1
|
Hu Z, Wang M, Zheng S, Xu X, Zhang Z, Ge Q, Li J, Yao Y. Clinical Decision Support Requirements for Ventricular Tachycardia Diagnosis Within the Frameworks of Knowledge and Practice: Survey Study. JMIR Hum Factors 2024; 11:e55802. [PMID: 38530337 PMCID: PMC11005434 DOI: 10.2196/55802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/15/2024] [Accepted: 03/02/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Ventricular tachycardia (VT) diagnosis is challenging due to the similarity between VT and some forms of supraventricular tachycardia, complexity of clinical manifestations, heterogeneity of underlying diseases, and potential for life-threatening hemodynamic instability. Clinical decision support systems (CDSSs) have emerged as promising tools to augment the diagnostic capabilities of cardiologists. However, a requirements analysis is acknowledged to be vital for the success of a CDSS, especially for complex clinical tasks such as VT diagnosis. OBJECTIVE The aims of this study were to analyze the requirements for a VT diagnosis CDSS within the frameworks of knowledge and practice and to determine the clinical decision support (CDS) needs. METHODS Our multidisciplinary team first conducted semistructured interviews with seven cardiologists related to the clinical challenges of VT and expected decision support. A questionnaire was designed by the multidisciplinary team based on the results of interviews. The questionnaire was divided into four sections: demographic information, knowledge assessment, practice assessment, and CDS needs. The practice section consisted of two simulated cases for a total score of 10 marks. Online questionnaires were disseminated to registered cardiologists across China from December 2022 to February 2023. The scores for the practice section were summarized as continuous variables, using the mean, median, and range. The knowledge and CDS needs sections were assessed using a 4-point Likert scale without a neutral option. Kruskal-Wallis tests were performed to investigate the relationship between scores and practice years or specialty. RESULTS Of the 687 cardiologists who completed the questionnaire, 567 responses were eligible for further analysis. The results of the knowledge assessment showed that 383 cardiologists (68%) lacked knowledge in diagnostic evaluation. The overall average score of the practice assessment was 6.11 (SD 0.55); the etiological diagnosis section had the highest overall scores (mean 6.74, SD 1.75), whereas the diagnostic evaluation section had the lowest scores (mean 5.78, SD 1.19). A majority of cardiologists (344/567, 60.7%) reported the need for a CDSS. There was a significant difference in practice competency scores between general cardiologists and arrhythmia specialists (P=.02). CONCLUSIONS There was a notable deficiency in the knowledge and practice of VT among Chinese cardiologists. Specific knowledge and practice support requirements were identified, which provide a foundation for further development and optimization of a CDSS. Moreover, it is important to consider clinicians' specialization levels and years of practice for effective and personalized support.
Collapse
Affiliation(s)
- Zhao Hu
- Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Min Wang
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Si Zheng
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaowei Xu
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhuxin Zhang
- Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Qiaoyue Ge
- West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jiao Li
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan Yao
- Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| |
Collapse
|
2
|
Dai L, Zuo Y, Lv Y, Zeng H, Chen L. Diabetes status, genetic susceptibility, and incident arrhythmias: A prospective cohort study of 457,151 participants. Diabetes Metab Syndr 2024; 18:102971. [PMID: 38458077 DOI: 10.1016/j.dsx.2024.102971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/10/2024]
Abstract
AIMS The association of diabetes onset age and duration with incident arrhythmias remains unclear. This study evaluates the association of diabetes onset age and duration with incident arrhythmias and assesses modifications by the genetic predisposition to atrial fibrillation (AF). METHODS We included 457,151 participants from the UK Biobank study. Multivariable Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) were used for the association between diabetes status, genetic predisposition, and risk of incident arrhythmias. The polygenic risk score (PRS) for AF comprised 142 single-nucleotide variants. RESULTS Over 12 years of follow-up, we documented 23,518 AF, 9079 bradyarrhythmia, 9280 conduction system diseases, 3358 supraventricular arrhythmias, and 3095 ventricular arrhythmias. Compared with non-diabetes, the risks of AF increased by 19%, 25%, and 36% for those with diabetes durations <5, 5-9, and ≥10 years, respectively. After multivariate adjustment, with the increase in diabetes onset age, the HRs of outcomes were gradually attenuated. The multivariable-adjusted HRs (95% CI) of diabetes for AF were 1.46 (1.24-1.71) in early middle age (<55 years), 1.21 (1.12-1.30) in late middle age (55-64 years), and 1.15 (1.06-1.24) in the elderly population (≥65 years). A significant interaction between diabetes status and AF-PRS for incident AF was observed (P for interaction <0.001). The same trends were observed for the other arrhythmias. CONCLUSIONS Diabetes was associated with higher risks of incident arrhythmias, and younger age at onset of diabetes was significantly associated with higher risk of subsequent arrhythmias.
Collapse
Affiliation(s)
- Lei Dai
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Provincial Engineering Research Center of Vascular Interventional Therapy, Wuhan, China
| | - Yuyue Zuo
- Department of Dermatology, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanling Lv
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hesong Zeng
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Provincial Engineering Research Center of Vascular Interventional Therapy, Wuhan, China.
| | - Liangkai Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
3
|
Pilia N, Schuler S, Rees M, Moik G, Potyagaylo D, Dössel O, Loewe A. Non-invasive localization of the ventricular excitation origin without patient-specific geometries using deep learning. Artif Intell Med 2023; 143:102619. [PMID: 37673581 DOI: 10.1016/j.artmed.2023.102619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 06/18/2023] [Accepted: 06/24/2023] [Indexed: 09/08/2023]
Abstract
Cardiovascular diseases account for 17 million deaths per year worldwide. Of these, 25% are categorized as sudden cardiac death, which can be related to ventricular tachycardia (VT). This type of arrhythmia can be caused by focal activation sources outside the sinus node. Catheter ablation of these foci is a curative treatment in order to inactivate the abnormal triggering activity. However, the localization procedure is usually time-consuming and requires an invasive procedure in the catheter lab. To facilitate and expedite the treatment, we present two novel localization support techniques based on convolutional neural networks (CNNs) that address these clinical needs. In contrast to existing methods, our approaches were designed to be independent of the patient-specific geometry and directly applicable to surface ECG signals, while also delivering a binary transmural position. Moreover, one of the method's outputs can be interpreted as several ranked solutions. The CNNs were trained on a dataset containing only simulated data and evaluated both on simulated test data and clinical data. On a novel large and open simulated dataset, the median test error was below 3 mm. The median localization error on the unseen clinical data ranged from 32 mm to 41 mm without optimizing the pre-processing and CNN to the clinical data. Interpreting the output of one of the approaches as ranked solutions, the best median error of the top-3 solutions decreased to 20 mm on the clinical data. The transmural position was correctly detected in up to 82% of all clinical cases. These results demonstrate a proof of principle to utilize CNNs to localize the activation source without the intrinsic need for patient-specific geometrical information. Furthermore, providing multiple solutions can assist physicians in identifying the true activation source amongst more than one possible location. With further optimization to clinical data, these methods have high potential to accelerate clinical interventions, replace certain steps within these procedures and consequently reduce procedural risk and improve VT patient outcomes.
Collapse
Affiliation(s)
- Nicolas Pilia
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
| | - Steffen Schuler
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Maike Rees
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Gerald Moik
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | | | - Olaf Dössel
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Axel Loewe
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| |
Collapse
|
4
|
Mitochondrial Dysfunction in Cardiac Arrhythmias. Cells 2023; 12:cells12050679. [PMID: 36899814 PMCID: PMC10001005 DOI: 10.3390/cells12050679] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Electrophysiological and structural disruptions in cardiac arrhythmias are closely related to mitochondrial dysfunction. Mitochondria are an organelle generating ATP, thereby satisfying the energy demand of the incessant electrical activity in the heart. In arrhythmias, the homeostatic supply-demand relationship is impaired, which is often accompanied by progressive mitochondrial dysfunction leading to reduced ATP production and elevated reactive oxidative species generation. Furthermore, ion homeostasis, membrane excitability, and cardiac structure can be disrupted through pathological changes in gap junctions and inflammatory signaling, which results in impaired cardiac electrical homeostasis. Herein, we review the electrical and molecular mechanisms of cardiac arrhythmias, with a particular focus on mitochondrial dysfunction in ionic regulation and gap junction action. We provide an update on inherited and acquired mitochondrial dysfunction to explore the pathophysiology of different types of arrhythmias. In addition, we highlight the role of mitochondria in bradyarrhythmia, including sinus node dysfunction and atrioventricular node dysfunction. Finally, we discuss how confounding factors, such as aging, gut microbiome, cardiac reperfusion injury, and electrical stimulation, modulate mitochondrial function and cause tachyarrhythmia.
Collapse
|
5
|
Wang S, Jia T, Liu G, Lu X, Yang Q, Zhu C. Mapping the research trends and hot topics of ventricular arrhythmia: A bibliometric analysis from 2001 to 2020. Front Cardiovasc Med 2022; 9:856695. [PMID: 36337873 PMCID: PMC9631785 DOI: 10.3389/fcvm.2022.856695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 10/03/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Studies of ventricular arrhythmia (VA) have drawn much scholarly attention over the past two decades. Our study aimed to assess the current situation and detect the changing research trends of VA quantitatively and qualitatively. MATERIALS AND METHODS All the information used in our statistical and bibliometric analysis were collected and summarized from papers retrieved from the Web of Science Core Collection (WoSCC) database on December 22, 2021 using certain criteria. Visual analytics were realized using CiteSpace, VOSviewer, the bibliometrix R package, and the bibliometric online analysis platform. RESULTS A total of 6,897 papers (6,711 original articles, 182 proceedings papers, three book chapters, and one data paper) were published in 796 journals that concentrated on the research areas of cardiovascular and critical care medicine. The most productive country and influential institution was the USA and the Mayo Clinic, respectively. Heart Rhythm (551 articles and 8,342 local citations) published the most manuscripts. The keyword co-occurrence and co-citation network of references analyses revealed that the most popular terms were ventricular tachycardia, ventricular fibrillation, catheter ablation, implantable cardioverter defibrillator (ICD), and sudden cardiac death (SCD). Further, the burst detection analysis demonstrated that topics strongly associated with clinical prognosis, such as meta-analysis, long-term outcomes, and impact, were new concerns. CONCLUSION Our study offers a comprehensive picture of VA research and provides profound insights into the current research status. Moreover, we show that new topics within the VA research field have focused more on prognosis and evidence-based clinical guidelines.
Collapse
Affiliation(s)
| | | | | | | | | | - Changqing Zhu
- Department of Emergency Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
6
|
Wide Complex Tachycardias. Emerg Med Clin North Am 2022; 40:733-753. [DOI: 10.1016/j.emc.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
7
|
Gerardo C, Bettschart‐Wolfensberger R. Pre‐operative management of paroxysmal ventricular tachycardia in a stallion scheduled for castration. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Citarella Gerardo
- Section of Anaesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty University of Zurich Zurich Switzerland
| | - Regula Bettschart‐Wolfensberger
- Section of Anaesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty University of Zurich Zurich Switzerland
| |
Collapse
|
8
|
Nantha Kumar N, Nyatsuro K, Ahmad S, Fazmin IT, Saadeh K, Tse G, Jeevaratnam K. Systematic review of renal denervation for the management of cardiac arrhythmias. Clin Res Cardiol 2021; 111:971-993. [PMID: 34748053 PMCID: PMC9424137 DOI: 10.1007/s00392-021-01950-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/04/2021] [Indexed: 01/19/2023]
Abstract
Background In the wake of the controversy surrounding the SYMPLICITY HTN-3 trial and data from subsequent trials, this review aims to perform an updated and more comprehensive review of the impact of renal sympathetic denervation on cardiac arrhythmias. Methods and results A systematic search was performed using the Medline, Scopus and Embase databases using the terms “Renal Denervation” AND “Arrhythmias or Atrial or Ventricular”, limited to Human and English language studies within the last 10 years. This search yielded 19 relevant studies (n = 6 randomised controlled trials, n = 13 non-randomised cohort studies) which comprised 783 patients. The studies show RSD is a safe procedure, not associated with increases in complications or mortality post-procedure. Importantly, there is no evidence RSD is associated with a deterioration in renal function, even in patients with chronic kidney disease. RSD with or without adjunctive pulmonary vein isolation (PVI) is associated with improvements in freedom from atrial fibrillation (AF), premature atrial complexes (PACs), ventricular arrhythmias and other echocardiographic parameters. Significant reductions in ambulatory and office blood pressure were also observed in the majority of studies. Conclusion This review provides evidence based on original research that ‘second generation’ RSD is safe and is associated with reductions in short-term blood pressure and AF burden. However, the authors cannot draw firm conclusions with regards to less prominent arrhythmia subtypes due to the paucity of evidence available. Large multi-centre RCTs investigating the role of RSD are necessary to comprehensively assess the efficacy of the procedure treating various arrhythmias. Graphic abstract ![]()
Collapse
Affiliation(s)
- Nakulan Nantha Kumar
- Bristol Medical School, University of Bristol, Bristol, UK.,Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK
| | - Kuda Nyatsuro
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Shiraz Ahmad
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK
| | - Ibrahim T Fazmin
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK.,Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Khalil Saadeh
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Gary Tse
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK.,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK.
| |
Collapse
|
9
|
Cardiac stereotactic ablative radiotherapy for refractory ventricular arrhythmias: A radical alternative? A narrative review of rationale and cardiological aspects. J Med Imaging Radiat Sci 2021; 52:626-635. [PMID: 34593358 DOI: 10.1016/j.jmir.2021.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 11/21/2022]
Abstract
Ventricular arrhythmias are serious life-threatening cardiac disorders. Despite many technological improvements, a non-negligible number of patients present refractory ventricular tachycardias, resistant to a catheter ablation procedure, placing these patients in a therapeutic impasse. Recently, a cardiac stereotactic radioablative technique has been developed to treat patients with refractory ventricular arrhythmias, as a bail out strategy. This new therapeutic option historically brings together two fields of expertise unknown to each other, pointing out the necessity of an optimal partnership between cardiologists and radiation oncologists. As described in this narrative review, the understanding of cardiological aspects of the technique for radiation oncologists and treatment technical aspects comprehension for cardiologists represent a major challenge for the application and the future development of this promising treatment.
Collapse
|
10
|
Li X, Zhou T, Ma H, Huang T, Gao X, Manson JE, Qi L. Healthy Sleep Patterns and Risk of Incident Arrhythmias. J Am Coll Cardiol 2021; 78:1197-1207. [PMID: 34531019 PMCID: PMC8454031 DOI: 10.1016/j.jacc.2021.07.023] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Emerging evidence has linked sleep behaviors with the risk of cardiac arrhythmias. The various sleep behaviors are typically correlated; however, most of the previous studies only focused on the individual sleep behavior, without considering the overall sleep patterns. OBJECTIVES The purpose of this study was to prospectively investigate the associations between a healthy sleep pattern with the risks of cardiac arrhythmias. METHODS A total of 403,187 participants from UK Biobank were included. A healthy sleep pattern was defined by chronotype, sleep duration, insomnia, snoring, and daytime sleepiness. Weighted genetic risk score for atrial fibrillation was calculated. RESULTS The healthy sleep pattern was significantly associated with lower risks of atrial fibrillation/flutter (AF) (HR comparing extreme categories: 0.71; 95% CI: 0.64-0.80) and bradyarrhythmia (HR: 0.65; 95% CI: 0.54-0.77), but not ventricular arrhythmias, after adjustment for demographic, lifestyle, and genetic risk factors. Compared with individuals with a healthy sleep score of 0-1 (poor sleep group), those with a healthy sleep score of 5 had a 29% and 35% lower risk of developing AF and bradyarrhythmia, respectively. Additionally, the genetic predisposition to AF significantly modified the association of the healthy sleep pattern with the risk of AF (P interaction = 0.017). The inverse association of the healthy sleep pattern with the risk of AF was stronger among those with a lower genetic risk of AF. CONCLUSIONS Our results indicate that a healthy sleep pattern is associated with lower risks of AF and bradyarrhythmia, independent of traditional risk factors, and the association with AF is modified by genetic susceptibility.
Collapse
Affiliation(s)
- Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA. https://twitter.com/XiangL9
| | - Tao Zhou
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA; Department of Epidemiology and Biostatistics, School of Public Health (Shenzhen), Sun Yat-sen University, Guangdong, Guangzhou, China
| | - Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Tao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, State College, Pennsylvania, USA
| | - JoAnn E Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
| |
Collapse
|
11
|
Nyns ECA, Jin T, Fontes MS, van den Heuvel T, Portero V, Ramsey C, Bart CI, Zeppenfeld K, Schalij MJ, van Brakel TJ, Ramkisoensing AA, Qi Zhang G, Poelma RH, Ördög B, de Vries AAF, Pijnappels DA. Optical ventricular cardioversion by local optogenetic targeting and LED implantation in a cardiomyopathic rat model. Cardiovasc Res 2021; 118:2293-2303. [PMID: 34528100 PMCID: PMC9328286 DOI: 10.1093/cvr/cvab294] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 09/09/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Ventricular tachyarrhythmias (VTs) are common in the pathologically remodelled heart. These arrhythmias can be lethal, necessitating acute treatment like electrical cardioversion to restore normal rhythm. Recently, it has been proposed that cardioversion may also be realized via optically controlled generation of bioelectricity by the arrhythmic heart itself through optogenetics and therefore without the need of traumatizing high-voltage shocks. However, crucial mechanistic and translational aspects of this strategy have remained largely unaddressed. Therefore, we investigated optogenetic termination of VTs 1) in the pathologically remodelled heart using a 2) implantable multi-LED device for 3) in vivo closed-chest, local illumination. METHODS AND RESULTS In order to mimic a clinically relevant sequence of events, transverse aortic constriction (TAC) was applied to adult male Wistar rats before optogenetic modification. This modification took place three weeks later by intravenous delivery of adeno-associated virus vectors encoding red-activatable channelrhodopsin (ReaChR) or Citrine for control experiments. At 8 to 10 weeks after TAC, VTs were induced ex vivo and in vivo, followed by programmed local illumination of the ventricular apex by a custom-made implanted multi-LED device. This resulted in effective and repetitive VT termination in the remodelled adult rat heart after optogenetic modification, leading to sustained restoration of sinus rhythm in the intact animal. Mechanistically, studies on the single cell and tissue level revealed collectively that, despite the cardiac remodelling, there were no significant differences in bioelectricity generation and subsequent transmembrane voltage responses between diseased and control animals, thereby providing insight into the observed robustness of optogenetic VT termination. CONCLUSION Our results show that implant-based optical cardioversion of VTs is feasible in the pathologically remodelled heart in vivo after local optogenetic targeting because of preserved optical control over bioelectricity generation. These findings add novel mechanistic and translational insight into optical ventricular cardioversion.
Collapse
Affiliation(s)
- Emile C A Nyns
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Tianyi Jin
- Department of Microelectronics, Delft University of Technology, Delft, the Netherlands
| | - Magda S Fontes
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Titus van den Heuvel
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Vincent Portero
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Catilin Ramsey
- Department of Microelectronics, Delft University of Technology, Delft, the Netherlands
| | - Cindy I Bart
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Katja Zeppenfeld
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Martin J Schalij
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | | | - Arti A Ramkisoensing
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Guo Qi Zhang
- Department of Microelectronics, Delft University of Technology, Delft, the Netherlands
| | - René H Poelma
- Department of Microelectronics, Delft University of Technology, Delft, the Netherlands
| | - Balazs Ördög
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Antoine A F de Vries
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Daniël A Pijnappels
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| |
Collapse
|
12
|
Menezes-Rodrigues FS, Errante PR, Araújo EA, Fernandes MPP, Silva MMD, Pires-Oliveira M, Scorza CA, Scorza FA, Taha MO, Caricati-Neto A. Cardioprotection stimulated by resveratrol and grape products prevents lethal cardiac arrhythmias in an animal model of ischemia and reperfusion. Acta Cir Bras 2021; 36:e360306. [PMID: 33978062 PMCID: PMC8112107 DOI: 10.1590/acb360306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/07/2021] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To evaluate the preventive cardioprotective effects of resveratrol and grape products, such as grape juice and red wine, in animal model of cardiac ischemia and reperfusion. METHODS Male Wistar rats orally pretreated for 21-days with resveratrol and grape products were anesthetized and placed on mechanical ventilation to surgically induce cardiac ischemia and reperfusion by obstruction (ischemia) followed by liberation (reperfusion) of blood circulation in left descending coronary artery. These rats were submitted to the electrocardiogram (ECG) analysis to evaluate the effects of pretreatment with resveratrol and grape products on the incidence of ventricular arrhythmias (VA), atrioventricular block (AVB) and lethality (LET) resulting from cardiac ischemia and reperfusion. RESULTS It was observed that the incidence of AVB was significantly lower in rats pretreated with resveratrol (25%), grape juice (37.5%) or red wine (12.5%) than in rats treated with saline solution (80%) or ethanol (80%). Similarly, incidence of LET was also significantly lower in rats pretreated with resveratrol (25%), grape juice (25%) or red wine (0%) than in rats treated with saline solution (62.5%) or ethanol (75%). CONCLUSIONS These results indicate that the cardioprotective response stimulated by resveratrol and grape products prevents the lethal cardiac arrhythmias in animal model of ischemia and reperfusion, supporting the idea that this treatment can be beneficial for prevention of severe cardiac arrhythmias in patients with ischemic heart disease.
Collapse
|
13
|
Gangani K, Fong HK, Faisaluddin M, Lodhi MU, Manaktala P, Sadolikar A, Shah V, Gandhi Z, Abu Hassan F, Savani S, Doshi R, Desai R. Arrhythmia in tumor lysis syndrome and associated in-hospital mortality: A nationwide inpatient analysis. J Arrhythm 2021; 37:121-127. [PMID: 33664894 PMCID: PMC7896454 DOI: 10.1002/joa3.12482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/15/2020] [Accepted: 11/30/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Tumor lysis syndrome (TLS) is a life-threatening oncologic emergency associated with fatal complications including arrhythmia. The epidemiology and mortality outcomes of arrhythmia in TLS are scarcely studied in the literature. METHODS We used the National Inpatient Sample (NIS) to study the prevalence and outcome of arrhythmia in patients hospitalized with TLS (ICD-9 code 277.88) from 2009 to 2014. Baseline characteristics, burden of arrhythmia, and pertinent outcomes were analyzed. Multivariable regression analysis was performed to identify the impact of underlying malignancy in predicting TLS-related mortality. RESULTS A total of 9034 cases of arrhythmia among 37 861 TLS patients were identified. More than half of the arrhythmia cases (67%) were found among white old (>65) males admitted to large bed size and urban teaching hospitals. Arrhythmic cohort showed higher frequency of comorbidities such as fluid-electrolyte disturbances, hypertension, congestive heart failure, renal failure, dyslipidemia, diabetes, pulmonary circulatory disorders, chronic pulmonary disease, coagulopathy, and deficiency anemia. The most common malignancies were leukemia, lymphoma, metastatic tumor, and solid tumor without metastasis. We found significantly higher odds of in-hospital mortality among patients with TLS compared to general inpatient population on unadjusted (OR 9.69, 95% CI: 9.27-10.13, P < .001) and adjusted (OR 4.62, 95% CI: 4.39-4.85) multivariable analyses. Overall in-hospital mortality (32% vs 21.3%), median length of stay (11 days vs 9 days), and hospital charges were higher among arrhythmic than nonarrhythmic patients. CONCLUSION With the availability of more advanced cancer therapy in the US, nearly one in four inpatient encounters of TLS had arrhythmia. Arrhythmia in TLS patients was associated with higher odds of mortality and increased resource utilization. Therefore, strategies to improve the supportive care of TLS patients plus timely diagnosis and treatment of arrhythmia are of utmost importance in reducing mortality and health-care cost.
Collapse
Affiliation(s)
- Kishorbhai Gangani
- Department of Internal MedicineTexas Health Arlington Memorial HospitalArlingtonTXUSA
| | - Hee K. Fong
- Division of Cardiovascular MedicineUC Davis Medical CenterSacramentoCAUSA
| | | | - Muhammad U. Lodhi
- Department of Internal MedicineEastern Idaho Regional Medical CenterIdaho FallsIDUSA
| | - Pritika Manaktala
- Department of Internal MedicineCanton Medical Education FoundationCantonOHUSA
| | - Ashish Sadolikar
- Department of Internal MedicineCreighton University School of Medicine AZ Health AlliancePhoenixAZUSA
| | - Vraj Shah
- Division of CardiologyMedical College BarodaVadodaraGujaratIndia
| | - Zainab Gandhi
- Department of MedicineC. U. Shah Medical CollegeSurendranagarGujaratIndia
| | - Falah Abu Hassan
- Department of General SurgeryPrincess of Wales hospitalBridgendUK
| | | | - Rajkumar Doshi
- Department of Internal MedicineUniversity of Nevada Reno School of MedicineRenoNEUSA
| | - Rupak Desai
- Division of CardiologyAtlanta VA Medical CenterDecaturGAUSA
| |
Collapse
|
14
|
Ouyang Z, Schoenhagen P, Wazni O, Tchou P, Saliba WI, Suh JH, Xia P. Analysis of cardiac motion without respiratory motion for cardiac stereotactic body radiation therapy. J Appl Clin Med Phys 2020; 21:48-55. [PMID: 32918386 PMCID: PMC7592981 DOI: 10.1002/acm2.13002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/14/2020] [Accepted: 07/21/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose/objective(s) To study the heart motion using cardiac gated computed tomographies (CGCT) to provide guidance on treatment planning margins during cardiac stereotactic body radiation therapy (SBRT). Materials/methods Ten patients were selected for this study, who received CGCT scans that were acquired with intravenous contrast under a voluntary breath‐hold using a dual source CT scanner. For each patient, CGCT images were reconstructed in multiple phases (10%–90%) of the cardiac cycle and the left ventricle (LV), right ventricle (RV), ascending aorta (AAo), ostia of the right coronary artery (O‐RCA), left coronary artery (O‐LCA), and left anterior descending artery (LAD) were contoured at each phase. For these contours, the centroid displacements from their corresponding average positions were measured at each phase in the superior–inferior (SI), medial–lateral (ML), and anterior–posterior (AP). The average volumes as well as the maximum to minimum ratios were analyzed for the LV and RV. Results For the six contoured substructures, more than 90% of the measured displacements were <5 mm. For these patients, the average volumes ranged from 191.25 to 429.51 cc for LV and from 91.76 to 286.88 cc for RV. For each patient, the ratios of maximum to minimum volumes within a cardiac cycle ranged from 1.15 to 1.54 for LV and from 1.34 to 1.84 for RV. Conclusion Based on this study, cardiac motion is variable depending on the specific substructure of the heart but is mostly within 5 mm. Depending on the location (central or peripheral) of the treatment target and treatment purposes, the treatment planning margins for targets and risk volumes should be adjusted accordingly. In the future, we will further assess heart motion and its dosimetric impact.
Collapse
Affiliation(s)
- Zi Ouyang
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Paul Schoenhagen
- Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Oussama Wazni
- Department of Cardiovascular Medicine, Miller Family Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Patrick Tchou
- Department of Cardiovascular Medicine, Miller Family Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Miller Family Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John H Suh
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ping Xia
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
15
|
Navas de Solis C. Ventricular arrhythmias in horses: Diagnosis, prognosis and treatment. Vet J 2020; 261:105476. [PMID: 32741491 DOI: 10.1016/j.tvjl.2020.105476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 01/02/2023]
Abstract
Ventricular arrhythmias (VAs) are often incidental or coincidental with systemic disease. Ventricular arrhythmias are also the most likely cause of many sudden cardiac deaths in horses. This dichotomy creates challenges in the management of horses with VAs. This review presents current knowledge of diagnosis, prognosis and treatment of VAs in horses.
Collapse
Affiliation(s)
- Cristobal Navas de Solis
- Department of Clinical Studies New Bolton Center, University of Pennsylvania, Kennett Square, PA 19348, USA.
| |
Collapse
|
16
|
Ozturk HM, Yetkin E, Ozturk S. Synthetic Cannabinoids and Cardiac Arrhythmia Risk: Review of the Literature. Cardiovasc Toxicol 2020; 19:191-197. [PMID: 31030341 DOI: 10.1007/s12012-019-09522-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Synthetic cannabinoids (SCBs) are widely used recreational substances especially among adults. Although they have been considered as safe during the marketing process, our knowledge about their adverse effects has evolved since years. SCBs are associated with various cardiac events including acute myocardial infarction and sudden cardiac death. There is also growing evidence that SCBs are associated with cardiac arrhythmia development both in acute and chronic exposure. SCBs have been shown to be associated with both supraventricular and ventricular arrhythmias. However, the exact mechanism of the SCB related arrhythmia remains unknown. Understanding the exact association and possible mechanisms may help us to identify high risk patients at an early stage and to develop treatment modalities to prevent or reverse the arrhythmic effects of SCBs.
Collapse
Affiliation(s)
| | - Ertan Yetkin
- Department of Cardiology, Istinye University Liv Hospital, Istanbul, Turkey
| | - Selcuk Ozturk
- Cardiology Clinic, Ankara Education and Research Hospital, Ankara, Turkey.
| |
Collapse
|
17
|
Tian XT, Xu YJ, Yang YQ. Gender Differences in Arrhythmias: Focused on Atrial Fibrillation. J Cardiovasc Transl Res 2019; 13:85-96. [PMID: 31637585 DOI: 10.1007/s12265-019-09918-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/20/2019] [Indexed: 01/08/2023]
Abstract
There are significant differences in clinical presentation and treatment of atrial fibrillation (AF) between women and men. The primary goal of AF management is to restore sinus rhythm and to prevent various complications, including stroke and heart failure. In many areas of AF, such as prevalence, clinical manifestations, morbidity, risk factors, pathophysiology, treatment strategies, and complications, gender-specific variability is observed and needs to be further addressed by large-scale population researches or randomized clinical trials, which help to promote the customization of AF treatment programs, hence to maximize the success rate of AF therapy in both sexes. This review highlights our current understanding of these gender differences in AF and how these differences affect treatment decisions on AF.
Collapse
Affiliation(s)
- Xiao-Ting Tian
- Department of Cardiology, Cardiovascular Research Laboratory, and Center Laboratory, The Fifth People's Hospital of Shanghai, Fudan University, No. 801 Heqing Road, Shanghai, 200240, China
| | - Ying-Jia Xu
- Department of Cardiology, Cardiovascular Research Laboratory, and Center Laboratory, The Fifth People's Hospital of Shanghai, Fudan University, No. 801 Heqing Road, Shanghai, 200240, China
| | - Yi-Qing Yang
- Department of Cardiology, Cardiovascular Research Laboratory, and Center Laboratory, The Fifth People's Hospital of Shanghai, Fudan University, No. 801 Heqing Road, Shanghai, 200240, China.
| |
Collapse
|
18
|
Affiliation(s)
- Kalyanam Shivkumar
- From the University of California, Los Angeles (UCLA), Cardiac Arrhythmia Center and Electrophysiology Programs, David Geffen School of Medicine at UCLA, Los Angeles
| |
Collapse
|
19
|
Grisanti LA. Diabetes and Arrhythmias: Pathophysiology, Mechanisms and Therapeutic Outcomes. Front Physiol 2018; 9:1669. [PMID: 30534081 PMCID: PMC6275303 DOI: 10.3389/fphys.2018.01669] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/06/2018] [Indexed: 12/17/2022] Open
Abstract
The prevalence of diabetes is rapidly increasing and closely associated with cardiovascular morbidity and mortality. While the major cardiovascular complication associated with diabetes is coronary artery disease, it is becoming increasingly apparent that diabetes impacts the electrical conduction system in the heart, resulting in atrial fibrillation, and ventricular arrhythmias. The relationship between diabetes and arrhythmias is complex and multifactorial including autonomic dysfunction, atrial and ventricular remodeling and molecular alterations. This review will provide a comprehensive overview of the link between diabetes and arrhythmias with insight into the common molecular mechanisms, structural alterations and therapeutic outcomes.
Collapse
Affiliation(s)
- Laurel A Grisanti
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| |
Collapse
|
20
|
Khurshid S, Choi SH, Weng LC, Wang EY, Trinquart L, Benjamin EJ, Ellinor PT, Lubitz SA. Frequency of Cardiac Rhythm Abnormalities in a Half Million Adults. Circ Arrhythm Electrophysiol 2018; 11:e006273. [PMID: 29954742 PMCID: PMC6051725 DOI: 10.1161/circep.118.006273] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/08/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND The frequency of cardiac rhythm abnormalities and their risk factors in community-dwelling adults are not well characterized. METHODS We determined the frequency of rhythm abnormalities in the UK Biobank, a national prospective cohort. We tested associations between risk factors and incident rhythm abnormalities using multivariable proportional hazards regression. RESULTS Of 502 627 adults (median age, 58 years [interquartile range, 13]; 54.4% women), 2.35% had a baseline rhythm abnormality. The prevalence increased with age with 4.84% of individuals aged 65 to 73 years affected. During 3 368 332 person-years of follow-up, 15 906 new rhythm abnormalities were detected (4.72 per 1000 person-years; 95% confidence interval [CI]: 4.65-4.80). Atrial fibrillation (3.11 per 1000 person-years; 95% CI: 3.05-3.17), bradyarrhythmias (0.89 per 1000 person-years; 95% CI: 0.86-0.92), and conduction system diseases (1.06 per 1000 person-years; 95% CI: 1.02-1.09) were more common than supraventricular (0.51 per 1000 person-years; 95% CI: 0.48-0.53) and ventricular arrhythmias (0.57 per 1000 person-years; 95% CI: 0.55-0.60). Older age (hazard ratio [HR]: 2.35 per 10-year increase; 95% CI: 2.29-2.41; P<0.01), male sex (HR: 1.83; 95% CI: 1.76-1.89; P<0.01), hypertension (HR: 1.49; 95% CI: 1.44-1.54; P<0.01), chronic kidney disease (HR: 1.95; 95% CI: 1.67-2.27; P<0.01), and heart failure (HR: 1.99; 95% CI: 1.76-2.26; P<0.01) were associated with new rhythm abnormalities. CONCLUSIONS The frequency of rhythm abnormalities in middle-aged to older community-dwelling adults is substantial. Atrial fibrillation, bradyarrhythmias, and conduction system diseases account for most rhythm conditions.
Collapse
Affiliation(s)
| | - Seung Hoan Choi
- Cardiovascular Research Center (S.H.C., L.-C.W., E.Y.W., P.T.E., S.A.L.)
| | - Lu-Chen Weng
- Cardiovascular Research Center (S.H.C., L.-C.W., E.Y.W., P.T.E., S.A.L.)
| | - Elizabeth Y Wang
- Cardiovascular Research Center (S.H.C., L.-C.W., E.Y.W., P.T.E., S.A.L.)
| | - Ludovic Trinquart
- Massachusetts General Hospital, Boston. Department of Biostatistics, Boston University School of Public Health, MA (L.T.)
- Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (L.T., E.J.B.)
| | - Emelia J Benjamin
- Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (L.T., E.J.B.)
- Sections of Preventive Medicine and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, MA (E.J.B.)
- Department of Epidemiology, Boston University School of Public Heath, MA (E.J.B.)
| | - Patrick T Ellinor
- Cardiovascular Research Center (S.H.C., L.-C.W., E.Y.W., P.T.E., S.A.L.)
- Cardiac Arrhythmia Service (P.T.E., S.A.L.)
| | - Steven A Lubitz
- Cardiovascular Research Center (S.H.C., L.-C.W., E.Y.W., P.T.E., S.A.L.)
- Cardiac Arrhythmia Service (P.T.E., S.A.L.)
| |
Collapse
|
21
|
Dell'Anna AM, Sandroni C, Lamanna I, Belloni I, Donadello K, Creteur J, Vincent JL, Taccone FS. Prognostic implications of blood lactate concentrations after cardiac arrest: a retrospective study. Ann Intensive Care 2017; 7:101. [PMID: 28986863 PMCID: PMC5630540 DOI: 10.1186/s13613-017-0321-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 09/19/2017] [Indexed: 01/12/2023] Open
Abstract
Background Elevated lactate concentration has been associated with increased mortality after out-of-hospital cardiac arrest (CA). We investigated the variables associated with high blood lactate concentrations and explored the relationship between blood lactate and neurological outcome in this setting. Methods This was a retrospective analysis of an institutional database that included all adult (> 18 years) patients admitted to a multidisciplinary Department of Intensive Care between January 2009 and January 2013 after resuscitation from CA. Blood lactate concentrations were collected at hospital admission and 6, 12, 24 and 48 h thereafter. Neurological outcome was evaluated 3 months post-CA using the Cerebral Performance Category (CPC) score: a CPC of 3–5 was used to define a poor outcome. Results Of the 236 patients included, 162 (69%) had a poor outcome. On admission, median lactate concentrations (5.3[2.9–9.0] vs. 2.5[1.5–5.5], p < 0.001) and cardiovascular sequential organ failure assessment (cSOFA) score (3[0–4] vs. 0[0–3], p = 0.003) were higher in patients with poor than in those with favourable outcomes. Lactate concentrations were higher in patients with poor outcomes at all time points. Lactate concentrations were similar in patients with out-of-hospital and in-hospital CA at all time points. After adjustment, high admission lactate was independently associated with a poor neurological outcome (OR 1.18, 95% CI 1.08–1.30; p < 0.001). In multivariable analysis, use of vasopressors and high PaO2 on admission, longer time to return of spontaneous circulation and altered renal function were associated with high admission lactate concentrations. Conclusions High lactate concentrations on admission were an independent predictor of poor neurological recovery post-CA, but the time course was not related to outcome. Prolonged resuscitation, use of vasopressors, high PaO2 and altered renal function were predictors of high lactate concentrations. Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0321-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Antonio Maria Dell'Anna
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.,Department of Anesthesiology and Intensive Care, Catholic University School of Medicine, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Claudio Sandroni
- Department of Anesthesiology and Intensive Care, Catholic University School of Medicine, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Irene Lamanna
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Ilaria Belloni
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Katia Donadello
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.,Anaesthesia and Intensive Care B, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, AOUI-University Hospital Integrated Trust of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| |
Collapse
|
22
|
Masarone D, Limongelli G, Rubino M, Valente F, Vastarella R, Ammendola E, Gravino R, Verrengia M, Salerno G, Pacileo G. Management of Arrhythmias in Heart Failure. J Cardiovasc Dev Dis 2017; 4:E3. [PMID: 29367535 PMCID: PMC5715690 DOI: 10.3390/jcdd4010003] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 02/03/2017] [Accepted: 02/22/2017] [Indexed: 12/14/2022] Open
Abstract
Heart failure patients are predisposed to develop arrhythmias. Supraventricular arrhythmias can exacerbate the heart failure symptoms by decreasing the effective cardiac output and their control require pharmacological, electrical, or catheter-based intervention. In the setting of atrial flutter or atrial fibrillation, anticoagulation becomes paramount to prevent systemic or cerebral embolism. Patients with heart failure are also prone to develop ventricular arrhythmias that can present a challenge to the managing clinician. The management strategy depends on the type of arrhythmia, the underlying structural heart disease, the severity of heart failure, and the range from optimization of heart failure therapy to catheter ablation. Patients with heart failure, irrespective of ejection fraction are at high risk for developing sudden cardiac death, however risk stratification is a clinical challenge and requires a multiparametric evaluation for identification of patients who should undergo implantation of a cardioverter defibrillator. Finally, patients with heart failure can also develop symptomatic bradycardia, caused by sinus node dysfunction or atrio-ventricular block. The treatment of bradycardia in these patients with pacing is usually straightforward but needs some specific issue.
Collapse
Affiliation(s)
- Daniele Masarone
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Giuseppe Limongelli
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Marta Rubino
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Fabio Valente
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Rossella Vastarella
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Ernesto Ammendola
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Rita Gravino
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Marina Verrengia
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Gemma Salerno
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| | - Giuseppe Pacileo
- Cardiologia SUN-Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, via L. Bianchi, Naples 80100, Italy.
| |
Collapse
|
23
|
Woods D, Chantavarin S. Serial neuropsychological assessment of an adolescent girl after suffering a sudden out-of-hospital-cardiac-arrest following recreational inhalant use. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 6:378-387. [PMID: 27216834 DOI: 10.1080/21622965.2016.1185372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sudden out-of-hospital-cardiac-arrest (OHCA) following recreational inhalant use is well documented in the literature. The present case study reports the long-term neuropsychological sequelae of a 14-year-old girl who suffered an OHCA secondary to recreational butane gas inhalation. The patient was assessed on day-13 as an inpatient, and again at 3- and 12-month outpatient follow-ups. Acutely the patient demonstrated significant impairment on tasks associated with verbal and non-verbal memory and executive functioning. Re-testing at 3-months post-acute state suggested improved executive and non-verbal functions while showing continued deficits in verbal memory. At 12-months she was cognitively performing at levels expected for her age. This case is reported for its rarity in successfully being able to track the patient's clinical course from hospital discharge to the successful reintegration back into school and community settings.
Collapse
Affiliation(s)
- Damith Woods
- a Faculty of Psychology, Cognitive Neuroscience Laboratory , Chulalongkorn University , Bangkok , Thailand
| | - Suphasiree Chantavarin
- a Faculty of Psychology, Cognitive Neuroscience Laboratory , Chulalongkorn University , Bangkok , Thailand
| |
Collapse
|
24
|
Maruyama D, Hirata N, Tokinaga Y, Kawaguchi R, Yamakage M. Nitrite Reduces Ischemia-Induced Ventricular Arrhythmias by Attenuating Connexin 43 Dephosphorylation in Rats. Anesth Analg 2016; 122:410-7. [DOI: 10.1213/ane.0000000000001063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
25
|
Weber S, Meyer-Roxlau S, Wagner M, Dobrev D, El-Armouche A. Counteracting Protein Kinase Activity in the Heart: The Multiple Roles of Protein Phosphatases. Front Pharmacol 2015; 6:270. [PMID: 26617522 PMCID: PMC4643138 DOI: 10.3389/fphar.2015.00270] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/28/2015] [Indexed: 12/19/2022] Open
Abstract
Decades of cardiovascular research have shown that variable and flexible levels of protein phosphorylation are necessary to maintain cardiac function. A delicate balance between phosphorylated and dephosphorylated states of proteins is guaranteed by a complex interplay of protein kinases (PKs) and phosphatases. Serine/threonine phosphatases, in particular members of the protein phosphatase (PP) family govern dephosphorylation of the majority of these cardiac proteins. Recent findings have however shown that PPs do not only dephosphorylate previously phosphorylated proteins as a passive control mechanism but are capable to actively control PK activity via different direct and indirect signaling pathways. These control mechanisms can take place on (epi-)genetic, (post-)transcriptional, and (post-)translational levels. In addition PPs themselves are targets of a plethora of proteinaceous interaction partner regulating their endogenous activity, thus adding another level of complexity and feedback control toward this system. Finally, novel approaches are underway to achieve spatiotemporal pharmacologic control of PPs which in turn can be used to fine-tune misleaded PK activity in heart disease. Taken together, this review comprehensively summarizes the major aspects of PP-mediated PK regulation and discusses the subsequent consequences of deregulated PP activity for cardiovascular diseases in depth.
Collapse
Affiliation(s)
- Silvio Weber
- Department of Pharmacology and Toxicology, Dresden University of Technology , Dresden, Germany
| | - Stefanie Meyer-Roxlau
- Department of Pharmacology and Toxicology, Dresden University of Technology , Dresden, Germany
| | - Michael Wagner
- Department of Pharmacology and Toxicology, Dresden University of Technology , Dresden, Germany
| | - Dobromir Dobrev
- Institute of Pharmacology, Faculty of Medicine, West German Heart and Vascular Center , Essen, Germany
| | - Ali El-Armouche
- Department of Pharmacology and Toxicology, Dresden University of Technology , Dresden, Germany
| |
Collapse
|
26
|
Schüler C, Fischer E, Shaltiel L, Steuer Costa W, Gottschalk A. Arrhythmogenic effects of mutated L-type Ca 2+-channels on an optogenetically paced muscular pump in Caenorhabditis elegans. Sci Rep 2015; 5:14427. [PMID: 26399900 PMCID: PMC4585839 DOI: 10.1038/srep14427] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/28/2015] [Indexed: 01/23/2023] Open
Abstract
Cardiac arrhythmias are often associated with mutations in ion channels or other proteins. To enable drug development for distinct arrhythmias, model systems are required that allow implementing patient-specific mutations. We assessed a muscular pump in Caenorhabditis elegans. The pharynx utilizes homologues of most of the ion channels, pumps and transporters defining human cardiac physiology. To yield precise rhythmicity, we optically paced the pharynx using channelrhodopsin-2. We assessed pharynx pumping by extracellular recordings (electropharyngeograms—EPGs), and by a novel video-microscopy based method we developed, which allows analyzing multiple animals simultaneously. Mutations in the L-type VGCC (voltage-gated Ca2+-channel) EGL-19 caused prolonged pump duration, as found for analogous mutations in the Cav1.2 channel, associated with long QT syndrome. egl-19 mutations affected ability to pump at high frequency and induced arrhythmicity. The pharyngeal neurons did not influence these effects. We tested whether drugs could ameliorate arrhythmia in the optogenetically paced pharynx. The dihydropyridine analog Nemadipine A prolonged pump duration in wild type, and reduced or prolonged pump duration of distinct egl-19 alleles, thus indicating allele-specific effects. In sum, our model may allow screening of drug candidates affecting specific VGCCs mutations, and permit to better understand the effects of distinct mutations on a macroscopic level.
Collapse
Affiliation(s)
- Christina Schüler
- Buchmann Institute for Molecular Life Sciences, Goethe University, Max von Laue Strasse 15, D-60438 Frankfurt, Germany.,Institute of Biochemistry, Goethe University, Max von Laue Strasse 9, D-60438 Frankfurt, Germany.,Cluster of Excellence Frankfurt-Macromolecular Complexes, Goethe University, Max von Laue Strasse 15, D-60438 Frankfurt, Germany
| | - Elisabeth Fischer
- Buchmann Institute for Molecular Life Sciences, Goethe University, Max von Laue Strasse 15, D-60438 Frankfurt, Germany.,Institute of Biochemistry, Goethe University, Max von Laue Strasse 9, D-60438 Frankfurt, Germany.,Cluster of Excellence Frankfurt-Macromolecular Complexes, Goethe University, Max von Laue Strasse 15, D-60438 Frankfurt, Germany
| | - Lior Shaltiel
- Buchmann Institute for Molecular Life Sciences, Goethe University, Max von Laue Strasse 15, D-60438 Frankfurt, Germany.,Institute of Biochemistry, Goethe University, Max von Laue Strasse 9, D-60438 Frankfurt, Germany
| | - Wagner Steuer Costa
- Buchmann Institute for Molecular Life Sciences, Goethe University, Max von Laue Strasse 15, D-60438 Frankfurt, Germany.,Institute of Biochemistry, Goethe University, Max von Laue Strasse 9, D-60438 Frankfurt, Germany
| | - Alexander Gottschalk
- Buchmann Institute for Molecular Life Sciences, Goethe University, Max von Laue Strasse 15, D-60438 Frankfurt, Germany.,Institute of Biochemistry, Goethe University, Max von Laue Strasse 9, D-60438 Frankfurt, Germany.,Cluster of Excellence Frankfurt-Macromolecular Complexes, Goethe University, Max von Laue Strasse 15, D-60438 Frankfurt, Germany
| |
Collapse
|
27
|
Chiu HY, Chang WL, Huang WF, Wen YW, Tsai YW, Tsai TF. Increased risk of arrhythmia in patients with psoriatic disease: A nationwide population-based matched cohort study. J Am Acad Dermatol 2015; 73:429-38. [DOI: 10.1016/j.jaad.2015.06.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 06/07/2015] [Accepted: 06/10/2015] [Indexed: 12/13/2022]
|
28
|
Nguyen MN, Kiriazis H, Ruggiero D, Gao XM, Su Y, Jian A, Han LP, McMullen JR, Du XJ. Spontaneous ventricular tachyarrhythmias in β2-adrenoceptor transgenic mice in relation to cardiac interstitial fibrosis. Am J Physiol Heart Circ Physiol 2015; 309:H946-57. [PMID: 26116714 DOI: 10.1152/ajpheart.00405.2015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 06/26/2015] [Indexed: 12/21/2022]
Abstract
Myocardial fibrosis is regarded as a pivotal proarrhythmic substrate, but there have been no comprehensive studies showing a correlation between the severity of fibrosis and ventricular tachyarrhythmias (VTAs). Our purpose was to document this relationship in a transgenic (TG) strain of mice with fibrotic cardiomyopathy. TG mice with cardiac overexpression of β2-adrenoceptors (β2-AR mice) and non-TG (NTG) littermates were studied at 4-12 mo of age. VTA was quantified by ECG telemetry. The effect of pharmacological blockade of β2-ARs on VTA was examined. Myocardial collagen content was determined by hydroxyproline assay. NTG and TG mice displayed circadian variation in heart rate, which was higher in TG mice than in NTG mice (P <0.05). Frequent spontaneous ventricular ectopic beats (VEBs) and ventricular tachycardia (VT) were prominent in TG mice but not present in NTG mice. The frequency of VEB and VT episodes in TG mice increased with age (P < 0.01). Ventricular collagen content was greater in TG mice than in NTG mice (P <0.001) and correlated with age (r = 0.71, P < 0.01). The number of VEBs or VT episodes correlated with age (r = 0.83 and r = 0.73) and the content of total or cross-linked collagen (r = 0.62∼0.66, all P <0.01). While having no effect in younger β2-TG mice, β2-AR blockade reduced the frequency of VTA in old β2-TG mice with more severe fibrosis. In conclusion, β2-TG mice exhibit interstitial fibrosis and spontaneous onset of VTA, becoming more severe with aging. The extent of cardiac fibrosis is a major determinant for both the frequency of VTA and proarrhythmic action of β2-AR activation.
Collapse
Affiliation(s)
- My-Nhan Nguyen
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Helen Kiriazis
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Diego Ruggiero
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; University of Milan, Milan, Italy
| | - Xiao-Ming Gao
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Yidan Su
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Anne Jian
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Li-Ping Han
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; WenZhou Medical University, WenZhou, China; and
| | - Julie R McMullen
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Physiology, Monash University, Melbourne, Australia
| | - Xiao-Jun Du
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia;
| |
Collapse
|
29
|
Leong DP, Hoogslag GE, Piers SRD, Höke U, Thijssen J, Marsan NA, Schalij MJ, Zeppenfeld K, Bax JJ, Delgado V. The relationship between time from myocardial infarction, left ventricular dyssynchrony, and the risk for ventricular arrhythmia: speckle-tracking echocardiographic analysis. J Am Soc Echocardiogr 2015; 28:470-7. [PMID: 25636367 DOI: 10.1016/j.echo.2014.12.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Differences in arrhythmogenic substrate may explain the variable efficacy of implantable cardioverter-defibrillators (ICDs) in primary sudden cardiac death prevention over time after myocardial infarction (MI). Speckle-tracking echocardiography allows the assessment left ventricular (LV) dyssynchrony, which may reflect the electromechanical heterogeneity of myocardial tissue. The aim of the present study was to evaluate the relationship among LV dyssynchrony, age of MI, and their association with the risk for ventricular tachycardia (VT) after MI. METHODS A total of 206 patients (median age, 67 years; 87% men) with prior MIs (median MI age, 6.2 years; interquartile range, 0.66-15 years) who underwent programmed electrical stimulation, speckle-tracking echocardiography, and ICD implantation were retrospectively evaluated. LV dyssynchrony was defined as the standard deviation of time to peak longitudinal systolic strain values using speckle-tracking strain echocardiography. LV scar burden was evaluated by the percentage of segments exhibiting scar (defined as an absolute longitudinal strain of magnitude < 4.5%). Patients were followed up for the occurrence of first monomorphic VT requiring ICD therapy (antitachycardia pacing or shock) for a median of 24 months. RESULTS In total, 75 individuals experienced the primary end point of monomorphic VT. LV dyssynchrony was independently associated with the occurrence of VT at follow-up (hazard ratio per 10-msec increase, 1.12; 95% confidence interval, 1.07-1.18; P < .001), together with nonrevascularization of the infarct-related artery and VT inducibility. Patients with older (>180 months) MIs had a higher likelihood of VT inducibility (88% vs 63%, P = .003) and greater scar burden (14.7 ± 15.8% vs 10.7 ± 11.4%, P = .03) compared with patients with recent (<8 months) MIs. CONCLUSIONS LV dyssynchrony is independently associated with the occurrence of VT after MI.
Collapse
Affiliation(s)
- Darryl P Leong
- Disciplines of Medicine, Flinders University and the University of Adelaide, Adelaide, Australia; Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Georgette E Hoogslag
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sebastiaan R D Piers
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ulas Höke
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joep Thijssen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
30
|
Shi QX, Zhang LJ, Yao Y, Zhang QY, Wang W, Li J, Shang YL, Bi H, Zhang SM, Guo HT, Wang YM, Yu SQ, Yi DH, Bueno FR, Kaye AD, Pei JM. κ-opioid receptor activation prevents against arrhythmias by preserving Cx43 protein via alleviation of intracellular calcium. Am J Ther 2014; 20:493-501. [PMID: 23011166 DOI: 10.1097/mjt.0b013e3182456676] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
κ-opioid receptor (κ-OR) activation with U50,488H, a selective κ-OR agonist, has been previously demonstrated to prevent against cardiac arrhythmias via stabilizing the synthesis and degradation of an integral membrane protein, Cx43, in gap junctions. However, the exact prevention mechanism remains unclear. The present study tested the hypothesis that the kappa OR agonist U50,488H mediates the prevention of arrhythmia through the regulation of intracellular calcium leading to the preservation of Cx43 protein. By performing electrocardiogram monitoring and immunoblotting in isolated Langendorff-perfused rat hearts, high concentrations of calcium-perfused rat hearts exhibited increased cardiac arrhythmias. Diminished expression of Cx43 protein was observed. The utilization of a whole-cell patch clamp technique revealed that U50,488H inhibited L-type calcium current in single ventricular myocytes in a dose-dependent manner. These effects were blocked by nor-binaltorphimine, potent and selective κ-OR antagonists. Administration of U50,488H before myocardial ischemia resulted in an attenuated of total arrhythmia scores. The attenuation effect was blocked by nor-binaltorphimine. The attenuation effect was antagonized both by Bay K8644, a L-type calcium channel agonist, and also by the Cx43 uncoupler heptanol. Finally, immunoblotting data demonstrated that the preservation of Cx43 protein conferred by U50,488H was reversed in the presence of Bay K8644. In summary, the present study demonstrates κ-OR activation with U50,488H may confer antiarrhythmic effects via modulation of the calcium-Cx43 pathway.
Collapse
Affiliation(s)
- Quan-Xing Shi
- 1Department of Physiology, National Key Discipline of Cell Biology, Fourth Military Medical University, Xi'an, China 2Department of Cardiology, Institute for Cardiovascular Research, General Hospital of Shenyang Military Region, Shenyang, China 3Department of Cardiosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China 4Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA 5Department of Pharmacology, Louisiana State University School of Medicine, New Orleans, LA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Vereckei A. Current algorithms for the diagnosis of wide QRS complex tachycardias. Curr Cardiol Rev 2014; 10:262-76. [PMID: 24827795 PMCID: PMC4040878 DOI: 10.2174/1573403x10666140514103309] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 05/28/2013] [Accepted: 01/28/2014] [Indexed: 11/22/2022] Open
Abstract
The differential diagnosis of a regular, monomorphic wide QRS complex tachycardia (WCT) mechanism represents a great diagnostic dilemma commonly encountered by the practicing physician, which has important implications for acute arrhythmia management, further work-up, prognosis and chronic management as well. This comprehensive review discusses the causes and differential diagnosis of WCT, and since the ECG remains the cornerstone of WCT differential diagnosis, focuses on the application and diagnostic value of different ECG criteria and algorithms in this setting and also provides a practical clinical approach to patients with WCTs.
Collapse
Affiliation(s)
- Andras Vereckei
- 3rd Department of Medicine, Semmelweis University, School of Medicine, Budapest, Kutvolgyi ut 4, Hungary 1125.
| |
Collapse
|
32
|
Zang M, Zhang T, Mao J, Zhou S, He B. Beneficial effects of catheter ablation of frequent premature ventricular complexes on left ventricular function. Heart 2014; 100:787-93. [DOI: 10.1136/heartjnl-2013-305175] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
33
|
Ramachandran R, Rewari V, Parakh N, Singh PM, Jayanandan S. Intraoperative interfascicular ventricular tachycardia: A rare occurrence. Indian J Anaesth 2014; 58:76-8. [PMID: 24700908 PMCID: PMC3968662 DOI: 10.4103/0019-5049.126807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
34
|
Nayyar S, Wilson L, Ganesan AN, Sullivan T, Kuklik P, Chapman D, Brooks AG, Mahajan R, Baumert M, Young GD, Sanders P, Roberts-Thomson KC. High-density mapping of ventricular scar: a comparison of ventricular tachycardia (VT) supporting channels with channels that do not support VT. Circ Arrhythm Electrophysiol 2014; 7:90-8. [PMID: 24382409 DOI: 10.1161/circep.113.000882] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Surviving myocytes within scar may form channels that support ventricular tachycardia (VT) circuits. There are little data on the properties of channels that comprise VT circuits and those that are non-VT supporting channels. METHODS AND RESULTS In 22 patients with ischemic cardiomyopathy and VT, high-density mapping was performed with the PentaRay catheter and Ensite NavX system during sinus rhythm. A channel was defined as a series of matching pace-maps with a stimulus (S) to QRS time of ≥40 ms. Sites were determined to be part of a VT channel if there were matching pace-maps to the VT morphology. This was confirmed with entrainment mapping when possible. Of the 238 channels identified, 57 channels corresponded to an inducible VT. Channels that were part of a VT circuit were more commonly located within dense scar than non-VT channels (97% versus 82%; P=0.036). VT supporting channels were of greater length (mean±SEM, 53±5 versus 33±4 mm), had higher longest S-QRS (130±12 versus 82±12 ms), longer conduction time (103±14 versus 43±13 ms), and slower conduction velocity (0.87±0.23 versus 1.39±0.21 m/s) than non-VT channels (P<0.001). Of all the fractionated, late, and very late potentials located in scar, only 21%, 26%, and 29%, respectively, were recorded within VT channels. CONCLUSIONS High-density mapping shows substantial differences among channels in ventricular scar. Channels supporting VT are more commonly located in dense scar, longer than non-VT channels, and have slower conduction velocity. Only a minority of scar-related potentials participate in the VT supporting channels.
Collapse
Affiliation(s)
- Sachin Nayyar
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Zhou P, Zhang SM, Wang QL, Wu Q, Chen M, Pei JM. Anti-arrhythmic effect of verapamil is accompanied by preservation of cx43 protein in rat heart. PLoS One 2013; 8:e71567. [PMID: 23951191 PMCID: PMC3741134 DOI: 10.1371/journal.pone.0071567] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 07/01/2013] [Indexed: 11/18/2022] Open
Abstract
The present study was to test the hypothesis that anti-arrhythmic properties of verapamil may be accompanied by preserving connexin43 (Cx43) protein via calcium influx inhibition. In an in vivo study, myocardial ischemic arrhythmia was induced by occlusion of the left anterior descending (LAD) coronary artery for 45 min in Sprague-Dawley rats. Verapamil, a calcium channel antagonist, was injected i.v. into a femoral vein prior to ischemia. Effects of verapamil on arrhythmias induced by Bay K8644 (a calcium channel agonist) were also determined. In an ex vivo study, the isolated heart underwent an initial 10 min of baseline normal perfusion and was subjected to high calcium perfusion in the absence or presence of verapamil. Cardiac arrhythmia was measured by electrocardiogram (ECG) and Cx43 protein was determined by immunohistochemistry and western blotting. Administration of verapamil prior to myocardial ischemia significantly reduced the incidence of ventricular arrhythmias and total arrhythmia scores, with the reductions in heat rate, mean arterial pressure and left ventricular systolic pressure. Verapamil also inhibited arrhythmias induced by Bay K8644 and high calcium perfusion. Effect of verapamil on ischemic arrhythmia scores was abolished by heptanol, a Cx43 protein uncoupler and Gap 26, a Cx43 channels inhibitor. Immunohistochemistry data showed that ischemia-induced redistribution and reduced immunostaining of Cx43 were prevented by verapamil. In addition, diminished expression of Cx43 protein determined by western blotting was observed following myocardial ischemia in vivo or following high calcium perfusion ex vivo and was preserved after verapamil administration. Our data suggest that verapamil may confer an anti-arrhythmic effect via calcium influx inhibition, inhibition of oxygen consumption and accompanied by preservation of Cx43 protein.
Collapse
Affiliation(s)
- Peng Zhou
- Department of Cardiology, Chengdu Medical College, Chengdu, P.R. China
| | - Shu-Miao Zhang
- Department of Physiology, Fourth Military Medical University, Xi’an, P.R. China
| | - Qiu-Lin Wang
- Department of Cardiology, Chengdu Medical College, Chengdu, P.R. China
| | - Qi Wu
- Department of Cardiology, Chengdu Medical College, Chengdu, P.R. China
| | - Mai Chen
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi’an, P.R. China
- * E-mail: (JMP); (MC)
| | - Jian-Ming Pei
- Department of Cardiology, Chengdu Medical College, Chengdu, P.R. China
- Department of Physiology, Fourth Military Medical University, Xi’an, P.R. China
- * E-mail: (JMP); (MC)
| |
Collapse
|
36
|
Wang Y, Patel D, Wang DW, Yan JT, Hsia HH, Liu H, Zhao CX, Zuo HJ, Wang DW. β1-Adrenoceptor blocker aggravated ventricular arrhythmia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1348-56. [PMID: 23750689 DOI: 10.1111/pace.12196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/11/2013] [Accepted: 04/18/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the impact of β1 -adrenoceptor blockers (β1 -blocker) and isoprenaline on the incidence of idiopathic repetitive ventricular arrhythmia that apparently decreases with preprocedural anxiety. METHODS From January 2010 to July 2012, six patients were identified who had idiopathic ventricular arrhythmias that apparently decreased (by greater than 90%) with preprocedural anxiety. The number of ectopic ventricular beats per hour (VPH) was calculated from Holter or telemetry monitoring to assess the ectopic burden. The mean VPH of 24 hours from Holter before admission (VPH-m) was used as baseline (100%) for normalization. β1 -Blockers, isoprenaline, and/or aminophylline were administrated successively on the ward and catheter lab to evaluate their effects on the ventricular arrhythmias. RESULTS Among 97 consecutive patients with idiopathic ventricular arrhythmias, six had reduction in normalized VPHs in the hour before the scheduled procedure time from (104.6 ± 4.6%) to (2.8 ± 1.6%) possibly due to preprocedural anxiety (P < 0.05), then increased to (97.9 ± 9.7%) during β1 -blocker administration (P < 0.05), then quickly reduced to (1.6 ± 1.0%) during subsequent isoprenaline infusion. Repeated β1 -blocker quickly counteracted the inhibitory effect of isoprenaline, and VPHs increased to (120.9 ± 2.4%) from (1.6 ± 1.0%; P < 0.05). Isoprenaline and β1 -blocker showed similar effects on the arrhythmias in catheter lab. CONCLUSIONS In some patients with structurally normal heart and ventricular arrhythmias there is a marked reduction of arrhythmias associated with preprocedural anxiety. These patients exhibit a reproducible sequence of β1 -blocker aggravation and catecholamine inhibition of ventricular arrhythmias, including both repetitive ventricular premature beats and monomorphic ventricular tachycardia.
Collapse
Affiliation(s)
- Yan Wang
- Cardivascular Division, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Physick-Sheard PW. Seek and ye shall find: Cardiac arrhythmias in the horse. Equine Vet J 2013; 45:270-2. [DOI: 10.1111/evj.12054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
38
|
Cell and gene therapy for arrhythmias: Repair of cardiac conduction damage. J Geriatr Cardiol 2012; 8:147-58. [PMID: 22783301 PMCID: PMC3390069 DOI: 10.3724/sp.j.1263.2011.00147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 08/10/2011] [Accepted: 08/17/2011] [Indexed: 11/25/2022] Open
Abstract
Action potentials generated in the sinoatrial node (SAN) dominate the rhythm and rate of a healthy human heart. Subsequently, these action potentials propagate to the whole heart via its conduction system. Abnormalities of impulse generation and/or propagation in a heart can cause arrhythmias. For example, SAN dysfunction or conduction block of the atrioventricular node can lead to serious bradycardia which is currently treated with an implanted electronic pacemaker. On the other hand, conduction damage may cause reentrant tachyarrhythmias which are primarily treated pharmacologically or by medical device-based therapies, including defibrillation and tissue ablation. However, drug therapies sometimes may not be effective or are associated with serious side effects. Device-based therapies for cardiac arrhythmias, even with well developed technology, still face inadequacies, limitations, hardware complications, and other challenges. Therefore, scientists are actively seeking other alternatives for antiarrhythmic therapy. In particular, cells and genes used for repairing cardiac conduction damage/defect have been investigated in various studies both in vitro and in vivo. Despite the complexities of the excitation and conduction systems of the heart, cell and gene-based strategies provide novel alternatives for treatment or cure of cardiac arrhythmias. This review summarizes some highlights of recent research progress in this field.
Collapse
|
39
|
Svendsen JH, Goette A, Dobreanu D, Marinskis G, Mabo P, Blomstrom-Lundqvist C. Outpatient evaluation and management of patients with ventricular premature beats or non-sustained ventricular tachycardia. Europace 2012; 14:294-6. [DOI: 10.1093/europace/eus009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
40
|
Surgical management of ventricular arrhythmias. Nat Rev Cardiol 2011; 8:666. [DOI: 10.1038/nrcardio.2011.15-c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|