1
|
Tsigkas G, Apostolos A, Despotopoulos S, Vasilagkos G, Kallergis E, Leventopoulos G, Mplani V, Davlouros P. Heart failure and atrial fibrillation: new concepts in pathophysiology, management, and future directions. Heart Fail Rev 2021; 27:1201-1210. [PMID: 34218400 DOI: 10.1007/s10741-021-10133-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 12/11/2022]
Abstract
A bidirectional pathophysiological link connects heart failure and atrial fibrillation, creating a frequent and challenging comorbidity, which includes neurohormonal hyperactivation, fibrosis development, and electrophysiologic remodeling, while they share mutual risk factors. Management for these devastating comorbidities includes most of the established treatment measures for heart failure as well as rhythm or rate control and anticoagulation mostly for atrial fibrillation, which can be achieved with either pharmaceutical or non-pharmaceutical approaches. The current manuscript aims to review the existing literature regarding the underlying pathophysiology, to present the novel trends of treatment, and to predict the future perspective of these two linked diseases with the numerous unanswered questions.
Collapse
Affiliation(s)
- Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, Patras, Greece.
| | | | | | | | | | | | - Virginia Mplani
- Department of Cardiology, University Hospital of Patras, Patras, Greece
| | | |
Collapse
|
2
|
Uskach TM, Safiullina AA, Makeev MI, Saidova MA, Shariya MA, Ustyuzhanin DV, Zhirov IV, Tereshchenko SN. [The effect of angiotensin receptors and neprilysin inhibitors on myocardial remodeling in patients with chronic heart failure and atrial fibrillation]. ACTA ACUST UNITED AC 2019; 59:64-72. [PMID: 31876463 DOI: 10.18087/cardio.n815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 11/18/2022]
Abstract
AIM To evaluate the effect of angiotensin-neprilysin receptor inhibitors on myocardial remodeling in patients with chronic heart failure and atrial fibrillation. MATERIALS AND METHODS We studied dynamics of the parameters of ultrasound structural and functional parameters of the left atrium and left ventricle of the heart was during 3-month therapy with sacubitryl-valsartan in a group of 15 patients with a combination of chronic heart failure due to dilated and paroxysmal paroxysmal forms of atrial fibrillation. RESULTS Showed a statistically significant positive effect of the use of angiotensin receptors and neprilysin inhibitors on the parameters of remodeling of the left atrium (according to transthoracic and transesophageal echocardiography), left ventricle, as well as levels of natriuretic peptides ANP and NT-pro-BNP. CONCLUSION The use of ARNI may be promising in terms of treatment and prevention of AF in patients with heart failure.
Collapse
Affiliation(s)
- T M Uskach
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - A A Safiullina
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - M I Makeev
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - M A Saidova
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - M A Shariya
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - D V Ustyuzhanin
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - I V Zhirov
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - S N Tereshchenko
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| |
Collapse
|
3
|
Molina CE, Abu-Taha IH, Wang Q, Roselló-Díez E, Kamler M, Nattel S, Ravens U, Wehrens XHT, Hove-Madsen L, Heijman J, Dobrev D. Profibrotic, Electrical, and Calcium-Handling Remodeling of the Atria in Heart Failure Patients With and Without Atrial Fibrillation. Front Physiol 2018; 9:1383. [PMID: 30356673 PMCID: PMC6189336 DOI: 10.3389/fphys.2018.01383] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/11/2018] [Indexed: 01/01/2023] Open
Abstract
Atrial fibrillation (AF) and heart failure (HF) are common cardiovascular diseases that often co-exist. Animal models have suggested complex AF-promoting atrial structural, electrical, and Ca2+-handling remodeling in the setting of HF, but data in human samples are scarce, particularly regarding Ca2+-handling remodeling. Here, we evaluated atrial remodeling in patients with severe left ventricular (LV) dysfunction (HFrEF), long-standing persistent ('chronic') AF (cAF) or both (HFrEF-cAF), and sinus rhythm controls with normal LV function (Ctl) using western blot in right-atrial tissue, sharp-electrode action potential (AP) measurements in atrial trabeculae and voltage-clamp experiments in isolated right-atrial cardiomyocytes. Compared to Ctl, expression of profibrotic markers (collagen-1a, fibronectin, periostin) was higher in HFrEF and HFrEF-cAF patients, indicative of structural remodeling. Connexin-43 expression was reduced in HFrEF patients, but not HFrEF-cAF patients. AP characteristics were unchanged in HFrEF, but showed classical indices of electrical remodeling in cAF and HFrEF-cAF (prolonged AP duration at 20% and shorter AP duration at 50% and 90% repolarization). L-type Ca2+ current (ICa,L) was significantly reduced in HFrEF, cAF and HFrEF-cAF, without changes in voltage-dependence. Potentially proarrhythmic spontaneous transient-inward currents were significantly more frequent in HFrEF and HFrEF-cAF compared to Ctl, likely resulting from increased sarcoplasmic reticulum (SR) Ca2+ load (integrated caffeine-induced current) in HFrEF and increased ryanodine-receptor (RyR2) single-channel open probability in HFrEF and HFrEF-cAF. Although expression and phosphorylation of the SR Ca2+-ATPase type-2a (SERCA2a) regulator phospholamban were unchanged in HFrEF and HFrEF-cAF patients, protein levels of SERCA2a were increased in HFrEF-cAF and sarcolipin expression was decreased in both HFrEF and HFrEF-cAF, likely increasing SR Ca2+ uptake and load. RyR2 protein levels were decreased in HFrEF and HFrEF-cAF patients, but junctin levels were higher in HFrEF and relative Ser2814-RyR2 phosphorylation levels were increased in HFrEF-cAF, both potentially contributing to the greater RyR2 open probability. These novel insights into the molecular substrate for atrial arrhythmias in HF-patients position Ca2+-handling abnormalities as a likely trigger of AF in HF patients, which subsequently produces electrical remodeling that promotes the maintenance of the arrhythmia. Our new findings may have important implications for the development of novel treatment options for AF in the context of HF.
Collapse
Affiliation(s)
- Cristina E Molina
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.,Biomedical Research Institute Barcelona (IIBB-CSIC) and Biomedical Research Institute Sant Pau, Hospital de Sant Pau, Barcelona, Spain.,Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Issam H Abu-Taha
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Qiongling Wang
- Cardiovascular Research Institute - Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, United States
| | - Elena Roselló-Díez
- Cardiac Surgery Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marcus Kamler
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Stanley Nattel
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.,Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, QC, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
| | - Ursula Ravens
- Institute of Experimental Cardiovascular Medicine, University Heart Center Freiburg, University of Freiburg, Bad Krozingen, Germany.,Institute of Physiology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Xander H T Wehrens
- Cardiovascular Research Institute - Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, United States
| | - Leif Hove-Madsen
- Biomedical Research Institute Barcelona (IIBB-CSIC) and Biomedical Research Institute Sant Pau, Hospital de Sant Pau, Barcelona, Spain
| | - Jordi Heijman
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
4
|
Li N, Dobrev D. Targeting atrial fibrillation promoting atrial structural remodeling: is this a viable strategy in patients with heart failure? Naunyn Schmiedebergs Arch Pharmacol 2018; 391:231-233. [PMID: 29327256 DOI: 10.1007/s00210-018-1463-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 01/05/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Na Li
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA.
- Department of Medicine (Section of Cardiovascular Research), Baylor College of Medicine, Houston, TX, USA.
- Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, USA.
- Baylor College of Medicine, One Baylor Plaza BCM285, Houston, TX, 77030, USA.
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.
- Faculty of Medicine, University Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany.
| |
Collapse
|
5
|
Report on the Ion Channel Symposium : Organized by the German Cardiac Society Working Group on Cellular Electrophysiology (AG 18). Herzschrittmacherther Elektrophysiol 2018; 29:4-13. [PMID: 29313139 DOI: 10.1007/s00399-017-0549-4] [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: 11/03/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
Abstract
To support scientific exchange and activity in the field of cardiac cellular electrophysiology, the German Cardiac Society Working Group on Cellular Electrophysiology (AG 18) established a two-day symposium to be held every 2 years. The second Ion Channel Symposium entitled "Göttingen Channels 2017-Of Benches and Beds" took place in Göttingen from September 22nd to 23rd under the auspices of the German Cardiac Society. A group of national and international experts presented scientific advances in cardiac electrophysiology and rhythmology. The symposium's primary focus was the significance of cellular electrophysiology findings for the optimization of diagnostic and therapeutic strategies against cardiac arrhythmias. To this end, speakers, chairpersons and attendees discussed the contribution of specific molecular alterations to the initiation and perpetuation of atrial and ventricular arrhythmias. Furthermore, the meeting highlighted how discoveries in electrophysiological research may lead to novel therapeutic targets. The interdisciplinary assessment of mechanisms and therapeutic strategies of cardiac arrhythmias represented a key feature of the meeting. A unique combination of topics and speakers representing both basic science and clinical electrophysiology ensured the scientific success of the "Göttingen Channels 2017" symposium. The next Ion Channel Symposium is planned to be hosted by the incoming co-chair of the German Cardiac Society Working Group on Cellular Electrophysiology in fall 2019.
Collapse
|
7
|
Heijman J, Voigt N, Nattel S, Dobrev D. Cellular and molecular electrophysiology of atrial fibrillation initiation, maintenance, and progression. Circ Res 2014; 114:1483-99. [PMID: 24763466 DOI: 10.1161/circresaha.114.302226] [Citation(s) in RCA: 478] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF) is the most common clinically relevant arrhythmia and is associated with increased morbidity and mortality. The incidence of AF is expected to continue to rise with the aging of the population. AF is generally considered to be a progressive condition, occurring first in a paroxysmal form, then in persistent, and then long-standing persistent (chronic or permanent) forms. However, not all patients go through every phase, and the time spent in each can vary widely. Research over the past decades has identified a multitude of pathophysiological processes contributing to the initiation, maintenance, and progression of AF. However, many aspects of AF pathophysiology remain incompletely understood. In this review, we discuss the cellular and molecular electrophysiology of AF initiation, maintenance, and progression, predominantly based on recent data obtained in human tissue and animal models. The central role of Ca(2+)-handling abnormalities in both focal ectopic activity and AF substrate progression is discussed, along with the underlying molecular basis. We also deal with the ionic determinants that govern AF initiation and maintenance, as well as the structural remodeling that stabilizes AF-maintaining re-entrant mechanisms and finally makes the arrhythmia refractory to therapy. In addition, we highlight important gaps in our current understanding, particularly with respect to the translation of these concepts to the clinical setting. Ultimately, a comprehensive understanding of AF pathophysiology is expected to foster the development of improved pharmacological and nonpharmacological therapeutic approaches and to greatly improve clinical management.
Collapse
Affiliation(s)
- Jordi Heijman
- From the Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany (J.H., N.V., D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada (S.N.); and Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada (S.N.)
| | | | | | | |
Collapse
|