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Nyns ECA, Poelma RH, Volkers L, Plomp JJ, Bart CI, Kip AM, van Brakel TJ, Zeppenfeld K, Schalij MJ, Zhang GQ, de Vries AAF, Pijnappels DA. An automated hybrid bioelectronic system for autogenous restoration of sinus rhythm in atrial fibrillation. Sci Transl Med 2020; 11:11/481/eaau6447. [PMID: 30814339 DOI: 10.1126/scitranslmed.aau6447] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/05/2018] [Accepted: 01/17/2019] [Indexed: 11/02/2022]
Abstract
Because of suboptimal therapeutic strategies, restoration of sinus rhythm in symptomatic atrial fibrillation (AF) often requires in-hospital delivery of high-voltage shocks, thereby precluding ambulatory AF termination. Continuous, rapid restoration of sinus rhythm is desired given the recurring and progressive nature of AF. Here, we present an automated hybrid bioelectronic system for shock-free termination of AF that enables the heart to act as an electric current generator for autogenous restoration of sinus rhythm. We show that local, right atrial delivery of adenoassociated virus vectors encoding a light-gated depolarizing ion channel results in efficient and spatially confined transgene expression. Activation of an implanted intrathoracic light-emitting diode device allows for termination of AF by illuminating part of the atria. Combining this newly obtained antiarrhythmic effector function of the heart with the arrhythmia detector function of a machine-based cardiac rhythm monitor in the closed chest of adult rats allowed automated and rapid arrhythmia detection and termination in a safe, effective, repetitive, yet shock-free manner. These findings hold translational potential for the development of shock-free antiarrhythmic device therapy for ambulatory treatment of AF.
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Affiliation(s)
- Emile C A Nyns
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - René H Poelma
- Department of Microelectronics, Delft University of Technology, 2628 CD, Delft, Netherlands
| | - Linda Volkers
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - Jaap J Plomp
- Department of Neurology and Neurophysiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - Cindy I Bart
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - Annemarie M Kip
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - Thomas J van Brakel
- Department of Cardiothoracic Surgery, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - Katja Zeppenfeld
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - Martin J Schalij
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - Guo Qi Zhang
- Department of Microelectronics, Delft University of Technology, 2628 CD, Delft, Netherlands
| | - Antoine A F de Vries
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - Daniël A Pijnappels
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands.
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Liu X, Qu C, Shi S, Ye T, Wang L, Liu S, Zhang C, Liang J, Hu D, Yang B. The Reversal Effect of Sigma-1 Receptor (S1R) Agonist, SA4503, on Atrial Fibrillation After Depression and Its Underlying Mechanism. Front Physiol 2019; 10:1346. [PMID: 31803058 PMCID: PMC6870537 DOI: 10.3389/fphys.2019.01346] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/10/2019] [Indexed: 12/26/2022] Open
Abstract
Aim Sigma-1 receptors have been investigated and shown to play a protective role in both depression and cardiovascular disease. SA4503, known as a σ1 receptor agonist, regulates cardiac calcium and potassium channels in rat models of depression. However, it remains unknown whether SA4503 can alleviate myocardial inflammation or conduction junctions in the atrium after exposure to chronic mild stress. Methods and Results Sprague-Dawley male rats received 28-day treatment with SA4503, simultaneously with chronic mild stress. Behavior measurements were assessed after the daily doses. Additionally, a multielectrode array assessment, electrophysiological study, immunohistochemistry analysis, histological analysis, and Western blot analysis were performed. Depression rats’ hearts showed abnormal electrical activity, including disordered excitation propagation and prolonged total activation time (TAT). In addition, atrial arrhythmias (AAs), induced by burst stimulation, showed higher incidence and longer duration in the depression group compared to the control group. These changes were related to reduced conduction junctions and enhanced spatial heterogeneity. Importantly, depressed rat hearts showed greater expression of inflammatory factors (TGF-α, IL-6, and TGF-β), more collagen distribution in the extracellular matrix, and lower expression of gap junction proteins (CX40 and CX43). Furthermore, SA4503 partially mitigated the above indices in the depression group (P < 0.01 for all groups). Conclusion These findings show the effects of the σ1R agonist SA4503; it alleviates atrial myocardial inflammation and conduction junctions after chronic mild stress. SA4503 may be the promising pharmacological agent to treat depression-related AAs by increasing conduction function, improving the expression of connexin 40 and 43, and reducing cardiac myocardial inflammation.
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Affiliation(s)
- Xin Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Chuan Qu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Shaobo Shi
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Tianxin Ye
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Linglin Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Steven Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Cui Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Jinjun Liang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Dan Hu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Bo Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
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Tanaka H. [Fluorescence imaging of the living heart for understanding the basis of arrhythmias]. Nihon Yakurigaku Zasshi 2019; 154:171-177. [PMID: 31597895 DOI: 10.1254/fpj.154.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent outstanding progress in microscopic imaging technology and the advent of fluorescent probes have enabled us to visualize high spatiotemporal dynamics of intracellular molecules in living tissues. Here I introduce our research outcomes on functional fluorescence imaging of the heart especially for understanding the pathogenesis of cardiac arrhythmias. On the in situ Ca2+ imaging of perfused rat heart by rapid-scanning confocal microscopy, we found that burst emergence of intracellular Ca2+ waves evokes arrhythmogenic triggered activity and subsequent oscillatory depolarizations via the Na+-Ca2+ exchanger. Besides, impairment of Ca2+ release from the sarcoplasmic reticulum leads to emergence of Ca2+ waves and spatiotemporally inhomogeneous Ca2+ dynamics on systole, resulting in beat-to-beat Ca2+ alternans. Such alternating behaviors of Ca2+ dynamics are partly due to poor development of the transverse tubules, which are identified in murine atria and failing ventricular myocytes. In addition, impairment of the gap junctional communication via connexin 43 induced by dominant negative inhibition of neonatal rat ventricular myocyte monolayers results in generation of spiral wave reentry, suggesting the pivotal role of intercellular communications in genesis of arrhythmias. Furthermore, alterations in atrial histoanatomy, e.g., density and arrangements of myocytes and distribution of Cx43, could provide intrinsic arrhythmogenic bases of atrial fibrillation, which was revealed by combined optical imaging of the atria and precise histoanatomical examinations. In combination, fluorescence imaging of the living organisms provides indispensable information for unveiling functions and disease states.
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Affiliation(s)
- Hideo Tanaka
- Department of Pathology and Cell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
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Cho KH, Kim JH, Murakami G, Abe H, Rodríguez-Vázquez JF, Chai OH. Nerve distribution in myocardium including the atrial and ventricular septa in late stage human fetuses. Anat Cell Biol 2019; 52:48-56. [PMID: 30984452 PMCID: PMC6449578 DOI: 10.5115/acb.2019.52.1.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/23/2018] [Accepted: 10/12/2018] [Indexed: 12/14/2022] Open
Abstract
Few information had been reported on deep intracardiac nerves in the myocardium of late human fetuses such as nerves at the atrial-pulmonary vein junction and in the atrial and ventricular septa. We examined histological sections of the heart obtained from 12 human fetuses at 25–33 weeks. A high density of intracardiac nerves was evident around the mitral valve annulus in contrast to few nerves around the tricuspid annulus. To the crux at the atrioventricular sulcus, the degenerating left common cardinal vein brought abundant nerve bundles coming from cardiac nerves descending along the anterior aspect of the pulmonary trunk. Likewise, nerve bundles in the left atrial nerve fold came from cardiac nerves between the ascending aorta and pulmonary artery. Conversely, another nerves from the venous pole to the atrium seemed to be much limited in number. Moreover, the primary atrial septum contained much fewer nerves than the secondary septum. Therefore, nerve density in the atrial wall varied considerably between sites. As ventricular muscles were degenerated from the luminal side for sculpturing of papillary muscles and trabeculae, deep nerves became exposed to the ventricular endothelium. Likewise, as pectineal muscles were sculptured, nerves were exposed in the atrial endothelium. Consequently, a myocardial assembly or sculpture seemed to be associated with degeneration and reconstruction of early-developed nerves. A failure in reconstruction during further expansion of the left atrium might be connected with an individual variation in anatomical substrates of atrial fibrillation.
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Affiliation(s)
- Kwang Ho Cho
- Department of Neurology, Wonkwang University School of Medicine and Hospital, Institute of Wonkwang Medical Science, Iksan, Korea
| | - Ji Hyun Kim
- Department of Anatomy and Institute of Medical Sciences, Chonbuk National University Medical School, Jeonju, Korea
| | - Gen Murakami
- Division of Internal Medicine, Asuka Hospital, Sapporo, Japan
| | - Hiroshi Abe
- Department of Anatomy, Akita University School of Medicine, Akita, Japan
| | | | - Ok Hee Chai
- Department of Anatomy and Institute of Medical Sciences, Chonbuk National University Medical School, Jeonju, Korea
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Label-free detection of myocardial ischaemia in the perfused rat heart by spontaneous Raman spectroscopy. Sci Rep 2017; 7:42401. [PMID: 28186163 PMCID: PMC5301243 DOI: 10.1038/srep42401] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/09/2017] [Indexed: 12/20/2022] Open
Abstract
Raman spectroscopy, which identifies intrinsic molecular constituents, has a potential for determining myocardial viability under label-free conditions. However, its suitability for evaluating myocardial ischaemia is undetermined. Focusing on cytochromes, i.e., representative molecules reflecting mitochondrial activity, we tested whether Raman spectroscopy is applicable for evaluating myocardial ischaemia especially during early ischaemic phase. We obtained spontaneous Raman spectra of the subepicardial myocardium in the Langendorff-perfused rat heart upon 532-nm excitation before and during the “stopped-flow,” global ischaemia. Semi-quantitative values of the peak intensities at 750 and 1127 cm−1, which reflect reduced cytochromes c and b, increased immediately and progressively after induction of the stopped flow, indicating progressive reduction of the mitochondrial respiration. Such spectral changes emerged before the loss of 1) mitochondrial membrane potentials measured by the fluorescence intensity of tetramethyl rhodamine ethyl ester or 2) staining of the triphenyl tetrazolium chloride dye in the myocardium. The progressive increases in the Raman peaks by stopped flow were significantly retarded by ischaemic preconditioning. Sequential measurements of the peak intensities at 750 and 1127 cm−1 enabled early detection of the myocardial ischaemia based on the mitochondrial functions. These data suggest that Raman spectroscopy offers the potential to evaluate acute ischaemic heart under label-free conditions.
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Tanaka H, Matsuyama TA, Takamatsu T. Towards an integrated understanding of cardiac arrhythmogenesis − Growing roles of experimental pathology. Pathol Int 2016; 67:8-16. [DOI: 10.1111/pin.12487] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/20/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Hideo Tanaka
- Department of Pathology and Cell Regulation; Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Taka-aki Matsuyama
- Department of Pathology and Cell Regulation; Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Tetsuro Takamatsu
- Department of Medical Photonics; Kyoto Prefectural University of Medicine; Kyoto Japan
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Liu H, Chen G, Zheng H, Qin H, Liang M, Feng K, Wu Z. Differences in atrial fibrillation‑associated proteins between the left and right atrial appendages from patients with rheumatic mitral valve disease: A comparative proteomic analysis. Mol Med Rep 2016; 14:4232-4242. [PMID: 27667121 PMCID: PMC5101960 DOI: 10.3892/mmr.2016.5776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 09/15/2016] [Indexed: 01/10/2023] Open
Abstract
The majority of proteomic studies have focused on identifying atrial fibrillation (AF)-associated proteins in the right atrium (RA), thus potential differences in AF-associated proteins between the RA and left atrium (LA) remain unknown. The aim of the present study was to perform proteomic analysis to compare the potential differences in AF-associated proteins between the right atrial appendage (RAA) and left atrial appendage (LAA) in patients with rheumatic mitral valve disease (RMVD). RAA and LAA tissues were obtained from 18 patients with RMVD (10 with AF) during mitral valve replacement surgery. Two-dimensional fluorescence difference gel electrophoresis (2-D DIGE) proteomics analysis was performed using these tissues to identify AF-associated proteins in RAA and LAA. Subsequently, the proteomics data was validated using western blot analysis of nine selected proteins. In RAA, 32 AF-associated proteins were significantly dysregulated (15 upregulated and 17 downregulated). In LAA, 31 AF-associated proteins were significantly dysregulated (13 upregulated and 18 downregulated). Among these AF-associated proteins, 17 were AF-associated in both RAA and LAA, 15 were AF-associated only in RAA, and 14 were AF-associated only in LAA. Amongst the differentially expressed proteins, western blot analysis validated the results for 6 AF-associated proteins, and demonstrated similar distributions in RAA and LAA compared with the 2-D DIGE results. Of these proteins, 2 proteins were AF-associated in both RAA and LAA, 2 were AF-associated only in RAA, and 2 were AF-associated only in LAA. Additionally, the different distributions of AF-associated proteins in the RAA and LAA of patients with RMVD was analyzed, which may reflect the different regulatory mechanisms of the RA and LA in AF. These findings may provide new insights into the underlying molecular mechanisms of AF in patients with RMVD.
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Affiliation(s)
- Hai Liu
- Second Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat‑Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Guangxian Chen
- Second Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat‑Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Hongsheng Zheng
- Department of Cardiac Surgery, Henan Provincial Chest Hospital, Zhengzhou, Henan 450008, P.R. China
| | - Han Qin
- Second Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat‑Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Mengya Liang
- Second Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat‑Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Kangni Feng
- Second Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat‑Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Zhongkai Wu
- Second Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat‑Sen University, Guangzhou, Guangdong 510080, P.R. China
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Simulation of Ectopic Pacemakers in the Heart: Multiple Ectopic Beats Generated by Reentry inside Fibrotic Regions. BIOMED RESEARCH INTERNATIONAL 2015; 2015:713058. [PMID: 26583127 PMCID: PMC4637158 DOI: 10.1155/2015/713058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/08/2015] [Accepted: 05/17/2015] [Indexed: 11/18/2022]
Abstract
The inclusion of nonconducting media, mimicking cardiac fibrosis, in two models of cardiac tissue produces the formation of ectopic beats. The fraction of nonconducting media in comparison with the fraction of healthy myocytes and the topological distribution of cells determines the probability of ectopic beat generation. First, a detailed subcellular microscopic model that accounts for the microstructure of the cardiac tissue is constructed and employed for the numerical simulation of action potential propagation. Next, an equivalent discrete model is implemented, which permits a faster integration of the equations. This discrete model is a simplified version of the microscopic model that maintains the distribution of connections between cells. Both models produce similar results when describing action potential propagation in homogeneous tissue; however, they slightly differ in the generation of ectopic beats in heterogeneous tissue. Nevertheless, both models present the generation of reentry inside fibrotic tissues. This kind of reentry restricted to microfibrosis regions can result in the formation of ectopic pacemakers, that is, regions that will generate a series of ectopic stimulus at a fast pacing rate. In turn, such activity has been related to trigger fibrillation in the atria and in the ventricles in clinical and animal studies.
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Peng H, Sun Z, Zhang H, Wu Y. Radiofrequency ablation of left atrial flutter mediated with double potentials in a seemingly normally structured heart. Int J Cardiol 2014; 175:522-7. [DOI: 10.1016/j.ijcard.2014.06.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/02/2014] [Accepted: 06/24/2014] [Indexed: 11/30/2022]
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Friedman DJ, Wang N, Meigs JB, Hoffmann U, Massaro JM, Fox CS, Magnani JW. Pericardial fat is associated with atrial conduction: the Framingham Heart Study. J Am Heart Assoc 2014; 3:e000477. [PMID: 24595189 PMCID: PMC4187474 DOI: 10.1161/jaha.113.000477] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Obesity is associated with altered atrial electrophysiology and a prominent risk factor for atrial fibrillation. Body mass index, the most widely used adiposity measure, has been related to atrial electrical remodeling. We tested the hypothesis that pericardial fat is independently associated with electrocardiographic measures of atrial conduction. Methods and Results We performed a cross‐sectional analysis of 1946 Framingham Heart Study participants (45% women) to determine the relation between pericardial fat and atrial conduction as measured by P wave indices (PWI): PR interval, P wave duration (P‐duration), P wave amplitude (P‐amplitude), P wave area (P‐area), and P wave terminal force (P‐terminal). We performed sex‐stratified linear regression analyses adjusted for relevant clinical variables and ectopic fat depots. Each 1‐SD increase in pericardial fat was significantly associated with PR interval (β=1.7 ms, P=0.049), P‐duration (β=2.3 ms, P<0.001), and P‐terminal (β=297 μV·ms, P<0.001) among women; and P‐duration (β=1.2 ms, P=0.002), P‐amplitude (β=−2.5 μV, P<0. 001), and P‐terminal (β=160 μV·ms, P=0.002) among men. Among both sexes, pericardial fat was significantly associated with P‐duration in analyses additionally adjusting for visceral fat or intrathoracic fat; a similar but non‐significant trend existed with P‐terminal. Among women, pericardial fat was significantly associated with P wave area after adjustment for visceral and intrathoracic fat. Conclusions Pericardial fat is associated with atrial conduction as quantified by PWI, even with adjustment for extracardiac fat depots. Further studies are warranted to identify the mechanisms through which pericardial fat may modify atrial electrophysiology and promote subsequent risk for arrhythmogenesis.
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Ganesan AN, Sanders P. Localising re-entry in atrial fibrillation: Anatomical clues to the substrate of rotors. J Arrhythm 2013. [DOI: 10.1016/j.joa.2013.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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12
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The left atrial myocardium: naturally "wired" for arrhythmogenicity? Heart Rhythm 2013; 10:1349-50. [PMID: 23707394 DOI: 10.1016/j.hrthm.2013.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Indexed: 11/22/2022]
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