1
|
Martínez Díaz P, Sánchez J, Fitzen N, Ravens U, Dössel O, Loewe A. The right atrium affects in silico arrhythmia vulnerability in both atria. Heart Rhythm 2024; 21:799-805. [PMID: 38301854 DOI: 10.1016/j.hrthm.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Affiliation(s)
- Patricia Martínez Díaz
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Jorge Sánchez
- Institute of Information and Communication Technologies (ITACA), Universitat Politècnica de València (UPV), Valencia, Spain
| | - Nikola Fitzen
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Ursula Ravens
- Institute for Experimental Cardiovascular Medicine, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Olaf Dössel
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Axel Loewe
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
| |
Collapse
|
2
|
Khan MS, Lange M, Ranjan R, Sharma V, Glotzbach JP, Selzman C, Dosdall DJ. Premature atrial stimulation accentuates conduction abnormalities in cardiac surgery patients that develop postoperative atrial fibrillation. J Electrocardiol 2021; 69:36-43. [PMID: 34555557 PMCID: PMC9265137 DOI: 10.1016/j.jelectrocard.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND postoperative atrial fibrillation (POAF) is a common cardiac surgery complication that is associated with increased complications and negative outcomes, but the association between presurgical atrial conduction abnormalities and POAF has not been investigated clinically during premature atrial S1S2 stimulation. This clinical study sought to examine whether intraoperative premature atrial stimulation reveals increased areas of slowed and/or blocked conduction in patients that develop POAF. METHODS High-density intraoperative epicardial left atrial mapping was conducted in 20 cardiac surgery patients with no prior history of atrial fibrillation (AF). In 20 patients, 6 (30%) developed POAF. A flexible-array of 240-electrodes was placed on the posterior left atrial wall in between the pulmonary veins. Activation maps were generated for sinus and premature atrial S1S2 stimulated beats. The area of conduction block (CB), conduction delay (CD) and the combination of both (CDCB) for conduction velocity < 0.1, 0.1 ≤ x < 0.2 and < 0.2 m/s, respectively were quantified. RESULTS For a premature atrial S2 beat with shortest cycle length captured, conduction velocity maps revealed a significantly higher area for CD (13.19 ± 6.59 versus 6.06 ± 4.22 mm2, p = 0.028) and CDCB (17.36 ± 8.75 versus 7.41 ± 6.39 mm2, p = 0.034), and a trend toward a larger area for CB (4.17 ± 3.66 versus 1.34 ± 2.86 mm2, p = 0.063) in patients who developed POAF in comparison to those that remained in the sinus. Sinus and S1 paced beats did not show substantial differences in abnormal conduction areas between patients with and without POAF. CONCLUSION In comparison to sinus and S1 beats, premature atrial S2 beats accentuate conduction abnormalities in the posterior left atrial wall of cardiac surgery patients that developed POAF.
Collapse
Affiliation(s)
- Muhammad S. Khan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah – Health, Salt Lake City, UT 84112, USA
| | - Matthias Lange
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah – Health, Salt Lake City, UT 84112, USA
| | - Ravi Ranjan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah – Health, Salt Lake City, UT 84112, USA.,Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Utah – Health, Salt Lake City, UT 84112, USA.,Department of Bioengineering, The University of Utah – Health, Salt Lake City, UT 84112, USA
| | - Vikas Sharma
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Utah – Health, Salt Lake City, UT 84112, USA
| | - Jason P. Glotzbach
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Utah – Health, Salt Lake City, UT 84112, USA
| | - Craig Selzman
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah – Health, Salt Lake City, UT 84112, USA.,Division of Cardiothoracic Surgery, Department of Surgery, The University of Utah – Health, Salt Lake City, UT 84112, USA
| | - Derek J. Dosdall
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah – Health, Salt Lake City, UT 84112, USA.,Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Utah – Health, Salt Lake City, UT 84112, USA.,Department of Bioengineering, The University of Utah – Health, Salt Lake City, UT 84112, USA.,Division of Cardiothoracic Surgery, Department of Surgery, The University of Utah – Health, Salt Lake City, UT 84112, USA.,Address For Correspondence: Dr. Derek J. Dosdall, PhD, FHRS, FAHA, Associate Professor of Surgery, Division of Cardiothoracic Surgery, The University of Utah – Health, Salt Lake City, UT 84112 USA, / Ph: (+1) 801-587-2036
| |
Collapse
|
3
|
Aliot E, Capucci A, Crijns HJ, Goette A, Tamargo J. Twenty-five years in the making: flecainide is safe and effective for the management of atrial fibrillation. Europace 2010; 13:161-73. [PMID: 21138930 PMCID: PMC3024037 DOI: 10.1093/europace/euq382] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in clinical practise and its prevalence is increasing. Over the last 25 years, flecainide has been used extensively worldwide, and its capacity to reduce AF symptoms and provide long-term restoration of sinus rhythm (SR) has been well documented. The increased mortality seen in patients treated with flecainide in the Cardiac Arrhythmia Suppression Trial (CAST) study, published in 1991, still deters many clinicians from using flecainide, denying many new AF patients a valuable treatment option. There is now a body of evidence that clearly demonstrates that flecainide has a favourable safety profile in AF patients without significant left ventricular disease or coronary heart disease. As a result of this evidence, flecainide is now recommended as one of the first-line treatment options for restoring and maintaining SR in patients with AF under current treatment guidelines. The objective of this article is to review the literature pertaining to the pharmacological characteristics, safety and efficacy of flecainide, and to place this drug in the context of current therapeutic management strategies for AF.
Collapse
Affiliation(s)
- Etienne Aliot
- Département de Cardiologie, CHU de Nancy, Hôpital de Brabois, rue du Morvan, 54511 Vandoeuvre-lès-Nancy Cedex, France.
| | | | | | | | | |
Collapse
|
4
|
Thilén U, Carlson J, Platonov P, Olsson S. Atrial myocardial pathoelectrophysiology in adults with a secundum atrial septal defect is unaffected by closure of the defect. A study using high resolution signal-averaged orthogonal P-wave technique. Int J Cardiol 2009; 132:364-8. [DOI: 10.1016/j.ijcard.2007.11.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 11/20/2007] [Indexed: 10/22/2022]
|
5
|
Goette A, Lendeckel U, Kuchenbecker A, Bukowska A, Peters B, Klein HU, Huth C, Röcken C. Cigarette smoking induces atrial fibrosis in humans via nicotine. Heart 2007; 93:1056-63. [PMID: 17395670 PMCID: PMC1955003 DOI: 10.1136/hrt.2005.087171] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Cigarette smoking (CS) promotes endothelial dysfunction and atherosclerosis in the vascular bed. The impact of smoking on atrial myocardium is not defined in humans. OBJECTIVE To determine the effect of CS on the development of interstitial fibrosis in atrial myocardium. DESIGN Case-control study. PATIENTS 95 patients (46 smokers and 49 non-smokers) undergoing coronary artery bypass grafting (CABG). MAIN OUTCOME MEASURES Amount of atrial fibrosis, collagen I, III and IV expression pattern, and quantitative reverse transcriptase-PCR. Occurrence of postoperative atrial fibrillation (AF). RESULTS In the study population, patient age correlated significantly with the amount of atrial fibrosis (r = 0.18; p<0.05). Nicotine misuse (pack years) was identified as the only factor related to atrial fibrosis in smokers (r = 0.311; p<0.05). The amount of fibrosis was higher in patients with postoperative AF (22.9% (6.2%) vs. 27.0% (8.2%); p<0.05). To show a causal relationship between CS and atrial fibrosis, atrial tissue slices from non-smokers (n = 8) were cultured in the presence of nicotine base (185 and 740 nmol/l). Nicotine base induced mRNA expression of collagen III (up to 10-fold) in a concentration-dependent manner resembling the immunohistological collagen expression pattern observed in CS. CONCLUSION CS contributes to the development of atrial fibrosis via nicotine. Atrial fibrosis by itself has been shown to provide an arrhythmogenic substrate, which may increase the likelihood of the occurrence of atrial arrhythmias, including postoperative AF.
Collapse
Affiliation(s)
- Andreas Goette
- Institute of Experimental Internal Medicine, Division of Cardiology, Department of Cardiovascular Surgery, University Hospital Magdeburg, Magdeburg, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Abstract
Surgical ablation of atrial fibrillation (AF) is the most effective means of curing this arrhythmia, with the classic Maze procedure eliminating AF in more than 90% of patients. A complex but safe operation, the Maze procedure has been applied by relatively few surgeons. However, recent advances in the understanding of the pathogenesis of AF and development of new ablation technologies enable surgeons to perform pulmonary vein ablation, create linear left atrial lesions, and remove the left atrial appendage rapidly and safely. Lesions are created under direct vision, minimizing the risk of damage to the pulmonary veins and adjacent mediastinal structures. Most surgical ablation procedures have been performed in conjunction with mitral valve surgery, the combination of mitral valve repair and cure of AF enabling patients to avoid lifelong anticoagulation. Recently developed surgical instrumentation now enables thoracoscopic and keyhole approaches, facilitating extension of epicardial AF ablation and excision of the left atrial appendage to patients with isolated AF and no other indication for cardiac surgery.
Collapse
Affiliation(s)
- A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
| | | |
Collapse
|
7
|
Gillinov AM. Surgical Ablation of Atrial Fibrillation. J Interv Card Electrophysiol 2005; 13:115-24. [PMID: 16133838 DOI: 10.1007/s10840-005-0302-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Accepted: 05/10/2005] [Indexed: 11/29/2022]
Affiliation(s)
- A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
| |
Collapse
|
8
|
Kim NH, Ahn Y, Oh SK, Cho JK, Park HW, Kim YS, Hong MH, Nam KI, Park WJ, Jeong MH, Ahn BH, Choi JB, Kook H, Park JC, Jeong JW, Kang JC. Altered Patterns of Gene Expression in Response to Chronic Atrial Fibrillation. Int Heart J 2005; 46:383-95. [PMID: 16043935 DOI: 10.1536/ihj.46.383] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To obtain greater insight into atrial remodeling at the molecular level we analyzed the changes in gene expression in human atrial tissue between patients with chronic atrial fibrillation (AF) and those with normal sinus rhythm (NSR). cDNA microarray analysis was used to identify genes differentially expressed during sustained AF of more than 6 months (n = 9, mean age, 45 +/- 12, 6 males and 3 females) as compared to those with NSR (n = 9, mean age, 47 +/- 13, 6 males and 3 females). Western blot analysis was performed to confirm the altered gene expression and to establish the changes in protein expression. DNA gel electrophoresis to establish DNA ladder formation, which was associated with apoptosis in response to chronic AF, was performed. Microscopic findings were observed via electron microscopy. In the microarray analysis, out of 8,167 candidate genes, 66 genes showed a significant change in the expression level in the patients with chronic AF, which was in contrast to those with NSR. Among those, 31 genes were consistently down-regulated and 35 up-regulated more than 2-fold. The relative amounts of the Bcl-2 and p27 in the atrial tissue were decreased and angiotensin II type 2 (AT2) receptor and p21 were increased in the patients with chronic AF as compared to those with NSR. The atrial cardiomyocytes in chronic AF showed a prominent DNA ladder, which is a biochemical hallmark of apoptosis. The expression of Bcl-2, AT2 receptor, p21, and p27 were consistent with a significant role in the apoptosis of cardiac myocytes in the patients with chronic AF.
Collapse
Affiliation(s)
- Nam-Ho Kim
- Department of Internal Medicine, Wonkwang University Hospital, Iksan, South Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
Atrial fibrillation (AF) is the most common clinical arrhythmia and one of the most important factors for ischemic stroke. In general, AF is treated with "channel-blocking drugs" to restore sinus rhythm and warfarin is recommended in the majority of patients to prevent atrial thrombus formation and thromboembolic events. In the recent years, a tremendous amount has been learned about the pathophysiology and molecular biology of AF. Thus, pharmacologic interference with specific signal transduction pathways with "non-channel-blocking drugs" appears promising as a novel antiarrhythmic approach to maintain sinus rhythm and to prevent atrial clot formation. Therefore, this review will highlight some novel "nonchannel drug targets" for AF therapy.
Collapse
Affiliation(s)
- Andreas Goette
- Division of Cardiology, Otto-von-Guericke University Magdeburg, Leipzigerstrasse 44, 39120 Magdeburg, Germany.
| | | |
Collapse
|
10
|
Abstract
There has been a resurgence in the surgical treatment of AF. Although the Maze procedure is extremely effective at curing AF, new surgical approaches are far simpler and include pulmonary vein isolation, left atrial lesions, and excision of the left atrial appendage. Currently applied as an adjunct to other cardiac operations, these new approaches are being modified for thoracoscopic, minimally invasive, epicardial AF ablation. This minimally invasive procedure will enable rapid and effective cure of AF in large numbers of patients.
Collapse
|
11
|
Niwano S, Wakisaka Y, Kojima J, Yumoto Y, Inuo K, Hara H, Saito J, Niwano H, Izumi T. Monitoring the progression of the atrial electrical remodeling in patients with paroxysmal atrial fibrillation. Circ J 2003; 67:133-8. [PMID: 12547995 DOI: 10.1253/circj.67.133] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
It is important to clarify how electrical remodeling develops in clinical cases of paroxysmal atrial fibrillation (PAF), because it has been suggested that this electrophysiological phenomenon promotes an increase in the frequency of PAF. In the present study, the f-f interval during PAF was analyzed from the ambulatory ECG recordings of 21 patients with PAF (total PAF duration >2/24 h with normal atrial size) to monitor the atrial electrophysiological changes. The patients were clinically followed-up for 6 months without any antiarrhythmic drugs. Before and after the follow-up period 24-h Holter monitoring was carried out and the duration of both the PAF and the f-f intervals during the PAF episode were evaluated. In selected cases, the atrial effective refractory period (ERP) was evaluated in an electrophysiologic study before and after the follow-up period. The total PAF duration was prolonged from 187+/-50 to 223+/-79 min (p=0.034) and the f-f interval was shortened from 0.14+/-0.03 to 0.12+/-0.02 ms (p=0.003). There was an inverse relationship between the changes in total PAF duration and f-f interval (p=0.027). The ERP was shortened from 214+/-15 to 194+/-5 ms (n=5, p=0.025) and there was a direct correlation between the changes in ERP and f-f interval (p=0.048). In clinical cases, the prolongation of the PAF was related to the shortening of the f-f interval during the PAF episodes and to the shortening of the atrial ERP. Electrical remodeling plays a role in promoting the development of the atrial fibrillation in patients with PAF.
Collapse
Affiliation(s)
- Shinichi Niwano
- Department of Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with morbidity and mortality. Traditional surgical treatment of AF is the Cox-Maze III procedure, a complicated operation. New surgical approaches include alternate energy sources (radiofrequency, microwave, cryothermy) and simplified left atrial lesion sets. These operations cure AF in 70% to 80% of patients. This review describes contemporary and emerging surgical approaches to AF, synthesizes results of these operations, and proposes new standards for reporting results of AF treatment.
Collapse
Affiliation(s)
- A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
| | | | | |
Collapse
|
13
|
Lehmann G, Horcher J, Dennig K, Plewan A, Ulm K, Alt E. Atrial mechanical performance after internal and external cardioversion of atrial fibrillation: an echocardiographic study. Chest 2002; 121:13-8. [PMID: 11796426 DOI: 10.1378/chest.121.1.13] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES To compare the time course of resumption of mechanical performance of the left and right atrium after the novel method of internal low-energy cardioversion (CV) and conventional external CV of atrial fibrillation (AF). BACKGROUND Right atrial performance has been shown to normalize before the left atrium after external CV. However, no data on atrial function after internal CV are available. PATIENTS AND INTERVENTIONS Sixty-three patients with chronic AF were randomized to participate in either external or internal CV. MEASUREMENTS Echocardiographic examinations were carried out before as well as immediately after CV (day 0), and at days 1, 7, and 28 thereafter for the determination of cardiac dimensions, volumes, and transvalvular flow patterns. RESULTS After randomized internal CV or external CV, stable sinus rhythm was restored in 59 patients. Irrespective of the mode of CV, the right atrium resumed its mechanical function immediately after CV, whereas the left atrium was stunned beyond day 7. The mode of CV, internal or external, had no influence on the recovery of atrial mechanical function. CONCLUSIONS The right atrium resumes its normal function immediately after internal as well as external CV, whereas left atrium function is delayed. In contrast to the assumption that low-energy internal CV would impact less on atrial mechanical recovery, the type of method of CV used has no effect on such recovery.
Collapse
Affiliation(s)
- Günter Lehmann
- Deutsches Herzzentrum, Klinikum an der Technischen Universität München, Germany
| | | | | | | | | | | |
Collapse
|
14
|
Goette A, Staack T, Röcken C, Arndt M, Geller JC, Huth C, Ansorge S, Klein HU, Lendeckel U. Increased expression of extracellular signal-regulated kinase and angiotensin-converting enzyme in human atria during atrial fibrillation. J Am Coll Cardiol 2000; 35:1669-77. [PMID: 10807475 DOI: 10.1016/s0735-1097(00)00611-2] [Citation(s) in RCA: 397] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The purpose of this study was to determine whether atrial expression of the extracellular signal-regulated kinases Erk1/Erk2 and of the angiotensin-converting enzyme (ACE) is altered in patients with atrial fibrillation (AF). BACKGROUND Recent studies have demonstrated that atrial fibrosis can provide a pathophysiologic substrate for AF. However, the molecular mechanisms responsible for the development of atrial fibrosis are unclear. METHODS Atrial tissue samples of 43 patients undergoing open heart surgery were examined. Seventeen patients had chronic persistent AF (> or =6 months; CAF), 8 patients had paroxysmal AF (PAF) and 18 patients had no history of AF. Erk expression was analyzed at the mRNA (quantitative reverse transcription polymerase chain reaction), the protein (immunoblot techniques) and atrial tissue (immunohistochemistry) levels. Erk-activating kinases (MEK1/2) and ACE were analyzed by immunoblot techniques. RESULTS Increased amounts of Erk2-mRNA were found in patients with CAF (75 +/- 20 U vs. sinus rhythm: 31 +/- 25 U; p < 0.05). Activated Erk1/Erk2 and MEK1/2 were increased to more than 150% in patients with AF compared to patients with sinus rhythm. No differences between CAF and PAF were found. The expression of ACE was three-fold increased during CAF. Amounts of activated Erk1/Erk2 were reduced in patients treated with ACE inhibitors. Patients with AF showed an increased expression of Erk1/Erk2 in interstitial cells and marked atrial fibrosis. CONCLUSIONS An ACE-dependent increase in the amounts of activated Erk1/Erk2 in atrial interstitial cells may contribute as a molecular mechanism for the development of atrial fibrosis in patients with AF. These findings may have important impact on the treatment of AF.
Collapse
Affiliation(s)
- A Goette
- University Hospital Magdeburg, Department of Internal Medicine, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|