Chronobiology of Cardiac Ventricular Fibrillation Development in Experimental Acute Coronary Failure

Improving Diuretic Response in Heart Failure by Implementing a Patient-Tailored Variability and Chronotherapy-Guided Algorithm

Heart failure is a major public health problem, which is associated with significant mortality, morbidity, and healthcare expenditures. A substantial amount of the morbidity is attributed to volume overload, for which loop diuretics are a mandatory treatment. However, the variability in response to diuretics and development of diuretic resistance adversely affect the clinical outcomes. Morevoer, there exists a marked intra- and inter-patient variability in response to diuretics that affects the clinical course and related adverse outcomes. In the present article, we review the mechanisms underlying the development of diuretic resistance. The role of the autonomic nervous system and chronobiology in the pathogenesis of congestive heart failure and response to therapy are also discussed. Establishing a novel model for overcoming diuretic resistance is presented based on a patient-tailored variability and chronotherapy-guided machine learning algorithm that comprises clinical, laboratory, and sensor-derived inputs, including inputs from pulmonary artery measurements. Inter- and intra-patient signatures of variabilities, alterations of biological clock, and autonomic nervous system responses are embedded into the algorithm; thus, it may enable a tailored dose regimen in a continuous manner that accommodates the highly dynamic complex system.

Characteristics and periodicity of sustained ventricular tachyarrhythmia events in a population of military veterans with implantable cardioverter defibrillator

PURPOSE

Circadian patterns of ventricular tachyarrhythmias (VTAs) in ICD patients from SCD-HeFT and MADIT-CRT have yielded differing results. The aim was to investigate VTA patterns in a large population of military veterans with ICD.

METHODS

This retrospective study analyzed biorhythm periodicity of sustained VTAs (≤ 300 ms). Findings were derived from the Veterans Affairs (VA) National Cardiac Device Surveillance database encompassing January 1, 2005, to December 31, 2017.

RESULTS

The patient population comprised 1559 consecutive patients with 17,039 VTAs. There were 763 patients with clinical information with the mean age of 67.8 ± 9 years old and 99% male. An hourly non-uniform VTA distribution with a bimodal pattern and a predominant afternoon peak was seen (χ² = 5057, P < 0.0001). VTAs treated successfully by anti-tachycardia pacing (ATP) showed a bimodal pattern with even distributions. VTAs treated by ICD shocks showed a bimodal pattern with a predominant afternoon peak. The duration of VTA peaks was increased from 13.5 to 17 h with increasing daylight time from 9.9 to 14.5 h. The weekly VTA distribution showed a significant septadian pattern with lowest frequency on weekend and highest on weekdays (χ² = 4840, P < 0.0001). No annual periodicity and monthly periodicity were seen.

CONCLUSIONS

Sustained VTA events exhibited a circadian rhythm in a large population of military veterans with ICD/CRT-D; specifically, a bimodal pattern with a predominant afternoon peak was observed. Further, the majority of VTA episodes treated by ICD shock occurred in the afternoon, and the duration of VTA peak lengthened with increased duration of daylight time.

Behavioral, neuroendocrine and physiological indicators of the circadian biology of male and female rabbits

Adult rabbits show robust circadian rhythms of: nursing, food and water intake, hard faeces excretion, locomotion, body temperature, blood and intraocular pressure, corticosteroid secretion, and sleep. Control of several circadian rhythms involves a light-entrained circadian clock and a food-entrained oscillator. Nursing periodicity, however, relies on a suckling stimulation threshold. Brain structures regulating this activity include the paraventricular nucleus and preoptic area, as determined by lesions and quantification of cFOS- and PER1 clock gene-immunoreactive proteins. Melatonin synthesis in the rabbit pineal gland shows a diurnal rhythm, with highest values at night and lowest ones during the day. In kits the main zeitgeber is milk intake, which synchronizes locomotor activity, body temperature, and corticosterone secretion. Brain regions involved in these effects include the median preoptic nucleus and several olfactory structures. As models for particular human illnesses rabbits have been valuable for studying glaucoma and cardiovascular disease. Circadian variations in intraocular pressure (main risk factor for glaucoma) have been found, with highest values at night, which depend on sympathetic innervation. Rabbits fed a high fat diet develop cholesterol plaques and high blood pressure, as do humans, and such increased fat intake directly modulates cardiovascular homeostasis and circadian patterns, independently of white adipose tissue accumulation. Rabbits have also been useful to investigate the characteristics of sleep across the day and its modulation by infections, cytokines and other endogenous humoral factors. Rabbit circadian biology warrants deeper investigation of the role of the suprachiasmatic nucleus in regulating most behavioral and physiological rhythms described above.