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Wolfes J, Uphoff J, Kemena S, Wegner F, Rath B, Eckardt L, Frommeyer G, Ellermann C. Divergent electrophysiologic action of dapagliflozin and empagliflozin on ventricular and atrial tachyarrhythmias in isolated rabbit hearts. Front Cardiovasc Med 2024; 11:1369250. [PMID: 38455723 PMCID: PMC10918010 DOI: 10.3389/fcvm.2024.1369250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Abstract
Background The use of SGLT-2 inhibitors has revolutionized heart failure therapy. Evidence suggests a reduced incidence of ventricular and atrial arrhythmias in patients with dapagliflozin or empagliflozin treatment. It is unclear to what extent the reduced arrhythmia burden is due to direct effects of the SGLT2 inhibitors or is solely a marker of improved cardiac function. Methods One hundred five rabbit hearts were allocated to eight groups and retrogradely perfused, employing a Langendorff setup. Action potential duration at 90% of repolarization (APD90), QT intervals, effective refractory periods, conduction velocity, and dispersion of repolarization were obtained with monophasic action potential catheters. A model for tachyarrhythmias was established with the IKr blocker erythromycin for QT prolongation associated proarrhythmia as well as the potassium channel opener pinacidil for a short-QT model. An atrial fibrillation (AF) model was created with isoproterenol and acetylcholine. With increasing concentrations of both SGLT2 inhibitors, reductions in QT intervals and APD90 were observed, accompanied by a slight increase in ventricular arrhythmia episodes. During drug-induced proarrhythmia, empagliflozin succeeded in decreasing QT intervals, APD90, and VT burden whereas dapagliflozin demonstrated no significant effects. In the presence of pinacidil induced arrhythmogenicity, neither SGLT2 inhibitor had a significant impact on cardiac electrophysiology. In the AF setting, perfusion with dapagliflozin showed significant suppression of AF in the course of restitution of electrophysiological parameters whereas empagliflozin showed no significant effect on atrial fibrillation incidence. Conclusion In this model, empagliflozin and dapagliflozin demonstrated opposite antiarrhythmic properties. Empagliflozin reduced ventricular tachyarrhythmias whereas dapagliflozin showed effective suppression of atrial arrhythmias.
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Affiliation(s)
- Julian Wolfes
- Department of Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
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Ellermann C, Dimanski D, Wolfes J, Rath B, Leitz P, Willy K, Wegner FK, Eckardt L, Frommeyer G. Electrophysiologic effects of sacubitril in different arrhythmia models. Eur J Pharmacol 2022; 917:174747. [PMID: 35026194 DOI: 10.1016/j.ejphar.2022.174747] [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: 10/15/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous studies report conflicting data regarding anti- or proarrhythmic effects of sacubitril. Aim of this study was to assess the impact of acute sacubitril treatment in different arrhythmia models. METHODS Sacubitril was administered (3, 5, 10 μM) in 12 isolated rabbit hearts. Further 12 hearts were treated with erythromycin to simulate long-QT-syndrome-2 (LQT2). Other 12 hearts were perfused with veratridine to mimic long-QT-syndrome-3 (LQT3). Both LQT-groups were treated with sacubitril (5 μM) additionally. Ventricular vulnerability was assessed by a pacing protocol. AV-blocked bradycardic hearts were perfused with a hypokalemic solution to trigger torsade de pointes (TdP). In further 13 hearts, AF was induced by a combination of acetylcholine and isoproterenol and sacubitril (5 μM) was added afterwards. RESULTS With sacubitril, action potential duration (APD) was abbreviated whereas spatial dispersion of repolarisation (SDR) remained stable. In both LQT groups, APD and SDR were increased. Infusion of sacubitril reduced APD (- 21 ms, p < 0.01) and SDR (- 8 ms) in the LQT2-group and did not alter APD (+2 ms) but reduced SDR (-19 ms, p < 0.01) in the LQT3-group. Ventricular vulnerability was not altered by sacubitril. No TdP were observed with sacubitril or under baseline conditions in any group. Sacubitril significantly suppressed TdP in the LQT2-group (3 vs. 43 episodes, p < 0.05) but not in the LQT3-group (10 vs. 16 episodes, p = ns). Sacubitril reduced inducibility of AF (9 vs. 31 episodes). CONCLUSION Sacubitril abbreviated APD. In addition, sacubitril exhibits potential antiarrhythmic effects in LQT2 and may be beneficial in LQT3 and AF.
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Affiliation(s)
- Christian Ellermann
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Darian Dimanski
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Julian Wolfes
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Benjamin Rath
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Patrick Leitz
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Kevin Willy
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Felix K Wegner
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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A Review on Atrial Fibrillation (Computer Simulation and Clinical Perspectives). HEARTS 2022. [DOI: 10.3390/hearts3010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Atrial fibrillation (AF), a heart condition, has been a well-researched topic for the past few decades. This multidisciplinary field of study deals with signal processing, finite element analysis, mathematical modeling, optimization, and clinical procedure. This article is focused on a comprehensive review of journal articles published in the field of AF. Topics from the age-old fundamental concepts to specialized modern techniques involved in today’s AF research are discussed. It was found that a lot of research articles have already been published in modeling and simulation of AF. In comparison to that, the diagnosis and post-operative procedures for AF patients have not yet been totally understood or explored by the researchers. The simulation and modeling of AF have been investigated by many researchers in this field. Cellular model, tissue model, and geometric model among others have been used to simulate AF. Due to a very complex nature, the causes of AF have not been fully perceived to date, but the simulated results are validated with real-life patient data. Many algorithms have been proposed to detect the source of AF in human atria. There are many ablation strategies for AF patients, but the search for more efficient ablation strategies is still going on. AF management for patients with different stages of AF has been discussed in the literature as well but is somehow limited mostly to the patients with persistent AF. The authors hope that this study helps to find existing research gaps in the analysis and the diagnosis of AF.
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Mitochondrial Dysfunction in Atrial Fibrillation-Mechanisms and Pharmacological Interventions. J Clin Med 2021; 10:jcm10112385. [PMID: 34071563 PMCID: PMC8199309 DOI: 10.3390/jcm10112385] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 12/22/2022] Open
Abstract
Despite the enormous progress in the treatment of atrial fibrillation, mainly with the use of invasive techniques, many questions remain unanswered regarding the pathomechanism of the arrhythmia and its prevention methods. The development of atrial fibrillation requires functional changes in the myocardium that result from disturbed ionic fluxes and altered electrophysiology of the cardiomyocyte. Electrical instability and electrical remodeling underlying the arrhythmia may result from a cellular energy deficit and oxidative stress, which are caused by mitochondrial dysfunction. The significance of mitochondrial dysfunction in the pathogenesis of atrial fibrillation remains not fully elucidated; however, it is emphasized by the reduction of atrial fibrillation burden after therapeutic interventions improving the mitochondrial welfare. This review summarizes the mechanisms of mitochondrial dysfunction related to atrial fibrillation and current pharmacological treatment options targeting mitochondria to prevent or improve the outcome of atrial fibrillation.
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Huang M, Liao Z, Li X, Yang Z, Fan X, Li Y, Zhao Z, Lang S, Cyganek L, Zhou X, Akin I, Borggrefe M, El-Battrawy I. Effects of Antiarrhythmic Drugs on hERG Gating in Human-Induced Pluripotent Stem Cell-Derived Cardiomyocytes From a Patient With Short QT Syndrome Type 1. Front Pharmacol 2021; 12:675003. [PMID: 34025432 PMCID: PMC8138577 DOI: 10.3389/fphar.2021.675003] [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: 03/02/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022] Open
Abstract
Aims: The short QT syndrome type 1 (SQT1) is linked to hERG channel mutations (e.g., N588K). Drug effects on hERG channel gating kinetics in SQT1-cells have not been investigated. Methods: This study used hiPSC-CMs of a healthy donor and a SQT1-patient carrying the N588K mutation and patch clamp to examine the drug effects on hERG channel gating kinetics. Results: Ajmaline, amiodarone, ivabradine, flecainide, quinidine, mexiletine and ranolazine inhibited the hERG channel current (IKr) less strongly in hiPSC-CMs from the SQTS1-patient (SQT1-hiPSC-CMs) comparing with cells from the healthy donor (donor-hiPSC-CMs). Quinidine and mexiletine reduced, but ajmaline, amiodarone, ivabradine and ranolazine increased the time to peak of IKr similarly in SQT1-hiPSC-CMs and donor-hiPSC-CMs. Although regarding the shift of activation and inactivation curves, tested drugs showed differential effects in donor- and SQT1-hiPSC-CMs, quinidine, ajmaline, ivabradine and mexiletine but not amiodarone, flecainide and ranolazine reduced the window current in SQT1-hiPSC-CMs. Quinidine, ajmaline, ivabradine and mexiletine differentially changed the time constant of recovery from inactivation, but all of them increased the time constant of deactivation in SQT1-hiPSC-CMs. Conclusion: The window current-reducing and deactivation-slowing effects may be important for the antiarrhythmic effect of ajmaline, ivabradine, quinidine and mexiletine in SQT1-cells. This information may be helpful for selecting drugs for treating SQT1-patients with hERG channel mutation.
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Affiliation(s)
- Mengying Huang
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Zhenxing Liao
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,North Sichuan Medical College, Nanchong, China
| | - Xin Li
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhen Yang
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,North Sichuan Medical College, Nanchong, China
| | - Xuehui Fan
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Yingrui Li
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Zhihan Zhao
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Sites, Heidelberg-Mannheim and Göttingen, Mannheim, Germany
| | - Lukas Cyganek
- DZHK (German Center for Cardiovascular Research), Partner Sites, Heidelberg-Mannheim and Göttingen, Mannheim, Germany.,Stem Cell Unit, Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Xiaobo Zhou
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China.,DZHK (German Center for Cardiovascular Research), Partner Sites, Heidelberg-Mannheim and Göttingen, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Sites, Heidelberg-Mannheim and Göttingen, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Sites, Heidelberg-Mannheim and Göttingen, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Sites, Heidelberg-Mannheim and Göttingen, Mannheim, Germany
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Electrophysiological effects of ranolazine in a goat model of lone atrial fibrillation. Heart Rhythm 2020; 18:615-622. [PMID: 33232809 DOI: 10.1016/j.hrthm.2020.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is still an unmet need for pharmacologic treatment of atrial fibrillation (AF) with few effects on ventricular electrophysiology. Ranolazine is an antiarrhythmic drug reported to have strong atrial selectivity. OBJECTIVE The purpose of this study was to investigate the electrophysiological effects of ranolazine in atria with AF-induced electrical remodeling in a model of lone AF in awake goats. METHODS Electrode patches were implanted on the atrial epicardium of 8 Dutch milk goats. Experiments were performed at baseline and after 2 and 14 days of electrically maintained AF. Several electrophysiological parameters and AF episode duration were measured during infusion of vehicle and different doses of ranolazine (target plasma levels 4, 8, and 16 μM, respectively). RESULTS The highest dose of ranolazine significantly prolonged atrial effective refractory period and decreased atrial conduction velocity at baseline and after 2 days of AF. After 2 weeks of AF, ranolazine prolonged the p5 and p50 of AF cycle length distribution in a dose-dependent manner but was not effective in restoring sinus rhythm. No adverse ventricular arrhythmic events (eg, premature ventricular beats or signs of hemodynamic instability) were observed during infusion of ranolazine at any point in the study. CONCLUSION The lowest investigated dose of ranolazine, which is expected to block both late INa and atrial peak INa, had no effect on the investigated electrophysiological parameters. The highest dose affected both atrial and ventricular electrophysiological parameters at different stages of AF-induced remodeling but was not efficacious in cardioverting AF to sinus rhythm in a goat model of lone AF.
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7
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Antiarrhythmic Effect of Ranolazine in Combination with Selective NCX-Inhibition in an Experimental Model of Atrial Fibrillation. Pharmaceuticals (Basel) 2020; 13:ph13100321. [PMID: 33092020 PMCID: PMC7589655 DOI: 10.3390/ph13100321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/09/2020] [Accepted: 10/16/2020] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to investigate the effects of a combination of ranolazine with different selective inhibitors of the Na+/Ca2+-exchanger (NCX) in an established experimental model of atrial fibrillation (AF). Eighteen hearts of New Zealand white rabbits were retrogradely perfused. Atrial catheters were used to record monophasic action potentials (aPRR). Hearts were paced at three different cycle lengths. Thereby, atrial action potential durations (aAPD90), atrial effective refractory periods (aERP) and atrial post-repolarization refractoriness were obtained. Isoproterenol and acetylcholine were employed to increase the occurrence of AF. Thereafter, the hearts were assigned to two groups (n = 9 each group) and additionally perfused with a combination of 10 µM ranolazine and 1 µM of the selective NCX-inhibitor ORM-10103 (group A: Rano-ORM) or 10 µM ranolazine and 1 µM of another NCX-inhibitor, SEA0400 (group B: Rano-SEA). The infusion of Iso/ACh led to a shortening of aAPD90, aERP, aPRR and the occurrence of AF episodes was significantly increased. Additional perfusion with ranolazine and ORM-10103 (group A) significantly prolonged the refractory periods and aPRR and AF episodes were effectively reduced. In group B, Rano-SEA led to a slight decrease in aAPD90 while aERP and aPRR were prolonged. The occurrence of AF episodes was consecutively reduced. To our knowledge, this is the first study investigating the effect of ranolazine combined with different selective NCX-inhibitors in an isolated whole-heart model of AF. Both combinations prolonged aERP and aPRR and thereby suppressed the induction of AF.
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8
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Aidonidis I, Simopoulos V, Stravela S, Dipla K, Stamatiou R, Hatziefthimiou A, Molyvdas PA. Ranolazine depresses conduction of rapid atrial depolarizations in a beating rabbit heart model. J Interv Card Electrophysiol 2020; 62:153-159. [PMID: 32996039 DOI: 10.1007/s10840-020-00865-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Previous clinical studies have shown that ranolazine (RAN) added to amiodarone (AMIO) might accelerate the termination of recent-onset atrial fibrillation. This study was undertaken to delineate possible mechanisms that contribute to the enhancement of the antiarrhythmic efficacy of RAN-AMIO coadministration. METHODS Ten rabbits were anesthetized and two monophasic action potential (MAP) catheters were sequentially inserted into the right atrium. One MAP electrode was used to pace and record; the other electrode was used only for recording MAP from an adjacent atrial region. Intraatrial conduction time (IACT), 2:1 intraatrial conduction block (IACB), and atrial post-repolarization refractoriness (aPRR) were consecutively determined by high-rate atrial burst pacing and programmed stimulation, respectively. All parameters were evaluated during baseline and following AMIO (3 mg/kg iv) or AMIO+RAN (2.4 mg/kg iv bolus +0.134 mg/kg/min maintenance infusion). RESULTS The IACT remained unchanged post AMIO compared with baseline (37.6 ± 3.8 vs 36.4 ± 2.4 ms), whereas the addition of RAN to AMIO significantly prolonged IACT (50.4 ± 3.6 ms, p < .001). The pacing cycle length producing 2:1 IACB was 101.2 ± 21.7 ms at baseline , 117.5 ± 15 ms after AMIO (p = 0.265), and 150 ± 14 ms after AMIO+RAN (p < .001). Baseline aPRR was longer following AMIO treatment (35 ± 5 vs 50 ± 9 ms, p < .01) but remarkably prolonged with RAN supplementation (105 ± 11 ms, p < .001). CONCLUSIONS RAN significantly prolonged the propagation time of rapid atrial depolarizations and potentiated the AMIO-induced moderate increases in aPRR. These mechanisms possibly contribute to the earlier termination of atrial fibrillation when RAN is co-administered with AMIO.
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Affiliation(s)
- I Aidonidis
- Department of Physiology, Faculty of Medicine, University of Thessaly, Larissa, Greece.
| | - V Simopoulos
- Department of Cardiac & Thoracic Surgery, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - S Stravela
- Department of Cardiac & Thoracic Surgery, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - K Dipla
- Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - R Stamatiou
- Department of Physiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - A Hatziefthimiou
- Department of Physiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - P-A Molyvdas
- Department of Physiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
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9
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Frommeyer G, Wolfes J, Ellermann C, Kochhäuser S, Dechering DG, Eckardt L. Acute electrophysiologic effects of the polyphenols resveratrol and piceatannol in rabbit atria. Clin Exp Pharmacol Physiol 2020; 46:94-98. [PMID: 29956844 DOI: 10.1111/1440-1681.13005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 11/28/2022]
Abstract
The natural polyphenol resveratrol and its analogue piceatannol have various beneficial effects including antiarrhythmic properties. The aim of the present study was to examine potential electrophysiologic effects in an experimental whole-heart model of atrial fibrillation (AF). Simultaneous infusion of resveratrol (50 μmol/L) or piceatannol (10 μmol/L) in rabbit hearts resulted in an increase in atrial refractory period. Both agents induced a significant slowing of atrial conduction and of intrinsic heart rate. In both groups, a trend toward a reduction in AF and a regularization of AF was observed.
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Affiliation(s)
- Gerrit Frommeyer
- Clinic for Cardiology II - Electrophysiology, University Hospital of Münster, Münster, Germany
| | - Julian Wolfes
- Clinic for Cardiology II - Electrophysiology, University Hospital of Münster, Münster, Germany
| | - Christian Ellermann
- Clinic for Cardiology II - Electrophysiology, University Hospital of Münster, Münster, Germany
| | - Simon Kochhäuser
- Clinic for Cardiology II - Electrophysiology, University Hospital of Münster, Münster, Germany
| | - Dirk G Dechering
- Clinic for Cardiology II - Electrophysiology, University Hospital of Münster, Münster, Germany
| | - Lars Eckardt
- Clinic for Cardiology II - Electrophysiology, University Hospital of Münster, Münster, Germany
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Simopoulos V, Hevas A, Hatziefthimiou A, Dipla K, Skoularigis I, Tsilimingas N, Aidonidis I. Amiodarone plus Ranolazine for Conversion of Post-Cardiac Surgery Atrial Fibrillation: Enhanced Effectiveness in Reduced Versus Preserved Ejection Fraction Patients. Cardiovasc Drugs Ther 2019; 32:559-565. [PMID: 30255400 DOI: 10.1007/s10557-018-6832-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Ranolazine (RAN) added to amiodarone (AMIO) has been shown to accelerate termination of postoperative atrial fibrillation (POAF) following coronary artery bypass surgery in patients without heart failure (HF). This study aimed to investigate if treatment efficacy with AMIO or AMIO + RAN differs between patients with concomitant HF with reduced or preserved ejection fraction (HFrEF or HFpEF). METHODS Patients with POAF and HFrEF (n = 511, 446 males; 65 ± 9 years) and with HFpEF (n = 301, 257 males; 66 ± 10 years) were enrolled. Onset of AF occurred 2.15 ± 1.0 days after cardiac surgery, and patients within each group were randomly assigned to receive either AMIO monotherapy (300 mg in 30 min + 1125 mg in 36 h iv) or AMIO+RAN combination (500 mg po + 375 mg, after 6 h and 375 mg twice daily thereafter). Primary endpoint was the time to conversion of POAF within 36 h after initiation of treatment. RESULTS AMIO restored sinus rhythm earlier in HFrEF vs. in HFpEF patients (24.3 ± 4.6 vs. 26.8 ± 2.8 h, p < 0.0001). AMIO + RAN converted POAF faster than AMIO alone in both HFrEF and HFpEF groups, with conversion times 10.4 ± 4.5 h in HFrEF and 12.2 ± 1.1 h in HFpEF patients (p < 0.0001). Left atrial diameter was significantly greater in HFrEF vs. HFpEF patients (48.2 ± 2.6 vs. 35.2 ± 2.9 mm, p < 0.0001). No serious adverse drug effects were observed during AF or after restoration to sinus rhythm in any of the patients enrolled. CONCLUSION AMIO alone or in combination with RAN converted POAF faster in patients with reduced EF than in those with preserved EF. Thus, AMIO + RAN seems to be a valuable alternative treatment for terminating POAF in HFrEF patients.
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Affiliation(s)
- Vasilios Simopoulos
- Department of Thoracic & Cardiovascular Surgery, University Hospital of Larissa, Larissa, Greece
| | - Athanasios Hevas
- Department of Thoracic & Cardiovascular Surgery, University Hospital of Larissa, Larissa, Greece
| | - Apostolia Hatziefthimiou
- Department of Physiology, School of Medicine, University of Thessaly, Larissa Medical School, 41500, Larissa, Greece
| | - Konstantina Dipla
- Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - Nikolaos Tsilimingas
- Department of Thoracic & Cardiovascular Surgery, University Hospital of Larissa, Larissa, Greece
| | - Isaac Aidonidis
- Department of Physiology, School of Medicine, University of Thessaly, Larissa Medical School, 41500, Larissa, Greece.
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11
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Zhao Z, Li X, El-Battrawy I, Lan H, Zhong R, Xu Q, Huang M, Liao Z, Lang S, Zimmermann WH, Cyganek L, Wieland T, Akin I, Zhou XB, Borggrefe M. Drug Testing in Human-Induced Pluripotent Stem Cell-Derived Cardiomyocytes From a Patient With Short QT Syndrome Type 1. Clin Pharmacol Ther 2019; 106:642-651. [PMID: 30947366 DOI: 10.1002/cpt.1449] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/13/2019] [Indexed: 12/19/2022]
Abstract
Short QT syndrome (SQTS) predisposes afflicted patients to sudden cardiac death. Until now, only one drug-quinidine-has been shown to be effective in patients with SQTS type 1(SQTS1). The objective of this study was to use human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) from a patient with SQTS1 to search for potentially effective drugs for the treatment of SQTS1 patients. Patch clamp and single-cell contraction measurements were employed to assess drug effects. Ivabradine, mexiletine, and ajmaline but not flecainide, ranolazine, or amiodarone prolonged the action potential duration (APD) in hiPSC-CMs from an SQTS1 patient. Ivabradine, ajmaline, and mexiletine inhibited KCNH2 channel currents significantly, which may underlie their APD-prolonging effects. Under proarrhythmic epinephrine stimulation in spontaneously beating SQTS1 hiPSC-CMs, ivabradine, mexiletine, and ajmaline but not flecainide reduced the epinephrine-induced arrhythmic events. The results demonstrate that ivabradine, ajmaline, and mexiletine may be candidate drugs for preventing tachyarrhythmias in SQTS1 patients.
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Affiliation(s)
- Zhihan Zhao
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,German Center for Cardiovascular Research, Partner Sites, Heidelberg, Mannheim, Göttingen, Germany.,Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Li
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,German Center for Cardiovascular Research, Partner Sites, Heidelberg, Mannheim, Göttingen, Germany
| | - Huan Lan
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,German Center for Cardiovascular Research, Partner Sites, Heidelberg, Mannheim, Göttingen, Germany
| | - Rujia Zhong
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Qiang Xu
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mengying Huang
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Zhenxing Liao
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,German Center for Cardiovascular Research, Partner Sites, Heidelberg, Mannheim, Göttingen, Germany
| | - Wolfram-Hubertus Zimmermann
- German Center for Cardiovascular Research, Partner Sites, Heidelberg, Mannheim, Göttingen, Germany.,Institute of Pharmacology and Toxicology, University of Göttingen, Göttingen, Germany
| | - Lukas Cyganek
- German Center for Cardiovascular Research, Partner Sites, Heidelberg, Mannheim, Göttingen, Germany.,Stem Cell Unit, Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Thomas Wieland
- German Center for Cardiovascular Research, Partner Sites, Heidelberg, Mannheim, Göttingen, Germany.,Institute of Experimental and Clinical Pharmacology and Toxicology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,German Center for Cardiovascular Research, Partner Sites, Heidelberg, Mannheim, Göttingen, Germany
| | - Xiao-Bo Zhou
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,German Center for Cardiovascular Research, Partner Sites, Heidelberg, Mannheim, Göttingen, Germany.,Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Martin Borggrefe
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,German Center for Cardiovascular Research, Partner Sites, Heidelberg, Mannheim, Göttingen, Germany
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12
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Tascanov MB. The Relationship Between Prolidase Activity and Atrial Electromechanical Changes in Patients with Paroxysmal Atrial Fibrillation. Comb Chem High Throughput Screen 2019; 22:69-75. [DOI: 10.2174/1386207322666190306143317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/31/2019] [Accepted: 02/15/2019] [Indexed: 12/16/2022]
Abstract
Background:Tissue fibrosis increases in the structure of the atrial tissue of atrial fibrillation patients. Prolidase enzyme regulates collagen synthesis. There may be an association between electrocardiography (ECG) findings and prolidase activity.Objective:This study investigated the association between atrial conduction time and prolidase activity, a collagen synthesis enzyme, and P-wave dispersion (PWD) in patients with Paroxysmal Atrial Fibrillation (PAF).Methods:Exclusion criteria included the age of <18 years, heart failure, diabetes, hypertension, hyperlipidemia, malignancy, cerebrovascular disease, chronic respiratory distress, osteoporosis, rheumatoid arthritis, renal disease, cirrhosis, and other types of arrhythmia. Patients diagnosed with PAF within 48 hours were considered to have a definite diagnosis. PWD was calculated using a 12-lead ECG, and inter- and intraatrial electromechanical delay (EMD) was assessed using tissue Doppler imaging and conventional echocardiography. Serum prolidase levels were measured in both groups.Results:A total of 43 patients with PAF (20 female, 23 male; mean age, 46.8 ± 5.7 years) and 42 healthy volunteers (21 female, 21 male; mean age, 43.9 ± 5.1 years) were included in the study.:Inter- and intraatrial EMD, PWD, minimum P-wave (Pmin), and maximum P-wave (Pmax) measurements were significantly higher (39.7 ± 2.7, 35.7 ± 2.3, p < 0.001; 13.2 ± 2.6, 8.5 ± 1.9, p < 0.001; 47.1 ± 11, 24.1 ± 7.1, p < 0.001; 69.8 ± 8.8, 66.7 ± 10.2, p < 0.130; 114.8 ± 13, 93.6 ± 8.6, p < 0.001, respectively) and serum prolidase levels were significantly lower in patients with PAF compared to healthy controls (3.96 ± 1.2, 8.5 ± 3.56, p < 0.001). In patients with PAF, correlation analysis showed a negative correlation between prolidase levels and intra- and interatrial EMD, PWD, and Pmax (r = -0.41, p < 0.05; r = -0.54, p < 0.05; r = -0.62, p < 0.05; r = -0.49, p < 0.05, respectively). Interatrial EMD showed a significant positive correlation with intraatrial EMD, Pmax, and PWD in patients with PAF (r = 0.90, p < 0.05; r = 0.574, p < 0.05; r = 0.43, p < 0.05, respectively). Additionally, the level of high-sensitivity C-reactive protein (hs-CRP) was significantly higher in patients with PAF (6.6 ± 8, 1.8 ± 1.6, p < 0.001).Conclusion:The decreased plasma prolidase activity in patients with PAF may explain the irregularity of the collagen metabolism of different extracellular components and may indicate the onset of atrial remodeling. Changes in PWD, interatrial EMD, and serum prolidase level may predict PAF before diagnosis.
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13
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Frommeyer G, Clauss C, Ellermann C, Bogossian H, Dechering DG, Kochhäuser S, Reinke F, Pott C, Eckardt L. Antiarrhythmic effect of vernakalant in an experimental model of Long-QT-syndrome. Europace 2018; 19:866-873. [PMID: 27702859 DOI: 10.1093/europace/euw182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/26/2016] [Indexed: 11/12/2022] Open
Abstract
Aims The antiarrhythmic drug vernakalant exerts antiarrhythmic effects in atrial fibrillation. Recent experimental data suggest interactions with the late sodium current and antiarrhythmic effects in ventricular arrhythmias. We aimed at investigating whether treatment with vernakalant reduces polymorphic ventricular tachycardia (VT) in an experimental model of Long-QT-syndrome (LQTS). Methods and results Twenty-nine isolated rabbit hearts were assigned to two groups and treated with erythromycin (300 µM, n = 15) or veratridine (0.5 µM, n = 14) after obtaining baseline data. Thereafter, vernakalant (10 µM) was additionally infused. Infusion of erythromycin or veratridine significantly increased action potential duration (APD90) and QT interval. Erythromycin and veratridine also significantly augmented spatial dispersion of repolarization (erythromycin: +43 ms; veratridine: +55 ms, P < 0.01, respectively) and temporal dispersion of repolarization. After lowering extracellular [K+] in bradycardic hearts, 11 of 15 erythromycin-treated hearts and 4 of 14 veratridine-treated hearts showed early afterdepolarizations and subsequent polymorphic VT. Additional treatment with vernakalant resulted in a significant reduction of spatial dispersion of spatial dispersion in both groups (erythromycin: -32 ms; veratridine: -35 ms, P < 0.05 each) and a stabilization of temporal dispersion. After additional treatment with vernakalant, only 5 of 15 erythromycin-treated hearts (P = 0.07) and 1 of 14 veratridine-treated hearts (P = 0.32) presented polymorphic VT. Conclusion Vernakalant has antiarrhythmic effects in this experimental model of acquired LQTS. A reduction of spatial dispersion of repolarization and a stabilization of temporal dispersion in hearts showing polymorphic VT represent the major underlying electrophysiological mechanisms.
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Affiliation(s)
- Gerrit Frommeyer
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer Campus 1, D-48149 Münster, Germany
| | - Catharina Clauss
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer Campus 1, D-48149 Münster, Germany
| | - Christian Ellermann
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer Campus 1, D-48149 Münster, Germany
| | - Harilaos Bogossian
- Märkische Kliniken GmbH, Department of Cardiology and Angiology, Klinikum Lüdenscheid, University of Witten-Herdecke, Witten, Germany
| | - Dirk G Dechering
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer Campus 1, D-48149 Münster, Germany
| | - Simon Kochhäuser
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer Campus 1, D-48149 Münster, Germany
| | - Florian Reinke
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer Campus 1, D-48149 Münster, Germany
| | - Christian Pott
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer Campus 1, D-48149 Münster, Germany
| | - Lars Eckardt
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer Campus 1, D-48149 Münster, Germany
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14
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Bazoukis G, Tse G, Letsas KP, Thomopoulos C, Naka KK, Korantzopoulos P, Bazoukis X, Michelongona P, Papadatos SS, Vlachos K, Liu T, Efremidis M, Baranchuk A, Stavrakis S, Tsioufis C. Impact of ranolazine on ventricular arrhythmias - A systematic review. J Arrhythm 2018; 34:124-128. [PMID: 29657587 PMCID: PMC5891418 DOI: 10.1002/joa3.12031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/29/2017] [Indexed: 12/15/2022] Open
Abstract
Ranolazine is a new medication for the treatment of refractory angina. However, except its anti-anginal properties, it has been found to act as an anti-arrhythmic. The aim of our systematic review is to present the existing data about the impact of ranolazine in ventricular arrhythmias. We searched MEDLINE and Cochrane databases as well clinicaltrials.gov until September 1, 2017 to find all studies (clinical trials, observational studies, case reports/series) reported data about the impact of ranolazine in ventricular arrhythmias. Our search revealed 14 studies (3 clinical trials, 2 observational studies, 8 case reports, 1 case series). These data reported a beneficial impact of ranolazine in ventricular tachycardia/fibrillation, premature ventricular beats, and ICD interventions in different clinical settings. The existing data highlight the anti-arrhythmic properties of ranolazine in ventricular arrhythmias.
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Affiliation(s)
- George Bazoukis
- Department of Cardiology Catheterization Laboratory Evangelismos General Hospital of Athens Athens Greece
| | - Gary Tse
- Department of Medicine and Therapeutics Faculty of Medicine Chinese University of Hong Kong Hong Kong China.,Li Ka Shing Institute of Health Sciences Faculty of Medicine Chinese University of Hong Kong Hong Kong China
| | - Konstantinos P Letsas
- Department of Cardiology Catheterization Laboratory Evangelismos General Hospital of Athens Athens Greece
| | | | - Katerina K Naka
- Second Department of Cardiology School of Medicine University of Ioannina Ioannina Greece
| | | | - Xenophon Bazoukis
- Department of Cardiology General Hospital of Ioannina, "G Hatzikosta" Ioannina Greece
| | - Paschalia Michelongona
- Department of Cardiology Catheterization Laboratory Evangelismos General Hospital of Athens Athens Greece
| | - Stamatis S Papadatos
- Faculty Department of Internal Medicine Athens School of Medicine Sotiria General Hospital National and Kapodistrian University of Athens Athens Greece
| | - Konstantinos Vlachos
- Department of Cardiology Catheterization Laboratory Evangelismos General Hospital of Athens Athens Greece
| | - Tong Liu
- Department of Cardiology Tianjin Institute of Cardiology Second Hospital of Tianjin Medical University Tianjin China
| | - Michael Efremidis
- Department of Cardiology Catheterization Laboratory Evangelismos General Hospital of Athens Athens Greece
| | - Adrian Baranchuk
- Division of Cardiology, Electrophysiology and Pacing Kingston General Hospital Queen's University Kingston ON Canada
| | - Stavros Stavrakis
- University of Oklahoma Health Sciences Center Oklahoma City Oklahoma
| | - Costas Tsioufis
- First Cardiology Clinic Hippokration Hospital University of Athens Athens Greece
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15
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Frommeyer G, Sterneberg M, Dechering DG, Kochhäuser S, Bögeholz N, Fehr M, Eckardt L. Comparison of vernakalant and ranolazine in atrial fibrillation. J Cardiovasc Med (Hagerstown) 2017; 18:663-668. [DOI: 10.2459/jcm.0000000000000545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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The anti-influenza drug oseltamivir reduces atrial fibrillation in an experimental whole-heart model. Naunyn Schmiedebergs Arch Pharmacol 2017; 390:1155-1161. [PMID: 28780600 DOI: 10.1007/s00210-017-1415-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
Recent experimental studies suggested direct effects of the anti-influenza drug oseltamivir on cardiac electrophysiology. We therefore aimed at analyzing potential antiarrhythmic effects of oseltamivir on atrial fibrillation (AF) in an experimental whole-heart model. Twelve rabbit hearts were isolated and Langendorff perfused. Thereafter, hearts were paced at cycle lengths of 350, 250, and 200 ms in the atrium. A standardized protocol employing atrial burst pacing induced AF in 4 of 12 hearts under baseline conditions (33%, 11 episodes). Subsequently, a combination of acetylcholine (1 μM) and isoproterenol (1 μM) was administered to increase AF occurrence. Two monophasic action potential recordings on the left and two on the right atrial epicardium displayed a decrease of atrial action potential duration (aAPD, -38 ms, p < 0.01) and atrial effective refractory period (aERP; -20 ms, p < 0.05). Under the influence of acetylcholine/isoproterenol AF was inducible in 8 of 12 hearts (66%; 69 episodes). Additional infusion of oseltamivir (100 μM) resulted in a significant increase of both aAPD (+ 29 ms, p < 0.05) and aERP (+ 40 ms, p < 0.01) leading to an increase of atrial post-repolarization refractoriness (aPRR). Under the influence of oseltamivir only 3 of 12 hearts (25%, 8 episodes) remained inducible. In six additional hearts oseltamivir (50 μM and 100 μM) did not significantly alter ventricular APD, QRS duration and QT interval but induced a significant increase of ventricular ERP. In the present experimental study, acute infusion of the anti-influenza drug oseltamivir reduced atrial fibrillation. The antiarrhythmic effect can be explained by a significant increase in aERP and aPRR. These results suggest an antiarrhythmic potential of oseltamivir in atrial arrhythmias.
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17
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Frommeyer G, Garthmann J, Ellermann C, Dechering DG, Kochhäuser S, Reinke F, Köbe J, Wasmer K, Eckardt L. Broad antiarrhythmic effect of mexiletine in different arrhythmia models. Europace 2017; 20:1375-1381. [DOI: 10.1093/europace/eux221] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 06/06/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Albert-Schweitzer Campus 1, Münster, Germany
| | - Jonas Garthmann
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Albert-Schweitzer Campus 1, Münster, Germany
| | - Christian Ellermann
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Albert-Schweitzer Campus 1, Münster, Germany
| | - Dirk G Dechering
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Albert-Schweitzer Campus 1, Münster, Germany
| | - Simon Kochhäuser
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Albert-Schweitzer Campus 1, Münster, Germany
| | - Florian Reinke
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Albert-Schweitzer Campus 1, Münster, Germany
| | - Julia Köbe
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Albert-Schweitzer Campus 1, Münster, Germany
| | - Kristina Wasmer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Albert-Schweitzer Campus 1, Münster, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Albert-Schweitzer Campus 1, Münster, Germany
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18
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Frommeyer G, Kohnke A, Ellermann C, Dechering DG, Kochhäuser S, Reinke F, Fehr M, Eckardt L. Acute infusion of levosimendan enhances atrial fibrillation in an experimental whole-heart model. Int J Cardiol 2017; 236:423-426. [DOI: 10.1016/j.ijcard.2017.01.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/13/2017] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
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19
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Frommeyer G, Sterneberg M, Dechering DG, Ellermann C, Bögeholz N, Kochhäuser S, Pott C, Fehr M, Eckardt L. Effective suppression of atrial fibrillation by ivabradine: Novel target for an established drug? Int J Cardiol 2017; 236:237-243. [DOI: 10.1016/j.ijcard.2017.02.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/25/2017] [Accepted: 02/15/2017] [Indexed: 12/28/2022]
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20
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Frommeyer G, Sterneberg M, Dechering DG, Kaese S, Bögeholz N, Pott C, Fehr M, Bogossian H, Milberg P, Eckardt L. Effective suppression of atrial fibrillation by the antihistaminic agent antazoline: First experimental insights into a novel antiarrhythmic agent. Cardiovasc Ther 2017; 35. [PMID: 28039911 DOI: 10.1111/1755-5922.12244] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The antihistaminic antazoline (ANT) was reported to be highly effective and safe for rapid conversion of atrial fibrillation (AF). We therefore analyzed underlying mechanisms in an experimental whole-heart model. METHODS AND RESULTS Isolated and retrogradely perfused rabbit hearts underwent a standardized protocol employing atrial burst pacing-induced AF in five of 20 hearts under baseline conditions (seven episodes). Thereafter, a combination of acetylcholine and isoproterenol was employed to enhance AF occurrence. Two monophasic action potential recordings on the left- and two on the right atrial epicardium showed a decrease in atrial action potential duration (aAPD, -25 msec, P<.05) and atrial effective refractory period (aERP; -52 msec, P<.01) after infusion of acetylcholine (1 μmol/L) and isoproterenol (1 μmol/L). This led to induction of AF in 14 of 20 hearts (145 episodes). Simultaneous infusion of ANT (20 μmol/L) led to a complete suppression of AF in all inducible hearts. Treatment with ANT also led to a significant increase in aAPD (+41 msec, P<.01) and aERP (+74 msec, P<.05), leading to a marked increase in atrial postrepolarization refractoriness (aPRR, +33 msec, P<.01). Results were compared to 13 rabbits treated with flecainide. Flecainide induced a significant increase in aPRR and resulted in induction of AF in seven of 13 hearts (51 episodes) while 11 of 13 hearts were inducible with acetylcholine and isoproterenol (93 episodes). CONCLUSION Administration of ANT was highly effective in suppressing AF. The antiarrhythmic effect could be explained by a significant increase in postrepolarization refractoriness as a result of a more marked increase in aERP as compared with aAPD.
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Affiliation(s)
- Gerrit Frommeyer
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Münster, Germany
| | - Magdalena Sterneberg
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Münster, Germany
| | - Dirk G Dechering
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Münster, Germany
| | - Sven Kaese
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Münster, Germany
| | - Nils Bögeholz
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Münster, Germany
| | - Christian Pott
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Münster, Germany
| | - Michael Fehr
- Clinic of Exotic Pets, Reptiles, Exotic and Feral Birds, University of Hanover, Hanover, Germany
| | - Harilaos Bogossian
- Märkische Kliniken GmbH, Department of Cardiology and Angiology, Klinikum Lüdenscheid, University of Witten-Herdecke, Witten, Germany
| | - Peter Milberg
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Münster, Germany
| | - Lars Eckardt
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Münster, Germany
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21
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Syeda F, Holmes AP, Yu TY, Tull S, Kuhlmann SM, Pavlovic D, Betney D, Riley G, Kucera JP, Jousset F, de Groot JR, Rohr S, Brown NA, Fabritz L, Kirchhof P. PITX2 Modulates Atrial Membrane Potential and the Antiarrhythmic Effects of Sodium-Channel Blockers. J Am Coll Cardiol 2016; 68:1881-1894. [PMID: 27765191 PMCID: PMC5075046 DOI: 10.1016/j.jacc.2016.07.766] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 07/05/2016] [Accepted: 07/20/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Antiarrhythmic drugs are widely used to treat patients with atrial fibrillation (AF), but the mechanisms conveying their variable effectiveness are not known. Recent data suggested that paired like homeodomain-2 transcription factor (PITX2) might play an important role in regulating gene expression and electrical function of the adult left atrium (LA). OBJECTIVES After determining LA PITX2 expression in AF patients requiring rhythm control therapy, the authors assessed the effects of Pitx2c on LA electrophysiology and the effect of antiarrhythmic drugs. METHODS LA PITX2 messenger ribonucleic acid (mRNA) levels were measured in 95 patients undergoing thoracoscopic AF ablation. The effects of flecainide, a sodium (Na+)-channel blocker, and d,l-sotalol, a potassium channel blocker, were studied in littermate mice with normal and reduced Pitx2c mRNA by electrophysiological study, optical mapping, and patch clamp studies. PITX2-dependent mechanisms of antiarrhythmic drug action were studied in human embryonic kidney (HEK) cells expressing human Na channels and by modeling human action potentials. RESULTS Flecainide 1 μmol/l was more effective in suppressing atrial arrhythmias in atria with reduced Pitx2c mRNA levels (Pitx2c+/-). Resting membrane potential was more depolarized in Pitx2c+/- atria, and TWIK-related acid-sensitive K+ channel 2 (TASK-2) gene and protein expression were decreased. This resulted in enhanced post-repolarization refractoriness and more effective Na-channel inhibition. Defined holding potentials eliminated differences in flecainide's effects between wild-type and Pitx2c+/- atrial cardiomyocytes. More positive holding potentials replicated the increased effectiveness of flecainide in blocking human Nav1.5 channels in HEK293 cells. Computer modeling reproduced an enhanced effectiveness of Na-channel block when resting membrane potential was slightly depolarized. CONCLUSIONS PITX2 mRNA modulates atrial resting membrane potential and thereby alters the effectiveness of Na-channel blockers. PITX2 and ion channels regulating the resting membrane potential may provide novel targets for antiarrhythmic drug development and companion therapeutics in AF.
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Affiliation(s)
- Fahima Syeda
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Andrew P Holmes
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ting Y Yu
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Physical Sciences of Imaging in the Biomedical Sciences, School of Chemistry, University of Birmingham, Birmingham, United Kingdom
| | - Samantha Tull
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | - Davor Pavlovic
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Daniel Betney
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Genna Riley
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jan P Kucera
- Department of Physiology, University of Bern, Bern, Switzerland
| | - Florian Jousset
- Department of Physiology, University of Bern, Bern, Switzerland
| | - Joris R de Groot
- Heart Center, Department of Cardiology, Academisch Medisch Centrum, Amsterdam, the Netherlands
| | - Stephan Rohr
- Department of Physiology, University of Bern, Bern, Switzerland
| | - Nigel A Brown
- St. George's Hospital Medical School, University of London, London, United Kingdom
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany; Atrial Fibrillation NETwork, Muenster, Germany; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany; Atrial Fibrillation NETwork, Muenster, Germany; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom.
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22
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FROMMEYER GERRIT, ELLERMANN CHRISTIAN, ECKARDT LARS. Considering Ranolazine as a Potential Treatment for K +
Channel Linked Short QT Syndrome. J Cardiovasc Electrophysiol 2016; 27:E6. [DOI: 10.1111/jce.13054] [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: 11/29/2022]
Affiliation(s)
- GERRIT FROMMEYER
- Division of Electrophysiology, Department of Cardiovascular Medicine; University of Münster; Münster Germany
| | - CHRISTIAN ELLERMANN
- Division of Electrophysiology, Department of Cardiovascular Medicine; University of Münster; Münster Germany
| | - LARS ECKARDT
- Division of Electrophysiology, Department of Cardiovascular Medicine; University of Münster; Münster Germany
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23
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FROMMEYER GERRIT, ELLERMANN CHRISTIAN, DECHERING DIRKG, KOCHHÄUSER SIMON, BÖGEHOLZ NILS, GÜNER FATIH, LEITZ PATRICK, POTT CHRISTIAN, ECKARDT LARS. Ranolazine and Vernakalant Prevent Ventricular Arrhythmias in an Experimental Whole-Heart Model of Short QT Syndrome. J Cardiovasc Electrophysiol 2016; 27:1214-1219. [DOI: 10.1111/jce.13029] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/01/2016] [Accepted: 06/07/2016] [Indexed: 12/13/2022]
Affiliation(s)
- GERRIT FROMMEYER
- Division of Electrophysiology, Department of Cardiovascular Medicine; University of Münster; Münster Germany
| | - CHRISTIAN ELLERMANN
- Division of Electrophysiology, Department of Cardiovascular Medicine; University of Münster; Münster Germany
| | - DIRK G. DECHERING
- Division of Electrophysiology, Department of Cardiovascular Medicine; University of Münster; Münster Germany
| | - SIMON KOCHHÄUSER
- Division of Electrophysiology, Department of Cardiovascular Medicine; University of Münster; Münster Germany
| | - NILS BÖGEHOLZ
- Division of Electrophysiology, Department of Cardiovascular Medicine; University of Münster; Münster Germany
| | - FATIH GÜNER
- Division of Electrophysiology, Department of Cardiovascular Medicine; University of Münster; Münster Germany
| | - PATRICK LEITZ
- Division of Electrophysiology, Department of Cardiovascular Medicine; University of Münster; Münster Germany
| | - CHRISTIAN POTT
- Division of Electrophysiology, Department of Cardiovascular Medicine; University of Münster; Münster Germany
| | - LARS ECKARDT
- Division of Electrophysiology, Department of Cardiovascular Medicine; University of Münster; Münster Germany
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Zou D, Geng N, Chen Y, Ren L, Liu X, Wan J, Guo S, Wang S. Ranolazine improves oxidative stress and mitochondrial function in the atrium of acetylcholine-CaCl2 induced atrial fibrillation rats. Life Sci 2016; 156:7-14. [DOI: 10.1016/j.lfs.2016.05.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 05/08/2016] [Accepted: 05/17/2016] [Indexed: 12/19/2022]
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Redfors B, Généreux P. Ranolazine following percutaneous coronary intervention: For whom? For what? Expert Rev Cardiovasc Ther 2016; 14:541-3. [PMID: 26840661 DOI: 10.1586/14779072.2016.1150176] [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]
Affiliation(s)
- Björn Redfors
- a Cardiovascular Research Foundation , New York , NY , USA.,b Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Philippe Généreux
- a Cardiovascular Research Foundation , New York , NY , USA.,c NewYork-Presbyterian/Columbia University Medical Center , New York , NY , USA.,d Hôpital du Sacré-Coeur de Montréal , Montréal , Québec , Canada
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Reiffel JA, Camm AJ, Belardinelli L, Zeng D, Karwatowska-Prokopczuk E, Olmsted A, Zareba W, Rosero S, Kowey P. The HARMONY Trial: Combined Ranolazine and Dronedarone in the Management of Paroxysmal Atrial Fibrillation: Mechanistic and Therapeutic Synergism. Circ Arrhythm Electrophysiol 2015; 8:1048-56. [PMID: 26226999 DOI: 10.1161/circep.115.002856] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 07/09/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) requires arrhythmogenic changes in atrial ion channels/receptors and usually altered atrial structure. AF is commonly treated with antiarrhythmic drugs; the most effective block many ion channels/receptors. Modest efficacy, intolerance, and safety concerns limit current antiarrhythmic drugs. We hypothesized that combining agents with multiple anti-AF mechanisms at reduced individual drug doses might produce synergistic efficacy plus better tolerance/safety. METHODS AND RESULTS HARMONY tested midrange ranolazine (750 mg BID) combined with 2 reduced dronedarone doses (150 mg BID and 225 mg BID; chosen to reduce dronedarone's negative inotropic effect-see text below) over 12 weeks in 134 patients with paroxysmal AF and implanted pacemakers where AF burden (AFB) could be continuously assessed. Patients were randomized double-blind to placebo, ranolazine alone (750 mg BID), dronedarone alone (225 mg BID), or one of the combinations. Neither placebo nor either drugs alone significantly reduced AFB. Conversely, ranolazine 750 mg BID/dronedarone 225 mg BID reduced AFB by 59% versus placebo (P=0.008), whereas ranolazine 750 mg BID/dronedarone 150 mg BID reduced AFB by 43% (P=0.072). Both combinations were well tolerated. CONCLUSIONS HARMONY showed synergistic AFB reduction by moderate dose ranolazine plus reduced dose dronedarone, with good tolerance/safety, in the population enrolled. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; Unique identifier: NCT01522651.
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Affiliation(s)
- James A Reiffel
- From the Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.A.R.); Department of Cardiovascular Sciences, St Georges University of London, London, United Kingdom (A.J.C.); Cardiovascular Clinical Research, Gilead Sciences, Inc, Foster City, CA (L.B., D.Z., E.K.-P., A.O.); Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY (W.Z., S.R.); Lankenau Institute for Medical Research, Wynnewood, PA (P.K.); and Division of Cardiovascular Diseases, Department of Medicine, Thomas Jefferson University, Philadelphia, PA (P.K.).
| | - A John Camm
- From the Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.A.R.); Department of Cardiovascular Sciences, St Georges University of London, London, United Kingdom (A.J.C.); Cardiovascular Clinical Research, Gilead Sciences, Inc, Foster City, CA (L.B., D.Z., E.K.-P., A.O.); Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY (W.Z., S.R.); Lankenau Institute for Medical Research, Wynnewood, PA (P.K.); and Division of Cardiovascular Diseases, Department of Medicine, Thomas Jefferson University, Philadelphia, PA (P.K.)
| | - Luiz Belardinelli
- From the Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.A.R.); Department of Cardiovascular Sciences, St Georges University of London, London, United Kingdom (A.J.C.); Cardiovascular Clinical Research, Gilead Sciences, Inc, Foster City, CA (L.B., D.Z., E.K.-P., A.O.); Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY (W.Z., S.R.); Lankenau Institute for Medical Research, Wynnewood, PA (P.K.); and Division of Cardiovascular Diseases, Department of Medicine, Thomas Jefferson University, Philadelphia, PA (P.K.)
| | - Dewan Zeng
- From the Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.A.R.); Department of Cardiovascular Sciences, St Georges University of London, London, United Kingdom (A.J.C.); Cardiovascular Clinical Research, Gilead Sciences, Inc, Foster City, CA (L.B., D.Z., E.K.-P., A.O.); Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY (W.Z., S.R.); Lankenau Institute for Medical Research, Wynnewood, PA (P.K.); and Division of Cardiovascular Diseases, Department of Medicine, Thomas Jefferson University, Philadelphia, PA (P.K.)
| | - Ewa Karwatowska-Prokopczuk
- From the Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.A.R.); Department of Cardiovascular Sciences, St Georges University of London, London, United Kingdom (A.J.C.); Cardiovascular Clinical Research, Gilead Sciences, Inc, Foster City, CA (L.B., D.Z., E.K.-P., A.O.); Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY (W.Z., S.R.); Lankenau Institute for Medical Research, Wynnewood, PA (P.K.); and Division of Cardiovascular Diseases, Department of Medicine, Thomas Jefferson University, Philadelphia, PA (P.K.)
| | - Ann Olmsted
- From the Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.A.R.); Department of Cardiovascular Sciences, St Georges University of London, London, United Kingdom (A.J.C.); Cardiovascular Clinical Research, Gilead Sciences, Inc, Foster City, CA (L.B., D.Z., E.K.-P., A.O.); Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY (W.Z., S.R.); Lankenau Institute for Medical Research, Wynnewood, PA (P.K.); and Division of Cardiovascular Diseases, Department of Medicine, Thomas Jefferson University, Philadelphia, PA (P.K.)
| | - Wojciech Zareba
- From the Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.A.R.); Department of Cardiovascular Sciences, St Georges University of London, London, United Kingdom (A.J.C.); Cardiovascular Clinical Research, Gilead Sciences, Inc, Foster City, CA (L.B., D.Z., E.K.-P., A.O.); Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY (W.Z., S.R.); Lankenau Institute for Medical Research, Wynnewood, PA (P.K.); and Division of Cardiovascular Diseases, Department of Medicine, Thomas Jefferson University, Philadelphia, PA (P.K.)
| | - Spencer Rosero
- From the Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.A.R.); Department of Cardiovascular Sciences, St Georges University of London, London, United Kingdom (A.J.C.); Cardiovascular Clinical Research, Gilead Sciences, Inc, Foster City, CA (L.B., D.Z., E.K.-P., A.O.); Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY (W.Z., S.R.); Lankenau Institute for Medical Research, Wynnewood, PA (P.K.); and Division of Cardiovascular Diseases, Department of Medicine, Thomas Jefferson University, Philadelphia, PA (P.K.)
| | - Peter Kowey
- From the Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.A.R.); Department of Cardiovascular Sciences, St Georges University of London, London, United Kingdom (A.J.C.); Cardiovascular Clinical Research, Gilead Sciences, Inc, Foster City, CA (L.B., D.Z., E.K.-P., A.O.); Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY (W.Z., S.R.); Lankenau Institute for Medical Research, Wynnewood, PA (P.K.); and Division of Cardiovascular Diseases, Department of Medicine, Thomas Jefferson University, Philadelphia, PA (P.K.)
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Frommeyer G, Eckardt L. Drug-induced proarrhythmia: risk factors and electrophysiological mechanisms. Nat Rev Cardiol 2015; 13:36-47. [PMID: 26194552 DOI: 10.1038/nrcardio.2015.110] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Drug-induced ventricular tachyarrhythmias can be caused by cardiovascular drugs, noncardiovascular drugs, and even nonprescription agents. They can result in arrhythmic emergencies and sudden cardiac death. If a new arrhythmia or aggravation of an existing arrhythmia develops during therapy with a drug at a concentration usually considered not to be toxic, the situation can be defined as proarrhythmia. Various cardiovascular and noncardiovascular drugs can increase the occurrence of polymorphic ventricular tachycardia of the 'torsade de pointes' type. Antiarrhythmic drugs, antimicrobial agents, and antipsychotic and antidepressant drugs are the most important groups. Age, female sex, and structural heart disease are important risk factors for the occurrence of torsade de pointes. Genetic predisposition and individual pharmacodynamic and pharmacokinetic sensitivity also have important roles in the generation of arrhythmias. An increase in spatial or temporal dispersion of repolarization and a triangular action-potential configuration have been identified as crucial predictors of proarrhythmia in experimental models. These studies emphasized that sole consideration of the QT interval is not sufficient to assess the proarrhythmic risk. In this Review, we focus on important triggers of proarrhythmia and the underlying electrophysiological mechanisms that can enhance or prevent the development of torsade de pointes.
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Affiliation(s)
- Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Albert-Schweitzer Strasse 33, D-48149 Münster, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Albert-Schweitzer Strasse 33, D-48149 Münster, Germany
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Gupta T, Khera S, Kolte D, Aronow WS, Iwai S. Antiarrhythmic properties of ranolazine: A review of the current evidence. Int J Cardiol 2015; 187:66-74. [PMID: 25828315 DOI: 10.1016/j.ijcard.2015.03.324] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/20/2015] [Indexed: 12/19/2022]
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Rosa GM, Dorighi U, Ferrero S, Brunacci M, Bertero G, Brunelli C. Ranolazine for the treatment of atrial fibrillation. Expert Opin Investig Drugs 2015; 24:825-36. [DOI: 10.1517/13543784.2015.1036984] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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30
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Kirchhoff JE, Goldin Diness J, Sheykhzade M, Grunnet M, Jespersen T. Synergistic antiarrhythmic effect of combining inhibition of Ca2+-activated K+ (SK) channels and voltage-gated Na+ channels in an isolated heart model of atrial fibrillation. Heart Rhythm 2015; 12:409-18. [DOI: 10.1016/j.hrthm.2014.12.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Indexed: 11/28/2022]
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Hammond DA, Smotherman C, Jankowski CA, Tan S, Osian O, Kraemer D, DeLosSantos M. Short-course of ranolazine prevents postoperative atrial fibrillation following coronary artery bypass grafting and valve surgeries. Clin Res Cardiol 2014; 104:410-7. [DOI: 10.1007/s00392-014-0796-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/13/2014] [Indexed: 11/24/2022]
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Frommeyer G, Schulze Grotthoff J, Fischer C, Bogossian H, Reinke F, Kochhäuser S, Dechering DG, Fehr M, Milberg P, Eckardt L. Vernakalant in an Experimental Model of Pacing-Induced Heart Failure: Lack of Proarrhythmia Despite Prolongation of Repolarization. J Card Fail 2014; 20:786-792. [DOI: 10.1016/j.cardfail.2014.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/27/2014] [Accepted: 07/23/2014] [Indexed: 01/10/2023]
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FRAGAKIS NIKOLAOS, KOSKINAS KONSTANTINOSC, VASSILIKOS VASSILIOS. Ranolazine as a Promising Treatment Option for Atrial Fibrillation: Electrophysiologic Mechanisms, Experimental Evidence, and Clinical Implications. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1412-20. [DOI: 10.1111/pace.12486] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 06/29/2014] [Accepted: 06/30/2014] [Indexed: 11/28/2022]
Affiliation(s)
- NIKOLAOS FRAGAKIS
- Third Department of Cardiology; Hippokrateion Hospital; Aristotle University Medical School; Thessaloniki Greece
| | - KONSTANTINOS C. KOSKINAS
- Third Department of Cardiology; Hippokrateion Hospital; Aristotle University Medical School; Thessaloniki Greece
| | - VASSILIOS VASSILIKOS
- Third Department of Cardiology; Hippokrateion Hospital; Aristotle University Medical School; Thessaloniki Greece
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Burashnikov A, Di Diego JM, Barajas-Martínez H, Hu D, Zygmunt AC, Cordeiro JM, Moise NS, Kornreich BG, Belardinelli L, Antzelevitch C. Ranolazine effectively suppresses atrial fibrillation in the setting of heart failure. Circ Heart Fail 2014; 7:627-33. [PMID: 24874201 DOI: 10.1161/circheartfailure.114.001129] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is a critical need for safer and more effective pharmacological management of atrial fibrillation (AF) in the setting of heart failure (HF). METHODS AND RESULTS This study investigates the electrophysiological, antiarrhythmic, and proarrhythmic effects of a clinically relevant concentration of ranolazine (5 μmol/L) in coronary-perfused right atrial and left ventricular preparations isolated from the hearts of HF dogs. HF was induced by ventricular tachypacing (2-6 weeks at 200-240 beats per minute; n=17). Transmembrane action potentials were recorded using standard microelectrode techniques. In atria, ranolazine slightly prolonged action potential duration but significantly depressed sodium channel current-dependent parameters causing a reduction of maximum rate of rise of the action potential upstroke, a prolongation of the effective refractory period secondary to the development of postrepolarization refractoriness, and an increase in diastolic threshold of excitation and atrial conduction time. Ranolazine did not significantly alter these parameters or promote arrhythmias in the ventricles. Ranolazine produced greater inhibition of peak sodium channel current in atrial cells isolated from HF versus normal dogs. A single premature beat reproducibly induced self-terminating AF in 10 of 17 atria. Ranolazine (5 μmol/L) suppressed induction of AF in 7 of 10 (70%) atria. In the remaining 3 atria, ranolazine reduced frequency and duration of AF. CONCLUSIONS Our results demonstrate more potent suppression of AF by ranolazine in the setting of HF than previously demonstrated in nonfailing hearts and absence of ventricular proarrhythmia. The data suggest that ranolazine may be of benefit as an alternative to amiodarone and dofetilide in the management of AF in patients with HF.
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Affiliation(s)
- Alexander Burashnikov
- From the Masonic Medical Research Laboratory, Utica, NY (A.B., J.M.D.D., H.B.-M., D.H., A.C.Z., J.M.C., C.A.); Department of Clinical and Biological Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY (N.S.M., B.G.K.); and Gilead Sciences, Foster City, CA (L.B.).
| | - José M Di Diego
- From the Masonic Medical Research Laboratory, Utica, NY (A.B., J.M.D.D., H.B.-M., D.H., A.C.Z., J.M.C., C.A.); Department of Clinical and Biological Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY (N.S.M., B.G.K.); and Gilead Sciences, Foster City, CA (L.B.)
| | - Hector Barajas-Martínez
- From the Masonic Medical Research Laboratory, Utica, NY (A.B., J.M.D.D., H.B.-M., D.H., A.C.Z., J.M.C., C.A.); Department of Clinical and Biological Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY (N.S.M., B.G.K.); and Gilead Sciences, Foster City, CA (L.B.)
| | - Dan Hu
- From the Masonic Medical Research Laboratory, Utica, NY (A.B., J.M.D.D., H.B.-M., D.H., A.C.Z., J.M.C., C.A.); Department of Clinical and Biological Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY (N.S.M., B.G.K.); and Gilead Sciences, Foster City, CA (L.B.)
| | - Andrew C Zygmunt
- From the Masonic Medical Research Laboratory, Utica, NY (A.B., J.M.D.D., H.B.-M., D.H., A.C.Z., J.M.C., C.A.); Department of Clinical and Biological Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY (N.S.M., B.G.K.); and Gilead Sciences, Foster City, CA (L.B.)
| | - Jonathan M Cordeiro
- From the Masonic Medical Research Laboratory, Utica, NY (A.B., J.M.D.D., H.B.-M., D.H., A.C.Z., J.M.C., C.A.); Department of Clinical and Biological Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY (N.S.M., B.G.K.); and Gilead Sciences, Foster City, CA (L.B.)
| | - N Sydney Moise
- From the Masonic Medical Research Laboratory, Utica, NY (A.B., J.M.D.D., H.B.-M., D.H., A.C.Z., J.M.C., C.A.); Department of Clinical and Biological Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY (N.S.M., B.G.K.); and Gilead Sciences, Foster City, CA (L.B.)
| | - Bruce G Kornreich
- From the Masonic Medical Research Laboratory, Utica, NY (A.B., J.M.D.D., H.B.-M., D.H., A.C.Z., J.M.C., C.A.); Department of Clinical and Biological Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY (N.S.M., B.G.K.); and Gilead Sciences, Foster City, CA (L.B.)
| | - Luiz Belardinelli
- From the Masonic Medical Research Laboratory, Utica, NY (A.B., J.M.D.D., H.B.-M., D.H., A.C.Z., J.M.C., C.A.); Department of Clinical and Biological Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY (N.S.M., B.G.K.); and Gilead Sciences, Foster City, CA (L.B.)
| | - Charles Antzelevitch
- From the Masonic Medical Research Laboratory, Utica, NY (A.B., J.M.D.D., H.B.-M., D.H., A.C.Z., J.M.C., C.A.); Department of Clinical and Biological Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY (N.S.M., B.G.K.); and Gilead Sciences, Foster City, CA (L.B.).
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Wan SH, Vogel MW, Chen HH. Pre-clinical diastolic dysfunction. J Am Coll Cardiol 2013; 63:407-16. [PMID: 24291270 DOI: 10.1016/j.jacc.2013.10.063] [Citation(s) in RCA: 231] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 10/08/2013] [Accepted: 10/15/2013] [Indexed: 12/30/2022]
Abstract
Pre-clinical diastolic dysfunction (PDD) has been broadly defined as left ventricular diastolic dysfunction without the diagnosis of congestive heart failure (HF) and with normal systolic function. PDD is an entity that remains poorly understood, yet has definite clinical significance. Although few original studies have focused on PDD, it has been shown that PDD is prevalent, and that there is a clear progression from PDD to symptomatic HF including dyspnea, edema, and fatigue. In diabetic patients and in patients with coronary artery disease or hypertension, it has been shown that patients with PDD have a significantly higher risk of progression to heart failure and death compared with patients without PDD. Because of these findings and the increasing prevalence of the heart failure epidemic, it is clear that an understanding of PDD is essential to decreasing patients' morbidity and mortality. This review will focus on what is known concerning pre-clinical diastolic dysfunction, including definitions, staging, epidemiology, pathophysiology, and the natural history of the disease. In addition, given the paucity of trials focused on PDD treatment, studies targeting risk factors associated with the development of PDD and therapeutic trials for heart failure with preserved ejection fraction will be reviewed.
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Affiliation(s)
- Siu-Hin Wan
- Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Mark W Vogel
- Division of Cardiovascular Diseases, Washington University, St. Louis, Missouri
| | - Horng H Chen
- Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota.
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Heijman J, Voigt N, Abu-Taha IH, Dobrev D. Rhythm Control of Atrial Fibrillation in Heart Failure. Heart Fail Clin 2013; 9:407-15, vii-viii. [DOI: 10.1016/j.hfc.2013.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Kaese S, Frommeyer G, Verheule S, van Loon G, Gehrmann J, Breithardt G, Eckardt L. The ECG in cardiovascular-relevant animal models of electrophysiology. Herzschrittmacherther Elektrophysiol 2013; 24:84-91. [PMID: 23740318 DOI: 10.1007/s00399-013-0260-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 03/20/2013] [Indexed: 06/02/2023]
Abstract
The most frequently used animal species in experimental cardiac electrophysiology are mice, rabbits, and dogs. Murine and human electrocardiograms (ECGs) show salient differences, including the occurrence of a pronounced J-wave and a less distinctive T-wave in the murine ECG. Mouse models can resemble human cardiac arrhythmias, although mice differ from human in cardiac electrophysiology. Thus, arrhythmia mechanisms in mice may differ from those in humans and should be transferred to the human situation with caution. Further relevant cardiovascular animal models are rabbits, dogs, and minipigs, as they show similarities of cardiac ion channel distribution with the human heart and are suitable to study ventricular repolarization or pro- and antiarrhythmic drug effects. ECG recordings in large animals like goats and horses are feasible. Both goats and horses are a suitable animal model to study atrial fibrillation (AF) mechanisms. Horses frequently show spontaneous AF due to their high vagal tone and large atria. The zebrafish has become an important animal model. Models in "exotic" animals such as kangaroos may be suitable for particular studies.
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Affiliation(s)
- Sven Kaese
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Muenster, Germany.
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Dehina L, Descotes J, Chevalier P, Bui-Xuan B, Romestaing C, Dizerens N, Mamou Z, Timour Q. Protective effects of ranolazine and propranolol, alone or combined, on the structural and functional alterations of cardiomyocyte mitochondria in a pig model of ischemia/reperfusion. Fundam Clin Pharmacol 2013; 28:257-67. [DOI: 10.1111/fcp.12033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 03/11/2013] [Accepted: 03/28/2013] [Indexed: 12/23/2022]
Affiliation(s)
- Leila Dehina
- EA 4612; Laboratory of Medical Pharmacology; Claude Bernard University; Lyon France
| | - Jacques Descotes
- EA 4612; Laboratory of Medical Pharmacology; Claude Bernard University; Lyon France
- Poison Center and Pharmacovigilance Department; Lyon University Hospitals; Lyon France
| | - Philippe Chevalier
- EA 4612; Laboratory of Medical Pharmacology; Claude Bernard University; Lyon France
| | - Bernard Bui-Xuan
- EA 4612; Laboratory of Medical Pharmacology; Claude Bernard University; Lyon France
| | - Caroline Romestaing
- Laboratory of Extreme Physiology; Claude Bernard University; Villeurbanne France
| | - Nicole Dizerens
- EA 4612; Laboratory of Medical Pharmacology; Claude Bernard University; Lyon France
| | - Zahida Mamou
- EA 4612; Laboratory of Medical Pharmacology; Claude Bernard University; Lyon France
| | - Quadiri Timour
- EA 4612; Laboratory of Medical Pharmacology; Claude Bernard University; Lyon France
- Poison Center and Pharmacovigilance Department; Lyon University Hospitals; Lyon France
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Kettlewell S, Burton FL, Smith GL, Workman AJ. Chronic myocardial infarction promotes atrial action potential alternans, afterdepolarizations, and fibrillation. Cardiovasc Res 2013; 99:215-24. [PMID: 23568957 PMCID: PMC3687753 DOI: 10.1093/cvr/cvt087] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aims Atrial fibrillation (AF) is increased in patients with heart failure resulting from myocardial infarction (MI). We aimed to determine the effects of chronic ventricular MI in rabbits on the susceptibility to AF, and underlying atrial electrophysiological and Ca2+-handling mechanisms. Methods and results In Langendorff-perfused rabbit hearts, under β-adrenergic stimulation with isoproterenol (ISO; 1 µM), 8 weeks MI decreased AF threshold, indicating increased AF susceptibility. This was associated with increased atrial action potential duration (APD)-alternans at 90% repolarization, by 147%, and no significant change in the mean APD or atrial global conduction velocity (CV; n = 6–13 non-MI hearts, 5–12 MI). In atrial isolated myocytes, also under β-stimulation, L-type Ca2+ current (ICaL) density and intracellular Ca2+-transient amplitude were decreased by MI, by 35 and 41%, respectively, and the frequency of spontaneous depolarizations (SDs) was substantially increased. MI increased atrial myocyte size and capacity, and markedly decreased transverse-tubule density. In non-MI hearts perfused with ISO, the ICaL-blocker nifedipine, at a concentration (0.02 µM) causing an equivalent ICaL reduction (35%) to that from the MI, did not affect AF susceptibility, and decreased APD. Conclusion Chronic MI in rabbits remodels atrial structure, electrophysiology, and intracellular Ca2+ handling. Increased susceptibility to AF by MI, under β-adrenergic stimulation, may result from associated production of atrial APD alternans and SDs, since steady-state APD and global CV were unchanged under these conditions, and may be unrelated to the associated reduction in whole-cell ICaL. Future studies may clarify potential contributions of local conduction changes, and cellular and subcellular mechanisms of alternans, to the increased AF susceptibility.
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Affiliation(s)
- Sarah Kettlewell
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G128TA, UK
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Maier LS, Sossalla S. The late Na current as a therapeutic target: where are we? J Mol Cell Cardiol 2013; 61:44-50. [PMID: 23500390 DOI: 10.1016/j.yjmcc.2013.03.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 02/26/2013] [Accepted: 03/04/2013] [Indexed: 12/19/2022]
Abstract
In this article we review the late Na current which functionally can be measured using patch-clamp electrophysiology (INa,late). This current is largely enhanced under pathological myocardial conditions such as ischemia and heart failure. In addition, INa,late can cause systolic and diastolic contractile dysfunction via a Na-dependent Ca-overload of the myocyte. Moreover, INa,late plays a crucial role as ventricular and atrial proarrhythmic substrate in myocardial pathology by changing cellular electrophysiology. We summarize recent experimental and clinical studies that investigate therapeutic inhibition of this current and discuss the significance of the available data and try to answer not only the question, where we currently are but also where we may go in the near future. This article is part of a Special Issue entitled "Na(+) Regulation in Cardiac Myocytes".
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Affiliation(s)
- Lars S Maier
- Abt. Kardiologie und Pneumologie/Herzzentrum, Deutsches Zentrum für Herzkreislaufforschung, Georg-August-Universität, Göttingen, Germany.
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Milberg P, Frommeyer G, Ghezelbash S, Rajamani S, Osada N, Razvan R, Belardinelli L, Breithardt G, Eckardt L. Sodium channel block by ranolazine in an experimental model of stretch-related atrial fibrillation: prolongation of interatrial conduction time and increase in post-repolarization refractoriness. ACTA ACUST UNITED AC 2013; 15:761-9. [DOI: 10.1093/europace/eus399] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Affiliation(s)
- Lars S. Maier
- Corresponding author. Tel: +49 551 39 9627, Fax: +49 551 39 14131,
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