1
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Oreto L, Briuglia S, Capra AP, Ruiz VG, Di Pino A. Bidirectional Ventricular Tachycardia and Prominent U Waves: Look at Fingers and Muscles and Use Flecainide. J Pediatr Pharmacol Ther 2023; 28:662-666. [PMID: 38025154 PMCID: PMC10681079 DOI: 10.5863/1551-6776-28.7.662] [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: 09/09/2022] [Accepted: 01/27/2023] [Indexed: 12/01/2023]
Abstract
We present a case of bidirectional ventricular tachycardia in a 15-year-old boy asymptomatic for arrhythmias, whose major complaint was muscle weakness. At our first evaluation he was receiving sotalol for his ventricular arrhythmias. In addition to bidirectional tachycardia, electrocardiogram during sinus rhythm showed prominent U waves and prolonged QT-U interval. These electrocardiographic signs, along with the evidence of clinodactyly and mild hypertelorism, led us to the diagnosis of Andersen-Tawil syndrome, confirmed by genetic analysis that revealed a "de novo" missense mutation of KCNJ2 gene. Monotherapy with flecainide was rapidly effective and almost eliminated ventricular arrhythmias. After a 4-year follow-up there were no adverse events, flecainide has been well tolerated without significant modification of the QRS or repolarization, and ventricular arrhythmias have not been relapsed to date. The case highlights the importance of a correct clinical diagnosis, which is crucial for the optimal selection of the most appropriate drug therapy, which is expected not to be harmful, before being beneficial.
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Affiliation(s)
- Lilia Oreto
- Mediterranean Pediatric Cardiology Center (LO, VGR, AD), Bambino Gesù Children’s Hospital, Taormina, Italy
| | - Silvana Briuglia
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences (SB, APC), University of Messina, Messina, Italy
| | - Anna Paola Capra
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences (SB, APC), University of Messina, Messina, Italy
| | - Victoria Garcia Ruiz
- Mediterranean Pediatric Cardiology Center (LO, VGR, AD), Bambino Gesù Children’s Hospital, Taormina, Italy
| | - Alfredo Di Pino
- Mediterranean Pediatric Cardiology Center (LO, VGR, AD), Bambino Gesù Children’s Hospital, Taormina, Italy
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2
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 901] [Impact Index Per Article: 450.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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3
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Munger MA, Olğar Y, Koleske ML, Struckman HL, Mandrioli J, Lou Q, Bonila I, Kim K, Ramos Mondragon R, Priori SG, Volpe P, Valdivia HH, Biskupiak J, Carnes CA, Veeraraghavan R, Györke S, Radwański PB. Tetrodotoxin-Sensitive Neuronal-Type Na + Channels: A Novel and Druggable Target for Prevention of Atrial Fibrillation. J Am Heart Assoc 2020; 9:e015119. [PMID: 32468902 PMCID: PMC7429002 DOI: 10.1161/jaha.119.015119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Atrial fibrillation (AF) is a comorbidity associated with heart failure and catecholaminergic polymorphic ventricular tachycardia. Despite the Ca2+‐dependent nature of both of these pathologies, AF often responds to Na+ channel blockers. We investigated how targeting interdependent Na+/Ca2+ dysregulation might prevent focal activity and control AF. Methods and Results We studied AF in 2 models of Ca2+‐dependent disorders, a murine model of catecholaminergic polymorphic ventricular tachycardia and a canine model of chronic tachypacing‐induced heart failure. Imaging studies revealed close association of neuronal‐type Na+ channels (nNav) with ryanodine receptors and Na+/Ca2+ exchanger. Catecholamine stimulation induced cellular and in vivo atrial arrhythmias in wild‐type mice only during pharmacological augmentation of nNav activity. In contrast, catecholamine stimulation alone was sufficient to elicit atrial arrhythmias in catecholaminergic polymorphic ventricular tachycardia mice and failing canine atria. Importantly, these were abolished by acute nNav inhibition (tetrodotoxin or riluzole) implicating Na+/Ca2+ dysregulation in AF. These findings were then tested in 2 nonrandomized retrospective cohorts: an amyotrophic lateral sclerosis clinic and an academic medical center. Riluzole‐treated patients adjusted for baseline characteristics evidenced significantly lower incidence of arrhythmias including new‐onset AF, supporting the preclinical results. Conclusions These data suggest that nNaVs mediate Na+‐Ca2+ crosstalk within nanodomains containing Ca2+ release machinery and, thereby, contribute to AF triggers. Disruption of this mechanism by nNav inhibition can effectively prevent AF arising from diverse causes.
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Affiliation(s)
- Mark A Munger
- Departments of Pharmacotherapy and Internal Medicine University of Utah Health Sciences Center Salt Lake City UT
| | - Yusuf Olğar
- Dorothy M. Davis Heart and Lung Research Institute College of Medicine The Ohio State University Wexner Medical Center Columbus OH.,Division of Pharmacy Practice and Sciences College of Pharmacy The Ohio State University Columbus OH
| | - Megan L Koleske
- Dorothy M. Davis Heart and Lung Research Institute College of Medicine The Ohio State University Wexner Medical Center Columbus OH.,Division of Pharmacy Practice and Sciences College of Pharmacy The Ohio State University Columbus OH
| | - Heather L Struckman
- Department of Biomedical Engineering College of Engineering The Ohio State University Columbus OH
| | - Jessica Mandrioli
- Department of Neuroscience St. Agostino Estense Hospital Azienda Ospedaliero Universitaria di Modena Italy
| | - Qing Lou
- Dorothy M. Davis Heart and Lung Research Institute College of Medicine The Ohio State University Wexner Medical Center Columbus OH.,Department of Physiology and Cell Biology College of Medicine The Ohio State University Columbus OH
| | - Ingrid Bonila
- Dorothy M. Davis Heart and Lung Research Institute College of Medicine The Ohio State University Wexner Medical Center Columbus OH.,Department of Physiology and Cell Biology College of Medicine The Ohio State University Columbus OH
| | - Kibum Kim
- Department of Pharmacotherapy University of Utah Health Sciences Center Salt Lake City UT
| | - Roberto Ramos Mondragon
- Department of Internal Medicine and of Molecular & Integrative Physiology University of Michigan Ann Arbor MI
| | - Silvia G Priori
- Molecular Cardiology Istituti Clinici Scientifici Maugeri IRCCS University of Pavia Italy.,Department of Molecular Medicine University of Pavia Italy
| | - Pompeo Volpe
- Department of Biomedical Sciences University of Padova Italy
| | - Héctor H Valdivia
- Department of Internal Medicine and of Molecular & Integrative Physiology University of Michigan Ann Arbor MI
| | - Joseph Biskupiak
- Department of Pharmacotherapy University of Utah Health Sciences Center Salt Lake City UT
| | - Cynthia A Carnes
- Dorothy M. Davis Heart and Lung Research Institute College of Medicine The Ohio State University Wexner Medical Center Columbus OH.,Division of Pharmacy Practice and Sciences College of Pharmacy The Ohio State University Columbus OH
| | - Rengasayee Veeraraghavan
- Department of Biomedical Engineering College of Engineering The Ohio State University Columbus OH.,Dorothy M. Davis Heart and Lung Research Institute College of Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Sándor Györke
- Dorothy M. Davis Heart and Lung Research Institute College of Medicine The Ohio State University Wexner Medical Center Columbus OH.,Department of Physiology and Cell Biology College of Medicine The Ohio State University Columbus OH
| | - Przemysław B Radwański
- Dorothy M. Davis Heart and Lung Research Institute College of Medicine The Ohio State University Wexner Medical Center Columbus OH.,Division of Pharmacy Practice and Sciences College of Pharmacy The Ohio State University Columbus OH.,Department of Physiology and Cell Biology College of Medicine The Ohio State University Columbus OH
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4
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Struckman HL, Baine S, Thomas J, Mezache L, Mykytyn K, Györke S, Radwański PB, Veeraraghavan R. Super-Resolution Imaging Using a Novel High-Fidelity Antibody Reveals Close Association of the Neuronal Sodium Channel Na V1.6 with Ryanodine Receptors in Cardiac Muscle. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2020; 26:157-165. [PMID: 31931893 PMCID: PMC7061261 DOI: 10.1017/s1431927619015289] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The voltage-gated sodium channel [pore-forming subunit of the neuronal voltage-gated sodium channel (NaV1.6)] has recently been found in cardiac myocytes. Emerging studies indicate a role for NaV1.6 in ionic homeostasis as well as arrhythmogenesis. Little is known about the spatial organization of these channels in cardiac muscle, mainly due to the lack of high-fidelity antibodies. Therefore, we developed and rigorously validated a novel rabbit polyclonal NaV1.6 antibody and undertook super-resolution microscopy studies of NaV1.6 localization in cardiac muscle. We developed and validated a novel rabbit polyclonal antibody against a C-terminal epitope on the neuronal sodium channel 1.6 (NaV1.6). Raw sera showed high affinity in immuno-fluorescence studies, which was improved with affinity purification. The antibody was rigorously validated for specificity via multiple approaches. Lastly, we used this antibody in proximity ligation assay (PLA) and super-resolution STochastic Optical Reconstruction Microscopy (STORM) studies, which revealed enrichment of NaV1.6 in close proximity to ryanodine receptor (RyR2), a key calcium (Ca2+) cycling protein, in cardiac myocytes. In summary, our novel NaV1.6 antibody demonstrates high degrees of specificity and fidelity in multiple preparations. It enabled multimodal microscopic studies and revealed that over half of the NaV1.6 channels in cardiac myocytes are located within 100 nm of ryanodine receptor Ca2+ release channels.
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Affiliation(s)
- Heather L. Struckman
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, US
| | - Stephen Baine
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, US
- Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, US
| | - Justin Thomas
- Division of Pharmacy Practice and Sciences, College of Pharmacy, The Ohio State University, Columbus, OH, US
| | - Louisa Mezache
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, US
| | - Kirk Mykytyn
- Department of Biological Chemistry and Pharmacology, The Ohio State University, Columbus, OH, US
| | - Sándor Györke
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, US
- Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, US
| | - Przemysław B. Radwański
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, US
- Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, US
- Division of Pharmacy Practice and Sciences, College of Pharmacy, The Ohio State University, Columbus, OH, US
| | - Rengasayee Veeraraghavan
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, US
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, US
- Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, US
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5
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Radwański PB, Johnson CN, Györke S, Veeraraghavan R. Cardiac Arrhythmias as Manifestations of Nanopathies: An Emerging View. Front Physiol 2018; 9:1228. [PMID: 30233404 PMCID: PMC6131669 DOI: 10.3389/fphys.2018.01228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/14/2018] [Indexed: 12/21/2022] Open
Abstract
A nanodomain is a collection of proteins localized within a specialized, nanoscale structural environment, which can serve as the functional unit of macroscopic physiologic processes. We are beginning to recognize the key roles of cardiomyocyte nanodomains in essential processes of cardiac physiology such as electrical impulse propagation and excitation–contraction coupling (ECC). There is growing appreciation of nanodomain dysfunction, i.e., nanopathy, as a mechanistic driver of life-threatening arrhythmias in a variety of pathologies. Here, we offer an overview of current research on the role of nanodomains in cardiac physiology with particular emphasis on: (1) sodium channel-rich nanodomains within the intercalated disk that participate in cell-to-cell electrical coupling and (2) dyadic nanodomains located along transverse tubules that participate in ECC. The beat to beat function of cardiomyocytes involves three phases: the action potential, the calcium transient, and mechanical contraction/relaxation. In all these phases, cell-wide function results from the aggregation of the stochastic function of individual proteins. While it has long been known that proteins that exist in close proximity influence each other’s function, it is increasingly appreciated that there exist nanoscale structures that act as functional units of cardiac biophysical phenomena. Termed nanodomains, these structures are collections of proteins, localized within specialized nanoscale structural environments. The nano-environments enable the generation of localized electrical and/or chemical gradients, thereby conferring unique functional properties to these units. Thus, the function of a nanodomain is determined by its protein constituents as well as their local structural environment, adding an additional layer of complexity to cardiac biology and biophysics. However, with the emergence of experimental techniques that allow direct investigation of structure and function at the nanoscale, our understanding of cardiac physiology and pathophysiology at these scales is rapidly advancing. Here, we will discuss the structure and functions of multiple cardiomyocyte nanodomains, and novel strategies that target them for the treatment of cardiac arrhythmias.
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Affiliation(s)
- Przemysław B Radwański
- Bob and Corinne Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, United States.,Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States.,Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Pharmacy Practice and Science, College of Pharmacy, The Ohio State University, Columbus, OH, United States
| | - Christopher N Johnson
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States.,Vanderbilt Center for Arrhythmia Research and Therapeutics, Nashville, TN, United States
| | - Sándor Györke
- Bob and Corinne Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, United States.,Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States.,Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Rengasayee Veeraraghavan
- Bob and Corinne Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, United States.,Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States.,Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
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6
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Koleske M, Bonilla I, Thomas J, Zaman N, Baine S, Knollmann BC, Veeraraghavan R, Györke S, Radwański PB. Tetrodotoxin-sensitive Na vs contribute to early and delayed afterdepolarizations in long QT arrhythmia models. J Gen Physiol 2018; 150:991-1002. [PMID: 29793933 PMCID: PMC6028491 DOI: 10.1085/jgp.201711909] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/30/2018] [Accepted: 04/30/2018] [Indexed: 01/08/2023] Open
Abstract
Neuronal Na+ channels contribute to catecholaminergic polymorphic ventricular tachycardia in the heart, but their role in other types of arrhythmias is unknown. Koleske et al. show that they contribute to early and delayed afterdepolarizations common to long QT, catecholaminergic polymorphic ventricular tachycardia, and overlap phenotypes. Recent evidence suggests that neuronal Na+ channels (nNavs) contribute to catecholamine-promoted delayed afterdepolarizations (DADs) and catecholaminergic polymorphic ventricular tachycardia (CPVT). The newly identified overlap between CPVT and long QT (LQT) phenotypes has stoked interest in the cross-talk between aberrant Na+ and Ca2+ handling and its contribution to early afterdepolarizations (EADs) and DADs. Here, we used Ca2+ imaging and electrophysiology to investigate the role of Na+ and Ca2+ handling in DADs and EADs in wild-type and cardiac calsequestrin (CASQ2)-null mice. In experiments, repolarization was impaired using 4-aminopyridine (4AP), whereas the L-type Ca2+ and late Na+ currents were augmented using Bay K 8644 (BayK) and anemone toxin II (ATX-II), respectively. The combination of 4AP and isoproterenol prolonged action potential duration (APD) and promoted aberrant Ca2+ release, EADs, and DADs in wild-type cardiomyocytes. Similarly, BayK in the absence of isoproterenol induced the same effects in CASQ2-null cardiomyocytes. In vivo, it prolonged the QT interval and, upon catecholamine challenge, precipitated wide QRS polymorphic ventricular tachycardia that resembled human torsades de pointes. Treatment with ATX-II produced similar effects at both the cellular level and in vivo. Importantly, nNav inhibition with riluzole or 4,9-anhydro-tetrodotoxin reduced the incidence of ATX-II–, BayK-, or 4AP-induced EADs, DADs, aberrant Ca2+ release, and VT despite only modestly mitigating APD prolongation. These data reveal the contribution of nNaVs to triggered arrhythmias in murine models of LQT and CPVT-LQT overlap phenotypes. We also demonstrate the antiarrhythmic impact of nNaV inhibition, independent of action potential and QT interval duration, and provide a basis for a mechanistically driven antiarrhythmic strategy.
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Affiliation(s)
- Megan Koleske
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ingrid Bonilla
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.,Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH
| | - Justin Thomas
- Division of Pharmacy Practice and Sciences, College of Pharmacy, The Ohio State University, Columbus, OH
| | - Naveed Zaman
- Division of Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH
| | - Stephen Baine
- Division of Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH
| | - Bjorn C Knollmann
- Division of Clinical Pharmacology, Vanderbilt University Medical School, Nashville, TN
| | - Rengasayee Veeraraghavan
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.,Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH
| | - Sándor Györke
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.,Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH
| | - Przemysław B Radwański
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH .,Division of Pharmacy Practice and Sciences, College of Pharmacy, The Ohio State University, Columbus, OH.,Division of Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH
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7
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Greer-Short A, Hund TJ. Editorial commentary: Mathematical modeling as a tool to elucidate fundamental principles in cardiac electrophysiology. Trends Cardiovasc Med 2017; 28:243-245. [PMID: 29269287 DOI: 10.1016/j.tcm.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Amara Greer-Short
- The Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH
| | - Thomas J Hund
- The Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH; Department of Internal Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH.
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8
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Fernández M, Marín MDR, Fernández-Armenta J, Mora-López F, Fernández Rivero R, Berruezo A, Cano Calabria L, Vázquez García R. Response to flecainide test in Andersen-Tawil syndrome with incessant ventricular tachycardia. Pacing Clin Electrophysiol 2017; 41:429-432. [PMID: 29023786 DOI: 10.1111/pace.13204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/06/2017] [Accepted: 09/14/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Marcos Fernández
- Arrhythmia Section, Cardiology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | | | - Juan Fernández-Armenta
- Arrhythmia Section, Cardiology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | | | | | - Antonio Berruezo
- Arrhythmia Section, Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Lucas Cano Calabria
- Arrhythmia Section, Cardiology Department, Puerta del Mar University Hospital, Cádiz, Spain
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9
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Greer-Short A, George SA, Poelzing S, Weinberg SH. Revealing the Concealed Nature of Long-QT Type 3 Syndrome. Circ Arrhythm Electrophysiol 2017; 10:e004400. [PMID: 28213505 DOI: 10.1161/circep.116.004400] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 12/13/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Gain-of-function mutations in the voltage-gated sodium channel (Nav1.5) are associated with the long-QT-3 (LQT3) syndrome. Nav1.5 is densely expressed at the intercalated disk, and narrow intercellular separation can modulate cell-to-cell coupling via extracellular electric fields and depletion of local sodium ion nanodomains. Models predict that significantly decreasing intercellular cleft widths slows conduction because of reduced sodium current driving force, termed "self-attenuation." We tested the novel hypothesis that self-attenuation can "mask" the LQT3 phenotype by reducing the driving force and late sodium current that produces early afterdepolarizations (EADs). METHODS AND RESULTS Acute interstitial edema was used to increase intercellular cleft width in isolated guinea pig heart experiments. In a drug-induced LQT3 model, acute interstitial edema exacerbated action potential duration prolongation and produced EADs, in particular, at slow pacing rates. In a computational cardiac tissue model incorporating extracellular electric field coupling, intercellular cleft sodium nanodomains, and LQT3-associated mutant channels, myocytes produced EADs for wide intercellular clefts, whereas for narrow clefts, EADs were suppressed. For both wide and narrow clefts, mutant channels were incompletely inactivated. However, for narrow clefts, late sodium current was reduced via self-attenuation, a protective negative feedback mechanism, masking EADs. CONCLUSIONS We demonstrated a novel mechanism leading to the concealing and revealing of EADs in LQT3 models. Simulations predict that this mechanism may operate independent of the specific mutation, suggesting that future therapies could target intercellular cleft separation as a compliment or alternative to sodium channels.
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Affiliation(s)
- Amara Greer-Short
- From the Virginia Tech Carilion Research Institute, Virginia Polytechnic Institute and State University, Roanoke (A.G.-S., S.A.G., S.P.); and Department of Biomedical Engineering, Virginia Commonwealth University, Richmond (S.H.W.)
| | - Sharon A George
- From the Virginia Tech Carilion Research Institute, Virginia Polytechnic Institute and State University, Roanoke (A.G.-S., S.A.G., S.P.); and Department of Biomedical Engineering, Virginia Commonwealth University, Richmond (S.H.W.)
| | - Steven Poelzing
- From the Virginia Tech Carilion Research Institute, Virginia Polytechnic Institute and State University, Roanoke (A.G.-S., S.A.G., S.P.); and Department of Biomedical Engineering, Virginia Commonwealth University, Richmond (S.H.W.).
| | - Seth H Weinberg
- From the Virginia Tech Carilion Research Institute, Virginia Polytechnic Institute and State University, Roanoke (A.G.-S., S.A.G., S.P.); and Department of Biomedical Engineering, Virginia Commonwealth University, Richmond (S.H.W.).
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10
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Veeraraghavan R, Györke S, Radwański PB. Neuronal sodium channels: emerging components of the nano-machinery of cardiac calcium cycling. J Physiol 2017; 595:3823-3834. [PMID: 28195313 DOI: 10.1113/jp273058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/05/2016] [Indexed: 01/07/2023] Open
Abstract
Excitation-contraction coupling is the bridge between cardiac electrical activation and mechanical contraction. It is driven by the influx of Ca2+ across the sarcolemma triggering Ca2+ release from the sarcoplasmic reticulum (SR) - a process termed Ca2+ -induced Ca2+ release (CICR) - followed by re-sequestration of Ca2+ into the SR. The Na+ /Ca2+ exchanger inextricably couples the cycling of Ca2+ and Na+ in cardiac myocytes. Thus, influx of Na+ via voltage-gated Na+ channels (NaV ) has emerged as an important regulator of CICR both in health and in disease. Recent insights into the subcellular distribution of cardiac and neuronal NaV isoforms and their ultrastructural milieu have important implications for the roles of these channels in mediating Ca2+ -driven arrhythmias. This review will discuss functional insights into the role of neuronal NaV isoforms vis-à-vis cardiac NaV s in triggering such arrhythmias and their potential as therapeutic targets in the context of the aforementioned structural observations.
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Affiliation(s)
- Rengasayee Veeraraghavan
- Virginia Tech Carilion Research Institute, and Center for Heart and Regenerative Medicine, Virginia Polytechnic University, Roanoke, VA, USA
| | - Sándor Györke
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, Ohio State University Wexner Medical Center, 473 West 12th Avenue, Room 510, Columbus, OH, 43210, USA.,Department of Physiology and Cell Biology, College of Medicine, Ohio State University, Columbus, OH, USA
| | - Przemysław B Radwański
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, Ohio State University Wexner Medical Center, 473 West 12th Avenue, Room 510, Columbus, OH, 43210, USA.,Department of Physiology and Cell Biology, College of Medicine, Ohio State University, Columbus, OH, USA.,Division of Pharmacy Practice and Science, College of Pharmacy, Ohio State University, Columbus, OH, USA
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11
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Radwański PB, Ho HT, Veeraraghavan R, Brunello L, Liu B, Belevych AE, Unudurthi SD, Makara MA, Priori SG, Volpe P, Armoundas AA, Dillmann WH, Knollmann BC, Mohler PJ, Hund TJ, Györke S. Neuronal Na + Channels Are Integral Components of Pro-arrhythmic Na +/Ca 2+ Signaling Nanodomain That Promotes Cardiac Arrhythmias During β-adrenergic Stimulation. JACC Basic Transl Sci 2016; 1:251-266. [PMID: 27747307 PMCID: PMC5065245 DOI: 10.1016/j.jacbts.2016.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cardiac arrhythmias are a leading cause of death in the US. Vast majority of these arrhythmias including catecholaminergic polymorphic ventricular tachycardia (CPVT) are associated with increased levels of circulating catecholamines and involve abnormal impulse formation secondary to aberrant Ca2+ and Na+ handling. However, the mechanistic link between β-AR stimulation and the subcellular/molecular arrhythmogenic trigger(s) remains elusive. METHODS AND RESULTS We performed functional and structural studies to assess Ca2+ and Na+ signaling in ventricular myocyte as well as surface electrocardiograms in mouse models of cardiac calsequestrin (CASQ2)-associated CPVT. We demonstrate that a subpopulation of Na+ channels (neuronal Na+ channels; nNav) that colocalize with RyR2 and Na+/Ca2+ exchanger (NCX) are a part of the β-AR-mediated arrhythmogenic process. Specifically, augmented Na+ entry via nNav in the settings of genetic defects within the RyR2 complex and enhanced sarcoplasmic reticulum (SR) Ca2+-ATPase (SERCA)-mediated SR Ca2+ refill is both an essential and a necessary factor for the arrhythmogenesis. Furthermore, we show that augmentation of Na+ entry involves β-AR-mediated activation of CAMKII subsequently leading to nNav augmentation. Importantly, selective pharmacological inhibition as well as silencing of Nav1.6 inhibit myocyte arrhythmic potential and prevent arrhythmias in vivo. CONCLUSION These data suggest that the arrhythmogenic alteration in Na+/Ca2+ handling evidenced ruing β-AR stimulation results, at least in part, from enhanced Na+ influx through nNav. Therefore, selective inhibition of these channels and Nav1.6 in particular can serve as a potential antiarrhythmic therapy.
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Affiliation(s)
- Przemysław B Radwański
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA ; Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, US ; Division of Pharmacy Practice and Sciences, College of Pharmacy, The Ohio State University, Columbus, OH, US
| | - Hsiang-Ting Ho
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA ; Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, US
| | - Rengasayee Veeraraghavan
- Center for Heart and Regenerative Medicine Research, Virginia Tech Carilion Research Institute, Virginia Polytechnic University, Roanoke, VA, USA
| | - Lucia Brunello
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA ; Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, US
| | - Bin Liu
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA ; Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, US
| | - Andriy E Belevych
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA ; Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, US
| | - Sathya D Unudurthi
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA ; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, USA
| | - Michael A Makara
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA ; Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, US
| | - Silvia G Priori
- Division of Cardiology and Molecular Cardiology, Maugeri Foundation-University of Pavia, Pavia, Italy
| | - Pompeo Volpe
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Antonis A Armoundas
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, USA
| | - Wolfgang H Dillmann
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Bjorn C Knollmann
- Division of Clinical Pharmacology, Vanderbilt University Medical School, Nashville, TN, USA
| | - Peter J Mohler
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA ; Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, US
| | - Thomas J Hund
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA ; Center for Heart and Regenerative Medicine Research, Virginia Tech Carilion Research Institute, Virginia Polytechnic University, Roanoke, VA, USA
| | - Sándor Györke
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA ; Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, US
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Greer-Short A, Poelzing S. Distinguishing between overdrive excited and suppressed ventricular beats in guinea pig ventricular myocardium. Front Physiol 2015; 6:14. [PMID: 25741282 PMCID: PMC4332283 DOI: 10.3389/fphys.2015.00014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/09/2015] [Indexed: 11/13/2022] Open
Abstract
Rapid ventricular pacing rates induces two types of beats following pacing cessation: recovery cycle length (RCL) prolongation (overdrive suppression) and RCL shortening (overdrive excitation). The goals of this study were to compare common experimental protocols for studying triggered activity in whole-heart preparations and differentiate between recovery beats using a new methodology. Post-pacing recovery beat cycle length (RCL) and QRS were normalized to pre-paced R-R and QRS intervals and analyzed using a K-means clustering algorithm. Control hearts only produced suppressed beats: RCL ratio increased with rapid pacing (25 ± 4.0%, n = 10) without changing QRS duration. Rapid pacing during hypercalcemia + hypothermia (5.5 mM and 34°C) produced significantly earlier excited beats (53 ± 14%, n = 5) with wider QRS durations (58 ± 6.3%, n = 5) than suppressed beats. Digoxin + hypothermia (0.75 μM) produced the most excited beats with significantly earlier RCL (44 ± 3.2%, n = 6) and wider QRS (60 ± 3.1%, n = 6) ratios relative to suppressed beats. Increasing pacing further shortened RCL (30 ± 7.8%, n = 6). In a prospective study, TTX (100 nM) increased RCL ratio (15 ± 6.0%, n = 10) without changing the QRS duration of excited beats. The algorithm was compared to a cross-correlation analysis with 93% sensitivity and 94% specificity. This ECG based algorithm distinguishes between triggered and automatic activity.
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Affiliation(s)
- Amara Greer-Short
- Department of Biomedical Engineering and Mechanics, Center for Heart and Regenerative Medicine, Virginia Polytechnic Institute and State University, Virginia Tech Carilion Research Institute Roanoke, VA, USA ; School of Biomedical Engineering and Sciences, Virginia Polytechnic Institute and State University Blacksburg, VA, USA
| | - Steven Poelzing
- Department of Biomedical Engineering and Mechanics, Center for Heart and Regenerative Medicine, Virginia Polytechnic Institute and State University, Virginia Tech Carilion Research Institute Roanoke, VA, USA ; School of Biomedical Engineering and Sciences, Virginia Polytechnic Institute and State University Blacksburg, VA, USA
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Radwański PB, Brunello L, Veeraraghavan R, Ho HT, Lou Q, Makara MA, Belevych AE, Anghelescu M, Priori SG, Volpe P, Hund TJ, Janssen PML, Mohler PJ, Bridge JHB, Poelzing S, Györke S. Neuronal Na+ channel blockade suppresses arrhythmogenic diastolic Ca2+ release. Cardiovasc Res 2014; 106:143-52. [PMID: 25538156 DOI: 10.1093/cvr/cvu262] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIMS Sudden death resulting from cardiac arrhythmias is the most common consequence of cardiac disease. Certain arrhythmias caused by abnormal impulse formation including catecholaminergic polymorphic ventricular tachycardia (CPVT) are associated with delayed afterdepolarizations resulting from diastolic Ca2+ release (DCR) from the sarcoplasmic reticulum (SR). Despite high response of CPVT to agents directly affecting Ca2+ cycling, the incidence of refractory cases is still significant. Surprisingly, these patients often respond to treatment with Na+ channel blockers. However, the relationship between Na+ influx and disturbances in Ca2+ handling immediately preceding arrhythmias in CPVT remains poorly understood and is the object of this study. METHODS AND RESULTS We performed optical Ca2+ and membrane potential imaging in ventricular myocytes and intact cardiac muscles as well as surface ECGs on a CPVT mouse model with a mutation in cardiac calsequestrin. We demonstrate that a subpopulation of Na+ channels (neuronal Na+ channels; nNav) colocalize with ryanodine receptor Ca2+ release channels (RyR2). Disruption of the crosstalk between nNav and RyR2 by nNav blockade with riluzole reduced and also desynchronized DCR in isolated cardiomyocytes and in intact cardiac tissue. Such desynchronization of DCR on cellular and tissue level translated into decreased arrhythmias in CPVT mice. CONCLUSIONS Thus, our study offers the first evidence that nNav contribute to arrhythmogenic DCR, thereby providing a conceptual basis for mechanism-based antiarrhythmic therapy.
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Affiliation(s)
- Przemysław B Radwański
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Room 507, Columbus, OH 43210, USA Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, USA Division of Pharmacy Practice and Administration, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Lucia Brunello
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Room 507, Columbus, OH 43210, USA Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Rengasayee Veeraraghavan
- VTC Research Institute, School of Biomedical Engineering and Sciences, Virginia Tech, Roanoke, VA, USA
| | - Hsiang-Ting Ho
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Room 507, Columbus, OH 43210, USA Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Qing Lou
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Room 507, Columbus, OH 43210, USA Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Michael A Makara
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Room 507, Columbus, OH 43210, USA Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Andriy E Belevych
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Room 507, Columbus, OH 43210, USA Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Mircea Anghelescu
- Department of Biological and Allied Health Sciences, Ohio Northern University, Ada, OH, USA
| | - Silvia G Priori
- Division of Cardiology and Molecular Cardiology, Maugeri Foundation-University of Pavia, Pavia, Italy
| | - Pompeo Volpe
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Thomas J Hund
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Room 507, Columbus, OH 43210, USA
| | - Paul M L Janssen
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Room 507, Columbus, OH 43210, USA Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Peter J Mohler
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Room 507, Columbus, OH 43210, USA Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, USA Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - John H B Bridge
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
| | - Steven Poelzing
- VTC Research Institute, School of Biomedical Engineering and Sciences, Virginia Tech, Roanoke, VA, USA
| | - Sándor Györke
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Room 507, Columbus, OH 43210, USA Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, USA
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Combined inhibition of Na+ and Ca2+ channels: A novel paradigm for the treatment of incessant ventricular arrhythmias in Andersen-Tawil syndrome. Heart Rhythm 2014; 11:318-20. [DOI: 10.1016/j.hrthm.2013.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Indexed: 12/23/2022]
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Sikkel MB, Collins TP, Rowlands C, Shah M, O'Gara P, Williams AJ, Harding SE, Lyon AR, MacLeod KT. Triple mode of action of flecainide in catecholaminergic polymorphic ventricular tachycardia: reply. Cardiovasc Res 2013; 98:327-8. [PMID: 23536607 DOI: 10.1093/cvr/cvt068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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