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Vandenberk B, Haemers P, Morillo C. The autonomic nervous system in atrial fibrillation-pathophysiology and non-invasive assessment. Front Cardiovasc Med 2024; 10:1327387. [PMID: 38239878 PMCID: PMC10794613 DOI: 10.3389/fcvm.2023.1327387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/13/2023] [Indexed: 01/22/2024] Open
Abstract
The autonomic nervous system plays a crucial role in atrial fibrillation pathophysiology. Parasympathetic hyperactivity result in a shortening of the action potential duration, a reduction of the conduction wavelength, and as such facilitates reentry in the presence of triggers. Further, autonomic remodeling of atrial myocytes in AF includes progressive sympathetic hyperinnervation by increased atrial sympathetic nerve density and sympathetic atrial nerve sprouting. Knowledge on the pathophysiological process in AF, including the contribution of the autonomic nervous system, may in the near future guide personalized AF management. This review focuses on the role of the autonomic nervous system in atrial fibrillation pathophysiology and non-invasive assessment of the autonomic nervous system.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Peter Haemers
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Carlos Morillo
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
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2
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Koh Y, Kwok C, Voskoboinik A, Kalman JM, Wong M. Serotonin antidepressants and atrial fibrillation burden from cardiac implantable electronic devices. J Arrhythm 2023; 39:876-883. [PMID: 38045466 PMCID: PMC10692859 DOI: 10.1002/joa3.12948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/16/2023] [Accepted: 10/17/2023] [Indexed: 12/05/2023] Open
Abstract
Objective Depression and anxiety show a bidirectional relationship with atrial fibrillation (AF). Antidepressant use is associated with a reduction in the incidence of AF. However, no studies have examined the relationship between antidepressant use and AF burden (time in AF). This retrospective cohort study examined cardiac implantable device-detected AF episodes and their relationship with antidepressant use, among other treatment factors. Methods Consecutive patients from the Western Health Cardiology Department attending pacemaker checks between 2015 and 2021 were included. Patients with permanent AF were excluded, yielding 285 patients with no or paroxysmal AF, with a total of 772 patient encounters. Generalized estimating equations were used to model two processes: binary AF (present/absent) and the number of days in AF for patients with AF. Results Each yearly increase with age was associated with an increase in the odds of developing AF (OR 1.03 [1.00-1.05], p = .027). Male gender conferred a reduction in AF incidence (OR 0.30 [0.13-0.68], p = .004). Digoxin use was associated with incident AF (OR 4.43 [1.07-18.4], p = .04). Sotalol and heart-failure beta blocker use were associated with a decrease in AF burden (IRR 0.30 [0.12-0.78], p = .013 and 0.33 [0.14-0.81], p = .015). Selective serotonin reuptake inhibitor antidepressant use was associated with reduced AF burden (IRR 0.27 [0.09-0.81], p = .019), as was selective serotonin/noradrenaline reuptake inhibitor use (IRR 0.07 [0.03-0.15], p < .001). Conclusions Older age, female gender and digoxin are associated with a higher odds of developing incident AF. Sotalol, heart failure beta blockers and serotonin-based antidepressants are associated with reduced AF burden. Further prospective study into the effects of antidepressants on atrial arrhythmias is warranted.
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Affiliation(s)
- Youlin Koh
- Department of CardiologyWestern HealthSt AlbansVictoriaAustralia
- Department of CardiologyRoyal Melbourne HospitalMelbourneVictoriaAustralia
| | - Cecilia Kwok
- Department of CardiologyWestern HealthSt AlbansVictoriaAustralia
| | - Aleksandr Voskoboinik
- Department of CardiologyWestern HealthSt AlbansVictoriaAustralia
- Department of CardiologyAlfred HealthMelbourneVictoriaAustralia
| | - Jonathan M. Kalman
- Department of CardiologyRoyal Melbourne HospitalMelbourneVictoriaAustralia
| | - Michael Wong
- Department of CardiologyWestern HealthSt AlbansVictoriaAustralia
- Department of CardiologyRoyal Melbourne HospitalMelbourneVictoriaAustralia
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3
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Yao Y, Kothare MV. Nonlinear Closed-Loop Predictive Control of Heart Rate and Blood Pressure Using Vagus Nerve Stimulation: An In Silico Study. IEEE Trans Biomed Eng 2023; 70:2764-2775. [PMID: 37656644 PMCID: PMC11058472 DOI: 10.1109/tbme.2023.3261744] [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] [Indexed: 09/03/2023]
Abstract
We propose a nonlinear model-based control technique for regulating the heart rate and blood pressure using vagus nerve neuromodulation. The closed-loop framework is based on an in silico model of the rat cardiovascular system for the simulation of the hemodynamic response to multi-location vagal nerve stimulation. The in silico model is derived by compartmentalizing the various physiological components involved in the closed-loop cardiovascular system with intrinsic baroreflex regulation to virtually generate nominal and hypertension-related heart dynamics of rats in rest and exercise states. The controller, using a reduced cycle-averaged model, monitors the outputs from the in silico model, estimates the current state of the reduced model, and computes the optimum stimulation locations and the corresponding parameters using a nonlinear model predictive control algorithm. The results demonstrate that the proposed control strategy is robust with respect to its ability to handle setpoint tracking and disturbance rejection in different simulation scenarios.
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Petrungaro M, Fusco L, Cavarretta E, Scarà A, Borrelli A, Romano S, Petroni R, D'Ascenzi F, Sciarra L. Long-Term Sports Practice and Atrial Fibrillation: An Updated Review of a Complex Relationship. J Cardiovasc Dev Dis 2023; 10:jcdd10050218. [PMID: 37233185 DOI: 10.3390/jcdd10050218] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/04/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023] Open
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice, and it is an enormous burden worldwide because of its high morbidity, disability and mortality. It is generally acknowledged that physical activity (PA) is strongly associated with a significant reduction in the risk of cardiovascular (CV) disease and all-cause mortality. Moreover, it has been observed that moderate and regular physical activity has the potential to reduce the risk of AF, in addition to improving overall well-being. Nevertheless, some studies have associated intense physical activity with an increased risk of AF. This paper aims to review the main related literature to investigate the association between PA and AF incidence and draw pathophysiological and epidemiological conclusions.
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Affiliation(s)
- Mattia Petrungaro
- Unit of Electrophysiology, Belcolle Hospital, 01100 Viterbo, Italy
- Cardiology Department, University of Rome Sapienza, 00100 Rome, Italy
| | - Liuba Fusco
- Cardiology Unit, University Hospital of Northamptonshire, Northampton NN1 5BD, UK
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
- Mediterranea Cardiocentro, 80133 Naples, Italy
| | - Antonio Scarà
- Unit of Cardiology and Electrophysiology, San Carlo di Nancy Hospital, 00100 Rome, Italy
| | - Alessio Borrelli
- Unit of Cardiology and Electrophysiology, San Carlo di Nancy Hospital, 00100 Rome, Italy
| | - Silvio Romano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Renata Petroni
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
- Department of Medicine, Di Lorenzo Clinic, 67052 Avezzano, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Luigi Sciarra
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
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5
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Paroxysmal Atrial Fibrillation with Rapid Ventricular Response Following COVID-19 Nasopharyngeal Swab: A Case Report. REPORTS 2023. [DOI: 10.3390/reports6010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Nasopharyngeal (NP) swab sampling is a simple procedure that has become extremely popular in the coronavirus disease 2019 (COVID-19) era, with hundreds of million specimens collected every day. However, rare but serious complications have been reported following NP swab acquisition. Here we present a case of paroxysmal atrial fibrillation associated with NP specimen collection in a healthy healthcare provider undergoing COVID-19 testing during departmental screening. This response may have been caused by an exaggerated vagal tone triggered by the trigeminocardiac reflex. Less invasive collection methods, such as saliva testing, may be warranted in predisposed individuals.
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The Old and the New: Cardiovascular and Respiratory Alterations Induced by Acute JWH-018 Administration Compared to Δ 9-THC-A Preclinical Study in Mice. Int J Mol Sci 2023; 24:ijms24021631. [PMID: 36675144 PMCID: PMC9865969 DOI: 10.3390/ijms24021631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
Several new psychoactive substances (NPS) are responsible for intoxication involving the cardiovascular and respiratory systems. Among NPS, synthetic cannabinoids (SCs) provoked side effects in humans characterized by tachycardia, arrhythmias, hypertension, breathing difficulty, apnoea, myocardial infarction, and cardiac arrest. Therefore, the present study investigated the cardio-respiratory (MouseOx Plus; EMKA electrocardiogram (ECG) and plethysmography TUNNEL systems) and vascular (BP-2000 systems) effects induced by 1-naphthalenyl (1-pentyl-1H-indol-3-yl)-methanone (JWH-018; 0.3-3-6 mg/kg) and Δ9-tetrahydrocannabinol (Δ9-THC; 0.3-3-6 mg/kg), administered in awake CD-1 male mice. The results showed that higher doses of JWH-018 (3-6 mg/kg) induced deep and long-lasting bradycardia, alternated with bradyarrhythmia, spaced out by sudden episodes of tachyarrhythmias (6 mg/kg), and characterized by ECG electrical parameters changes, sustained bradypnea, and systolic and transient diastolic hypertension. Otherwise, Δ9-THC provoked delayed bradycardia (minor intensity tachyarrhythmias episodes) and bradypnea, also causing a transient and mild hypertensive effect at the tested dose range. These effects were prevented by both treatment with selective CB1 (AM 251, 6 mg/kg) and CB2 (AM 630, 6 mg/kg) receptor antagonists and with the mixture of the antagonists AM 251 and AM 630, even if in a different manner. Cardio-respiratory and vascular symptoms could be induced by peripheral and central CB1 and CB2 receptors stimulation, which could lead to both sympathetic and parasympathetic systems activation. These findings may represent a starting point for necessary future studies aimed at exploring the proper antidotal therapy to be used in SCs-intoxicated patient management.
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Sridharan A, Bradfield JS, Shivkumar K, Ajijola OA. Autonomic nervous system and arrhythmias in structural heart disease. Auton Neurosci 2022; 243:103037. [DOI: 10.1016/j.autneu.2022.103037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/28/2022]
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Chen JJ, Lin C, Chuang YC, Lee SF, Lin TY, Yu CC, Tsai CT, Liao MT, Lin TT, Lin LY, Lo MT. Alterations of sympathetic dynamics after atrial fibrillation ablation by analysis sympathetic nerve activity provide prognostic value for recurrence and mechanistic insights into ablation. Front Cardiovasc Med 2022; 9:1024156. [DOI: 10.3389/fcvm.2022.1024156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022] Open
Abstract
BackgroundPulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Success is associated with autonomic function modulation; however, the relationship between the changes after ablation is not fully understood. We aimed to investigate the effect of ablation on autonomic modulation by skin sympathetic nerve activity (SKNA) using conventional electrocardiogram (ECG) electrodes and to predict the treatment success.MethodsWe enrolled 79 patients. We recorded neuECG for 10 min at 10 kHz before and after ablation. The NeuECG was bandpass-filtered (500–1,000 Hz) and integrated at intervals of 100 ms (iSKNA). iSKNA was averaged over different time windows (1-, 5-,10-s; aSKNAs), and burst analyses were derived from aSKNAs to quantify the dynamics of sympathetic activities. AF recurrence after 3 months was defined as the study endpoint.ResultsSixteen patients experienced AF recurrence after the ablation. For burst analysis of 1-s aSKNA, the recurrence group had a higher bursting frequency than the non-recurrence group (0.074 ± 0.055 vs. 0.109 ± 0.067; p < 0.05) before ablation. The differences between pre- and post-ablation of firing duration longer than 2 s were more in the non-recurrence group (2.75 ± 6.41 vs. −1.41 ± 5.14; p < 0.05), while no significant changes were observed in the percentage of duration longer than 10 s using 5-s aSKNA. In addition, decreases in differences in firing frequency and percentage of both overall firing duration and longer firing duration (> 2 s) between pre- and post-ablation were independently associated with AF recurrence and more area under receiver operating characteristics (ROC) curve in combination with CHADS2 score (0.833).ConclusionWe demonstrated the applicability of neuECG for determining sympathetic modulation during AF ablation. Decreasing sympathetic activity is the key to successful ablation.
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Rao P, Belanger MJ, Robbins JM. Exercise, Physical Activity, and Cardiometabolic Health: Insights into the Prevention and Treatment of Cardiometabolic Diseases. Cardiol Rev 2022; 30:167-178. [PMID: 34560712 PMCID: PMC8920940 DOI: 10.1097/crd.0000000000000416] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Physical activity (PA) and exercise are widely recognized as essential components of primary and secondary cardiovascular disease (CVD) prevention efforts and are emphasized in the health promotion guidelines of numerous professional societies and committees. The protean benefits of PA and exercise extend across the spectrum of CVD, and include the improvement and reduction of risk factors and events for atherosclerotic CVD (ASCVD), cardiometabolic disease, heart failure, and atrial fibrillation (AF), respectively. Here, we highlight recent insights into the salutary effects of PA and exercise on the primary and secondary prevention of ASCVD, including their beneficial effects on both traditional and nontraditional risk mediators; exercise "prescriptions" for ASCVD; the role of PA regular exercise in the prevention and treatment of heart failure; and the relationships between, PA, exercise, and AF. While our understanding of the relationship between exercise and CVD has evolved considerably, several key questions remain including the association between extreme volumes of exercise and subclinical ASCVD and its risk; high-intensity exercise and resistance (strength) training as complementary modalities to continuous aerobic exercise; and dose- and intensity-dependent associations between exercise and AF. Recent advances in molecular profiling technologies (ie, genomics, transcriptomics, proteomics, and metabolomics) have begun to shed light on interindividual variation in cardiometabolic responses to PA and exercise and may provide new opportunities for clinical prediction in addition to mechanistic insights.
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Affiliation(s)
- Prashant Rao
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Cardiovascular Research Center, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Jeremy M. Robbins
- Cardiovascular Research Center, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Goddard J, Speights CJ, Borganelli M. Salt as a Trigger for Atrial Tachycardia/Fibrillation. Cureus 2022; 14:e26168. [PMID: 35891840 PMCID: PMC9302945 DOI: 10.7759/cureus.26168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
A variety of potential triggers of atrial fibrillation (AF) have been reported, including alcohol consumption, caffeine, exercise, and stress. Vagal AF triggers include gastrointestinal factors such as the amount of food consumed, types of foods, and gas and bloating. In this case report, detailed data of seven dietary and behavioral factors (many vagal) believed to be possible atrial tachycardia (AT) or AF triggers in a single patient with paroxysmal AT/AF were recorded. Episodes of AT and AF were recorded in the patient using a Medtronic loop recorder and analyzed by a cardiac electrophysiologist. To evaluate these potential triggers of AT/AF events, a general linear model with binomial family error distribution was used to fit the data. Then, a stepAIC function from the MASS package in R was used to perform a stepwise model selection using AIC (Akaike information criterion). The analysis only identified the amount of salt intake and the use of polyethylene glycol 3350 as predictors of AT/AF, and high salt intake was the only factor significantly associated with the onset of AT/AF (P < 0.05). Thus, salt intake may trigger AT/AF in ways other than via hypertension.
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11
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Bressi E, Rebecchi M, Sgueglia M, Crescenzi C, Panattoni G, Martino A, Casalese A, Sangiorgi C, Politano A, Cicogna F, Fagagnini A, Grieco D, DE Ruvo E, Calò L. Atrial fibrillation and sport: need for monitoring. Minerva Cardiol Angiol 2022; 70:594-605. [PMID: 35343173 DOI: 10.23736/s2724-5683.22.05842-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Historically, regular exercise contributed to reduce the arrhythmic burden and improve cardiovascular outcomes in the general population. However, a heightened risk of Atrial Fibrillation (AF) seems to occur mainly amongst endurance athletes. The exact mechanisms are not fully elucidated, but dynamic interactions between electroanatomical changes induced by exercise, the autonomic system, variable triggers, along individual genetic predisposition are the main contributors to AF development in athletes. The type and training load of sports are also crucial in determining the arrhythmogenic milieu predisposing to AF insurgence and perpetuation. Moreover, a sex difference seems to influence an increased risk of AF only in men undergoing strenuous exercise, whereas women appear protected even during more vigorous training. In the absence of solid evidence, the advent of modern technologies could help to monitor and deep investigate the peculiar aspects of AF in these athletes. This review aims to describe the pathophysiology, diagnosis, and management of AF in athletes, shedding light on possible future strategies to face AF in this population.
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Affiliation(s)
- Edoardo Bressi
- Department of Cardiology, Policlinico Casilino of Rome, Rome, Italy -
| | - Marco Rebecchi
- Department of Cardiology, Policlinico Casilino of Rome, Rome, Italy
| | | | - Cinzia Crescenzi
- Department of Cardiology, Policlinico Casilino of Rome, Rome, Italy
| | | | | | | | - Catia Sangiorgi
- Department of Cardiology, Policlinico Casilino of Rome, Rome, Italy
| | | | | | | | - Domenico Grieco
- Department of Cardiology, Policlinico Casilino of Rome, Rome, Italy
| | | | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino of Rome, Rome, Italy
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Salvador-Montañés Ó, Ramirez RJ, Takemoto Y, Ennis SR, Garcia-Iglesias D, Wang S, Wolfer PJ, Jiang J, Mironov SV, Pandit SV, Jalife J, Berenfeld O. Panoramic Endocardial Optical Mapping Demonstrates Serial Rotors Acceleration and Increasing Complexity of Activity During Onset of Cholinergic Atrial Fibrillation. J Am Heart Assoc 2021; 10:e022300. [PMID: 34726079 PMCID: PMC8751940 DOI: 10.1161/jaha.121.022300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Activation during onset of atrial fibrillation is poorly understood. We aimed at developing a panoramic optical mapping system for the atria and test the hypothesis that sequential rotors underlie acceleration of atrial fibrillation during onset. Methods and Results Five sheep hearts were Langendorff perfused in the presence of 0.25 µmol/L carbachol. Novel optical system recorded activations simultaneously from the entire left and right atrial endocardial surfaces. Twenty sustained (>40 s) atrial fibrillation episodes were induced by a train and premature stimuli protocol. Movies obtained immediately (Initiation stage) and 30 s (Early Stabilization stage) after premature stimulus were analyzed. Serial rotor formation was observed in all sustained inductions and none in nonsustained inductions. In sustained episodes maximal dominant frequency increased from (mean±SD) 11.5±1.74 Hz during Initiation to 14.79±1.30 Hz at Early Stabilization (P<0.0001) and stabilized thereafter. At rotor sites, mean cycle length (CL) during 10 prerotor activations increased every cycle by 0.53% (P=0.0303) during Initiation and 0.34% (P=0.0003) during Early Stabilization. In contrast, CLs at rotor sites showed abrupt decreases after the rotors appearances by a mean of 9.65% (P<0.0001) during both stages. At Initiation, atria‐wide accelerations and decelerations during rotors showed a net acceleration result whereby post‐rotors atria‐wide minimal CL (CLmin) were 95.5±6.8% of the prerotor CLmin (P=0.0042). In contrast, during Early Stabilization, there was no net acceleration in CLmin during accelerating rotors (prerotor=84.9±11.0% versus postrotor=85.8±10.8% of Initiation, P=0.4029). Levels of rotor drift distance and velocity correlated with atria‐wide acceleration. Nonrotor phase singularity points did not accelerate atria‐wide activation but multiplied during Initiation until Early Stabilization. Increasing number of singularity points, indicating increased complexity, correlated with atria‐wide CLmin reduction (P<0.0001). Conclusions Novel panoramic optical mapping of the atria demonstrates shortening CL at rotor sites during cholinergic atrial fibrillation onset. Atrial fibrillation acceleration toward Early Stabilization correlates with the net result of atria‐wide accelerations during drifting rotors activity.
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Affiliation(s)
- Óscar Salvador-Montañés
- Center for Arrhythmia Research Department of Internal Medicine - Cardiology University of Michigan Ann Arbor MI.,Facultad de Medicina Universidad Francisco de Vitoria, Pozuelo de Alarcon Mardid Spain.,Hospital Universitario de Torrejón Mardid Spain
| | - Rafael J Ramirez
- Center for Arrhythmia Research Department of Internal Medicine - Cardiology University of Michigan Ann Arbor MI.,The Department of Physiology and Biophysics Virginia Commonwealth University Richmond VA
| | - Yoshio Takemoto
- Center for Arrhythmia Research Department of Internal Medicine - Cardiology University of Michigan Ann Arbor MI.,Cardiovascular Medicine Gifu Prefectural Tajimi Hospital Tajimi Japan
| | - Steven R Ennis
- Center for Arrhythmia Research Department of Internal Medicine - Cardiology University of Michigan Ann Arbor MI
| | - Daniel Garcia-Iglesias
- Center for Arrhythmia Research Department of Internal Medicine - Cardiology University of Michigan Ann Arbor MI.,Hospital Universitario Central de Asturias Oviedo Spain
| | - Sicong Wang
- Center for Arrhythmia Research Department of Internal Medicine - Cardiology University of Michigan Ann Arbor MI.,Institute for Stem Cell Biology and Regenerative Medicine Stanford University Palo Alto CA
| | - Patrick J Wolfer
- Center for Arrhythmia Research Department of Internal Medicine - Cardiology University of Michigan Ann Arbor MI.,Michigan Technological University Houghton MI
| | - Jiang Jiang
- Center for Arrhythmia Research Department of Internal Medicine - Cardiology University of Michigan Ann Arbor MI
| | - Sergey V Mironov
- Center for Arrhythmia Research Department of Internal Medicine - Cardiology University of Michigan Ann Arbor MI
| | - Sandeep V Pandit
- Center for Arrhythmia Research Department of Internal Medicine - Cardiology University of Michigan Ann Arbor MI
| | - José Jalife
- Center for Arrhythmia Research Department of Internal Medicine - Cardiology University of Michigan Ann Arbor MI.,Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid Spain
| | - Omer Berenfeld
- Center for Arrhythmia Research Department of Internal Medicine - Cardiology University of Michigan Ann Arbor MI
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13
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Okazaki T, Yoshida T, Uchino S, Sasabuchi Y. Association of onset time of new-onset atrial fibrillation with in-hospital mortality among critically ill patients: A secondary analysis of a prospective multicenter observational study. IJC HEART & VASCULATURE 2021; 36:100880. [PMID: 34632043 PMCID: PMC8488237 DOI: 10.1016/j.ijcha.2021.100880] [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] [Received: 08/08/2021] [Revised: 09/01/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022]
Abstract
Background New-onset atrial fibrillation (AF) in critically ill patients is associated with adverse outcomes. In non-critical settings, the circadian variation in paroxysmal AF is of significant interest; however, circadian variation in critically ill patients with new-onset AF has not been thoroughly studied. This study aimed to examine the association between AF onset time and in-hospital mortality. Methods This was a secondary analysis of a prospective multicenter observational study enrolling adult critically ill patients. According to AF onset time, patients were divided into nighttime (0:00–7:59), daytime (8:00–15:59), and evening (16:00–23:59). We conducted a multiple logistic regression analysis to assess the potential association between AF onset time and in-hospital mortality. We also assessed the distribution of AF onset, crude in-hospital mortality, and adjusted in-hospital mortality according to bihourly intervals. Results Of 423 patients, in-hospital mortality was 26%. During nighttime, 135 patients (32%) developed new-onset AF. AF emerged during daytime for 141 (33%) and during evening for 147 (35%). Daytime AF was significantly associated with an increased risk of in-hospital mortality (adjusted OR: 1.92; 95% CI: 1.07–3.44; p = 0.030). Bihourly interval analysis showed that adjusted in-hospital mortality was unevenly distributed and bimodal with troughs between 6:00 and 7:59 and between 18:00 and 19:59. A similar trend was seen in the distribution of the number of new-onset AF. Conclusions We found that the bihourly adjusted in-hospital mortality was distributed in a bimodal fashion. Further research is needed to determine the causes of the diurnal variation and its impact on patient outcomes.
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Affiliation(s)
- Tomoya Okazaki
- Emergency Medical Center, Kagawa University Hospital, Japan
| | - Takuo Yoshida
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Japan.,Department of Intensive Care Medicine, Tokyo Women's Medical University, Japan
| | - Shigehiko Uchino
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Japan
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Dalgleish AS, Kania AM, Stauss HM, Jelen AZ. Occipitoatlantal decompression and noninvasive vagus nerve stimulation slow conduction velocity through the atrioventricular node in healthy participants. J Osteopath Med 2021; 121:349-359. [PMID: 33694346 DOI: 10.1515/jom-2020-0213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/10/2020] [Indexed: 11/15/2022]
Abstract
CONTEXT Management of atrial fibrillation includes either rhythm control that aims at establishing a sinus rhythm or rate control that aims at lowering the ventricular rate, usually with atrioventricular nodal blocking agents. Another potential strategy for ventricular rate control is to induce a negative dromotropic effect by augmenting cardiac vagal activity, which might be possible through noninvasive and nonpharmacologic techniques. Thus, the hypothesis of this study was that occipitoatlantal decompression (OA-D) and transcutaneous auricular vagus nerve stimulation (taVNS) not only increase cardiac parasympathetic tone as assessed by heart rate variability (HRV), but also slow atrioventricular conduction, assessed by the PQ-interval of the electrocardiogram (EKG) in generally healthy study participants without atrial fibrillation. OBJECTIVES To test whether OA-D and/or transcutaneous taVNS, which have been demonstrated to increase cardiac parasympathetic nervous system activity, would also elicit a negative dromotropic effect and prolong atrioventricular conduction. METHODS EKGs were recorded in 28 healthy volunteers on three consecutive days during a 30 min baseline recording, a 15 min intervention, and a 30 min recovery period. Participants were randomly assigned to one of three experimental groups that differed in the 15 min intervention. The first group received OA-D for 5 min, followed by 10 min of rest. The second group received 15 min of taVNS. The intervention in the third group that served as a time control group (CTR) consisted of 15 min of rest. The RR- and PQ-intervals were extracted from the EKGs and then used to assess HRV and AV-conduction, respectively. RESULTS The OA-D group had nine participants (32.1%), the taVNS group had 10 participants (35.7%), and the CTR group had nine participants (32.1%). The root mean square of successive differences between normal heartbeats (RMSSD), an HRV measure of cardiac parasympathetic modulation, tended to be higher during the recovery period than during the baseline recording in the OA-D group (mean ± standard error of the mean [SEM], 54.6 ± 15.5 vs. 49.8 ± 15.8 ms; p<0.10) and increased significantly in the taVNS group (mean ± SEM, 28.8 ± 5.7 vs. 24.7 ± 4.8 ms; p<0.05), but not in the control group (mean ± SEM, 31.4 ± 4.2 vs. 28.5 ± 3.8 ms; p=0.31). This increase in RMSSD was accompanied by a lengthening of the PQ-interval in the OA-D (mean ± SEM, 170.5 ± 9.6 vs. 166.8 ± 9.7 ms; p<0.05) and taVNS (mean ± SEM, 166.6 ± 6.0 vs. 162.1 ± 5.6 ms; p<0.05) groups, but not in the control group (mean ± SEM, 164.3 ± 9.2 vs. 163.1 ± 9.1 ms; p=0.31). The PQ-intervals during the baseline recordings did not differ on the three study days in any of the three groups, suggesting that the negative dromotropic effect of OA-D and taVNS did not last into the following day. CONCLUSIONS The lengthening of the PQ-interval in the OA-D and taVNS groups was accompanied by an increase in RMSSD. This implies that the negative dromotropic effects of OA-D and taVNS are mediated through an increase in cardiac parasympathetic tone. Whether these findings suggest their utility in controlling ventricular rates during persistent atrial fibrillation remains to be determined.
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Affiliation(s)
- Ariana S Dalgleish
- Department of Clinical Medicine, Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - Adrienne M Kania
- Department of Clinical Medicine, Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - Harald M Stauss
- Departments of Biomedical Sciences, Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - Adrianna Z Jelen
- Department of Clinical Medicine, Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
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15
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Atrial fibrillation in the athlete: Case report and a contemporary appraisal. J Electrocardiol 2021; 66:6-11. [PMID: 33676172 DOI: 10.1016/j.jelectrocard.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most prevalent sustained arrhythmia affecting up to 1% of the world's population. The overwhelming majority of patients with AF have concomitant structural heart disease and comorbidities, including hypertension and diabetes mellitus. One out of ten AF patients has no substantial comorbidities and has been traditionally termed "lone AF". Paradoxically, there exists an association of highintensity endurance exercises and AF. CASE 43-year-old competitive cyclist and cross-country skier with no known cardiac comorbidities who presented with multiple episodes of dyspnea and palpitations. He was found to have exercise-induced AF without structural heart abnormalities. DISCUSSION This case highlights the clinical diversity of AF in athletes. In this review, we delve into the specifics of the pathophysiology and clinical features of AF in athletes. We then review the key points in managing AF in athletes, including medical therapy and catheter ablation. CONCLUSION AF in the athletes is incompletely understood due to a lack of prospective study volume. There exist some crucial pathophysiological differences between AF in athletes and AF in older patients with structural heart disease. Treating physicians must be aware of the nuances of management of AF in athletes, including the concepts of detraining, medical therapy options, and ablation.
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16
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Exercise and Athletic Activity in Atrial Fibrillation. Card Electrophysiol Clin 2021; 13:173-182. [PMID: 33516395 DOI: 10.1016/j.ccep.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Moderate-intensity exercise improves cardiovascular outcomes. However, mounting clinical evidence demonstrates that long-term, high-intensity endurance training predisposes male and veteran athletes to an increased risk of atrial fibrillation (AF), a risk that is not observed across both genders. Although increased mortality associated with AF in the general population is not shared by athletes, clinically significant morbidities exist (eg, reduced exercise capacity, athletic performance, and quality of life). Additional research is needed to fill current gaps in knowledge pertaining to the natural history, pathophysiologic mechanisms, and management strategies of AF in the athlete.
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17
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Pachon-M JC, Pachon-M EI, Pachon CTC, Santillana-P TG, Lobo TJ, Pachon-M JC, Zerpa-A JC, Cunha-P MZ, Higuti C, Ortencio FA, Amarante RC, Silva RF, Osorio TG. Long-Term Evaluation of the Vagal Denervation by Cardioneuroablation Using Holter and Heart Rate Variability. Circ Arrhythm Electrophysiol 2020; 13:e008703. [DOI: 10.1161/circep.120.008703] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background:
Several disorders present reflex or persistent increase in vagal tone that may cause refractory symptoms even in a normal heart patient. Cardioneuroablation, the vagal denervation by radiofrequency ablation of the neuromyocardial interface, was developed to treat these conditions without pacemaker implantation. A theoretical limitation could be the reinnervation, that naturally grows in the first year, that could recover the vagal hyperactivity. This study aims to verify the vagal denervation degree in the chronic phase after cardioneuroablation. Additionally, it intends to investigate the arrhythmias behavior after cardioneuroablation.
Methods:
Prospective longitudinal study with intrapatient comparison of 83 very symptomatic cases without significant cardiopathy, submitted to cardioneuroablation, 49 (59%) male, 47.3±17 years old, having vagal paroxysmal atrial fibrillation 58 (70%) or neurocardiogenic syncope 25 (30%), New York Heart Association class<II and absence of significant comorbidities. Cardioneuroablation was performed in both atria by interatrial septum puncture, with irrigated conventional catheter and electroanatomic reconstruction. Ablation targeted the neuromiocardial interface by fragmentation mapping (AF-Nests) using the velocity fractionation software, conventional recording, and anatomic localization of the ganglionated plexi. Heart rate variability (time and frequency domain) and arrhythmias were compared by 24h-Holter, before, and 1 year and 2 years after cardioneuroablation. In a 40 month follow-up, 80% of patients were asymptomatic.
Results:
Time- and frequency-domain heart rate variability demonstrated significant decrease in all autonomic parameters, showing an important parasympathetic and sympathetic activity reduction at 2-year post-cardioneuroablation (
P
<0.001). There was no difference in heart rate variability between the 1-year and 2-year post-cardioneuroablation (
P
>0.05) suggesting that the reinnervation has halted. There was also an important reduction in all bradyarrhythmias and tachyarrhythmias pre-cardioneuroablation versus post-cardioneuroablation (
P
<0.01).
Conclusions:
There is an important and significant vagal and sympathetic denervation after 2 years of cardioneuroablation with a significant reduction in bradyarrhythmia and tachyarrhythmia in the whole group. There were no complications.
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Affiliation(s)
- Jose Carlos Pachon-M
- USP, Sao Paulo University, Brazil (Jose Carlos Pachon-M, E.I.P.-M., Juan Carlos Pachon-M, R.C.A., R.F.S.)
- HCor, Sao Paulo Heart Hospital (Jose Carlos Pachon-M, E.I.P.-M., C.T.C.P., T.G.S.-P., T.J.L., Juan Carlos Pachon-M, J.C.Z.-A., M.Z.C.P., C.H., F.A.O., R.C.A., R.F.S., T.G.O.)
- IDPC, Sao Paulo Dante Pazzanese Cardiology Institute, Brazil (Jose Carlos Pachon-M, E.I.P.-M., Jose Carlos Pachon-M, C.H., R.C.A., R.F.S., T.G.O.)
| | - Enrique I. Pachon-M
- USP, Sao Paulo University, Brazil (Jose Carlos Pachon-M, E.I.P.-M., Juan Carlos Pachon-M, R.C.A., R.F.S.)
- HCor, Sao Paulo Heart Hospital (Jose Carlos Pachon-M, E.I.P.-M., C.T.C.P., T.G.S.-P., T.J.L., Juan Carlos Pachon-M, J.C.Z.-A., M.Z.C.P., C.H., F.A.O., R.C.A., R.F.S., T.G.O.)
- IDPC, Sao Paulo Dante Pazzanese Cardiology Institute, Brazil (Jose Carlos Pachon-M, E.I.P.-M., Jose Carlos Pachon-M, C.H., R.C.A., R.F.S., T.G.O.)
| | - Carlos Thiene C. Pachon
- HCor, Sao Paulo Heart Hospital (Jose Carlos Pachon-M, E.I.P.-M., C.T.C.P., T.G.S.-P., T.J.L., Juan Carlos Pachon-M, J.C.Z.-A., M.Z.C.P., C.H., F.A.O., R.C.A., R.F.S., T.G.O.)
| | - Tomas G. Santillana-P
- HCor, Sao Paulo Heart Hospital (Jose Carlos Pachon-M, E.I.P.-M., C.T.C.P., T.G.S.-P., T.J.L., Juan Carlos Pachon-M, J.C.Z.-A., M.Z.C.P., C.H., F.A.O., R.C.A., R.F.S., T.G.O.)
| | - Tasso J. Lobo
- HCor, Sao Paulo Heart Hospital (Jose Carlos Pachon-M, E.I.P.-M., C.T.C.P., T.G.S.-P., T.J.L., Juan Carlos Pachon-M, J.C.Z.-A., M.Z.C.P., C.H., F.A.O., R.C.A., R.F.S., T.G.O.)
| | - Juan Carlos Pachon-M
- USP, Sao Paulo University, Brazil (Jose Carlos Pachon-M, E.I.P.-M., Juan Carlos Pachon-M, R.C.A., R.F.S.)
- HCor, Sao Paulo Heart Hospital (Jose Carlos Pachon-M, E.I.P.-M., C.T.C.P., T.G.S.-P., T.J.L., Juan Carlos Pachon-M, J.C.Z.-A., M.Z.C.P., C.H., F.A.O., R.C.A., R.F.S., T.G.O.)
- IDPC, Sao Paulo Dante Pazzanese Cardiology Institute, Brazil (Jose Carlos Pachon-M, E.I.P.-M., Jose Carlos Pachon-M, C.H., R.C.A., R.F.S., T.G.O.)
| | - Juan Carlos Zerpa-A
- HCor, Sao Paulo Heart Hospital (Jose Carlos Pachon-M, E.I.P.-M., C.T.C.P., T.G.S.-P., T.J.L., Juan Carlos Pachon-M, J.C.Z.-A., M.Z.C.P., C.H., F.A.O., R.C.A., R.F.S., T.G.O.)
| | - Maria Z. Cunha-P
- HCor, Sao Paulo Heart Hospital (Jose Carlos Pachon-M, E.I.P.-M., C.T.C.P., T.G.S.-P., T.J.L., Juan Carlos Pachon-M, J.C.Z.-A., M.Z.C.P., C.H., F.A.O., R.C.A., R.F.S., T.G.O.)
| | - Christian Higuti
- HCor, Sao Paulo Heart Hospital (Jose Carlos Pachon-M, E.I.P.-M., C.T.C.P., T.G.S.-P., T.J.L., Juan Carlos Pachon-M, J.C.Z.-A., M.Z.C.P., C.H., F.A.O., R.C.A., R.F.S., T.G.O.)
| | - Felipe Augusto Ortencio
- HCor, Sao Paulo Heart Hospital (Jose Carlos Pachon-M, E.I.P.-M., C.T.C.P., T.G.S.-P., T.J.L., Juan Carlos Pachon-M, J.C.Z.-A., M.Z.C.P., C.H., F.A.O., R.C.A., R.F.S., T.G.O.)
| | - Ricardo C. Amarante
- USP, Sao Paulo University, Brazil (Jose Carlos Pachon-M, E.I.P.-M., Juan Carlos Pachon-M, R.C.A., R.F.S.)
- HCor, Sao Paulo Heart Hospital (Jose Carlos Pachon-M, E.I.P.-M., C.T.C.P., T.G.S.-P., T.J.L., Juan Carlos Pachon-M, J.C.Z.-A., M.Z.C.P., C.H., F.A.O., R.C.A., R.F.S., T.G.O.)
- IDPC, Sao Paulo Dante Pazzanese Cardiology Institute, Brazil (Jose Carlos Pachon-M, E.I.P.-M., Jose Carlos Pachon-M, C.H., R.C.A., R.F.S., T.G.O.)
| | - Ricardo F. Silva
- USP, Sao Paulo University, Brazil (Jose Carlos Pachon-M, E.I.P.-M., Juan Carlos Pachon-M, R.C.A., R.F.S.)
- HCor, Sao Paulo Heart Hospital (Jose Carlos Pachon-M, E.I.P.-M., C.T.C.P., T.G.S.-P., T.J.L., Juan Carlos Pachon-M, J.C.Z.-A., M.Z.C.P., C.H., F.A.O., R.C.A., R.F.S., T.G.O.)
- IDPC, Sao Paulo Dante Pazzanese Cardiology Institute, Brazil (Jose Carlos Pachon-M, E.I.P.-M., Jose Carlos Pachon-M, C.H., R.C.A., R.F.S., T.G.O.)
| | - Thiago G. Osorio
- HCor, Sao Paulo Heart Hospital (Jose Carlos Pachon-M, E.I.P.-M., C.T.C.P., T.G.S.-P., T.J.L., Juan Carlos Pachon-M, J.C.Z.-A., M.Z.C.P., C.H., F.A.O., R.C.A., R.F.S., T.G.O.)
- IDPC, Sao Paulo Dante Pazzanese Cardiology Institute, Brazil (Jose Carlos Pachon-M, E.I.P.-M., Jose Carlos Pachon-M, C.H., R.C.A., R.F.S., T.G.O.)
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Belgium (T.G.O.)
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18
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Buckley BJR, Lip GYH, Thijssen DHJ. The counterintuitive role of exercise in the prevention and cause of atrial fibrillation. Am J Physiol Heart Circ Physiol 2020; 319:H1051-H1058. [DOI: 10.1152/ajpheart.00509.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia, characterized by irregular atrial activity. AF is related to increased risk of thromboembolic events, heart failure, and premature mortality. Recent advances in our understanding of its pathophysiology include a potentially central role for inflammation and presence of cardiovascular risk factors. The role of physical activity and exercise in the development and progression of AF, however, are not yet fully understood. Physical activity is protective for modifiable cardiovascular risk factors, including those associated with AF. Indeed, emerging research has demonstrated beneficial effects of exercise on AF-specific outcomes, including AF recurrence postablation. Counterintuitively, the prevalence of AF in veteran endurance athletes seems higher compared with the general population. In this review, we discuss the novel evidence and underlying mechanisms underpinning the role of exercise as medicine in the development and management of AF but also the counterintuitive detrimental role of excessive endurance exercise. Finally, we advocate regular (but not long-term high-intensity endurance) exercise training as a safe and effective strategy to reduce the risk of incident AF and to minimize the associated risk of secondary cardiovascular events.
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Affiliation(s)
- Benjamin J. R. Buckley
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Dick H. J. Thijssen
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, United Kingdom
- Research Institute for Health Science, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
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19
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Rattanawong P, Kewcharoen J, S Srivathsan K, Shen WK. Drug Therapy for Vagally-Mediated Atrial Fibrillation and Sympatho-Vagal Balance in the Genesis of Atrial Fibrillation: A Review of the Current Literature. J Atr Fibrillation 2020; 13:2410. [PMID: 33024510 DOI: 10.4022/jafib.2410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/27/2020] [Accepted: 03/28/2020] [Indexed: 12/13/2022]
Abstract
Objective The presence of both sympathetic activation-mediated triggers and parasympathetic activation-mediated substrates are required to initiate and maintain some forms of atrial fibrillation (AF). AF predominantly precipitated by parasympathetic stimulation is known as vagally-mediated AF (VM-AF). The role of novel drugs and molecular targeted gene therapy that modulate the autonomic nervous system are therapeutic options in this unique population with VM-AF. Here, we review the role of the sympatho-vagal balance in the genesis of AF and consider drug therapy for VM-AF. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, literature search was conducted using the keywords "vagal", "vagal nerve", "vagus", "vagus nerve", and "atrial fibrillation". Retrieved citations were first screened independently by 2 reviewers for inclusion and exclusion criteria. Results A total of 14 studies and 3 practice guidelines from 1986-2017 were included. Only two clinical investigations evaluated the effectiveness of disopyramide and sotalol in human subjects with VM-AF. The potential role of antiarrhythmic drugs has been studied in animal models. Conclusions Growing evidence suggests that the autonomic nervous system is integral in the development of VM-AF. Novel medications and genetic targets are undergoing investigation with promising results.
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Affiliation(s)
| | - Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | | | - Win-Kuang Shen
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
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20
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Vinson DR. Redressing Underrecognition of "Cold Drink Heart": Patients Teaching Physicians about Atrial Fibrillation Triggered by Cold Drink and Food. Perm J 2020; 24:19.238. [PMID: 32589580 DOI: 10.7812/tpp/19.238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In this essay I tell the story of insightful patients from around the world with cold-drink atrial arrhythmias, particularly atrial fibrillation (AF). This common condition has received little research attention and remains unknown to many physicians. The under-representation of "cold drink heart" in the literature led me and a colleague a few years ago to publish a case report on this topic in an open-access journal. I included my email address so that physicians and researchers could contact me. Although I sought a physician audience, the report struck a chord with patients. Sixteen individuals have since written me to express their gratitude for having received medical validation of the causal connection they had made between swallowing cold drink or food and their episodes of paroxysmal AF. The validation was all the more important because of their physicians' prevalent disregard of the link, making them miss out on the opportunity to partner with their patients in AF management by trigger avoidance. I explain here how these patients have handled their cold-drink AF and connect their reports with the few published in the literature. These rich email exchanges illustrate how eager patients can be for an explanation of their medical condition and for an opportunity to manage their symptoms. These communications also remind us about the important role patients play in physician education. These email-writing patients have done us all a great service by teaching about the precipitants, prevention, and underrecognition of cold-drink atrial arrhythmias.
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Affiliation(s)
- David R Vinson
- Department of Emergency Medicine, Kaiser Permanente (KP) Sacramento Medical Center, Sacramento, CA; The Permanente Medical Group, the CREST Network, and the KP Division of Research, Oakland, CA
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21
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Richards JR. Mechanisms for the Risk of Acute Coronary Syndrome and Arrhythmia Associated With Phytogenic and Synthetic Cannabinoid Use. J Cardiovasc Pharmacol Ther 2020; 25:508-522. [PMID: 32588641 DOI: 10.1177/1074248420935743] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Phytogenic cannabinoids from Cannabis sativa and synthetic cannabinoids are commonly used substances for their recreational and medicinal properties. There are increasing reports of cardiotoxicity in close temporal association with cannabinoid use in patients with structurally normal hearts and absence of coronary arterial disease. Associated adverse events include myocardial ischemia, conduction abnormalities, arrhythmias, and sudden death. This review details the effects of phytogenic and synthetic cannabinoids on diverse receptors based on evidence from in vitro, human, and animal studies to establish a molecular basis for these deleterious clinical effects. The synergism between endocannabinoid dysregulation, cannabinoid receptor, and noncannabinoid receptor binding, and impact on cellular ion flux and coronary microvascular circulation is delineated. Pharmacogenetic factors placing certain patients at higher risk for cardiotoxicity are also correlated with the diverse effects of cannabinoids.
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Affiliation(s)
- John R Richards
- Department of Emergency Medicine, 70083University of California Davis Medical Center, Sacramento, California, CA, USA
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22
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Pachon-M EI, Pachon-Mateos JC, Higuti C, Santillana-P TG, Lobo T, Pachon C, Pachon-Mateos J, Zerpa J, Ortencio F, Amarante RC, Silva RF, Osório TG. Relation of Fractionated Atrial Potentials With the Vagal Innervation Evaluated by Extracardiac Vagal Stimulation During Cardioneuroablation. Circ Arrhythm Electrophysiol 2020; 13:e007900. [PMID: 32188285 DOI: 10.1161/circep.119.007900] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Vagal hyperactivity is directly related to several clinical conditions as reflex/functional bradyarrhythmias and vagal atrial fibrillation (AF). Cardioneuroablation provides therapeutic vagal denervation through endocardial radiofrequency ablation for these cases. The main challenges are neuromyocardium interface identification and the denervation control and validation. The finding that the AF-Nest (AFN) ablation eliminates the atropine response and decreases RR variability suggests that they are related to the vagal innervation. METHOD Prospective, controlled, longitudinal, nonrandomized study enrolling 62 patients in 2 groups: AFN group (AFN group 32 patients) with functional or reflex bradyarrhythmias or vagal AF treated with AFN ablation and a control group (30 patients) with anomalous bundles, ventricular premature beats, atrial flutter, atrioventricular nodal reentry, and atrial tachycardia, treated with conventional ablation (non-AFN ablation). In AFN group, ablation delivered at AFN detected by fragmentation/fractionation of the endocardial electrograms and by 3-dimensional anatomic location of the ganglionated plexus. Vagal response was evaluated before, during, and postablation by 5 s noncontact vagal stimulation at the jugular foramen, through the internal jugular veins (extracardiac vagal stimulation [ECVS]), analyzing 15 s mean heart rate, longest RR, pauses, and atrioventricular block. All patients had current guidelines arrhythmia ablation indication. RESULTS Preablation ECVS induced sinus pauses, asystole, and transient atrioventricular block in both groups showing a strong vagal response (P=0.96). Postablation ECVS in the AFN group showed complete abolishment of the cardiac vagal response in all cases (pre/postablation ECVS=P<0.0001), demonstrating robust vagal denervation. However, in the control group, vagal response remained practically unchanged postablation (P=0.35), showing that non-AFN ablation promotes no significant denervation. CONCLUSIONS AFN ablation causes significant vagal denervation. Non-AFN ablation causes no significant vagal denervation. These results suggest that AFNs are intrinsically related to vagal innervation. ECVS was fundamental to stepwise vagal denervation validation during cardioneuroablation. Visual Overview A visual overview is available for this article.
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Affiliation(s)
- Enrique I Pachon-M
- Sao Paulo University, Brazil (E.I.P.-M., J.C.P.-M., J.P.-M., R.C.A.).,Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.).,Dante Pazzanese Cardiology Institute, Sao Paulo, Brazil (J.C.P.-M., C.H., J.P.-M., R.C.A., R.F.S.). Brussels Universiteit, Belgium (T.G.O)
| | - Jose Carlos Pachon-Mateos
- Sao Paulo University, Brazil (E.I.P.-M., J.C.P.-M., J.P.-M., R.C.A.).,Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.)
| | - Christian Higuti
- Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.).,Dante Pazzanese Cardiology Institute, Sao Paulo, Brazil (J.C.P.-M., C.H., J.P.-M., R.C.A., R.F.S.). Brussels Universiteit, Belgium (T.G.O)
| | - Tomas G Santillana-P
- Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.)
| | - Tasso Lobo
- Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.)
| | - Carlos Pachon
- Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.)
| | - Juan Pachon-Mateos
- Sao Paulo University, Brazil (E.I.P.-M., J.C.P.-M., J.P.-M., R.C.A.).,Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.).,Dante Pazzanese Cardiology Institute, Sao Paulo, Brazil (J.C.P.-M., C.H., J.P.-M., R.C.A., R.F.S.). Brussels Universiteit, Belgium (T.G.O)
| | - Juan Zerpa
- Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.)
| | - Felipe Ortencio
- Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.)
| | - Ricardo Carneiro Amarante
- Sao Paulo University, Brazil (E.I.P.-M., J.C.P.-M., J.P.-M., R.C.A.).,Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.).,Dante Pazzanese Cardiology Institute, Sao Paulo, Brazil (J.C.P.-M., C.H., J.P.-M., R.C.A., R.F.S.). Brussels Universiteit, Belgium (T.G.O)
| | - Ricardo Ferreira Silva
- Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.).,Dante Pazzanese Cardiology Institute, Sao Paulo, Brazil (J.C.P.-M., C.H., J.P.-M., R.C.A., R.F.S.). Brussels Universiteit, Belgium (T.G.O)
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23
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Capilupi MJ, Kerath SM, Becker LB. Vagus Nerve Stimulation and the Cardiovascular System. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a034173. [PMID: 31109966 DOI: 10.1101/cshperspect.a034173] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The vagus nerve plays an important role in maintaining physiological homeostasis, which includes reflex pathways that regulate cardiac function. The link between vagus nerve activity and the high-frequency component of heart rate variability (HRV) has been well established, correlating with vagal tone. Recently, vagus nerve stimulation (VNS) has been investigated as a therapeutic for a multitude of diseases, such as treatment-resistant epilepsy, rheumatoid arthritis, Crohn's disease, and asthma. Because of the vagus nerve's innervation of the heart, VNS has been identified as a potential therapy for cardiovascular disorders, such as cardiac arrest, acute myocardial infarction, and stroke. Here, we review the current state of preclinical and clinical studies, as well as the potential application of VNS in relation to the cardiovascular system.
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Affiliation(s)
- Michael J Capilupi
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, New York 11030
| | - Samantha M Kerath
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York 11030
| | - Lance B Becker
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, New York 11030.,Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York 11030.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549
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24
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Etemad T, Hosseinsabet A. Determinants of left intra-atrial electromechanical delay as evaluated by tissue Doppler imaging in candidates for coronary artery bypass graft surgery. Echocardiography 2020; 37:260-269. [PMID: 32003911 DOI: 10.1111/echo.14599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/05/2019] [Accepted: 01/10/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Inhomogeneity in the atrial conduction time is a predisposing factor for atrial fibrillation. The aim of our study was to determine the independent determinants of the left intra-atrial electromechanical delay (LIAEMD) as a marker of left atrial (LA) dyssynchrony in candidates for coronary artery bypass graft surgery (CABGS). METHODS This prospective cross-sectional study recruited 516 consecutive candidates for CABGS. Via the pulsed-wave tissue Doppler imaging modality in echocardiography, the times between the P wave and the peak of the a' wave at the septal and lateral mitral annuli were measured and the difference between these times was considered to be LIAEMD. Additionally, clinical and laboratory data on each patient were gathered. The odds ratio for an increased LIAEMD was calculated in patients with and without diabetes in univariate and multivariate analyses. RESULTS The multivariable analysis revealed that in the patients without diabetes, obesity, calcium-channel blocker usage, an increased maximal LA volume, and a decreased lateral e'/a' ratio and in the diabetic patients, diuretic usage and a decreased lateral e'/a' ratio were independently correlated with an increased likelihood of LIAEMD occurrence (P < .05). CONCLUSIONS In our study on CABGS candidates, in the patients without diabetes, obesity, an increased maximal LA volume, calcium-channel blocker usage, and a decreased lateral e'/a' ratio and in the diabetic patients, diuretic usage and a decreased lateral e'/a' ratio independently determined increased LIAEMD. The prevention or treatment of factors that are detrimental to the LA electromechanical function may be helpful for the preservation of the LA electromechanical integrity.
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Affiliation(s)
- Taimoor Etemad
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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25
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Kostopoulou A, Zeljko HM, Bogossian H, Ciudin R, Costa F, Heijman J, Kochhaeuser S, Manola S, Scherr D, Sohal M, Wakili R, Wolf M, Irfan G. Atrial fibrillation-related stroke in women: Evidence and inequalities in epidemiology, mechanisms, clinical presentation, and management. Clin Cardiol 2019; 43:14-23. [PMID: 31691981 PMCID: PMC6954380 DOI: 10.1002/clc.23284] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 12/17/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common clinical arrhythmia and one of the major causes of stroke, heart failure, sudden death, and cardiovascular morbidity. Despite substantial advances in (interventional) rhythm control treatment during the last decade, anticoagulation for stroke prevention remains a major component of AF treatment. Hypothesis There are important sex‐specific differences in AF‐related stroke, resulting from sex‐specific mechanisms and therapeutic differences. Methods This review summarizes available data on sex differences in risk assessment and prevention of stroke and highlights current knowledge gaps in AF‐related stroke mechanisms, prevention and management that warrant further research. Results Increased thrombotic risk in women is multifactorial, involving hormonal changes after menopause, structural, endocrine and lifestyle/social factors and their interactions. It is clear from randomized studies that women benefit from anticoagulant treatment and that their bleeding risk is similar to men. Women should therefore receive equivalent treatment to men, based on the validated criteria for anticoagulation therapy. However, women are not represented equally in the large randomized studies and sex‐related information in many fields is lacking. Conclusions Female sex is an established risk factor for stroke in AF patients. The evidence for sex‐specific differences in stroke risk assessment and stroke prevention is accumulating. However, the underlying biological mechanisms remain incompletely understood and further studies are required in order to decrease AF‐related morbidity and mortality.
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Affiliation(s)
- Anna Kostopoulou
- Department of Electrophysiology and Pacing, Onassis Cardiac Surgery Center, Athens, Greece.,Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Hrvojka M Zeljko
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia.,Cardiology Department, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, UK
| | - Harilaos Bogossian
- Department of Cardiology and Angiology, Klinikum Lüdenscheid, Witten/Herdecke University, Germany
| | - Radu Ciudin
- Department of Cardiology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Cardiology, Prof C. C. Iliescu Institute of Cardiovascular Diseases, Bucharest, Romania
| | - Francisco Costa
- Department of Cardiology, Hospital Santa Cruz, Lisbon, Portugal
| | - Jordi Heijman
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Simon Kochhaeuser
- Department of Cardiology II-Electrophysiology, University Hospital of Muenster, Muenster, Germany
| | - Sime Manola
- Department of Cardiovascular Disease, "Sestre Milosrdnice" University Hospital Centre, Zagreb, Croatia
| | - Daniel Scherr
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands.,Division of Cardiology, Department of Medicine, Medical University of Graz, Austria
| | - Manav Sohal
- Department of Cardiology, Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, UK
| | - Reza Wakili
- Department of Cardiology and Angiology, Universitätsklinikum Essen, Westdeutsches Herz und Gefäßzentrum Essen, Germany
| | - Michael Wolf
- Department of Cardiology, ZNA Middelheim, Antwerp, Belgium
| | - Ghazala Irfan
- Department of Cardiac Electrophysiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
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26
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Invited review: hypertension and atrial fibrillation: epidemiology, pathophysiology, and implications for management. J Hum Hypertens 2019; 33:824-836. [DOI: 10.1038/s41371-019-0279-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/09/2019] [Accepted: 10/15/2019] [Indexed: 02/08/2023]
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27
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Bush KNV, Gerasimon GG. The Role of Catheter Ablation in Military Personnel with Atrial Fibrillation. Mil Med 2019; 184:e379-e382. [PMID: 31184712 PMCID: PMC6906589 DOI: 10.1093/milmed/usz126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/26/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Kelvin N V Bush
- Division of Cardiology, San Antonio Military Medical Center, 3551 Roger Brooke Dr., San Antonio, TX
| | - Gregg G Gerasimon
- Division of Cardiology, San Antonio Military Medical Center, 3551 Roger Brooke Dr., San Antonio, TX
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28
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D’Souza A, Trussell T, Morris GM, Dobrzynski H, Boyett MR. Supraventricular Arrhythmias in Athletes: Basic Mechanisms and New Directions. Physiology (Bethesda) 2019; 34:314-326. [DOI: 10.1152/physiol.00009.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Athletes are prone to supraventricular rhythm disturbances including sinus bradycardia, heart block, and atrial fibrillation. Mechanistically, this is attributed to high vagal tone and cardiac electrical and structural remodeling. Here, we consider the supporting evidence for these three pro-arrhythmic mechanisms in athletic human cohorts and animal models, featuring current controversies, emerging data, and future directions of relevance to the translational research agenda.
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Affiliation(s)
- Alicia D’Souza
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Tariq Trussell
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Gwilym M. Morris
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Halina Dobrzynski
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Mark R. Boyett
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
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29
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Groh CA, Faulkner M, Getabecha S, Taffe V, Nah G, Sigona K, McCall D, Hills MT, Sciarappa K, Pletcher MJ, Olgin JE, Marcus GM. Patient-reported triggers of paroxysmal atrial fibrillation. Heart Rhythm 2019; 16:996-1002. [DOI: 10.1016/j.hrthm.2019.01.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Indexed: 11/29/2022]
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30
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Hamon D, Swid MA, Rajendran PS, Liu A, Boyle NG, Shivkumar K, Bradfield JS. Premature ventricular contraction diurnal profiles predict distinct clinical characteristics and beta‐blocker responses. J Cardiovasc Electrophysiol 2019; 30:836-843. [DOI: 10.1111/jce.13944] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 11/28/2022]
Affiliation(s)
- David Hamon
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos Angeles California
- Department of CardiologyUniversity Hospital Henri MondorCreteil France
| | - Mohammed Amer Swid
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos Angeles California
| | - Pradeep S. Rajendran
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos Angeles California
| | - Albert Liu
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos Angeles California
| | - Noel G. Boyle
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos Angeles California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos Angeles California
| | - Jason S. Bradfield
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos Angeles California
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31
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San Antonio R, Guasch E, Tolosana JM, Mont L. Determining the best approach to reduce the impact of exercise-induced atrial fibrillation: prevention, screening, or symptom-based treatment? Expert Rev Cardiovasc Ther 2018; 17:19-29. [DOI: 10.1080/14779072.2019.1550720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rodolfo San Antonio
- Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Eduard Guasch
- Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- IDIBAPS, Barcelona, Catalonia, Spain
- CIBERCV, Madrid, Spain
| | - José María Tolosana
- Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- IDIBAPS, Barcelona, Catalonia, Spain
- CIBERCV, Madrid, Spain
| | - Lluís Mont
- Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- IDIBAPS, Barcelona, Catalonia, Spain
- CIBERCV, Madrid, Spain
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32
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Time-dependent cervical vagus nerve stimulation and frequency-dependent right atrial pacing mediates induction of atrial fibrillation. Anatol J Cardiol 2018; 20:206-212. [PMID: 30297578 PMCID: PMC6249522 DOI: 10.14744/anatoljcardiol.2018.73558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: This study aimed to investigate the effects of right cervical vagus trunk simulation (RVTS) and/or right atrial pacing (RAP) on the induction of atrial fibrillation (AF). Methods: Twenty-four healthy adult dogs were randomly divided into four groups: RAP groups comprising RAP500 (RAP with 500 beats/min) and RAP1000 (RAP with 1000 beats/min) and RVTS groups comprising RVTS and RAP500+RVTS. All dogs underwent 12-h intermittent RAP and/or RVTS once every 2 h. The AF induction rate, AF duration, atrial effective refractory period (ERP), and dispersion of ERP (dERP) were compared after every 2 h of RAP or/and RVTS. Results: All groups had successful AF induction. The RAP1000 group had the highest AF induction rate and the longest AF duration. The RAP1000 group also had a shortened ERP in comparison to the other groups as well as the maximum dERP. Compared to the RAP500 group, RAP500+RVTS had an increased capacity to induce AF as measured by the AF induction rates, AF duration, ERP, and dERP. Conclusion: Increased tension in the vagus nerve and the intrinsic cardiac autonomic nervous system plays an important role in AF induction through different potential mechanisms. Interventions involving the vagus nerve and/or intrinsic cardiac autonomic nervous system can be a future potential therapy for AF.
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33
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Atrial fibrillation in athletes: From epidemiology to treatment in the novel oral anticoagulants era. J Cardiol 2018; 72:269-276. [DOI: 10.1016/j.jjcc.2018.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/09/2018] [Accepted: 04/23/2018] [Indexed: 12/17/2022]
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34
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Eickholt C, Jungen C, Drexel T, Alken F, Kuklik P, Muehlsteff J, Makimoto H, Hoffmann B, Kelm M, Ziegler D, Kloecker N, Willems S, Meyer C. Sympathetic and Parasympathetic Coactivation Induces Perturbed Heart Rate Dynamics in Patients with Paroxysmal Atrial Fibrillation. Med Sci Monit 2018; 24:2164-2172. [PMID: 29641513 PMCID: PMC5910663 DOI: 10.12659/msm.905209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Recent evidence indicates that sympathetic/parasympathetic coactivation (CoA) is causally linked to changes in heart rate (HR) dynamics. Whether this is relevant for patients with atrial fibrillation (AF) is unknown. Material/Methods In patients with paroxysmal AF (n=26) and age-matched controls, (n=10) we investigated basal autonomic outflow and HR dynamics during separate sympathetic (cold hand immersion) and parasympathetic activation (O2-inhalation), as well as during CoA (cold face test). In an additional cohort (n=7), HR response was assessed before and after catheter-based pulmonary vein isolation (PVI). Ultra-high-density endocardial mapping was performed in patients (n=6) before and after CoA. Results Sympathetic activation increased (control: 74±3 vs. 77±3 bpm, p=0.0098; AF: 60±2 vs. 64±2 bpm, p=0.0076) and parasympathetic activation decreased HR (control: 71±3 vs. 69±3 bpm, p=0.0547; AF: 60±1 vs. 58±2 bpm, p<0.0009), while CoA induced a paradoxical HR increase in patients with AF (control: 73±3 vs. 71±3 bpm, p=0.084; AF: 59±2 vs. 61±2 bpm, p=0.0006), which was abolished after PVI. Non-linear parameters of HR variability (SD1) were impaired during coactivation in patients with AF (control: 61±7 vs. 69±6 ms, p=0.042, AF: 44±32 vs. 32±5 ms, p=0.3929). CoA was associated with a shift of the earliest activation site (18±4 mm) of the sinoatrial nodal region, as documented by ultra-high-density mapping (3442±343 points per map). Conclusions CoA perturbs HR dynamics and shifts the site of earliest endocardial activation in patients with paroxysmal AF. This effect is abolished by PVI, supporting the value of emerging methods targeting the intrinsic cardiac autonomic nervous system to treat AF. CoA might be a valuable tool to assess cardiac autonomic function in a clinical setting.
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Affiliation(s)
- Christian Eickholt
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Jungen
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Drexel
- Department of Internal Medicine, Evangelisches Krankenhaus, Duesseldorf, Germany
| | - Fares Alken
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pawel Kuklik
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Muehlsteff
- Philips Research, Patient Care Solutions, Eindhoven, Netherlands
| | - Hisaki Makimoto
- Section for Rhythmology, Department of Cardiology, Pneumology and Angiology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Boris Hoffmann
- Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Malte Kelm
- Department of Cardiology, Pneumology and Angiology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center and Leibniz Center for Diabetes Research at the Department of Metabolic Diseases, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Nikolaj Kloecker
- Institute for Neural and Sensory Physiology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Stephan Willems
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Meyer
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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35
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Flannery MD, Kalman JM, Sanders P, La Gerche A. State of the Art Review: Atrial Fibrillation in Athletes. Heart Lung Circ 2017; 26:983-989. [DOI: 10.1016/j.hlc.2017.05.132] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/16/2017] [Accepted: 05/19/2017] [Indexed: 01/27/2023]
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36
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Estes NM, Madias C. Atrial Fibrillation in Athletes. JACC Clin Electrophysiol 2017; 3:921-928. [DOI: 10.1016/j.jacep.2017.03.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/20/2017] [Accepted: 03/23/2017] [Indexed: 01/02/2023]
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Dzeshka MS, Shahid F, Shantsila A, Lip GYH. Hypertension and Atrial Fibrillation: An Intimate Association of Epidemiology, Pathophysiology, and Outcomes. Am J Hypertens 2017; 30:733-755. [PMID: 28338788 DOI: 10.1093/ajh/hpx013] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 01/18/2023] Open
Abstract
Atrial fibrillation (AF) is the most prevalent sustained arrhythmia found in clinical practice. AF rarely exists as a single entity but rather as part of a diverse clinical spectrum of cardiovascular diseases, related to structural and electrical remodeling within the left atrium, leading to AF onset, perpetuation, and progression. Due to the high overall prevalence within the AF population arterial hypertension plays a significant role in the pathogenesis of AF and its complications. Fibroblast proliferation, apoptosis of cardiomyocytes, gap junction remodeling, accumulation of collagen both in atrial and ventricular myocardium all accompany ageing-related structural remodeling with impact on electrical activity. The presence of hypertension also stimulates oxidative stress, systemic inflammation, rennin-angiotensin-aldosterone and sympathetic activation, which further drives the remodeling process in AF. Importantly, both hypertension and AF independently increase the risk of cardiovascular and cerebrovascular events, e.g., stroke and myocardial infarction. Given that both AF and hypertension often present with limited on patient wellbeing, treatment may be delayed resulting in development of complications as the first clinical manifestation of the disease. Antithrombotic prevention in AF combined with strict blood pressure control is of primary importance, since stroke risk and bleeding risk are both greater with underlying hypertension.
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Affiliation(s)
- Mikhail S Dzeshka
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
- Grodno State Medical University, Grodno, Belarus
| | - Farhan Shahid
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Alena Shantsila
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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38
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Atrial fibrillation in highly trained endurance athletes — Description of a syndrome. Int J Cardiol 2017; 226:11-20. [DOI: 10.1016/j.ijcard.2016.10.047] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 12/22/2022]
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39
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Sanchis-Gomar F, Lucia A. Pathophysiology of atrial fibrillation in endurance athletes: an overview of recent findings. CMAJ 2016; 188:E433-E435. [PMID: 27601603 DOI: 10.1503/cmaj.160416] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Fabian Sanchis-Gomar
- Research Institute of the Hospital Universitario 12 de Octubre (Sanchis-Gomar, Lucia); European University of Madrid (Lucia), Madrid, Spain
| | - Alejandro Lucia
- Research Institute of the Hospital Universitario 12 de Octubre (Sanchis-Gomar, Lucia); European University of Madrid (Lucia), Madrid, Spain
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40
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Field ME, Wasmund SL, Page RL, Hamdan MH. Restoring Sinus Rhythm Improves Baroreflex Function in Patients With Persistent Atrial Fibrillation. J Am Heart Assoc 2016; 5:e002997. [PMID: 26908410 PMCID: PMC4802450 DOI: 10.1161/jaha.115.002997] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/13/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Studies have suggested that patients with atrial fibrillation (AF) have impairment in the baroreflex. It is not clear whether these findings are the result of the associated comorbid conditions or the arrhythmia itself. We hypothesized that AF is associated with impairment in baroreflex function and that the arrhythmia itself is a contributing factor. METHODS AND RESULTS Twenty-four patients with persistent AF referred for cardioversion were enrolled. A second group of patients with no history of AF matched for age and left ventricular ejection fraction was identified and served as the control group. In the AF group, baroreflex gain (BRG) was measured on the day of cardioversion (Day 1) and again at 30 days post-cardioversion (Day 30) in patients who remained in sinus rhythm (SR). The clinical characteristics of patients with AF were not different than those of the control group. The mean BRG in the AF group on Day 1 was significantly lower than the mean BRG of the control group (5.2±3.6 versus 10.8±5.5 ms/mm Hg, P<0.05). Ten patients experienced AF recurrence before the 30-day follow-up and 14 patients remained in SR. In the group that remained in SR, BRG increased from 4.1±3.7 ms/mm Hg on Day 1 to 7.0±6.0 ms/mm Hg on Day 30 (P<0.01). CONCLUSION We have shown that AF is associated with impairment of the baroreflex and that restoration of SR improves BRG. Our data suggest that AF might be a contributing factor to the observed impairment in BRG and that restoring SR might help improve baroreflex function.
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Affiliation(s)
- Michael E Field
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Stephen L Wasmund
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Richard L Page
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Mohamed H Hamdan
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Lugovskaya N, Vinson DR. Paroxysmal Atrial Fibrillation and Brain Freeze: A Case of Recurrent Co-Incident Precipitation From a Frozen Beverage. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:23-6. [PMID: 26757615 PMCID: PMC4718113 DOI: 10.12659/ajcr.896035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Patient: Male, 29 Final Diagnosis: Paroxysmal atrial fibrillation • cold-stimulus headache Symptoms: Palpitations • headache Medication: Diltiazem • Ibutilide Clinical Procedure: None Specialty: Emergency Medicine • Internal Medicine
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Affiliation(s)
- Nelya Lugovskaya
- Department of Neurobiology, Physiology and Behavior, University of California, Davis, CA, USA
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