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Kahnert K, Soattin L, Mills RW, Wilson C, Maurya S, Sorrentino A, Al-Othman S, Tikhomirov R, van de Vegte YJ, Hansen FB, Achter J, Hu W, Zi M, Smith M, van der Harst P, Olesen MS, Boisen Olsen K, Banner J, Jensen THL, Zhang H, Boyett MR, D’Souza A, Lundby A. Proteomics couples electrical remodelling to inflammation in a murine model of heart failure with sinus node dysfunction. Cardiovasc Res 2024; 120:927-942. [PMID: 38661182 PMCID: PMC11218694 DOI: 10.1093/cvr/cvae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 04/26/2024] Open
Abstract
AIMS In patients with heart failure (HF), concomitant sinus node dysfunction (SND) is an important predictor of mortality, yet its molecular underpinnings are poorly understood. Using proteomics, this study aimed to dissect the protein and phosphorylation remodelling within the sinus node in an animal model of HF with concurrent SND. METHODS AND RESULTS We acquired deep sinus node proteomes and phosphoproteomes in mice with heart failure and SND and report extensive remodelling. Intersecting the measured (phospho)proteome changes with human genomics pharmacovigilance data, highlighted downregulated proteins involved in electrical activity such as the pacemaker ion channel, Hcn4. We confirmed the importance of ion channel downregulation for sinus node physiology using computer modelling. Guided by the proteomics data, we hypothesized that an inflammatory response may drive the electrophysiological remodeling underlying SND in heart failure. In support of this, experimentally induced inflammation downregulated Hcn4 and slowed pacemaking in the isolated sinus node. From the proteomics data we identified proinflammatory cytokine-like protein galectin-3 as a potential target to mitigate the effect. Indeed, in vivo suppression of galectin-3 in the animal model of heart failure prevented SND. CONCLUSION Collectively, we outline the protein and phosphorylation remodeling of SND in heart failure, we highlight a role for inflammation in electrophysiological remodelling of the sinus node, and we present galectin-3 signalling as a target to ameliorate SND in heart failure.
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Affiliation(s)
- Konstantin Kahnert
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Luca Soattin
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Robert W Mills
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Claire Wilson
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
| | - Svetlana Maurya
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Andrea Sorrentino
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Sami Al-Othman
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Roman Tikhomirov
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
- National Heart and Lung Institute, Imperial College London, Imperial Centre for Translational and Experimental Medicine (ICTEM), 72 Du Cane Road, London W12 0NN, UK
| | - Yordi J van de Vegte
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Finn B Hansen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Jonathan Achter
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Wei Hu
- Department of Physics & Astronomy, Biological Physics Group, University of Manchester, Manchester, UK
| | - Min Zi
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Matthew Smith
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
- National Heart and Lung Institute, Imperial College London, Imperial Centre for Translational and Experimental Medicine (ICTEM), 72 Du Cane Road, London W12 0NN, UK
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Durrer Center for Cardiogenetic Research, Netherlands Heart Institute, Utrecht, the Netherlands
| | - Morten S Olesen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Kristine Boisen Olsen
- Department of Forensic Medicine, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Jytte Banner
- Department of Forensic Medicine, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | | | - Henggui Zhang
- Department of Physics & Astronomy, Biological Physics Group, University of Manchester, Manchester, UK
| | - Mark R Boyett
- Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - Alicia D’Souza
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
- National Heart and Lung Institute, Imperial College London, Imperial Centre for Translational and Experimental Medicine (ICTEM), 72 Du Cane Road, London W12 0NN, UK
| | - Alicia Lundby
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
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Ababei A, Hrib LA, Iancu AC, Hadarag AV, Khebbaiz A, Vătășescu R, Bogdan Ș. Anti-bradycardia pacing-impact on patients with HFpEF: a systematic review. Heart Fail Rev 2024; 29:523-534. [PMID: 38282011 PMCID: PMC10942895 DOI: 10.1007/s10741-024-10382-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) has become an emerging concern. The protective effect of bradycardia in patients with reduced ejection fraction using beta-blockers or ivabradine does not improve symptoms in HFpEF. This review aims to assess current data regarding the impact of anti-bradycardia pacing in patients with HFpEF. A search was conducted on PubMed, ScienceDirect, Springer, and Wiley Online Library, selecting studies from 2013 to 2023. Relevant and eligible prospective studies and randomized controlled trials were included. Functional status, quality of life, and echocardiographic parameters were assessed. Six studies conformed to the selection criteria. Four were prospective studies with a total of 90 patients analyzed. Two were randomized controlled trials with a total of 129 patients assessed. The 6-min walk test (6MWT) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) score improved in all prospective studies. My-PACE trial showed improvements in MLHFQ score (p < 0.001), significant relative lowering in NT-proBNP levels (p = 0.02), and an increased mean daily activity in the personalized accelerated pacing group compared to usual care. RAPID-HF trial proved that pacemaker implantation to enhance exercise heart rate (HR) did not improve exercise capacity and was associated with increased adverse events. HFpEF requires a more individualized approach and quality of life management. This review demonstrates that higher resting HR by atrial pacing may improve symptoms and even outcomes in HFpEF, while a higher adaptive rate during exertion has not been proven beneficial.
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Affiliation(s)
- Alexandru Ababei
- Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, Sector 5, 050474, Bucharest, Romania
| | - Luciana Andreea Hrib
- Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, Sector 5, 050474, Bucharest, Romania
| | - Adalia Cristiana Iancu
- Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, Sector 5, 050474, Bucharest, Romania.
| | - Andra-Valeria Hadarag
- Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, Sector 5, 050474, Bucharest, Romania
| | - Ahmad Khebbaiz
- Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, Sector 5, 050474, Bucharest, Romania
| | - Radu Vătășescu
- Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, Sector 5, 050474, Bucharest, Romania
- Clinic Emergency Hospital, Bucharest, Romania
| | - Ștefan Bogdan
- Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, Sector 5, 050474, Bucharest, Romania
- Elias Emergency Hospital, Bucharest, Romania
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3
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Manolis AS, Manolis TA, Manolis AA, Melita H. Atrial fibrillation-induced tachycardiomyopathy and heart failure: an underappreciated and elusive condition. Heart Fail Rev 2022; 27:2119-2135. [PMID: 35318562 DOI: 10.1007/s10741-022-10221-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/04/2022]
Abstract
Many patients with persistent, chronic, or frequently recurring paroxysmal atrial fibrillation (AF) may develop a tachycardiomyopathy (TCM) with left ventricular (LV) dysfunction and heart failure (HF), which is reversible upon restoration and maintenance of sinus rhythm, when feasible, or via better and tighter ventricular rate (VR) control. Mechanisms involved in producing this leading cause of TCM (AF-TCM) include loss of atrial contraction, irregular heart rate, fast VR, neurohumoral activation, and structural myocardial changes. The most important of all mechanisms relates to optimal VR control, which seems to be an elusive target. Uncontrolled AF may also worsen preexisting LV dysfunction and exacerbate HF symptoms. Data, albeit less robust, also point to deleterious effects of slow VRs on LV function. Thus, a J-shaped relationship between VR and clinical outcome has been suggested, with the optimal VR control hovering at ~ 65 bpm, ranging between 60 and 80 bpm; VRs above and below this range may confer higher morbidity and mortality rates. A convergence of recent guidelines is noted towards a stricter rather than a more lenient VR control with target heart rate < 80 bpm at rest and < 110 bpm during moderate exercise which seems to prevent TCM or improve LV function and exercise capacity and relieve TCM-related symptoms and signs. Of course, restoring and maintaining sinus rhythm is always a most desirable target, when feasible, either with drugs or more likely with ablation. All these issues are herein reviewed, current guidelines are discussed and relevant data are tabulated and pictorially illustrated.
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Affiliation(s)
- Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece.
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Imamura T, Hori M, Narang N, Besser S, Kinugawa K. Prognostic Implications of Mitral Valve Inflow Pattern Overlap during Ivabradine Therapy. Int Heart J 2022; 63:43-48. [DOI: 10.1536/ihj.21-366] [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: 11/18/2022]
Affiliation(s)
| | - Masakazu Hori
- Second Department of Internal Medicine, University of Toyama
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Regulation of sinus node pacemaking and atrioventricular node conduction by HCN channels in health and disease. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2021; 166:61-85. [PMID: 34197836 DOI: 10.1016/j.pbiomolbio.2021.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 12/19/2022]
Abstract
The funny current, If, was first recorded in the heart 40 or more years ago by Dario DiFrancesco and others. Since then, we have learnt that If plays an important role in pacemaking in the sinus node, the innate pacemaker of the heart, and more recently evidence has accumulated to show that If may play an important role in action potential conduction through the atrioventricular (AV) node. Evidence has also accumulated to show that regulation of the transcription and translation of the underlying Hcn genes plays an important role in the regulation of sinus node pacemaking and AV node conduction under normal physiological conditions - in athletes, during the circadian rhythm, in pregnancy, and during postnatal development - as well as pathological states - ageing, heart failure, pulmonary hypertension, diabetes and atrial fibrillation. There may be yet more pathological conditions involving changes in the expression of the Hcn genes. Here, we review the role of If and the underlying HCN channels in physiological and pathological changes of the sinus and AV nodes and we begin to explore the signalling pathways (microRNAs, transcription factors, GIRK4, the autonomic nervous system and inflammation) involved in this regulation. This review is dedicated to Dario DiFrancesco on his retirement.
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Falsing MM, Brainin P, Andersen DM, Larroudé CE, Lindhardt TB, Ravnkilde K, Modin D, Karsum EH, Gislason G, Biering-Sørensen T. Sex differences in echocardiographic predictors of bradycardia detected by implantable loop recorder in patients with syncope and palpitations. Echocardiography 2021; 38:1186-1194. [PMID: 34037991 DOI: 10.1111/echo.15085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/21/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Our aim was to investigate whether echocardiography may aid in identifying patients, specifically men, at risk of bradycardia as detected by implantable loop recorders (ILR) in patients evaluated for syncope and palpitations. METHODS We included ambulatory patients undergoing ILR implantation for syncope (84%), presyncope (9%), and palpitations (8%). Echocardiographic examination was performed prior to implantation (2.9 months [IQR 1.0-6.0 months]). Echocardiograms were analyzed for conventional and speckle tracking parameters. We examined time to first event of bradycardia, defined as (a) heart rate <30 beats/min and (b) ≥4 beats, including sinus arrest, asystole, sinoatrial block, and second- and third-degree atrioventricular nodal block. We applied Cox proportional hazards models. RESULTS A total of 285 patients we enrolled, and during a median time of 2.7 years [IQR 1.0, 3.3 years] of continuous heart rhythm monitoring, 84 (29%) had bradycardia detected by ILR. Patients with bradycardia were older (61 ± 19 years vs 55 ± 18 years, P = .01) and more frequently men (62% vs 44%, P = .01). Sex modified the association between echocardiographic parameters and bradycardia (P interaction <0.05 for all), such that left ventricular LV mass index (HR: 1.02 per 1g/m2 increase [1.01-1.04], P < .001), LV ejection fraction (HR: 1.04 per 1% decrease [1.01-1.08], P = .02), and global longitudinal strain (HR: 1.09 per 1% decrease [1.01-1.19], P = .03) were associated with bradycardia in men but not women (P > .05 for all in female). After adjusting for baseline clinical characteristics, medical therapy, and loop indication, the abovementioned parameters remained significantly associated with incident bradycardia in men. CONCLUSION Echocardiographic parameters of LV structure and function may potentially be more useful for predicting bradycardia in men than women, among patients undergoing ILR implantation for syncope, presyncope, and palpations.
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Affiliation(s)
- Mathilde Musoni Falsing
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Philip Brainin
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Federal University of Acre, Acre, Brazil
| | - Ditte Madsen Andersen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Ellen Larroudé
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tommi Bo Lindhardt
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kirstine Ravnkilde
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Modin
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Emil Høegholm Karsum
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Gislason
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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7
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Yanni J, D'Souza A, Wang Y, Li N, Hansen BJ, Zakharkin SO, Smith M, Hayward C, Whitson BA, Mohler PJ, Janssen PML, Zeef L, Choudhury M, Zi M, Cai X, Logantha SJRJ, Nakao S, Atkinson A, Petkova M, Doris U, Ariyaratnam J, Cartwright EJ, Griffiths-Jones S, Hart G, Fedorov VV, Oceandy D, Dobrzynski H, Boyett MR. Silencing miR-370-3p rescues funny current and sinus node function in heart failure. Sci Rep 2020; 10:11279. [PMID: 32647133 PMCID: PMC7347645 DOI: 10.1038/s41598-020-67790-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/02/2020] [Indexed: 01/13/2023] Open
Abstract
Bradyarrhythmias are an important cause of mortality in heart failure and previous studies indicate a mechanistic role for electrical remodelling of the key pacemaking ion channel HCN4 in this process. Here we show that, in a mouse model of heart failure in which there is sinus bradycardia, there is upregulation of a microRNA (miR-370-3p), downregulation of the pacemaker ion channel, HCN4, and downregulation of the corresponding ionic current, If, in the sinus node. In vitro, exogenous miR-370-3p inhibits HCN4 mRNA and causes downregulation of HCN4 protein, downregulation of If, and bradycardia in the isolated sinus node. In vivo, intraperitoneal injection of an antimiR to miR-370-3p into heart failure mice silences miR-370-3p and restores HCN4 mRNA and protein and If in the sinus node and blunts the sinus bradycardia. In addition, it partially restores ventricular function and reduces mortality. This represents a novel approach to heart failure treatment.
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Affiliation(s)
- Joseph Yanni
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Alicia D'Souza
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Yanwen Wang
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Ning Li
- Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia Research and Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, 43210, USA
| | - Brian J Hansen
- Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia Research and Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, 43210, USA
| | - Stanislav O Zakharkin
- Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Matthew Smith
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Christina Hayward
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Bryan A Whitson
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia Research and Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, 43210, USA
- Department of Surgery, Division of Cardiac Surgery, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Peter J Mohler
- Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia Research and Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, 43210, USA
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Paul M L Janssen
- Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia Research and Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, 43210, USA
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Leo Zeef
- Bioinformatics Core Facility, University of Manchester, Manchester, UK
| | - Moinuddin Choudhury
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Min Zi
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Xue Cai
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Sunil Jit R J Logantha
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Shu Nakao
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Andrew Atkinson
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Maria Petkova
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Ursula Doris
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Jonathan Ariyaratnam
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Elizabeth J Cartwright
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Sam Griffiths-Jones
- Division of Evolution and Genomics Sciences, University of Manchester, Manchester, UK
| | - George Hart
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Vadim V Fedorov
- Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia Research and Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, 43210, USA
| | - Delvac Oceandy
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Halina Dobrzynski
- Division of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mark R Boyett
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200N, Copenhagen, Denmark.
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Nagatomo D, Kotooka N, Yoshioka G, Node K. Strategy for estimating optimal heart rate in refractory heart failure with relative sinus bradycardia: A case report. J Cardiol Cases 2019; 21:153-156. [PMID: 32256865 DOI: 10.1016/j.jccase.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/22/2019] [Accepted: 11/29/2019] [Indexed: 11/16/2022] Open
Abstract
Relative bradycardia (mild sinus bradycardia) is one of the major barriers for the effective treatment of hemodynamically unstable patients with heart failure and reduced cardiac output. We report a case of a man aged 58 years with an old broad anterior myocardial infarction and relative bradycardia (about 60 bpm) suffering from symptoms of congestive heart failure at rest in spite of optimal medical therapy, including the use of the inotropes. Transvenous atrial pacing during right heart catheterization indicated that an increase in heart rate (up to 80 bpm) improved hemodynamics immediately. Implantation of a pacemaker (atrial pacing of 80 bpm) was effective for stabilizing the heart failure symptoms. Transvenous atrial pacing during right heart catheterization is effective for estimating the optimal heart rate in patients with heart failure and relative bradycardia. <Learning objective: Temporary atrial pacing during right heart catheterization is effective for estimating the optimal heart rate in patients with refractory heart failure and relative bradycardia. We present a case of inotrope-dependent heart failure. Our findings, obtained through echocardiography and right heart catheterization, showed dramatic improvements in hemodynamic parameters following an increase in heart rate via a cardiac pacemaker. This case assesses the impact of optimal heart rate in severe heart failure with relative bradycardia.>.
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Affiliation(s)
- Daisuke Nagatomo
- Department of Cardiovascular Medicine, Saga University Hospital, Saga, Japan
| | - Norihiko Kotooka
- Department of Cardiovascular Medicine, Saga University Hospital, Saga, Japan
| | - Goro Yoshioka
- Department of Cardiovascular Medicine, Saga University Hospital, Saga, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University Hospital, Saga, Japan
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9
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Corletto A, Fröhlich H, Täger T, Hochadel M, Zahn R, Kilkowski C, Winkler R, Senges J, Katus HA, Frankenstein L. Beta blockers and chronic heart failure patients: prognostic impact of a dose targeted beta blocker therapy vs. heart rate targeted strategy. Clin Res Cardiol 2018; 107:1040-1049. [PMID: 29774407 DOI: 10.1007/s00392-018-1277-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 05/08/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Beta blockers improve survival in patients with chronic systolic heart failure (CHF). Whether physicians should aim for target dose, target heart rate (HR), or both is still under debate. METHODS AND RESULTS We identified 1,669 patients with systolic CHF due to ischemic heart disease or idiopathic dilated cardiomyopathy from the University Hospital Heidelberg and the Clinic of Ludwigshafen, Germany. All patients were treated with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker and had a history of CHF known for at least 6 months. Target dose was defined as treatment with ≥ 95% of the respective published guideline-recommended dose. Target HR was defined as 51-69 bpm. All-cause mortality during the median follow-up of 42.8 months was analysed with respect to beta blocker dosing and resting HR. 201 (12%) patients met the dose target (group A), 285 (17.1%) met the HR target (group B), 627 (37.6%) met no target (group C), and 556 (33.3%) did not receive beta blockers (Group D). 5-year mortality was 23.7, 22.7, 37.6, and 55.6% for group A, B, C, and D, respectively (p < 0.001). Survival for group A patients with a HR ≥ 70 bpm was 28.8% but 14.8% if HR was 50-70 bpm (p = 0.054). CONCLUSIONS Achieving guidelines recommended beta blocker dose or to HR control has a similar positive impact on survival. When on target dose, supplemental HR control additionally improves survival.
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Affiliation(s)
- Anna Corletto
- Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany
| | - Hanna Fröhlich
- Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany
| | - Tobias Täger
- Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany
| | - Matthias Hochadel
- Medizinische Klinik B-Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen GmbH, Ludwigshafen am Rhein, 67059, Germany
| | - Ralf Zahn
- Medizinische Klinik B-Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen GmbH, Ludwigshafen am Rhein, 67059, Germany
| | - Caroline Kilkowski
- Medizinische Klinik B-Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen GmbH, Ludwigshafen am Rhein, 67059, Germany
| | - Ralph Winkler
- Medizinische Klinik B-Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen GmbH, Ludwigshafen am Rhein, 67059, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Bremserstraße 79, 67063, Ludwigshafen am Rhein, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany.
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10
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Rivers EP, McCord J, Otero R, Jacobsen G, Loomba M. Clinical Utility of B-Type Natriuretic Peptide in Early Severe Sepsis and Septic Shock. J Intensive Care Med 2016; 22:363-73. [DOI: 10.1177/0885066607307523] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
B-type natriuretic peptide (BNP) has diagnostic, therapeutic, and prognostic utility in critically ill patients. For severe sepsis and septic shock patients in particular, similar clinical utility from the most proximal aspects of hospital presentation to the intensive care unit has not been examined. BNP levels were measured at 0, 3, 6, 12, 24, 36, 48, 60, and 72 hours in 252 patients presenting to the emergency department with severe sepsis and septic shock. The clinicians were blinded to the BNP levels. Elevated BNP levels (>100 pg/mL) were seen in 42% and 69% of patients on presentation and at 24 hours, respectively. Elevated BNP ranges (>230 pg/mL) were significantly associated with myocardial dysfunction and severity of global tissue hypoxia. When adjusted for age, gender, history of heart failure, renal function, organ dysfunction, and mean arterial pressure, a BNP greater than 210 pg/mL at 24 hours was the most significant independent indicator of increased mortality: odds ratio 1.061 (1.026-1.097), P < .001, 95% confidence interval. Patients with severe sepsis and septic shock often have elevated BNP levels, which are significantly associated with organ and myocardial dysfunction, global tissue hypoxia, and mortality. Serial BNP levels may be a useful adjunct in the early detection, stratification, treatment, and prognostication of high-risk patients.
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Affiliation(s)
- Emanuel P. Rivers
- Department of Emergency Medicine, Henry Ford Hospital, Wayne State University, Detroit, Michigan, Department of Surgery, Henry Ford Hospital, Wayne State University, Detroit, Michigan,
| | - James McCord
- Department of Cardiology, Henry Ford Hospital, Wayne State University, Detroit, Michigan
| | - Ronny Otero
- Department of Emergency Medicine, Henry Ford Hospital, Wayne State University, Detroit, Michigan
| | - Gordon Jacobsen
- Department of Biostatistics and Epidemiology (GJ), Henry Ford Hospital, Wayne State University, Detroit, Michigan
| | - Manisha Loomba
- Department of Anesthesiology, Henry Ford Hospital, Wayne State University Detroit, Michigan
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11
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Iwataki M, Kim YJ, Sun BJ, Jang JY, Takeuchi M, Fukuda S, Otani K, Yoshitani H, Ohe H, Kohno R, Oginosawa Y, Abe H, Levine RA, Song JK, Otsuji Y. Different characteristics of heart failure due to pump failure and bradyarrhythmia. J Echocardiogr 2014; 13:27-34. [PMID: 25750577 PMCID: PMC4346665 DOI: 10.1007/s12574-014-0235-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/20/2014] [Accepted: 11/25/2014] [Indexed: 11/29/2022]
Abstract
Background Heart failure (HF) can be caused by left ventricular (LV) pump failure as well as by bradyarrhythmias. Hemodynamic differences between HF by LV pump failure and that by bradyarrhythmia have not been fully investigated. We hypothesized that HF by LV pump failure could be associated with both reduced cardiac output (CO) and increased LV filling pressure due to associated LV diastolic dysfunction, whereas HF by bradyarrhythmia could be associated with reduced CO but only modestly increased LV filling pressure due to the absence of LV diastolic dysfunction. Methods In 39 patients with HF by LV pump failure (LV ejection fraction <35 %), 24 with HF by bradyarrhythmia, and 22 normal controls, LV volume, ejection fraction, stroke volume, left atrial volume, and early diastolic mitral valve flow to tissue annular velocity ratio (E/E′) were measured by echocardiography. Results Compared to patients with HF by LV pump failure, those with HF by bradyarrhythmia had significantly lower heart rates, less LV dilatation, preserved LV ejection fraction, preserved stroke volume, similarly reduced cardiac index (1.8 ± 0.4 vs. 1.6 ± 0.4 L/min/m2, n.s.), preserved LV diastolic function (E′) (4.4 ± 2.1 vs. 7.1 ± 2.9 cm/s, p < 0.001), less dilated end-systolic LA volume, and preserved E/E′ (24 ± 10 vs. 13 ± 7, p < 0.001). Conclusions HF by LV pump failure is characterized by both significantly reduced CO and increased LV filling pressure, whereas HF by bradyarrhythmia is characterized by a similar reduction in CO but only modestly increased LV filling pressure.
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Affiliation(s)
- Mai Iwataki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan
| | - Yun-Jeong Kim
- Echocardiography Laboratory, Asan Medical Center, Seoul, Korea
| | - Byung-Joo Sun
- Echocardiography Laboratory, Asan Medical Center, Seoul, Korea
| | - Jeong-Yoon Jang
- Echocardiography Laboratory, Asan Medical Center, Seoul, Korea
| | - Masaaki Takeuchi
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan
| | - Shota Fukuda
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan
| | - Kyoko Otani
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan
| | - Hidetoshi Yoshitani
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan
| | - Hisaharu Ohe
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan
| | - Ritsuko Kohno
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Yasushi Oginosawa
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan
| | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, MA USA
| | - Jae-Kwan Song
- Echocardiography Laboratory, Asan Medical Center, Seoul, Korea
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan
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12
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Esfandiari S, Fuchs F, Wainstein RV, Chelvanathan A, Mitoff P, Sasson Z, Mak S. Heart rate-dependent left ventricular diastolic function in patients with and without heart failure. J Card Fail 2014; 21:68-75. [PMID: 25451706 DOI: 10.1016/j.cardfail.2014.10.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 10/09/2014] [Accepted: 10/20/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chronic heart rate (HR) reduction in the treatment of heart failure (HF) with systolic dysfunction is beneficial, but the immediate mechanical advantages or disadvantages of altering HR are incompletely understood. We examined the effects of increasing HR on early and late diastole in humans with and without HF. METHODS AND RESULTS We studied force-interval relationships of the left ventricle (LV) in 11 HF patients and 14 control subjects. HR was controlled by right atrial pacing, and LV pressure was recorded by a micromanometer-tipped catheter. The time constant of isovolumic relaxation (tau) was calculated, and simultaneous sonographic images were analyzed for LV volumes. The end-diastolic pressure-volume relationship (EDPVR) was analyzed with the use of a single-beat method. Tau was shortened in response to increasing HR in both groups; the slope of this relationship was steeper in HF than in control subjects. The predicted volume at a theoretic pressure of 0 mm Hg (V30) increased at higher HRs compared with baseline, shifting the predicted EDPVR compliance curve to the right in HF patients but not in control subjects. CONCLUSIONS In HF, changes in HR affect early relaxation and diastolic compliance to a greater extent than in control subjects. Our study reinforces current recommendations for HR-lowering drug treatment in HF.
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Affiliation(s)
- Sam Esfandiari
- Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Felipe Fuchs
- Division of Cardiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada
| | - Rodrigo V Wainstein
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Anjala Chelvanathan
- Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter Mitoff
- Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Zion Sasson
- Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Susanna Mak
- Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
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13
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Schmitt N, Grunnet M, Olesen SP. Cardiac potassium channel subtypes: new roles in repolarization and arrhythmia. Physiol Rev 2014; 94:609-53. [PMID: 24692356 DOI: 10.1152/physrev.00022.2013] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
About 10 distinct potassium channels in the heart are involved in shaping the action potential. Some of the K+ channels are primarily responsible for early repolarization, whereas others drive late repolarization and still others are open throughout the cardiac cycle. Three main K+ channels drive the late repolarization of the ventricle with some redundancy, and in atria this repolarization reserve is supplemented by the fairly atrial-specific KV1.5, Kir3, KCa, and K2P channels. The role of the latter two subtypes in atria is currently being clarified, and several findings indicate that they could constitute targets for new pharmacological treatment of atrial fibrillation. The interplay between the different K+ channel subtypes in both atria and ventricle is dynamic, and a significant up- and downregulation occurs in disease states such as atrial fibrillation or heart failure. The underlying posttranscriptional and posttranslational remodeling of the individual K+ channels changes their activity and significance relative to each other, and they must be viewed together to understand their role in keeping a stable heart rhythm, also under menacing conditions like attacks of reentry arrhythmia.
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14
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Ryu M, Gombojav B, Nam CM, Lee Y, Han K. Modifying effects of resting heart rate on the association of binge drinking with all-cause and cardiovascular mortality in older Korean men: the Kangwha Cohort Study. J Epidemiol 2014; 24:274-80. [PMID: 24705645 PMCID: PMC4074631 DOI: 10.2188/jea.je20130101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although binge drinking and high resting heart rate independently affect cardiovascular and all-cause mortality risk, the combined effect of these two risk factors and their interaction has rarely been studied. This study examined the association between binge drinking and cardiovascular and all-cause mortality and evaluated the potential modifying effect on this association of resting heart rate in Korean men. METHODS Men aged 55 years or older in 1985 (n = 2600) were followed for cardiovascular and all-cause mortality for 20.8 years, until 2005. We estimated hazard ratios (HRs) for cardiovascular and all-cause mortality by binge drinking and resting heart rate using the Cox proportional hazard model. RESULTS Heavy binge drinkers (≥12 drinks on one occasion) with elevated resting heart rate (≥80 bpm) had a HR of 2.25 (95% confidence interval [CI], 1.47-3.45) for death from cardiovascular disease and 1.37 (95% CI, 0.87-2.14) for all-cause mortality compared to the reference group (non-drinking and resting heart rate 61-79 bpm). The HRs of dying from cardiovascular disease increased linearly from 1.36 to 1.52, 1.71, and 2.25 among individuals with resting heart rate greater than or equal to 80 bpm within the four alcohol consumption categories (non-drinking, non-binge, moderate binge, and heavy binge), respectively. CONCLUSIONS Our findings suggest that, among older Korean men, heavy binge drinkers with an elevated resting heart rate are at high risk for cardiovascular and all-cause mortality.
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Affiliation(s)
- Mikyung Ryu
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine
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15
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Chiu SN, Lin LY, Wang JK, Lu CW, Chang CW, Lin MT, Hua YC, Lue HC, Wu MH. Long-term outcomes of pediatric sinus bradycardia. J Pediatr 2013; 163:885-9.e1. [PMID: 23623512 DOI: 10.1016/j.jpeds.2013.03.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 03/04/2013] [Accepted: 03/19/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To delineate the long-term outcomes and mechanisms of pediatric sinus bradycardia. STUDY DESIGN Participants with sinus bradycardia who were identified from a survey of 432,166 elementary and high school students, were enrolled 10 years after the survey. The clinical course, heart rate variability, and hyperpolarization-activated cyclic nucleotide-gated potassium channel 4 (HCN4) gene were assessed. RESULTS A total of 104 (male:female was 60:44; prevalence, 0.025%) participants were observed to have sinus bradycardia at age 15.5 ± 0.2 years with a mean heart rate of 48.4 ± 0.4 beats per minute; 86 study participants (83%) responded to clinical assessment and 37 (36%) underwent laboratory assessment. Athletes composed 37.8% of the study participants. During the extended 10-year follow-up, 15 (17%) of the participants had self-limited syncopal episodes, but none had experienced life-threatening events. According to Holter recordings, none of the participants had heart rate <30 beats per minute or a pause longer than 3 seconds. Compared with 67 age- and sex-matched controls, the variables of heart rate based on the spectral and time domain analysis of the participants with sinus bradycardia were all significantly higher, indicating higher parasympathetic activity. The results of mutation analysis were negative in the HCN4 gene in all of our participants. CONCLUSIONS The long-term outcomes of the children and adolescents with sinus bradycardia identified using school electrocardiographic survey are favorable. Parasympathetic hyperactivity, instead of HCN4 gene mutation, is responsible for the occurrence of sinus bradycardia.
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Affiliation(s)
- Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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16
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Wang NC, Piccini JP, Fonarow GC, Knight BP, Harinstein ME, Butler J, Lahiri MK, Metra M, Vaduganathan M, Gheorghiade M. The potential role of nonpharmacologic electrophysiology-based interventions in improving outcomes in patients hospitalized for heart failure. Heart Fail Clin 2013; 9:331-43, vi-vii. [PMID: 23809419 DOI: 10.1016/j.hfc.2013.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hospitalization for heart failure (HHF) is commonly associated with symptomatic improvement in response to standard medical therapy, yet there remains a substantial risk of rehospitalization and death. Clinically stable outpatients and decompensated inpatients represent two types of patients with chronic heart failure. In the former, treatment of common heart rhythm disorders with nonpharmacologic electrophysiology-based interventions is of substantial benefit in select patients. The potential benefits of these interventions in the hospitalized setting are not well studied. In this review, current knowledge is discussed and future research directions are suggested with nonpharmacologic electrophysiology-based interventions to reduce the morbidity and mortality associated with patients with HHF.
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Affiliation(s)
- Norman C Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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17
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McLachlan CS, Ocsan R, Spence I, Hambly B, Matthews S, Wang L, Jelinek HF. Increased total heart rate variability and enhanced cardiac vagal autonomic activity in healthy humans with sinus bradycardia. Proc (Bayl Univ Med Cent) 2011; 23:368-70. [PMID: 20944759 DOI: 10.1080/08998280.2010.11928655] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Sinus bradycardia can be defined as a sinus rhythm with a resting heart rate of 60 beats per minute or less. While it is assumed that increased autonomic parasympathetic activity is associated with sinus bradycardia, such an association has yet to be proven. The aims of this study were to compute a number of heart rate variability (HRV) parameters in healthy individuals with sinus bradycardia and determine whether there was a significant vagal component to sinus bradycardia. Forty-three healthy adults with normal sinus rhythm and 25 healthy adults with sinus bradycardia had an electrocardiogram recorded for 20 minutes, from which HRV indices were calculated. Results showed significant increases in SDNN (standard deviation of NN intervals) (P < 0.05), RMSDD (square root of the mean squared differences of successive NN intervals) (P < 0.05), and DFA32 (detrended fluctuation analysis) (P < 0.05) in bradycardic subjects compared with subjects with normal sinus rhythm. There were no significant differences in sympathetic frequency domain indices between the two groups. In conclusion, there were significant increases in total heart variability and increased parasympathetic drive in subjects with bradycardia. Clinically, bradycardia is likely to be cardioprotective in aging populations based upon these HRV findings.
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Affiliation(s)
- Craig S McLachlan
- Department of Physiology, National University of Singapore, Singapore (McLachlan); the Kolling Institute, the Sydney Medical School, the University of Sydney, Australia (McLachlan); the Departments of Pharmacology (Spence, Matthews) and Pathology (Ocsan, Hambly), the University of Sydney, Sydney, Australia; the School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, Australia (Wang); and the School of Community Health, Charles Sturt University, Albury, Australia (Jelinek)
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18
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Caliskan K, Balk AHMM, Jordaens L, Szili-Torok T. Bradycardiomyopathy: the case for a causative relationship between severe sinus bradycardia and heart failure. J Cardiovasc Electrophysiol 2010; 21:822-4. [PMID: 20132390 DOI: 10.1111/j.1540-8167.2009.01704.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 28-year-old man presented with progressive fatigue. Physical examination and ECG revealed severe sinus bradycardia. Echocardiography showed features of noncompaction cardiomyopathy and moderate aortic valve regurgitation. We hypothesized that the chronic volume overload exaggerated by prolonged diastole due to the bradycardia resulted in heart failure and noncompaction cardiomyopathy look-alike features. After implantation of an AAI pacemaker, his symptoms and signs of cardiomyopathy were fully recovered.
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Schuller S, Van Israël N, Else RW. Third Degree Atrioventricular Block and Accelerated Idioventricular Rhythm Associated with A Heart Base Chemodectoma in A Syncopal Rottweiler. ACTA ACUST UNITED AC 2007; 54:618-23. [DOI: 10.1111/j.1439-0442.2007.00972.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Nattel S, Maguy A, Le Bouter S, Yeh YH. Arrhythmogenic Ion-Channel Remodeling in the Heart: Heart Failure, Myocardial Infarction, and Atrial Fibrillation. Physiol Rev 2007; 87:425-56. [PMID: 17429037 DOI: 10.1152/physrev.00014.2006] [Citation(s) in RCA: 597] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Rhythmic and effective cardiac contraction depends on appropriately timed generation and spread of cardiac electrical activity. The basic cellular unit of such activity is the action potential, which is shaped by specialized proteins (channels and transporters) that control the movement of ions across cardiac cell membranes in a highly regulated fashion. Cardiac disease modifies the operation of ion channels and transporters in a way that promotes the occurrence of cardiac rhythm disturbances, a process called “arrhythmogenic remodeling.” Arrhythmogenic remodeling involves alterations in ion channel and transporter expression, regulation and association with important protein partners, and has important pathophysiological implications that contribute in major ways to cardiac morbidity and mortality. We review the changes in ion channel and transporter properties associated with three important clinical and experimental paradigms: congestive heart failure, myocardial infarction, and atrial fibrillation. We pay particular attention to K+, Na+, and Ca2+channels; Ca2+transporters; connexins; and hyperpolarization-activated nonselective cation channels and discuss the mechanisms through which changes in ion handling processes lead to cardiac arrhythmias. We highlight areas of future investigation, as well as important opportunities for improved therapeutic approaches that are being opened by an improved understanding of the mechanisms of arrhythmogenic remodeling.
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Affiliation(s)
- Stanley Nattel
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Quebec, Canada.
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Abstract
We report the case of a patient with chronic bradycardia and congestive heart failure whose clinical and hemodynamic status improved immediately after the implantation of a VVI pacing system. The role of chronic bradycardia in the development of congestive heart failure is discussed.
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Affiliation(s)
- Argirios Ntalianis
- University of Athens School of Medicine, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
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22
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Sugden PH. RGS proteins to the rescue. J Mol Cell Cardiol 2001; 33:189-95. [PMID: 11162125 DOI: 10.1006/jmcc.2000.1310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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