; Centre for Clinical Brain Sciences, University of Edinburgh, Scotland (G.C., J.M.W., P.S.); and George Institute for Global Health and Discipline of Medicine, University of Sydney, New South Wales, Australia (R.I.L.)
| | - Richard I. Lindley
- From the Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University (L.A.S., V.H.), and Stroke, Dementia & Heart Disease Laboratory (L.A.S.), Ontario, Canada; Centre for Clinical Brain Sciences, University of Edinburgh, Scotland (G.C., J.M.W., P.S.); and George Institute for Global Health and Discipline of Medicine, University of Sydney, New South Wales, Australia (R.I.L.)
| | - Vladimir Hachinski
- From the Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University (L.A.S., V.H.), and Stroke, Dementia & Heart Disease Laboratory (L.A.S.), Ontario, Canada; Centre for Clinical Brain Sciences, University of Edinburgh, Scotland (G.C., J.M.W., P.S.); and George Institute for Global Health and Discipline of Medicine, University of Sydney, New South Wales, Australia (R.I.L.)
| | - Rudiger von Kummer
- Department of Neuroradiology, University Hospital, Technische Universität Dresden, Germany
| | | | - Nick Bradey
- Neuroradiology, James Cook University Hospital, South Tees Hospital NHS Trust, Middlesbrough, United Kingdom
| | - Andre Peeters
- Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Lesley Cala
- School of Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Western Australia
| | - Alessandro Adami
- Stroke Center, Department of Neurology, Ospedale Sacro Cuore-Don Calabria, Via Sempreboni 6, 37024, Negrar, Verona, Italy
| | | | | | - Gillian Potter
- Salford Royal NHS Foundation Trust, Salford, Greater Manchester
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110
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Chen X, Yu L, Shi S, Jiang H, Huang C, Desai M, Li Y, Barajas-Martinez H, Hu D. Neuronal Nav1.8 Channels as a Novel Therapeutic Target of Acute Atrial Fibrillation Prevention. J Am Heart Assoc 2016; 5:e004050. [PMID: 27806967 PMCID: PMC5210368 DOI: 10.1161/jaha.116.004050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/27/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Ganglionated plexus have been developed as additional ablation targets to improve the outcome of atrial fibrillation (AF) besides pulmonary vein isolation. Recent studies implicated an intimate relationship between neuronal sodium channel Nav1.8 (encoded by SCN10A) and AF. The underlying mechanism between Nav1.8 and AF remains unclear. This study aimed to determine the role of Nav1.8 in cardiac electrophysiology in an acute AF model and explore possible therapeutic targets. METHODS AND RESULTS Immunohistochemical study was used on canine cardiac ganglionated plexus. Both Nav1.5 and Nav1.8 were expressed in ganglionated plexus with canonical neuronal markers. Sixteen canines were randomly administered either saline or the Nav1.8 blocker A-803467. Electrophysiological study was compared between the 2 groups before and after 6-hour rapid atrial pacing. Compared with the control group, administration of A-803467 decreased the incidence of AF (87.5% versus 25.0%, P<0.05), shortened AF duration, and prolonged AF cycle length. A-803467 also significantly suppressed the decrease in the effective refractory period and the increase in effective refractory period dispersion and cumulative window of vulnerability caused by rapid atrial pacing in all recording sites. Patch clamp study was performed under 100 nmol/L A-803467 in TSA201 cells cotransfected with SCN10A-WT, SCN5A-WT, and SCN3B-WT. INa,P was reduced by 45.34% at -35 mV, and INa,L by 68.57% at -20 mV. Evident fast inactivation, slow recovery, and use-dependent block were also discovered after applying the drug. CONCLUSIONS Our study demonstrates that Nav1.8 could exert its effect on electrophysiological characteristics through cardiac ganglionated plexus. It indicates that Nav1.8 is a novel target in understanding cardiac electrophysiology and SCN10A-related arrhythmias.
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Affiliation(s)
- XiaoMeng Chen
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - LiLei Yu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China
| | - ShaoBo Shi
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hong Jiang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China
| | - CongXin Huang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China
| | | | - YiGang Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | | | - Dan Hu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China
- Masonic Medical Research Laboratory, Utica, NY
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Abstract
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in modern clinical practice, with an estimated prevalence of 1.5-2%. The prevalence of AF is expected to double in the next decades, progressing with age and increasingly becoming a global medical challenge. The first-line treatment for AF is often medical treatment with either rate control or anti-arrhythmic agents for rhythm control, in addition to anti-coagulants such as warfarin for stroke prevention in patient at risk. Catheter ablation has emerged as an alternative for AF treatment, which involves myocardial tissue lesions to disrupt the underlying triggers and substrates for AF. Surgical approaches have also been developed for treatment of AF, particularly for patients requiring concomitant cardiac surgery or those refractory to medical and catheter ablation treatments. Since the introduction of the Cox-Maze III, this procedure has evolved into several modern variations, including the use of alternative energy sources (Cox-Maze IV) such as radiofrequency, cryo-energy and microwave, as well as minimally invasive thoracoscopic epicardial approaches. Another recently introduced technique is the hybrid ablation approach, where in a single setting both epicardial thoracoscopic ablation lesions and endocardial catheter ablation lesions are performed by the cardiothoracic surgeon and cardiologist. There remains controversy surrounding the optimal approach for AF ablation, energy sources, and lesion sets employed. The goal of this article is review the history, classifications, pathophysiology and current treatment options for AF.
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Affiliation(s)
- Joshua Xu
- Sydney Medical School, University of Sydney, Sydney, Australia;; The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Jessica G Y Luc
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Kevin Phan
- Sydney Medical School, University of Sydney, Sydney, Australia;; The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia;; Faculty of Medicine, University of New South Wales, Sydney, Australia
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112
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Wei Y, Xu J, Zhou G, Chen S, Ouyang P, Liu S. Renal Denervation Suppresses the Inducibility of Atrial Fibrillation in a Rabbit Model for Atrial Fibrosis. PLoS One 2016; 11:e0160634. [PMID: 27529427 PMCID: PMC4986963 DOI: 10.1371/journal.pone.0160634] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/23/2016] [Indexed: 11/18/2022] Open
Abstract
Renal denervation (RD) was reported to reduce the susceptibility of atrial fibrillation (AF), but the underlying mechanism has not been well understood. This study was performed to investigate the effect of RD on the inducibility of AF in a rabbit model for atrial fibrosis and to explore the potential mechanisms. Thirty-five rabbits were randomly assigned into sham-operated group (n = 12), abdominal aortic constriction (AAC) group (n = 12) and AAC with RD (AAC-RD) group (n = 11). The incidence of AF induced by burst pacing in atriums was determined. Blood was collected to measure the levels of rennin, angiotensin II and aldosterone. Atrial samples were preserved to evaluate protein and gene expression of collagen, connective tissue growth factor (CTGF) and transforming growth factor-β1 (TGF-β1). Our data suggested cardiac structure remodeling and atrial fibrosis were successfully induced by AAC. Compared with the AAC group, the AAC-RD rabbits had smaller ascending aortic diameter and left ventricular end-systolic diameter. For burst pacing at the left atrium (LA), AF was induced in two of the 12 rabbits in the sham-operated group, 10 of the 12 rabbits in the AAC group, and 2 of the 11 rabbits in the AAC-RD group, with great difference among the three groups (P = 0.001). The percentage of LA burst stimulations with induced AF achieved 47.2% in the AAC group, which was higher than those in both the AAC-RD (12.1%) and the Sham-operated (5.6%) groups. Significantly increasing intercellular space in the AAC group (P<0.001) compared with the sham-operated rabbits. RD clearly decreased the volume fraction of collagen in LA and right atrium compared with that of the AAC group (P< 0.01). AAC-induced elevation of collagen I, CTGF and TGF-β1 was suppressed by RD. In conclusion, RD suppressed the inducibility of AF in a rabbit model for pressure associated atrial fibrosis, potentially by modulating renin-angiotensin-aldosterone system and decreasing pro-fibrotic factors.
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Affiliation(s)
- Yong Wei
- Department of cardiology, Shanghai Songjiang Central Hospital, Shanghai, 201600, China
- Department of cardiology, Shanghai First People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200800, China
| | - Juan Xu
- Department of cardiology, Shanghai First People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200800, China
| | - Genqing Zhou
- Department of cardiology, Shanghai First People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200800, China
| | - Songwen Chen
- Department of cardiology, Shanghai First People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200800, China
| | - Ping Ouyang
- Department of cardiology, Shanghai Songjiang Central Hospital, Shanghai, 201600, China
| | - Shaowen Liu
- Department of cardiology, Shanghai First People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200800, China
- * E-mail:
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113
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Abstract
Atrial fibrillation (AF) is an extremely prevalent arrhythmia that presents a wide range of therapeutic challenges. AF usually begins in a self-terminating paroxysmal form (pAF). With time, the AF pattern often evolves to become persistent (nonterminating within 7 days). Important differences exist between pAF and persistent AF in terms of clinical features, in particular the responsiveness to antiarrhythmic drugs and ablation therapy. AF mechanisms have been extensively reviewed, but few or no Reviews focus specifically on the pathophysiology of pAF. Accordingly, in this Review, we examine the available data on the electrophysiological basis for pAF occurrence and maintenance, as well as the molecular mechanisms forming the underlying substrate. We first consider the mechanistic insights that have been obtained from clinical studies in the electrophysiology laboratory, noninvasive observations, and genetic studies. We then discuss the information about underlying molecular mechanisms that has been obtained from experimental studies on animal models and patient samples. Finally, we discuss the data available from animal models with spontaneous AF presentation, their relationship to clinical findings, and their relevance to understanding the mechanisms underlying pAF. Our analysis then turns to potential factors governing cases of progression from pAF to persistent AF and the clinical implications of the basic mechanisms we review. We conclude by identifying and discussing questions that we consider particularly important to address through future research in this area.
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114
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Zhao Y, Jiang Z, Tsai WC, Yuan Y, Chinda K, Choi EK, Fishbein MC, Lin SF, Chen PS, Everett TH. Ganglionated plexi and ligament of Marshall ablation reduces atrial vulnerability and causes stellate ganglion remodeling in ambulatory dogs. Heart Rhythm 2016; 13:2083-90. [PMID: 27426436 DOI: 10.1016/j.hrthm.2016.07.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Simultaneous activation of the stellate ganglion (SG), the ligament of Marshall (LOM), and the ganglionated plexi often precedes the onset of paroxysmal atrial tachyarrhythmia (PAT). OBJECTIVE The purpose of this study was to test the hypothesis that ablation of the LOM and the superior left ganglionated plexi (SLGP) reduces atrial vulnerability and results in remodeling of the SG. METHODS Nerve activity was correlated to PAT and ventricular rate (VR) at baseline, after ablation of the LOM and SLGP, and after atrial fibrillation. Neuronal cell death was assessed with tyrosine hydroxylase and terminal deoxynucleotidyl transferase dUTP nick end label (TUNEL) staining. RESULTS There were 4 ± 2 PAT episodes per day in controls. None were observed in the ablation group, even though SG nerve activity and VR increased from 2.2 µV (95% confidence interval [CI] 1.2-3.3 µV) and 80 bpm (95% CI 68-92 bpm) at baseline, to 3.0 µV (95% CI 2.6-3.4 µV, P = .046) and 90 bpm (95% CI 75-108 bpm, P = .026) after ablation, and to 3.1 µV (95% CI 1.7-4.5 µV, P = .116) and 95 bpm (95% CI 79-110 bpm, P = .075) after atrial fibrillation. There was an increase in tyrosine hydroxylase-negative cells in the ablation group and 19.7% (95% CI 8.6%-30.8%) TUNEL-positive staining in both the left and right SG. None were observed in the control group. CONCLUSION LOM and SLGP ablation caused left SG remodeling and cell death. There was reduced correlation of the VR response and PAT to SG nerve activity. These findings support the importance of SLGP and LOM in atrial arrhythmogenesis.
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Affiliation(s)
- Ye Zhao
- Krannert Institute of Cardiology, Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiac Surgery, The First Affiliated Hospital of China Medical University, Sheng Yang, China
| | - Zhaolei Jiang
- Krannert Institute of Cardiology, Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei-Chung Tsai
- Krannert Institute of Cardiology, Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan Yuan
- Krannert Institute of Cardiology, Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kroekkiat Chinda
- Krannert Institute of Cardiology, Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Physiology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
| | - Eue-Keun Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, California
| | - Shien-Fong Lin
- Krannert Institute of Cardiology, Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan
| | - Peng-Sheng Chen
- Krannert Institute of Cardiology, Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas H Everett
- Krannert Institute of Cardiology, Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
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Cagnoni F, Destro M, Bontempelli E, Locatelli G, Hering D, Schlaich MP. Central Sympathetic Inhibition: a Neglected Approach for Treatment of Cardiac Arrhythmias? Curr Hypertens Rep 2016; 18:13. [PMID: 26781253 DOI: 10.1007/s11906-015-0619-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Overactivation of the sympathetic nervous system (SNS) plays an important role in the pathogenesis of comorbidities related to AF such as hypertension, congestive heart failure, obesity, insulin resistance, and obstructive sleep apnea. Methods that reduce sympathetic drive, such as centrally acting sympatho-inhibitory agents, have been shown to reduce the incidence of spontaneous or induced atrial arrhythmias, suggesting that neuromodulation may be helpful in controlling AF. Moxonidine acts centrally to reduce activity of the SNS, and clinical trials indicate that this is associated with a decreased AF burden in hypertensive patients with paroxysmal AF and reduced post-ablation recurrence of AF in patients with hypertension who underwent pulmonary vein isolation (PVI). Furthermore, device-based approaches to reduce sympathetic drive, such as renal denervation, have yielded promising results in the prevention and treatment of cardiac arrhythmias. In light of these recent findings, targeting elevated sympathetic drive with either pharmacological or device-based approaches has become a focus of clinical research. Here, we review the data currently available to explore the potential utility of sympatho-inhibitory therapies in the prevention and treatment of cardiac arrhythmias.
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Affiliation(s)
- Francesca Cagnoni
- Department of Medical Science, Internal Medicine Ward and Hypertension Centre Azienda Ospedaliera, Treviglio, BG, Italy.,Dobney Hypertension Centre School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia
| | - Maurizio Destro
- Department of Medical Science, Internal Medicine Ward and Hypertension Centre Azienda Ospedaliera, Treviglio, BG, Italy
| | - Erika Bontempelli
- Department of Medical Science, Internal Medicine Ward and Hypertension Centre Azienda Ospedaliera, Treviglio, BG, Italy
| | - Giovanni Locatelli
- Department of Medical Science, Internal Medicine Ward and Hypertension Centre Azienda Ospedaliera, Treviglio, BG, Italy
| | - Dagmara Hering
- Dobney Hypertension Centre School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia.
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Lo LW, Chang HY, Scherlag BJ, Lin YJ, Chou YH, Lin WL, Chen SA, Po SS. Temporary Suppression of Cardiac Ganglionated Plexi Leads to Long-Term Suppression of Atrial Fibrillation: Evidence of Early Autonomic Intervention to Break the Vicious Cycle of "AF Begets AF". J Am Heart Assoc 2016; 5:JAHA.116.003309. [PMID: 27381759 PMCID: PMC5015371 DOI: 10.1161/jaha.116.003309] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Botulinum toxin (BTX), temporarily suppressing cholinergic transmission (<3 weeks), has been reported to suppress atrial fibrillation (AF) for ≥1 year. We aimed to investigate the mechanism underlying long-term suppression of AF caused by injecting BTX into major atrial ganglionated plexi (GPs). METHODS AND RESULTS Bilateral thoracotomies in anesthetized dogs allowed programmed stimulation at 4 pulmonary veins, biatrial appendages, and the superior vena cava to determine the effective refractory period (ERP) in the first operation. Group 1 (n=10) received BTX injection into all GPs; group 2 (n=7) received no injection. Groups 1 and 2 received rapid atrial pacing (800 bpm) 6 days a week. Group 3 (n=7) did not undergo thoracotomy or rapid atrial pacing to serve as controls for histological studies. A second operation and the same measurements were made 3 months later. During the first operation in group 1, ERPs of 4 pulmonary veins, but not biatrial appendages or superior vena cava, increased immediately after BTX injection. AF burdens increased significantly from the fifth week after the first operation in group 2 but not in group 1. In the second operation, ERPs remained unchanged compared with ERPs before BTX injection in group 1, whereas ERPs shortened significantly at all sites except the superior vena cava in group 2. There was no difference of autonomic nerve density between group 1 and group 3. The GP choline acetyltransferase (+) and atrial tyrosine hydroxylase (+) nerve densities were higher in group 2 than in group 1 and group 3. CONCLUSIONS Temporary suppression of major atrial GPs by BTX prevents autonomic remodeling and provides long-term suppression of AF, indicating the critical role of GPs in AF progression.
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Affiliation(s)
- Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Yu Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Benjamin J Scherlag
- Department of Medicine and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Hui Chou
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Lun Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Sunny S Po
- Department of Medicine and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Abstract
BACKGROUND The mechanism(s) of how atrial fibrillation (AF) sustains itself in the first 24 hours is not well understood. OBJECTIVE We sought to investigate the role of autonomic remodeling in the first 24 hours of AF simulated by rapid atrial pacing (RAP). METHODS Forty-eight rabbits were divided into 6 groups. One group (n = 8) was euthanized after baseline recordings. Another group (n = 8) did not receive RAP during the 24-hour period to serve as controls. In the other 4 groups, rabbits were euthanized after RAP for 4, 8, 12, or 24 hours (n = 8 for each). Before and after designated hours of RAP, atrial effective refractory period, heart rate variability, and left vagal and sympathetic nerve activity (VNA and SNA, respectively) were determined. The right and left atrial tissues were obtained for immunocytochemical analysis for growth-associated protein 43 (GAP43), tyrosine hydroxylase (TH), and choline acetyltransferase (ChAT). RESULTS RAP resulted in progressively shortened atrial effective refractory period and slower heart rate. In the first 12 hours of RAP, both SNA and VNA progressively increased. Then, VNA remained stably elevated but SNA began to attenuate. The high-frequency component and low-frequency/high-frequency ratio of heart rate variability followed the trend of VNA and SNA, respectively. The density of GAP43-positive, ChAT-positive, and TH-positive neural elements in the right and left atria was progressively higher with RAP. CONCLUSIONS AF resulted in progressive autonomic remodeling, manifesting as nerve sprouting, sympathetic and vagal hyperinnervation. Autonomic remodeling may play an important role in sustaining AF in the first 24 hours.
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Linz D, Hohl M, Vollmar J, Ukena C, Mahfoud F, Böhm M. Atrial fibrillation and gastroesophageal reflux disease: the cardiogastric interaction. Europace 2016; 19:16-20. [PMID: 27247004 DOI: 10.1093/europace/euw092] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 03/14/2016] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with significant morbidity and mortality. Multiple conditions like hypertension, heart failure, diabetes, sleep apnoea, and obesity play a role for the initiation and perpetuation of AF. Recently, a potential association between gastroesophageal reflux disease (GERD) and AF development has been proposed due to the close anatomic vicinity of the oesophagus and the left atrium. As an understanding of the association between acid reflux disease and AF may be important in the global multimodal treatment strategy to further improve outcomes in a subset of patients with AF, we discuss potential atrial arrhythmogenic mechanisms in patients with GERD, such as gastric and subsequent systemic inflammation, impaired autonomic stimulation, mechanical irritation due to anatomical proximity of the left atrium and the oesophagus, as well as common comorbidities like obesity and sleep-disordered breathing. Data on GERD and oesophageal lesions after AF-ablation procedures will be reviewed. Treatment of GERD to avoid AF or to reduce AF burden might represent a future treatment perspective but needs to be scrutinized in prospective trials.
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Affiliation(s)
- Dominik Linz
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, Geb. 40, Homburg, Saar D-66421, Germany
| | - Mathias Hohl
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, Geb. 40, Homburg, Saar D-66421, Germany
| | - Johanna Vollmar
- Gastroenterologie, Hepatologie, Nephrologie, Rheumatologie, Infektiologie, Endokrinologie und Stoffwechselerkrankungen, Universitätsklinikum Mainz, Mainz, Germany
| | - Christian Ukena
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, Geb. 40, Homburg, Saar D-66421, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, Geb. 40, Homburg, Saar D-66421, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, Geb. 40, Homburg, Saar D-66421, Germany
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Paroxysmal atrial fibrillation in seven dogs with presumed neurally-mediated syncope. J Vet Cardiol 2016; 18:1-9. [DOI: 10.1016/j.jvc.2015.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 09/29/2015] [Accepted: 10/20/2015] [Indexed: 11/17/2022]
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Pellman J, Sheikh F. Atrial fibrillation: mechanisms, therapeutics, and future directions. Compr Physiol 2016; 5:649-65. [PMID: 25880508 DOI: 10.1002/cphy.c140047] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, affecting 1% to 2% of the general population. It is characterized by rapid and disorganized atrial activation leading to impaired atrial function, which can be diagnosed on an EKG by lack of a P-wave and irregular QRS complexes. AF is associated with increased morbidity and mortality and is a risk factor for embolic stroke and worsening heart failure. Current research on AF support and explore the hypothesis that initiation and maintenance of AF require pathophysiological remodeling of the atria, either specifically as in lone AF or secondary to other heart disease as in heart failure-associated AF. Remodeling in AF can be grouped into three categories that include: (i) electrical remodeling, which includes modulation of L-type Ca(2+) current, various K(+) currents and gap junction function; (ii) structural remodeling, which includes changes in tissues properties, size, and ultrastructure; and (iii) autonomic remodeling, including altered sympathovagal activity and hyperinnervation. Electrical, structural, and autonomic remodeling all contribute to creating an AF-prone substrate which is able to produce AF-associated electrical phenomena including a rapidly firing focus, complex multiple reentrant circuit or rotors. Although various remodeling events occur in AF, current AF therapies focus on ventricular rate and rhythm control strategies using pharmacotherapy and surgical interventions. Recent progress in the field has started to focus on the underlying substrate that drives and maintains AF (termed upstream therapies); however, much work is needed in this area. Here, we review current knowledge of AF mechanisms, therapies, and new areas of investigation.
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Affiliation(s)
- Jason Pellman
- Department of Medicine, University of California, San Diego, La Jolla, California, USA
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122
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Spinal cord stimulation suppresses atrial fibrillation by inhibiting autonomic remodeling. Heart Rhythm 2016; 13:274-81. [DOI: 10.1016/j.hrthm.2015.08.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Indexed: 11/19/2022]
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Chinda K, Tsai WC, Chan YH, Lin AYT, Patel J, Zhao Y, Tan AY, Shen MJ, Lin H, Shen C, Chattipakorn N, Rubart-von der Lohe M, Chen LS, Fishbein MC, Lin SF, Chen Z, Chen PS. Intermittent left cervical vagal nerve stimulation damages the stellate ganglia and reduces the ventricular rate during sustained atrial fibrillation in ambulatory dogs. Heart Rhythm 2015; 13:771-80. [PMID: 26607063 DOI: 10.1016/j.hrthm.2015.11.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The effects of intermittent open-loop vagal nerve stimulation (VNS) on the ventricular rate (VR) during atrial fibrillation (AF) remain unclear. OBJECTIVE The purpose of this study was to test the hypothesis that VNS damages the stellate ganglion (SG) and improves VR control during persistent AF. METHODS We performed left cervical VNS in ambulatory dogs while recording the left SG nerve activity (SGNA) and vagal nerve activity. Tyrosine hydroxylase (TH) staining and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining were used to assess neuronal cell death in the SG. RESULTS We induced persistent AF by atrial pacing in 6 dogs, followed by intermittent VNS with short ON-time (14 seconds) and long OFF-time (66 seconds). The integrated SGNA and VR during AF were 4.84 mV·s (95% confidence interval [CI] 3.08-6.60 mV·s) and 142 beats/min (95% CI 116-168 beats/min), respectively. During AF, VNS reduced the integrated SGNA and VR, respectively, to 3.74 mV·s (95% CI 2.27-5.20 mV·s; P = .021) and 115 beats/min (95% CI 96-134 beats/min; P = .016) during 66-second OFF-time and to 4.07 mV·s (95% CI 2.42-5.72 mV·s; P = .037) and 114 beats/min (95% CI 83-146 beats/min; P = .039) during 3-minute OFF-time. VNS increased the frequencies of prolonged (>3 seconds) pauses during AF. TH staining showed large confluent areas of damage in the left SG, characterized by pyknotic nuclei, reduced TH staining, increased percentage of TH-negative ganglion cells, and positive TUNEL staining. Occasional TUNEL-positive ganglion cells were also observed in the right SG. CONCLUSION VNS damaged the SG, leading to reduced SGNA and better rate control during persistent AF.
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Affiliation(s)
- Kroekkiat Chinda
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Department of Physiology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
| | - Wei-Chung Tsai
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Hsin Chan
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Division of Cardiology, The First Department of Medicine, Chang-Gung Memorial Hospital, Taipei, Taiwan
| | - Andrew Y-T Lin
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jheel Patel
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ye Zhao
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiac Surgery, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Alex Y Tan
- Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Mark J Shen
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Hongbo Lin
- Department of Biostatistics, Indiana University School of Medicine and the Fairbanks School of Public Health, Indianapolis, Indiana
| | - Changyu Shen
- Department of Biostatistics, Indiana University School of Medicine and the Fairbanks School of Public Health, Indianapolis, Indiana
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Lan S Chen
- The Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Shien-Fong Lin
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan
| | - Zhenhui Chen
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Peng-Sheng Chen
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
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Lau DH, Schotten U, Mahajan R, Antic NA, Hatem SN, Pathak RK, Hendriks JML, Kalman JM, Sanders P. Novel mechanisms in the pathogenesis of atrial fibrillation: practical applications. Eur Heart J 2015; 37:1573-81. [DOI: 10.1093/eurheartj/ehv375] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 07/21/2015] [Indexed: 12/21/2022] Open
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Ishigaki D, Arimoto T, Iwayama T, Hashimoto N, Kutsuzawa D, Kumagai Y, Nishiyama S, Takahashi H, Shishido T, Miyamoto T, Watanabe T, Kubota I. Prevention of immediate recurrence of atrial fibrillation with low-dose landiolol after radiofrequency catheter ablation. J Arrhythm 2015; 31:279-85. [PMID: 26550083 PMCID: PMC4600890 DOI: 10.1016/j.joa.2015.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 02/16/2015] [Accepted: 02/24/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Immediate recurrence of atrial fibrillation (AF) after radiofrequency (RF) catheter ablation is commonly observed within 3 d after the procedure. The mechanism and pharmacological management of immediate AF recurrence remain unclear. METHODS A total of 50 consecutive patients with paroxysmal AF were randomized to receive either low-dose landiolol (landiolol group) or a placebo (placebo group). In the landiolol group, intravenous landiolol (0.5 μg kg(-1) min(-1)) was administered for 3 d after AF ablation. RESULTS No serious adverse event associated with RF catheter ablation or landiolol administration was observed. The prevalence of immediate AF recurrence (≤3 d after RF catheter ablation) was significantly lower in the landiolol group than in the placebo group (16% vs. 48%, p=0.015). Although the postprocedural change in heart rate was significantly lower in the landiolol group compared to that in the placebo group, the changes in blood pressure and body temperature were not different between the two groups. Multiple logistic regression analysis revealed that landiolol treatment was the only independent predictor of immediate AF recurrence after ablation (odds ratio: 0.180; 95% confidence interval: 0.044-0.729; p=0.016). CONCLUSIONS Prophylactic administration of low-dose landiolol after AF ablation may be effective and safe for preventing immediate AF recurrence within 3 d after AF ablation.
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Affiliation(s)
| | - Takanori Arimoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
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Zhao Q, Deng H, Jiang X, Dai Z, Wang X, Wang X, Guo Z, Hu W, Yu S, Yang B, Tang Y, Huang C. Effects of Intrinsic and Extrinsic Cardiac Nerves on Atrial Arrhythmia in Experimental Pulmonary Artery Hypertension. Hypertension 2015; 66:1042-9. [PMID: 26418021 DOI: 10.1161/hypertensionaha.115.05846] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/02/2015] [Indexed: 11/16/2022]
Abstract
Atrial arrhythmia, which includes atrial fibrillation (AF) and atrial flutter (AFL), is common in patients with pulmonary arterial hypertension (PAH), who often have increased sympathetic nerve activity. Here, we tested the hypothesis that autonomic nerves play important roles in vulnerability to AF/AFL in PAH. The atrial effective refractory period and AF/AFL inducibility at baseline and after anterior right ganglionated plexi ablation were determined during left stellate ganglion stimulation or left renal sympathetic nerve stimulation in beagle dogs with or without PAH. Then, sympathetic nerve, β-adrenergic receptor densities and connexin 43 expression in atrial tissues were assessed. The sum of the window of vulnerability to AF/AFL was increased in the right atrium compared with the left atrium at baseline in the PAH dogs but not in the controls. The atrial effective refractory period dispersion was increased in the control dogs, but not in the PAH dogs, during left stellate ganglion stimulation. The voltage thresholds for inducing AF/AFL during anterior right ganglionated plexi stimulation were lower in the PAH dogs than in the controls. The AF/AFL inducibility was suppressed after ablation of the anterior right ganglionated plexi in the PAH dogs. The PAH dogs had higher sympathetic nerve and β1-adrenergic receptor densities, increased levels of nonphosphorylated connexin 43, and heterogeneous connexin 43 expression in the right atrium when compared with the control dogs. The anterior right ganglionated plexi play important roles in the induction of AF/AFL. AF/AFL induction was associated with right atrium substrate remodeling in dogs with PAH.
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Affiliation(s)
- Qingyan Zhao
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Hongping Deng
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Xuejun Jiang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Zixuan Dai
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Xiaozhan Wang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Xule Wang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Zongwen Guo
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Wei Hu
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Shengbo Yu
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Bo Yang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Yanhong Tang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Congxin Huang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China.
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Abstract
Autonomic dysfunction has been associated with paroxysmal atrial fibrillation (PAF). The head-up tilt test (HUTT) is an important diagnostic tool for autonomic dysfunction. The aim of this study was to examine atrial fibrillation recurrence after RFCA by performing HUTT. A total of 488 consecutive patients with PAF who underwent RFCA were prospectively enrolled. HUTT was positive in 154 (31.6%) patients after a mean follow-up of 22.7 ± 3.5 months, and 163 (33.4%) had a recurrence. HUTT positive was significantly higher in PAF patients with recurrence compared to those without (68 (41.7%) versus 86 (26.5%), P < 0.001). Multivariate Cox regression analysis revealed that HUTT positive (HR: 1.96; 95% CI: 1.49-2.48, P < 0.001), left atrial diameter (HR: 1.77; 95%CI: 1.15-2.11, P = 0.004), AF duration (HR: 1.27; 95%CI: 0.98-1.83, P = 0.014), and sleep apnea (HR: 1.02; 95%CI: 0.81-1.53, P = 0.032) were independent predictors of clinical recurrence after RFCA. The success rate of ablation was 70.4% in patients in the HUTT negative group compared with 58.4% in patients in the HUTT positive group (log-rank P = 0.006). Patients with a positive headup tilt test were at an increased risk of AF recurrence after catheter ablation. Our results suggest that HUTT was a significant predictor for AF recurrence after catheter ablation for PAF.
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Affiliation(s)
- Jinyi Xu
- Department of Heart Function, Henan Province People's Hospital & The People's Hospital of Zhengzhou University
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128
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Huang B, Yu L, He B, Wang S, Lu Z, Liao K, Wang Z, Zhou X, He W, Jiang H. Sympathetic denervation of heart and kidney induces similar effects on ventricular electrophysiological properties. EUROINTERVENTION 2015; 11:598-604. [DOI: 10.4244/eijv11i5a119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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129
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Stephan S, Antonio E, Christian M. Autonomic nervous system and cardiac channelopathies in sleep apnea-one more piece of a complex puzzle? Sleep Breath 2015; 20:1003-4. [PMID: 26318591 DOI: 10.1007/s11325-015-1248-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 08/16/2015] [Accepted: 08/20/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Steiner Stephan
- Department of Medicine, Division of Cardiology, Pneumology and Intensive Care Medicine, St. Vincenz Hospital, Auf dem Schafsberg, 65549, Limburg/Lahn, Germany.
| | - Esquinas Antonio
- Intensive Care Unit, Hospital Morales Meseguer, Avenida Marques Vélez s/n, Murcia, 30.008, Spain
| | - Meyer Christian
- Department of Cardiology and Electrophysiology, University Hamburg, Martinistrasse 52, Hamburg, Germany
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130
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Morotti S, McCulloch AD, Bers DM, Edwards AG, Grandi E. Atrial-selective targeting of arrhythmogenic phase-3 early afterdepolarizations in human myocytes. J Mol Cell Cardiol 2015; 96:63-71. [PMID: 26241847 DOI: 10.1016/j.yjmcc.2015.07.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/16/2015] [Accepted: 07/30/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND We have previously shown that non-equilibrium Na(+) current (INa) reactivation drives isoproterenol-induced phase-3 early afterdepolarizations (EADs) in mouse ventricular myocytes. In these cells, EAD initiation occurs secondary to potentiated sarcoplasmic reticulum Ca(2+) release and enhanced Na(+)/Ca(2+) exchange (NCX). This can be abolished by tetrodotoxin-blockade of INa, but not ranolazine, which selectively inhibits ventricular late INa. AIM Since repolarization of human atrial myocytes is similar to mouse ventricular myocytes in that it is relatively rapid and potently modulated by Ca(2+), we investigated whether similar mechanisms can evoke EADs in human atrium. Indeed, phase-3 EADs have been shown to re-initiate atrial fibrillation (AF) during autonomic stimulation, which is a well-recognized initiator of AF. METHODS We integrated a Markov model of INa gating in our human atrial myocyte model. To simulate experimental results, we rapidly paced this cell model at 10Hz in the presence of 0.1μM acetylcholine and 1μM isoproterenol, and assessed EAD occurrence upon return to sinus rhythm (1Hz). RESULTS Cellular Ca(2+) loading during fast pacing results in a transient period of hypercontractility after return to sinus rhythm. Here, fast repolarization and enhanced NCX facilitate INa reactivation via the canonical gating mode (i.e., not late INa burst mode), which drives EAD initiation. Simulating ranolazine administration reduces atrial peak INa and leads to faster repolarization, during which INa fails to reactivate and EADs are prevented. CONCLUSIONS Non-equilibrium INa reactivation can critically contribute to arrhythmias, specifically in human atrial myocytes. Ranolazine might be beneficial in this context by blocking peak (not late) atrial INa.
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Affiliation(s)
- Stefano Morotti
- Department of Pharmacology, University of California Davis, Davis, CA, USA
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Donald M Bers
- Department of Pharmacology, University of California Davis, Davis, CA, USA
| | - Andrew G Edwards
- Institute for Experimental Medicine, Oslo University Hospital Ullevål, Oslo, Norway; Simula Research Laboratory, Lysaker, Norway
| | - Eleonora Grandi
- Department of Pharmacology, University of California Davis, Davis, CA, USA.
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131
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Suita K, Fujita T, Hasegawa N, Cai W, Jin H, Hidaka Y, Prajapati R, Umemura M, Yokoyama U, Sato M, Okumura S, Ishikawa Y. Norepinephrine-Induced Adrenergic Activation Strikingly Increased the Atrial Fibrillation Duration through β1- and α1-Adrenergic Receptor-Mediated Signaling in Mice. PLoS One 2015. [PMID: 26203906 PMCID: PMC4512675 DOI: 10.1371/journal.pone.0133664] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmias among old people. It causes serious long-term health problems affecting the quality of life. It has been suggested that the autonomic nervous system is involved in the onset and maintenance of AF in human. However, investigation of its pathogenesis and potential treatment has been hampered by the lack of suitable AF models in experimental animals. OBJECTIVES Our aim was to establish a long-lasting AF model in mice. We also investigated the role of adrenergic receptor (AR) subtypes, which may be involved in the onset and duration of AF. METHODS AND RESULTS Trans-esophageal atrial burst pacing in mice could induce AF, as previously shown, but with only a short duration (29.0 ± 8.1 sec). We found that adrenergic activation by intraperitoneal norepinephrine (NE) injection strikingly increased the AF duration. It increased the duration to more than 10 minutes, i.e., by more than 20-fold (656.2 ± 104.8 sec; P<0.001). In this model, a prior injection of a specific β1-AR blocker metoprolol and an α1-AR blocker prazosin both significantly attenuated NE-induced elongation of AF. To further explore the mechanisms underlying these receptors' effects on AF, we assessed the SR Ca(2+) leak, a major trigger of AF, and consequent spontaneous SR Ca(2+) release (SCR) in atrial myocytes. Consistent with the results of our in-vivo experiments, both metoprolol and prazosin significantly inhibited the NE-induced SR Ca(2+) leak and SCR. These findings suggest that both β1-AR and α1-AR may play important roles in the development of AF. CONCLUSIONS We have established a long-lasting AF model in mice induced by adrenergic activation, which will be valuable in future AF study using experimental animals, such as transgenic mice. We also revealed the important role of β1- and α1-AR-mediated signaling in the development of AF through in-vivo and in-vitro experiments.
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MESH Headings
- Adrenergic alpha-Antagonists/pharmacology
- Adrenergic beta-Antagonists/pharmacology
- Animals
- Atrial Fibrillation/chemically induced
- Atrial Fibrillation/physiopathology
- Calcium Signaling/drug effects
- Cells, Cultured
- Disease Models, Animal
- Heart Conduction System/drug effects
- Heart Conduction System/physiopathology
- Injections, Intraperitoneal
- Male
- Metoprolol/pharmacology
- Mice
- Mice, Inbred C57BL
- Myocytes, Cardiac/drug effects
- Myocytes, Cardiac/physiology
- Norepinephrine/administration & dosage
- Norepinephrine/toxicity
- Prazosin/pharmacology
- Receptors, Adrenergic, alpha-1/drug effects
- Receptors, Adrenergic, alpha-1/physiology
- Receptors, Adrenergic, beta-1/drug effects
- Receptors, Adrenergic, beta-1/physiology
- Sarcoplasmic Reticulum/drug effects
- Sympathetic Nervous System/drug effects
- Sympathetic Nervous System/physiopathology
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Affiliation(s)
- Kenji Suita
- Cardiovascular Research Institute, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takayuki Fujita
- Cardiovascular Research Institute, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- * E-mail: (TF); (YI)
| | - Nozomi Hasegawa
- Cardiovascular Research Institute, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Wenqian Cai
- Cardiovascular Research Institute, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Huiling Jin
- Cardiovascular Research Institute, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yuko Hidaka
- Cardiovascular Research Institute, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Rajesh Prajapati
- Cardiovascular Research Institute, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masanari Umemura
- Cardiovascular Research Institute, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Utako Yokoyama
- Cardiovascular Research Institute, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Motohiko Sato
- Cardiovascular Research Institute, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Physiology, Aichi Medical University School of Medicine, Aichi, Japan
| | - Satoshi Okumura
- Cardiovascular Research Institute, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Physiology, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Yoshihiro Ishikawa
- Cardiovascular Research Institute, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- * E-mail: (TF); (YI)
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Wang S, Zhou X, Wang Z, Huang B, Zhou L, Chen M, Yu L, Jiang H. Magnetic fields in noninvasive heart stimulation: A novel approach for anti-atrial fibrillation. Int J Cardiol 2015; 190:54-5. [PMID: 25912123 DOI: 10.1016/j.ijcard.2015.04.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/18/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Songyun Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, China
| | - Xiaoya Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, China
| | - Zhuo Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, China
| | - Bing Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, China
| | - Liping Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, China
| | - Mingxian Chen
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Lilei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, China.
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, China.
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133
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Rhee KS, Hsueh CH, Hellyer JA, Park HW, Lee YS, Garlie J, Onkka P, Doytchinova AT, Garner JB, Patel J, Chen LS, Fishbein MC, Everett T, Lin SF, Chen PS. Cervical vagal nerve stimulation activates the stellate ganglion in ambulatory dogs. Korean Circ J 2015; 45:149-57. [PMID: 25810737 PMCID: PMC4372981 DOI: 10.4070/kcj.2015.45.2.149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 11/12/2014] [Accepted: 01/08/2015] [Indexed: 12/04/2022] Open
Abstract
Background and Objectives Recent studies showed that, in addition to parasympathetic nerves, cervical vagal nerves contained significant sympathetic nerves. We hypothesized that cervical vagal nerve stimulation (VNS) may capture the sympathetic nerves within the vagal nerve and activate the stellate ganglion. Materials and Methods We recorded left stellate ganglion nerve activity (SGNA), left thoracic vagal nerve activity (VNA), and subcutaneous electrocardiogram in seven dogs during left cervical VNS with 30 seconds on-time and 30 seconds off time. We then compared the SGNA between VNS on and off times. Results Cervical VNS at moderate (0.75 mA) output induced large SGNA, elevated heart rate (HR), and reduced HR variability, suggesting sympathetic activation. Further increase of the VNS output to >1.5 mA increased SGNA but did not significantly increase the HR, suggesting simultaneous sympathetic and parasympathetic activation. The differences of integrated SGNA and integrated VNA between VNS on and off times (ΔSGNA) increased progressively from 5.2 mV-s {95% confidence interval (CI): 1.25-9.06, p=0.018, n=7} at 1.0 mA to 13.7 mV-s (CI: 5.97-21.43, p=0.005, n=7) at 1.5 mA. The difference in HR (ΔHR, bpm) between on and off times was 5.8 bpm (CI: 0.28-11.29, p=0.042, n=7) at 1.0 mA and 5.3 bpm (CI 1.92 to 12.61, p=0.122, n=7) at 1.5 mA. Conclusion Intermittent cervical VNS may selectively capture the sympathetic components of the vagal nerve and excite the stellate ganglion at moderate output. Increasing the output may result in simultaneously sympathetic and parasympathetic capture.
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Affiliation(s)
- Kyoung-Suk Rhee
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. ; Department of Internal Medicine, Chonbuk National University School of Medicine, Jeonju, Korea
| | - Chia-Hsiang Hsueh
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jessica A Hellyer
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hyung Wook Park
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. ; Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young Soo Lee
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. ; Division of Cardiology, College of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Jason Garlie
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Patrick Onkka
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anisiia T Doytchinova
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John B Garner
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jheel Patel
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lan S Chen
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, The David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Thomas Everett
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shien-Fong Lin
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Peng-Sheng Chen
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Krummen DE, Hebsur S, Salcedo J, Narayan SM, Lalani GG, Schricker AA. Mechanisms Underlying AF: Triggers, Rotors, Other? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:371. [PMID: 25778423 DOI: 10.1007/s11936-015-0371-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OPINION STATEMENT There is ongoing debate regarding the precise mechanisms underlying atrial fibrillation (AF). An improved understanding of these mechanisms is urgently needed to improve interventional strategies to suppress and eliminate AF, since the success of current strategies is suboptimal. At present, guidelines for AF ablation focus on pulmonary vein (PV) isolation for the prevention of arrhythmia. Additional targets are presently unclear, and include additional linear ablation and electrogram-guided substrate modification, without clear mechanistic relevance. PV and non-PV triggers are likely central in the first few seconds of AF initiation. Rapid activation from such triggers interacts with transitional mechanisms including conduction velocity slowing, action potential duration (APD) alternans, and steep APD restitution to cause conduction block and initiate functional reentry. However, complete suppression of potential triggers has proven elusive, and the intra-procedural mapping and targeting of transitional mechanisms has not been reported. A growing body of research implicates electrical rotors and focal sources as central mechanisms for the maintenance of AF. In several recent series, they were observed in nearly all patients with sustained arrhythmia. Ablation of rotor and focal source sites, prior to pulmonary vein isolation, substantially modulated atrial fibrillation in a high proportion of patients, and improved ablation outcomes versus pulmonary vein isolation alone. These results have subsequently been confirmed in multicenter series, and the improved outcomes have been found to persist to a mean follow-up of 3 years. Recently, rotors have been observed by multiple groups using diverse technologies. These findings represent a paradigm shift in AF, focusing on sustaining mechanisms, as is currently done with other arrhythmias such as atrioventricular node reentrant tachycardia. Studies are currently underway to assess the optimal strategy for the application of rotor-based ablation in AF management, including clinical trials on the relative efficacy of rotor-only ablation versus PVI-only ablation, which will inform future practice guidelines.
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Affiliation(s)
- David E Krummen
- University of California San Diego and VA San Diego Healthcare System, 3350 La Jolla Village Drive, Cardiology Section 111A, San Diego, CA, 92161, USA,
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Moss E, Cardinal R, Yin Y, Pagé P. Biatrial neuroablation attenuates atrial remodeling and vulnerability to atrial fibrillation in canine chronic rapid atrial pacing. Auton Neurosci 2015; 189:43-9. [PMID: 25746009 DOI: 10.1016/j.autneu.2015.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/24/2014] [Accepted: 02/17/2015] [Indexed: 11/26/2022]
Abstract
AIMS We investigated the proposition that an intact cardiac nervous system may contribute to electrophysiological remodeling and increased vulnerability to atrial fibrillation (AF) following chronic rapid atrial pacing (RAP). METHODS AND RESULTS Baseline study was conducted prior to ablating right and left ganglionated plexuses (RAGP, LAGP) in 11 anesthetized canines (Neuroablation group) and in 11 canines without neuroablation (Intact GP). After being subjected to RAP (400 beats/min) for 6 weeks, animals were reanesthetized for terminal study. The ERP shortening typical of chronic RAP was significantly more pronounced in the Intact GP (baseline: 112 ± 12 to terminal: 80 ± 11 ms) than in the Neuroablation group (113 ± 18 to 102 ± 21 ms, p < .001), and AF inducibility (extrastimulus protocol) showed significantly greater increment in the Intact GP (baseline: 23 ± 19% to terminal: 60 ± 17% of trials) than in the Neuroablation group (18 ± 15% to 27 ± 17%, p = 0.029). Negative chronotropic responses to right vagus nerve stimulation were markedly reduced immediately after the neuroablation procedure but had recovered at terminal study. Vagally-evoked repolarization changes (from 191 unipolar electrograms) occurred in a majority of Intact GP animals in the superior, middle and inferior RA free wall, and in the LA appendage. In the Neuroablation group, repolarization changes were restricted to the superior RA free wall but none occurred in the inferior RA and only infrequently in the LA appendage, yielding significantly smaller affected areas in Neuroablation than in Intact GP animals. CONCLUSION Persistent functional denervation in LA and RA regions other than RA pacemaker areas may contribute to prevent the development of a tachycardia-dependent AF substrate.
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Affiliation(s)
- Emmanuel Moss
- Centre de recherche, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada; Department of Surgery, Université de Montréal, Montreal, Canada
| | - René Cardinal
- Centre de recherche, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada; Department of Pharmacology, Université de Montréal, Montreal, Canada
| | - Yalin Yin
- Centre de recherche, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
| | - Pierre Pagé
- Centre de recherche, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada; Department of Surgery, Université de Montréal, Montreal, Canada.
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Xi Y, Cheng J. Dysfunction of the autonomic nervous system in atrial fibrillation. J Thorac Dis 2015; 7:193-8. [PMID: 25713736 DOI: 10.3978/j.issn.2072-1439.2015.01.12] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 12/02/2014] [Indexed: 11/14/2022]
Affiliation(s)
- Yutao Xi
- 1 Texas Heart Institute, St. Luke's Hospital, Houston, TX 77030, USA ; 2 Section of Cardiology, University of Texas School of Medicine at Houston, Houston, TX 77030, USA
| | - Jie Cheng
- 1 Texas Heart Institute, St. Luke's Hospital, Houston, TX 77030, USA ; 2 Section of Cardiology, University of Texas School of Medicine at Houston, Houston, TX 77030, USA
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Jiang Z, Zhao Y, Doytchinova A, Kamp NJ, Tsai WC, Yuan Y, Adams D, Wagner D, Shen C, Chen LS, Everett TH, Lin SF, Chen PS. Using skin sympathetic nerve activity to estimate stellate ganglion nerve activity in dogs. Heart Rhythm 2015; 12:1324-32. [PMID: 25681792 DOI: 10.1016/j.hrthm.2015.02.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Stellate ganglion nerve activity (SGNA) is important in cardiac arrhythmogenesis. However, direct recording of SGNA requires access to the thoracic cavity. Skin of upper thorax is innervated by sympathetic nerve fibers originating from the stellate ganglia and is easily accessible. OBJECTIVE The purpose of this study was to test the hypothesis that thoracic skin nerve activity (SKNA) can be used to estimate SGNA. METHODS We recorded SGNA and SKNAs using surface electrocardiogram leads in 5 anesthetized and 4 ambulatory dogs. Apamin injected into the right stellate ganglion abruptly increased both right SGNA and SKNA in 5 anesthetized dogs. We integrated nerve activities and averaged heart rate in each 1-minure window over 10 minutes. We implanted a radiotransmitter to record left SGNA in 4 ambulatory dogs (2 normal, 1 with myocardial infarction, 1 with intermittent rapid atrial pacing). After 2 weeks of recovery, we simultaneously recorded the SKNA and left SGNA continuously for 30 minutes when the dogs were ambulatory. RESULTS There was a positive correlation [average r = 0.877, 95% confidence interval (CI) 0.732-1.000, P <.05 for each dog] between integrated skin nerve activity (iSKNA) and SGNA (iSGNA) and between iSKNA and heart rate (average r = 0.837, 95% CI 0.752-0.923, P <.05). Similar to that found in the anesthetized dogs, there was a positive correlation (average r = 0.746, 95% CI 0.527-0.964, P <.05) between iSKNA and iSGNA and between iSKNA and heart rate (average r = 0.706, 95% CI 0.484-0.927, P <.05). CONCLUSION SKNAs can be used to estimate SGNA in dogs.
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Affiliation(s)
- Zhaolei Jiang
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ye Zhao
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiac Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Anisiia Doytchinova
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Nicholas J Kamp
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Wei-Chung Tsai
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University
| | - Yuan Yuan
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - David Adams
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - David Wagner
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Changyu Shen
- Department of Biostatistics, Indiana University School of Medicine and the Fairbanks School of Public Health, Indianapolis, Indiana
| | - Lan S Chen
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana,.
| | - Thomas H Everett
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Shien-Fong Lin
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Institute of Biomedical Engineering, National Chiao-Tung University
| | - Peng-Sheng Chen
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Huang B, Yu L, Jiang H. A potential link between left stellate ganglion and renal sympathetic nerve: An important mechanism for cardiac arrhythmias? Int J Cardiol 2015; 179:123-4. [DOI: 10.1016/j.ijcard.2014.10.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/09/2014] [Accepted: 10/18/2014] [Indexed: 11/30/2022]
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Doytchinova A, Patel J, Zhou S, Chen LS, Lin H, Shen C, Everett TH, Lin SF, Chen PS. Subcutaneous nerve activity and spontaneous ventricular arrhythmias in ambulatory dogs. Heart Rhythm 2014; 12:612-620. [PMID: 25460171 DOI: 10.1016/j.hrthm.2014.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Stellate ganglion nerve activity (SGNA) is important in ventricular arrhythmogenesis. However, because thoracotomy is needed to access the stellate ganglion, it is difficult to use SGNA for risk stratification. OBJECTIVE The purpose of this study was to test the hypothesis that subcutaneous nerve activity (SCNA) in canines can be used to estimate SGNA and predict ventricular arrhythmia. METHODS We implanted radiotransmitters to continuously monitor left stellate ganglion and subcutaneous electrical activities in 7 ambulatory dogs with myocardial infarction, complete heart block, and nerve growth factor infusion to the left stellate ganglion. RESULTS Spontaneous ventricular tachycardia (VT) or ventricular fibrillation (VF) was documented in each dog. SCNA preceded a combined 61 episodes of VT and VF, 61 frequent bigeminy or couplets, and 61 premature ventricular contractions within 15 seconds in 70%, 59%, and 61% of arrhythmias, respectively. Similar incidence of 75%, 69%, and 62% was noted for SGNA. Progressive increase in SCNA [48.9 (95% confidence interval [CI] 39.3-58.5) vs 61.8 (95% CI 45.9-77.6) vs 75.1 (95% CI 57.5-92.7) mV-s] and SGNA [48.6 (95% CI 40.9-56.3) vs 58.5 (95% CI 47.5-69.4) vs 69.0 (95% CI 53.8-84.2) mV-s] integrated over 20-second intervals was demonstrated 60 seconds, 40 seconds, and 20 seconds before VT/VF (P <.05), respectively. The Pearson correlation coefficient for integrated SCNA and SGNA was 0.73 ± 0.18 (P <.0001 for all dogs, n = 5). Both SCNA and SGNA exhibited circadian variation. CONCLUSION SCNA can be used as an estimate of SGNA to predict susceptibility to VT and VF in a canine model of ventricular arrhythmia and sudden cardiac death.
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Affiliation(s)
- Anisiia Doytchinova
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jheel Patel
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Shengmei Zhou
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Lan S Chen
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Hongbo Lin
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana; Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Changyu Shen
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana; Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Thomas H Everett
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Shien-Fong Lin
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Peng-Sheng Chen
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
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Zhao LQ, Liu SW. Atrial fibrillation in essential hypertension: an issue of concern. J Cardiovasc Med (Hagerstown) 2014; 15:100-6. [PMID: 24553088 DOI: 10.2459/jcm.0b013e3283640ff7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Many clinical studies indicate that atrial fibrillation is closely related to hypertension. Atrial fibrillation is not only associated with the level of blood pressure (BP) but also with the circadian rhythms of BP. However, the underlying mechanisms of atrial fibrillation in essential hypertension patients remain largely unknown. Hypertension may facilitate the onset and persistence of atrial fibrillation by stretch-induced changes in the repolarization of atrial myocytes (triggers of atrial fibrillation) and atrial remodeling (structural and electrical remodeling). Importantly, the effects of hypertension on atrial fibrillation are progressive. These progressive anatomic, functional, electrophysiological and structural changes occur at different times. This characterization of the time course of atrial changes presents an intervention window before remodeling progresses to changes that are difficult to reverse. Given that the medium to long-term efficacy of antiarrhythmic drugs has proved poor, it is essential to seek new therapies to prevent the onset of atrial fibrillation and to effectively control recurrences of atrial fibrillation. The study of nonantiarrhythmic drugs that act on the atrial remodeling that constitutes the substrate of the arrhythmia is a new and very interesting field of research. Treatment with angiotensin-converting enzyme inhibitors angiotension-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) seems more promising. However, from recent trials, only hypertension with structural heart disease, left ventricular dysfunction and left ventricular hypertrophy benefit from ACEIs and ARBs. This article reviews many aspects of atrial fibrillatio in essential hypertension patients to provide the foundation of atrial fibrillatio treatment.
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Affiliation(s)
- Li-Qun Zhao
- Shanghai Jiao Tong University affiliated first people's Hospital, Shanghai, China
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141
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Tsai WC, Chen PS. Cross talk between renal and cardiac autonomic nerves: is this how renal denervation works? J Cardiovasc Electrophysiol 2014; 25:1257-8. [PMID: 25154503 DOI: 10.1111/jce.12532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Wei-Chung Tsai
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Yin X, Zhao Y, Xi Y, Cheng N, Xia Y, Zhang S, Dong Y, Chang D, Cheng J, Yang Y, Gao L. The early stage of the atrial electroanatomic remodeling as substrates for atrial fibrillation in hypertensive patients. J Am Heart Assoc 2014; 3:e001033. [PMID: 25237045 PMCID: PMC4323835 DOI: 10.1161/jaha.114.001033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hypertension is one of the most important risk factors for atrial fibrillation (AF). Recent studies suggest right atrial remodeling in hypertensive patients may be associated with increased inducibility of AF. This study sought to characterize the electroanatomic features of left and right atria and pulmonary veins (PVs) in hypertensive patients. METHODS AND RESULTS A prospective observational study was conducted on patients who underwent ablation for paroxysmal supraventricular tachycardia or paroxysmal AF. Electrophysiological features of the PVs and atria, including event-related potentials, conduction time, and inducibility and vulnerability of AF, were characterized during cardiac catheterization. Anatomic and hemodynamic features were assessed by using echocardiographic and computer tomography imaging. When 15 hypertensive patients with paroxysmal supraventricular tachycardia were compared with 17 normotensive patients with paroxysmal supraventricular tachycardia, the hypertensive patients had significantly shortened PV event-related potentials with increased dispersions (P<0.001) but slightly prolonged atrial event-related potentials (P=NS) and had prolonged interatrial and intra-atrial conduction times (P<0.001). Additionally, the hypertensive patients had increased vulnerability and inducibility of AF and prolonged duration of induced AF (P<0.01). All of these changes were more pronounced in hypertensive patients with paroxysmal AF. Anatomically, compared with the normotensive patients, the diameters of 4 PVs in the hypertensive patients with paroxysmal supraventricular tachycardia were significantly enlarged (P<0.01) and became more remarkable in hypertensive patients with paroxysmal AF (P<0.0001), although the diameter and volume index of the left atrium among 3 groups were similar. CONCLUSIONS The hypertensive patients showed electroanatomic changes associated with increased vulnerability to AF, including shortened event-related potentials with increased dispersion, prolonged conduction time, and increased PV diameter, but these changes were not appreciated in the atria. Additionally, these changes became more dramatic in hypertensive patients with paroxysmal AF.
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Affiliation(s)
- Xiaomeng Yin
- First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (X.Y., Y.Z., Y.X., S.Z., Y.D., D.C., Y.Y., L.G.) Texas Heart Institute/St Luke's Hospital, Houston, TX (X.Y., Y.X., N.C., J.C.)
| | - Yan Zhao
- First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (X.Y., Y.Z., Y.X., S.Z., Y.D., D.C., Y.Y., L.G.)
| | - Yutao Xi
- Texas Heart Institute/St Luke's Hospital, Houston, TX (X.Y., Y.X., N.C., J.C.) Section of Cardiology, University of Texas School of Medicine at Houston, Houston, TX (Y.X., J.C.)
| | - Nancy Cheng
- Texas Heart Institute/St Luke's Hospital, Houston, TX (X.Y., Y.X., N.C., J.C.)
| | - Yunlong Xia
- First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (X.Y., Y.Z., Y.X., S.Z., Y.D., D.C., Y.Y., L.G.)
| | - Shulong Zhang
- First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (X.Y., Y.Z., Y.X., S.Z., Y.D., D.C., Y.Y., L.G.)
| | - Yingxue Dong
- First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (X.Y., Y.Z., Y.X., S.Z., Y.D., D.C., Y.Y., L.G.)
| | - Dong Chang
- First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (X.Y., Y.Z., Y.X., S.Z., Y.D., D.C., Y.Y., L.G.)
| | - Jie Cheng
- Texas Heart Institute/St Luke's Hospital, Houston, TX (X.Y., Y.X., N.C., J.C.) Section of Cardiology, University of Texas School of Medicine at Houston, Houston, TX (Y.X., J.C.)
| | - Yanzong Yang
- First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (X.Y., Y.Z., Y.X., S.Z., Y.D., D.C., Y.Y., L.G.)
| | - Lianjun Gao
- First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (X.Y., Y.Z., Y.X., S.Z., Y.D., D.C., Y.Y., L.G.)
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Billette J, Tadros R. Continuous sensing of sympathetic tone: an eventual clinical tool. J Cardiovasc Electrophysiol 2014; 26:79-81. [PMID: 25223885 DOI: 10.1111/jce.12548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jacques Billette
- Département de physiologie, Faculté de médecine, Université de Montréal, Montréal, Canada
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Li Z, Wang M, Zhang Y, Zheng S, Wang X, Hou Y. The effect of the left stellate ganglion on sympathetic neural remodeling of the left atrium in rats following myocardial infarction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:107-14. [PMID: 25224585 DOI: 10.1111/pace.12513] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/09/2014] [Accepted: 08/07/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND The neural remodeling of the atrium plays an important role in the initiation of atrial fibrillation after myocardial infarction (MI); however, the effects of the left stellate ganglion (LSG) on the neural remodeling of the atrium remain incompletely understood. Thus, this study investigated the mechanism by which the LSG mediates sympathetic neural remodeling of the left atrium (LA) in rats after MI. METHODS Sixty rats were randomly divided into a Sham group and an MI group. The expression levels of growth-associated protein-43 (GAP43) and nerve growth factor (NGF) messenger ribonucleic acid (mRNA) were measured by reverse transcription polymerase chain reaction. Immunohistochemistry was used to detect the distribution and density of GAP43- and NGF-positive nerves. The expression levels of the proteins were quantified by Western blotting. RESULTS Compared with the Sham group, GAP43 mRNA expression in the LSG was increased in the MI group (P < 0.01), but not significantly increased in the LA. Immunohistochemical analysis demonstrated that in both the LSG and the LA, the mean densities of GAP43- and NGF-positive nerves in the MI group were increased (P < 0.01). In both the LSG and the LA, the protein levels of GAP43 and NGF in the MI group were increased relative to the Sham group (P < 0.01). CONCLUSIONS The increased levels of NGF and GAP43 proteins can induce sympathetic nerve hyperinnervation in the LSG and the LA after MI. The increased GAP43 proteins in the LA, which may have been transported from the LSG, accelerated LA sympathetic neural remodeling in rats.
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Affiliation(s)
- Zhiyuan Li
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China; Department of Cardiology, Shandong Provincial Taishan Hospital, Tai'an, Shandong, China
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145
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Robinson EA, Rhee KS, Doytchinova A, Kumar M, Shelton R, Jiang Z, Kamp NJ, Adams D, Wagner D, Shen C, Chen LS, Everett TH, Fishbein MC, Lin SF, Chen PS. Estimating sympathetic tone by recording subcutaneous nerve activity in ambulatory dogs. J Cardiovasc Electrophysiol 2014; 26:70-8. [PMID: 25091691 DOI: 10.1111/jce.12508] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 07/27/2014] [Accepted: 07/29/2014] [Indexed: 01/30/2023]
Abstract
INTRODUCTION We tested the hypothesis that subcutaneous nerve activity (SCNA) of the thorax correlates with the stellate ganglion nerve activity (SGNA) and can be used to estimate the sympathetic tone. METHODS AND RESULTS We implanted radio transmitters in 11 ambulatory dogs to record left SGNA, left thoracic vagal nerve activity (VNA), and left thoracic SCNA, including 3 with simultaneous video monitoring and nerve recording. Two additional dogs were studied under general anesthesia with apamin injected into the right stellate ganglion while the right SGNA and the right SCNA were recorded. There was a significant positive correlation between integrated SGNA (iSGNA) and integrated SCNA (iSCNA) in the first 7 ambulatory dogs, with correlation coefficient of 0.70 (95% confidence interval [CI] 0.61-0.84, P < 0.05 for each dog). Tachycardia episodes (heart rate exceeding 150 bpm for ≥3 seconds) were invariably preceded by SGNA and SCNA. There was circadian variation of both SCNA and SGNA. Crosstalk was ruled out because SGNA, VNA, and SCNA bursts had different timing and activation patterns. In an eighth dog, closely spaced bipolar subcutaneous electrodes also recorded SCNA, but with reduced signal to noise ratio. Video monitoring in additional 3 dogs showed that movement was not a cause of high frequency SCNA. The right SGNA correlated strongly with right SCNA and heart rate in 2 anesthetized dogs after apamin injection into the right stellate ganglion. CONCLUSIONS SCNA recorded by bipolar subcutaneous electrodes correlates with the SGNA and can be used to estimate the sympathetic tone.
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Affiliation(s)
- Eric A Robinson
- Division of Cardiology, Department of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana, USA
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Huang B, Yu L, Scherlag BJ, Wang S, He B, Yang K, Liao K, Lu Z, He W, Zhang L, Po SS, Jiang H. Left renal nerves stimulation facilitates ischemia-induced ventricular arrhythmia by increasing nerve activity of left stellate ganglion. J Cardiovasc Electrophysiol 2014; 25:1249-56. [PMID: 25066536 DOI: 10.1111/jce.12498] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/14/2014] [Accepted: 07/21/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Renal sympathetic nerve (RSN) activity plays a key role in systemic sympathetic hyperactivity. Previous studies have shown that cardiac sympathetic hyperactivity, especially the left stellate ganglion (LSG), contributes to the pathogenesis of ventricular arrhythmias (VAs) after acute myocardial infarction (AMI). METHODS AND RESULTS Twenty-eight dogs received 3 hours of continuous left-sided electrical stimulation of RSN (LRS; Group-1, n = 9), sham RSN stimulation (Group-2, n = 9), or LSG ablation plus 3 hours of LRS (Group-3, n = 10) were included. AMI was induced by ligating the proximal left anterior descending coronary artery. LRS was performed using electrical stimulation on the adventitia of left renal artery at the voltage increasing the systolic blood pressure (BP) by 10%. BP, heart rate variability (HRV), serum norepinephrine (NE) level, and LSG function were measured at baseline and the end of each hour of LRS. C-fos and nerve growth factor (NGF) protein expressed in the LSG were examined in Group-1 and Group-2. Compared with baseline, 3 hours of LRS induced a significant increase in BP, sympathetic indices of HRV, serum NE level, and LSG function. The incidence of VAs in Group-1 was significantly higher than other groups. The expression of c-fos and NGF protein in the LSG was significantly higher in Group-1 than Group-2. CONCLUSION Three hours of LRS induces both systemic and cardiac sympathetic hyperactivity and increases the incidence of ischemia-induced VAs.
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Affiliation(s)
- Bing Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
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147
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Cho Y, Cha MJ, Choi EK, Oh IY, Oh S. Effects of low-intensity autonomic nerve stimulation on atrial electrophysiology. Korean Circ J 2014; 44:243-9. [PMID: 25089136 PMCID: PMC4117845 DOI: 10.4070/kcj.2014.44.4.243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/09/2014] [Accepted: 04/23/2014] [Indexed: 12/03/2022] Open
Abstract
Background and Objectives The cardiac autonomic nervous system is an emerging target for therapeutic control of atrial fibrillation (AF). We evaluated the effects of low-intensity autonomic nerve stimulation (LI-ANS) on atrial electrophysiology, AF vulnerability, and neural remodeling. Subjects and Methods Fourteen dogs were subjected to 3 hours rapid atrial pacing (RAP, 5 Hz) and concomitant high frequency LI-ANS (20 Hz, at voltages 40% below the threshold) as follows: no autonomic stimulation (control, n=3); or right cervical vagus nerve (RVN, n=6), anterior right ganglionated plexi (ARGP, n=3), and superior left ganglionated plexi (SLGP, n=2) stimulation. Programmed and burst atrial pacing were performed at baseline and at the end of each hour to determine atrial effective refractory period (ERP), window of vulnerability (WOV), and inducibility of sustained AF. Results Atrial ERP was significantly shortened by 3 hours RAP (in control group, ΔERP=-47.9±8.9%, p=0.032), and RAP-induced ERP shortening was attenuated by LI-ANS (in LI-ANS group, ΔERP=-15.4±5.9%, p=0.019; vs. control, p=0.035). Neither WOV for AF nor AF inducibility changed significantly during 3 hours RAP with simultaneous LI-ANS. There was no significant difference between the control and LI-ANS group in nerve density and sprouting evaluated by anti-tyrosine hydroxylase and anti-growth associated protein-43 staining. Among the various sites for LI-ANS, the ARGP-stimulation group showed marginally lower ΔWOV (p=0.077) and lower nerve sprouting (p=0.065) compared to the RVN-stimulation group. Conclusion Low-intensity autonomic nerve stimulation significantly attenuated the shortening of atrial ERP caused by RAP. ARGP may be a better target for LI-ANS than RVN for the purpose of suppressing atrial remodeling in AF.
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Affiliation(s)
- Youngjin Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Myung-Jin Cha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Il-Young Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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148
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Nishida K, Datino T, Macle L, Nattel S. Atrial Fibrillation Ablation. J Am Coll Cardiol 2014; 64:823-31. [DOI: 10.1016/j.jacc.2014.06.1172] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/26/2014] [Accepted: 06/27/2014] [Indexed: 10/24/2022]
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Trayanova NA. Mathematical approaches to understanding and imaging atrial fibrillation: significance for mechanisms and management. Circ Res 2014; 114:1516-31. [PMID: 24763468 DOI: 10.1161/circresaha.114.302240] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia in humans. The mechanisms that govern AF initiation and persistence are highly complex, of dynamic nature, and involve interactions across multiple temporal and spatial scales in the atria. This article aims to review the mathematical modeling and computer simulation approaches to understanding AF mechanisms and aiding in its management. Various atrial modeling approaches are presented, with descriptions of the methodological basis and advancements in both lower-dimensional and realistic geometry models. A review of the most significant mechanistic insights made by atrial simulations is provided. The article showcases the contributions that atrial modeling and simulation have made not only to our understanding of the pathophysiology of atrial arrhythmias, but also to the development of AF management approaches. A summary of the future developments envisioned for the field of atrial simulation and modeling is also presented. The review contends that computational models of the atria assembled with data from clinical imaging modalities that incorporate electrophysiological and structural remodeling could become a first line of screening for new AF therapies and approaches, new diagnostic developments, and new methods for arrhythmia prevention.
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Affiliation(s)
- Natalia A Trayanova
- From the Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD
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150
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Renin-angiotensin system inhibitors prevent the recurrence of atrial fibrillation: a meta-analysis of randomized controlled trials. J Cardiovasc Pharmacol 2014; 62:405-15. [PMID: 23921300 DOI: 10.1097/fjc.0b013e3182a094a1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This study was designed to assess whether angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) could prevent the recurrence of atrial fibrillation (AF). METHODS A systemic literature search of PubMed, EMBASE, and Cochrane Controlled Trials Register till 2012 was performed to identify randomized controlled trials involving the prevention of recurrence of AF with renin-angiotensin system blockade therapy. Subgroup analysis and meta-regression were performed. Publication bias was checked through funnel plot and Egger's test. RESULTS Twenty-one randomized controlled trials including 13,184 patients with AF were identified. Overall, the recurrence of AF was significantly reduced in patients using ACEI/ARBs [odds ratio (OR), 0.43; 95% confidence interval (CI), 0.32-0.56; P < 0.00001], especially both in irbesartan subgroup (OR, 0.38; 95% CI, 0.21-0.68; P = 0.001) and in patients receiving antiarrhythmic drug (AAD) (OR, 0.37; 95% CI, 0.29-0.48; P < 0.00001), and there was no significant difference between ACEIs and ARBs (ACEIs: OR, 0.42; 95% CI, 0.31-0.57 and ARBs: OR, 0.42; 95% CI, 0.31-0.57). Moreover, it was found that the benefits of ACEI/ARBs revealed positive correlation to systolic blood pressure (regression coefficient: -0.0700257, P = 0.000) in no-AAD users. CONCLUSIONS ACEI/ARBs are effective on the secondary prevention of AF, especially in patients receiving AAD and suffering from hypertension.
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