101
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Senaratne JM, Sandhu R, Barnett CF, Grunau B, Wong GC, van Diepen S. Approach to Ventricular Arrhythmias in the Intensive Care Unit. J Intensive Care Med 2020; 36:731-748. [PMID: 32705919 DOI: 10.1177/0885066620912701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Arrhythmias are commonly encountered in the intensive care unit as a primary admitting diagnosis or secondary to an acute illness. Appropriate identification and treatment of ventricular arrhythmias in this setting are particularly important to reduce morbidity and mortality. This review highlights the epidemiology, mechanisms, electrocardiographic features, and treatment of ventricular arrhythmias.
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Affiliation(s)
- Janek M Senaratne
- Division of Cardiology, 3158University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Roopinder Sandhu
- Division of Cardiology, 3158University of Alberta Hospital, Edmonton, Alberta, Canada
| | | | - Brian Grunau
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graham C Wong
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean van Diepen
- Division of Cardiology, 3158University of Alberta Hospital, Edmonton, Alberta, Canada.,Department of Critical Care Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
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102
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Alvarez-Collazo J, López-Requena A, Alvarez JL, Talavera K. The Citrus Flavonoid Hesperetin Has an Inadequate Anti-Arrhythmic Profile in the ΔKPQ Na V1.5 Mutant of the Long QT Type 3 Syndrome. Biomolecules 2020; 10:biom10060952. [PMID: 32599724 PMCID: PMC7355927 DOI: 10.3390/biom10060952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 11/19/2022] Open
Abstract
Type 3 long QT syndromes (LQT3) are associated with arrhythmogenic gain-of-function mutations in the cardiac voltage-gated Na+ channel (hNaV1.5). The citrus flavanone hesperetin (HSP) was previously suggested as a template molecule to develop new anti-arrhythmic drugs, as it blocks slowly-inactivating currents carried by the LQT3-associated hNaV1.5 channel mutant R1623Q. Here we investigated whether HSP also has potentially beneficial effects on another LQT3 hNaV1.5 channel variant, the ΔKPQ, which is associated to lethal ventricular arrhythmias. We used whole-cell patch-clamp to record Na+ currents (INa) in HEK293T cells transiently expressing hNaV1.5 wild type or ΔKPQ mutant channels. HSP blocked peak INa and the late INa carried by ΔKPQ mutant channels with an effective concentration of ≈300 μM. This inhibition was largely voltage-independent and tonic. HSP decreased the rate of inactivation of ΔKPQ channels and, consequently, was relatively weak in reducing the intracellular Na+ load in this mutation. We conclude that, although HSP has potential value for the treatment of the R1623Q LQT3 variant, this compound is inadequate to treat the LQT3 associated to the ΔKPQ genetic variant. Our results underscore the precision medicine rationale of better understanding the basic pathophysiological and pharmacological mechanisms to provide phenotype- genotype-directed individualization of treatment.
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103
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Mačianskienė R, Pudžiuvelytė L, Bernatonienė J, Almanaitytė M, Navalinskas A, Treinys R, Andriulė I, Jurevičius J. Antiarrhythmic Properties of Elsholtzia ciliata Essential Oil on Electrical Activity of the Isolated Rabbit Heart and Preferential Inhibition of Sodium Conductance. Biomolecules 2020; 10:E948. [PMID: 32586017 PMCID: PMC7356736 DOI: 10.3390/biom10060948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 11/30/2022] Open
Abstract
Elsholtzia ciliata essential oil (E. ciliata) has been developed in Lithuania and internationally patented as exerting antiarrhythmic properties. Here we demonstrate the pharmacological effects of this herbal preparation on cardiac electrical activity. We used cardiac surface ECG and a combination of microelectrode and optical mapping techniques to track the action potentials (APs) in the Langendorff-perfused rabbit heart model during atrial/endo-/epi-cardial pacing. Activation time, conduction velocity and AP duration (APD) maps were constructed. E. ciliata increased the QRS duration and shortened QT interval of ECG at concentrations of 0.01-0.1 μL/mL, whereas 0.3 μL/mL (0.03%) concentration resulted in marked strengthening of changes. In addition, the E. ciliata in a concentration dependent manner reduced the AP upstroke dV/dtmax and AP amplitude as well as APD. A marked attenuation of the AP dV/dtmax and a slowing spread of electrical signals suggest the impaired functioning of Na+channels, and the effect was usedependent. Importantly, all these changes were at least partially reversible. Our results indicate that E. ciliata modulates cardiac electrical activity preferentially inhibiting Na+ conductance, which may contribute to its effects as a natural antiarrhythmic medicine.
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Affiliation(s)
- Regina Mačianskienė
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukilėlių pr. 15, LT-50161 Kaunas, Lithuania; (R.M.); (M.A.); (A.N.); (R.T.); (I.A.)
| | - Lauryna Pudžiuvelytė
- Institute of Pharmaceutical Technologies, Medical Academy, Lithuanian University of Health Sciences, Sukilėlių pr. 13, LT-50161 Kaunas, Lithuania; (L.P.); (J.B.)
- Department of Drug Technology and Social Pharmacy, Medical Academy, Lithuanian University of Health Sciences, Sukilėlių pr. 13, LT-50161 Kaunas, Lithuania
| | - Jurga Bernatonienė
- Institute of Pharmaceutical Technologies, Medical Academy, Lithuanian University of Health Sciences, Sukilėlių pr. 13, LT-50161 Kaunas, Lithuania; (L.P.); (J.B.)
- Department of Drug Technology and Social Pharmacy, Medical Academy, Lithuanian University of Health Sciences, Sukilėlių pr. 13, LT-50161 Kaunas, Lithuania
| | - Mantė Almanaitytė
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukilėlių pr. 15, LT-50161 Kaunas, Lithuania; (R.M.); (M.A.); (A.N.); (R.T.); (I.A.)
| | - Antanas Navalinskas
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukilėlių pr. 15, LT-50161 Kaunas, Lithuania; (R.M.); (M.A.); (A.N.); (R.T.); (I.A.)
| | - Rimantas Treinys
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukilėlių pr. 15, LT-50161 Kaunas, Lithuania; (R.M.); (M.A.); (A.N.); (R.T.); (I.A.)
| | - Inga Andriulė
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukilėlių pr. 15, LT-50161 Kaunas, Lithuania; (R.M.); (M.A.); (A.N.); (R.T.); (I.A.)
| | - Jonas Jurevičius
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukilėlių pr. 15, LT-50161 Kaunas, Lithuania; (R.M.); (M.A.); (A.N.); (R.T.); (I.A.)
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104
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Ang YS, Rajamani S, Haldar SM, Hüser J. A New Therapeutic Framework for Atrial Fibrillation Drug Development. Circ Res 2020; 127:184-201. [DOI: 10.1161/circresaha.120.316576] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Atrial fibrillation (AF) is a highly prevalent cardiac arrhythmia and cause of significant morbidity and mortality. Its increasing prevalence in aging societies constitutes a growing challenge to global healthcare systems. Despite substantial unmet needs in AF prevention and treatment, drug developments hitherto have been challenging, and the current pharmaceutical pipeline is nearly empty. In this review, we argue that current drugs for AF are inadequate because of an oversimplified system for patient classification and the development of drugs that do not interdict underlying disease mechanisms. We posit that an improved understanding of AF molecular pathophysiology related to the continuous identification of novel disease-modifying drug targets and an increased appreciation of patient heterogeneity provide a new framework to personalize AF drug development. Together with recent innovations in diagnostics, remote rhythm monitoring, and big data capabilities, we anticipate that adoption of a new framework for patient subsegmentation based on pathophysiological, genetic, and molecular subsets will improve success rates of clinical trials and advance drugs that reduce the individual patient and public health burden of AF.
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Affiliation(s)
- Yen-Sin Ang
- From Amgen Research, Cardiometabolic Disorders, South San Francisco, CA (Y.-S.A., S.R., S.M.H.)
| | - Sridharan Rajamani
- From Amgen Research, Cardiometabolic Disorders, South San Francisco, CA (Y.-S.A., S.R., S.M.H.)
| | - Saptarsi M. Haldar
- From Amgen Research, Cardiometabolic Disorders, South San Francisco, CA (Y.-S.A., S.R., S.M.H.)
- Gladstone Institutes, San Francisco, CA (S.M.H.)
- Department of Medicine, Cardiology Division, UCSF School of Medicine, San Francisco, CA (S.M.H.)
| | - Jörg Hüser
- Bayer AG, Pharma-RD-PCR TA Cardiovascular Disease, Wuppertal, Germany (J.H.)
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105
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Williams EA, Russo V, Ceraso S, Gupta D, Barrett-Jolley R. Anti-arrhythmic properties of non-antiarrhythmic medications. Pharmacol Res 2020; 156:104762. [PMID: 32217149 PMCID: PMC7248574 DOI: 10.1016/j.phrs.2020.104762] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
Abstract
Traditional anti-arrhythmic drugs are classified by the Vaughan-Williams classification scheme based on their mechanisms of action, which includes effects on receptors and/or ion channels. Some known anti-arrhythmic drugs do not perfectly fit into this classification scheme. Other medications/molecules with established non-anti-arrhythmic indications have shown anti-arrhythmic properties worth exploring. In this narrative review, we discuss the molecular mechanisms and evidence base for the anti-arrhythmic properties of traditional non-antiarrhythmic drugs such as inhibitors of the renin angiotensin system (RAS), statins and polyunsaturated fatty acids (PUFAs). In summary, RAS antagonists, statins and PUFAs are 'upstream target modulators' that appear to have anti-arrhythmic roles. RAS blockers prevent the downstream arrhythmogenic effects of angiotensin II - the main effector peptide of RAS - and the angiotensin type 1 receptor. Statins have pleiotropic effects including anti-inflammatory, immunomodulatory, modulation of autonomic nervous system, anti-proliferative and anti-oxidant actions which appear to underlie their anti-arrhythmic properties. PUFAs have the ability to alter ion channel function and prevent excessive accumulation of calcium ions in cardiac myocytes, which might explain their benefits in certain arrhythmic conditions. Clearly, whilst a number of anti-arrhythmic drugs exist, there is still a need for randomised trials to establish whether additional agents, including those already in clinical use, have significant anti-arrhythmic effects.
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Affiliation(s)
- Emmanuel Ato Williams
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, United Kingdom; Institute of Aging and Chronic Disease, University of Liverpool, United Kingdom
| | - Vincenzo Russo
- Chair of Cardiology, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Sergio Ceraso
- Specialization Fellow in Cardiology, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, United Kingdom
| | - Richard Barrett-Jolley
- Chair Neuropharmacology, Institute of Aging and Chronic Disease, University of Liverpool, United Kingdom.
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106
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Guimaraes TACD, Georgiou M, Robson AG, Michaelides M. KCNV2 retinopathy: clinical features, molecular genetics and directions for future therapy. Ophthalmic Genet 2020; 41:208-215. [PMID: 32441199 PMCID: PMC7446039 DOI: 10.1080/13816810.2020.1766087] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
-associated retinopathy or “cone dystrophy with supernormal rod responses” is an
autosomal recessive cone-rod dystrophy with pathognomonic ERG findings. This gene
encodes Kv8.2, a voltage-gated potassium channel subunit that acts as a modulator by
shifting the activation range of the K+ channels in photoreceptor inner
segments. Currently, no treatment is available for the condition. However, there is a
lack of prospective long-term data in large molecularly confirmed cohorts, which is a
prerequisite for accurate patient counselling/prognostication, to identify an optimal
window for intervention and outcome measures, and ultimately to design future therapy
trials. Herein we provide a detailed review of the clinical features, retinal imaging,
electrophysiology and psychophysical studies, molecular genetics, and briefly discuss
future prospects for therapy trials.
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Affiliation(s)
- Thales A C De Guimaraes
- UCL Institute of Ophthalmology, University College London , London, UK.,Moorfields Eye Hospital , London, UK
| | - Michalis Georgiou
- UCL Institute of Ophthalmology, University College London , London, UK.,Moorfields Eye Hospital , London, UK
| | - Anthony G Robson
- UCL Institute of Ophthalmology, University College London , London, UK.,Moorfields Eye Hospital , London, UK
| | - Michel Michaelides
- UCL Institute of Ophthalmology, University College London , London, UK.,Moorfields Eye Hospital , London, UK
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107
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Kowey PR, Robinson VM. The Relentless Pursuit of New Drugs to Treat Cardiac Arrhythmias. Circulation 2020; 141:1507-1509. [PMID: 32392105 DOI: 10.1161/circulationaha.119.045149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter R Kowey
- The Lankenau Institute for Medical Research, Wynnewood, PA (P.R.K., V.M.R.)
- Thomas Jefferson University, Philadelphia, PA (P.R.K.)
| | - Victoria M Robinson
- The Lankenau Institute for Medical Research, Wynnewood, PA (P.R.K., V.M.R.)
- The University of Manchester, UK (V.M.R.)
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108
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Huang CLH, Ferenczi EA, Lei M. Editorial: Optogenetics: An Emerging Approach in Cardiac Electrophysiology. Front Physiol 2020; 11:414. [PMID: 32411019 PMCID: PMC7198899 DOI: 10.3389/fphys.2020.00414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/06/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Christopher L.-H. Huang
- Physiological Laboratory and Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
- Key Laboratory of Medical Electrophysiology of the Ministry of Education and Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Emily A. Ferenczi
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA, United States
| | - Ming Lei
- Key Laboratory of Medical Electrophysiology of the Ministry of Education and Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
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109
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Isaac E, Cooper SM, Jones SA, Loubani M. Do age-associated changes of voltage-gated sodium channel isoforms expressed in the mammalian heart predispose the elderly to atrial fibrillation? World J Cardiol 2020; 12:123-135. [PMID: 32431783 PMCID: PMC7215965 DOI: 10.4330/wjc.v12.i4.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/18/2020] [Accepted: 03/15/2020] [Indexed: 02/06/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide. The prevalence of the disease increases with age, strongly implying an age-related process underlying the pathology. At a time when people are living longer than ever before, an exponential increase in disease prevalence is predicted worldwide. Hence unraveling the underlying mechanics of the disease is paramount for the development of innovative treatment and prevention strategies. The role of voltage-gated sodium channels is fundamental in cardiac electrophysiology and may provide novel insights into the arrhythmogenesis of AF. Nav1.5 is the predominant cardiac isoform, responsible for the action potential upstroke. Recent studies have demonstrated that Nav1.8 (an isoform predominantly expressed within the peripheral nervous system) is responsible for cellular arrhythmogenesis through the enhancement of pro-arrhythmogenic currents. Animal studies have shown a decline in Nav1.5 leading to a diminished action potential upstroke during phase 0. Furthermore, the study of human tissue demonstrates an inverse expression of sodium channel isoforms; reduction of Nav1.5 and increase of Nav1.8 in both heart failure and ventricular hypertrophy. This strongly suggests that the expression of voltage-gated sodium channels play a crucial role in the development of arrhythmias in the diseased heart. Targeting aberrant sodium currents has led to novel therapeutic approaches in tackling AF and continues to be an area of emerging research. This review will explore how voltage-gated sodium channels may predispose the elderly heart to AF through the examination of laboratory and clinical based evidence.
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Affiliation(s)
- Emmanuel Isaac
- Department of Cardiothoracic Surgery, Hull University Teaching Hospitals, Cottingham HU16 5JQ, United Kingdom
| | - Stephanie M Cooper
- Department of Biomedical Sciences, University of Hull, Hull HU6 7RX, United Kingdom
| | - Sandra A Jones
- Department of Biomedical Sciences, University of Hull, Hull HU6 7RX, United Kingdom
| | - Mahmoud Loubani
- Department of Cardiothoracic Surgery, Hull University Teaching Hospitals, Cottingham HU16 5JQ, United Kingdom
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110
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Beik A, Joukar S, Najafipour H. A review on plants and herbal components with antiarrhythmic activities and their interaction with current cardiac drugs. J Tradit Complement Med 2020; 10:275-287. [PMID: 32670823 PMCID: PMC7340875 DOI: 10.1016/j.jtcme.2020.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/06/2020] [Accepted: 03/18/2020] [Indexed: 01/10/2023] Open
Abstract
This paper aimed to compile information on plants or their compounds which have experimentally shown antiarrhythmic effect and to scrutinize the efficacy and potency of them and their potential interaction with conventional cardiac drugs. Literature searches were accomplished by using numerous electronic databases, and the available knowledge on different parts of herbs and their ingredients with antiarrhythmic effects up to 2019 were identified and collected. The results indicate that 36 herbs or their derivatives can be effective in the treatment of arrhythmias, especially in animal and cellular models. They affect various ionic channels in different action potential phases. The alterations in ionic currents lead to changing in the amplitude and duration of the action potential, effective refractory period, maximum velocity, resting membrane potential, channel trafficking, or intracellular calcium concentration. The agents that prolong action potential duration and effective refractory period such as dauricine and sophocarpine seem to be more beneficial if more comprehensive studies confirm their efficacy and safety. It is noteworthy that the consumption of some herbal agents for cardiovascular (e.g. Hawthorn and Ginseng) or other (e.g. Ginseng and Licorice) therapeutic purposes may boost the pro-arrhythmogenic effect of current cardiovascular drugs such as cardiac glycosides. This study accentuates known plants or their derivatives with anti-arrhythmic effects, potential interaction with other cardiac drugs, and the possible mechanisms involved. It can assist clinicians and scientists in research and therapeutic approaches to the management of cardiac arrhythmias.
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Affiliation(s)
- Ahmad Beik
- Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, Department of Physiology and Pharmacology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Siyavash Joukar
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Department of Physiology and Pharmacology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.,Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, Department of Physiology and Pharmacology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.,Neuroscience Research Center, Institute of Neuropharmacology, Department of Physiology and Pharmacology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Najafipour
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Department of Physiology and Pharmacology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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111
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Hu H, Zhou S, Sun X, Xue Y, Yan L, Sun X, Lei M, Li J, Zeng X, Hao L. A potent antiarrhythmic drug N-methyl berbamine extends the action potential through inhibiting both calcium and potassium currents. J Pharmacol Sci 2020; 142:131-139. [DOI: 10.1016/j.jphs.2019.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/14/2019] [Accepted: 12/20/2019] [Indexed: 01/06/2023] Open
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112
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Swart R. A case report of successful digoxin use for fast atrial fibrillation to facilitate emergency surgery in a bleeding patient. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2020. [DOI: 10.36303/sajaa.2020.26.2.2355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- R Swart
- University of the Free State
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113
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Poulsen CB, Damkjær M, Løfgren B, Schmidt M. Trends in Antiarrhythmic Drug Use in Denmark Over 19 Years. Am J Cardiol 2020; 125:562-569. [PMID: 31883680 DOI: 10.1016/j.amjcard.2019.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
Antiarrhythmic drugs are widely used in the treatment of supraventricular and ventricular arrhythmias. Yet, nationwide long-term utilization trends remain unexplored. We examined 19-year trends in the use of antiarrhythmic drugs in Denmark. Using nationwide prescription data, we obtained information on hospital and primary healthcare use of Class I-V antiarrhythmic drugs from 1999 to 2017. Data was stratified according to sex and age groups. From 1999 to 2017, the total use of antiarrhythmic drugs per 1000 inhabitants/day increased 16% from 36.3 in 1999 to 41.9 in 2017 with peak consumption in 2008 (46.5). In primary healthcare, Class I usage decreased from 0.8 to 0.5 defined daily doses (DDD) per 1000 inhabitants/day, driven by a decreased prescription rate of propafenone (0.4 to 0.1) whereas prescription of flecainide (Class Ic) increased from 0.3 to 0.4 DDD per 1000 inhabitants/day (mainly in men of age 45 to 79 years). Class II usage increased from 15.4 to 33.6 DDD per 1000 inhabitants/day. Class III usage decreased from 2.6 to 1.1 DDD per 1000 inhabitants/day, reflecting reduced prescription rate of sotalol (2.1 to 0.2) whereas amiodarone increased from 0.5 to 0.9 (mainly due to increased prescription among men and women >80 years). Class IV usage declined from 8.6 to 2.8 DDD per 1000 inhabitants/day. Finally, Class V drugs decreased 8.1 to 3.3 DDD per 1000 inhabitants/day. In conclusion, during the past 2 decades considerable changes in prescription rate of antiarrhythmic drugs have occurred, most notably a reduction in sotalol and increased usage of flecainide, Class II drugs, and amiodarone.
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114
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Huang CLH, Wu L, Jeevaratnam K, Lei M. Update on antiarrhythmic drug pharmacology. J Cardiovasc Electrophysiol 2020; 31:579-592. [PMID: 31930579 DOI: 10.1111/jce.14347] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/22/2019] [Accepted: 01/03/2020] [Indexed: 12/28/2022]
Abstract
Cardiac arrhythmias constitute a major public health problem. Pharmacological intervention remains mainstay to their clinical management. This, in turn, depends upon systematic drug classification schemes relating their molecular, cellular, and systems effects to clinical indications and therapeutic actions. This approach was first pioneered in the 1960s Vaughan-Williams classification. Subsequent progress in cardiac electrophysiological understanding led to a lag between the fundamental science and its clinical translation, partly addressed by The working group of the European Society of Cardiology (1991), which, however, did not emerge with formal classifications. We here utilize the recent Revised Oxford Classification Scheme to review antiarrhythmic drug pharmacology. We survey drugs and therapeutic targets offered by the more recently characterized ion channels, transporters, receptors, intracellular Ca2+ handling, and cell signaling molecules. These are organized into their strategic roles in cardiac electrophysiological function. Following analysis of the arrhythmic process itself, we consider (a) pharmacological agents directly targeting membrane function, particularly the Na+ and K+ ion channels underlying depolarizing and repolarizing events in the cardiac action potential. (b) We also consider agents that modify autonomic activity that, in turn, affects both the membrane and (c) the Ca2+ homeostatic and excitation-contraction coupling processes linking membrane excitation to contractile activation. Finally, we consider (d) drugs acting on more upstream energetic and structural remodeling processes currently the subject of clinical trials. Such systematic correlations of drug actions and arrhythmic mechanisms at different molecular to systems levels of cardiac function will facilitate current and future antiarrhythmic therapy.
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Affiliation(s)
- Christopher L-H Huang
- Department of Biochemistry and Physiological Laboratory, University of Cambridge, Cambridge, UK.,Key Laboratory of Medical Electrophysiology of Ministry of Education, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China.,Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Lin Wu
- Key Laboratory of Medical Electrophysiology of Ministry of Education, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China.,Department of Cardiology, Peking University First Hospital, Beijing, China
| | | | - Ming Lei
- Key Laboratory of Medical Electrophysiology of Ministry of Education, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China.,Department of Pharmacology, University of Oxford, Oxford, UK
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115
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Gutierrez C, Hatamy E. Cardiac Arrhythmias. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_84-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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116
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Wang W, Zhang X, Chen K, Yin L, Gong M, Liu Y, Tse G, Wu L, Li G, Liu T. Effects of nicorandil infusion on ECG parameters in patients with unstable angina pectoris and percutaneous coronary intervention. Ann Noninvasive Electrocardiol 2019; 25:e12736. [PMID: 31849155 PMCID: PMC7358839 DOI: 10.1111/anec.12736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/02/2019] [Accepted: 11/19/2019] [Indexed: 01/01/2023] Open
Abstract
Background Percutaneous coronary intervention (PCI) is effective in treating patients with acute coronary syndrome (ACS) but is associated with some serious complications. Nicorandil is an anti‐anginal agent acting to improve microvascular circulation and to increase coronary blood flow. The objective of this article is to evaluate the effects of intracoronary injection followed with continuous intravenous injection of nicorandil on ECG parameters in patients with unstable angina pectoris (UA) undergoing PCI. Methods A single‐center, self‐controlled clinical trial was conducted at the Second Hospital of Tianjin Medical University between January 2019 and April 2019. Sixty‐three consecutive patients with UA who received coronary angiography and selective PCI were enrolled. ECG was recorded and analyzed before and 24 hr after nicorandil infusion. Results Patients were divided into three groups: control group (n = 23, aged 63.43 ± 12.55 years), short‐term, and prolonged use with nicorandil group (n = 20 and 20, aged 66.45 ± 8.06 years and 65.80 ± 9.49 years, respectively). Clinical characteristics and ECG parameters were similar before PCI among three groups (p > .05). In nicorandil treatment groups, intervals of QTd and Tp‐e in patients post‐PCI were significantly shorter than that in control and pre‐PCI (p < .05). Conclusions Nicorandil infusion reduces QTd and Tp‐e interval in patients with UA. Further studies will be needed to determine whether these electrophysiological changes are associated with a reduction of ventricular arrhythmias and improved outcomes.
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Affiliation(s)
- Weiding Wang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xu Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Kangyin Chen
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Li Yin
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yang Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Lin Wu
- Department of Cardiology, Peking University First Hospital, Beijing, China.,Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
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Gao J, Wang T, Yao X, Xie W, Shi X, He S, Zhao T, Wang C, Zhu Y. Clinical evidence-guided network pharmacology analysis reveals a critical contribution of β1-adrenoreceptor upregulation to bradycardia alleviation by Shenxian-Shengmai. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:357. [PMID: 31822281 PMCID: PMC6902583 DOI: 10.1186/s12906-019-2769-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/25/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Shenxian-Shengmai (SXSM) Oral Liquid is a CFDA-approved patent Chinese Herbal medicine, which has been clinically used for the treatment of bradycardia. However, its active components and action mechanism remain to be established. The present study aimed to evaluate the efficacy of SXSM on bradycardia and to identify the possible active components and their pharmacological targets for this action. METHODS A literature-based meta-analysis was performed to evaluate the clinical efficacy of SXSM on bradycardia, which was confirmed by a rat ex vivo cardiac model. Network pharmacology analysis was then conducted to reveal the potential targets of SXSM active components and their anti-arrhythmia mechanisms. Finally, the identified drug-target interaction was confirmed by immunofluorescence assay in cardiomyocyte. RESULTS Meta-analysis of the available clinical study data shows that Shenxian-Shengmai Oral Liquid has a favorable effect for bradycardia. In an ex vivo bradycardia model of rat heart, SXSM restored heart rate by affecting Heart rate variability (HRV) which is associated with autonomic nervous system activity. A drug-target-pathway network analysis connecting SXSM components with arrhythmia suggested that a prominent anti-arrhythmia mechanisms of SXSM was via β1-adrenergic signaling pathway, which was subsequently validated by immunofluorescence assay showing that SXSM indeed increased the expression of ADRB1 in cultured cardiomyocytes. CONCLUSION By combining approaches of clinical evidence mining, experimental model confirmation, network pharmacology analyses and molecular mechanistic validation, we show that SXSM is an effective treatment for bradycardia and it involves multiple component interacting via multiple pathways, among which is the critical β1-adrenergic receptor upregulation. Our integrative approach could be applied to other multi-component traditional Chinese medicine investigation where ample clinical data are accumulated but advanced mechanistic studies are lacking.
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Affiliation(s)
- Jiaming Gao
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193 China
- Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology & Medicine, Tianjin, 300457 China
| | - Taiyi Wang
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193 China
- Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology & Medicine, Tianjin, 300457 China
| | - Xi Yao
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193 China
- Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology & Medicine, Tianjin, 300457 China
| | - Weiwei Xie
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193 China
- Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology & Medicine, Tianjin, 300457 China
| | - Xianru Shi
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193 China
- Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology & Medicine, Tianjin, 300457 China
| | - Shuang He
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193 China
- Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology & Medicine, Tianjin, 300457 China
| | - Tao Zhao
- Xian Buchang Chinese Medicine Cardio Cerebral Disease Hospital, Xian, China
| | - Chunhua Wang
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193 China
- Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology & Medicine, Tianjin, 300457 China
| | - Yan Zhu
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193 China
- Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology & Medicine, Tianjin, 300457 China
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Zhang H, Zhang H, Wang C, Wang Y, Zou R, Shi C, Guan B, Gamper N, Xu Y. Auxiliary subunits control biophysical properties and response to compound NS5806 of the Kv4 potassium channel complex. FASEB J 2019; 34:807-821. [PMID: 31914636 PMCID: PMC6972550 DOI: 10.1096/fj.201902010rr] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/28/2019] [Accepted: 11/04/2019] [Indexed: 12/19/2022]
Abstract
Kv4 pore‐forming subunits co‐assemble with β‐subunits including KChIP2 and DPP6 and the resultant complexes conduct cardiac transient outward K+ current (Ito). Compound NS5806 has been shown to potentate Ito in canine cardiomyocytes; however, its effects on Ito in other species yet to be determined. We found that NS5806 inhibited native Ito in a concentration‐dependent manner (0.1~30 μM) in both mouse ventricular cardiomyocytes and human‐induced pluripotent stem cell‐derived cardiomyocytes (hiPSC‐CMs), but potentiated Ito in the canine cardiomyocytes. In HEK293 cells co‐transfected with cloned Kv4.3 (or Kv4.2) and β‐subunit KChIP2, NS5806 significantly increased the peak current amplitude and slowed the inactivation. In contrast, NS5806 suppressed the current and accelerated inactivation of the channels when cells were co‐transfected with Kv4.3 (or Kv4.2), KChIP2 and another β‐subunit, DPP6‐L (long isoform). Western blot analysis showed that DPP6‐L was dominantly expressed in both mouse ventricular myocardium and hiPSC‐CMs, while it was almost undetectable in canine ventricular myocardium. In addition, low level of DPP6‐S expression was found in canine heart, whereas levels of KChIP2 expression were comparable among all three species. siRNA knockdown of DPP6 antagonized the Ito inhibition by NS5806 in hiPSC‐CMs. Molecular docking simulation suggested that DPP6‐L may associate with KChIP2 subunits. Mutations of putative KChIP2‐interacting residues of DPP6‐L reversed the inhibitory effect of NS5806 into potentiation of the current. We conclude that a pharmacological modulator can elicit opposite regulatory effects on Kv4 channel complex among different species, depending on the presence of distinct β‐subunits. These findings provide novel insight into the molecular design and regulation of cardiac Ito. Since Ito is a potential therapeutic target for treatment of multiple cardiovascular diseases, our data will facilitate the development of new therapeutic Ito modulators.
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Affiliation(s)
- Hongxue Zhang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Ministry of Education, Shijiazhuang, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, China
| | - Hua Zhang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Ministry of Education, Shijiazhuang, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, China
| | - Chanjuan Wang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Ministry of Education, Shijiazhuang, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, China
| | - Yuhong Wang
- Institute of Masteria Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruya Zou
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Ministry of Education, Shijiazhuang, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, China
| | - Chenxia Shi
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Ministry of Education, Shijiazhuang, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, China
| | - Bingcai Guan
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Ministry of Education, Shijiazhuang, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, China
| | - Nikita Gamper
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.,School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Yanfang Xu
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Ministry of Education, Shijiazhuang, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, China
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Viskin S, Hochstadt A, Chorin E, Viskin D, Havakuk O, Khoury S, Lee JK, Belhassen B, Rosso R. Quinidine-responsive out-of-hospital polymorphic ventricular tachycardia in patients with coronary heart disease. Europace 2019; 22:265-273. [DOI: 10.1093/europace/euz290] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/01/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
We recently reported that patients with coronary artery disease (CAD) who develop polymorphic ventricular tachycardia (VT) during the healing phase of an acute coronary event, generally fail to respond to revascularization or standard antiarrhythmic therapy but respond immediately to quinidine therapy. Here, we describe that CAD patients presenting with out-of-hospital polymorphic VT without a recent coronary event or an obvious precipitating factor, also respond uniquely to quinidine therapy.
Methods and results
Retrospective study of patients with unheralded, mainly out-of-hospital, polymorphic VT related to CAD but without evidence of acute myocardial ischaemia. We identified 20 patients who developed polymorphic VT without precipitating factors. The polymorphic VT events were triggered by extrasystoles with short (376 ± 49 ms) coupling interval. Arrhythmic storms occurred in 70% patients. These arrhythmic storms were generally refractory to conventional antiarrhythmic therapy but invariably responded to quinidine therapy. Revascularization was antiarrhythmic in 3 patients despite the absent clinical or ECG signs of ischaemia. During long-term follow-up (range 2 months to 11 years), 3 (15%) of patients not receiving quinidine developed recurrent polymorphic VT. There were no recurrent arrhythmias during long-term quinidine therapy.
Conclusions
Patients with CAD may develop polymorphic VT in the absence of obvious acute ischaemia or apparent precipitating factors, presenting as out-of-hospital polymorphic VT with high risk of arrhythmic storms that respond uniquely to quinidine therapy.
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Affiliation(s)
- Sami Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel
| | - Ehud Chorin
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel
| | - Dana Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel
| | - Ofer Havakuk
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel
| | - Shafik Khoury
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel
| | - John K Lee
- St Luke’s Hospital Mid America Heart Institute, Kansas City, MI, USA
| | - Bernard Belhassen
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel
| | - Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel
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Pérez-Riera AR, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, Nikus K. Current aspects of the basic concepts of the electrophysiology of the sinoatrial node. J Electrocardiol 2019; 57:112-118. [DOI: 10.1016/j.jelectrocard.2019.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 12/14/2022]
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Sutanto H, Laudy L, Clerx M, Dobrev D, Crijns HJ, Heijman J. Maastricht antiarrhythmic drug evaluator (MANTA): A computational tool for better understanding of antiarrhythmic drugs. Pharmacol Res 2019; 148:104444. [DOI: 10.1016/j.phrs.2019.104444] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/10/2019] [Accepted: 09/03/2019] [Indexed: 12/14/2022]
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122
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Dong R, Mu-u-min R, Reith AJM, O’Shea C, He S, Duan K, Kou K, Grassam-Rowe A, Tan X, Pavlovic D, Ou X, Lei M. A Protocol for Dual Calcium-Voltage Optical Mapping in Murine Sinoatrial Preparation With Optogenetic Pacing. Front Physiol 2019; 10:954. [PMID: 31456689 PMCID: PMC6698704 DOI: 10.3389/fphys.2019.00954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 07/09/2019] [Indexed: 01/08/2023] Open
Abstract
Among the animal models for studying the molecular basis of atrial and sinoatrial node (SAN) biology and disease, the mouse is a widely used species due to its feasibility for genetic modifications in genes encoding ion channels or calcium handling and signaling proteins in the heart. It is therefore highly valuable to develop robust methodologies for studying SAN and atrial electrophysiological function in this species. Here, we describe a protocol for performing dual calcium-voltage optical mapping on mouse sinoatrial preparation (SAP), in combination with an optogenetic approach, for studying SAP membrane potential, intracellular Ca2+ transients, and pacemaker activity. The protocol includes the details for preparing the intact SAP, robust tissue dual-dye loading, light-programmed pacing, and high-resolution optical mapping. Our protocol provides an example of use of the combination of optogenetic and optical mapping techniques for investigating SAP membrane potential and intracellular Ca2+ transients and pacemaker activity with high temporal and spatial resolution in specific cardiac tissues. Thus, our protocol provides a useful tool for studying SAP physiology and pathophysiology in mice.
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Affiliation(s)
- Ruirui Dong
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Razik Mu-u-min
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | | | - Christopher O’Shea
- Institute for Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Shicheng He
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Kaizhong Duan
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Kun Kou
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | | | - Xiaoqiu Tan
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Davor Pavlovic
- Institute for Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Xianhong Ou
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Ming Lei
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
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Hu J, Yu J, Chen Q, Hu J, Huang Q, Xia Z, Xia Z, Ju Z, Yuan P, Fan S, Xiong Q, Zhu B, Huang L, You C, Bao H, Wu Y, Cheng X, Li J, Marian AJ, Hong K. Efficacy of Nifekalant in Patients With Wolff-Parkinson-White Syndrome and Atrial Fibrillation: Electrophysiological and Clinical Findings. J Am Heart Assoc 2019; 8:e012511. [PMID: 31234695 PMCID: PMC6662361 DOI: 10.1161/jaha.119.012511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The efficacy of nifekalant in preexcited atrial fibrillation (AF) has not been assessed. Methods and Results The study populations consisted of patients with sustained preexcited AF (n=51), paroxysmal supraventricular tachycardia (n=201), and persistent AF (n=87). Effects of intravenous infusion of nifekalant were assessed on electrophysiological and clinical parameters. Nifekalant prolonged the shortest preexcited R‐R, the average preexcited R‐R, and the average R‐R intervals from 290±35 to 333±44 ms, 353±49 to 443±64 ms, and 356±53 to 467±75 ms, respectively, in patients with preexcited AF (all P<0.001). Nifekalant also decreased the percentage of preexcited QRS complexes, heart rate, and increased systolic pressure (all P<0.001). Nifekalant terminated AF in 33 of 51 patients (65%). Similar effects were also observed in a subgroup of 12 patients with preexcited AF and impaired left ventricular function. In patients with paroxysmal supraventricular tachycardia, nifekalant significantly prolonged the effective refractory period, the block cycle length of the antegrade accessory pathway, and the atrial effective refractory period (all P<0.001). Nifekalant had no effect on the effective refractory period of the antegrade atrioventricular node. Finally, in patients with persistent AF without an accessory pathway, nifekalant did not significantly decrease the ventricular rate of AF. One patient developed Torsades de Pointes. No other adverse effects were observed. Conclusions Nifekalant prolongs the effective refractory period of the antegrade accessory pathway and atrium without blocking antegrade conduction through the atrioventricular node, leading to slowing and/or to termination of preexcited AF. Thus, nifekalant might be an effective and a relatively safe drug in patients with preexcited AF.
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Affiliation(s)
- Jinzhu Hu
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Jianhua Yu
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Qi Chen
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Jianxin Hu
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Qianghui Huang
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Zhen Xia
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Zirong Xia
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Zhenzhen Ju
- 3 Post-Anesthetic Care Unit The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Ping Yuan
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Siyang Fan
- 4 Clinical EP Laboratory and Arrhythmia Service Center of Fuwai Heart Hospital Beijing China
| | - Qinmei Xiong
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Bo Zhu
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Lin Huang
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Chunjiao You
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Huihui Bao
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Yanqing Wu
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Xiaoshu Cheng
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Juxiang Li
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Ali J Marian
- 5 Center for Cardiovascular Genetics Brown Foundation Institute of Molecular Medicine The University of Texas Health Science Center Houston TX
| | - Kui Hong
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China.,2 Jiangxi Key Laboratory of Molecular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
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Hausner EA, Elmore SA, Yang X. Overview of the Components of Cardiac Metabolism. Drug Metab Dispos 2019; 47:673-688. [PMID: 30967471 PMCID: PMC7333657 DOI: 10.1124/dmd.119.086611] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/26/2019] [Indexed: 12/20/2022] Open
Abstract
Metabolism in organs other than the liver and kidneys may play a significant role in how a specific organ responds to chemicals. The heart has metabolic capability for energy production and homeostasis. This homeostatic machinery can also process xenobiotics. Cardiac metabolism includes the expression of numerous organic anion transporters, organic cation transporters, organic carnitine (zwitterion) transporters, and ATP-binding cassette transporters. Expression and distribution of the transporters within the heart may vary, depending on the patient’s age, disease, endocrine status, and various other factors. Several cytochrome P450 (P450) enzyme classes have been identified within the heart. The P450 hydroxylases and epoxygenases within the heart produce hydroxyeicosatetraneoic acids and epoxyeicosatrienoic acids, metabolites of arachidonic acid, which are critical in regulating homeostatic processes of the heart. The susceptibility of the cardiac P450 system to induction and inhibition from exogenous materials is an area of expanding knowledge, as are the metabolic processes of glucuronidation and sulfation in the heart. The susceptibility of various transcription factors and signaling pathways of the heart to disruption by xenobiotics is not fully characterized but is an area with implications for disruption of normal postnatal development, as well as modulation of adult cardiac health. There are knowledge gaps in the timelines of physiologic maturation and deterioration of cardiac metabolism. Cross-species characterization of cardiac-specific metabolism is needed for nonclinical work of optimum translational value to predict possible adverse effects, identify sensitive developmental windows for the design and conduct of informative nonclinical and clinical studies, and explore the possibilities of organ-specific therapeutics.
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Affiliation(s)
- Elizabeth A Hausner
- United States Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland (E.A.H., X.Y.); and National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina (S.A.E.)
| | - Susan A Elmore
- United States Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland (E.A.H., X.Y.); and National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina (S.A.E.)
| | - Xi Yang
- United States Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland (E.A.H., X.Y.); and National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina (S.A.E.)
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Hu D, Huang Y, Huang C. Letter by Hu et al Regarding Article, "Modernized Classification of Cardiac Antiarrhythmic Drugs". Circulation 2019; 139:1650-1651. [PMID: 30908103 DOI: 10.1161/circulationaha.118.038831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Dan Hu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Hubei, China (D.H., Y.H., C.H.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (D.H., Y.H., C.H.)
| | - Yan Huang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Hubei, China (D.H., Y.H., C.H.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (D.H., Y.H., C.H.)
| | - Congxin Huang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Hubei, China (D.H., Y.H., C.H.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (D.H., Y.H., C.H.)
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Lei M, Wu L, Terrar DA, Huang CLH. Response by Lei et al to Letter Regarding Article, "Modernized Classification of Cardiac Antiarrhythmic Drugs". Circulation 2019; 139:1652-1653. [PMID: 30908105 DOI: 10.1161/circulationaha.118.039292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ming Lei
- Department of Pharmacology, University of Oxford, UK (M.L., D.A.T.).,Key Laboratory of Medical Electrophysiology of the Ministry of Education and Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China (M.L., L.W.)
| | - Lin Wu
- Department of Cardiology, Peking University First Hospital, China (L.W.).,Key Laboratory of Medical Electrophysiology of the Ministry of Education and Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China (M.L., L.W.)
| | - Derek A Terrar
- Department of Pharmacology, University of Oxford, UK (M.L., D.A.T.)
| | - Christopher L-H Huang
- Physiological Laboratory and Department of Biochemistry, University of Cambridge, UK (C.L.-H.H.)
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Quinidine Rebooted. JACC Clin Electrophysiol 2019; 5:383-386. [DOI: 10.1016/j.jacep.2019.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/10/2019] [Accepted: 01/17/2019] [Indexed: 11/17/2022]
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