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Shi Q, Malik H, Crawford RM, Streeter J, Wang J, Huo R, Shih JC, Chen B, Hall D, Abel ED, Song LS, Anderson EJ. Cardiac monoamine oxidase-A inhibition protects against catecholamine-induced ventricular arrhythmias via enhanced diastolic calcium control. Cardiovasc Res 2024; 120:596-611. [PMID: 38198753 PMCID: PMC11074799 DOI: 10.1093/cvr/cvae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 11/01/2023] [Accepted: 11/22/2023] [Indexed: 01/12/2024] Open
Abstract
AIMS A mechanistic link between depression and risk of arrhythmias could be attributed to altered catecholamine metabolism in the heart. Monoamine oxidase-A (MAO-A), a key enzyme involved in catecholamine metabolism and longstanding antidepressant target, is highly expressed in the myocardium. The present study aimed to elucidate the functional significance and underlying mechanisms of cardiac MAO-A in arrhythmogenesis. METHODS AND RESULTS Analysis of the TriNetX database revealed that depressed patients treated with MAO inhibitors had a lower risk of arrhythmias compared with those treated with selective serotonin reuptake inhibitors. This effect was phenocopied in mice with cardiomyocyte-specific MAO-A deficiency (cMAO-Adef), which showed a significant reduction in both incidence and duration of catecholamine stress-induced ventricular tachycardia compared with wild-type mice. Additionally, cMAO-Adef cardiomyocytes exhibited altered Ca2+ handling under catecholamine stimulation, with increased diastolic Ca2+ reuptake, reduced diastolic Ca2+ leak, and diminished systolic Ca2+ release. Mechanistically, cMAO-Adef hearts had reduced catecholamine levels under sympathetic stress, along with reduced levels of reactive oxygen species and protein carbonylation, leading to decreased oxidation of Type II PKA and CaMKII. These changes potentiated phospholamban (PLB) phosphorylation, thereby enhancing diastolic Ca2+ reuptake, while reducing ryanodine receptor 2 (RyR2) phosphorylation to decrease diastolic Ca2+ leak. Consequently, cMAO-Adef hearts exhibited lower diastolic Ca2+ levels and fewer arrhythmogenic Ca2+ waves during sympathetic overstimulation. CONCLUSION Cardiac MAO-A inhibition exerts an anti-arrhythmic effect by enhancing diastolic Ca2+ handling under catecholamine stress.
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MESH Headings
- Animals
- Female
- Humans
- Male
- Mice
- Calcium/metabolism
- Calcium-Calmodulin-Dependent Protein Kinase Type 2/metabolism
- Catecholamines/metabolism
- Cells, Cultured
- Cyclic AMP-Dependent Protein Kinases/metabolism
- Diastole/drug effects
- Disease Models, Animal
- Heart Rate/drug effects
- Mice, Inbred C57BL
- Mice, Knockout
- Monoamine Oxidase/metabolism
- Monoamine Oxidase Inhibitors/pharmacology
- Myocytes, Cardiac/drug effects
- Myocytes, Cardiac/enzymology
- Myocytes, Cardiac/metabolism
- Myocytes, Cardiac/pathology
- Phosphorylation
- Reactive Oxygen Species/metabolism
- Ryanodine Receptor Calcium Release Channel/metabolism
- Tachycardia, Ventricular/enzymology
- Tachycardia, Ventricular/physiopathology
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Affiliation(s)
- Qian Shi
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 285 Newton Rd, Iowa City, IA 52242, USA
| | - Hamza Malik
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 285 Newton Rd, Iowa City, IA 52242, USA
| | - Rachel M Crawford
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, 180 S Grand Ave., Iowa City, IA 52242, USA
| | - Jennifer Streeter
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 285 Newton Rd, Iowa City, IA 52242, USA
| | - Jinxi Wang
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 285 Newton Rd, Iowa City, IA 52242, USA
| | - Ran Huo
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, 180 S Grand Ave., Iowa City, IA 52242, USA
| | - Jean C Shih
- Department of Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, 1985 Zonal Avenue, Los Angeles, CA 90089, USA
| | - Biyi Chen
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 285 Newton Rd, Iowa City, IA 52242, USA
| | - Duane Hall
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 285 Newton Rd, Iowa City, IA 52242, USA
- Abboud Cardiovascular Research Center, Carver College of Medicine, University of Iowa, CBRB 2267285, Newton Rd, Iowa City, IA 52242, USA
| | - E Dale Abel
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 285 Newton Rd, Iowa City, IA 52242, USA
- Abboud Cardiovascular Research Center, Carver College of Medicine, University of Iowa, CBRB 2267285, Newton Rd, Iowa City, IA 52242, USA
- Fraternal Order of Eagles Diabetes Research Center, Carver College of Medicine, University of Iowa, 169 Newton Rd, Iowa City, IA 52242, USA
| | - Long-Sheng Song
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 285 Newton Rd, Iowa City, IA 52242, USA
- Abboud Cardiovascular Research Center, Carver College of Medicine, University of Iowa, CBRB 2267285, Newton Rd, Iowa City, IA 52242, USA
- Fraternal Order of Eagles Diabetes Research Center, Carver College of Medicine, University of Iowa, 169 Newton Rd, Iowa City, IA 52242, USA
| | - Ethan J Anderson
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, 180 S Grand Ave., Iowa City, IA 52242, USA
- Abboud Cardiovascular Research Center, Carver College of Medicine, University of Iowa, CBRB 2267285, Newton Rd, Iowa City, IA 52242, USA
- Fraternal Order of Eagles Diabetes Research Center, Carver College of Medicine, University of Iowa, 169 Newton Rd, Iowa City, IA 52242, USA
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2
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Payne FM, Nie S, Diffee GM, Wilkins GT, Larsen DS, Harrison JC, Baldi JC, Sammut IA. The carbon monoxide prodrug oCOm-21 increases Ca 2+ sensitivity of the cardiac myofilament. Physiol Rep 2024; 12:e15974. [PMID: 38491822 PMCID: PMC10943376 DOI: 10.14814/phy2.15974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/18/2024] Open
Abstract
Patients undergoing cardiopulmonary bypass procedures require inotropic support to improve hemodynamic function and cardiac output. Current inotropes such as dobutamine, can promote arrhythmias, prompting a demand for improved inotropes with little effect on intracellular Ca2+ flux. Low-dose carbon monoxide (CO) induces inotropic effects in perfused hearts. Using the CO-releasing pro-drug, oCOm-21, we investigated if this inotropic effect results from an increase in myofilament Ca2+ sensitivity. Male Sprague Dawley rat left ventricular cardiomyocytes were permeabilized, and myofilament force was measured as a function of -log [Ca2+ ] (pCa) in the range of 9.0-4.5 under five conditions: vehicle, oCOm-21, the oCOm-21 control BP-21, and levosimendan, (9 cells/group). Ca2+ sensitivity was assessed by the Ca2+ concentration at which 50% of maximal force is produced (pCa50 ). oCOm-21, but not BP-21 significantly increased pCa50 compared to vehicle, respectively (pCa50 5.52 vs. 5.47 vs. 5.44; p < 0.05). No change in myofilament phosphorylation was seen after oCOm-21 treatment. Pretreatment of cardiomyocytes with the heme scavenger hemopexin, abolished the Ca2+ sensitizing effect of oCOm-21. These results support the hypothesis that oCOm-21-derived CO increases myofilament Ca2+ sensitivity through a heme-dependent mechanism but not by phosphorylation. Further analyses will confirm if this Ca2+ sensitizing effect occurs in an intact heart.
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Affiliation(s)
- Fergus M. Payne
- School of Biomedical Sciences, Department of Pharmacology and ToxicologyUniversity of OtagoDunedinOtagoNew Zealand
- Otago Medical School, Department of MedicineUniversity of OtagoDunedinOtagoNew Zealand
- HeartOtagoUniversity of OtagoDunedinNew Zealand
| | - Samantha Nie
- School of Biomedical Sciences, Department of Pharmacology and ToxicologyUniversity of OtagoDunedinOtagoNew Zealand
- HeartOtagoUniversity of OtagoDunedinNew Zealand
| | - Gary M. Diffee
- Department of KinesiologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Gerard T. Wilkins
- Otago Medical School, Department of MedicineUniversity of OtagoDunedinOtagoNew Zealand
- HeartOtagoUniversity of OtagoDunedinNew Zealand
| | - David S. Larsen
- School of Science, Department of ChemistryUniversity of OtagoDunedinOtagoNew Zealand
| | - Joanne C. Harrison
- School of Biomedical Sciences, Department of Pharmacology and ToxicologyUniversity of OtagoDunedinOtagoNew Zealand
- HeartOtagoUniversity of OtagoDunedinNew Zealand
| | - James C. Baldi
- Otago Medical School, Department of MedicineUniversity of OtagoDunedinOtagoNew Zealand
- HeartOtagoUniversity of OtagoDunedinNew Zealand
| | - Ivan A. Sammut
- School of Biomedical Sciences, Department of Pharmacology and ToxicologyUniversity of OtagoDunedinOtagoNew Zealand
- HeartOtagoUniversity of OtagoDunedinNew Zealand
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3
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Zhang Y, Kim C, Wasif N, Li Y, Huang Y, Kobayashi S, Udo-Bellner L, Stout R, Ojamaa K. Alcohol and caffeine synergistically induce spontaneous ventricular tachyarrhythmias: ameliorated with dantrolene treatment. Heart Rhythm O2 2023; 4:549-555. [PMID: 37744935 PMCID: PMC10513921 DOI: 10.1016/j.hroo.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background Alcohol and caffeine are the 2 frequently consumed substances in the general population, and the 2 substances are frequently co-consumed. Both substances may increase cardiac arrhythmia risk. However, it is unknown whether alcohol and caffeine co-consumption can synergistically enhance cardiac arrhythmogenesis. Objective The study sought to investigate whether caffeine and binge drinking synergistically affect cardiac arrhythmogenesis. Methods A binge drinking rat model (alcohol 2 g/kg, intraperitoneal, every other day for 3 times) was used. Rats (4 months old, both sexes) were randomized into the following 4 groups: binge alcohol-only group (A) (n = 8), nonalcohol, caffeine-only (60 mg/kg, intraperitoneal) group (C) (n = 8), binge alcohol plus caffeine group (A+C) (n = 8), and binge alcohol + caffeine + dantrolene group (A+D) (n = 7, treated with dantrolene 10 mg/kg before each alcohol injection). We also investigated whether alcohol induces Ca2+ sparks and dantrolene treatment attenuates alcohol-induced Ca2+ leak in ventricular myocytes. Results No arrhythmia was induced with caffeine alone (group C, n = 0 of 8) or alcohol alone (group A, n = 0 of 8). However, alcohol + caffeine induced spontaneous ventricular tachyarrhythmias in all rats (group A+C, n = 8 of 8; P < .001 vs group C or A). Dantrolene prevented ventricular tachyarrhythmia induction in all 7 rats (group A+D, n = 0 of 7; P < .001 vs group A+C). In isolated ventricular myocytes, alcohol significantly increased Ca2+ sparks and dantrolene treatment reduced alcohol-induced Ca2+ sparks. Conclusion Co-consumption of caffeine and binge drinking synergistically promote spontaneous ventricular tachyarrhythmias in rats. Dantrolene treatment can decrease alcohol-enhanced Ca2+ sparks in vitro and prevented alcohol and caffeine induced ventricular tachyarrhythmias in vivo.
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Affiliation(s)
- Youhua Zhang
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Christopher Kim
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Nawal Wasif
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Ying Li
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Yuan Huang
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Satoru Kobayashi
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Lars Udo-Bellner
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Randy Stout
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Kaie Ojamaa
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
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4
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Velmurugan S, Liu T, Chen KC, Despa F, O'Rourke B, Despa S. Distinct Effects of Mitochondrial Na +/Ca 2+ Exchanger Inhibition and Ca 2+ Uniporter Activation on Ca 2+ Sparks and Arrhythmogenesis in Diabetic Rats. J Am Heart Assoc 2023; 12:e029997. [PMID: 37421267 PMCID: PMC10382117 DOI: 10.1161/jaha.123.029997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/26/2023] [Indexed: 07/10/2023]
Abstract
Background Mitochondrial dysfunction contributes to the cardiac remodeling triggered by type 2 diabetes (T2D). Mitochondrial Ca2+ concentration ([Ca2+]m) modulates the oxidative state and cytosolic Ca2+ regulation. Thus, we investigated how T2D affects mitochondrial Ca2+ fluxes, the downstream consequences on myocyte function, and the effects of normalizing mitochondrial Ca2+ transport. Methods and Results We compared myocytes/hearts from transgenic rats with late-onset T2D (rats that develop late-onset T2D due to heterozygous expression of human amylin in the pancreatic β-cells [HIP] model) and their nondiabetic wild-type (WT) littermates. [Ca2+]m was significantly lower in myocytes from diabetic HIP rats compared with WT cells. Ca2+ extrusion through the mitochondrial Na+/Ca2+ exchanger (mitoNCX) was elevated in HIP versus WT myocytes, particularly at moderate and high [Ca2+]m, while mitochondrial Ca2+ uptake was diminished. Mitochondrial Na+ concentration was comparable in WT and HIP rat myocytes and remained remarkably stable while manipulating mitoNCX activity. Lower [Ca2+]m was associated with oxidative stress, increased sarcoplasmic reticulum Ca2+ leak in the form of Ca2+ sparks, and mitochondrial dysfunction in T2D hearts. MitoNCX inhibition with CGP-37157 reduced oxidative stress, Ca2+ spark frequency, and stress-induced arrhythmias in HIP rat hearts while having no significant effect in WT rats. In contrast, activation of the mitochondrial Ca2+ uniporter with SB-202190 enhanced spontaneous sarcoplasmic reticulum Ca2+ release and had no significant effect on arrhythmias in both WT and HIP rat hearts. Conclusions [Ca2+]m is reduced in myocytes from rats with T2D due to a combination of exacerbated mitochondrial Ca2+ extrusion through mitoNCX and impaired mitochondrial Ca2+ uptake. Partial mitoNCX inhibition limits sarcoplasmic reticulum Ca2+ leak and arrhythmias in T2D hearts, whereas mitochondrial Ca2+ uniporter activation does not.
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Affiliation(s)
- Sathya Velmurugan
- Department of Pharmacology and Nutritional SciencesUniversity of KentuckyLexingtonKYUSA
| | - Ting Liu
- Division of Cardiology, Department of MedicineThe Johns Hopkins UniversityBaltimoreMDUSA
| | - Kuey C. Chen
- Department of Pharmacology and Nutritional SciencesUniversity of KentuckyLexingtonKYUSA
| | - Florin Despa
- Department of Pharmacology and Nutritional SciencesUniversity of KentuckyLexingtonKYUSA
| | - Brian O'Rourke
- Division of Cardiology, Department of MedicineThe Johns Hopkins UniversityBaltimoreMDUSA
| | - Sanda Despa
- Department of Pharmacology and Nutritional SciencesUniversity of KentuckyLexingtonKYUSA
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5
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Chen Z, Lin Z, Obaid SN, Rytkin E, George SA, Bach C, Madrid M, Liu M, LaPiano J, Fehr A, Shi X, Quirion N, Russo B, Knight H, Aduwari A, Efimov IR, Lu L. Soft, bioresorbable, transparent microelectrode arrays for multimodal spatiotemporal mapping and modulation of cardiac physiology. SCIENCE ADVANCES 2023; 9:eadi0757. [PMID: 37406128 DOI: 10.1126/sciadv.adi0757] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/01/2023] [Indexed: 07/07/2023]
Abstract
Transparent microelectrode arrays (MEAs) that allow multimodal investigation of the spatiotemporal cardiac characteristics are important in studying and treating heart disease. Existing implantable devices, however, are designed to support chronic operational lifetimes and require surgical extraction when they malfunction or are no longer needed. Meanwhile, bioresorbable systems that can self-eliminate after performing temporary functions are increasingly attractive because they avoid the costs/risks of surgical extraction. We report the design, fabrication, characterization, and validation of a soft, fully bioresorbable, and transparent MEA platform for bidirectional cardiac interfacing over a clinically relevant period. The MEA provides multiparametric electrical/optical mapping of cardiac dynamics and on-demand site-specific pacing to investigate and treat cardiac dysfunctions in rat and human heart models. The bioresorption dynamics and biocompatibility are investigated. The device designs serve as the basis for bioresorbable cardiac technologies for potential postsurgical monitoring and treating temporary patient pathological conditions in certain clinical scenarios, such as myocardial infarction, ischemia, and transcatheter aortic valve replacement.
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Affiliation(s)
- Zhiyuan Chen
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Zexu Lin
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Sofian N Obaid
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Eric Rytkin
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Sharon A George
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Christopher Bach
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Micah Madrid
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Miya Liu
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Jessica LaPiano
- MedStar Georgetown University Hospital, Washington, DC 20037, USA
| | - Amy Fehr
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Xinyu Shi
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Nathaniel Quirion
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Benjamin Russo
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Helen Knight
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Anthony Aduwari
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Igor R Efimov
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Medicine (Cardiology), Northwestern University, Chicago, IL 60611, USA
| | - Luyao Lu
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
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6
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Lin Z, Kireev D, Liu N, Gupta S, LaPiano J, Obaid SN, Chen Z, Akinwande D, Efimov IR. Graphene Biointerface for Cardiac Arrhythmia Diagnosis and Treatment. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2212190. [PMID: 36965107 DOI: 10.1002/adma.202212190] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/16/2023] [Indexed: 06/02/2023]
Abstract
Heart rhythm disorders, known as arrhythmias, cause significant morbidity and are one of the leading causes of mortality. Cardiac arrhythmias are frequently treated by implantable devices, such as pacemakers and defibrillators, or by ablation therapy guided by electroanatomical mapping. Both implantable and ablation therapies require sophisticated biointerfaces for electrophysiological measurements of electrograms and delivery of therapeutic stimulation or ablation energy. In this work, a graphene biointerface for in vivo cardiac electrophysiology is reported for the first time. Leveraging sub-micrometer-thick tissue-conformable graphene arrays, sensing and stimulation of the open mammalian heart are demonstrated both in vitro and in vivo. Furthermore, the graphene biointerface treatment of atrioventricular block (the kind of arrhythmia where the electrical conduction from the atria to the ventricles is interrupted) is demonstrated. The graphene arrays show effective electrochemical properties, namely interface impedance down to 40 Ω cm2 at 1 kHz, charge storage capacity up to 63.7 mC cm-2 , and charge injection capacity up to 704 µC cm-2 . Transparency of the graphene structures allows for simultaneous optical mapping of cardiac action potentials, calcium transients, and optogenetic stimulation while performing electrical measurements and stimulation. The report presents evidence of the significant potential of graphene biointerfaces for advanced cardiac electrophysiology and arrhythmia therapy.
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Affiliation(s)
- Zexu Lin
- Department of Biomedical Engineering, The George Washington University, Washington, DC, 20052, USA
| | - Dmitry Kireev
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX, 78758, USA
- Microelectronics Research Center, The University of Texas at Austin, Austin, TX, 78758, USA
| | - Ning Liu
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX, 78758, USA
| | - Shubham Gupta
- Department of Biomedical Engineering, The George Washington University, Washington, DC, 20052, USA
| | - Jessica LaPiano
- MedStar Georgetown University Hospital, Washington, DC, 20007, USA
| | - Sofian N Obaid
- Department of Biomedical Engineering, The George Washington University, Washington, DC, 20052, USA
| | - Zhiyuan Chen
- Department of Biomedical Engineering, The George Washington University, Washington, DC, 20052, USA
| | - Deji Akinwande
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX, 78758, USA
- Microelectronics Research Center, The University of Texas at Austin, Austin, TX, 78758, USA
| | - Igor R Efimov
- Department of Biomedical Engineering, The George Washington University, Washington, DC, 20052, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA
- Department of Medicine (Cardiology), Northwestern University, Chicago, IL, 60611, USA
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7
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Almarzuqi A, Kimber S, Quadros K, Senaratne J. Bidirectional Ventricular Tachycardia: Challenges and Solutions. Vasc Health Risk Manag 2022; 18:397-406. [PMID: 35698640 PMCID: PMC9188370 DOI: 10.2147/vhrm.s274857] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/14/2022] [Indexed: 11/23/2022] Open
Abstract
Bidirectional ventricular tachycardia (BiVT) is a rare form of ventricular tachycardia that manifests on surface electrocardiogram by dual QRS morphologies alternating on a beat-to-beat basis. It was first reported in the 1920s as a complication of digoxin, and since then, it has been reported in other conditions including fulminant myocarditis, sarcoidosis, catecholaminergic polymorphic ventricular tachycardia, and Andersen-Tawil syndrome. The mechanism for BiVT is not as well known as other forms of ventricular tachycardia but appears to include typical mechanisms including triggered activity from afterdepolarizations, abnormal automaticity, or reentry. This review will go beyond the definition, surface electrocardiogram, mechanisms, causes, and treatment of BiVT as per our current understanding.
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Affiliation(s)
- Ahmed Almarzuqi
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Shane Kimber
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Kenneth Quadros
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Janek Senaratne
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, Canada
- Correspondence: Janek Senaratne, Tel +1 (780) 463-2184, Fax +1 (780) 450-8359, Email
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