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Mahadevan A, Garikipati S, Vanani S, Sundaram DM, Thompson-Edwards A, Reyaz N, Babu K, Rajarajan S, Dhavapalani D, Anand DP, Vasavada A, Desai R. Meta-analysis of Renin Angiotensin Aldosterone Modulators Mitigating Atrial Fibrillation Risk in Hypertensive Patients. Am J Med Sci 2024:S0002-9629(24)01351-X. [PMID: 38997068 DOI: 10.1016/j.amjms.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 05/14/2024] [Accepted: 07/08/2024] [Indexed: 07/14/2024]
Abstract
INTRODUCTION Hypertension is associated with left ventricular hypertrophy/enlargement/fibrosis and atrial ectopic rhythm, leading to an increased risk of Atrial Fibrillation (AF). We aimed to stratify the effect of Angiotensin Converting Enzyme Inhibitors (ACEi) and Angiotensin Receptor Blockers (ARB) on the risk of AF. METHODS PubMed, Scopus, and Google Scholar databases were screened, and cross-citation was conducted for studies reporting AF in hypertensive patients on ACEi and ARB. Of 145 studies found till May 2023, 19 were included in this study. Binary random-effects models estimated the pooled odds ratios, I2 statistics assessed heterogeneity and sensitivity analysis was assessed using the leave-one-out method. RESULTS 153,559 hypertensive patients met the inclusion criteria. For incidental AF, ACEi and ARB showed a significant decrease in both unadjusted (OR 0.75, 95% CI [0.66- 0.85], I²=20.79%, p=0.29) and adjusted risks (OR 0.76, 95% CI [0.62-0.93], I²=88.41%, p<0.01). In recurrent AF, the unadjusted analysis showed no significant effect (OR 0.89, 95% CI [0.55-1.42], I²=78.44%, p<0.01), while the adjusted analysis indicated a reduced risk (OR 0.62, 95% CI [0.50-0.76], I²=65.71%, p<0.01). Leave-one-out sensitivity analysis confirmed these results. CONCLUSIONS ACEi and ARB considerably decrease the risk of incidental and recurrent AF in hypertensive patients, emphasizing the importance of treating clinical hypertension with these drugs.
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Affiliation(s)
| | | | | | | | | | - Nafisa Reyaz
- Jawaharlal Nehru Medical College and Hospital, Aligarh, India.
| | - Kalaivani Babu
- Sri Ramachandra Medical College and Research Center, Chennai, India.
| | | | | | | | | | - Rupak Desai
- Independent Outcomes Researcher, Atlanta, GA, USA.
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2
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Tubeeckx MRL, De Keulenaer GW, Heidbuchel H, Segers VFM. Pathophysiology and clinical relevance of atrial myopathy. Basic Res Cardiol 2024; 119:215-242. [PMID: 38472506 DOI: 10.1007/s00395-024-01038-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/14/2024]
Abstract
Atrial myopathy is a condition that consists of electrical, structural, contractile, and autonomic remodeling of the atria and is the substrate for development of atrial fibrillation, the most common arrhythmia. Pathophysiologic mechanisms driving atrial myopathy are inflammation, oxidative stress, atrial stretch, and neurohormonal signals, e.g., angiotensin-II and aldosterone. These mechanisms initiate the structural and functional remodeling of the atrial myocardium. Novel therapeutic strategies are being developed that target the pathophysiologic mechanisms of atrial myopathy. In this review, we will discuss the pathophysiology of atrial myopathy, as well as diagnostic and therapeutic strategies.
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Affiliation(s)
- Michiel R L Tubeeckx
- Laboratory of Physiopharmacology, Universiteitsplein 1, Building T (2nd Floor), 2610, Antwerp, Belgium.
| | - Gilles W De Keulenaer
- Laboratory of Physiopharmacology, Universiteitsplein 1, Building T (2nd Floor), 2610, Antwerp, Belgium
- Department of Cardiology, ZNA Middelheim Hospital Antwerp, Antwerp, Belgium
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Vincent F M Segers
- Laboratory of Physiopharmacology, Universiteitsplein 1, Building T (2nd Floor), 2610, Antwerp, Belgium
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
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3
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Gao P, Gao X, Xie B, Tse G, Liu T. Aging and atrial fibrillation: A vicious circle. Int J Cardiol 2024; 395:131445. [PMID: 37848123 DOI: 10.1016/j.ijcard.2023.131445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/17/2023] [Accepted: 10/12/2023] [Indexed: 10/19/2023]
Abstract
Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia observed in clinical practice. Its prevalence increases dramatically with advancing age. This review article discusses the recent advances in studies investigating the relationship between aging and AF and the possible underlying mechanisms.
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Affiliation(s)
- Pan Gao
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xinyi Gao
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Bingxin Xie
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
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4
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Cunha PS, Laranjo S, Heijman J, Oliveira MM. The Atrium in Atrial Fibrillation - A Clinical Review on How to Manage Atrial Fibrotic Substrates. Front Cardiovasc Med 2022; 9:879984. [PMID: 35859594 PMCID: PMC9289204 DOI: 10.3389/fcvm.2022.879984] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/03/2022] [Indexed: 12/27/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia in the population and is associated with a significant clinical and economic burden. Rigorous assessment of the presence and degree of an atrial arrhythmic substrate is essential for determining treatment options, predicting long-term success after catheter ablation, and as a substrate critical in the pathophysiology of atrial thrombogenesis. Catheter ablation of AF has developed into an essential rhythm-control strategy. Nowadays is one of the most common cardiac ablation procedures performed worldwide, with its success inversely related to the extent of atrial structural disease. Although atrial substrate evaluation remains complex, several diagnostic resources allow for a more comprehensive assessment and quantification of the extent of left atrial structural remodeling and the presence of atrial fibrosis. In this review, we summarize the current knowledge on the pathophysiology, etiology, and electrophysiological aspects of atrial substrates promoting the development of AF. We also describe the risk factors for its development and how to diagnose its presence using imaging, electrocardiograms, and electroanatomic voltage mapping. Finally, we discuss recent data regarding fibrosis biomarkers that could help diagnose atrial fibrotic substrates.
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Affiliation(s)
- Pedro Silva Cunha
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Center, Lisbon, Portugal
- Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Sérgio Laranjo
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Center, Lisbon, Portugal
- Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Jordi Heijman
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Mário Martins Oliveira
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Center, Lisbon, Portugal
- Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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5
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Akhtar Z, Leung LWM, Kontogiannis C, Chung I, Bin Waleed K, Gallagher MM. Arrhythmias in Chronic Kidney Disease. Eur Cardiol 2022; 17:e05. [PMID: 35321526 PMCID: PMC8924956 DOI: 10.15420/ecr.2021.52] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/06/2021] [Indexed: 11/04/2022] Open
Abstract
Arrhythmias cause disability and an increased risk of premature death in the general population but far more so in patients with renal failure. The association between the cardiac and renal systems is complex and derives in part from common causality of renal and myocardial injury from conditions including hypertension and diabetes. In many cases, there is a causal relationship, with renal dysfunction promoting arrhythmias and arrhythmias exacerbating renal dysfunction. In this review, the authors expand on the challenges faced by cardiologists in treating common and uncommon arrhythmias in patients with renal failure using pharmacological interventions, ablation and cardiac implantable device therapies. They explore the most important interactions between heart rhythm disorders and renal dysfunction while evaluating the ways in which the coexistence of renal dysfunction and cardiac arrhythmia influences the management of both.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Lisa WM Leung
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Christos Kontogiannis
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Isaac Chung
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Khalid Bin Waleed
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Mark M Gallagher
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK
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6
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Ma J, Chen Q, Ma S. Left atrial fibrosis in atrial fibrillation: Mechanisms, clinical evaluation and management. J Cell Mol Med 2021; 25:2764-2775. [PMID: 33576189 PMCID: PMC7957273 DOI: 10.1111/jcmm.16350] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF), the commonest arrhythmia, shows associations with various disease conditions. Mounting evidence indicates that atrial fibrosis is an important part of the arrhythmogenic substrate, with an essential function in the generation of conduction abnormalities that underlie the transition from paroxysmal to persistent AF, which in turn contributes to AF perpetuation. Left atrial (LA) fibrosis is considered a possible major factor and predictor in AF treatment. The present review provides insights into LA fibrosis’ association with AF. The information is focused on clinical aspects and mechanisms, clinical evaluating methods that evaluate fibrosis changes and examining possible options for the prevention of atrial fibrosis.
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Affiliation(s)
- Jin Ma
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Qiuxiong Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Shiyu Ma
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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7
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Li CY, Zhang JR, Hu WN, Li SN. Atrial fibrosis underlying atrial fibrillation (Review). Int J Mol Med 2021; 47:9. [PMID: 33448312 PMCID: PMC7834953 DOI: 10.3892/ijmm.2020.4842] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/07/2020] [Indexed: 01/17/2023] Open
Abstract
Atrial fibrillation (AF) is one of the most common tachyarrhythmias observed in the clinic and is characterized by structural and electrical remodelling. Atrial fibrosis, an emblem of atrial structural remodelling, is a complex multifactorial and patient-specific process involved in the occurrence and maintenance of AF. Whilst there is already considerable knowledge regarding the association between AF and fibrosis, this process is extremely complex, involving intricate neurohumoral and cellular and molecular interactions, and it is not limited to the atrium. Current technological advances have made the non-invasive evaluation of fibrosis in the atria and ventricles possible, facilitating the selection of patient-specific ablation strategies and upstream treatment regimens. An improved understanding of the mechanisms and roles of fibrosis in the context of AF is of great clinical significance for the development of treatment strategies targeting the fibrous region. In the present review, a focus was placed on the atrial fibrosis underlying AF, outlining its role in the occurrence and perpetuation of AF, by reviewing recent evaluations and potential treatment strategies targeting areas of fibrosis, with the aim of providing a novel perspective on the management and prevention of AF.
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Affiliation(s)
- Chang Yi Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Jing Rui Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Wan Ning Hu
- Department of Cardiology, Laboratory of Molecular Biology, Head and Neck Surgery, Tangshan Gongren Hospital, Tangshan, Hebei 063000, P.R. China
| | - Song Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
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8
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Ding WY, Gupta D, Wong CF, Lip GYH. Pathophysiology of atrial fibrillation and chronic kidney disease. Cardiovasc Res 2020; 117:1046-1059. [PMID: 32871005 DOI: 10.1093/cvr/cvaa258] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/28/2020] [Accepted: 08/25/2020] [Indexed: 01/06/2023] Open
Abstract
Atrial fibrillation (AF) and chronic kidney disease (CKD) are closely related conditions with shared risk factors. The growing prevalence of both AF and CKD indicates that more patients will suffer from concurrent conditions. There are various complex interlinking mechanisms with important implications for the management of these patients. Furthermore, there is uncertainty regarding the use of oral anticoagulation (OAC) in AF and CKD that is reflected by a lack of consensus between international guidelines. Therefore, the importance of understanding the implications of co-existing AF and CKD should not be underestimated. In this review, we discuss the pathophysiology and association between AF and CKD, including the underlying mechanisms, risk of thrombo-embolic and bleeding complications, influence on stroke management, and evidence surrounding the use of OAC for stroke prevention.
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Affiliation(s)
- Wern Yew Ding
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Christopher F Wong
- Department of Renal Medicine, Liverpool University Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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9
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Zhao Z, Li R, Wang X, Li J, Xu X, Liu T, Liu E, Li G. Suppression of experimental atrial fibrillation in a canine model of rapid atrial pacing by the phosphodiesterase 3 inhibitor cilostazol. J Electrocardiol 2020; 60:151-158. [PMID: 32371198 DOI: 10.1016/j.jelectrocard.2020.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/16/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Atrial fibrillation (AF) represents the most common arrhythmia encountered in cardiology department. The purpose of this study was designed to investigate whether cilostazol, an oral phosphodiesterase 3 inhibitor (PDE3) could have protective effects on atrial remodeling in a canine model of AF and explore the potential molecular mechanisms. METHODS Dogs were randomly assigned to Sham, Paced, Paced + cilostazol group, 7 dogs in each group. In Sham group, pacemaker was instrumented but without pacing. Rapid atrial pacing (RAP) at 600 or 500 bpm/min was maintained in Paced group and Paced + cilo group for 2 h or 2 weeks in acute or chronic experiment, respectively. The Paced + cilo group of dogs were pretreated with cilostazol orally (10 mg·kg-1·d-1, cilo) for 1 h or 2 days prior RAP induction and served as treatment group. Atrial effective refractory periods (AERP) at different basic cycle lengths (BCLs), inducibility, and duration time of AF were measured after pacing for 2 h. The blood sample, echocardiography, histopathology, inflammation and oxidative stress makers, protein and mRNA expression levels of matrix metalloproteinase-2 (MMP-2) and MMP-9 were detected after 2 weeks pacing in each group. RESULTS Significant changes in electrophysiological parameters were observed in the acute RAP canine model, the AERPs shortened with increased inducibility and duration of AF, which was attenuated by cilostazol (P < 0.05). The serum inflammation makers as interleukin-8 (IL-8) and toll like receptor 4 (TLR 4) levels and oxidative stress indicators like xanthine oxidative (XO) and reactive oxygen species (ROS) in the Paced group was significantly higher than that in Sham group (P < 0.01), and was significantly reduced by cilostazol treatment (P < 0.01). The level of mean platelet volume (MPV) which is one of the platelet indices was significantly elevated in Paced group (P < 0.01). While after cilostazol treated for 2 weeks, the level of MPV was obviously decreased than Paced group (P < 0.01). Pathology and echocardiography studies showed that cilostazol can also prevent RAP induced cardiac fibrosis and structural remodeling. The MPV level has close correlations with IL-8, TLR4, XO and ROS (all P < 0.01). MMP-2 and MMP-9 expression were significantly increased in Paced group (all P < 0.01), which can be attenuated by cilostazol. CONCLUSIONS Cilostazol may have protective effects on RAP-induced atrial remodeling by anti-inflammatory, anti-oxidative stress action and regulate the extracellular collagen matrix in a canine model. Moreover, MPV level is associated with inflammation and oxidative stress response of RAP, which might be an important predictors of new-onset and recurrent AF.
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Affiliation(s)
- Zhiqiang Zhao
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Ruiling Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Xinghua Wang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Jian Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Xiaona Xu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Enzhao Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China.
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Effects of febuxostat on atrial remodeling in a rabbit model of atrial fibrillation induced by rapid atrial pacing. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2019; 16:540-551. [PMID: 31447893 PMCID: PMC6689522 DOI: 10.11909/j.issn.1671-5411.2019.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Febuxostat, a novel nonpurine selective inhibitor of xanthine oxidase (XO), may be used in the prevention and management of atrial fibrillation (AF). The purpose of this study was to evaluate the effects of febuxostat on atrial remodeling in a rabbit model of AF induced by rapid atrial pacing (RAP) and the mechanisms by which it acts. Methods Twenty-four rabbits were randomly divided into four groups: sham-operated group (Group S), RAP group (Group P), RAP with 5 mg/kg per day febuxostat group (Group LFP), and RAP with 10 mg/kg per day febuxostat group (Group HFP). All rabbits except those in Group S were subjected to RAP at 600 beats/min for four weeks. The effects of febuxostat on atrial electrical and structural remodeling, markers of inflammation and oxidative stress, and signaling pathways involved in the left atrium were examined. Results Shortened atrial effective refractory period (AERP), increased AF inducibility, decreased mRNA levels of Cav1.2 and Kv4.3, and left atrial enlargement and dysfunction were observed in Group P, and these changes were suppressed in the groups treated with febuxostat. Prominent atrial fibrosis was observed in Group P, as were increased levels of TGF-β1, Collagen I, and α-SMA and decreased levels of Smad7 and eNOS. Treatment with febuxostat attenuated these differences. Changes in inflammatory and oxidative stress markers induced by RAP were consistent with the protective effects of febuxostat. Conclusions This study is the first to find that febuxostat can inhibit atrial electrical and structural remodeling of AF by suppressing XO and inhibiting the TGF-β1/Smad signaling pathway.
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11
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Metoprolol prevents chronic obstructive sleep apnea-induced atrial fibrillation by inhibiting structural, sympathetic nervous and metabolic remodeling of the atria. Sci Rep 2017; 7:14941. [PMID: 29097705 PMCID: PMC5668297 DOI: 10.1038/s41598-017-14960-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/04/2017] [Indexed: 11/30/2022] Open
Abstract
Chronic obstructive sleep apnea (OSA) may promote the development of atrial fibrillation (AF) by inducing atrial electrical and structural remodeling as well as autonomic nerve hyperinnervation. Here, we investigated the roles of metoprolol in regulation of atrial remodeling induced by chronic OSA. A canine model of chronic OSA was established by stopping the ventilator and closing the airway for 4 h/day every other day for 12 weeks, while metoprolol (5 mg·kg-1·day-1) was continuously administered. Using that model, we observed that increases in sympathetic sprouting and atrial structural remodeling were sharply inhibited by metoprolol. Moreover, metoprolol dramatically inhibited the impairment of atrial energy metabolism by activating the Sirt1-AMPK pathway. In vitro, metoprolol significantly activated the Sirt1-AMPK pathway in intermittent hypoxic and isoproterenol-treated HL-1 cells, and the effect was abolished by the coadministration of EX-527, an inhibitor of Sirt1 activation. In summary, metoprolol protects against chronic OSA-induced atrial remodeling. Our results suggest a new and feasible treatment strategy for AF induced by OSA.
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12
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Ding YH, Ma Y, Qian LY, Xu Q, Wang LH, Huang DS, Zou H. Linking atrial fibrillation with non-alcoholic fatty liver disease: potential common therapeutic targets. Oncotarget 2017; 8:60673-60683. [PMID: 28948002 PMCID: PMC5601170 DOI: 10.18632/oncotarget.19522] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/13/2017] [Indexed: 01/18/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) and atrial fibrillation (AF) are common chronic non-infectious diseases with rising incidences. NAFLD is an independent risk factor for the onset of AF, after adjusting potentially related factors. The pathogenesis of these diseases share several mechanisms including reduced adiponectin level, insulin resistance, and renin angiotensin aldosterone system (RAAS) activation, in addition to activation of common disease pathways that promote inflammation, oxidative stress, and fibrosis. Furthermore, statins and RAAS blockers exert therapeutic effects concurrently on NAFLD and AF. The common pathogenesis of NAFLD and AF may serve as a potential therapeutic target in the future.
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Affiliation(s)
- Ya-Hui Ding
- Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou 310014, China.,People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Yuan Ma
- Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou 310014, China.,People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Lin-Yan Qian
- Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou 310014, China.,People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Qiang Xu
- Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou 310014, China.,People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Li-Hong Wang
- Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou 310014, China.,People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Dong-Sheng Huang
- Department of Hepatobiliary Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, China.,People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Hai Zou
- Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou 310014, China.,People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
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13
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Habibi M, Samiei S, Ambale Venkatesh B, Opdahl A, Helle-Valle TM, Zareian M, Almeida ALC, Choi EY, Wu C, Alonso A, Heckbert SR, Bluemke DA, Lima JAC. Cardiac Magnetic Resonance-Measured Left Atrial Volume and Function and Incident Atrial Fibrillation: Results From MESA (Multi-Ethnic Study of Atherosclerosis). Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004299. [PMID: 27511974 DOI: 10.1161/circimaging.115.004299] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 06/23/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Early detection of structural changes in left atrium (LA) before atrial fibrillation (AF) development could be helpful in identification of those at higher risk for AF. Using cardiac magnetic resonance imaging, we examined the association of LA volume and function, and incident AF in a multiethnic population free of clinical cardiovascular diseases. METHODS AND RESULTS In a case-cohort study embedded in MESA (Multi-Ethnic Study of Atherosclerosis), baseline LA size and function assessed by cardiac magnetic resonance feature-tracking were compared between 197 participants with incident AF and 322 participants randomly selected from the whole MESA cohort. Participants were followed up for 8 years. Incident AF cases had a larger LA volume and decreased passive, active, and total LA emptying fractions and peak global LA longitudinal strain (peak LA strain) at baseline. In multivariable analysis, elevated LA maximum volume index (hazard ratio, 1.38 per SD; 95% confidence interval, 1.01-1.89) and decreased peak LA strain (hazard ratio, 0.68 per SD; 95% confidence interval, 0.48-0.96), and passive and total LA emptying fractions (hazard ratio for passive LA emptying fractions, 0.55 per SD; 95% confidence interval, 0.40-0.75 and hazard ratio for active LA emptying fractions, 0.70 per SD; 95% confidence interval, 0.52-0.95), but not active LA emptying fraction, were associated with incident AF. CONCLUSIONS Elevated LA volumes and decreased passive and total LA emptying fractions were independently associated with incident AF in an asymptomatic multiethnic population. Including LA functional variables along with other risk factors of AF may help to better risk stratify individuals at risk of AF development.
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Affiliation(s)
- Mohammadali Habibi
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Sanaz Samiei
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Bharath Ambale Venkatesh
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Anders Opdahl
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Thomas M Helle-Valle
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Mytra Zareian
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Andre L C Almeida
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Eui-Young Choi
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Colin Wu
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Alvaro Alonso
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Susan R Heckbert
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - David A Bluemke
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - João A C Lima
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.).
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14
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NAVARAVONG LEENHAPONG, BARAKAT MICHEL, BURGON NATHAN, MAHNKOPF CHRISTIAN, KOOPMANN MATTHIAS, RANJAN RAVI, KHOLMOVSKI EUGENE, MARROUCHE NASSIR, AKOUM NAZEM. Improvement in Estimated Glomerular Filtration Rate in Patients with Chronic Kidney Disease Undergoing Catheter Ablation for Atrial Fibrillation. J Cardiovasc Electrophysiol 2014; 26:21-7. [DOI: 10.1111/jce.12530] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/22/2014] [Accepted: 07/31/2014] [Indexed: 12/23/2022]
Affiliation(s)
- LEENHAPONG NAVARAVONG
- Comprehensive Arrhythmia Research and Management (CARMA) Center; University of Utah Division of Cardiovascular Medicine; Salt Lake City Utah USA
| | - MICHEL BARAKAT
- Comprehensive Arrhythmia Research and Management (CARMA) Center; University of Utah Division of Cardiovascular Medicine; Salt Lake City Utah USA
| | - NATHAN BURGON
- Comprehensive Arrhythmia Research and Management (CARMA) Center; University of Utah Division of Cardiovascular Medicine; Salt Lake City Utah USA
| | - CHRISTIAN MAHNKOPF
- Comprehensive Arrhythmia Research and Management (CARMA) Center; University of Utah Division of Cardiovascular Medicine; Salt Lake City Utah USA
| | - MATTHIAS KOOPMANN
- Comprehensive Arrhythmia Research and Management (CARMA) Center; University of Utah Division of Cardiovascular Medicine; Salt Lake City Utah USA
| | - RAVI RANJAN
- Comprehensive Arrhythmia Research and Management (CARMA) Center; University of Utah Division of Cardiovascular Medicine; Salt Lake City Utah USA
| | - EUGENE KHOLMOVSKI
- Comprehensive Arrhythmia Research and Management (CARMA) Center; University of Utah Division of Cardiovascular Medicine; Salt Lake City Utah USA
| | - NASSIR MARROUCHE
- Comprehensive Arrhythmia Research and Management (CARMA) Center; University of Utah Division of Cardiovascular Medicine; Salt Lake City Utah USA
| | - NAZEM AKOUM
- Comprehensive Arrhythmia Research and Management (CARMA) Center; University of Utah Division of Cardiovascular Medicine; Salt Lake City Utah USA
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15
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Chhabra L, Devadoss R, Chaubey VK, Spodick DH. Interatrial block in the modern era. Curr Cardiol Rev 2014; 10:181-9. [PMID: 24827803 PMCID: PMC4040870 DOI: 10.2174/1573403x10666140514101748] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 01/25/2013] [Accepted: 01/28/2014] [Indexed: 12/13/2022] Open
Abstract
Interatrial block (IAB; P-wave duration ≥ 110 ms), which represents a delay in the conduction between the atria, is a pandemic conduction abnormality that is frequently underappreciated in clinical practice. Despite its comprehensive documentation in the medical literature, it has still not received adequate attention and also not adequately described and discussed in most cardiology textbooks. IAB can be of varying degrees and classified based on the degree of P-duration and its morphology. It can transform into a higher degree block and can also manifest transiently. IAB may be a preceding or causative risk factor for various atrial arrhythmias (esp. atrial fibrillation) and also be associated with various other clinical abnormalities ranging from left atrial dilation and thromboembolism including embolic stroke and mesenteric ischemia. IAB certainly deserves more attention and prospective studies are needed to formulate a standard consensus regarding appropriate management strategies.
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16
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Corradi D. Atrial fibrillation from the pathologist's perspective. Cardiovasc Pathol 2013; 23:71-84. [PMID: 24462196 DOI: 10.1016/j.carpath.2013.12.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 12/03/2013] [Accepted: 12/07/2013] [Indexed: 12/18/2022] Open
Abstract
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia encountered in clinical practice, is associated with increased morbidity and mortality. Electrophysiologically, it is characterized by a high rate of asynchronous atrial cell depolarization causing a loss of atrial contractile function and irregular ventricular rates. For a long time, AF was considered as a pure functional disorder without any structural background. Only in recent years, have new mapping and imaging techniques identified atrial locations, which are very often involved in the initiation and maintenance of this supraventricular arrhythmia (i.e. the distal portion of the pulmonary veins and the surrounding atrial myocardium). Morphological analysis of these myocardial sites has demonstrated significant structural remodeling as well as paved the way for further knowledge of AF natural history, pathogenesis, and treatment. This architectural myocardial disarrangement is induced by the arrhythmia itself and the very frequently associated cardiovascular disorders. At the same time, the structural remodeling is also capable of sustaining AF, thereby creating a sort of pathogenetic vicious circle. This review focuses on current understanding about the structural and genetic bases of AF with reference to their classification, pathogenesis, and clinical implications.
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Affiliation(s)
- Domenico Corradi
- Department of Biomedical, Biotechnological, and Translational Sciences (S.Bi.Bi.T.), Unit of Pathology, University of Parma, Parma, Italy.
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17
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Phillips KP. Role of Inflammation in Initiation and Perpetuation of Atrial Fibrillation: A Systematic Review of the Published Data. J Atr Fibrillation 2013; 6:935. [PMID: 28496901 PMCID: PMC5153043 DOI: 10.4022/jafib.935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/14/2013] [Accepted: 10/18/2013] [Indexed: 11/10/2022]
Abstract
Inflammation has emerged as being strongly associated with AF initiation and perpetuation, including being implicated as a possible causal factor. Its role needs further elucidation to assist with the optimal prevention and treatment of AF using an individualized strategy. In the present review article the current published data linking inflammation to AF is summarized.
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Affiliation(s)
- Karen P Phillips
- Heart Care Partners,Greenslopes Private Hospital,Newdegate St, Greenslopes,QLD, Australia 4120
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18
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Pan Z, Sun X, Shan H, Wang N, Wang J, Ren J, Feng S, Xie L, Lu C, Yuan Y, Zhang Y, Wang Y, Lu Y, Yang B. MicroRNA-101 inhibited postinfarct cardiac fibrosis and improved left ventricular compliance via the FBJ osteosarcoma oncogene/transforming growth factor-β1 pathway. Circulation 2012; 126:840-50. [PMID: 22811578 DOI: 10.1161/circulationaha.112.094524] [Citation(s) in RCA: 239] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cardiac interstitial fibrosis is a major cause of the deteriorated performance of the heart in patients with chronic myocardial infarction. MicroRNAs (miRs) have recently been proven to be a novel class of regulators of cardiovascular diseases, including those associated with cardiac fibrosis. This study aimed to explore the role of miR-101 in cardiac fibrosis and the underlying mechanisms. METHODS AND RESULTS Four weeks after coronary artery ligation of rats, the expression of miR-101a and miR-101b (miR-101a/b) in the peri-infarct area was decreased. Treatment of cultured rat neonatal cardiac fibroblasts with angiotensin II also suppressed the expression of miR-101a/b. Forced expression of miR-101a/b suppressed the proliferation and collagen production in rat neonatal cardiac fibroblasts, as revealed by cell counting, MTT assay, and quantitative reverse transcription-polymerase chain reaction. The effect was abrogated by cotransfection with AMO-101a/b, the antisense inhibitors of miR-101a/b. c-Fos was found to be a target of miR-101a because overexpression of miR-101a decreased the protein and mRNA levels of c-Fos and its downstream protein transforming growth factor-β1. Silencing c-Fos by siRNA mimicked the antifibrotic action of miR-101a, whereas forced expression of c-Fos protein canceled the effect of miR-101a in cultured cardiac fibroblasts. Strikingly, echocardiography and hemodynamic measurements indicated remarkable improvement of the cardiac performance 4 weeks after adenovirus-mediated overexpression of miR-101a in rats with chronic myocardial infarction. Furthermore, the interstitial fibrosis was alleviated and the expression of c-Fos and transforming growth factor-β1 was inhibited. CONCLUSION Overexpression of miR-101a can mitigate interstitial fibrosis and the deterioration of cardiac performance in postinfarct rats, indicating the therapeutic potential of miR-101a for cardiac disease associated with fibrosis.
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Affiliation(s)
- Zhenwei Pan
- Department of Pharmacology (the State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), Harbin Medical University, Harbin, China
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19
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Zografos T, Katritsis DG. Inhibition of the renin-angiotensin system for prevention of atrial fibrillation. Pacing Clin Electrophysiol 2011; 33:1270-85. [PMID: 20636314 DOI: 10.1111/j.1540-8159.2010.02832.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Atrial fibrillation (AF) is a source of considerable morbidity and mortality. There has been compelling evidence supporting the role of renin-angiotensin system (RAS) in the genesis and perpetuation of AF through atrial remodeling, and experimental studies have validated the utilization of RAS inhibition for AF prevention. This article reviews clinical trials on the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) for the prevention of AF. Results have been variable, depending on the clinical background of treated patients. ACEIs and ARBs appear beneficial for primary prevention of AF in patients with heart failure, whereas they are not equally effective in hypertensive patients with normal left ventricular function. Furthermore, the use of ACEIs or ARBs for secondary prevention of AF has been found beneficial only after electrical cardioversion. Additional data are needed to establish the potential clinical role of renin-angiotensin inhibition for prevention of AF.
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Affiliation(s)
- Theodoros Zografos
- Department of Cardiology, Athens Euroclinic, 9 Athanassiadou Street, Athens, Greece
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20
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Wang H, Li J, Hong C, Liu X, Shang F, He Y, Wang Z, Zheng Q. Epicardial ablation of right pulmonary artery ganglionated plexi for the prevention of atrial fibrillation originating in the pulmonary veins. J Electrocardiol 2010; 43:367-72. [DOI: 10.1016/j.jelectrocard.2010.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Indexed: 11/17/2022]
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21
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Kitkungvan D, Spodick DH. Interatrial block: is it time for more attention? J Electrocardiol 2009; 42:687-92. [PMID: 19698951 DOI: 10.1016/j.jelectrocard.2009.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Indexed: 10/20/2022]
Abstract
Interatrial block (IAB) is defined as delayed conduction between the right and left atrium, which results in prolonged P-wave duration (> or =110 milliseconds). Interatrial block can be partial or advanced (much less common), depending on the severity of the conduction abnormality. Several studies have reported that the prevalence of IAB is more than 40% in hospital inpatients. Despite this, IAB remains largely underdiagnosed and commonly ignored. Although more investigations are needed to identify the cause of IAB, coronary artery disease and conditions related to cardiovascular disease, such as hypertension or diabetes mellitus, have been described as potential risk factors for developing IAB. Interatrial block has strong associations with multiple medical conditions including atrial fibrillation, myocardial ischemia, left atrial enlargement, and systemic emboli. Treatment modalities for IAB to preclude its consequences include pacing and medical management, in which angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have given promising results. However, more interest, attention, and research for IAB is required to explore this uncertain issue thoroughly.
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Affiliation(s)
- Danai Kitkungvan
- Department of Medicine, Saint Vincent Hospital, Worcester, MA 01608, USA.
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22
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Park JH, Oh YS, Kim JH, Chung WB, Oh SS, Lee DH, Choi YS, Shin WS, Park CS, Youn HJ, Chung WS, Lee MY, Seung KB, Rho TH, Kim JH, Hong SJ. Effect of Angiotensin converting enzyme inhibitors and Angiotensin receptor blockers on patients following ablation of atrial fibrillation. Korean Circ J 2009; 39:185-9. [PMID: 19949577 PMCID: PMC2771783 DOI: 10.4070/kcj.2009.39.5.185] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 01/02/2009] [Accepted: 02/03/2009] [Indexed: 12/20/2022] Open
Abstract
Background and Objectives It is known that angiotensin converting enzyme inhibitors and angiotensin II type 1 receptor blockers (ACEIs and ARBs, respectively) are effective in preventing atrial fibrillation (AF) in high-risk patients. However, it is not known whether ACEIs and ARBs are effective in preventing the recurrence of AF after catheter ablation. Subjects and Methods One hundred fifty-two patients (mean age, 57±10 years; M : F=94 : 58) who underwent catheter ablation due to drug-refractory paroxysmal (mean age, 57±10 years; M : F=58 : 43) or persistent AF (mean age, 56±10 years; M : F=36 : 15) were enrolled. We compared the recurrence rates between the groups with and without ACEIs or ARBs use in paroxysmal and persistent AF. The mean duration of follow-up was 18±14 months. Results The overall recurrence rate after ablation therapy was 26% (n=39). The recurrence rate was significantly decreased in the patients with persistent AF with the use of ACEIs or ARBs (12.1% vs. 61.1%, p<0.01), but this difference was not observed in the patients with paroxysmal AF (24.2% vs. 22.9%, p=0.87). In patients with persistent AF with and without recurrence, the size of the left atrium (44.2±8.4 mm vs. 44.3±5.8 mm, respectively, p=0.45) and the ejection fraction (62±6.5% vs. 61.5±6.2%, respectively, p=0.28) were not significantly different. In multivariate analysis, the use of ACEIs or ARBs was independently associated with recurrence after adjusting for the size of the left atrium and the ejection fraction {odds ratio (OR)=0.078, 95% confidence interval (CI)=0.02-0.35, p<0.01}. Conclusion ACEIs and ARBs were shown to be effective in preventing AF recurrence after catheter ablation in patients with persistent AF.
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Affiliation(s)
- Jeong-Hwan Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Li Y, Sheng L, Li W, Liu W, Gong Y, Xue H, Shan H. Probucol attenuates atrial structural remodeling in prolonged pacing-induced atrial fibrillation in dogs. Biochem Biophys Res Commun 2009; 381:198-203. [PMID: 19338773 DOI: 10.1016/j.bbrc.2009.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 02/05/2009] [Indexed: 11/17/2022]
Abstract
AIMS Oxidative stress has recently been implicated in atrial fibrillation (AF); however, the mechanisms remain unclear. Herein, we hypothesize that probucol can attenuate atrial structure remodeling. METHODS Twenty dogs were randomly divided into sham-operated, control, and probucol-treated groups. We identified apoptosis and histopathological changes in the atria. Oxidative stress was measured by lipid peroxidation and echocardiographic examinations were performed. RESULTS Atrial apoptosis indexes were dramatically decreased in the probucol-treated group compared to the control group. Relative to the control group, the percentage of myolysis was dramatically decreased in the probucol-treated group (p < 0.01). There was less lipid peroxidation in the probucol-treated group than the control group. Atrial function was dramatically elevated in the probucol-treated group. CONCLUSIONS The results of this study indicate that the antioxidant probucol suppresses atrial structural remodeling and may act as a new therapy for AF.
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Affiliation(s)
- Yue Li
- The First Clinical Hospital of Harbin Medical University, Harbin 150001, China
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Burstein B, Nattel S. Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation. J Am Coll Cardiol 2008; 51:802-9. [PMID: 18294563 DOI: 10.1016/j.jacc.2007.09.064] [Citation(s) in RCA: 886] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 08/16/2007] [Accepted: 09/07/2007] [Indexed: 01/14/2023]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in the clinical setting, and traditional pharmacological approaches have proved to have important weaknesses. Structural remodeling has been observed in both clinical and experimental AF paradigms, and is an important feature of the AF substrate, producing fibrosis that alters atrial tissue composition and function. The precise mechanisms underlying atrial fibrosis are not fully elucidated, but recent experimental studies and clinical investigations have provided valuable insights. A variety of signaling systems, particularly involving angiotensin II and related mediators, seem to be centrally involved in the promotion of fibrosis. This paper reviews the current understanding of how atrial fibrosis creates a substrate for AF, summarizes what is known about the mechanisms underlying fibrosis and its progression, and highlights emerging therapeutic approaches aimed at attenuating structural remodeling to prevent AF.
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Affiliation(s)
- Brett Burstein
- Research Center and Department of Medicine, Montreal Heart Institute and Université de Montréal, and Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
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Casaclang-Verzosa G, Gersh BJ, Tsang TSM. Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation. J Am Coll Cardiol 2008; 51:1-11. [PMID: 18174029 DOI: 10.1016/j.jacc.2007.09.026] [Citation(s) in RCA: 345] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 09/26/2007] [Indexed: 12/13/2022]
Abstract
Left atrial (LA) structural and functional remodeling reflects a spectrum of pathophysiological changes that have occurred in response to specific stressors. These changes include alterations at the levels of ionic channels, cellular energy balance, neurohormonal expression, inflammatory response, and physiologic adaptations. There is convincing evidence demonstrating an important pathophysiological association between LA remodeling and atrial fibrillation (AF). Measures that will prevent, attenuate, or halt these processes of LA remodeling may have a major public health impact with respect to the epidemic of AF. In this review, we describe the mechanisms involved in LA remodeling and highlight the existing and potential therapeutic options for its reversal, and implications for AF development.
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Affiliation(s)
- Grace Casaclang-Verzosa
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55901, USA
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Roka A, Toth E, Szilagyi S, Merkely B. Electrical atrial fibrillation induction affects the characteristics of induced arrhythmia. J Electrocardiol 2007; 41:131-7. [PMID: 17631892 DOI: 10.1016/j.jelectrocard.2007.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Accepted: 05/25/2007] [Indexed: 11/27/2022]
Abstract
Several methods are being used to induce atrial fibrillation (AF) in experimental investigations, which may affect the electrophysiologic parameters of the induced arrhythmia. The aim of our study was the investigation of temporal characteristics of AF during and after electrical induction. Direct current and high-frequency stimulation was used for induction in bipolar biatrial, right and left atrial appendage configurations in 6 dogs. Atrial and ventricular electrical activity was recorded near the bundle of His. Seven statistical parameters were calculated to analyze the temporal characteristics of electrical activity of both chambers. The induction method affected 5 atrial and no ventricular electrophysiologic parameters during stimulation, and the effect disappeared after ceasing induction, during the induced transient or persistent AF. Electrical stimulation affects the properties of the induced arrhythmia during the induction; thus, the investigation of AF is recommended only after ceasing the induction to avoid bias.
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Affiliation(s)
- Attila Roka
- Department of Cardiovascular Surgery, Cardiovascular Centre, Semmelweis University, Budapest, Hungary.
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Abstract
Atrial fibrillation (AF) is commonly associated with congestive heart failure (CHF), and CHF has been shown to be associated with atrial structural remodeling resulting in fibrosis. Atrial interstitial fibrosis has been seen in patients with CHF and in animal models of pacing-induced heart failure. With atrial fibrosis, conduction abnormalities result in increased AF vulnerability. The mechanism of AF associated with CHF is under debate, as both focal and reentrant mechanisms have been observed in animal models of CHF. However, recent studies using frequency-domain analysis have shown that the AF within this model is characterized by discrete, stable, high-frequency areas. The precise signaling processes involved in the development of atrial fibrosis are unknown. Angiotensin appears to play a role, as inhibition of angiotensin-converting enzyme (or angiotensin-receptor blocker) blunts atrial fibrosis in animal models of heart failure and decreases the incidence of AF in patients with heart failure. Transforming growth factor-beta (TGF-beta) also appears to play an important role. Mouse models that overexpress TGF-beta1 have profound atrial fibrosis and AF (with normal ventricles). Heart failure in canine models also produces increases in atrial TGF-beta1 expression, and inhibition of this expression prevents atrial fibrosis and the development of a substrate for AF. Atrial fibrosis appears to play a role in the development of a vulnerable substrate for AF, especially in the setting of CHF.
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Affiliation(s)
- Thomas H Everett
- Division of Cardiology and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, California 94143-1354, USA
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