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Xiao L, Chen XJ, Feng JK, Li WN, Yuan S, Hu Y. Natural products as the calcium channel blockers for the treatment of arrhythmia: Advance and prospect. Fitoterapia 2023; 169:105600. [PMID: 37419421 DOI: 10.1016/j.fitote.2023.105600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023]
Abstract
Arrhythmia is one of the commonly heart diseases with observed abnormal heart-beat rhythm that caused by the obstacles of cardiac activity and conduction. The arrhythmic pathogenesis is complex and capricious and related with other cardiovascular diseases that may lead to heart failure and sudden death. In particular, calcium overload is recognized as the main reason causing arrhythmia through inducing apoptosis in cardiomyocytes. Moreover, calcium channel blockers have been widely used as the routine drugs for the treatment of arrhythmia, but the different arrhythmic complications and adverse effects limit their further applications and demand new drug discovery. Natural products have always been the rich minerals for the development of new drugs that could be employed as the versatile player for the discovery of safe and effective anti-arrhythmia drugs with new mechanisms. In this review, we summarized natural products with the activity against calcium signaling and the relevant mechanism of actions. We are expected to provide an inspiration for the pharmaceutical chemists to develop more potent calcium channel blockers for the treatment of arrhythmia.
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Affiliation(s)
- Lu Xiao
- China Academy of Chinese Medical Sciences Guang'anmen Hospital, Beijing 100053, China
| | - Xing-Juan Chen
- China Academy of Chinese Medical Sciences Guang'anmen Hospital, Beijing 100053, China
| | | | - Wei-Na Li
- China Academy of Chinese Medical Sciences Guang'anmen Hospital, Beijing 100053, China
| | - Shuo Yuan
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China.
| | - Ying Hu
- China Academy of Chinese Medical Sciences Guang'anmen Hospital, Beijing 100053, China; Beijing University of Chinese Medicine, Beijing 100029, China.
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Magtibay K, Massé S, Nanthakumar K, Umapathy K. Pro-arrhythmic role of adrenergic spatial densities in the human atria: An in-silico study. PLoS One 2023; 18:e0290676. [PMID: 37624832 PMCID: PMC10456151 DOI: 10.1371/journal.pone.0290676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Chronic stress among young patients (≤ 45 years old) could result in autonomic dysfunction. Autonomic dysfunction could be exhibited via sympathetic hyperactivity, sympathetic nerve sprouting, and diffuse adrenergic stimulation in the atria. Adrenergic spatial densities could alter atrial electrophysiology and increase arrhythmic susceptibility. Therefore, we examined the role of adrenergic spatial densities in creating arrhythmogenic substrates in silico. We simulated three 25 cm2 atrial sheets with varying adrenergic spatial densities (ASD), activation rates, and external transmembrane currents. We measured their effects on spatial and temporal heterogeneity of action potential durations (APD) at 50% and 20%. Increasing ASD shortens overall APD, and maximum spatial heterogeneity (31%) is achieved at 15% ASD. The addition of a few (5% to 10%) adrenergic elements decreases the excitation threshold, below 18 μA/cm2, while ASDs greater than 10% increase their excitation threshold up to 22 μA/cm2. Increase in ASD during rapid activation increases APD50 and APD20 by 21% and 41%, respectively. Activation times of captured beats during rapid activation could change by as much as 120 ms from the baseline cycle length. Rapidly activated atrial sheets with high ASDs significantly increase temporal heterogeneity of APD50 and APD20. Rapidly activated atrial sheets with 10% ASD have a high likelihood (0.7 ± 0.06) of fragmenting otherwise uniform wavefronts due to the transient inexcitability of adrenergically stimulated elements, producing an effective functional block. The likelihood of wave fragmentation due to ASD highly correlates with the spatial variations of APD20 (ρ = 0.90, p = 0.04). Our simulations provide a novel insight into the contributions of ASD to spatial and temporal heterogeneities of APDs, changes in excitation thresholds, and a potential explanation for wave fragmentation in the human atria due to sympathetic hyperactivity. Our work may aid in elucidating an electrophysiological link to arrhythmia initiation due to chronic stress among young patients.
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Affiliation(s)
- Karl Magtibay
- Biomedical Signal and Image Processing Laboratory, Faculty of Engineering and Architectural Science, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Stéphane Massé
- Toby Hull Cardiac Fibrillation Management Laboratory, Department of Medicine/Cardiology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- Toby Hull Cardiac Fibrillation Management Laboratory, Department of Medicine/Cardiology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Karthikeyan Umapathy
- Biomedical Signal and Image Processing Laboratory, Department of Electrical, Computer, and Biomedical Engineering, Faculty of Engineering and Architectural Science, Toronto Metropolitan University, Toronto, Ontario, Canada
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Theodorou A, Bakola E, Chondrogianni M, Melanis K, Tsantzali I, Frogoudaki A, Tsivgoulis G. Covid-vaccine-fear-induced paroxysmal atrial fibrillation causing multiple acute arterial infarctions: a case report. Ther Adv Neurol Disord 2022; 15:17562864221094714. [PMID: 35498366 PMCID: PMC9047779 DOI: 10.1177/17562864221094714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Aikaterini Theodorou
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, ‘Attikon’ University Hospital Athens, Athens, Greece
| | - Eleni Bakola
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, ‘Attikon’ University Hospital Athens, Athens, Greece
| | - Maria Chondrogianni
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, ‘Attikon’ University Hospital Athens, Athens, Greece
| | - Konstantinos Melanis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, ‘Attikon’ University Hospital Athens, Athens, Greece
| | - Ioanna Tsantzali
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, ‘Attikon’ University Hospital Athens, Athens, Greece
| | - Alexandra Frogoudaki
- Second Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, ‘Attikon’ University Hospital Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, ‘Attikon’ University Hospital Athens, Rimini 1, Chaidari, 12462 Athens, Greece
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Avendaño R, Hashemi-Zonouz T, Sandoval V, Liu C, Burg M, Sinusas AJ, Lampert R, Liu YH. Anger recall mental stress decreases 123I-metaiodobenzylguanidine ( 123I-MIBG) uptake and increases heterogeneity of cardiac sympathetic activity in the myocardium in patients with ischemic cardiomyopathy. J Nucl Cardiol 2022; 29:798-809. [PMID: 33034036 DOI: 10.1007/s12350-020-02372-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute psychological stressors such as anger can precipitate ventricular arrhythmias, but the mechanism is incompletely understood. Quantification of regional myocardial sympathetic activity with 123I-metaiodobenzylguanidine (123I-mIBG) SPECT imaging in conjunction with perfusion imaging during mental stress may identify a mismatch between perfusion and sympathetic activity that may exacerbate a mismatch between perfusion and sympathetic activity that could create a milieu of increased vulnerability to ventricular arrhythmia. METHODS Five men with ischemic cardiomyopathy (ICM), and five age-matched healthy male controls underwent serial 123I-mIBG and 99mTc-Tetrofosmin SPECT/CT imaging during an anger recall mental stress task and dual isotope imaging was repeated approximately 1 week later during rest. Images were reconstructed using an iterative reconstruction algorithm with CT-based attenuation correction. The mismatch of left ventricular myocardial 123I-mIBG and 99mTc-Tetrofosmin was assessed along with radiotracer heterogeneity and the 123I-mIBG heart-to-mediastinal ratios (HMR) were calculated using custom software developed at Yale. RESULTS The hemodynamic response to mental stress was similar in both groups. The resting-HMR was greater in healthy control subjects (3.67 ± 0.95) than those with ICM (3.18 ± 0.68, P = .04). Anger recall significantly decreased the HMR in ICM patients (2.62 ± 0.3, P = .04), but not in normal subjects. The heterogeneity of 123I-mIBG uptake in the myocardium was significantly increased in ICM patients during mental stress (26% ± 8.23% vs. rest: 19.62% ± 9.56%; P = .01), whereas the 99mTc-Tetrofosmin uptake pattern was unchanged. CONCLUSION Mental stress decreased the 123I-mIBG HMR, increased mismatch between sympathetic activity and myocardial perfusion, and increased the heterogeneity of 123I-mIBG uptake in ICM patients, while there was no significant change in myocardial defect size or the heterogeneity of 99mTc-Tetrofosmin perfusion. The changes observed in this proof-of-concept study may provide valuable information about the trigger-substrate interaction and the potential vulnerability for ventricular arrhythmias.
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Affiliation(s)
- Ricardo Avendaño
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, PO Box 208017, New Haven, CT, 06520-8017, USA
| | - Taraneh Hashemi-Zonouz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, PO Box 208017, New Haven, CT, 06520-8017, USA
| | - Veronica Sandoval
- Nuclear Cardiology Laboratory, Yale-New Haven Hospital, New Haven, CT, USA
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew Burg
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, PO Box 208017, New Haven, CT, 06520-8017, USA
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, PO Box 208017, New Haven, CT, 06520-8017, USA
- Nuclear Cardiology Laboratory, Yale-New Haven Hospital, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University School of Medicine, New Haven, CT, USA
| | - Rachel Lampert
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, PO Box 208017, New Haven, CT, 06520-8017, USA
| | - Yi-Hwa Liu
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, PO Box 208017, New Haven, CT, 06520-8017, USA.
- Nuclear Cardiology Laboratory, Yale-New Haven Hospital, New Haven, CT, USA.
- Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan.
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Mefford MT, Rana JS, Reynolds K, Ranasinghe O, Mittleman MA, Liu JY, Qian L, Zhou H, Harrison TN, Geller AC, Sloan RP, Mostofsky E, Williams DR, Sidney S. Association of the 2020 US Presidential Election With Hospitalizations for Acute Cardiovascular Conditions. JAMA Netw Open 2022; 5:e228031. [PMID: 35442454 PMCID: PMC9021908 DOI: 10.1001/jamanetworkopen.2022.8031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Prior studies found a higher risk of acute cardiovascular disease (CVD) around population-wide psychosocial or environmental stressors. Less is known about acute CVD risk in relation to political events. OBJECTIVE To examine acute CVD hospitalizations following the 2020 presidential election. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study examined acute CVD hospitalizations following the 2020 presidential election. Participants were adult members aged 18 years or older at Kaiser Permanente Southern California and Kaiser Permanente Northern California, 2 large, integrated health care delivery systems. Statistical analysis was performed from March to July 2021. EXPOSURE 2020 US presidential election. MAIN OUTCOMES AND MEASURES Hospitalizations for acute CVD around the 2020 presidential election were examined. CVD was defined as hospitalizations for acute myocardial infarction (AMI), heart failure (HF), or stroke. Rate ratios (RR) and 95% CIs were calculated comparing rates of CVD hospitalization in the 5 days following the 2020 election with the same 5-day period 2 weeks prior. RESULTS Among 6 396 830 adults (3 970 077 [62.1%] aged 18 to 54 years; 3 422 479 [53.5%] female; 1 083 128 [16.9%] Asian/Pacific Islander, 2 101 367 [32.9%] Hispanic, and 2 641 897 [41.3%] White), rates of hospitalization for CVD following the election (666 hospitalizations; rate = 760.5 per 100 000 person-years [PY]) were 1.17 times higher (95% CI, 1.05-1.31) compared with the same 5-day period 2 weeks prior (569 hospitalizations; rate = 648.0 per 100 000 PY). Rates of AMI were significantly higher following the election (RR, 1.42; 95% CI, 1.13-1.79). No significant difference was found for stroke (RR, 1.02; 95% CI, 0.86-1.21) or HF (RR, 1.18; 95% CI, 0.98-1.42). CONCLUSIONS AND RELEVANCE Higher rates of acute CVD hospitalization were observed following the 2020 presidential election. Awareness of the heightened risk of CVD and strategies to mitigate risk during notable political events are needed.
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Affiliation(s)
- Matthew T. Mefford
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Jamal S. Rana
- Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, California
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Omesh Ranasinghe
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Murray A. Mittleman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jennifer Y. Liu
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Lei Qian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Hui Zhou
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Teresa N. Harrison
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Alan C. Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Richard P. Sloan
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Elizabeth Mostofsky
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of African and African American Studies, Harvard University, Cambridge, Massachusetts
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland
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Obrova J, Sovova E, Ivanova K, Furstova J, Taborsky M. Let It Beat: How Lifestyle and Psychosocial Factors Affect the Risk of Sudden Cardiac Death-A 10-Year Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052627. [PMID: 35270315 PMCID: PMC8909732 DOI: 10.3390/ijerph19052627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022]
Abstract
(1) Background: The aim of this study was to evaluate the lifestyle and occurrence of psychosocial factors in patients with a high risk of sudden cardiac death (SCD) and to explore their effect on the occurrence of the adequate therapy of an Implantable Cardioverter Defibrillator (ICD). (2) Methods: In this retro-prospective single-centre study, a group of patients aged 18-65 years old, who underwent the first ICD implantation for primary (PP) or secondary (SP) prevention between 2010-2014, was studied. The control group consisted of pair-matched (age ± 5 years, gender) respondents without a high risk of SCD. Information was obtained using a self-reported questionnaire and hospital electronic health records. The adequacy of ICD therapy was evaluated regularly until 31 January 2020. Multivariate logistic regression models were employed to assess the risk of SCD. (3) Results: A family history of SCD, coronary artery disease, diabetes mellitus and depression significantly aggravated the odds of being at a high risk of SCD. The occurrence of an appropriate ICD therapy was significantly associated with being in the SP group, BMI, education level and TV/PC screen time. (4) Conclusions: Lifestyle and psychosocial factors have been confirmed to affect the risk of SCD. Early identification and treatment of coronary artery disease and its risk factors remain the cornerstones of preventive effort. Further research is needed to evaluate the complex nature of psychosocial determinants of cardiac health.
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Affiliation(s)
- Jana Obrova
- Department of Internal Medicine I—Cardiology, University Hospital Olomouc, 779 00 Olomouc, Czech Republic;
- Correspondence: ; Tel.: +420-588-44-5429
| | - Eliska Sovova
- Department of Exercise Medicine and Cardiovascular Rehabilitation, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, 779 00 Olomouc, Czech Republic;
| | - Katerina Ivanova
- Department of Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic;
| | - Jana Furstova
- Olomouc University Social Health Institute, Palacký University Olomouc, 779 00 Olomouc, Czech Republic;
| | - Milos Taborsky
- Department of Internal Medicine I—Cardiology, University Hospital Olomouc, 779 00 Olomouc, Czech Republic;
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Hu LX, Tang M, Hua W, Ren XQ, Jia YH, Chu JM, Zhang JT, Liu XN. Psychological Disturbances and Their Association with Sleep Disturbance in Patients Admitted for Arrhythmia Diseases. Neuropsychiatr Dis Treat 2022; 18:1739-1750. [PMID: 36000025 PMCID: PMC9393031 DOI: 10.2147/ndt.s370128] [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] [Received: 04/09/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study aimed to assess the depression and anxiety status and their association with sleep disturbance among one single center Chinese inpatients with arrhythmia and help cardiologists better identify patients who need psychological care. METHODS A cross-sectional survey was conducted among 495 inpatients with arrhythmia treated in Fuwai Hospital from October to December 2019. The psychological status and sleep quality were assessed using the Zung Self-Rating Anxiety Scale (SAS), the Zung Self-Rating Depression Scale (SDS) and the Pittsburgh Sleep Quality Index (PSQI). Multivariate logistic regression was used to identify the potential risk factors for anxiety and depression. RESULTS The mean age of the participants was 52.8 ± 14.4 years, and 58.0% were male. Approximately 18.3% were in an anxious state, and 33.5% were in a depressive state. In multivariate logistic regression, age from 50 to 59 (p = 0.03), unemployment (p = 0.026) and sleep disturbance (p < 0.001) were the risk factors for anxiety status. Cardiac implanted electronic devices (CIEDs) (p = 0.004) and sleep disturbance (p < 0.001) were the risk factors for depression status. A total of 150 patients (30.3%) were categorized as having poor sleep quality (PSQI > 7). The adjusted odds ratio (OR) of having poor sleep quality was 4.30-fold higher in patients with both anxiety and depression (OR: 4.30; 95% confidence interval [CI]: 2.52-7.35); 2.67-fold higher in patients with depression (OR: 2.67; 95% CI: 1.78-4.00); and 3.94-fold higher in patients with anxiety (OR: 3.94; 95% CI: 2.41-6.44). CONCLUSIONS Psychological intervention is critical for Chinese inpatients with arrhythmia, especially for patients aged 50-59, unemployed, or those using CIEDs. Poor sleep quality could be an important risk factor linked to psychological disturbances.
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Affiliation(s)
- Li-Xing Hu
- Center of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Min Tang
- Center of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Wei Hua
- Center of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Xiao-Qing Ren
- Center of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Yu-He Jia
- Center of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Jian-Min Chu
- Center of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Jing-Tao Zhang
- Center of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Xiao-Ning Liu
- Center of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
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Dossett ML, Needles EW, Donahue Z, Gadenne G, Macklin EA, Ruskin JN, Denninger JW. A SMART approach to reducing paroxysmal atrial fibrillation symptoms: Results from a pilot randomized controlled trial. Heart Rhythm O2 2021; 2:326-332. [PMID: 34430937 PMCID: PMC8369288 DOI: 10.1016/j.hroo.2021.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Stress and negative emotions contribute to atrial fibrillation (AF). Mind-body practices decrease stress and negative emotions and may reduce AF episodes and improve quality of life for patients with AF. Objective We examined the effects of a multimodal mind-body program, the SMART Program, on AF-related quality of life in patients with paroxysmal AF (PAF). Methods In this randomized, waitlist-controlled pilot trial, 18 subjects with PAF participated in an 8-week SMART Program delivered online immediately or 3 months later. Validated measures were completed at baseline and at 3 and 6 months (waitlist group only). Results Comparing pre- vs post-program scores among all 18 participants, subjects reported improvement in AF-related quality of life (Cohen’s d = 0.75, P = .005) and depression (d = 0.50, P = .05) but not anxiety (d = 0.35, P = .16). Subjects also reported improvements in AF symptom severity (P = .026), distress (P = .014), positive affect (P = .003), and ability to cope with stress (P = .001). Compared to waitlist control subjects, those in the immediate group reported improvement in positive affect (d = 1.20, P = .021) and coping with stress (d = 1.36, P = .011) after participating in the program. Conclusion The SMART Program, delivered virtually, may enhance positive emotions and coping with stress as well as decrease negative emotions and AF symptoms. These results warrant a larger trial to better understand the potential benefits of such programs for patients with PAF.
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Affiliation(s)
- Michelle L. Dossett
- Department of Medicine, University of California Davis, Sacramento, California
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Address reprint requests and correspondence: Dr Michelle L. Dossett, University of California Davis, Division of General Internal Medicine, 4150 V St, Suite 2400, Sacramento, CA 95817.
| | - Emma W. Needles
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Zachary Donahue
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Gillian Gadenne
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric A. Macklin
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeremy N. Ruskin
- Department of Medicine, University of California Davis, Sacramento, California
| | - John W. Denninger
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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9
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Rosman L, Salmoirago-Blotcher E, Mahmood R, Yang H, Li Q, Mazzella AJ, Lawrence Klein J, Bumgarner J, Gehi A. Arrhythmia Risk During the 2016 US Presidential Election: The Cost of Stressful Politics. J Am Heart Assoc 2021; 10:e020559. [PMID: 34014121 PMCID: PMC8483504 DOI: 10.1161/jaha.120.020559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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 Anger and extreme stress can trigger potentially fatal cardiovascular events in susceptible people. Political elections, such as the 2016 US presidential election, are significant stressors. Whether they can trigger cardiac arrhythmias is unknown. Methods and Results In this retrospective case‐crossover study, we linked cardiac device data, electronic health records, and historic voter registration records from 2436 patients with implanted cardiac devices. The incidence of arrhythmias during the election was compared with a control period with Poisson regression. We also tested for effect modification by demographics, comorbidities, political affiliation, and whether an individual's political affiliation was concordant with county‐level election results. Overall, 2592 arrhythmic events occurred in 655 patients during the hazard period compared with 1533 events in 472 patients during the control period. There was a significant increase in the incidence of composite outcomes for any arrhythmia (incidence rate ratio [IRR], 1.77 [95% CI, 1.42–2.21]), supraventricular arrhythmia (IRR, 1.82 [95% CI, 1.36–2.43]), and ventricular arrhythmia (IRR, 1.60 [95% CI, 1.22–2.10]) during the election relative to the control period. There was also an increase in specific types of arrhythmia, including atrial fibrillation (IRR, 1.50 [95% CI, 1.06–2.11]), supraventricular tachycardia (IRR, 3.7 [95% CI, 2.2–6.2]), nonsustained ventricular tachycardia (IRR, 1.7 [95% CI, 1.3–2.2]), and daily atrial fibrillation burden (P<0.001). No significant interaction was found for sex, race/ethnicity, device type, age ≥65 years, hypertension, coronary artery disease, heart failure, political affiliation, or concordance between individual political affiliation and county‐level election results. Conclusions There was a significant increase in cardiac arrhythmias during the 2016 US presidential election. These findings suggest that exposure to stressful sociopolitical events may trigger arrhythmogenesis in susceptible people.
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Affiliation(s)
- Lindsey Rosman
- Division of Cardiology Department of Medicine University of North Carolina at Chapel Hill NC
| | - Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine The Miriam Hospital Providence RI.,Schools of Medicine and Public Health Brown University Providence RI
| | - Rafat Mahmood
- Department of Medicine University of North Carolina at Chapel Hill NC
| | - Hannan Yang
- Department of Biostatistics University of North Carolina at Chapel Hill NC
| | - Quefeng Li
- Department of Biostatistics University of North Carolina at Chapel Hill NC
| | - Anthony J Mazzella
- Division of Cardiology Department of Medicine University of North Carolina at Chapel Hill NC
| | - Jeffrey Lawrence Klein
- Division of Cardiology Department of Medicine University of North Carolina at Chapel Hill NC
| | - Joseph Bumgarner
- Rex HospitalUniversity of North Carolina at Chapel Hill Health Raleigh NC
| | - Anil Gehi
- Division of Cardiology Department of Medicine University of North Carolina at Chapel Hill NC
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10
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Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights. Circ Res 2020; 127:4-20. [PMID: 32716709 DOI: 10.1161/circresaha.120.316340] [Citation(s) in RCA: 610] [Impact Index Per Article: 152.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Accompanying the aging of populations worldwide, and increased survival with chronic diseases, the incidence and prevalence of atrial fibrillation (AF) are rising, justifying the term global epidemic. This multifactorial arrhythmia is intertwined with common concomitant cardiovascular diseases, which share classical cardiovascular risk factors. Targeted prevention programs are largely missing. Prevention needs to start at an early age with primordial interventions at the population level. The public health dimension of AF motivates research in modifiable AF risk factors and improved precision in AF prediction and management. In this review, we summarize current knowledge in an attempt to untangle these multifaceted associations from an epidemiological perspective. We discuss disease trends, preventive opportunities offered by underlying risk factors and concomitant disorders, current developments in diagnosis and risk prediction, and prognostic implications of AF and its complications. Finally, we review current technological (eg, eHealth) and methodological (artificial intelligence) advances and their relevance for future prevention and disease management.
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Affiliation(s)
- Jelena Kornej
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts & Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center (J.K., E.J.B.), Boston University School of Medicine, MA
| | - Christin S Börschel
- Department of General and Interventional Cardiology, University Heart & Vascular Center Hamburg Eppendorf, Hamburg, Germany (C.B., R.B.S.)
- German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck (C.B., R.B.S.)
| | - Emelia J Benjamin
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts & Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center (J.K., E.J.B.), Boston University School of Medicine, MA
- Department of Epidemiology (E.J.B.), Boston University School of Medicine, MA
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart & Vascular Center Hamburg Eppendorf, Hamburg, Germany (C.B., R.B.S.)
- German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck (C.B., R.B.S.)
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11
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Emotion-body connection dispositions modify the insulae-midcingulate effective connectivity during anger processing. PLoS One 2020; 15:e0228404. [PMID: 32053605 PMCID: PMC7018059 DOI: 10.1371/journal.pone.0228404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/14/2020] [Indexed: 11/25/2022] Open
Abstract
The link between anger and bodily states is readily apparent based on the autonomic and behavioral responses elicited. In everyday life angry people react in different ways, from being agitated with an increased heart rate to remaining silent or detached. Neuroimaging evidence supports the role of mid-posterior insula and midcingulate cortex/MCC as key nodes of a sensorimotor network that predominantly responds to salient stimuli, integration of interoceptive and autonomic information, as well as to awareness of bodily movements for coordinated motion. However, there is still a lack of clarity concerning how interindividual variability in bodily states reactions drives the connectivity within these key nodes in the sensorimotor network during anger processing. Therefore, we investigated whether individual differences in body-centered emotional experience, that is an active (inward prone) or inactive (outward prone) emotion-body connection disposition, would differently affect the information flow within these brain regions. Two groups of participants underwent fMRI scanning session watching video clips of actors performing simple actions with angry and joyful facial expressions. The whole-brain group-by-session interaction analysis showed that the bilateral insula and the right MCC were selectively activated by inward group during the angry session, whereas the outward group activated more the precuneus during the joyful session. Accordingly, dynamic causal modeling analyses (DCM) revealed an excitatory modulatory effect exerted by anger all over the insulae-MCC connectivity in the inward group, whereas in the outward group the modulatory effect exerted was inhibitory. Modeling the variability related to individual differences in body-centered emotional experience allowed to better explain to what extent subjective dispositions contributed to the insular activity and its connectivity. In addition, from the perspective of a hierarchical model of neurovisceral integration, these findings add knowledge to the multiple ways which the insula and MCC dynamically integrate affective and bodily aspects of the human experience.
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Rosman L, Lampert R, Ramsey CM, Dziura J, Chui PW, Brandt C, Haskell S, Burg MM. Posttraumatic Stress Disorder and Risk for Early Incident Atrial Fibrillation: A Prospective Cohort Study of 1.1 Million Young Adults. J Am Heart Assoc 2019; 8:e013741. [PMID: 31564191 PMCID: PMC6806049 DOI: 10.1161/jaha.119.013741] [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] [Indexed: 01/13/2023]
Abstract
Background Acute psychological stress and negative emotions are known risk factors for atrial fibrillation (AF). Whether exposure to chronic stress syndromes, such as posttraumatic stress disorder (PTSD), also increases susceptibility to AF is unknown. Methods and Results We prospectively assessed the incidence of AF over a 13-year period among 988 090 young and middle-aged veterans (mean age, 30.29±9.19 years; 87.8% men, 64.5% white) who first accessed care through the Veterans Health Administration from October 2001 to November 2014 and were free of AF, atrial flutter, or atrial tachycardia at baseline. Time-varying, multivariate Cox proportional hazard models were used to examine the independent contribution of PTSD to new AF. We also tested for effect modification by sex and controlled for healthcare use. During a mean follow-up of 4.8 years, 2491 patients were diagnosed with AF. Patients with PTSD had a higher overall incidence of AF (P<0.0001) and were more likely to develop AF at a younger age than those without PTSD (P=0.004). PTSD was significantly associated with incident AF in unadjusted models (hazard ratio, 1.31; 95% CI, 1.19-1.43) and models that adjusted for demographics, lifestyle factors, cardiovascular risk factors, and depression (hazard ratio, 1.13; 95% CI, 1.02-1.24). The interaction with sex was nonsignificant (P=0.93). Conclusions PTSD was associated increased risk for early incident AF after adjustment for established AF risk factors and depression in this cohort of young and middle-aged veterans. Findings from this study require validation in more diverse populations to determine their generalizability.
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Affiliation(s)
- Lindsey Rosman
- Department of Medicine-Cardiology University of North Carolina School of Medicine Chapel Hill NC.,Department of Internal Medicine (Cardiovascular Medicine) Yale School of Medicine New Haven CT.,VA Connecticut Healthcare System West Haven CT
| | - Rachel Lampert
- Department of Internal Medicine (Cardiovascular Medicine) Yale School of Medicine New Haven CT
| | - Christine M Ramsey
- Yale Center for Medical Informatics Yale School of Medicine New Haven CT
| | - James Dziura
- Yale Center for Medical Informatics Yale School of Medicine New Haven CT
| | - Phillip W Chui
- Department of Internal Medicine (Cardiovascular Medicine) Yale School of Medicine New Haven CT.,VA Connecticut Healthcare System West Haven CT
| | - Cynthia Brandt
- Department of Emergency Medicine Yale School of Medicine New Haven CT.,Yale Center for Medical Informatics Yale School of Medicine New Haven CT.,VA Connecticut Healthcare System West Haven CT
| | - Sally Haskell
- Department of Internal Medicine Yale School of Medicine New Haven CT.,VA Connecticut Healthcare System West Haven CT
| | - Matthew M Burg
- Department of Internal Medicine (Cardiovascular Medicine) Yale School of Medicine New Haven CT.,Department of Anesthesiology Yale School of Medicine New Haven CT.,VA Connecticut Healthcare System West Haven CT
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13
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Albus C, Waller C, Fritzsche K, Gunold H, Haass M, Hamann B, Kindermann I, Köllner V, Leithäuser B, Marx N, Meesmann M, Michal M, Ronel J, Scherer M, Schrader V, Schwaab B, Weber CS, Herrmann-Lingen C. Significance of psychosocial factors in cardiology: update 2018. Clin Res Cardiol 2019; 108:1175-1196. [DOI: 10.1007/s00392-019-01488-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/29/2019] [Indexed: 12/13/2022]
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Seok JW, Cheong C. Dynamic Causal Modeling of Effective Connectivity During Anger Experience in Healthy Young Men: 7T Magnetic Resonance Imaging Study. Adv Cogn Psychol 2019; 15:52-62. [PMID: 32537036 PMCID: PMC7278524 DOI: 10.5709/acp-0256-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Little is known about how anger-associated brain regions integrate and modulate external input. Therefore, we investigated the neural connectivity architecture of anger processing using a dynamic causal modeling (DCM) approach. Thirteen subjects underwent functional magnetic resonance imaging (fMRI) while viewing anger-inducing film clips. Conventional fMRI and DCM analyses were conducted to identify a dominant connectivity model. Viewing anger-inducing film clips led to activation in the left superior temporal gyrus, left insula, and left orbitofrontal cortex (OFC). The results of a group-level comparison of eight connectivity models based on conventional fMRI findings showed superiority of the model including reciprocal effective connectivities between the left insula, left superior temporal gyrus, and left orbitofrontal gyrus and bottom-up connectivity from the left superior temporal gyrus to the left orbitofrontal gyrus. Positive coupling effects were identified for connectivities between the left superior temporal gyrus and left insula and the left superior temporal gyrus and left OFC. A negative coupling effect was identified for connectivity between the left OFC and left insula. In conclusion, we propose a model of effective connectivity associated with the anger experience based on dynamic causal modeling. The findings have implications for various psychiatric disorders related to abnormalities in anger processing.
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Affiliation(s)
- Ji-Woo Seok
- Department of Counseling Psychology, Honam University, Kwangju, South Korea
- Bioimaging Research Team, Korea Basic Science Institute, Cheongju, South Korea
| | - Chaejoon Cheong
- Bioimaging Research Team, Korea Basic Science Institute, Cheongju, South Korea
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16
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Isakadze N, Soliman EZ, Vaccarino V, Whang W, Lampert R, Bremner JD, Shah AJ. Association of positive well-being with reduced cardiac repolarization abnormalities in the First National Health and Nutrition Examination Survey. Int J Cardiol 2018; 265:246-250. [PMID: 29735423 PMCID: PMC5994381 DOI: 10.1016/j.ijcard.2018.04.135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 02/02/2018] [Accepted: 04/30/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND The mechanisms by which psychological factors may influence possibly arrhythmia risk are not known. We hypothesized that psychological wellness, measured by the General Well-Being Schedule (GBWS), is associated with less repolarization heterogeneity as measured by T-axis. We also explored whether T-axis was a mediator in the relationship of GWBS with adverse cardiac outcomes. METHODS We studied 5533 adults aged 25-74 years without a history of CVD from NHANES I (National Health and Nutrition Examination Survey) (1971-75). Frontal T-axis was obtained through 12-lead ECG and characterized as normal (15° to 75°), borderline (-15° to 15° or 75° to 105°) or abnormal (>105° or <-15°). RESULTS The mean ± SD age was 43.1 ± 11.5 years and 55% were women. A 1-SD increase in GWBS score associated with a 23% reduced odds of abnormal T-axis (p < 0.001) and 11% lower hazard of composite CHD hospitalization and death (p = 0.02). When adjusting for sociodemographic factors, health behaviors, and CHD risk factors, the association was minimally changed and remained statistically significant. Additional adjustment for T-axis did not change the relationship with outcomes. CONCLUSION General well-being is independently associated with less abnormal frontal T-axis and CHD events in otherwise healthy individuals.
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Affiliation(s)
- Nino Isakadze
- Division of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, United States; Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - William Whang
- Division of Cardiology, Mount Sinai Medical Center, NY, United States
| | - Rachel Lampert
- Department of Internal Medicine, Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - J Douglas Bremner
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States; Division of Cardiology, Department of Medicine, Atlanta Veterans Affairs Medical Center, Atlanta, GA, United States.
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17
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Abstract
Anger and other negative emotions can precipitate sudden death, as shown in studies of population stressors. Clinical studies of patients with implantable defibrillators demonstrate that anger can trigger ventricular arrhythmias. Long-term negative emotions also increase vulnerability to arrhythmias. Mechanisms linking anger and arrhythmias include autonomic changes, which alter repolarization, possibly enhanced in patients with sympathetic denervation, which in turn trigger potentially lethal polymorphic ventricular tachycardias. Interventions which decrease negative emotions and resultant autonomic responses may be therapeutic in patients with implantable cardioverter defibrillators.
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19
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Mazzola V, Arciero G, Fazio L, Lanciano T, Gelao B, Popolizio T, Vuilleumier P, Bondolfi G, Bertolino A. What Impact does An Angry Context have Upon Us? The Effect of Anger on Functional Connectivity of the Right Insula and Superior Temporal Gyri. Front Behav Neurosci 2016; 10:109. [PMID: 27375449 PMCID: PMC4893496 DOI: 10.3389/fnbeh.2016.00109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 05/20/2016] [Indexed: 11/29/2022] Open
Abstract
Being in a social world requires an understanding of other people that is co-determined in its meaning by the situation at hand. Therefore, we investigated the underlying neural activation occurring when we encounter someone acting in angry or joyful situation. We hypothesized a dynamic interplay between the right insula, both involved in mapping visceral states associated with emotional experiences and autonomic control, and the bilateral superior temporal gyri (STG), part of the “social brain”, when facing angry vs. joyful situations. Twenty participants underwent a functional magnetic resonance imaging (fMRI) scanning session while watching video clips of actors grasping objects in joyful and angry situations. The analyses of functional connectivity, psychophysiological interaction (PPI) and dynamic causal modeling (DCM), all revealed changes in functional connectivity associated with the angry situation. Indeed, the DCM model showed that the modulatory effect of anger increased the ipsilateral forward connection from the right insula to the right STG, while it suppressed the contralateral one. Our findings reveal a critical role played by the right insula when we are engaged in angry situations. In addition, they suggest that facing angry people modulates the effective connectivity between these two nodes associated, respectively, with autonomic responses and bodily movements and human-agent motion recognition. Taken together, these results add knowledge to the current understanding of hierarchical brain network for social cognition.
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Affiliation(s)
- Viridiana Mazzola
- Department of Mental Health, Psychiatry de Liaison, University Hospitals of GenevaGeneva, Switzerland; Laboratory for Behavioral Neurology and Imaging of Cognition, Department of Neurology, University Hospital and Department of Neuroscience, Medical School University of GenevaGeneva, Switzerland
| | - Giampiero Arciero
- Department of Mental Health, Psychiatry de Liaison, University Hospitals of GenevaGeneva, Switzerland; Institute of Post-Rationalist Psychology IPRARome, Italy
| | - Leonardo Fazio
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro" Bari, Italy
| | - Tiziana Lanciano
- Department of Education, Psychology, Communication, University of Bari Bari, Italy
| | - Barbara Gelao
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro" Bari, Italy
| | - Teresa Popolizio
- Department of Neuroradiology, "Casa Sollievo della Sofferenza" IRCCSS San Giovanni Rotondo, FG, Italy
| | - Patrik Vuilleumier
- Laboratory for Behavioral Neurology and Imaging of Cognition, Department of Neurology, University Hospital and Department of Neuroscience, Medical School University of Geneva Geneva, Switzerland
| | - Guido Bondolfi
- Department of Mental Health, Psychiatry de Liaison, University Hospitals of GenevaGeneva, Switzerland; Department of Psychiatry, University of GenevaGeneva, Switzerland
| | - Alessandro Bertolino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro" Bari, Italy
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Buckley U, Shivkumar K. Stress-induced cardiac arrhythmias: The heart-brain interaction. Trends Cardiovasc Med 2016; 26:78-80. [PMID: 26051207 PMCID: PMC4662914 DOI: 10.1016/j.tcm.2015.05.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 05/02/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Una Buckley
- UCLA Cardiac Arrhythmia Center, Los Angeles, CA; UCLA Neurocardiology Research Center of Excellence, David Geffen School of Medicine, Los Angeles, CA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, Los Angeles, CA; UCLA Neurocardiology Research Center of Excellence, David Geffen School of Medicine, Los Angeles, CA.
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