1
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Medvedev RY, Afolabi SO, Turner DGP, Glukhov AV. Mechanisms of stretch-induced electro-anatomical remodeling and atrial arrhythmogenesis. J Mol Cell Cardiol 2024; 193:11-24. [PMID: 38797242 DOI: 10.1016/j.yjmcc.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024]
Abstract
Atrial fibrillation (AF) is the most common cardiac rhythm disorder, often occurring in the setting of atrial distension and elevated myocardialstretch. While various mechano-electrochemical signal transduction pathways have been linked to AF development and progression, the underlying molecular mechanisms remain poorly understood, hampering AF therapies. In this review, we describe different aspects of stretch-induced electro-anatomical remodeling as seen in animal models and in patients with AF. Specifically, we focus on cellular and molecular mechanisms that are responsible for mechano-electrochemical signal transduction and the development of ectopic beats triggering AF from pulmonary veins, the most common source of paroxysmal AF. Furthermore, we describe structural changes caused by stretch occurring before and shortly after the onset of AF as well as during AF progression, contributing to longstanding forms of AF. We also propose mechanical stretch as a new dimension to the concept "AF begets AF", in addition to underlying diseases. Finally, we discuss the mechanisms of these electro-anatomical alterations in a search for potential therapeutic strategies and the development of novel antiarrhythmic drugs targeted at the components of mechano-electrochemical signal transduction not only in cardiac myocytes, but also in cardiac non-myocyte cells.
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Affiliation(s)
- Roman Y Medvedev
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Saheed O Afolabi
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA; Department of Pharmacology and Therapeutics, University of Ilorin, Ilorin, Nigeria
| | - Daniel G P Turner
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Alexey V Glukhov
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
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2
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Förster CY, Künzel SR, Shityakov S, Stavrakis S. Synergistic Effects of Weight Loss and Catheter Ablation: Can microRNAs Serve as Predictive Biomarkers for the Prevention of Atrial Fibrillation Recurrence? Int J Mol Sci 2024; 25:4689. [PMID: 38731908 PMCID: PMC11083177 DOI: 10.3390/ijms25094689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
In atrial fibrillation (AF), multifactorial pathologic atrial alterations are manifested by structural and electrophysiological changes known as atrial remodeling. AF frequently develops in the context of underlying cardiac abnormalities. A critical mechanistic role played by atrial stretch is played by abnormal substrates in a number of conditions that predispose to AF, including obesity, heart failure, hypertension, and sleep apnea. The significant role of overweight and obesity in the development of AF is known; however, the differential effect of overweight, obesity, cardiovascular comorbidities, lifestyle, and other modifiable risk factors on the occurrence and recurrence of AF remains to be determined. Reverse remodeling of the atrial substrate and subsequent reduction in the AF burden by conversion into a typical sinus rhythm has been associated with weight loss through lifestyle changes or surgery. This makes it an essential pillar in the management of AF in obese patients. According to recently published research, microRNAs (miRs) may function as post-transcriptional regulators of genes involved in atrial remodeling, potentially contributing to the pathophysiology of AF. The focus of this review is on their modulation by both weight loss and catheter ablation interventions to counteract atrial remodeling in AF. Our analysis outlines the experimental and clinical evidence supporting the synergistic effects of weight loss and catheter ablation (CA) in reversing atrial electrical and structural remodeling in AF onset and in recurrent post-ablation AF by attenuating pro-thrombotic, pro-inflammatory, pro-fibrotic, arrhythmogenic, and male-sex-associated hypertrophic remodeling pathways. Furthermore, we discuss the promising role of miRs with prognostic potential as predictive biomarkers in guiding approaches to AF recurrence prevention.
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Affiliation(s)
- Carola Y. Förster
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University of Würzburg, 97080 Würzburg, Germany
| | - Stephan R. Künzel
- Institute for Transfusion Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany;
- Institute for Transfusion Medicine, German Red Cross Blood Donation Service North-East, 01307 Dresden, Germany
| | - Sergey Shityakov
- Laboratory of Chemoinformatics, Infochemistry Scientific Center, ITMO University, 197101 Saint-Petersburg, Russia;
| | - Stavros Stavrakis
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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3
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Louradour J, Ottersberg R, Segiser A, Olejnik A, Martínez-Salazar B, Siegrist M, Egle M, Barbieri M, Nimani S, Alerni N, Döring Y, Odening KE, Longnus S. Simultaneous assessment of mechanical and electrical function in Langendorff-perfused ex-vivo mouse hearts. Front Cardiovasc Med 2023; 10:1293032. [PMID: 38028448 PMCID: PMC10663365 DOI: 10.3389/fcvm.2023.1293032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background The Langendorff-perfused ex-vivo isolated heart model has been extensively used to study cardiac function for many years. However, electrical and mechanical function are often studied separately-despite growing proof of a complex electro-mechanical interaction in cardiac physiology and pathology. Therefore, we developed an isolated mouse heart perfusion system that allows simultaneous recording of electrical and mechanical function. Methods Isolated mouse hearts were mounted on a Langendorff setup and electrical function was assessed via a pseudo-ECG and an octapolar catheter inserted in the right atrium and ventricle. Mechanical function was simultaneously assessed via a balloon inserted into the left ventricle coupled with pressure determination. Hearts were then submitted to an ischemia-reperfusion protocol. Results At baseline, heart rate, PR and QT intervals, intra-atrial and intra-ventricular conduction times, as well as ventricular effective refractory period, could be measured as parameters of cardiac electrical function. Left ventricular developed pressure (DP), left ventricular work (DP-heart rate product) and maximal velocities of contraction and relaxation were used to assess cardiac mechanical function. Cardiac arrhythmias were observed with episodes of bigeminy during which DP was significantly increased compared to that of sinus rhythm episodes. In addition, the extrasystole-triggered contraction was only 50% of that of sinus rhythm, recapitulating the "pulse deficit" phenomenon observed in bigeminy patients. After ischemia, the mechanical function significantly decreased and slowly recovered during reperfusion while most of the electrical parameters remained unchanged. Finally, the same electro-mechanical interaction during episodes of bigeminy at baseline was observed during reperfusion. Conclusion Our modified Langendorff setup allows simultaneous recording of electrical and mechanical function on a beat-to-beat scale and can be used to study electro-mechanical interaction in isolated mouse hearts.
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Affiliation(s)
- Julien Louradour
- Department of Physiology, Translational Cardiology/Electrophysiology, Institute of Physiology, University of Bern, Bern, Switzerland
| | - Rahel Ottersberg
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian Segiser
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Agnieszka Olejnik
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Division of Clinical Chemistry and Laboratory Hematology, Department of Medical Laboratory Diagnostics, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Berenice Martínez-Salazar
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Department of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mark Siegrist
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Department of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Manuel Egle
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Miriam Barbieri
- Department of Physiology, Translational Cardiology/Electrophysiology, Institute of Physiology, University of Bern, Bern, Switzerland
| | - Saranda Nimani
- Department of Physiology, Translational Cardiology/Electrophysiology, Institute of Physiology, University of Bern, Bern, Switzerland
| | - Nicolò Alerni
- Department of Physiology, Translational Cardiology/Electrophysiology, Institute of Physiology, University of Bern, Bern, Switzerland
| | - Yvonne Döring
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Department of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich (LMU), Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Heart Alliance Munich, Munich, Germany
| | - Katja E. Odening
- Department of Physiology, Translational Cardiology/Electrophysiology, Institute of Physiology, University of Bern, Bern, Switzerland
- Department of Cardiology, Translational Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarah Longnus
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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4
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Rolland L, Torrente AG, Bourinet E, Maskini D, Drouard A, Chevalier P, Jopling C, Faucherre A. Prolonged Piezo1 Activation Induces Cardiac Arrhythmia. Int J Mol Sci 2023; 24:ijms24076720. [PMID: 37047693 PMCID: PMC10094979 DOI: 10.3390/ijms24076720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/29/2023] [Accepted: 04/01/2023] [Indexed: 04/14/2023] Open
Abstract
The rhythmical nature of the cardiovascular system constantly generates dynamic mechanical forces. At the centre of this system is the heart, which must detect these changes and adjust its performance accordingly. Mechanoelectric feedback provides a rapid mechanism for detecting even subtle changes in the mechanical environment and transducing these signals into electrical responses, which can adjust a variety of cardiac parameters such as heart rate and contractility. However, pathological conditions can disrupt this intricate mechanosensory system and manifest as potentially life-threatening cardiac arrhythmias. Mechanosensitive ion channels are thought to be the main proponents of mechanoelectric feedback as they provide a rapid response to mechanical stimulation and can directly affect cardiac electrical activity. Here, we demonstrate that the mechanosensitive ion channel PIEZO1 is expressed in zebrafish cardiomyocytes. Furthermore, chemically prolonging PIEZO1 activation in zebrafish results in cardiac arrhythmias. indicating that this ion channel plays an important role in mechanoelectric feedback. This also raises the possibility that PIEZO1 gain of function mutations could be linked to heritable cardiac arrhythmias in humans.
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Affiliation(s)
- Laura Rolland
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, LabEx ICST, 34094 Montpellier, France
| | - Angelo Giovanni Torrente
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, LabEx ICST, 34094 Montpellier, France
| | - Emmanuel Bourinet
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, LabEx ICST, 34094 Montpellier, France
| | - Dounia Maskini
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, LabEx ICST, 34094 Montpellier, France
| | - Aurélien Drouard
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, LabEx ICST, 34094 Montpellier, France
| | - Philippe Chevalier
- Neuromyogene Institut, Claude Bernard University, Lyon 1, 69008 Villeurbanne, France
- Service de Rythmologie, Hospices Civils de Lyon, 69500 Lyon, France
| | - Chris Jopling
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, LabEx ICST, 34094 Montpellier, France
| | - Adèle Faucherre
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, LabEx ICST, 34094 Montpellier, France
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5
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Odening KE, van der Linde HJ, Ackerman MJ, Volders PGA, ter Bekke RMA. OUP accepted manuscript. Eur Heart J 2022; 43:3018-3028. [PMID: 35445703 PMCID: PMC9443984 DOI: 10.1093/eurheartj/ehac135] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
An abundance of literature describes physiological and pathological determinants of cardiac performance, building on the principles of excitation–contraction coupling. However, the mutual influencing of excitation–contraction and mechano-electrical feedback in the beating heart, here designated ‘electromechanical reciprocity’, remains poorly recognized clinically, despite the awareness that external and cardiac-internal mechanical stimuli can trigger electrical responses and arrhythmia. This review focuses on electromechanical reciprocity in the long-QT syndrome (LQTS), historically considered a purely electrical disease, but now appreciated as paradigmatic for the understanding of mechano-electrical contributions to arrhythmogenesis in this and other cardiac conditions. Electromechanical dispersion in LQTS is characterized by heterogeneously prolonged ventricular repolarization, besides altered contraction duration and relaxation. Mechanical alterations may deviate from what would be expected from global and regional repolarization abnormalities. Pathological repolarization prolongation outlasts mechanical systole in patients with LQTS, yielding a negative electromechanical window (EMW), which is most pronounced in symptomatic patients. The electromechanical window is a superior and independent arrhythmia-risk predictor compared with the heart rate-corrected QT. A negative EMW implies that the ventricle is deformed—by volume loading during the rapid filling phase—when repolarization is still ongoing. This creates a ‘sensitized’ electromechanical substrate, in which inadvertent electrical or mechanical stimuli such as local after-depolarizations, after-contractions, or dyssynchrony can trigger abnormal impulses. Increased sympathetic-nerve activity and pause-dependent potentiation further exaggerate electromechanical heterogeneities, promoting arrhythmogenesis. Unraveling electromechanical reciprocity advances the understanding of arrhythmia formation in various conditions. Real-time image integration of cardiac electrophysiology and mechanics offers new opportunities to address challenges in arrhythmia management.
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Affiliation(s)
| | - Henk J van der Linde
- Janssen Research & Development, Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Michael J Ackerman
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services (Windland Smith Rice Genetic Heart Rhythm Clinic), Mayo Clinic, Rochester, MN, USA
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
- Department of Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, MN, USA
| | - Paul G A Volders
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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6
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Garg PK, Norby FL, Wang W, Krishnappa D, Soliman EZ, Lutsey PL, Selvin E, Ballantyne CM, Alonso A, Chen LY. Association of Longitudinal Changes in Cardiac Biomarkers With Atrial and Ventricular Arrhythmias (from the Atherosclerosis Risk in Communities [ARIC] Study). Am J Cardiol 2021; 158:45-52. [PMID: 34465464 PMCID: PMC8497411 DOI: 10.1016/j.amjcard.2021.07.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
We evaluated the association of longitudinal changes in circulating levels of N-terminal pro B-type natriuretic peptide (NT-proBNP) and high sensitivity cardiac troponin T (hs-cTnT) with the burden of arrhythmias as captured by 2-week ambulatory ECG monitoring. This study included 1,930 Atherosclerosis Risk in Communities Study participants who wore a leadless, ambulatory ECG monitor (Zio XT Patch) at visit 6 (2016 to 2017) and had cardiac biomarkers measured at visit 6 and visit 4 (median of 19 years earlier). The mean age of participants at V6 was 79 ± 5 years, 41% were men, and 22% were black. Adjusting for demographics, body mass index, smoking, diabetes, hypertension, stroke, left ventricular mass, cardiac medications, patch wear time, visit 4 levels of NT-proBNP and hs-cTnT, and relative change in hs-cTnT, each log-transformed unit relative increase in NT-proBNP was associated with a higher likelihood of nonsustained ventricular tachycardia (odds ratio 1.29, 95% confidence interval [CI] 1.12 to 1.48), a higher number of daily atrial tachycardia episodes (geometric mean ratio [GMR] 1.16, 95% CI 1.10 to 1.21), and a higher daily ectopic burden (premature ventricular contractions -GMR 1.42, 95% CI 1.25 to 1.62; premature atrial contractions -GMR 1.40, 95% CI 1.25 to 1.57). In fully adjusted analyses, each log-transformed unit relative increase in hs-cTnT was only found to be weakly associated with a higher daily premature ventricular contraction burden (GMR 1.31, 95% CI 1.01 to 1.70). In conclusion, longitudinal change in NT-proBNP was associated with an increased atrial and ventricular arrhythmia burden.
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Affiliation(s)
- Parveen K Garg
- Division of Cardiology, USC Keck School of Medicine, Los Angeles, California.
| | - Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Darshan Krishnappa
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, and Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Christie M Ballantyne
- Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, Houston, Texas; The Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart Center, Houston, Texas
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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7
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Cao X, Aimoto M, Nagasawa Y, Zhang HX, Zhang CS, Takahara A. Electrophysiological Response to Acehytisine Was Modulated by Aldosterone in Rats with Aorto-Venocaval Shunts. Biol Pharm Bull 2021; 44:1044-1049. [PMID: 34078775 DOI: 10.1248/bpb.b20-00974] [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] [Indexed: 11/22/2022]
Abstract
Aldosterone induces cardiac electrical and structural remodeling, which leads to the development of heart failure and/or atrial fibrillation (AF). However, it remains unknown whether aldosterone-induced remodeling may modulate the efficacy of anti-AF drugs. In this study, we aimed to jeopardize the structural and functional remodeling by aldosterone in rats with aorto-venocaval shunts (AVS rats) and evaluate the effect of acehytisine in this model. An AVS operation was performed on rats (n = 6, male) and it was accompanied by the intraperitoneal infusion of aldosterone (AVS + Ald) at 2.0 µg/h for 28 d. The cardiopathy was characterized by echocardiography, electrophysiologic and hemodynamic testing, and morphometric examination in comparison with sham-operated rats (n = 3), sham + Ald (n = 6), and AVS (n = 5). Aldosterone accelerated the progression from asymptomatic heart failure to overt heart failure and induced sustained AF resistant to electrical fibrillation in one out of six rats. In addition, it prolonged PR, QT interval and Wenckebach cycle length. Acehytisine failed to suppress AF in the AVS + Ald rats. In conclusion, aldosterone jeopardized electrical remodeling and blunted the electrophysiological response to acehytisine on AF.
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Affiliation(s)
- Xin Cao
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University
| | - Megumi Aimoto
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University
| | - Yoshinobu Nagasawa
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University
| | - Han-Xiao Zhang
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine
| | - Cheng-Shun Zhang
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine
| | - Akira Takahara
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University
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8
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El-Battrawy I, Cammann VL, Kato K, Szawan KA, Di Vece D, Rossi A, Wischnewsky M, Hermes-Laufer J, Gili S, Citro R, Bossone E, Neuhaus M, Franke J, Meder B, Jaguszewski M, Noutsias M, Knorr M, Heiner S, D'Ascenzo F, Dichtl W, Burgdorf C, Kherad B, Tschöpe C, Sarcon A, Shinbane J, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Koenig W, Pott A, Meyer P, David Arroja J, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Napp LC, Budnik M, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, Gilyarova E, Shilova A, Gilyarov M, Kozel M, Tousek P, Winchester DE, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Hauck C, Paolini C, Bilato C, Kobayashi Y, Prasad A, Rihal CS, Liu K, Schulze PC, Bianco M, Jörg L, Rickli H, Pestana G, Nguyen TH, Böhm M, Maier LS, Pinto FJ, Widimský P, Felix SB, Opolski G, Braun-Dullaeus RC, Rottbauer W, Hasenfuß G, Pieske BM, Schunkert H, Thiele H, Bauersachs J, Katus HA, Horowitz JD, Di Mario C, Münzel T, Crea F, Bax JJ, Lüscher TF, Ruschitzka F, Duru F, Borggrefe M, Ghadri JR, Akin I, Templin C. Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry. J Am Heart Assoc 2021; 10:e014059. [PMID: 34315238 PMCID: PMC8475688 DOI: 10.1161/jaha.119.014059] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher (P<0.001), and there were fewer women (P=0.046) in the AF than in the non‐AF group. Left ventricular ejection fraction was significantly lower (P=0.001), and cardiogenic shock was more often observed (P<0.001) in the AF group. Both in‐hospital (P<0.001) and long‐term mortality (P<0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long‐term mortality (hazard ratio, 2.31; 95% CI, 1.50–3.55; P<0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in‐hospital and long‐term outcomes compared with those with a history of AF. Conclusions In patients presenting with TTS, AF on admission is significantly associated with increased in‐hospital and long‐term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01947621.
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Affiliation(s)
- Ibrahim El-Battrawy
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim University of Heidelberg Mannheim Germany.,German Center for Cardiovascular Researchpartner site Heidelberg-Mannheim Mannheim Germany
| | - Victoria L Cammann
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Ken Kato
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Konrad A Szawan
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Davide Di Vece
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Aurelio Rossi
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | | | - Julia Hermes-Laufer
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | | | - Rodolfo Citro
- Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy
| | - Eduardo Bossone
- Division of Cardiology "Antonio Cardarelli" Hospital Naples Italy
| | - Michael Neuhaus
- Department of Cardiology Kantonsspital Frauenfeld Frauenfeld Switzerland
| | - Jennifer Franke
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Benjamin Meder
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Milosz Jaguszewski
- First Department of Cardiology Medical University of Gdansk Gdansk Poland
| | - Michel Noutsias
- Mid-German Heart Center Department of Internal Medicine III Division of Cardiology, Angiology and Intensive Medical Care University Hospital HalleMartin-Luther-University Halle-Wittenberg Halle (Saale) Germany
| | - Maike Knorr
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Susanne Heiner
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Fabrizio D'Ascenzo
- Division of Cardiology Department of Medical Sciences AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology) Medical University Innsbruck Innsbruck Austria
| | | | - Behrouz Kherad
- Department of Cardiology CharitéCampus Rudolf Virchow Berlin Germany
| | - Carsten Tschöpe
- Department of Cardiology CharitéCampus Rudolf Virchow Berlin Germany
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology Department of Medicine University of California-San Francisco San Francisco CA
| | - Jerold Shinbane
- Keck School of Medicine University of Southern California Los Angeles CA
| | | | - Guido Michels
- Department of Internal Medicine III Heart Center University of Cologne Cologne Germany
| | - Roman Pfister
- Department of Internal Medicine III Heart Center University of Cologne Cologne Germany
| | | | - Claudius Jacobshagen
- Department of Cardiology Intensive Care Medicine and Angiology Vincentius-Diakonissen-Hospital Karlsruhe Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Centre for Cardiovascular Research partner site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany.,German Centre for Cardiovascular Research partner site Munich Heart Alliance Munich Germany
| | - Alexander Pott
- Department of Internal Medicine II-Cardiology University of UlmMedical Center Ulm Germany
| | - Philippe Meyer
- Service de Cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland
| | - Jose David Arroja
- Service de Cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland
| | - Adrian Banning
- Department of Cardiology John Radcliffe HospitalOxford University Hospitals Oxford United Kingdom
| | - Florim Cuculi
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Richard Kobza
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Thomas A Fischer
- Department of Cardiology Kantonsspital Winterthur Winterthur Switzerland
| | - Tuija Vasankari
- Heart Center Turku University Hospital and University of Turku Turku Finland
| | | | - L Christian Napp
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Monika Budnik
- Department of Cardiology Medical University of Warsaw Warsaw Poland
| | - Rafal Dworakowski
- Department of Cardiology King's College Hospital London United Kingdom
| | - Philip MacCarthy
- Department of Cardiology King's College Hospital London United Kingdom
| | - Christoph Kaiser
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Stefan Osswald
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
| | - Christina Chan
- Department of Cardiology Christchurch Hospital Christchurch New Zealand
| | - Paul Bridgman
- Department of Cardiology Christchurch Hospital Christchurch New Zealand
| | - Daniel Beug
- Department of Cardiology and Internal Medicine B University Medicine Greifswald Greifswald Germany.,German Centre for Cardiovascular Researchpartner site Greifswald Greifswald Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Martin Kozel
- Cardiocenter Third Faculty of Medicine Charles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Petr Tousek
- Cardiocenter Third Faculty of Medicine Charles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine Department of Medicine College of Medicine University of Florida Gainesville FL
| | - Jan Galuszka
- Department of Internal Medicine I-Cardiology University Hospital Olomouc Olomouc Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center University Medical Center Ljubljana Ljubljana Slovenia
| | - Pedro Carrilho-Ferreira
- Cardiology Department Santa Maria University HospitalCHLNCAMLCCULFaculty of MedicineUniversity of Lisbon Lisbon Portugal
| | - Christian Hauck
- Klinik und Poliklinik für Innere Medizin II Universitätsklinikum Regensburg Regensburg Germany
| | | | | | - Yoshio Kobayashi
- Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Abhiram Prasad
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Kan Liu
- Division of Cardiology, Heart and Vascular Center University of Iowa Iowa City IA
| | - P Christian Schulze
- Department of Internal Medicine I University Hospital JenaFriedrich-Schiller-University Jena Jena Germany
| | - Matteo Bianco
- Division of Cardiology A.O.U. San Luigi Gonzaga Orbassano, Turin Italy
| | - Lucas Jörg
- Department of Cardiology Kantonsspital St. Gallen St. Gallen Switzerland
| | - Hans Rickli
- Department of Cardiology Kantonsspital St. Gallen St. Gallen Switzerland
| | - Gonçalo Pestana
- Department of Cardiology Centro Hospitalar Universitário de São JoãoE.P.E. Porto Portugal
| | - Thanh H Nguyen
- Department of Cardiology Basil Hetzel InstituteQueen Elizabeth HospitalUniversity of Adelaide Adelaide Australia
| | - Michael Böhm
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II Universitätsklinikum Regensburg Regensburg Germany
| | - Fausto J Pinto
- Cardiology Department Santa Maria University HospitalCHLNCAMLCCULFaculty of MedicineUniversity of Lisbon Lisbon Portugal
| | - Petr Widimský
- Cardiocenter Third Faculty of Medicine Charles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Stephan B Felix
- Department of Cardiology and Internal Medicine B University Medicine Greifswald Greifswald Germany.,German Centre for Cardiovascular Researchpartner site Greifswald Greifswald Germany
| | - Grzegorz Opolski
- Department of Cardiology Medical University of Warsaw Warsaw Poland
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology University of UlmMedical Center Ulm Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany
| | - Burkert M Pieske
- Department of Cardiology CharitéCampus Rudolf Virchow Berlin Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany.,German Centre for Cardiovascular Research partner site Munich Heart Alliance Munich Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig-University Hospital Leipzig Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Hugo A Katus
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - John D Horowitz
- Department of Cardiology Basil Hetzel InstituteQueen Elizabeth HospitalUniversity of Adelaide Adelaide Australia
| | - Carlo Di Mario
- Structural Interventional Cardiology Careggi University Hospital Florence Italy
| | - Thomas Münzel
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
| | - Jeroen J Bax
- Department of Cardiology Leiden University Medical Centre Leiden The Netherlands
| | - Thomas F Lüscher
- Center for Molecular Cardiology Schlieren Campus University of Zurich Zurich Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College London United Kingdom
| | - Frank Ruschitzka
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Firat Duru
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Martin Borggrefe
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim University of Heidelberg Mannheim Germany.,German Center for Cardiovascular Researchpartner site Heidelberg-Mannheim Mannheim Germany
| | - Jelena R Ghadri
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Ibrahim Akin
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim University of Heidelberg Mannheim Germany.,German Center for Cardiovascular Researchpartner site Heidelberg-Mannheim Mannheim Germany
| | - Christian Templin
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
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9
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Jakob D, Klesen A, Allegrini B, Darkow E, Aria D, Emig R, Chica AS, Rog-Zielinska EA, Guth T, Beyersdorf F, Kari FA, Proksch S, Hatem SN, Karck M, Künzel SR, Guizouarn H, Schmidt C, Kohl P, Ravens U, Peyronnet R. Piezo1 and BK Ca channels in human atrial fibroblasts: Interplay and remodelling in atrial fibrillation. J Mol Cell Cardiol 2021; 158:49-62. [PMID: 33974928 DOI: 10.1016/j.yjmcc.2021.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 04/18/2021] [Accepted: 05/04/2021] [Indexed: 12/17/2022]
Abstract
AIMS Atrial Fibrillation (AF) is an arrhythmia of increasing prevalence in the aging populations of developed countries. One of the important indicators of AF is sustained atrial dilatation, highlighting the importance of mechanical overload in the pathophysiology of AF. The mechanisms by which atrial cells, including fibroblasts, sense and react to changing mechanical forces, are not fully elucidated. Here, we characterise stretch-activated ion channels (SAC) in human atrial fibroblasts and changes in SAC- presence and activity associated with AF. METHODS AND RESULTS Using primary cultures of human atrial fibroblasts, isolated from patients in sinus rhythm or sustained AF, we combine electrophysiological, molecular and pharmacological tools to identify SAC. Two electrophysiological SAC- signatures were detected, indicative of cation-nonselective and potassium-selective channels. Using siRNA-mediated knockdown, we identified the cation-nonselective SAC as Piezo1. Biophysical properties of the potassium-selective channel, its sensitivity to calcium, paxilline or iberiotoxin (blockers), and NS11021 (activator), indicated presence of calcium-dependent 'big potassium channels' (BKCa). In cells from AF patients, Piezo1 activity and mRNA expression levels were higher than in cells from sinus rhythm patients, while BKCa activity (but not expression) was downregulated. Both Piezo1-knockdown and removal of extracellular calcium from the patch pipette resulted in a significant reduction of BKCa current during stretch. No co-immunoprecipitation of Piezo1 and BKCa was detected. CONCLUSIONS Human atrial fibroblasts contain at least two types of ion channels that are activated during stretch: Piezo1 and BKCa. While Piezo1 is directly stretch-activated, the increase in BKCa activity during mechanical stimulation appears to be mainly secondary to calcium influx via SAC such as Piezo1. During sustained AF, Piezo1 is increased, while BKCa activity is reduced, highlighting differential regulation of both channels. Our data support the presence and interplay of Piezo1 and BKCa in human atrial fibroblasts in the absence of physical links between the two channel proteins.
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Affiliation(s)
- Dorothee Jakob
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg, Bad Krozingen, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | - Alexander Klesen
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg, Bad Krozingen, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | - Benoit Allegrini
- CNRS University Cote d'Azur laboratory Institut Biology Valrose, Nice, France
| | - Elisa Darkow
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg, Bad Krozingen, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany; Spemann Graduate School of Biology and Medicine (SGBM), University of Freiburg, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Diana Aria
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg, Bad Krozingen, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany; G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Operative Dentistry and Periodontology, Medical Center - University of Freiburg, Germany
| | - Ramona Emig
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg, Bad Krozingen, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany; CIBSS Centre for Integrative Biological Signalling Studies, Faculty of Biology, University of Freiburg, Germany
| | - Ana Simon Chica
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg, Bad Krozingen, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | - Eva A Rog-Zielinska
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg, Bad Krozingen, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | - Tim Guth
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg, Bad Krozingen, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | - Friedhelm Beyersdorf
- Faculty of Medicine, University of Freiburg, Germany; Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Medical Center - University of Freiburg, Germany
| | - Fabian A Kari
- Faculty of Medicine, University of Freiburg, Germany; Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Medical Center - University of Freiburg, Germany
| | - Susanne Proksch
- Faculty of Medicine, University of Freiburg, Germany; G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Operative Dentistry and Periodontology, Medical Center - University of Freiburg, Germany
| | - Stéphane N Hatem
- Sorbonne University, Assistance Publique-Hôpitaux de Paris, GH Pitié-Salpêtrière Hospital, INSERM UMR_S1166, Cardiology department, Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Matthias Karck
- Department of Cardiac Surgery, University of Heidelberg, Germany
| | - Stephan R Künzel
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Hélène Guizouarn
- CNRS University Cote d'Azur laboratory Institut Biology Valrose, Nice, France
| | - Constanze Schmidt
- Department of Cardiology, University of Heidelberg, Germany; DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, University of Heidelberg, Germany
| | - Peter Kohl
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg, Bad Krozingen, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany; CIBSS Centre for Integrative Biological Signalling Studies, Faculty of Biology, University of Freiburg, Germany
| | - Ursula Ravens
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg, Bad Krozingen, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | - Rémi Peyronnet
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg, Bad Krozingen, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany.
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10
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Marta Varela, Roy A, Lee J. A survey of pathways for mechano-electric coupling in the atria. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2020; 159:136-145. [PMID: 33053408 PMCID: PMC7848589 DOI: 10.1016/j.pbiomolbio.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/09/2020] [Accepted: 09/29/2020] [Indexed: 11/26/2022]
Abstract
Mechano-electric coupling (MEC) in atrial tissue has received sparse investigation to date, despite the well-known association between chronic atrial dilation and atrial fibrillation (AF). Of note, no fewer than six different mechanisms pertaining to stretch-activated channels, cellular capacitance and geometric effects have been identified in the literature as potential players. In this mini review, we briefly survey each of these pathways to MEC. We then perform computational simulations using single cell and tissue models in presence of various stretch regimes and MEC pathways. This allows us to assess the relative significance of each pathway in determining action potential duration, conduction velocity and rotor stability. For chronic atrial stretch, we find that stretch-induced alterations in membrane capacitance decrease conduction velocity and increase action potential duration, in agreement with experimental findings. In the presence of time-dependent passive atrial stretch, stretch-activated channels play the largest role, leading to after-depolarizations and rotor hypermeandering. These findings suggest that physiological atrial stretches, such as passive stretch during the atrial reservoir phase, may play an important part in the mechanisms of atrial arrhythmogenesis. Passive strains caused by ventricular contraction need to be considered when incorporating mechano-electro feedback in atrial electrophysiology models. In chronic stretch, stretch-induced capacitance changes dominate. Chronic stretch leads to an increase in action potential duration and a reduction in conduction velocity, consistent with experimental studies. In the presence of passive stretch, stretch-activated channels can induce delayed after-depolarisations and lead to rotor hypermeandering. Mechano-electro feedback is thus likely to have implications for the genesis and maintenance of atrial arrhythmias.
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Affiliation(s)
- Marta Varela
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
| | - Aditi Roy
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department of Computing, University of Oxford, Oxford, UK
| | - Jack Lee
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
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11
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Ravelli F, Masè M. MicroRNAs: New contributors to mechano-electric coupling and atrial fibrillation. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2020; 159:146-156. [PMID: 33011190 DOI: 10.1016/j.pbiomolbio.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 09/17/2020] [Accepted: 09/27/2020] [Indexed: 12/29/2022]
Abstract
Atrial fibrillation (AF) is a multifactorial disease, which often occurs in the presence of underlying cardiac abnormalities and is supported by electrophysiological and structural alterations, generally referred to as atrial remodeling. Abnormal substrates are commonly encountered in various conditions that predispose to AF, such as hypertension, heart failure, obesity, and sleep apnea, in which atrial stretch plays a key mechanistic role. Emerging evidence suggests a role for microRNAs (small non-coding RNAs) in the pathogenesis of AF, where they can act as post-transcriptional regulators of the genes involved in atrial remodeling. This review summarizes the experimental and clinical evidence that supports the role of microRNAs in the modulation of atrial electrical and structural remodeling with a focus on overload-induced atrial alterations, and discusses the potential contribution of microRNAs to mechano-electrical coupling and AF.
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Affiliation(s)
- Flavia Ravelli
- Laboratory of Biophysics and Biosignals, University of Trento, Trento, Italy.
| | - Michela Masè
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Healthcare Research and Innovation Program, IRCS-HTA, Bruno Kessler Foundation, Trento, Italy
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12
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Hu WS, Lin CL. Comparison of CHA2DS2-VASc and C2HEST scores for predicting the incidence of atrial fibrillation among patients with end-stage renal disease. Perfusion 2020; 35:842-846. [PMID: 32666900 DOI: 10.1177/0267659120930931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE The authors have studied assessment of CHA2DS2-VASc score versus C2HEST score in atrial fibrillation risk prediction in end-stage renal disease patients. METHODS The authors conducted this study by Longitudinal Health Insurance Database 2000. The authors totally enrolled 4,601 end-stage renal disease patients. The predictive capability of atrial fibrillation by using CHA2DS2-VASc and C2HEST score was estimated by area under the receiver operating characteristic curve (AUROC). RESULTS The AUROC for CHA2DS2-VASc score in predicting atrial fibrillation events was 0.5786, and AUROC for C2HEST score for atrial fibrillation prediction was 0.5983. CONCLUSION Both scores yield almost identical AUROC values implying no difference in predictive power. Further work is warranted to verify the prognostic value of the current scores.
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Affiliation(s)
- Wei-Syun Hu
- School of Medicine, College of Medicine, China Medical University, Taichung.,Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung
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13
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Larsen TR, Sargent D, Moyes M, Huizar JF, Tan AY, Ellenbogen KA, Kaszala K. Proarrhythmic effect of automatic threshold testing algorithm in dual chamber devices. J Cardiovasc Electrophysiol 2020; 31:2078-2085. [PMID: 32510718 DOI: 10.1111/jce.14606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/03/2020] [Accepted: 05/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Operation of auto-threshold testing (ATT) algorithm in current dual chamber cardiac devices require temporary shortening of atrio-ventricular (AV) delay to accurately measure evoked potential (capture) after a pacing pulse. Near simultaneous AV pacing causes atrial pressure elevation and may be associated with atrial arrhythmias. OBJECTIVE We evaluated the prevalence of atrial arrhythmias induced by ATT in Abbott devices. METHODS Device clinic records were reviewed at a single center for patients with dual chamber Abbott pacemaker/ICD. ATT-induced atrial fibrillation (AF) cases were defined as new appropriate mode switch episodes while the ATT was operating. The auto-capture test trends were defined as unstable if there were deviations >1 V in capture threshold trend events that did not correlate with routine in-office testing. RESULTS One hundred and seventy patients were programmed in dual chamber pacing mode. The ventricular ATT was active in 118 patients and of these 78 had true mode switch episodes. Six patients developed AF during ventricular ATT. Three patients had most recorded atrial arrhythmias in close association with ATT (63%, 66%, 100% vs 2%,9%, 33% in other patients with known prior AF). An unstable auto-capture trend curve was seen in 33 patients (6 showing ATT-induced AF) versus 85 patients with stable auto-capture curve and no ATT-induced AF (P = .0001, the χ2 test). CONCLUSION Ventricular auto-capture algorithm use is associated with induction of AF in dual chamber Abbott devices with a prevalence of over 5%. AF occur more frequently (18%) in patients with erratic ventricular ATT trend results.
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Affiliation(s)
- Timothy R Larsen
- Division of Cardiology, Section of Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.,Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Donna Sargent
- Division of Cardiology, Section of Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Meredith Moyes
- Division of Cardiology, Section of Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Jose F Huizar
- Division of Cardiology, Section of Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.,Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Alex Y Tan
- Division of Cardiology, Section of Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.,Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Kenneth A Ellenbogen
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Karoly Kaszala
- Division of Cardiology, Section of Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.,Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
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14
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Quinn TA, Kohl P. Cardiac Mechano-Electric Coupling: Acute Effects of Mechanical Stimulation on Heart Rate and Rhythm. Physiol Rev 2020; 101:37-92. [PMID: 32380895 DOI: 10.1152/physrev.00036.2019] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The heart is vital for biological function in almost all chordates, including humans. It beats continually throughout our life, supplying the body with oxygen and nutrients while removing waste products. If it stops, so does life. The heartbeat involves precise coordination of the activity of billions of individual cells, as well as their swift and well-coordinated adaption to changes in physiological demand. Much of the vital control of cardiac function occurs at the level of individual cardiac muscle cells, including acute beat-by-beat feedback from the local mechanical environment to electrical activity (as opposed to longer term changes in gene expression and functional or structural remodeling). This process is known as mechano-electric coupling (MEC). In the current review, we present evidence for, and implications of, MEC in health and disease in human; summarize our understanding of MEC effects gained from whole animal, organ, tissue, and cell studies; identify potential molecular mediators of MEC responses; and demonstrate the power of computational modeling in developing a more comprehensive understanding of ‟what makes the heart tick.ˮ.
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Affiliation(s)
- T Alexander Quinn
- Department of Physiology and Biophysics and School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/Bad Krozingen, Medical Faculty of the University of Freiburg, Freiburg, Germany; and CIBSS-Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| | - Peter Kohl
- Department of Physiology and Biophysics and School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/Bad Krozingen, Medical Faculty of the University of Freiburg, Freiburg, Germany; and CIBSS-Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
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15
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Böhm A, Vachalcova M, Snopek P, Bacharova L, Komarova D, Hatala R. Molecular Mechanisms, Diagnostic Aspects and Therapeutic Opportunities of Micro Ribonucleic Acids in Atrial Fibrillation. Int J Mol Sci 2020; 21:ijms21082742. [PMID: 32326592 PMCID: PMC7215603 DOI: 10.3390/ijms21082742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 12/22/2022] Open
Abstract
Micro ribonucleic acids (miRNAs) are short non-coding RNA molecules responsible for regulation of gene expression. They are involved in many pathophysiological processes of a wide spectrum of diseases. Recent studies showed their involvement in atrial fibrillation. They seem to become potential screening biomarkers for atrial fibrillation and even treatment targets for this arrhythmia. The aim of this review article was to summarize the latest knowledge about miRNA and their molecular relation to the pathophysiology, diagnosis and treatment of atrial fibrillation.
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Affiliation(s)
- Allan Böhm
- National Cardiovascular Institute, 831 01 Bratislava, Slovakia;
- Faculty of Medicine, Slovak Medical University, 831 01 Bratislava, Slovakia
- Academy—Research Organization, 811 02 Bratislava, Slovakia; (M.V.); (P.S.); (D.K.)
- Correspondence:
| | - Marianna Vachalcova
- Academy—Research Organization, 811 02 Bratislava, Slovakia; (M.V.); (P.S.); (D.K.)
- East-Slovak Institute of Cardiovascular Diseases, 040 11 Kosice, Slovakia
| | - Peter Snopek
- Academy—Research Organization, 811 02 Bratislava, Slovakia; (M.V.); (P.S.); (D.K.)
- Cardiology Clinic Faculty Hospital, 950 01 Nitra, Slovakia
- Saint Elisabeth University of Health and Social work, 811 02 Bratislava, Slovakia
| | - Ljuba Bacharova
- Faculty of Medicine, Comenius University, 813 72 Bratislava, Slovakia;
- International Laser Center, 841 04 Bratislava, Slovakia
| | - Dominika Komarova
- Academy—Research Organization, 811 02 Bratislava, Slovakia; (M.V.); (P.S.); (D.K.)
| | - Robert Hatala
- National Cardiovascular Institute, 831 01 Bratislava, Slovakia;
- Faculty of Medicine, Slovak Medical University, 831 01 Bratislava, Slovakia
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16
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Egorov YV, Lang D, Tyan L, Turner D, Lim E, Piro ZD, Hernandez JJ, Lodin R, Wang R, Schmuck EG, Raval AN, Ralphe CJ, Kamp TJ, Rosenshtraukh LV, Glukhov AV. Caveolae-Mediated Activation of Mechanosensitive Chloride Channels in Pulmonary Veins Triggers Atrial Arrhythmogenesis. J Am Heart Assoc 2019; 8:e012748. [PMID: 31597508 PMCID: PMC6818041 DOI: 10.1161/jaha.119.012748] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Atrial fibrillation often occurs in the setting of hypertension and associated atrial dilation with pathologically increased cardiomyocyte stretch. In the setting of atrial dilation, mechanoelectric feedback has been linked to the development of ectopic beats that trigger paroxysmal atrial fibrillation mainly originating from pulmonary veins (PVs). However, the precise mechanisms remain poorly understood. Methods and Results We identify mechanosensitive, swelling‐activated chloride ion channels (ICl,swell) as a crucial component of the caveolar mechanosensitive complex in rat and human cardiomyocytes. In vitro optical mapping of rat PV, single rat PV, and human cardiomyocyte patch clamp studies showed that stretch‐induced activation of ICl,swell leads to membrane depolarization and decreased action potential amplitude, which trigger conduction discontinuities and both ectopic and reentrant activities within the PV. Reverse transcription quantitative polymerase chain reaction, immunofluorescence, and coimmunoprecipitation studies showed that ICl,swell likely consists of at least 2 components produced by mechanosensitive ClC‐3 (chloride channel‐3) and SWELL1 (also known as LRRC8A [leucine rich repeat containing protein 8A]) chloride channels, which form a macromolecular complex with caveolar scaffolding protein Cav3 (caveolin 3). Downregulation of Cav3 protein expression and disruption of caveolae structures during chronic hypertension in spontaneously hypertensive rats facilitates activation of ICl,swell and increases PV sensitivity to stretch 10‐ to 50‐fold, promoting the development of atrial fibrillation. Conclusions Our findings identify caveolae‐mediated activation of mechanosensitive ICl,swell as a critical cause of PV ectopic beats that can initiate atrial arrhythmias including atrial fibrillation. This mechanism is exacerbated in the setting of chronically elevated blood pressures.
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Affiliation(s)
- Yuriy V. Egorov
- Laboratory of Heart ElectrophysiologyCardiology Research CentreMoscowRussian Federation
| | - Di Lang
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Leonid Tyan
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Daniel Turner
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Evi Lim
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Zachary D. Piro
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Jonathan J. Hernandez
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
- Department of PediatricsPediatric CardiologyUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Rylie Lodin
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Rose Wang
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Eric G. Schmuck
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Amish N. Raval
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Carter J. Ralphe
- Department of PediatricsPediatric CardiologyUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Timothy J. Kamp
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | | | - Alexey V. Glukhov
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
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17
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Masè M, Grasso M, Avogaro L, Nicolussi Giacomaz M, D'Amato E, Tessarolo F, Graffigna A, Denti MA, Ravelli F. Upregulation of miR-133b and miR-328 in Patients With Atrial Dilatation: Implications for Stretch-Induced Atrial Fibrillation. Front Physiol 2019; 10:1133. [PMID: 31551809 PMCID: PMC6748158 DOI: 10.3389/fphys.2019.01133] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/16/2019] [Indexed: 12/12/2022] Open
Abstract
Atrial stretch and dilatation are common features of many clinical conditions predisposing to atrial fibrillation (AF). MicroRNAs (miRs) are emerging as potential molecular determinants of AF, but their relationship with atrial dilatation (AD) is poorly understood. The present study was designed to assess the specific miR expression profiles associated with AD in human atrial tissue. The expressions of a preselected panel of miRs, previously described as playing a role in cardiac disease, were quantified by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) in atrial tissue samples from 30 cardiac surgery patients, who were characterized by different grades of AD and arrhythmic profiles. Our results showed that AD per se was associated with significant up-regulation of miR-328-3p and miR-133b (p < 0.05) with respect to controls, with a fold-change of 1.53 and 1.74, respectively. In a multivariate model including AD and AF as independent variables, miR-328-3p expression was mainly associated with AD grade (p < 0.05), while miR-133b was related to both AD (p < 0.005) and AF (p < 0.05), the two factors exerting opposite modulation effects. The presence of AF was associated with significant (p < 0.05) up-regulation of the expression level of miR-1-3p, miR-21-5p, miR-29a-3p, miR-208b-3p, and miR-590-5p. These results showed the existence of specific alterations of miR expression associated with AD, which may pave the way to future experimental studies to test the involvement of post-transcriptional mechanisms in the stretch-induced formation of a pro-arrhythmic substrate.
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Affiliation(s)
- Michela Masè
- Laboratory of Biophysics and Biosignals, University of Trento, Trento, Italy.,Healthcare Research and Innovation Program, Bruno Kessler Foundation, Trento, Italy
| | - Margherita Grasso
- Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Laura Avogaro
- Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | | | - Elvira D'Amato
- Laboratory of Biophysics and Biosignals, University of Trento, Trento, Italy
| | - Francesco Tessarolo
- Healthcare Research and Innovation Program, Bruno Kessler Foundation, Trento, Italy
| | - Angelo Graffigna
- Division of Cardiac Surgery, Santa Chiara Hospital, Trento, Italy
| | - Michela Alessandra Denti
- Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Flavia Ravelli
- Laboratory of Biophysics and Biosignals, University of Trento, Trento, Italy
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18
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Hazim A, Belhamadia Y, Dubljevic S. Effects of mechano-electrical feedback on the onset of alternans: A computational study. CHAOS (WOODBURY, N.Y.) 2019; 29:063126. [PMID: 31266317 DOI: 10.1063/1.5095778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/05/2019] [Indexed: 06/09/2023]
Abstract
Cardiac alternans is a heart rhythm instability that is associated with cardiac arrhythmias and may lead to sudden cardiac death. The onset of this instability, which is linked to period-doubling bifurcation and may be a route to chaos, is of particular interest. Mechano-electric feedback depicts the effects of tissue deformation on cardiac excitation. The main effect of mechano-electric feedback is delivered via the so-called stretch-activated ion channels and is caused by stretch-activated currents. Mechano-electric feedback, which is believed to have proarrhythmic and antiarrhythmic effects on cardiac electrophysiology, affects the action potential duration in a manner dependent on cycle length, but the mechanisms by which this occurs remain to be elucidated. In this study, a biophysically detailed electromechanical model of cardiac tissue is employed to show how a stretch-activated current can affect the action potential duration at cellular and tissue levels, illustrating its effects on the onset of alternans. Also, using a two-dimensional iterated map that incorporates stretch-activated current effects, we apply linear stability analysis to study the stability of the bifurcation. We show that alternans bifurcation can be prevented depending on the strength of the stretch-activated current.
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Affiliation(s)
- Azzam Hazim
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta T6G 2V2, Canada
| | - Youssef Belhamadia
- Department of Mathematics and Statistics, American University of Sharjah, Sharjah, United Arab Emirates
| | - Stevan Dubljevic
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta T6G 2V4, Canada
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19
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Loppini A, Gizzi A, Ruiz-Baier R, Cherubini C, Fenton FH, Filippi S. Competing Mechanisms of Stress-Assisted Diffusivity and Stretch-Activated Currents in Cardiac Electromechanics. Front Physiol 2018; 9:1714. [PMID: 30559677 PMCID: PMC6287028 DOI: 10.3389/fphys.2018.01714] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 11/14/2018] [Indexed: 12/13/2022] Open
Abstract
We numerically investigate the role of mechanical stress in modifying the conductivity properties of cardiac tissue, and also assess the impact of these effects in the solutions generated by computational models for cardiac electromechanics. We follow the recent theoretical framework from Cherubini et al. (2017), proposed in the context of general reaction-diffusion-mechanics systems emerging from multiphysics continuum mechanics and finite elasticity. In the present study, the adapted models are compared against preliminary experimental data of pig right ventricle fluorescence optical mapping. These data contribute to the characterization of the observed inhomogeneity and anisotropy properties that result from mechanical deformation. Our novel approach simultaneously incorporates two mechanisms for mechano-electric feedback (MEF): stretch-activated currents (SAC) and stress-assisted diffusion (SAD); and we also identify their influence into the nonlinear spatiotemporal dynamics. It is found that (i) only specific combinations of the two MEF effects allow proper conduction velocity measurement; (ii) expected heterogeneities and anisotropies are obtained via the novel stress-assisted diffusion mechanisms; (iii) spiral wave meandering and drifting is highly mediated by the applied mechanical loading. We provide an analysis of the intrinsic structure of the nonlinear coupling mechanisms using computational tests conducted with finite element methods. In particular, we compare static and dynamic deformation regimes in the onset of cardiac arrhythmias and address other potential biomedical applications.
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Affiliation(s)
- Alessandro Loppini
- Unit of Nonlinear Physics and Mathematical Modeling, Department of Engineering, University Campus Bio-Medico of Rome, Rome, Italy
| | - Alessio Gizzi
- Unit of Nonlinear Physics and Mathematical Modeling, Department of Engineering, University Campus Bio-Medico of Rome, Rome, Italy
| | - Ricardo Ruiz-Baier
- Mathematical Institute, University of Oxford, Oxford, United Kingdom.,Laboratory of Mathematical Modelling, Institute of Personalized Medicine, Sechenov University, Moscow, Russia
| | - Christian Cherubini
- Unit of Nonlinear Physics and Mathematical Modeling, Department of Engineering, University Campus Bio-Medico of Rome, Rome, Italy.,ICRANet, Pescara, Italy
| | - Flavio H Fenton
- Georgia Institute of Technology, School of Physics, Atlanta, GA, United States
| | - Simonetta Filippi
- Unit of Nonlinear Physics and Mathematical Modeling, Department of Engineering, University Campus Bio-Medico of Rome, Rome, Italy.,ICRANet, Pescara, Italy
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20
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Berntsson J, Smith JG, Johnson LSB, Söderholm M, Borné Y, Melander O, Orho-Melander M, Nilsson J, Engström G. Increased vascular endothelial growth factor D is associated with atrial fibrillation and ischaemic stroke. Heart 2018; 105:553-558. [PMID: 30327392 DOI: 10.1136/heartjnl-2018-313684] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/31/2018] [Accepted: 09/19/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Vascular endothelial growth factor D (VEGF-D) has important functions in lymphangiogenesis and angiogenesis. High plasma levels of VEGF-D have been associated with incidence of heart failure. The association of VEGF-D with atrial fibrillation (AF) and stroke is unclear and we hypothesised that VEGF-D could also be associated with incidence of AF and ischaemic stroke. METHODS VEGF-D was measured in fasting blood samples of 4689 subjects (40% men) without a history of AF from the Malmö Diet and Cancer Study, a prospective, population-based study in Sweden. Median age was 58 years (range 46-68). Cox regression analyses, adjusted for multiple risk factors, was used to assess AF and ischaemic stroke risk in relation to VEGF-D levels. RESULTS During a median follow-up time of 20.6 years, there were 637 cases of incident AF and 322 cases of first ischaemic stroke. After adjustment, VEGF-D was significantly associated with AF (HR 1.13(95% CI 1.04 to 1.23) per 1 SD increase) and ischaemic stroke (HR 1.14(95% CI 1.02 to 1.28) per 1 SD). The association with ischaemic stroke was explained by an increased incidence of AF-related stroke. HRs per 1 SD were 1.34 (95% CI 1.04 to 1.71) for AF-related ischaemic stroke and 1.04 (95% CI 0.90 to 1.19) for ischaemic stroke without AF. CONCLUSIONS Increased VEGF-D concentrations were associated with AF and ischaemic stroke. The relationship with ischaemic stroke was more pronounced in subjects with a diagnosis of AF.
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Affiliation(s)
- John Berntsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.,Department of Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Linda S B Johnson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Martin Söderholm
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Malmö, Sweden
| | - Yan Borné
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Marju Orho-Melander
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jan Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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21
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Denham NC, Pearman CM, Caldwell JL, Madders GWP, Eisner DA, Trafford AW, Dibb KM. Calcium in the Pathophysiology of Atrial Fibrillation and Heart Failure. Front Physiol 2018; 9:1380. [PMID: 30337881 PMCID: PMC6180171 DOI: 10.3389/fphys.2018.01380] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/11/2018] [Indexed: 12/20/2022] Open
Abstract
Atrial fibrillation (AF) is commonly associated with heart failure. A bidirectional relationship exists between the two-AF exacerbates heart failure causing a significant increase in heart failure symptoms, admissions to hospital and cardiovascular death, while pathological remodeling of the atria as a result of heart failure increases the risk of AF. A comprehensive understanding of the pathophysiology of AF is essential if we are to break this vicious circle. In this review, the latest evidence will be presented showing a fundamental role for calcium in both the induction and maintenance of AF. After outlining atrial electrophysiology and calcium handling, the role of calcium-dependent afterdepolarizations and atrial repolarization alternans in triggering AF will be considered. The atrial response to rapid stimulation will be discussed, including the short-term protection from calcium overload in the form of calcium signaling silencing and the eventual progression to diastolic calcium leak causing afterdepolarizations and the development of an electrical substrate that perpetuates AF. The role of calcium in the bidirectional relationship between heart failure and AF will then be covered. The effects of heart failure on atrial calcium handling that promote AF will be reviewed, including effects on both atrial myocytes and the pulmonary veins, before the aspects of AF which exacerbate heart failure are discussed. Finally, the limitations of human and animal studies will be explored allowing contextualization of what are sometimes discordant results.
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Affiliation(s)
- Nathan C. Denham
- Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | | | | | | | | | | | - Katharine M. Dibb
- Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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22
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Nikolova-Krstevski V, Wagner S, Yu ZY, Cox CD, Cvetkovska J, Hill AP, Huttner IG, Benson V, Werdich AA, MacRae C, Feneley MP, Friedrich O, Martinac B, Fatkin D. Endocardial TRPC-6 Channels Act as Atrial Mechanosensors and Load-Dependent Modulators of Endocardial/Myocardial Cross-Talk. ACTA ACUST UNITED AC 2017; 2:575-590. [PMID: 30062171 PMCID: PMC6058914 DOI: 10.1016/j.jacbts.2017.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/05/2017] [Accepted: 05/22/2017] [Indexed: 12/01/2022]
Abstract
Mechanoelectrical feedback may increase arrhythmia susceptibility, but the molecular mechanisms are incompletely understood. This study showed that mechanical stretch altered the localization, protein levels, and function of the cation-selective transient receptor potential channel (TRPC)-6 in atrial endocardial cells in humans, pigs, and mice. In endocardial/myocardial cross-talk studies, addition of media from porcine atrial endocardium (AE) cells altered the calcium (Ca2+) transient characteristics of human-induced pluripotent stem cell-derived cardiomyocytes. These changes did not occur with media from stretched AE cells. Our data suggested that endocardial TRPC-6-dependent paracrine signaling may modulate myocardial Ca2+ homeostasis under basal conditions and protect against stretch-induced atrial arrhythmias.
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Key Words
- AE, atrial endocardium
- AF, atrial fibrillation
- APB, aminoethoxydiphenyl borate
- Ab, antibody
- CM, cardiomyocyte
- Ca2+, calcium
- Dil-Ac-LDL, dil acetylated−low-density lipoprotein
- ET, endothelin
- HUVEC, human umbilical vein endothelial cell
- OAG, 1-oleoyl-2-acetyl-sn-glycerol
- TAC, thoracic aortic constriction
- TRPC, transient receptor potential channel
- Tet, tetanus toxin
- [Ca2+]i, intracellular global Ca2+
- atrial endocardium
- endothelium
- iPS, induced pluripotent stem
- mechanical stretch
- transient receptor potential channels
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Affiliation(s)
- Vesna Nikolova-Krstevski
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Soeren Wagner
- Department of Anesthesiology, University Clinic Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Ze Yan Yu
- St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia.,Cardiac Physiology and Transplantation Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
| | - Charles D Cox
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
| | - Jasmina Cvetkovska
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
| | - Adam P Hill
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Inken G Huttner
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Victoria Benson
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andreas A Werdich
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Calum MacRae
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael P Feneley
- St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia.,Cardiac Physiology and Transplantation Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,Cardiology Department, St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Oliver Friedrich
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,Institute of Medical Biotechnology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Boris Martinac
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Diane Fatkin
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia.,Cardiology Department, St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
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23
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Cherubini C, Filippi S, Gizzi A, Ruiz-Baier R. A note on stress-driven anisotropic diffusion and its role in active deformable media. J Theor Biol 2017; 430:221-228. [PMID: 28755956 DOI: 10.1016/j.jtbi.2017.07.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/10/2017] [Accepted: 07/13/2017] [Indexed: 12/13/2022]
Abstract
We introduce a new model to describe diffusion processes within active deformable media. Our general theoretical framework is based on physical and mathematical considerations, and it suggests to employ diffusion tensors directly influenced by the coupling with mechanical stress. The proposed generalised reaction-diffusion-mechanics model reveals that initially isotropic and homogeneous diffusion tensors turn into inhomogeneous and anisotropic quantities due to the intrinsic structure of the nonlinear coupling. We study the physical properties leading to these effects, and investigate mathematical conditions for its occurrence. Together, the mathematical model and the numerical results obtained using a mixed-primal finite element method, clearly support relevant consequences of stress-driven diffusion into anisotropy patterns, drifting, and conduction velocity of the resulting excitation waves. Our findings also indicate the applicability of this novel approach in the description of mechano-electric feedback in actively deforming bio-materials such as the cardiac tissue.
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Affiliation(s)
- Christian Cherubini
- Unit of Nonlinear Physics and Mathematical Modeling, Department of Engineering, University Campus Bio-Medico of Rome, Via A. del Portillo 21, 00128 Rome, Italy; International Center for Relativistic Astrophysics, I.C.R.A., University Campus Bio-Medico of Rome, Via A. del Portillo 21, 00128 Rome, Italy.
| | - Simonetta Filippi
- Unit of Nonlinear Physics and Mathematical Modeling, Department of Engineering, University Campus Bio-Medico of Rome, Via A. del Portillo 21, 00128 Rome, Italy; International Center for Relativistic Astrophysics, I.C.R.A., University Campus Bio-Medico of Rome, Via A. del Portillo 21, 00128 Rome, Italy.
| | - Alessio Gizzi
- Unit of Nonlinear Physics and Mathematical Modeling, Department of Engineering, University Campus Bio-Medico of Rome, Via A. del Portillo 21, 00128 Rome, Italy.
| | - Ricardo Ruiz-Baier
- Mathematical Institute, University of Oxford, A. Wiles Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom.
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24
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Roever L, Resende ES, Roerver-Borges AS. Impact of pro-atrial natriuretic peptide in atrial fibrillation and stroke. Eur J Prev Cardiol 2017; 24:1239-1241. [PMID: 28452559 DOI: 10.1177/2047487317707832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Leonardo Roever
- 1 Federal University of Uberlândia, Department of Clinical Research, Uberlândia, Brazil
| | - Elmiro Santos Resende
- 1 Federal University of Uberlândia, Department of Clinical Research, Uberlândia, Brazil
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25
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Berntsson J, Smith JG, Nilsson PM, Hedblad B, Melander O, Engström G. Pro-atrial natriuretic peptide and prediction of atrial fibrillation and stroke: The Malmö Preventive Project. Eur J Prev Cardiol 2017; 24:788-795. [DOI: 10.1177/2047487317693948] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- John Berntsson
- Department of Clinical Sciences, Lund University, Sweden
| | - J Gustav Smith
- Department of Cardiology, Lund University, Sweden
- Department of Heart Failure and Valvular Disease, Skåne University Hospital, Sweden
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, USA
| | | | - Bo Hedblad
- Department of Clinical Sciences, Lund University, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Sweden
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26
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WIECZOREK MARCUS, HOELTGEN REINHARD. Transient Elimination of Posterior Right Ventricular Outflow Tract Ectopy by Sternal Pressure. Pacing Clin Electrophysiol 2016; 39:1156-1158. [DOI: 10.1111/pace.12887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/24/2016] [Accepted: 04/26/2016] [Indexed: 11/29/2022]
Affiliation(s)
- MARCUS WIECZOREK
- School of Medicine; Witten/Herdecke University; Bocholt Germany
- Division of Cardiology and Electrophysiology; St. Agnes-Hospital; Bocholt Germany
| | - REINHARD HOELTGEN
- Division of Cardiology and Electrophysiology; St. Agnes-Hospital; Bocholt Germany
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27
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Alonso S, Bär M, Echebarria B. Nonlinear physics of electrical wave propagation in the heart: a review. REPORTS ON PROGRESS IN PHYSICS. PHYSICAL SOCIETY (GREAT BRITAIN) 2016; 79:096601. [PMID: 27517161 DOI: 10.1088/0034-4885/79/9/096601] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The beating of the heart is a synchronized contraction of muscle cells (myocytes) that is triggered by a periodic sequence of electrical waves (action potentials) originating in the sino-atrial node and propagating over the atria and the ventricles. Cardiac arrhythmias like atrial and ventricular fibrillation (AF,VF) or ventricular tachycardia (VT) are caused by disruptions and instabilities of these electrical excitations, that lead to the emergence of rotating waves (VT) and turbulent wave patterns (AF,VF). Numerous simulation and experimental studies during the last 20 years have addressed these topics. In this review we focus on the nonlinear dynamics of wave propagation in the heart with an emphasis on the theory of pulses, spirals and scroll waves and their instabilities in excitable media with applications to cardiac modeling. After an introduction into electrophysiological models for action potential propagation, the modeling and analysis of spatiotemporal alternans, spiral and scroll meandering, spiral breakup and scroll wave instabilities like negative line tension and sproing are reviewed in depth and discussed with emphasis on their impact for cardiac arrhythmias.
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Affiliation(s)
- Sergio Alonso
- Physikalisch-Technische Bundesanstalt, Abbestr. 2-12 10587, Berlin, Germany. Department of Physics, Universitat Politècnica de Catalunya, Av. Dr. Marañón 44, E-08028 Barcelona, Spain
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28
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Quinn TA, Kohl P. Rabbit models of cardiac mechano-electric and mechano-mechanical coupling. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2016; 121:110-22. [PMID: 27208698 PMCID: PMC5067302 DOI: 10.1016/j.pbiomolbio.2016.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/01/2016] [Indexed: 12/11/2022]
Abstract
Cardiac auto-regulation involves integrated regulatory loops linking electrics and mechanics in the heart. Whereas mechanical activity is usually seen as 'the endpoint' of cardiac auto-regulation, it is important to appreciate that the heart would not function without feed-back from the mechanical environment to cardiac electrical (mechano-electric coupling, MEC) and mechanical (mechano-mechanical coupling, MMC) activity. MEC and MMC contribute to beat-by-beat adaption of cardiac output to physiological demand, and they are involved in various pathological settings, potentially aggravating cardiac dysfunction. Experimental and computational studies using rabbit as a model species have been integral to the development of our current understanding of MEC and MMC. In this paper we review this work, focusing on physiological and pathological implications for cardiac function.
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Affiliation(s)
- T Alexander Quinn
- Department of Physiology and Biophysics, Dalhousie University, Halifax, Canada.
| | - Peter Kohl
- Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany; National Heart and Lung Institute, Imperial College London, London, UK
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29
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Effect of transcatheter aortic valve replacement on P-wave duration, P-wave dispersion and left atrial size. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 12:613-7. [PMID: 26788037 PMCID: PMC4712366 DOI: 10.11909/j.issn.1671-5411.2015.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background P-wave dispersion (PWD), a measure of heterogeneity of atrial refractoriness, is defined as the difference between the maximum and minimum P-wave duration. In patients with severe aortic stenosis (AS), P-wave duration and PWD were shown to be increased, indicating atrial electrical remodeling. However, the effect of transcatheter aortic valve replacement (TAVR) on P-wave morphology has not been established yet. The aim of this study is to assess the short and long-term effects of TAVR with two types of bioprosthetic valves on P-wave duration and PWD in association with left atrial (LA) size. Methods Fifty-two (36 female) eligible patients in sinus rhythm who underwent transfemoral TAVR between June 01, 2012 and July 31, 2014 with either a Medtronic CoreValve (MCV) (n = 32) or an Edwards SAPIEN XT Valve (n = 20) were enrolled. Standard 12-lead electrocardiogram and echocardiographic evaluations were performed pre-procedurally, post-TAVR day one and 6 months post-TAVR. P-wave duration and PWD were measured and correlation analyses with echocardiographic variables were performed. Results P-wave duration and PWD were significantly decreased on post-TAVR day one (P < 0.05). They continued to decrease during the six month follow-up period, but were not significantly different from short-term values (P > 0.05). The decrease of LA diameter was found significant at the sixth-months of follow-up (P < 0.05). These changes were independent from the types of bioprosthetic valves implanted (P > 0.05). A positive correlation was detected between minimum P-wave duration and maximum aortic valve gradients at post-TAVR day one (r = 0.297, P = 0.032). Conclusions P-wave duration and PWD were significantly reduced early after TAVR indicating early reverse atrial electrical remodeling. Moreover, structural reverse remodeling of atrium was detected at the 6-months of follow-up. The effects of two types of bioprosthetic valves on atrial remodeling were similar.
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Kostin VA, Osipov GV. Transient and periodic spatiotemporal structures in a reaction-diffusion-mechanics system. CHAOS (WOODBURY, N.Y.) 2016; 26:013101. [PMID: 26826853 DOI: 10.1063/1.4938736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We study transient spatiotemporal structures induced by a weak space-time localized stimulus in an excitable contractile fiber within a two-component globally coupled reaction-diffusion model. The model which we develop allows us to analyze various regimes of excitation spreading and determine origin of the induced structures for various contraction types (defined by the fiber fixation) and global coupling strengths. One of the most notable effects we observed is the after-excitation effect. It leads to emergence of multiple excitation pulses excited by a single external stimulus and can result in long-lasting transient activity and appearance of new oscillatory attractor regimes, including the ones with multiple phase clusters.
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Affiliation(s)
- V A Kostin
- University of Nizhny Novgorod, Nizhny Novgorod 603950, Russia
| | - G V Osipov
- University of Nizhny Novgorod, Nizhny Novgorod 603950, Russia
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Barrabés JA, Inserte J, Agulló L, Rodríguez-Sinovas A, Alburquerque-Béjar JJ, Garcia-Dorado D. Effects of the Selective Stretch-Activated Channel Blocker GsMtx4 on Stretch-Induced Changes in Refractoriness in Isolated Rat Hearts and on Ventricular Premature Beats and Arrhythmias after Coronary Occlusion in Swine. PLoS One 2015; 10:e0125753. [PMID: 25938516 PMCID: PMC4418727 DOI: 10.1371/journal.pone.0125753] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/26/2015] [Indexed: 01/19/2023] Open
Abstract
Mechanical factors may contribute to ischemic ventricular arrhythmias. GsMtx4 peptide, a selective stretch-activated channel blocker, inhibits stretch-induced atrial arrhythmias. We aimed to assess whether GsMtx4 protects against ventricular ectopy and arrhythmias following coronary occlusion in swine. First, the effects of 170-nM GsMtx4 on the changes in the effective refractory period (ERP) induced by left ventricular (LV) dilatation were assessed in 8 isolated rat hearts. Then, 44 anesthetized, open-chest pigs subjected to 50-min left anterior descending artery occlusion and 2-h reperfusion were blindly allocated to GsMtx4 (57 μg/kg iv. bolus and 3.8 μg/kg/min infusion, calculated to attain the above concentration in plasma) or saline, starting 5-min before occlusion and continuing until after reflow. In rat hearts, LV distension induced progressive reductions in ERP (35±2, 32±2, and 29±2 ms at 0, 20, and 40 mmHg of LV end-diastolic pressure, respectively, P<0.001) that were prevented by GsMTx4 (33±2, 33±2, and 32±2 ms, respectively, P=0.002 for the interaction with LV end-diastolic pressure). Pigs receiving GsMtx4 had similar number of ventricular premature beats during the ischemic period as control pigs (110±28 vs. 103±21, respectively, P=0.842). There were not significant differences among treated and untreated animals in the incidence of ventricular fibrillation (13.6 vs. 22.7%, respectively, P=0.696) or tachycardia (36.4 vs. 50.0%, P=0.361) or in the number of ventricular tachycardia episodes during the occlusion period (1.8±0.7 vs. 5.5±2.6, P=0.323). Thus, GsMtx4 administered under these conditions does not suppress ventricular ectopy following coronary occlusion in swine. Whether it might protect against malignant arrhythmias should be tested in studies powered for these outcomes.
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Affiliation(s)
- José A. Barrabés
- Servicio de Cardiología, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- * E-mail:
| | - Javier Inserte
- Servicio de Cardiología, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Agulló
- Servicio de Cardiología, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Rodríguez-Sinovas
- Servicio de Cardiología, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan J. Alburquerque-Béjar
- Servicio de Cardiología, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Garcia-Dorado
- Servicio de Cardiología, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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Khouri Y, Stephens T, Ayuba G, AlAmeri H, Juratli N, McCullough PA. Understanding and Managing Atrial Fibrillation in Patients with Kidney Disease. J Atr Fibrillation 2015; 7:1069. [PMID: 27957157 DOI: 10.4022/jafib.1069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 03/21/2015] [Accepted: 03/28/2015] [Indexed: 01/21/2023]
Abstract
Chronic kidney disease (CKD) is on the rise due to the increased rate of related comorbidities such as diabetes and hypertension. Patients with CKD are at higher risk of cardiovascular events and atrial fibrillation is more common in this patient population. It is estimated that the prevalence of chronic atrial fibrillation in patients with CKD is two to three times higher than general population. Furthermore, patients with CKD are less likely to stay in sinus rhythm. Atrial fibrillation presents a major burden in this population due to difficult treatment decisions in the setting of a lack of evidence from randomized clinical trials. Patients with CKD have higher risk of stroke with more than half having a CHADS2 score ≥ 2. Anticoagulation have been shown to significantly decrease embolic stroke risk, however bleeding complications such as hemorrhagic stroke is twofold higher with warfarin. Although newer novel anticoagulation drugs have shown promise with lower intracranial hemorrhage risk in comparison to warfarin, lack clinical trial data in CKD and the unavailability of an antidote remains an issue. In this review, we discuss the treatment options available including anticoagulation and the evidence behind them in patients with chronic kidney disease suffering from atrial fibrillation.
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Affiliation(s)
- Yazan Khouri
- Oakwood Health System, Oakwood Hospital and Medical Center, Department of Cardiovascular Medicine, Dearborn, MI
| | - Tiona Stephens
- Oakwood Health System, Oakwood Hospital and Medical Center, Department of Cardiovascular Medicine, Dearborn, MI
| | - Gloria Ayuba
- Oakwood Health System, Oakwood Hospital and Medical Center, Department of Cardiovascular Medicine, Dearborn, MI
| | - Hazim AlAmeri
- Oakwood Health System, Oakwood Hospital and Medical Center, Department of Cardiovascular Medicine, Dearborn, MI
| | - Nour Juratli
- Oakwood Health System, Oakwood Hospital and Medical Center, Department of Cardiovascular Medicine, Dearborn, MI
| | - Peter A McCullough
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, The Heart Hospital, Plano, TX
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Ueda N, Yamamoto M, Honjo H, Kodama I, Kamiya K. The role of gap junctions in stretch-induced atrial fibrillation. Cardiovasc Res 2014; 104:364-70. [PMID: 25183791 PMCID: PMC4217686 DOI: 10.1093/cvr/cvu202] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aims The aim of this study was to investigate the role of gap junctions in atrial fibrillation (AF) by analysing the effects of a gap junction enhancer and blocker on AF vulnerability and electrophysiological properties of isolated hearts. Methods and results The acute atrial stretch model of AF in the isolated rabbit heart was used. Sustained AF (SAF) was induced by a burst of high-frequency stimulation of the Bachmann's bundle. The effective refractory period (ERP) was measured, and the total conduction time (TCT) and the pattern of conduction of the anterior surface of the left atrium were monitored by using an optical mapping system. The effect of enhancing gap junction function by 100–1000 nM rotigaptide (ZP123) and block by 30 μM carbenoxolone on these parameters was measured. SAF inducibility was increased with an elevation of intra-atrial pressure. Enhanced gap junction conductance induced by treatment with 100–1000 nM rotigaptide reduced SAF inducibility, and the gap junction blocker carbenoxolone increased SAF inducibility. In the absence of gap junction enhancer or blocker, normal conduction was observed at 0 cmH2O. When intra-atrial pressure was raised to 12 cmH2O, the conduction pattern was changed to a heterogeneous zig-zag pattern and TCT was prolonged. Conduction pattern was not affected by either agent. Rotigaptide shortened TCT, whereas carbenoxolone prolonged TCT. ERP was significantly shortened with an increase in intra-atrial pressure, but ERP was unaffected by either agent. Conclusion Gap junction modulators changed AF inducibility through their effects on atrial conduction, not by altering ERP.
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Affiliation(s)
- Norihiro Ueda
- Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan
| | - Mitsuru Yamamoto
- Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan
| | - Haruo Honjo
- Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan
| | | | - Kaichiro Kamiya
- Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan
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Sinner MF, Stepas KA, Moser CB, Krijthe BP, Aspelund T, Sotoodehnia N, Fontes JD, Janssens ACJW, Kronmal RA, Magnani JW, Witteman JC, Chamberlain AM, Lubitz SA, Schnabel RB, Vasan RS, Wang TJ, Agarwal SK, McManus DD, Franco OH, Yin X, Larson MG, Burke GL, Launer LJ, Hofman A, Levy D, Gottdiener JS, Kääb S, Couper D, Harris TB, Astor BC, Ballantyne CM, Hoogeveen RC, Arai AE, Soliman EZ, Ellinor PT, Stricker BHC, Gudnason V, Heckbert SR, Pencina MJ, Benjamin EJ, Alonso A. B-type natriuretic peptide and C-reactive protein in the prediction of atrial fibrillation risk: the CHARGE-AF Consortium of community-based cohort studies. Europace 2014; 16:1426-33. [PMID: 25037055 DOI: 10.1093/europace/euu175] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIMS B-type natriuretic peptide (BNP) and C-reactive protein (CRP) predict atrial fibrillation (AF) risk. However, their risk stratification abilities in the broad community remain uncertain. We sought to improve risk stratification for AF using biomarker information. METHODS AND RESULTS We ascertained AF incidence in 18 556 Whites and African Americans from the Atherosclerosis Risk in Communities Study (ARIC, n=10 675), Cardiovascular Health Study (CHS, n = 5043), and Framingham Heart Study (FHS, n = 2838), followed for 5 years (prediction horizon). We added BNP (ARIC/CHS: N-terminal pro-B-type natriuretic peptide; FHS: BNP), CRP, or both to a previously reported AF risk score, and assessed model calibration and predictive ability [C-statistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI)]. We replicated models in two independent European cohorts: Age, Gene/Environment Susceptibility Reykjavik Study (AGES), n = 4467; Rotterdam Study (RS), n = 3203. B-type natriuretic peptide and CRP were significantly associated with AF incidence (n = 1186): hazard ratio per 1-SD ln-transformed biomarker 1.66 [95% confidence interval (CI), 1.56-1.76], P < 0.0001 and 1.18 (95% CI, 1.11-1.25), P < 0.0001, respectively. Model calibration was sufficient (BNP, χ(2) = 17.0; CRP, χ(2) = 10.5; BNP and CRP, χ(2) = 13.1). B-type natriuretic peptide improved the C-statistic from 0.765 to 0.790, yielded an IDI of 0.027 (95% CI, 0.022-0.032), a relative IDI of 41.5%, and a continuous NRI of 0.389 (95% CI, 0.322-0.455). The predictive ability of CRP was limited (C-statistic increment 0.003). B-type natriuretic peptide consistently improved prediction in AGES and RS. CONCLUSION B-type natriuretic peptide, not CRP, substantially improved AF risk prediction beyond clinical factors in an independently replicated, heterogeneous population. B-type natriuretic peptide may serve as a benchmark to evaluate novel putative AF risk biomarkers.
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Affiliation(s)
- Moritz F Sinner
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, 81377 Munich, Germany
| | - Katherine A Stepas
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Carlee B Moser
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Bouwe P Krijthe
- Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands Netherlands Consortium for Healthy Aging (NCHA), 2300 RC Leiden, The Netherlands
| | - Thor Aspelund
- Icelandic Heart Association, Research Institute, IS-201 Kopavogur, Iceland The University of Iceland, IS-101 Reykjavik, Iceland
| | - Nona Sotoodehnia
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA 98195, USA Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 98101, USA
| | - João D Fontes
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
| | - A Cecile J W Janssens
- Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands Netherlands Consortium for Healthy Aging (NCHA), 2300 RC Leiden, The Netherlands
| | - Richard A Kronmal
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Jared W Magnani
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Jacqueline C Witteman
- Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands Netherlands Consortium for Healthy Aging (NCHA), 2300 RC Leiden, The Netherlands
| | | | - Steven A Lubitz
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02129, USA Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart Center, 20246 Hamburg-Eppendorf, Germany
| | - Ramachandran S Vasan
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Thomas J Wang
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA Cardiology Division, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sunil K Agarwal
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - David D McManus
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA Departments of Medicine and Quantitative Health Sciences, University of Massachusetts, Worcester, MA 01605, USA Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA 01609, USA
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Xiaoyan Yin
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
| | - Martin G Larson
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
| | - Gregory L Burke
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Lenore J Launer
- Laboratory of Epidemiology, Demography, and Biometry, National Institute of Aging, National Institutes of Health, Bethesda, MD 20892, USA
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands Netherlands Consortium for Healthy Aging (NCHA), 2300 RC Leiden, The Netherlands
| | - Daniel Levy
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA Center for Population Studies, NHLBI, Framingham, MA 01702, USA
| | - John S Gottdiener
- Division of Cardiology, University of Maryland Medical Center, Baltimore, MD 21201, USA
| | - Stefan Kääb
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, 81377 Munich, Germany Deutsches Zentrum für Herz-Kreislauferkrankungen (DZHK), partner site Munich Heart Alliance, 80802 Munich, Germany
| | - David Couper
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Tamara B Harris
- Laboratory of Epidemiology, Demography, and Biometry, National Institute of Aging, National Institutes of Health, Bethesda, MD 20892, USA
| | - Brad C Astor
- University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705, USA
| | - Christie M Ballantyne
- Baylor College of Medicine, Houston, TX 77030, USA Methodist DeBakey Heart and Vascular Center, Houston, TX 77030, USA
| | | | - Andrew E Arai
- Cardiovascular and Pulmonary Branch, NHLBI, Bethesda, MD 20892, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Patrick T Ellinor
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02129, USA Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Bruno H C Stricker
- Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands Netherlands Consortium for Healthy Aging (NCHA), 2300 RC Leiden, The Netherlands Department of Internal Medicine, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands Inspectorate for Health Care, 3500 GR The Hague, The Netherlands Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Vilmundur Gudnason
- Icelandic Heart Association, Research Institute, IS-201 Kopavogur, Iceland The University of Iceland, IS-101 Reykjavik, Iceland
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - Michael J Pencina
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Emelia J Benjamin
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA
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Buiten MS, de Bie MK, Rotmans JI, Gabreëls BA, van Dorp W, Wolterbeek R, Trines SA, Schalij MJ, Jukema JW, Rabelink TJ, van Erven L. The dialysis procedure as a trigger for atrial fibrillation: new insights in the development of atrial fibrillation in dialysis patients. Heart 2014; 100:685-90. [DOI: 10.1136/heartjnl-2013-305417] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Frommeyer G, Milberg P, Uphaus T, Kaiser D, Kaese S, Breithardt G, Eckardt L. Antiarrhythmic Effect of Ranolazine in Combination with Class III Drugs in an Experimental Whole-Heart Model of Atrial Fibrillation. Cardiovasc Ther 2013; 31:e63-71. [DOI: 10.1111/1755-5922.12035] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Gerrit Frommeyer
- Division of Electrophysiology; Department of Cardiovascular Medicine; University Hospital of Münster; Münster Germany
| | - Peter Milberg
- Division of Electrophysiology; Department of Cardiovascular Medicine; University Hospital of Münster; Münster Germany
| | - Timo Uphaus
- Division of Electrophysiology; Department of Cardiovascular Medicine; University Hospital of Münster; Münster Germany
| | - Dennis Kaiser
- Division of Electrophysiology; Department of Cardiovascular Medicine; University Hospital of Münster; Münster Germany
| | - Sven Kaese
- Division of Electrophysiology; Department of Cardiovascular Medicine; University Hospital of Münster; Münster Germany
| | - Günter Breithardt
- Division of Electrophysiology; Department of Cardiovascular Medicine; University Hospital of Münster; Münster Germany
| | - Lars Eckardt
- Division of Electrophysiology; Department of Cardiovascular Medicine; University Hospital of Münster; Münster Germany
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Milberg P, Frommeyer G, Ghezelbash S, Rajamani S, Osada N, Razvan R, Belardinelli L, Breithardt G, Eckardt L. Sodium channel block by ranolazine in an experimental model of stretch-related atrial fibrillation: prolongation of interatrial conduction time and increase in post-repolarization refractoriness. ACTA ACUST UNITED AC 2013; 15:761-9. [DOI: 10.1093/europace/eus399] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Bang CN, Greve AM, Abdulla J, Køber L, Gislason GH, Wachtell K. The preventive effect of statin therapy on new-onset and recurrent atrial fibrillation in patients not undergoing invasive cardiac interventions: a systematic review and meta-analysis. Int J Cardiol 2012; 167:624-30. [PMID: 22999824 DOI: 10.1016/j.ijcard.2012.08.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 08/31/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous meta-analyses suggest that pre-procedural use of statin therapy may reduce atrial fibrillation (AF) following invasive cardiac interventions (coronary artery by-pass grafting and percutaneous coronary intervention). However, the current evidence on the benefit of statins unrelated to invasive cardiac interventions has not been clarified systematically. METHODS Through a systematic literature search, trials examining the effect of statin therapy on AF were selected. Trials using statins before any percutaneous or surgical cardiac interventions were excluded. RESULTS The search identified 11 randomized and 16 observational eligible studies, totaling 106,640 patients receiving statin therapy and 129,305 serving as controls. Fourteen studies investigated the effect of statins on new-onset AF, 13 studies investigated the effect of statins on recurrent AF and one in both new-onset and recurrent AF. In the statin versus control group the mean age was 60.7 ± 8.3 versus 68.6 ± 6.2 years and females comprised 8.4% versus 10.3%. Statin therapy was associated with significant reduction of AF (Risk ratio (RR): 0.81 [95% confidence interval (CI): 0.80-0.83], p<0.001) combining all studies. Assessing exclusively randomized trials, statin therapy showed no significant risk reduction (RR: 0.97 [95%CI: 0.90-1.05], p=0.509), heterogeneity p>0.05. Assessing exclusively observational studies the risk reduction of new-onset AF was 12% (RR: 0.88 [95%CI: 0.85-0.91], p<0.001) and recurrent AF 15% (RR: 0.85 [95%CI: 0.80-0.90], p<0.001), heterogeneity p<0.001. CONCLUSION The hitherto published randomized clinical trials do not support a beneficial effect of statins on AF in patients not undergoing invasive cardiac interventions. This is in contrast to the results of observational and interventional studies.
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Affiliation(s)
- Casper N Bang
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark.
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Jacquemet V, Kappenberger L, Henriquez CS. Modeling atrial arrhythmias: impact on clinical diagnosis and therapies. IEEE Rev Biomed Eng 2012; 1:94-114. [PMID: 22274901 DOI: 10.1109/rbme.2008.2008242] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atrial arrhythmias are the most frequent sustained rhythm disorders in humans and often lead to severe complications such as heart failure and stroke. Despite the important insights provided by animal models into the mechanisms of atrial arrhythmias, direct translation of experimental findings to new therapies in patients has not been straightforward. With the advances in computer technology, large-scale electroanatomical computer models of the atria that integrate information from the molecular to organ scale have reached a level of sophistication that they can be used to interpret the outcome of experimental and clinical studies and aid in the rational design of therapies. This paper reviews the state-of-the-art of computer models of the electrical dynamics of the atria and discusses the evolving role of simulation in assisting the clinical diagnosis and treatment of atrial arrhythmias.
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Affiliation(s)
- Vincent Jacquemet
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.
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Collet A, Desaive T, Dauby PC. [One-dimensional time-dependent model of the cardiac pacemaker activity induced by the mechanoelectric feedback in a thermo-electro-mechanical background]. Ann Cardiol Angeiol (Paris) 2012; 61:156-161. [PMID: 22681984 DOI: 10.1016/j.ancard.2012.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 04/15/2012] [Indexed: 06/01/2023]
Abstract
AIM OF THE STUDY In a healthy heart, the mechanoelectric feedback (MEF) process acts as an intrinsic regulatory mechanism of the myocardium which allows the normal cardiac contraction by damping mechanical perturbations in order to generate a new healthy electromechanical situation. However, under certain conditions, the MEF can be a generator of dramatic arrhythmias by inducing local electrical depolarizations as a result of abnormal cardiac tissue deformations, via stretch-activated channels (SACs). Then, these perturbations can propagate in the whole heart and lead to global cardiac dysfunctions. In the present study, we qualitatively investigate the influence of temperature on autonomous electrical activity generated by the MEF. METHOD We introduce a one-dimensional time-dependent model containing all the key ingredients that allow accounting for the excitation-contraction coupling, the MEF and the thermoelectric coupling. RESULTS Our simulations show that an autonomous electrical activity can be induced by cardiac deformations, but only inside a certain temperature interval. In addition, in some cases, the autonomous electrical activity takes place in a periodic way like a pacemaker. We also highlight that some properties of action potentials, generated by the mechanoelectric feedback, are significantly influenced by temperature. Moreover, in the situation where a pacemaker activity occurs, we also show that the period is heavily temperature-dependent. CONCLUSIONS Our qualitative model shows that the temperature is a significant factor with regards to the electromechanical behavior of the heart and more specifically, with regards to the autonomous electrical activity induced by the cardiac tissue deformations.
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Affiliation(s)
- A Collet
- Cardiovascular research center, université de Liège, allée du 6-août, 17 (B5a), 4000 Liège, Belgique.
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Shen H, Choe W. Spontaneous high-frequency action potential. SCIENCE CHINA-LIFE SCIENCES 2011; 54:311-35. [PMID: 21509656 DOI: 10.1007/s11427-011-4157-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 12/27/2010] [Indexed: 11/24/2022]
Abstract
Action potential, which is the foundation of physiology and electrophysiology, is most vital in physiological research. This work starts by detecting cardiac electrophysiology (tachyarrhythmias), combined with all spontaneous discharge phenomena in vivo such as wound currents and spontaneous neuropathic pain, elaborates from generation, induction, initiation, to all of the features of spontaneous high-frequency action potential-SSL action potential mechanism, i.e., connecting-end hyperpolarization initiates spontaneous depolarization and action potential in somatic membrane. This work resolves the conundrums of in vivo spontaneous discharge in tachyarrhythmias, wounds, denervation supersensitivity, neurogenic pain (hyperalgesia and allodynia), epileptic discharge and diabetic pain in pathophysiological and clinical researches that have puzzled people for a hundred years.
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Affiliation(s)
- Haiying Shen
- Department of Biochemistry and Molecular Biology, Medical Research Center and Biomedical Science Institute, School of Medicine, Kyung Hee University, Seoul 130-701, Republic of Korea
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Alterations of atrial electrophysiology related to hemodialysis session: insights from a multiscale computer model. J Electrocardiol 2011; 44:176-83. [DOI: 10.1016/j.jelectrocard.2010.11.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Indexed: 11/22/2022]
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Lee YL, Blaha MJ, Jones SR. Statin therapy in the prevention and treatment of atrial fibrillation. J Clin Lipidol 2011; 5:18-29. [DOI: 10.1016/j.jacl.2010.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 10/06/2010] [Accepted: 11/09/2010] [Indexed: 11/17/2022]
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Hammad FT, Lammers WJ, Stephen B, Lubbad L. Propagation of the electrical impulse in reversible unilateral ureteral obstruction as determined at high electrophysiological resolution. J Urol 2010; 185:744-50. [PMID: 21168883 DOI: 10.1016/j.juro.2010.09.078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE We investigated the propagation of electrical impulses in a reversible, complete or partial unilateral ureteral obstruction model in vivo. MATERIALS AND METHODS In Wistar rats the left mid ureter was completely (8) or partially (7) occluded and released after 24 hours. We recorded electrical activity of the left and right ureter before, during and after obstruction at different stages up to 2 weeks after obstruction using a high resolution, 64 extracellular electrode probe. RESULTS Complete obstruction in the left proximal ureter caused an immediate increase in frequency from a mean ± SEM of 14.8 ± 1.3 to 18.6 ± 1.7 per minute (p <0.05), followed by a 1.4 ± 0.9 per minute decrease (p <0.001). Within the first 2 days after reversal velocity gradually decreased from 1.82 ± 0.12 to 0.79 ± 0.17 cm per second (p <0.001). Release of obstruction gradually restored frequency and velocity, which returned to baseline at 2 weeks. Generally the alterations in rats with complete and partial obstruction were similar but they were less marked in those with partial obstruction. Distal to the obstruction site the impulses disappeared (38%) or propagated retrograde (43%) at some stage in the post-obstruction period. These abnormal impulse propagations also gradually disappeared in the post-obstruction stage. CONCLUSIONS After complete or partial ureteral obstruction there were immediate, significant changes in the propagation of electrical impulses in the proximal and distal left ureter, which were generally less marked after partial than after complete obstruction. Reversal of obstruction resulted in the gradual disappearance of this abnormality in 2 weeks.
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Affiliation(s)
- Fayez T Hammad
- Department of Surgery, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
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Kuijpers NHL, Potse M, van Dam PM, ten Eikelder HMM, Verheule S, Prinzen FW, Schotten U. Mechanoelectrical coupling enhances initiation and affects perpetuation of atrial fibrillation during acute atrial dilation. Heart Rhythm 2010; 8:429-36. [PMID: 21075218 DOI: 10.1016/j.hrthm.2010.11.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 11/03/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Acute atrial dilation increases the susceptibility to atrial fibrillation (AF). However, the mechanisms by which atrial stretch may contribute to the initiation and perpetuation of AF remain to be determined. OBJECTIVE The purpose of this study was to use a novel multiscale model of atrial electromechanics and mechanoelectrical feedback to test the hypothesis that acute stretch increases vulnerability to AF by heterogeneous activation of stretch-activated channels. METHODS Human atria were represented by a triangular mesh obtained from magnetic resonance imaging data. Atrial trabecular bundle structure was incorporated by varying thicknesses of the atrial wall. Atrial membrane behavior was modeled by the Courtemanche-Ramirez-Nattel model with the addition of a nonselective stretch-activated cation current (I(sac)). Mechanical behavior was modeled by a series elastic, a contractile, and a parallel elastic element in which contractile force was related to intracellular concentration of free calcium and sarcomere length. RESULTS Acute atrial dilation was simulated by increasing stretch throughout the atrial wall. Stimulation near the pulmonary vein ostia at an interval of 600 ms induced AF at an overall stretch ratio of 1.10. Initiation and perpetuation of AF in our model were related to increased dispersion of effective refractory period, conduction slowing, and local conduction block, all related to heterogeneous activation of I(sac). Upon local contraction, mechanoelectrical coupling affects perpetuation of AF by temporarily changing local excitability. CONCLUSION During acute atrial dilation, heterogeneous activation of I(sac) enhances initiation and can affect perpetuation of AF.
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Affiliation(s)
- Nico H L Kuijpers
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands.
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Hammad FT, Lammers WJ, Stephen B, Lubbad L. Propagation characteristics of the electrical impulse in the normal and obstructed ureter as determined at high electrophysiological resolution. BJU Int 2010; 108:E36-42. [PMID: 21044242 DOI: 10.1111/j.1464-410x.2010.09793.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the propagation of the electrical impulses in a unilateral ureteric obstruction model using a high-resolution technique in vivo. MATERIALS AND METHODS In Wistar rats (n= 15), the left mid-ureter was occluded and the electrical activity was recorded from the proximal and distal part of the obstructed ureter and from the right ureter at different times up to 2 weeks post-obstruction using 64 extracellular electrodes. RESULTS In the left ureter, impulses propagated in an antegrade direction at a frequency of 15.5 ± 1.3/min and a velocity of 1.6 ± 0.1 cm/s. Immediately post-obstruction, the proximal part showed an increase in frequency (19.1 ± 2.5/min; P < 0.05) followed by a gradual decrease (at 2 weeks: 2.5 ± 1.2/min; P < 0.001). The velocity of these impulses decreased gradually (at 2 weeks: 0.5 ± 0.1 cm/s; P < 0.05). Distally, the antegrade propagations gradually disappeared and, at 1 week, 33% of ureters showed retrograde impulses and 67% displayed no electrical activity. The frequency of both antegrade and retrograde impulses distal to the obstruction dropped immediately after obstruction so that, at 1 day, it was 1.0 ± 0.3 and 1.5 ± 0.2/min, respectively (P < 0.01 for both). The velocity of these antegrade and retrograde impulses showed a significant rise throughout the post-obstruction period. The right ureter showed only a transient increase in frequency from 18.7 ± 2.7 to 30.3 ± 6.1/min (P < 0.05). CONCLUSIONS Using this high-resolution technique, it is concluded that, after ureteric obstruction, there were immediate and significant changes in the propagation of electrical impulses in the proximal and distal left ureter and in the right ureter, all of which behaved differently. This data may provide a better insight into the electrophysiological function of the normal and obstructed ureter.
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Affiliation(s)
- Fayez T Hammad
- Department of Surgery, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
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RAVELLI FLAVIA, MASÈ MICHELA, DEL GRECO MAURIZIO, MARINI MASSIMILIANO, DISERTORI MARCELLO. Acute Atrial Dilatation Slows Conduction and Increases AF Vulnerability in the Human Atrium. J Cardiovasc Electrophysiol 2010; 22:394-401. [DOI: 10.1111/j.1540-8167.2010.01939.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Coronel R, Langerveld J, Boersma LVA, Wever EFD, Bon L, van Dessel PFHM, Linnenbank AC, van Gilst WH, Ernst SMPG, Opthof T, van Hemel NM. Left atrial pressure reduction for mitral stenosis reverses left atrial direction-dependent conduction abnormalities. Cardiovasc Res 2009; 85:711-8. [PMID: 19939964 DOI: 10.1093/cvr/cvp374] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ruben Coronel
- Experimental Cardiology Group , Center for Heart Failure Research, Academic Medical Center, rm K2-112, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Alvarez-Lacalle E, Echebarria B. Global coupling in excitable media provides a simplified description of mechanoelectrical feedback in cardiac tissue. PHYSICAL REVIEW. E, STATISTICAL, NONLINEAR, AND SOFT MATTER PHYSICS 2009; 79:031921. [PMID: 19391985 DOI: 10.1103/physreve.79.031921] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 02/16/2009] [Indexed: 05/27/2023]
Abstract
Cardiac mechanoelectric feedback can play an important role in different heart pathologies. In this paper, we show that mechanoelectric models which describe both the electric propagation and the mechanic contraction of cardiac tissue naturally lead to close systems of equations with global coupling among the variables. This point is exemplified using the Nash-Panfilov model, which reduces to a FitzHugh-Nagumo-type equation with global coupling in the linear elastic regime. We explain the appearance of self-oscillatory regimes in terms of the system nullclines and describe the different dynamical attractors. Finally, we study their basin of attraction in terms of the system size and the strength of the stretch-induced currents.
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Affiliation(s)
- E Alvarez-Lacalle
- Departament de Física Aplicada, Universitat Politècnica de Catalunya, Av. Dr. Marañón 44-50, E-08028 Barcelona, Spain
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