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Zhang H, Wang Y, Wu Y, Luo Z, Zhong M, Hong Z, Wang D. Intrathecal Anesthesia Prevents Ventricular Arrhythmias in Rats with Myocardial Ischemia/Reperfusion. Pharmacology 2024:1. [PMID: 38648737 DOI: 10.1159/000538997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/05/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Ventricular arrhythmia is commonly provoked by acute cardiac ischemia through sympathetic exaggeration and is often resistant to anti-arrhythmic therapies. Thoracic epidural anesthesia has been reported to terminate fatal ventricular arrhythmia; however, its underlying mechanism is unknown. METHODS Rats were randomly divided into four groups: sham, sham plus bupivacaine, ischemia/reperfusion (IR), and IR plus bupivacaine groups. Bupivacaine (1 mg/mL, 0.05 mL/100 g body weight) was injected intrathecally into the L5-L6 intervertebral space prior to establishing a myocardial IR rat model. Thereafter, cardiac arrhythmia, cardiac function, myocardial injury, and electrical activities of the heart and spinal cord were evaluated. RESULTS Intrathecal bupivacaine inhibited spinal neural activity, improved heart rate variability, reduced ventricular arrhythmia score, and ameliorated cardiac dysfunction in IR rats. Furthermore, intrathecal bupivacaine attenuated cardiac injury and myocardial apoptosis and regulated cardiomyocyte autophagy and connexin-43 distribution during myocardial IR. CONCLUSION Our results indicate that intrathecal bupivacaine blunts spinal neural activity to prevent cardiac arrhythmia and dysfunction induced by IR and that this anti-arrhythmic activity may be associated with regulation of autonomic balance, myocardial apoptosis and autophagy, and cardiac gap junction function.
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Affiliation(s)
- Huabin Zhang
- Department of Gerontology, The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, Wuhu, China
| | - Yue Wang
- Department of Gerontology, The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, Wuhu, China
| | - Yong Wu
- Department of Gerontology, The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, Wuhu, China
- Department of Geriatrics, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Zhongxu Luo
- Department of Gerontology, The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, Wuhu, China
| | - Ming Zhong
- Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution, Wannan Medical College, Wuhu, China
| | - Zongyuan Hong
- School of Pharmacy, Wannan Medical College, Wuhu, China
| | - Deguo Wang
- Department of Gerontology, The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, Wuhu, China
- Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution, Wannan Medical College, Wuhu, China
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Xu W, Wang DY, Chen ZY, Gao Q, Zou YL, Sun DH, Zhang S, Zhao XB, Gong YT, Zhang Y, Zhang DX, Li Y. Noninvasive Stereotactic Radiotherapy for PADN in an Acute Canine Model of Pulmonary Arterial Hypertension. JACC Basic Transl Sci 2024; 9:244-256. [PMID: 38510719 PMCID: PMC10950402 DOI: 10.1016/j.jacbts.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 03/22/2024]
Abstract
This study assesses the feasibility, safety, and effectiveness of noninvasive stereotactic body radiotherapy (SBRT) as an approach for pulmonary artery denervation in canine models. SBRT with CyberKnife resulted in reduced mean pulmonary artery pressure, pulmonary capillary wedge pressure, and pulmonary vascular resistance, and insignificantly increased cardiac output. In comparison to the control group, serum norepinephrine levels at 1 month and 6 months were significantly lower in the CyberKnife group. Computed tomography, pulmonary angiography, and histology analysis revealed that SBRT was associated with minimal collateral damage.
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Affiliation(s)
- Wei Xu
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Ding-yu Wang
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Zi-yin Chen
- Department of Oncology, the First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Qiang Gao
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yi-lun Zou
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Dang-hui Sun
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Song Zhang
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Xin-bo Zhao
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yong-tai Gong
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yun Zhang
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Da-xin Zhang
- Department of Oncology, the First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yue Li
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin Medical University, Harbin, China
- NHC Key Laboratory of Cell Transplantation, Harbin Medical University, Harbin, Heilongjiang Province, China
- Institute of Metabolic Disease, Heilongjiang Academy of Medical Science, Harbin, China
- Heilongjiang Province Clinical Medical Research Center for Hypertension, the First Affiliated Hospital, Harbin Medical University, Harbin, China
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Yang X, Zhang L, Liu H, Shao Y, Zhang S. Cardiac Sympathetic Denervation Suppresses Atrial Fibrillation and Blood Pressure in a Chronic Intermittent Hypoxia Rat Model of Obstructive Sleep Apnea. J Am Heart Assoc 2020; 8:e010254. [PMID: 30757948 PMCID: PMC6405657 DOI: 10.1161/jaha.118.010254] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Chronic intermittent hypoxia ( CIH ) is a distinct pathological mechanism of obstructive sleep apnea ( OSA ), which is recognized as an independent risk factor for cardiovascular diseases. The aims of this study were to ascertain whether CIH induces atrial fibrillation ( AF ), to determine whether cardiac sympathetic denervation ( CSD ) can prevent it and suppress blood pressure, and to explore the potential molecular mechanisms involved. Methods and Results Sixty Sprague-Dawley male rats were randomly divided into 4 groups: sham, CSD , CIH , CIH + CSD . The rats were exposed either to CIH 8 hours daily or normoxia for 6 weeks. Cardiac pathology and structure were analyzed by hematoxylin and eosin staining and echocardiogram. ECG, blood pressure, body weight, and blood gas were recorded. Connexin 43 and tyrosine hydroxylase were detected by western blot, immunohistochemistry, and immunofluorescence. CIH induced atrial remodeling, and increased AF inducibility. CSD treatment reduced postapneic blood pressure rises and AF susceptibility, which could attenuate CIH -associated structural atrial arrhythmogenic remodeling. In addition, CIH -induced sympathetic nerve hyperinnervation and CSD treatment reduced sympathetic innervation, which may affect CIH -induced AF -associated sympathovagal imbalance. Connexin 43 was specifically downregulated in CIH , whereas CSD treatment increased its expression. Conclusions These results suggested CIH induces atrial remodeling, increases AF inducibility, results in sympathetic nerve hyperinnervation, and decreases connexin 43 expression, but CSD treatment reduces AF susceptibility, postapneic blood pressure increase, sympathetic innervation, and the alteration of Cx43, which may be a key point in the genesis of CIH -induced AF .
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Affiliation(s)
- Xuechao Yang
- 1 Department of Cardiothoracic Surgery The First Affiliated Hospital of Nanjing Medical University Nanjing Jiangsu People's Republic of China
| | - Linfei Zhang
- 1 Department of Cardiothoracic Surgery The First Affiliated Hospital of Nanjing Medical University Nanjing Jiangsu People's Republic of China
| | - Huan Liu
- 1 Department of Cardiothoracic Surgery The First Affiliated Hospital of Nanjing Medical University Nanjing Jiangsu People's Republic of China
| | - Yongfeng Shao
- 1 Department of Cardiothoracic Surgery The First Affiliated Hospital of Nanjing Medical University Nanjing Jiangsu People's Republic of China
| | - Shijiang Zhang
- 1 Department of Cardiothoracic Surgery The First Affiliated Hospital of Nanjing Medical University Nanjing Jiangsu People's Republic of China
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Liu JY, Shang J, Mu XD, Gao ZY. RETRACTED: Protective effect of down-regulated microRNA-27a mediating high thoracic epidural block on myocardial ischemia-reperfusion injury in mice through regulating ABCA1 and NF-κB signaling pathway. Biomed Pharmacother 2019; 112:108606. [PMID: 30802823 DOI: 10.1016/j.biopha.2019.108606] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 12/30/2022] Open
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief. An Expression of Concern for this article was previously published while an investigation was conducted (see related editorial: https://doi.org/10.1016/j.biopha.2022.113812). This retraction notice supersedes the Expression of Concern published earlier. Concern was raised about the reliability of the heart images shown in Figure 1A, which appear to contain similar features to those found in other publications, as detailed here: https://pubpeer.com/publications/108A0BE9F52724D6879E23FAE7F361; and here: https://docs.google.com/spreadsheets/d/1r0MyIYpagBc58BRF9c3luWNlCX8VUvUuPyYYXzxWvgY/edit#gid=262337249. Concerns over the provenance of the flow cytometry data in Figure 7A were also raised. The journal requested the corresponding author comment on these concerns and provide the associated raw data. The authors did not respond to this request and therefore the Editor-in-Chief decided to retract the article.
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Affiliation(s)
- Jin-Yu Liu
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, 264000, PR China
| | - Jie Shang
- Department of Electrocardiogram, Yantai Yuhuangding Hospital, Yantai, 264000, PR China
| | - Xiao-Dong Mu
- Clinical Laboratory, Yantai Yuhuangding Hospital, Yantai, 264000, PR China
| | - Zhi-Yong Gao
- Department of Rehabilitation, Yantai Yuhuangding Hospital, Yantai, 264000, PR China.
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Carnagarin R, Kiuchi MG, Ho JK, Matthews VB, Schlaich MP. Sympathetic Nervous System Activation and Its Modulation: Role in Atrial Fibrillation. Front Neurosci 2019; 12:1058. [PMID: 30728760 PMCID: PMC6351490 DOI: 10.3389/fnins.2018.01058] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/31/2018] [Indexed: 12/17/2022] Open
Abstract
The autonomic nervous system (ANS) has a significant influence on the structural integrity and electrical conductivity of the atria. Aberrant activation of the sympathetic nervous system can induce heterogeneous changes with arrhythmogenic potential which can result in atrial tachycardia, atrial tachyarrhythmias and atrial fibrillation (AF). Methods to modulate autonomic activity primarily through reduction of sympathetic outflow reduce the incidence of spontaneous or induced atrial arrhythmias in animal models and humans, suggestive of the potential application of such strategies in the management of AF. In this review we focus on the relationship between the ANS, sympathetic overdrive and the pathophysiology of AF, and the potential of sympathetic neuromodulation in the management of AF. We conclude that sympathetic activity plays an important role in the initiation and maintenance of AF, and modulating ANS function is an important therapeutic approach to improve the management of AF in selected categories of patients. Potential therapeutic applications include pharmacological inhibition with central and peripheral sympatholytic agents and various device based approaches. While the role of the sympathetic nervous system has long been recognized, new developments in science and technology in this field promise exciting prospects for the future.
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Affiliation(s)
- Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Marcio G Kiuchi
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Jan K Ho
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Vance B Matthews
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia.,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia.,Neurovascular Hypertension and Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
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Effect of Thoracic Epidural Anesthesia on Ventricular Excitability in a Porcine Model. Anesthesiology 2017; 126:1096-1106. [PMID: 28358748 DOI: 10.1097/aln.0000000000001613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Imbalances in the autonomic nervous system, namely, excessive sympathoexcitation, contribute to ventricular tachyarrhythmias. While thoracic epidural anesthesia clinically suppresses ventricular tachyarrhythmias, its effects on global and regional ventricular electrophysiology and electrical wave stability have not been fully characterized. The authors hypothesized that thoracic epidural anesthesia attenuates myocardial excitability and the proarrhythmic effects of sympathetic hyperactivity. METHODS Yorkshire pigs (n = 15) had an epidural catheter inserted (T1 to T4) and a 56-electrode sock placed on the heart. Myocardial excitability was measured by activation recovery interval, dispersion of repolarization, and action potential duration restitution at baseline and during programed ventricular extrastimulation or left stellate ganglion stimulation, before and 30 min after thoracic epidural anesthesia (0.25% bupivacaine). RESULTS After thoracic epidural anesthesia infusion, there was no change in baseline activation recovery interval or dispersion of repolarization. During programmed ventricular extrastimulation, thoracic epidural anesthesia decreased the maximum slope of ventricular electrical restitution (0.70 ± 0.24 vs. 0.89 ± 0.24; P = 0.021) reflecting improved electrical wave stability. Thoracic epidural anesthesia also reduced myocardial excitability during left stellate ganglion stimulation-induced sympathoexcitation through attenuated shortening of activation recovery interval (-7 ± 4% vs. -4 ± 3%; P = 0.001), suppression of the increase in dispersion of repolarization (313 ± 293% vs. 185 ± 234%; P = 0.029), and reduction in sympathovagal imbalance as measured by heart rate variability. CONCLUSIONS Our study describes the electrophysiologic mechanisms underlying antiarrhythmic effects of thoracic epidural anesthesia during sympathetic hyperactivity. Thoracic epidural anesthesia attenuates ventricular myocardial excitability and induces electrical wave stability through its effects on activation recovery interval, dispersion of repolarization, and the action potential duration restitution slope.
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Qiao G, Xia D, Cheng Z, Zhang G. Role of Sprouty1 (Spry1) in the pathogenesis of atrial fibrosis. Pathol Res Pract 2017; 214:308-313. [PMID: 29096943 DOI: 10.1016/j.prp.2017.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/28/2017] [Accepted: 04/20/2017] [Indexed: 11/19/2022]
Abstract
Atrial fibrosis is the hallmark of atrial fibrillation (AF) dependent structure remodeling. Besides, sprouty 1 (Spry1) plays a key role in the process of fibrosis. In this study, we investigated whether Spry1 could regulate TGF-β1 in atrial fibrosis. Ten dogs or patients were assigned to control (n=4) and AF group (n=6). The left atrium of dogs or right atrial appendage of patients was taken. After that, cardiac fibroblasts were treated with or without angiotensin II (Ang II). Furthermore, cardiac fibroblasts were transfected with lentivirus of Spry1 over-expression vector, Spry1 shRNA or negative control (NC). And the protein expression of Spry1 and TGF-β1 was analyzed by western blot and immunohistochemistry. The results showed that TGF-β1 was highly expressed while Spry1 was lowly expressed in the models of human and canine with AF. Besides, the protein expression of TGF-β1 was up-regulated and Spry1 was down-regulated in Ang II stimulated cardiac fibroblasts. Furthermore, when Spry1 was knockdown in Ang II-induced cardiac fibroblasts, the cell proliferation and the TGF-β1 protein expression increased significantly, while Spry1 over-expression showed inverse results. Our results demonstrated that Spry1 may target TGF-β1 in regulating fibrosis. These findings may provide possible therapeutic targets in atrial fibrosis.
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Affiliation(s)
- Gang Qiao
- Department of Cardiovascular Surgery, Henan Provincial Hospital, Zhengzhou University 450003, Zhengzhou, China
| | - Dongsheng Xia
- Department of Cardiovascular Surgery, Henan Provincial Hospital, Zhengzhou University 450003, Zhengzhou, China
| | - Zhaoyun Cheng
- Department of Cardiovascular Surgery, Henan Provincial Hospital, Zhengzhou University 450003, Zhengzhou, China
| | - Guobao Zhang
- Department of Cardiovascular Surgery, Henan Provincial Hospital, Zhengzhou University 450003, Zhengzhou, China.
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Ripplinger CM, Noujaim SF, Linz D. The nervous heart. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2016; 120:199-209. [PMID: 26780507 DOI: 10.1016/j.pbiomolbio.2015.12.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 12/23/2022]
Abstract
Many cardiac electrophysiological abnormalities are accompanied by autonomic nervous system dysfunction. Here, we review mechanisms by which the cardiac nervous system controls normal and abnormal excitability and may contribute to atrial and ventricular tachyarrhythmias. Moreover, we explore the potential antiarrhythmic and/or arrhythmogenic effects of modulating the autonomic nervous system by several strategies, including ganglionated plexi ablation, vagal and spinal cord stimulations, and renal sympathetic denervation as therapies for atrial and ventricular arrhythmias.
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Affiliation(s)
- Crystal M Ripplinger
- Department of Pharmacology, University of California Davis, 451 Health Sciences Drive, Davis, CA 95616, USA.
| | - Sami F Noujaim
- Molecular Pharmacology and Physiology, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA.
| | - Dominik Linz
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421 Homburg, Saar, Germany.
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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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Linz D, van Hunnik A, Hohl M, Mahfoud F, Wolf M, Neuberger HR, Casadei B, Reilly SN, Verheule S, Böhm M, Schotten U. Catheter-based renal denervation reduces atrial nerve sprouting and complexity of atrial fibrillation in goats. Circ Arrhythm Electrophysiol 2015; 8:466-74. [PMID: 25713217 DOI: 10.1161/circep.114.002453] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) leads to structural and neural remodeling in the atrium, which enhances AF complexity and perpetuation. Renal denervation (RDN) can reduce renal and whole-body sympathetic activity. Aim of this study was to determine the effect of sympathetic nervous system modulation by RDN on atrial arrhythmogenesis. METHODS AND RESULT Eighteen goats were instrumented with an atrial endocardial pacemaker lead and a burst pacemaker. Percutaneous catheter-based RDN was performed in 8 goats (RDN-AF). Ten goats undergoing a sham procedure served as control (SHAM-AF). AF was induced and maintained by burst pacing for 6 weeks. High-resolution mapping was used to record epicardial conduction patterns of the right and left atrium. RDN reduced tyrosine hydroxylase-positive sympathetic nerve staining and resulted in lower transcardiac norepinephrine levels. This was associated with reduced expression of nerve growth factor-β, indicating less atrial nerve sprouting. Atrial endomysial fibrosis content was lower and myocyte diameter was smaller in RDN-AF. Median conduction velocity was higher (75 ± 9 versus 65 ± 10 cm/s, P = 0.02), and AF cycle length was shorter in RDN-AF compared with SHAM-AF. Left atrial AF complexity (4.8 ± 0.8 fibrillation waves/AF cycle length versus 8.5 ± 0.8 waves/AF cycle length, P = 0.001) and incidence of breakthroughs (2.0 ± 0.3 versus 4.3 ± 0.5 waves/AF cycle length, P = 0.059) were lower in RDN-AF compared with SHAM-AF. Blood pressure was normal and not significantly different between the groups. CONCLUSIONS RDN reduces atrial sympathetic nerve sprouting, structural alterations, and AF complexity in goats with persistent AF, independent of changes in blood pressure.
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Affiliation(s)
- Dominik Linz
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Arne van Hunnik
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Mathias Hohl
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Felix Mahfoud
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Milan Wolf
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Hans-Ruprecht Neuberger
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Barbara Casadei
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Svetlana N Reilly
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Sander Verheule
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Michael Böhm
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.)
| | - Ulrich Schotten
- From the Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (D.L., M.H., F.M., M.W., H.-R.N., M.B.); Department of Physiology, University Maastricht, Maastricht, The Netherlands (A.v. H., S.V., U.S.); Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom (B.C., S.N.R.).
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11
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Linz D, Hunnik AV, Ukena C, Mahfoud F, Ewen S, Verheule S, Böhm M, Schotten U. Effects of renal denervation on atrial arrhythmogenesis. Future Cardiol 2014; 10:813-22. [DOI: 10.2217/fca.14.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Atrial fibrillation is the most common sustained arrhythmia and is associated with significant morbidity and mortality. In addition to mechanisms such as atrial stretch and atrial remodeling, the activity of the autonomic nervous system has also been suggested to contribute to the progression from paroxysmal to persistent atrial fibrillation. Catheter-based renal denervation was introduced as a minimally invasive approach to reduce renal and whole body sympathetic activation with accompanying blood pressure reduction and left-ventricular morphological and functional improvement in drug-resistant hypertension. This review focuses on the potential effects of renal denervation on different arrhythmogenic mechanisms in the atrium and discusses potential anti-remodeling effects in atrial fibrillation patients with hypertension, heart failure and sleep apnea.
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Affiliation(s)
- Dominik Linz
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Arne van Hunnik
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Christian Ukena
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Felix Mahfoud
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Sebastian Ewen
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Sander Verheule
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Michael Böhm
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Ulrich Schotten
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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GE TONG, QIN HAO, WANG XU, YANG SHUSEN, GUO LI, HAN WEI, CHANG HUIYING. Effects of Thoracic Epidural Anesthesia on Cardiac Function and Myocardial Cell Apoptosis in Isoproterenol-Induced Chronic Heart Failure Rats. J Interv Cardiol 2014; 27:446-55. [PMID: 25267251 DOI: 10.1111/joic.12147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- TONG GE
- Department of Respiratory Medicine; the Second Hospital of Harbin; Harbin 150000 P.R. China
| | - HAO QIN
- Department of Respiratory Medicine; the Second Hospital of Harbin; Harbin 150000 P.R. China
| | - XU WANG
- Department of Cardiology; The First Affiliated Hospital of Harbin Medical University; Harbin P.R. China
| | - SHU-SEN YANG
- Department of Cardiology; The First Affiliated Hospital of Harbin Medical University; Harbin P.R. China
| | - LI GUO
- Department of Respiratory Medicine; the Second Hospital of Harbin; Harbin 150000 P.R. China
| | - WEI HAN
- Department of Cardiology; The First Affiliated Hospital of Harbin Medical University; Harbin P.R. China
| | - HUI-YING CHANG
- Department of Cardiology; The First Affiliated Hospital of Harbin Medical University; Harbin P.R. China
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Zhao J, Xu W, Yun F, Zhao H, Li W, Gong Y, Yuan Y, Yan S, Zhang S, Ding X, Wang D, Zhang C, Dong D, Xiu C, Yang N, Liu L, Xue J, Li Y. Chronic obstructive sleep apnea causes atrial remodeling in canines: mechanisms and implications. Basic Res Cardiol 2014; 109:427. [PMID: 25015734 DOI: 10.1007/s00395-014-0427-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 07/04/2014] [Accepted: 07/08/2014] [Indexed: 01/09/2023]
Abstract
Obstructive sleep apnea (OSA) is closely related to atrial fibrillation (AF). However, the roles and mechanisms of chronic OSA in atrial remodeling are still unclear. Canine model of chronic OSA was simulated by stopping the ventilator and closing the airway for 4 h per day and lasting for 12 weeks. AF inducibility and duration was increased while atrial effective refractory period (AERP) was shortened after chronic apnea. Meanwhile, upregulation of proteins encoding inward rectifier K(+) current (IK1), delayed rectifier K(+) current (IKr and IKs), acetylcholine activated K(+) current (IKACh), transient outward K(+) current (Ito) and ultra-rapid delayed rectifier potassium current (IKur) as well as downregulation of protein encoding L-type Ca(2+) current (ICa,L) were found after chronic OSA. Besides abnormal electrical activity, chronic OSA induced apoptosis and interstitial fibrosis of atrial myocytes, which was partly mediated by caspase 9, phosphorylation of extracellular-regulated kinase 1/2, and α-smooth muscle actin. In addition, atrial sympathetic and parasympathetic hyperinnervation were found manifesting by enhanced growth-associated protein 43, tyrosine hydroxylase and elevated choline acetyltransferase. Moreover, protein expression of β1, β2, and M2 receptor were markedly increased by chronic OSA. In summary, we firstly demonstrated in canine model that chronic OSA could shorten AERP and lead to altered expression of important channel proteins, moreover, induce atrial structure remodeling by increased atrial apoptosis, fibrosis, and autonomic remodeling, eventually promoting the development of a substrate of AF. Our findings suggested that reversing atrial remodeling might be a potential therapeutic strategy for OSA-induced AF.
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Affiliation(s)
- Jing Zhao
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Youzheng Street 23#, Nangang District, Harbin, 150001, Heilongjiang, People's Republic of China
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Abstract
Renal artery denervation (RDN) has been introduced as an ablation procedure that can effectively treat drug-resistant forms of hypertension. The ablative lesions reduce the afferent and efferent sympathetic nerve traffic to and from the kidneys, thus improving blood pressure control. Because of better control of blood pressure, and because the procedure reduces central sympathetic output to sensitive structures within the cardiovascular system, it has been hypothesized that RDN may be a valuable antiarrhythmic intervention. Preliminary results using RDN for atrial fibrillation control are promising. This review focuses on the mechanisms by which RDN may function as an antiarrhythmic treatment and early clinical results.
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Linz D, Ukena C, Mahfoud F, Neuberger HR, Böhm M. Atrial Autonomic Innervation. J Am Coll Cardiol 2014; 63:215-24. [DOI: 10.1016/j.jacc.2013.09.020] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/03/2013] [Accepted: 09/10/2013] [Indexed: 10/26/2022]
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Cardiac sympathetic denervation in patients with refractory ventricular arrhythmias or electrical storm: intermediate and long-term follow-up. Heart Rhythm 2013; 11:360-6. [PMID: 24291775 DOI: 10.1016/j.hrthm.2013.11.028] [Citation(s) in RCA: 260] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Left and bilateral cardiac sympathetic denervation (CSD) have been shown to reduce burden of ventricular arrhythmias acutely in a small number of patients with ventricular tachyarrhythmia (VT) storm. The effects of this procedure beyond the acute setting are unknown. OBJECTIVE The purpose of this study was to evaluate the intermediate and long-term effects of left and bilateral CSD in patients with cardiomyopathy and refractory VT or VT storm. METHODS Retrospective analysis of medical records for patients who underwent either left or bilateral CSD for VT storm or refractory VT between April 2009 and December 2012 was performed. RESULTS Forty-one patients underwent CSD (14 left CSD, 27 bilateral CSD). There was a significant reduction in the burden of implantable cardioverter-defibrillator (ICD) shocks during follow-up compared to the 12 months before the procedure. The number of ICD shocks was reduced from a mean of 19.6 ± 19 preprocedure to 2.3 ± 2.9 postprocedure (P < .001), with 90% of patients experiencing a reduction in ICD shocks. At mean follow-up of 367 ± 251 days postprocedure, survival free of ICD shock was 30% in the left CSD group and 48% in the bilateral CSD group. Shock-free survival was greater in the bilateral group than in the left CSD group (P = .04). CONCLUSION In patients with VT storm, bilateral CSD is more beneficial than left CSD. The beneficial effects of bilateral CSD extend beyond the acute postsympathectomy period, with continued freedom from ICD shocks in 48% of patients and a significant reduction in ICD shocks in 90% of patients.
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Linz D, Mahfoud F, Schotten U, Ukena C, Hohl M, Neuberger HR, Wirth K, Böhm M. Renal sympathetic denervation provides ventricular rate control but does not prevent atrial electrical remodeling during atrial fibrillation. Hypertension 2012; 61:225-31. [PMID: 23150501 DOI: 10.1161/hypertensionaha.111.00182] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Renal denervation (RDN) reduces renal efferent and afferent sympathetic activity thereby lowering blood pressure in resistant hypertension. The effect of modulation of the autonomic nervous system by RDN on atrial electrophysiology and ventricular rate control during atrial fibrillation (AF) is unknown. Here we report a reduction of ventricular heart rate in a patient with permanent AF undergoing RDN. Subsequently, we investigated the effect of RDN on AF-induced shortening of atrial effective refractory period, AF inducibility, and ventricular rate control during AF maintained by rapid atrial pacing in 12 pigs undergoing RDN (n=7) or sham procedure (n=5). During sinus rhythm, RDN reduced heart rate (RR-interval, 708±12 versus 577±19 ms; P=0.0021) and increased atrioventricular node conduction time (PQ-interval, 112±12 versus 88±9 ms; P=0.0001). Atrial tachypacing for 30 minutes increased AF inducibility and decreased AF cycle length. This was not influenced by RDN. RDN reduced ventricular rate during AF episodes by ≈24% (119±9 versus 158±19 bpm; P=0.0001). AF episodes were shorter after RDN compared with sham (12±3 versus 34±4 s; P=0.0091), but atrial effective refractory period was not modified by RDN. RDN reduced heart rate and reduced atrioventricular node conduction time during sinus rhythm and provided rate control during AF. AF-induced atrial electrical remodeling, AF inducibility, and AF cycle length were not modified, but duration of AF episodes was shorter after RDN. Modulation of the autonomic nervous system by RDN might provide rate control and reduce susceptibility to AF. Whether RDN may provide rate control in a larger number of patients with AF deserves further clinical studies.
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Affiliation(s)
- Dominik Linz
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
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Artemisinin suppresses sympathetic hyperinnervation following myocardial infarction via anti-inflammatory effects. J Mol Histol 2012; 43:737-43. [DOI: 10.1007/s10735-012-9440-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 08/11/2012] [Indexed: 11/26/2022]
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Lin YK, Chen YC, Chen JH, Chen SA, Chen YJ. Adipocytes modulate the electrophysiology of atrial myocytes: implications in obesity-induced atrial fibrillation. Basic Res Cardiol 2012; 107:293. [DOI: 10.1007/s00395-012-0293-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 07/17/2012] [Accepted: 07/31/2012] [Indexed: 01/19/2023]
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Role of miR-21 in the pathogenesis of atrial fibrosis. Basic Res Cardiol 2012; 107:278. [PMID: 22760500 DOI: 10.1007/s00395-012-0278-0] [Citation(s) in RCA: 203] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 06/06/2012] [Accepted: 06/21/2012] [Indexed: 01/11/2023]
Abstract
Atrial fibrosis is important for the pathogenesis of atrial fibrillation (AF) but the underlying signal transduction is incompletely understood. We therefore studied the role of microRNA-21 (miR-21) and its downstream target Sprouty 1 (Spry1) during atrial fibrillation. Left atria (LA) from patients with AF showed a 2.5-fold increased expression of miR-21 compared to matched LA of patients in sinus rhythm. Increased miR-21 expression correlated positively with atrial collagen content and was associated with a reduced protein expression of Spry1 and increased expression of connective tissue growth factor (CTGF), lysyl oxidase and Rac1-GTPase. Neonatal cardiac fibroblasts treated with angiotensin II (AngII) or CTGF showed an increased miR-21 and decreased Spry1 expression. Pretreatment with an inhibitor of Rac1 GTPase, NSC23766, reduced the AngII-induced upregulation of miR-21. A small molecule inhibitor of lysyl oxidase, BAPN, prevented the AngII as well as the CTGF-induced miR-21 expression. Transgenic mice with cardiac overexpression of Rac1, which develop spontaneous AF and atrial fibrosis with increasing age, showed upregulation of miR-21 expression associated with reduced Spry1 expression. miR-21 expression and signalling in vivo were prevented by long-term treatment of the mice with statins. Direct inhibition of miR-21 by antagomir-21 prevented fibrosis of the atrial myocardium post-myocardial infarction. Left atria of patients with atrial fibrillation are characterized by upregulation of miR-21 und reduced expression of Spry1. Activation of Rac1 by angiotensin II leads to a CTGF- and lysyl oxidase-mediated increase of miR-21 expression contributing to structural remodelling of the atrial myocardium.
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Genetic suppression of Gαs protein provides rate control in atrial fibrillation. Basic Res Cardiol 2012; 107:265. [DOI: 10.1007/s00395-012-0265-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 02/27/2012] [Accepted: 03/15/2012] [Indexed: 11/28/2022]
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