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Shan L, Chen J, Sun Y, Pan Y, Wang C, Wang Y, Zhang Y. Advances of Liquid Biopsy for Diagnosis of Atrial Fibrillation and Its Recurrence After Ablation in Clinical Application. Methods Mol Biol 2023; 2695:351-365. [PMID: 37450131 DOI: 10.1007/978-1-0716-3346-5_24] [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: 07/18/2023]
Abstract
Atrial fibrillation (AF) is a common arrhythmia disease with high morbidity in clinical practice and leads to stroke, heart failure, peripheral embolism, and other severe complications. With aging of the society, AF has become one of the biggest public health challenges. Effective treatments including antiarrhythmic drugs, electrical cardioversion, and ablation (with or without catheters) can alleviate the symptoms of AF. Ablation is the most effective method for the treatment of persistent AF, but cannot cure all patients. Recurrence of AF is a realistic and unavoidable problem. For early predicting and warning of AF and its recurrence, liquid biopsy for accurate molecular analysis of biofluids is a new strategy with potential value and easy sampling and can detect genetic and epigenetic polymorphisms, especially microRNAs. In this review, liquid biopsy is constructed as a new powerful way for diagnosing AF and predicting its recurrence, contributing to the treatment of AF.
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Affiliation(s)
- Lingtong Shan
- Department of Thoracic Surgery, Sheyang County People's Hospital, Yancheng, Jiangsu, People's Republic of China
| | - Jiapeng Chen
- Xinglin College, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Yangyang Sun
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Yilin Pan
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Chong Wang
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuliang Wang
- Department of Immunology, Nanjing Medical University, Nanjing, China.
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Pensa AV, Baman JR, Puckelwartz MJ, Wilcox JE. Genetically Based Atrial Fibrillation: Current Considerations for Diagnosis and Management. J Cardiovasc Electrophysiol 2022; 33:1944-1953. [PMID: 35262243 DOI: 10.1111/jce.15446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 11/30/2022]
Abstract
Atrial fibrillation (AF) is the most common atrial arrhythmia and is subcategorized into numerous clinical phenotypes. Given its heterogeneity, investigations into the genetic mechanisms underlying AF have been pursued in recent decades, with predominant analyses focusing on early onset or lone AF. Linkage analyses, genome wide association studies (GWAS), and single gene analyses have led to the identification of rare and common genetic variants associated with AF risk. Significant overlap with genetic variants implicated in dilated cardiomyopathy syndromes, including truncating variants of the sarcomere protein titin, have been identified through these analyses, in addition to other genes associated with cardiac structure and function. Despite this, widespread utilization of genetic testing in AF remains hindered by the unclear impact of genetic risk identification on clinical outcomes and the high prevalence of variants of unknown significance (VUS). However, genetic testing is a reasonable option for patients with early onset AF and in those with significant family history of arrhythmia. While many knowledge gaps remain, emerging data support genotyping to inform selection of AF therapeutics. In this review we highlight the current understanding of the complex genetic basis of AF and explore the overlap of AF with inherited cardiomyopathy syndromes. We propose a set of criteria for clinical genetic testing in AF patients and outline future steps for the integration of genetics into AF care. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Anthony V Pensa
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jayson R Baman
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Megan J Puckelwartz
- Department of Pharmacology, Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jane E Wilcox
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Erhard N, Metzner A, Fink T. Late arrhythmia recurrence after atrial fibrillation ablation: incidence, mechanisms and clinical implications. Herzschrittmacherther Elektrophysiol 2022; 33:71-76. [PMID: 35006336 PMCID: PMC8873127 DOI: 10.1007/s00399-021-00836-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022]
Abstract
Background and objectives Catheter ablation of atrial fibrillation (AF) has become a well-established and widely used therapy, with pulmonary vein isolation (PVI) being the key modality of ablation. However, arrhythmia recurrences after PVI are common, with a relevant number of patients undergoing repeat ablation. Arrhythmia recurrence after PVI may vary regarding time point and mode of recurrence. While early arrhythmia recurrences of AF after PVI are mostly found to be the product of electrical reconnection of the pulmonary veins, the exact mechanisms of very late arrhythmia recurrence, occurring later than 12 months after successful PVI, remain unclear. This review provides an overview on the current evidence on time point and mechanisms of arrhythmia recurrence after PVI focussing on late arrhythmia recurrence. Recent findings The incidence of late arrhythmia recurrence after PVI can lie at a rate of up to 30% according to long-term follow-up studies. Mechanisms of recurrence include electrical reconnection of previously isolated pulmonary veins and development of atrial fibrosis. The use of cryoballoon ablation is likely to be more effective in reducing late arrhythmia recurrences compared to radiofrequency ablation. Novel scores such as the MB-LATER score or the APPLE score may become useful tools in predicting arrhythmia recurrence after PVI. Results and conclusion Late arrhythmia recurrence after PVI is common and leads to a relevant impairment of long-term success. Relevant data are currently limited and exact mechanisms of arrhythmia recurrence remain unclear. Further studies are needed to elucidate pathogenetic mechanisms of late arrhythmia recurrence after PVI in order to improve treatment strategies.
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Affiliation(s)
- Nico Erhard
- Department of Electrophysiology, German Heart Centre Munich, Lazarettstr. 36, 80636, Munich, Germany.
| | - Andreas Metzner
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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Huang Y, Chen XM, Barajas-Martinez H, Jiang H, Antzelevitch C, Hu D. Common variants in SCN10A gene associated with Brugada syndrome. Hum Mol Genet 2021; 31:157-165. [PMID: 34312669 DOI: 10.1093/hmg/ddab217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Genome-wide association studies indicate that SCN10A plays an important role in cardiac electrophysiology. Common and rare SCN10A variants are suggested to contribute to Brugada Syndrome (BrS), an inherited channelopathy resulting from genetic-determined loss-of-function in cardiac sodium channel. This study sought to characterize the role of SCN10A common variants in BrS. METHODS AND RESULTS Clinical and genetic analyses were performed in 197 patients diagnosed with BrS. Baseline ECG parameters were evaluated in patients carrying each of four common variants associated with BrS. Cellular electrophysiological study was performed in SCN5A-SCN10A co-transfected TSA201 cells to investigate the possible electrophysiological characteristics of the allele of rs6795970, which displayed the most significant association with BrS. Four SCN10A common variants (rs7630989, rs57326399, rs6795970, rs12632942) displayed significant association with BrS susceptibility. There were no evident associations between baseline ECG parameters in BrS patients and the different genotypes of the four variants. Rs6795970 (V1073) was strongly associated with a risk for BrS, which suggests the different electrophysiological characters between these two alleles. Functional study showed a positive shift in steady-state activation (V1/2: -62.2 ± 2.6 vs. -53.5 ± 1.6 for A1073 and V1073 group, respectively; P < 0.05) and slower recovery from inactivation in mutant SCN5A-SCN10A co-transfected cells with, which contribute to the slow conduction in BrS patients with rs6795970. CONCLUSIONS SCN10A common variants are associated with increased susceptibility to BrS. An allele rs6795970 (V1073) increases the risk for BrS. The electrophysiological changes in a positive shift in steady-state activation and slower recovery from inactivation by SCN10A-V1073 contribute to this variant associated BrS.
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Affiliation(s)
- Yan Huang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, 430060, China
| | - Xiao-Meng Chen
- Department of Cardiology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, 266071, China
| | - Hector Barajas-Martinez
- Lankenau Institute for Medical Research, and Lankenau Heart Institute, Wynnwood, Pennsylvania and Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | - Hong Jiang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, 430060, China
| | - Charles Antzelevitch
- Lankenau Institute for Medical Research, and Lankenau Heart Institute, Wynnwood, Pennsylvania and Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | - Dan Hu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, 430060, China
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Kany S, Reissmann B, Metzner A, Kirchhof P, Darbar D, Schnabel RB. Genetics of atrial fibrillation-practical applications for clinical management: if not now, when and how? Cardiovasc Res 2021; 117:1718-1731. [PMID: 33982075 PMCID: PMC8208749 DOI: 10.1093/cvr/cvab153] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Indexed: 12/12/2022] Open
Abstract
The prevalence and economic burden of atrial fibrillation (AF) are predicted to more than double over the next few decades. In addition to anticoagulation and treatment of concomitant cardiovascular conditions, early and standardized rhythm control therapy reduces cardiovascular outcomes as compared with a rate control approach, favouring the restoration, and maintenance of sinus rhythm safely. Current therapies for rhythm control of AF include antiarrhythmic drugs (AADs) and catheter ablation (CA). However, response in an individual patient is highly variable with some remaining free of AF for long periods on antiarrhythmic therapy, while others require repeat AF ablation within weeks. The limited success of rhythm control therapy for AF is in part related to incomplete understanding of the pathophysiological mechanisms and our inability to predict responses in individual patients. Thus, a major knowledge gap is predicting which patients with AF are likely to respond to rhythm control approach. Over the last decade, tremendous progress has been made in defining the genetic architecture of AF with the identification of rare mutations in cardiac ion channels, signalling molecules, and myocardial structural proteins associated with familial (early-onset) AF. Conversely, genome-wide association studies have identified common variants at over 100 genetic loci and the development of polygenic risk scores has identified high-risk individuals. Although retrospective studies suggest that response to AADs and CA is modulated in part by common genetic variation, the development of a comprehensive clinical and genetic risk score may enable the translation of genetic data to the bedside care of AF patients. Given the economic impact of the AF epidemic, even small changes in therapeutic efficacy may lead to substantial improvements for patients and health care systems.
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Affiliation(s)
- Shinwan Kany
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20251 Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Martinistraße 52, 20251 Hamburg, Hamburg, Germany
| | - Bruno Reissmann
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20251 Hamburg, Hamburg, Germany
| | - Andreas Metzner
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20251 Hamburg, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20251 Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Martinistraße 52, 20251 Hamburg, Hamburg, Germany.,The Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston Birmingham B15 2TT, UK
| | - Dawood Darbar
- Division of Cardiology, Departments of Medicine, University of Illinois at Chicago and Jesse Brown Veterans Administration, 840 South Wood Street, Suite 928 M/C 715, Chicago, IL 60612, USA
| | - Renate B Schnabel
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20251 Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Martinistraße 52, 20251 Hamburg, Hamburg, Germany
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Liu X, Li Y, Zhang H, Ji Y, Zhao Z, Wang C. The research of ion channel-related gene polymorphisms with atrial fibrillation in the Chinese Han population. Mol Genet Genomic Med 2019; 7:e835. [PMID: 31270966 PMCID: PMC6687643 DOI: 10.1002/mgg3.835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/20/2019] [Accepted: 06/10/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is one of the common arrhythmia in clinics. Its incidence is high among the elderly. This study aimed to identify a possible connection between ion channel-related gene polymorphisms and the risk of AF. METHODS A total of 381 patients with coronary heart disease were recruited. Based on complete cardiac examination, the patients were divided into two subgroups: 185 patients with AF and 196 patients without AF. An association analysis was performed using 13 genotyped SNPs. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated by conditional logistic regression. RESULTS In our research, we found that KCNE2 rs8134775 was associated with a decreased AF risk in the allele model (OR = 0.70; 95% CI: 0.50-0.97; p = 0.034). Genetic model analysis shown that the minor allele T of GJA5 rs35594137 was associated with a decreased AF risk under the recessive model (OR = 0.40; 95% CI: 0.19-0.86; p = 0.018) and the minor allele G of KCNJ2 rs8079702 was associated with an increased AF risk in the recessive model (OR = 2.31; 95% CI: 1.20-4.42; p = 0.012). CONCLUSIONS Our results suggest that KCNE2, KCNJ2, and GJA5 influence the development of AF.
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Affiliation(s)
- Xiumin Liu
- Department of Cardiovascular Medicinethe Affiliated Hospital of Northwest University & Xi’an No.3 HospitalXi’anShaanxiChina
| | - Yujie Li
- Department of Cardiovascular MedicineFirst hospital of Xi’anXi’anShaanxiChina
| | - Huan Zhang
- Department of Cardiovascular Medicinethe Affiliated Hospital of Northwest University & Xi’an No.3 HospitalXi’anShaanxiChina
| | - Yuqiang Ji
- Department of Cardiovascular MedicineFirst hospital of Xi’anXi’anShaanxiChina
| | - Zhao Zhao
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi’anShaanxiChina
| | - Changyu Wang
- Department of Cardiovascular Medicinethe Affiliated Hospital of Northwest University & Xi’an No.3 HospitalXi’anShaanxiChina
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Zhu D, Liu K, Wan CL, Lu J, Zhao HX. Identification of novel therapeutic targets for neuropathic pain based on gene expression patterns. J Cell Physiol 2019; 234:19494-19501. [PMID: 31187496 DOI: 10.1002/jcp.28448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 11/12/2022]
Abstract
Neuropathic pain (NP) caused by nerve injury or dysfunction is one of the most challenging neurological diseases. In-depth study of disease signatures contributes to the development of novel target treatment for NP. In this study, we analyzed expression profiles of qualified NP datasets (GSE24982 and GSE63442) deposited at Gene Expression Omnibus database by systematic bioinformatics approaches. We analyzed the differentially expressed genes of high and low pain compared with normal control group, and between spinal nerve ligation (SNL) injury model and sham-operation group. A total of 1,243 upregulated and 1,533 downregulated genes were identified in GSE24982, 380 upregulated and 355 downregulated genes were identified in GSE63442. By comparing low-pain samples with the corresponding sham-operation group, we identified 457 upregulated and 409 downregulated genes. Overlapping genes were screened out and signaling pathway and expression regulation model analyses were performed. SCN10A and SST were identified as biomarkers for NP. In conclusion, our study showed the expression pattern of gene about NP. These identified biomarkers could serve as potential therapeutic targets for treating NP.
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Affiliation(s)
- Di Zhu
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital and the People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Kang Liu
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Cheng-Liang Wan
- Department of General Surgery, Kunming Children's Hospital, Kunming, China
| | - Jangnin Lu
- School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hong-Xia Zhao
- Department of Neurology, Huai'an Second People's Hospital and The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
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Abstract
PURPOSE OF REVIEW Atrial fibrillation is a common cardiac arrhythmia with a high morbidity and mortality affecting 34 million worldwide. Current therapies are inadequate and often fail to directly address molecular mechanisms of the disease. In this review, we will provide an overview of recent advances in our understanding of the genetic underpinnings of atrial fibrillation. RECENT FINDINGS Large-scale genetic association studies have more than doubled the number of genetic loci associated with atrial fibrillation during the last year. Studies examining how genes at or near these loci can affect the pathogenesis of atrial fibrillation are ongoing in cellular, animal, and computational models. In addition, several recent clinical studies have also demonstrated that variants at these loci can aid in risk stratification of patients. SUMMARY There are now over 30 genetic loci associated with atrial fibrillation. A better understanding of how these loci relate to disease pathogenesis may provide insight into novel therapeutic targets and ultimately lead to improved clinical care.
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