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Yamaguchi T. Atrial structural remodeling and atrial fibrillation substrate: A histopathological perspective. J Cardiol 2024:S0914-5087(24)00096-0. [PMID: 38810728 DOI: 10.1016/j.jjcc.2024.05.007] [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: 04/10/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
Atrial fibrillation (AF) substrate progresses with the advancement of atrial structural remodeling, resulting in AF perpetuation and recurrence. Although fibrosis is considered a hallmark of atrial structural remodeling, the histological background has not been fully elucidated because obtaining atrial specimens is difficult, especially in patients not undergoing open-heart surgery. Bipolar voltage reduction evaluated using electroanatomic mapping during AF ablation is considered a surrogate marker for the progression of structural remodeling; however, histological validation is lacking. We developed an intracardiac echocardiography-guided endomyocardial atrial biopsy technique to evaluate atrial structural remodeling in patients undergoing catheter ablation for nonvalvular AF. The histological factors associated with a decrease in bipolar voltage were interstitial fibrosis, as well as an increase in myocardial intercellular space preceding fibrosis, myofibrillar loss, and a decrease in cardiomyocyte nuclear density, which is a surrogate marker for cardiomyocyte density. Cardiomyocyte hypertrophy is closely associated with a decrease in cardiomyocyte nuclear density, suggesting that hypertrophic changes compensate for cardiomyocyte loss. Electron microscopy also revealed that increased intercellular spaces indicated the leakage of plasma components owing to increased vascular permeability. Additionally, amyloid deposition was observed in 4 % of biopsy cases. Only increased intercellular space and interstitial fibrosis were significantly higher for long-standing persistent AF than for paroxysmal AF and associated with recurrence after AF ablation, suggesting that this interstitial remodeling is the AF substrate. An increase in intercellular space that occurs early in AF formation is a therapeutic target for the AF substrate, which prevents irreversible interstitial degeneration due to collagen accumulation. This endomyocardial atrial biopsy technique will allow the collection of atrial tissue from a wide variety of patients and significantly facilitate the elucidation of the mechanisms of atrial cardiomyopathy, structural remodeling, and AF substrates.
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Gondal MUR, Mehmood RS, Khan RP, Malik J. Atrial myopathy. Curr Probl Cardiol 2024; 49:102381. [PMID: 38191102 DOI: 10.1016/j.cpcardiol.2024.102381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/10/2024]
Abstract
This paper delves into the progressive concept of atrial myopathy, shedding light on its development and its impact on atrial characteristics. It extensively explores the intricate connections between atrial myopathy, atrial fibrillation (AF), and strokes. Researchers have sought additional contributors to AF-related strokes due to the absence of a clear timing correlation between paroxysmal AF episodes and strokes in patients with cardiac implantable electronic devices. Through various animal models and human investigations, a close interrelation among aging, inflammation, oxidative stress, and stretching mechanisms has been identified. These mechanisms contribute to fibrosis, alterations in electrical properties, autonomic remodeling, and a heightened pro-thrombotic state. These interconnected factors establish a detrimental cycle, exacerbating atrial myopathy and elevating the risk of sustained AF and strokes. By emphasizing the significance of atrial myopathy and the risk of strokes that are distinct from AF, the paper also discusses methods for identifying patients with atrial myopathy. Moreover, it proposes an approach to incorporate the concept of atrial myopathy into clinical practice to guide anticoagulation decisions in individuals with AF.
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Affiliation(s)
| | - Raja Sadam Mehmood
- Department of Medicine, Shifa International Hospital, Islamabad, Pakistan
| | | | - Jahanzeb Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan.
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3
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Higuchi S, Voskoboinik A, Im SI, Lee A, Olgin J, Arbil A, Afzal J, Marcus GM, Stillson C, Bibby D, Abraham T, Wilson E, Gerstenfeld EP. Frequent Premature Atrial Contractions Lead to Adverse Atrial Remodeling and Atrial Fibrillation in a Swine Model. Circulation 2024; 149:463-474. [PMID: 37994608 PMCID: PMC10872765 DOI: 10.1161/circulationaha.123.065874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/26/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Frequent premature atrial complexes (PACs) are associated with future incident atrial fibrillation (AF), but whether PACs contribute to development of AF through adverse atrial remodeling has not been studied. This study aimed to explore the effect of frequent PACs from different sites on atrial remodeling in a swine model. METHODS Forty swine underwent baseline electrophysiologic studies and echocardiography followed by pacemaker implantations and paced PACs (50% burden) at 250-ms coupling intervals for 16 weeks in 4 groups: (1) lateral left atrium (LA) PACs by the coronary sinus (Lat-PAC; n=10), (2) interatrial septal PACs (Sep-PAC; n=10), (3) regular LA pacing at 130 beats/min (Reg-130; n=10), and (4) controls without PACs (n=10). At the final study, repeat studies were performed, followed by tissue histology and molecular analyses focusing on fibrotic pathways. RESULTS Lat-PACs were associated with a longer P-wave duration (93.0±9.0 versus 74.2±8.2 and 58.8±7.6 ms; P<0.001) and greater echocardiographic mechanical dyssynchrony (57.5±11.6 versus 35.7±13.0 and 24.4±11.1 ms; P<0.001) compared with Sep-PACs and controls, respectively. After 16 weeks, Lat-PACs led to slower LA conduction velocity (1.1±0.2 versus 1.3±0.2 [Sep-PAC] versus 1.3±0.1 [Reg-130] versus 1.5±0.2 [controls] m/s; P<0.001) without significant change in atrial ERP. The Lat-PAC group had a significantly increased percentage of LA fibrosis and upregulated levels of extracellular matrix proteins (lysyl oxidase and collagen 1 and 8), as well as TGF-β1 (transforming growth factor-β1) signaling proteins (latent and monomer TGF-β1 and phosphorylation/total ratio of SMAD2/3; P<0.05). The Lat-PAC group had the longest inducible AF duration (terminal to baseline: 131 [interquartile range 30, 192] seconds versus 16 [6, 26] seconds [Sep-PAC] versus 22 [11, 64] seconds [Reg-130] versus -1 [-16, 7] seconds [controls]; P<0.001). CONCLUSIONS In this swine model, frequent PACs resulted in adverse atrial structural remodeling with a heightened propensity to AF. PACs originating from the lateral LA produced greater atrial remodeling and longer induced AF duration than the septal-origin PACs. These data provide evidence that frequent PACs can cause adverse atrial remodeling as well as AF, and that the location of ectopic PACs may be clinically meaningful.
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Affiliation(s)
- Satoshi Higuchi
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Aleksandr Voskoboinik
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Sung Il Im
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Adam Lee
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Jeffrey Olgin
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Ayla Arbil
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Junaid Afzal
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Gregory M Marcus
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Carol Stillson
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Dwight Bibby
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Theodore Abraham
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Emily Wilson
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
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4
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Yang H, Majumder JA, Huang Z, Saluja D, Laurita K, Rollins AM, Hendon CP. Robust, high-density lesion mapping in the left atrium with near-infrared spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:028001. [PMID: 38419756 PMCID: PMC10901242 DOI: 10.1117/1.jbo.29.2.028001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
Significance Radiofrequency ablation (RFA) procedures for atrial fibrillation frequently fail to prevent recurrence, partially due to limitations in assessing extent of ablation. Optical spectroscopy shows promise in assessing RFA lesion formation but has not been validated in conditions resembling those in vivo. Aim Catheter-based near-infrared spectroscopy (NIRS) was applied to porcine hearts to demonstrate that spectrally derived optical indices remain accurate in blood and at oblique incidence angles. Approach Porcine left atria were ablated and mapped using a custom-fabricated NIRS catheter. Each atrium was mapped first in phosphate-buffered saline (PBS) then in porcine blood. Results NIRS measurements showed little angle dependence up to 60 deg. A trained random forest model predicted lesions with a sensitivity of 81.7%, a specificity of 86.1%, and a receiver operating characteristic curve area of 0.921. Predicted lesion maps achieved a mean structural similarity index of 0.749 and a mean normalized inner product of 0.867 when comparing maps obtained in PBS and blood. Conclusions Catheter-based NIRS can precisely detect RFA lesions on left atria submerged in blood. Optical parameters are reliable in blood and without perpendicular contact, confirming their ability to provide useful feedback during in vivo RFA procedures.
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Affiliation(s)
- Haiqiu Yang
- Columbia University, Department of Electrical Engineering, New York, United States
| | - Jonah A. Majumder
- Columbia University, Department of Biomedical Engineering, New York, United States
| | - Ziyi Huang
- Columbia University, Department of Electrical Engineering, New York, United States
| | - Deepak Saluja
- Columbia University Irving Medical Center, Cardiology Division, Department of Medicine, New York, United States
| | - Kenneth Laurita
- MetroHealth Hospital, Cardiology Division, Department of Medicine, Cleveland, Ohio, United States
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States
| | - Andrew M. Rollins
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States
| | - Christine P. Hendon
- Columbia University, Department of Electrical Engineering, New York, United States
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5
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Begic Z, Djukic M, Begic E, Aziri B, Mladenovic Z, Iglica A, Sabanovic-Bajramovic N, Begic N, Kovacevic-Preradovic T, Stanetic B, Badnjevic A. Left atrial strain analysis in the realm of pediatric cardiology: Advantages and implications. Technol Health Care 2024; 32:1255-1272. [PMID: 37840514 DOI: 10.3233/thc-231087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND Left atrial (LA) strain analysis has emerged as a noninvasive technique for assessing LA function and early detection of myocardial deformation. Recently, its application has also shown promise in the pediatric population, spanning diverse cardiac conditions that demand accurate and sensitive diagnostic measures. OBJECTIVE This research article endeavors to explore the role of LA strain parameters and contribute to the growing body of knowledge in pediatric cardiology, paving the way for more effective and tailored approaches to patient care. METHODS A comprehensive literature review was conducted to gather evidence from studies using echocardiographic strain imaging techniques across pediatric populations. RESULTS LA strain parameters exhibited greater sensitivity than conventional atrial function indicators, with early detection of diastolic dysfunction and LA remodeling in pediatric cardiomyopathy, children with multisystem inflammatory syndrome, rheumatic heart disease, as well as childhood renal insufficiency and obesity offering prognostic relevance as potential markers in these pediatric subpopulations. However, there remains a paucity of evidence concerning pediatric mitral valve pathology, justifying further exploration. CONCLUSION LA strain analysis carries crucial clinical and prognostic implications in pediatric cardiac conditions, with reliable accuracy and sensitivity to early functional changes.
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Affiliation(s)
- Zijo Begic
- Department of Cardiology, Pediatric Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Milan Djukic
- Department of Cardiology, University Children's Hospital, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Edin Begic
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
- Department of Cardiology, General Hospital "Prim. Dr. Abdulah Nakas", Sarajevo, Bosnia and Herzegovina
| | - Buena Aziri
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Zorica Mladenovic
- Department of Cardiology, Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Amer Iglica
- Intensive Care Unit, Clinic for Heart, Blood Vessels and Rheumatism, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Nirvana Sabanovic-Bajramovic
- Intensive Care Unit, Clinic for Heart, Blood Vessels and Rheumatism, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Nedim Begic
- Department of Cardiology, Pediatric Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Tamara Kovacevic-Preradovic
- Department of Cardiology, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Department of Internal Medicine, Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Bojan Stanetic
- Department of Cardiology, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Department of Internal Medicine, Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Almir Badnjevic
- Verlab Research Institute for Biomedical Engineering, Medical Devices and Artificial Intelligence, Sarajevo, Bosnia and Herzegovina
- Faculty of Pharmacy, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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O’Neill L, De Becker B, Smet MAD, Francois C, Le Polain De Waroux JB, Tavernier R, Duytschaever M, Knecht S. Catheter Ablation of Persistent AF-Where are We Now? Rev Cardiovasc Med 2023; 24:339. [PMID: 39077091 PMCID: PMC11262453 DOI: 10.31083/j.rcm2412339] [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: 05/13/2023] [Revised: 08/20/2023] [Accepted: 08/28/2023] [Indexed: 07/31/2024] Open
Abstract
Persistent atrial fibrillation (AF) is a diverse condition that includes various subtypes and underlying causes of arrhythmia. Progress made in catheter ablation technology in recent years has significantly enhanced the durability of ablation. Despite these advances however, the effectiveness of ablation in treating persistent AF is still relatively modest. Studies exploring the mechanisms behind persistent AF have identified substrate-driven focal and re-entrant sources within the atrial body as crucial in sustaining AF among individuals with persistent AF. Furthermore, the widespread adoption of atrial late gadolinium enhancement cardiac magnetic resonance (CMR) imaging and the ongoing refinement of invasive voltage mapping techniques have allowed for detailed assessment of fibrotic remodelling prior to or at the time of procedure. Translation into clinical practice, however, has yielded overall disappointing results. The clinical application of AF mapping in ablation procedures has not shown any substantial advantages beyond the use of pulmonary vein isolation (PVI) alone and adjunct ablation of fibrotic areas has yielded conflicting results in recent randomized trials. The emergence of pulsed field ablation represents a welcome development in the field and several studies have demonstrated an enhanced safety profile and increased procedural efficiency with this non-thermal energy modality. Pulsed field ablation also holds promise for safe and efficient substrate ablation beyond the pulmonary veins, but further trials are needed to assess its impact on longer term success rates. Continued advancements in our comprehension of AF mechanisms, alongside ongoing developments in catheter technology aimed at safe formation of transmural lesions, are essential for achieving better clinical outcomes for patients with persistent AF.
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Affiliation(s)
- Louisa O’Neill
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium
- Department of Cardiology, Blackrock Clinic, A94 E4X7 Dublin, Ireland
| | | | | | - Clara Francois
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium
| | | | - Rene Tavernier
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium
| | | | - Sebastien Knecht
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium
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7
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Yates TA, Vijayakumar R, McGilvray M, Khiabani AJ, Razo N, Sinn L, Schill MR, Marrouche N, Zemlin C, Damiano RJ. Delayed-enhancement cardiac magnetic resonance imaging detects disease progression in patients with mitral valve disease and atrial fibrillation. JTCVS OPEN 2023; 16:292-302. [PMID: 38204711 PMCID: PMC10774962 DOI: 10.1016/j.xjon.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 01/12/2024]
Abstract
Objectives The mechanism by which mitral valve (MV) disease leads to atrial fibrillation (AF) remains poorly understood. Delayed-enhancement cardiac magnetic resonance imaging (DE-MRI) has been used to assess left atrial (LA) fibrosis in patients with lone AF before catheter ablation; however, few studies have used DE-MRI to assess MV-induced LA fibrosis in patients with or without AF undergoing MV surgery. Methods Between March 2018 and September 2022, 38 subjects were enrolled; 15 age-matched controls, 14 patients with lone mitral regurgitation (MR), and 9 patients with MR and AF (MR + AF). Indexed LA volume, total LA wall, and regional LA posterior wall (LAPW) enhancement were defined by the DE-MRI. One-way analysis of variance was performed. Results LA volume and LA enhancement were associated (r = 0.451, P = .004). LA volume differed significantly between controls (37.1 ± 10.6 mL) and patients with lone MR (71.0 ± 35.9, P = .020 and controls and patients with MR + AF (99.3 ± 47.4, P < .001). The difference in LA enhancement was significant between MR + AF (16.7 ± 9.6%) versus controls (8.3 ± 3.9%, P = .006) and MR + AF versus lone MR (8.0 ± 4.8%, P = .004). Similarly, the was significantly more LAPW enhancement in the MR + AF (17.5 ± 8.7%) versus control (9.2 ± 5.1%, P = .011) and MR + AF versus lone MR (9.8 ± 6.0%, P = .020). Conclusions Patients with MR + AF had significantly more total and LAPW fibrosis compared with both controls and lone MR. Volume and delayed enhancement were associated, but there was no difference between MR and MR + AF.
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Affiliation(s)
- Tari-Ann Yates
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
| | - Ramya Vijayakumar
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
| | - Martha McGilvray
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
| | - Ali J. Khiabani
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
| | - Nicholas Razo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
| | - Laurie Sinn
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
| | - Matthew R. Schill
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
| | - Nassir Marrouche
- Department of Cardiology, Tulane University School of Medicine, New Orleans, La
| | - Christian Zemlin
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
| | - Ralph J. Damiano
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
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Takahashi Y, Yamaguchi T, Otsubo T, Nakashima K, Shinzato K, Osako R, Shichida S, Kawano Y, Fukui A, Kawaguchi A, Aishima S, Saito T, Takahashi N, Node K. Histological validation of atrial structural remodelling in patients with atrial fibrillation. Eur Heart J 2023; 44:3339-3353. [PMID: 37350738 PMCID: PMC10499545 DOI: 10.1093/eurheartj/ehad396] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 05/03/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND AND AIMS This study aimed to histologically validate atrial structural remodelling associated with atrial fibrillation. METHODS AND RESULTS Patients undergoing atrial fibrillation ablation and endomyocardial atrial biopsy were included (n = 230; 67 ± 12 years old; 69 women). Electroanatomic mapping was performed during right atrial pacing. Voltage at the biopsy site (Vbiopsy), global left atrial voltage (VGLA), and the proportion of points with fractionated electrograms defined as ≥5 deflections in each electrogram (%Fractionated EGM) were evaluated. SCZtotal was calculated as the total width of slow conduction zones, defined as regions with a conduction velocity of <30 cm/s. Histological factors potentially associated with electroanatomic characteristics were evaluated using multiple linear regression analyses. Ultrastructural features and immune cell infiltration were evaluated by electron microscopy and immunohistochemical staining in 33 and 60 patients, respectively. Fibrosis, intercellular space, myofibrillar loss, and myocardial nuclear density were significantly associated with Vbiopsy (P = .014, P < .001, P < .001, and P = .002, respectively) and VGLA (P = .010, P < .001, P = .001, and P < .001, respectively). The intercellular space was associated with the %Fractionated EGM (P = .001). Fibrosis, intercellular space, and myofibrillar loss were associated with SCZtotal (P = .028, P < .001, and P = .015, respectively). Electron microscopy confirmed plasma components and immature collagen fibrils in the increased intercellular space and myofilament lysis in cardiomyocytes, depending on myofibrillar loss. Among the histological factors, the severity of myofibrillar loss was associated with an increase in macrophage infiltration. CONCLUSION Histological correlates of atrial structural remodelling were fibrosis, increased intercellular space, myofibrillar loss, and decreased nuclear density. Each histological component was defined using electron microscopy and immunohistochemistry studies.
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Affiliation(s)
- Yuya Takahashi
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Takanori Yamaguchi
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Toyokazu Otsubo
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Kana Nakashima
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Kodai Shinzato
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Ryosuke Osako
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Shigeki Shichida
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Yuki Kawano
- Division of Cardiology, Saiseikai Futsukaichi Hospital, 3-13-1, Yumachi, Chikushino, Fukoka 818-8516, Japan
| | - Akira Fukui
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1, Idaigaoka, Hasama, Yufu, Oita 879-5593, Japan
| | - Atsushi Kawaguchi
- Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Shinichi Aishima
- Department of Pathology and Microbiology, Saga University, Saga, Japan
| | - Tsunenori Saito
- Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama Hospital, Tama, Tokyo, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1, Idaigaoka, Hasama, Yufu, Oita 879-5593, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
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9
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Zghaib T, Quinaglia A. C. Silva T, Ambale-Venkatesh B, Xie E, Ostovaneh MR, Habibi M, Bluemke DA, Soliman EZ, Wu CO, Heckbert SR, Nazarian S, Lima JAC. Association between Left Atrial Late Gadolinium Enhancement and Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis (MESA). Radiol Cardiothorac Imaging 2023; 5:e220047. [PMID: 37693199 PMCID: PMC10483245 DOI: 10.1148/ryct.220047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 03/26/2023] [Accepted: 05/10/2023] [Indexed: 09/12/2023]
Abstract
Purpose To determine the prevalence and correlates of left atrial (LA) late gadolinium enhancement (LGE) at cardiac MRI and its association with atrial fibrillation (AF) in a population-based sample from the Multi-Ethnic Study of Atherosclerosis (MESA). Materials and Methods In this secondary post hoc analysis of the MESA cohort (ClinicalTrials.gov no. NCT00005487), participants without AF underwent LGE cardiac MRI at the fifth examination (2010-2012). LA LGE burden was quantified using the image intensity ratio technique on biplane long-axis two-dimensional (2D) LGE images without fat saturation. Survival analysis was performed with log-rank testing and Cox regression. Results Of 1697 participants (mean age, 67 years ± 9 [SD]; 872 men), 1035 (61%) had LA LGE, and 75 (4.4%) developed AF during follow-up (median, 3.95 years). At univariable analysis, LA LGE was associated with age (β = .010 [95% CI: .005, .015], P < .001), diastolic blood pressure (β = .005 [95% CI: .001, .009], P = .02), HbA1c level (β = .06 [95% CI: .02, .11], P = .009), heart failure (β = .60 [95% CI: .11, 1.08], P = .02), LA volume (β = .008 [95% CI: .004, .012], P < .001), and LA function (emptying fraction, LA global longitudinal strain, LA early diastolic peak longitudinal strain rate, and LA late diastolic peak strain rate; all P < .05). After adjusting for the variables in the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) AF score, LA LGE independently helped predict incident AF (hazard ratio = 1.46 [95% CI: 1.13, 1.88], P = .003). The highest tertile (LGE > 2%) was twice as likely to develop AF. Conclusion Although limited by the 2D LGE technique employed, LA LGE was associated with adverse atrial remodeling and helped predict AF in a multiethnic population-based sample.Clinical trial registration no. NCT00005487Keywords: MR Imaging, Cardiac, Epidemiology Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Tarek Zghaib
- From the Departments of Medicine (T.Z., E.X.) and Cardiology (T.Z.,
T.Q.A.C.S., M.R.O., M.H., J.A.C.L.), Johns Hopkins University School of
Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287; Department of
Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md
(B.A.V.); Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, Wis (D.A.B.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); National
Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md
(C.O.W.); Department of Epidemiology, University of Washington, Seattle, Wash
(S.R.H.); and Division of Cardiology, University of Pennsylvania Perelman School
of Medicine, Philadelphia, Pa (S.N.)
| | - Thiago Quinaglia A. C. Silva
- From the Departments of Medicine (T.Z., E.X.) and Cardiology (T.Z.,
T.Q.A.C.S., M.R.O., M.H., J.A.C.L.), Johns Hopkins University School of
Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287; Department of
Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md
(B.A.V.); Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, Wis (D.A.B.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); National
Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md
(C.O.W.); Department of Epidemiology, University of Washington, Seattle, Wash
(S.R.H.); and Division of Cardiology, University of Pennsylvania Perelman School
of Medicine, Philadelphia, Pa (S.N.)
| | - Bharath Ambale-Venkatesh
- From the Departments of Medicine (T.Z., E.X.) and Cardiology (T.Z.,
T.Q.A.C.S., M.R.O., M.H., J.A.C.L.), Johns Hopkins University School of
Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287; Department of
Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md
(B.A.V.); Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, Wis (D.A.B.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); National
Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md
(C.O.W.); Department of Epidemiology, University of Washington, Seattle, Wash
(S.R.H.); and Division of Cardiology, University of Pennsylvania Perelman School
of Medicine, Philadelphia, Pa (S.N.)
| | - Eric Xie
- From the Departments of Medicine (T.Z., E.X.) and Cardiology (T.Z.,
T.Q.A.C.S., M.R.O., M.H., J.A.C.L.), Johns Hopkins University School of
Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287; Department of
Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md
(B.A.V.); Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, Wis (D.A.B.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); National
Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md
(C.O.W.); Department of Epidemiology, University of Washington, Seattle, Wash
(S.R.H.); and Division of Cardiology, University of Pennsylvania Perelman School
of Medicine, Philadelphia, Pa (S.N.)
| | - Mohammad R. Ostovaneh
- From the Departments of Medicine (T.Z., E.X.) and Cardiology (T.Z.,
T.Q.A.C.S., M.R.O., M.H., J.A.C.L.), Johns Hopkins University School of
Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287; Department of
Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md
(B.A.V.); Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, Wis (D.A.B.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); National
Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md
(C.O.W.); Department of Epidemiology, University of Washington, Seattle, Wash
(S.R.H.); and Division of Cardiology, University of Pennsylvania Perelman School
of Medicine, Philadelphia, Pa (S.N.)
| | - Mohammadali Habibi
- From the Departments of Medicine (T.Z., E.X.) and Cardiology (T.Z.,
T.Q.A.C.S., M.R.O., M.H., J.A.C.L.), Johns Hopkins University School of
Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287; Department of
Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md
(B.A.V.); Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, Wis (D.A.B.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); National
Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md
(C.O.W.); Department of Epidemiology, University of Washington, Seattle, Wash
(S.R.H.); and Division of Cardiology, University of Pennsylvania Perelman School
of Medicine, Philadelphia, Pa (S.N.)
| | - David A. Bluemke
- From the Departments of Medicine (T.Z., E.X.) and Cardiology (T.Z.,
T.Q.A.C.S., M.R.O., M.H., J.A.C.L.), Johns Hopkins University School of
Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287; Department of
Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md
(B.A.V.); Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, Wis (D.A.B.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); National
Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md
(C.O.W.); Department of Epidemiology, University of Washington, Seattle, Wash
(S.R.H.); and Division of Cardiology, University of Pennsylvania Perelman School
of Medicine, Philadelphia, Pa (S.N.)
| | - Elsayed Z. Soliman
- From the Departments of Medicine (T.Z., E.X.) and Cardiology (T.Z.,
T.Q.A.C.S., M.R.O., M.H., J.A.C.L.), Johns Hopkins University School of
Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287; Department of
Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md
(B.A.V.); Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, Wis (D.A.B.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); National
Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md
(C.O.W.); Department of Epidemiology, University of Washington, Seattle, Wash
(S.R.H.); and Division of Cardiology, University of Pennsylvania Perelman School
of Medicine, Philadelphia, Pa (S.N.)
| | - Colin O. Wu
- From the Departments of Medicine (T.Z., E.X.) and Cardiology (T.Z.,
T.Q.A.C.S., M.R.O., M.H., J.A.C.L.), Johns Hopkins University School of
Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287; Department of
Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md
(B.A.V.); Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, Wis (D.A.B.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); National
Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md
(C.O.W.); Department of Epidemiology, University of Washington, Seattle, Wash
(S.R.H.); and Division of Cardiology, University of Pennsylvania Perelman School
of Medicine, Philadelphia, Pa (S.N.)
| | - Susan R. Heckbert
- From the Departments of Medicine (T.Z., E.X.) and Cardiology (T.Z.,
T.Q.A.C.S., M.R.O., M.H., J.A.C.L.), Johns Hopkins University School of
Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287; Department of
Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md
(B.A.V.); Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, Wis (D.A.B.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); National
Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md
(C.O.W.); Department of Epidemiology, University of Washington, Seattle, Wash
(S.R.H.); and Division of Cardiology, University of Pennsylvania Perelman School
of Medicine, Philadelphia, Pa (S.N.)
| | - Saman Nazarian
- From the Departments of Medicine (T.Z., E.X.) and Cardiology (T.Z.,
T.Q.A.C.S., M.R.O., M.H., J.A.C.L.), Johns Hopkins University School of
Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287; Department of
Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md
(B.A.V.); Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, Wis (D.A.B.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); National
Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md
(C.O.W.); Department of Epidemiology, University of Washington, Seattle, Wash
(S.R.H.); and Division of Cardiology, University of Pennsylvania Perelman School
of Medicine, Philadelphia, Pa (S.N.)
| | - João A. C. Lima
- From the Departments of Medicine (T.Z., E.X.) and Cardiology (T.Z.,
T.Q.A.C.S., M.R.O., M.H., J.A.C.L.), Johns Hopkins University School of
Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287; Department of
Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md
(B.A.V.); Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, Wis (D.A.B.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); National
Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md
(C.O.W.); Department of Epidemiology, University of Washington, Seattle, Wash
(S.R.H.); and Division of Cardiology, University of Pennsylvania Perelman School
of Medicine, Philadelphia, Pa (S.N.)
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10
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Molnár AÁ, Sánta A, Pásztor DT, Merkely B. Atrial Cardiomyopathy in Valvular Heart Disease: From Molecular Biology to Clinical Perspectives. Cells 2023; 12:1796. [PMID: 37443830 PMCID: PMC10340254 DOI: 10.3390/cells12131796] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
This review discusses the evolving topic of atrial cardiomyopathy concerning valvular heart disease. The pathogenesis of atrial cardiomyopathy involves multiple factors, such as valvular disease leading to atrial structural and functional remodeling due to pressure and volume overload. Atrial enlargement and dysfunction can trigger atrial tachyarrhythmia. The complex interaction between valvular disease and atrial cardiomyopathy creates a vicious cycle of aggravating atrial enlargement, dysfunction, and valvular disease severity. Furthermore, atrial remodeling and arrhythmia can predispose to atrial thrombus formation and stroke. The underlying pathomechanism of atrial myopathy involves molecular, cellular, and subcellular alterations resulting in chronic inflammation, atrial fibrosis, and electrophysiological changes. Atrial dysfunction has emerged as an essential determinant of outcomes in valvular disease and heart failure. Despite its predictive value, the detection of atrial fibrosis and dysfunction is challenging and is not included in the clinical routine. Transthoracic echocardiography and cardiac magnetic resonance imaging are the main diagnostic tools for atrial cardiomyopathy. Recently published data have revealed that both left atrial volumes and functional parameters are independent predictors of cardiovascular events in valvular disease. The integration of atrial function assessment in clinical practice might help in early cardiovascular risk estimation, promoting early therapeutic intervention in valvular disease.
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11
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Çiçek ÖF, Esenboğa K, Yalçın MU, Durdu MS, Altunkeser BB, Büyükateş M. Myocardial Blush Grade Predicts Postoperative Atrial Fibrillation following Mitral Valve Replacement: A Novel Perspective. J Cardiovasc Dev Dis 2023; 10:275. [PMID: 37504531 PMCID: PMC10380330 DOI: 10.3390/jcdd10070275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/18/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
Background: Atrial fibrillation (AF) remains the most common arrhythmia following mitral valve surgery. Although numerous clinical and laboratory indicators and possible mechanisms of postoperative AF (PoAF) have been described, the role of microvascular dysfunction in pathogenesis has not been assessed. We aimed to evaluate the association between microvascular dysfunction and PoAF in patients undergoing isolated mitral valve replacement. Methods: 188 patients undergoing mitral valve replacement were included in this retrospective study. Demographic characteristics of the patients were recorded. Angiographic assessment of microvascular perfusion was performed using the myocardial blush grading technique for each patient. Univariate and multivariate logistic regression analyses were utilized to determine predictors of PoAF. Results: Of 188 patients (56.69 ± 8.9 years, 39.4% male) who underwent mitral valve replacement, 64 (34%) patients developed PoAF. In the PoAF group, a lower basal hemoglobin level (12.64 ± 0.89 vs. 14.46 ± 0.91 g/dL; p < 0.001), a higher left atrial diameter [5.9 (5.2-6.47) vs. 4.9 (4.5-5.8) cm; p < 0.001], and a lower total blush score (TBS) (8.33 ± 0.84 vs. 8.9 ± 0.31; p < 0.001) were detected. Multivariate logistic regression analysis revealed that preoperative LA diameter (OR:2.057; 95% CI: 1.166-3.63; p = 0.013), preoperative hemoglobin (OR:0.12; 95% CI: 0.058-0.245; p < 0.001), and abnormal TBS (OR:15.1; 95% CI: 1.602-142.339; p = 0.018) were independent predictors of PoAF. Conclusions: Our findings demonstrated that TBS at the preoperative period was an independent predictor of PoAF in patients undergoing isolated mitral valve replacement.
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Affiliation(s)
- Ömer Faruk Çiçek
- Department of Cardiovascular Surgery, Medical Faculty, Selçuk University, Konya 42250, Turkey
| | - Kerim Esenboğa
- Department of Cardiology, Medical Faculty, Ankara University, Ankara 06590, Turkey
| | - Muhammed Ulvi Yalçın
- Department of Cardiology, Medical Faculty, Selçuk University, Konya 42250, Turkey
| | - Mustafa Serkan Durdu
- Department of Cardiovascular Surgery, Medical Faculty, Ankara University, Ankara 06590, Turkey
| | | | - Mustafa Büyükateş
- Department of Cardiovascular Surgery, Medical Faculty, Selçuk University, Konya 42250, Turkey
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12
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Kuang N, Shu B, Yang F, Li S, Zhang M. TRAIL or TRAIL-R2 as a Predictive Biomarker for Mortality or Cardiovascular Events: A Systematic Review and Meta-analysis. J Cardiovasc Pharmacol 2023; 81:348-354. [PMID: 36888983 DOI: 10.1097/fjc.0000000000001415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/10/2023] [Indexed: 03/10/2023]
Abstract
ABSTRACT Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and TRAIL-receptor-2 (TRAIL-R2) are associated with atherosclerosis. This meta-analysis aimed to investigate the potential association between TRAIL/TRAIL-R2 with mortality or cardiovascular (CV) events. PubMed, Embase, and Cochrane Library were searched for reports published up to May 2021. Reports were included when the association between TRAIL or TRAIL-R2 and mortality or CV events was reported. Considering the heterogeneity between studies, we used the random-effects model for all analyses. Ultimately, the meta-analysis included 18 studies (16,295 patients). The average follow-up ranged from 0.25 to 10 years. Decreased TRAIL levels were negatively associated with all-cause mortality [rank variable, hazard ratio (HR), 95% CI, 2.93, 1.94-4.42; I2 = 0.0%, Pheterogeneity = 0.835]. Increased TRAIL-R2 levels were positively associated with all-cause mortality (continuous variable, HR, 95% CI, 1.43, 1.23-1.65; I2 = 0.0%, Pheterogeneity = 0.548; rank variable, HR, 95% CI, 7.08, 2.70-18.56; I2 = 46.5%, Pheterogeneity = 0.154), CV mortality (continuous variable, HR, 95% CI, 1.33, 1.14-1.57; I2 = 0.0%, Pheterogeneity = 0.435), myocardial infarction (continuous variable, HR, 95% CI, 1.23, 1.02-1.49; rank variable, HR, 95% CI, 1.49, 1.26-1.76; I2 = 0.7%, Pheterogeneity = 0.402), and new-onset heart failure (rank variable, HR, 95% CI, 3.23, 1.32-7.87; I2 = 83.0%, Pheterogeneity = 0.003). In conclusion, decreased TRAIL was negatively associated with all-cause mortality, and increased TRAIL-R2 was positively associated with all-cause mortality, CV mortality, myocardial infarction, and heart failure.
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Affiliation(s)
- Na Kuang
- Department of Cardiology, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, China
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13
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López-Galvez R, Rivera-Caravaca JM, Roldán V, Orenes-Piñero E, Esteve-Pastor MA, López-García C, Saura D, González J, Lip GYH, Marín F. Imaging in atrial fibrillation: A way to assess atrial fibrosis and remodeling to assist decision-making. Am Heart J 2023; 258:1-16. [PMID: 36526006 DOI: 10.1016/j.ahj.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/22/2022] [Accepted: 12/10/2022] [Indexed: 05/11/2023]
Abstract
The 2020 ESC atrial fibrillation (AF) guidelines suggest the novel 4S-AF scheme for the characterization of AF. Imaging techniques could be helpful for this objective in everyday clinical practice, and information derived from these techniques reflects basic aspects of the pathophysiology of AF, which may facilitate treatment decision-making, and optimal management of AF patients. The aim of this review is to provide an overview of the mechanisms associated with atrial fibrosis and to describe imaging techniques that may help the management of AF patients in clinical practice. Transthoracic echocardiography is the most common procedure given its versatility, safety, and simplicity. Transesophageal echocardiography provides higher resolution exploration, and speckle tracking echocardiography can provide incremental functional and prognostic information over conventional echocardiographic parameters. In addition, LA deformation imaging, including LA strain and strain rate, are related to the extent of fibrosis. On the other hand, multidetector-row computed tomography and cardiac magnetic resonance provide higher resolution data and more accurate assessment of the dimensions, structure, and spatial relationships of the LA. Imaging is central when deciding on catheter ablation or cardioversion, and helps in selecting those patients who will really benefit from these procedures. Moreover, imaging enhances the understanding of the underlying mechanisms of atrial remodeling and might assists in refining the risk of stroke, which help to select the best medical therapies/interventions. In summary, evaluation of LA enlargement, LA remodeling and fibrosis with imaging techniques adds clinical and prognostic information and should be assessed as a part of routine comprehensive AF evaluation.
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Affiliation(s)
- Raquel López-Galvez
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - José Miguel Rivera-Caravaca
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain; School of Nursing, University of Murcia, Murcia, Spain; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
| | - Vanessa Roldán
- Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Esteban Orenes-Piñero
- Department of Biochemistry and Molecular Biology, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - María Asunción Esteve-Pastor
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Cecilia López-García
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Daniel Saura
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Josefa González
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
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14
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Zhu M, Yan T, Zhu S, Weng F, Zhu K, Wang C, Guo C. Identification and verification of FN1, P4HA1 and CREBBP as potential biomarkers in human atrial fibrillation. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:6947-6965. [PMID: 37161136 DOI: 10.3934/mbe.2023300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common arrhythmia that can lead to cardiac complications. The mechanisms involved in AF remain elusive. We aimed to explore the potential biomarkers and mechanisms underpinning AF. METHODS An independent dataset, GSE2240, was obtained from the Gene Expression Omnibus database. The R package, "limma", was used to screen for differentially expressed genes (DEGs) in individuals with AF and normal sinus rhythm (SR). Weighted gene co-expression network analysis (WGCNA) was applied to cluster DEGs into different modules based on functional disparities. Enrichment analyses were performed using the Database for Annotation, Visualization and Integrated Discovery. A protein-protein interaction network was constructed, and hub genes were identified using cytoHubba. Quantitative reverse-transcription PCR was used to validate mRNA expression in individuals with AF and SR. RESULTS We identified 2, 589 DEGs clustered into 10 modules using WGCNA. Gene Ontology analysis showed specific clustered genes significantly enriched in pathways associated with the extracellular matrix and collagen organization. Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed that the target genes were mainly enriched for proteoglycans in cancer, extracellular matrix-receptor interaction, focal adhesion, and the PI3K-Akt signaling pathway. Three hub genes, FN1, P4HA1 and CREBBP, were identified, which were highly correlated with AF endogenesis. mRNA expression of hub genes in patients with AF were higher than in individuals with normal SR, consistent with the results of bioinformatics analysis. CONCLUSIONS FN1, P4HA1, and CREBBP may play critical roles in AF. Using bioinformatics, we found that expression of these genes was significantly elevated in patients with AF than in individuals with normal SR. Furthermore, these genes were elevated at core positions in the mRNA interaction network. These genes should be further explored as novel biomarkers and target candidates for AF therapy.
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Affiliation(s)
- Miao Zhu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Tao Yan
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Shijie Zhu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Fan Weng
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Kai Zhu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Chunsheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Changfa Guo
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
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15
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Gottlieb LA, Coronel R, Dekker LRC. Reduction in atrial and pulmonary vein stretch as a therapeutic target for prevention of atrial fibrillation. Heart Rhythm 2023; 20:291-298. [PMID: 36265692 DOI: 10.1016/j.hrthm.2022.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/21/2022] [Accepted: 10/05/2022] [Indexed: 11/04/2022]
Abstract
Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with increased mortality. Heart failure, hypertension, valvular disease, and obstructive sleep apnea are risk factors for incident AF. A common characteristic of these diseases is that they increase atrial wall stretch. Multiple experimental studies confirm a proarrhythmic effect of atrial stretch. Conversely, a reduction in stretch is antiarrhythmic. A therapeutic target for AF, therefore, lies in local reduction of atrial stretch. This review focuses on atrial stretch and its clinical associations in patients with AF and its downstream effects on electrophysiology. We discuss the possible application of targeted atrial stretch reduction in AF prevention. We conclude that a reduction in local atrial stretch should be considered an essential element in rhythm control.
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Affiliation(s)
- Lisa A Gottlieb
- Department of Cardiology, University Hospital Copenhagen - Bispebjerg, Copenhagen, Denmark; AUMC, location Academic Medical Centre, Department of Experimental Cardiology, Amsterdam, The Netherlands; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Ruben Coronel
- AUMC, location Academic Medical Centre, Department of Experimental Cardiology, Amsterdam, The Netherlands; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France.
| | - Lukas R C Dekker
- Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands
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16
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Feng R, Wan J, He Y, Gong H, Xu Z, Feng J. Angiotensin-receptor blocker losartan alleviates atrial fibrillation in rats by downregulating frizzled 8 and inhibiting the activation of WNT-5A pathway. Clin Exp Pharmacol Physiol 2023; 50:19-27. [PMID: 36047789 DOI: 10.1111/1440-1681.13715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 12/13/2022]
Abstract
Atrial fibrillation (AF) is a common arrhythmia. Angiotensin-receptor blocker (ARB) is related to AF treatment. This study explored the mechanism of ARB in AF. AF rat models were established by Ach-CaCl2 mixed solution injection. Rats were treated with ARB by gavage and injected with pcDNA3.1-based frizzled homolog 8 (FZD8) overexpression plasmids (oe-FZD8) through the tail vein. The 12-lead electrocardiogram was recorded by biological signal acquisition and processing system and AF duration was recorded, and atrial effective refractory period (AERP) was monitored by electrophysiology. Atrial fibrosis degree, FZD8 messenger RNA and protein levels, collagen I, collagen III, transforming growth factor β1 (TGF-β1), fibronectin, α smooth muscle actin (α-SMA), WBT-5B, and p-JNK1/2 levels, interleukin 1 β (IL-1β) and interleukin 6 (IL-6) levels were detected by Masson staining, reverse transcription quantitative polymerase chain reaction, western blot assay, immunohistochemistry, and enzyme-linked immunosorbent assay. ACh-CaCl2-induced AF rats showed a large area of fused necrosis, abnormal collagen fibre proliferation, high atrial fibrosis degree, and increased atrial fibrosis area in atrial interstitium, elevated collagen I, collagen III, TGF-β1, fibronectin, α-SMA, IL-1β, and IL-6 levels, whereas these trends were averted by ARB treatment. FZD8 was highly expressed in AF rat myocardium. ARB repressed FZD8 expression, prolonged AERP and reduced AF incidence. FZD8 overexpression annulled the effects of ARB on improving AF rat myocardial fibrosis. ARB inactivated the WNT-5A pathway by suppressing FZD8. ARB inactivated the WNT-5A pathway by silencing FZD8, therefore, alleviating AF rat atrial fibrosis.
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Affiliation(s)
- Ronghua Feng
- Department of Cardiovascular Medicine, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang City, Jiangxi Province, China
| | - Jinjie Wan
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Yongsheng He
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Hui Gong
- Department of Cardiovascular Medicine, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang City, Jiangxi Province, China
| | - Zeqin Xu
- Department of Cardiovascular Medicine, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang City, Jiangxi Province, China
| | - Jiugeng Feng
- Department of Postgraduate, Medical College of Nanchang University, Nanchang City, Jiangxi Province, China
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17
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Nery PB, Wells GA, Verma A, Joza J, Nair GM, Veenhuyzen G, Andrade J, Nault I, Wong JA, Sikkel M, Essebag V, Macle L, Sapp J, Roux JF, Skanes A, Angaran P, Novak P, Redfearn D, Golian M, Redpath CJ, Sturmer M, Birnie D. Characterization of arrhythmia substrate to ablate persistent atrial fibrillation (COAST-AF): Randomized controlled trial design and rationale. Am Heart J 2022; 254:133-140. [PMID: 36030965 DOI: 10.1016/j.ahj.2022.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Atrial low voltage area (LVA) catheter ablation has emerged as a promising strategy for ablation of persistent atrial fibrillation (AF). It is unclear if catheter ablation of atrial LVA increases treatment success rates in patients with persistent AF. OBJECTIVE The primary aim of this trial is to assess the potential benefit of adjunctive catheter ablation of atrial LVA in addition to pulmonary vein isolation (PVI) in patients with persistent AF, when compared to PVI alone. The secondary aims are to evaluate safety outcomes, the quality of life and the healthcare resource utilization. METHODS/DESIGN A multicenter, prospective, parallel-group, 2-arm, single-blinded randomized controlled trial is under way (NCT03347227). Patients who are candidates for catheter ablation for persistent AF will be randomly assigned (1:1) to either PVI alone or PVI + atrial LVA ablation. The primary outcome is 18-month documented event rate of atrial arrhythmia (AF, atrial tachycardia or atrial flutter) post catheter ablation. Secondary outcomes include procedure-related complications, freedom from atrial arrhythmia at 12 months, AF burden, need for emergency department visits/hospitalization, need for repeat ablation for atrial arrhythmia, quality of life at 12 and 18 months, ablation time, and procedure duration. DISCUSSION Characterization of Arrhythmia Mechanism to Ablate Atrial Fibrillation (COAST-AF) is a multicenter randomized trial evaluating ablation strategies for catheter ablation. We hypothesize that catheter ablation of atrial LVA in addition to PVI will result in higher procedural success rates when compared to PVI alone in patients with persistent AF.
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Affiliation(s)
- Pablo B Nery
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada..
| | - George A Wells
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.; Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Canada
| | - Atul Verma
- McGill University Health Center, Montreal, Quebec, Canada
| | | | - Girish M Nair
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
| | - George Veenhuyzen
- Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Jason Andrade
- Vancouver General Hospital, University of British Columbia,Vancouver, Canada
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Quebec City, Quebec, Canada
| | - Jorge A Wong
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Markus Sikkel
- Victoria Cardiac Arrhythmia Trials, Victoria, British Columbia, Canada
| | - Vidal Essebag
- McGill University Health Center, Montreal, Quebec, Canada; Hôpital Sacré-Cœur, Université de Montréal, Montréal, Québec, Canada
| | | | - John Sapp
- Queen Elizabeth II Health Sciences, Halifax, Nova Scotia, Canada
| | | | - Allan Skanes
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Paul Angaran
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Novak
- Victoria Cardiac Arrhythmia Trials, Victoria, British Columbia, Canada
| | | | - Mehrdad Golian
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
| | - Calum J Redpath
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
| | - Marcio Sturmer
- Hôpital Sacré-Cœur, Université de Montréal, Montréal, Québec, Canada
| | - David Birnie
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
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Wang X, Peng X, Li Y, Lin R, Liu X, Ruan Y, Ma C, Liu N. Colchicine for Prevention of Post-Cardiac Surgery and Post-Pulmonary Vein Isolation Atrial Fibrillation: A Meta-Analysis. Rev Cardiovasc Med 2022; 23:387. [PMID: 39076666 PMCID: PMC11270460 DOI: 10.31083/j.rcm2312387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/27/2022] [Accepted: 09/05/2022] [Indexed: 07/31/2024] Open
Abstract
Background Post-cardiac procedure atrial fibrillation (PCP-AF) is a significant medical problem. Inflammation is one of the key factors in the pathogenesis of PCP-AF. As a classical anti-inflammatory drug, colchicine may prevent the occurrence of PCP-AF. This meta-analysis of 12 randomized controlled trials (RCTs) analyzed the feasibility and safety of colchicine for the prevention of PCP-AF. Methods PubMed, EMBASE, Web of Science, the Cochrane Library, and Google Scholar were retrieved for RCTs on the efficacy of colchicine in preventing atrial fibrillation. The primary endpoint was the diagnosis of PCP-AF, which includes cardiac surgery or pulmonary vein isolation. Evaluation was performed with estimated odds ratios (OR) and 95% confidence intervals (CI). Results In this meta-analysis, 12 RCTs were selected and a total of 2297 patients were included. Colchicine therapy was associated with a reduced incidence of PCP-AF both in post-cardiac surgery (OR: 0.62; 95% CI: 0.49-0.78, p < 0.0001, I 2 = 0%), and in post-pulmonary vein isolation (OR: 0.43; 95% CI: 0.30-0.62, p < 0.0001, I 2 = 0%). Colchicine therapy was associated with increased side effects (OR: 2.81; 95% CI: 1.96-4.03, p < 0.00001, I 2 = 26%). Conclusion Colchicine can effectively prevent post-cardiac operative atrial fibrillation and relapse of atrial fibrillation after pulmonary vein isolation (PVI). However, colchicine can also increase the incidence of side effects, mainly gastrointestinal adverse events. More studies are needed to find a more appropriate treatment dose and time.
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Affiliation(s)
- Xuesi Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, 100029 Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, 100029
Beijing, China
| | - Xiaodong Peng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, 100029 Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, 100029
Beijing, China
| | - Yukun Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, 100029 Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, 100029
Beijing, China
| | - Rong Lin
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, 100029 Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, 100029
Beijing, China
| | - Xinmeng Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, 100029 Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, 100029
Beijing, China
| | - Yanfei Ruan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, 100029 Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, 100029
Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, 100029 Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, 100029
Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, 100029 Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, 100029
Beijing, China
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Huo Y, Gaspar T, Schönbauer R, Wójcik M, Fiedler L, Roithinger FX, Martinek M, Pürerfellner H, Kirstein B, Richter U, Ulbrich S, Mayer J, Krahnefeld O, Agdirlioglu T, Zedda A, Piorkowski J, Piorkowski C. Low-Voltage Myocardium-Guided Ablation Trial of Persistent Atrial Fibrillation. NEJM EVIDENCE 2022; 1:EVIDoa2200141. [PMID: 38319851 DOI: 10.1056/evidoa2200141] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND: Clinically effective ablation approaches for patients with persistent atrial fibrillation (AF) are still being debated. So far, ablation targets and strategies beyond pulmonary vein isolation (PVI) have failed to show systematic outcome improvement in randomized controlled clinical trials. METHODS: We conducted a multicenter, randomized trial to determine whether PVI plus individualized substrate ablation of atrial low-voltage myocardium improves outcome in patients with persistent AF. We randomly assigned 324 patients in a 1:1 ratio to receive PVI alone (163 patients; PVI only) or PVI plus substrate modification (161 patients; PVI+SM). The primary study end point was the first recurrence of an atrial arrhythmia longer than 30 seconds after single ablation, with 3 months blanking, using serial 7-day electrocardiogram recordings over 12 months of observation. Patients were also encouraged to receive implantable cardiac monitors. RESULTS: The primary study end point occurred in 75 PVI-only patients (50%) and in 54 PVI+SM patients (35%) (Kaplan–Meier event rate estimates: hazard ratio=0.62, 95% confidence interval [CI]=0.43 to 0.88, log rank P=0.006). Adverse events occurred in three PVI-only patients (1.8%) and in six PVI+SM patients (3.7%) (difference: −1.9 percentage points, 95% CI=−5.5 to 1.7 percentage points). Implant monitoring was used in 242 patients. Among them, 65 PVI-only patients (55%) versus 47 PVI+SM patients (39%) experienced recurrences (difference: 15 percentage points, 95% CI=3 to 28 percentage points). CONCLUSIONS: In this randomized trial, PVI plus individualized ablation of atrial low-voltage myocardium significantly improved outcomes in patients with persistent AF. (ClinicalTrials.gov number, NCT02732626.)
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Affiliation(s)
- Yan Huo
- Department of Electrophysiology, Heart Center, Dresden University of Technology, Dresden, Germany
| | - Thomas Gaspar
- Department of Electrophysiology, Heart Center, Dresden University of Technology, Dresden, Germany
| | - Robert Schönbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna
| | - Maciej Wójcik
- Department of Cardiology, Medical University in Lublin, Lublin, Poland
| | - Lukas Fiedler
- Department of Internal Medicine II, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
- University Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Franz Xaver Roithinger
- Department of Internal Medicine II, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Martin Martinek
- Department of Internal Medicine 2, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Helmut Pürerfellner
- Department of Internal Medicine 2, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Bettina Kirstein
- Heart Center, University Hospital Schleswig-Holstein Lübeck, Lübeck, Germany
| | - Utz Richter
- Department of Electrophysiology, Heart Center, Dresden University of Technology, Dresden, Germany
| | - Stefan Ulbrich
- Department of Electrophysiology, Heart Center, Dresden University of Technology, Dresden, Germany
| | - Julia Mayer
- Department of Electrophysiology, Heart Center, Dresden University of Technology, Dresden, Germany
| | - Olaf Krahnefeld
- Department of Electrophysiology, Sana Kliniken Lübeck, Lübeck, Germany
| | - Tolga Agdirlioglu
- Department of Electrophysiology, Sana Kliniken Lübeck, Lübeck, Germany
| | - Angela Zedda
- Department of Electrophysiology, Heart Center, Dresden University of Technology, Dresden, Germany
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20
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Bijvoet GP, Nies HMJM, Holtackers RJ, Linz D, Adriaans BP, Nijveldt R, Wildberger JE, Vernooy K, Chaldoupi SM, Mihl C. Correlation between Cardiac MRI and Voltage Mapping in Evaluating
Atrial Fibrosis: A Systematic Review. RADIOLOGY: CARDIOTHORACIC IMAGING 2022; 4:e220061. [PMID: 36339060 PMCID: PMC9627236 DOI: 10.1148/ryct.220061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/31/2022] [Accepted: 09/13/2022] [Indexed: 11/07/2022]
Abstract
Purpose To provide an overview of existing literature on the association between
late gadolinium enhancement (LGE) cardiac MRI and low voltage areas
(LVA) obtained with electroanatomic mapping (EAM) or histopathology when
assessing atrial fibrosis. Materials and Methods A systematic literature search was conducted in the PubMed, Embase, and
Cochrane Library databases to identify all studies published until June
7, 2022, comparing LGE cardiac MRI to LVA EAM and/or histopathology for
evaluation of atrial fibrosis. The study protocol was registered at
PROSPERO (registration no. CRD42022338243). Two reviewers independently
evaluated the studies for inclusion. Risk of bias and applicability for
each included study were assessed using Quality Assessment of Diagnostic
Accuracy Studies–2 (QUADAS-2) criteria. Data regarding
demographics, electrophysiology, LGE cardiac MRI, and study outcomes
were extracted. Results The search yielded 1048 total results, of which 22 studies were included.
Nineteen of the 22 included studies reported a significant correlation
between high signal intensity at LGE cardiac MRI and LVA EAM or
histopathology. However, there was great heterogeneity between included
studies regarding study design, patient samples, cardiac MRI performance
and postprocessing, and EAM performance. Conclusion Current literature suggests a correlation between LGE cardiac MRI and LVA
EAM or histopathology when evaluating atrial fibrosis but high
heterogeneity between studies, demonstrating the need for uniform
choices regarding cardiac MRI and EAM acquisition in future studies. Keywords: Cardiac, MR Imaging, Left Atrium Supplemental material is available for this
article. © RSNA, 2022
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21
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Mining of Potential Biomarkers and Pathway in Valvular Atrial Fibrillation (VAF) via Systematic Screening of Gene Coexpression Network. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3645402. [PMID: 36226239 PMCID: PMC9550484 DOI: 10.1155/2022/3645402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/06/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022]
Abstract
Purpose. We apply the bioinformatics method to excavate the potential genes and therapeutic targets associated with valvular atrial fibrillation (VAF). Methods. The downloaded gene expression files from the gene expression omnibus (GEO) included patients with primary severe mitral regurgitation complicated with sinus or atrial fibrillation rhythm. Subsequently, the differential gene expression in left and right atrium was analyzed by R software. Additionally, weighted correlation network analysis (WGCNA), principal component analysis (PCA), and linear model for microarray data (LIMMA) algorithm were used to determine hub genes. Then, Metascape database, DAVID database, and STRING database were used to annotate and visualize the gene ontology (GO) analysis, KEGG pathway enrichment analysis, and PPI network analysis of differentially expressed genes (DEGs). Finally, the TFs and miRNAs were predicted by using online tools, such as PASTAA and miRDB. Results. 20,484 differentially expressed genes related to atrial fibrillation were obtained through the analysis of left and right atrial tissue samples of GSE115574 gene chip, and 1,009 were with statistical significance, including 45 upregulated genes and 964 downregulated genes. And the hub genes implicated in AF of NPC2, ODC1, SNAP29, LAPTM5, ST8SIA5, and FCGR3B were screened. Finally, the main regulators of targeted candidate biomarkers and microRNAs, EIF5A2, HIF1A, ZIC2, ELF1, and STAT2, were found in this study. Conclusion. These hub genes, NPC2, ODC1, SNAP29, LAPTM5, ST8SIA5, and FCGR3B, are important for the development of VAF, and their enrichment pathways and TFs elucidate the involved molecular mechanisms and assist in the validation of drug targets.
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22
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Yang H, Yuan C, Yang J, Xiang H, Lan W, Tang Y. A novel predictive model for new-onset atrial fibrillation in patients after isolated cardiac valve surgery. Front Cardiovasc Med 2022; 9:949259. [PMID: 36247462 PMCID: PMC9556269 DOI: 10.3389/fcvm.2022.949259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPostoperative atrial fibrillation (POAF) is a severe complication after cardiac surgery and is associated with an increased risk of ischemic stroke and mortality. The main aim of this study was to identify the independent predictors associated with POAF after isolated valve operation and to develop a risk prediction model.MethodsThis retrospective observational study involved patients without previous AF who underwent isolated valve surgery from November 2018 to October 2021. Patients were stratified into two groups according to the development of new-onset POAF. Baseline characteristics and perioperative data were collected from the two groups of patients. Univariate and multivariate logistic regression analyses were applied to identify independent risk factors for the occurrence of POAF, and the results of the multivariate analysis were used to create a predictive nomogram.ResultsA total of 422 patients were included in the study, of which 163 (38.6%) developed POAF. The Multivariate logistic regression analysis indicated that cardiac function (odds ratio [OR] = 2.881, 95% confidence interval [CI] = 1.595–5.206; P < 0.001), Left atrial diameter index (OR = 1.071, 95%CI = 1.028–1.117; P = 0.001), Operative time (OR = 1.532, 95%CI = 1.095–2.141; P = 0.013), Neutrophil count (OR = 1.042, 95%CI = 1.006–1.08; P = 0.021) and the magnitude of fever (OR = 3.414, 95%CI = 2.454–4.751; P < 0.001) were independent predictors of POAF. The above Variables were incorporated, and a nomogram was successfully constructed with a C-index of 0.810. The area under the receiver operating characteristic curve was 0.817.ConclusionCardiac function, left atrial diameter index, operative time, neutrophil count, and fever were independent predictors of POAF in patients with isolated valve surgery. Establishing a nomogram model based on the above predictors helps predict the risk of POAF and may have potential clinical utility in preventive interventions.
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Affiliation(s)
- Heng Yang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Chen Yuan
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Juesheng Yang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haiyan Xiang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wanqi Lan
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Yanhua Tang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Yanhua Tang,
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23
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Mao S, Fan H, Wang L, Wang Y, Wang X, Zhao J, Yu B, Zhang Y, Zhang W, Liang B. A systematic review and meta-analysis of the safety and efficacy of left atrial substrate modification in atrial fibrillation patients with low voltage areas. Front Cardiovasc Med 2022; 9:969475. [PMID: 36204581 PMCID: PMC9530701 DOI: 10.3389/fcvm.2022.969475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background The left atrial low-voltage areas (LVAs) are associated with atrial fibrosis; however, it is not clear how the left atrial LVAs affect the recurrence of arrhythmias after catheter ablation, and the efficacy and safety of the left atrial substrate modification based on LVAs as a strategy for catheter ablation of atrial fibrillation (AF) are not evident for AF patients with LVAs. Methods We performed a systematic search to compare the arrhythmia recurrence in AF patients with and without LVAs after conventional ablation and arrhythmia recurrence in LVAs patients after conventional ablation with and without substrate modification based on LVAs. Result A total of 6 studies were included, involving 1,175 patients. The arrhythmia recurrence was higher in LVA patients after conventional ablation (OR: 5.14, 95% CI: [3.11, 8.49]; P < 0.00001). Additional LVAs substrate modification could improve the freedom of arrhythmia in LVAs patients after the first procedure (OR: 0.30, 95% CI: [0.15, 0.62]; P = 0.0009). However, there was no significant difference after multiple procedures (P = 0.19). The procedure time (MD: 26.61, 95% CI [15.79, 37.42]; P < 0.00001) and fluoroscopy time (MD: 6.90, 95% CI [4.34, 9.47]; P < 0.00001) in LVAs patients with additional LVAs substrate modification were significantly increased compared to LVAs patients' without substrate modification. Nevertheless, there were no higher LVAs substrate modification-related complications (P = 0.93) between LVAs patients with and without additional LVAs substrate modification. In the subgroup analysis, the additional LVAs substrate modification reduced the risk of arrhythmia recurrence in LVAs patients during the follow-up time, which was 12 months (OR: 0.32, 95% CI (0.17, 0.58); P = 0.002), and box isolation (OR: 0.37, 95% CI (0.20, 0.69); P = 0.002) subgroups, but the type of AF, follow up >12 months and homogenization subgroups were not statistically significant. Trial sequential analysis shows conclusive evidence for the LVAs ablation. Conclusion This study has shown that LVAs could improve the risk of arrhythmia recurrence in AF patients after conventional ablation. And additional LVAs substrate modification after conventional ablation could increase the freedom of arrhythmia recurrence in LVAs patients. Interestingly, the box isolation approach appeared more promising. Systematic review registration [http://www.crd.york.ac.uk/prospero], identifier [CRD42021239277].
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Affiliation(s)
- Shaobin Mao
- Graduate school of Shanxi Medical University, Taiyuan, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Hongxuan Fan
- Graduate school of Shanxi Medical University, Taiyuan, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Leigang Wang
- Graduate school of Shanxi Medical University, Taiyuan, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yongle Wang
- Graduate school of Shanxi Medical University, Taiyuan, China
| | - Xun Wang
- Graduate school of Shanxi Medical University, Taiyuan, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jianqi Zhao
- Graduate school of Shanxi Medical University, Taiyuan, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Bing Yu
- Graduate school of Shanxi Medical University, Taiyuan, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yao Zhang
- Graduate school of Shanxi Medical University, Taiyuan, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Wenjing Zhang
- Graduate school of Shanxi Medical University, Taiyuan, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Bin Liang
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, Taiyuan, China
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24
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Bax M, Ajmone Marsan N, Delgado V, Bax JJ, van der Bijl P. Effect of Bi-Atrial Size and Function in Patients With Paroxysmal or Permanent Atrial Fibrillation. Am J Cardiol 2022; 183:33-39. [PMID: 36114023 DOI: 10.1016/j.amjcard.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022]
Abstract
Atrial fibrillation (AF) remains the most common arrhythmia in clinical practice. The choice between a rate-control and rhythm-control strategy depends on various factors, including the anatomical and functional substrate. This study investigates the anatomical and functional characteristics of both atria in patients with AF and explores the potential therapeutic implications. From an ongoing registry of patients with paroxysmal or permanent AF, those who underwent cardiac computed tomography (CCT) were included. Left atrial (LA) and right atrial (RA) sizes were measured on CCT, whereas bi-atrial function was quantified with speckle tracking strain echocardiography. The mean LA volume index was 41.6 ± 5.6 ml/m2, and the mean RA volume index was 71.0 ± 21.6 ml/m2. Mean LA reservoir strain was 24.3 ± 15.1%, compared with the mean RA reservoir strain of 21.6 ± 13.2%. Patients with smaller LA volumes had higher LA reservoir strain values than those with larger LA volumes (24.6% [interquartile range (IQR) 15.8 to 35.8] vs 16.5% [IQR 11.2 to 25.0], p <0.001). Patients with permanent AF had larger LA volumes (44.0 [IQR 33.7 to 55.2] ml/m2 vs 36.9 [IQR 30.1 to 47.1] ml/m2, p = 0.025) compared with paroxysmal AF. Patients with permanent AF had more impaired LA reservoir strain (15.5% [IQR 11.6 to 22.7] vs 26.9% [IQR 17.4 to 35.6], p <0.001) compared with paroxysmal AF. Similar trends were observed in the RA. In conclusion, atrial substrate characterization by CCT and speckle tracking strain echocardiography may have therapeutic implications, especially for choosing between a rate-control and rhythm-control strategy.
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Affiliation(s)
- Maxim Bax
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, The Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Pieter van der Bijl
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, The Netherlands.
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25
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Trifan G, Testai FD. Neurological Manifestations of Myocarditis. Curr Neurol Neurosci Rep 2022; 22:363-374. [PMID: 35588043 PMCID: PMC9117837 DOI: 10.1007/s11910-022-01203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The present review discusses the neurological complications associated with myocarditis of different etiologies. RECENT FINDINGS Myocarditis can be idiopathic or caused by different conditions, including toxins, infections, or inflammatory diseases. Clinical findings are variable and range from mild self-limited shortness of breath or chest pain to hemodynamic instability which may result in cardiogenic shock and death. Several neurologic manifestations can be seen in association with myocarditis. Tissue remodeling, fibrosis, and myocyte dysfunction can result in heart failure and arrhythmias leading to intracardiac thrombus formation and cardioembolism. In addition, peripheral neuropathies, status epilepticus, or myasthenia gravis have been reported in association with specific types of myocarditis. Multiple studies suggest the increasing risk of neurologic complications in patients with myocarditis. Neurologists should maintain a high suspicion of myocarditis in cases presenting with both cardiovascular and neurological dysfunction without a clear etiology.
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Affiliation(s)
- Gabriela Trifan
- Department of Neurology and Rehabilitation, University of Illinois at Chicago College of Medicine, 912 S. Wood Street, M/C 796, Chicago, IL, 172C60612, USA.
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois at Chicago College of Medicine, 912 S. Wood Street, M/C 796, Chicago, IL, 172C60612, USA
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26
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The Pathogenesis of Cardiac Arrhythmias in Vitamin D Deficiency. Biomedicines 2022; 10:biomedicines10061239. [PMID: 35740261 PMCID: PMC9220304 DOI: 10.3390/biomedicines10061239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
The global prevalence of vitamin D deficiency is more than 20%, and the main causes include insufficient intake, reduced absorption, abnormal metabolism, or resistance to its effects. The levels of serum vitamin D appear to influence cardiovascular risk, and the mechanism involved is linked to the transient outward current and the ultrarapid delayed rectifier K+ current densities, activated through the nuclear vitamin D receptor and Akt pathway. A significant number of studies have correlated vitamin D deficiency with an increased risk of developing cardiac arrhythmias and sudden cardiac death. For this reason, the purpose of this review is to analyze the relation between vitamin D deficiency and the pathogenesis of cardiac arrhythmias. Atrial fibrillation, increased QT interval, and QT dispersion were the most common findings associated with vitamin D deficiency. Due to the heterogeneity among existing studies, further research is necessary to confirm the existing data and to analyze its relationship with other types of arrhythmias.
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27
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Demers J, Ton A, Huynh F, Thibault S, Ducharme A, Paradis P, Nemer M, Fiset C. Atrial Electrical Remodeling in Mice With Cardiac‐Specific Overexpression of Angiotensin II Type 1 Receptor. J Am Heart Assoc 2022; 11:e023974. [PMID: 35435021 PMCID: PMC9238446 DOI: 10.1161/jaha.121.023974] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Elevated angiotensin II levels are thought to play an important role in atrial electrical and structural remodeling associated with atrial fibrillation. However, the mechanisms by which this remodeling occurs are still unclear. Accordingly, we explored the effects of angiotensin II on atrial remodeling using transgenic mice overexpressing angiotensin II type 1 receptor (AT1R) specifically in cardiomyocytes.
Methods and Results
Voltage‐clamp techniques, surface ECG, programmed electrical stimulations along with quantitative polymerase chain reaction, Western blot, and Picrosirius red staining were used to compare the atrial phenotype of AT1R mice and their controls at 50 days and 6 months. Atrial cell capacitance and fibrosis were increased only in AT1R mice at 6 months, indicating the presence of structural remodeling. Ca
2+
(
I
CaL
) and K
+
currents were not altered by AT1R overexpression (AT1R at 50 days). However,
I
CaL
density and Ca
V
1.2 messenger RNA expression were reduced by structural remodeling (AT1R at 6 months). Conversely, Na
+
current (
I
Na
) was reduced (−65%) by AT1R overexpression (AT1R at 50 days) and the presence of structural remodeling (AT1R at 6 months) yields no further effect. The reduced
I
Na
density was not explained by lower Na
V
1.5 expression but was rather associated with an increase in sarcolemmal protein kinase C alpha expression in the atria, suggesting that chronic AT1R activation reduced
I
Na
through protein kinase C alpha activation. Furthermore, connexin 40 expression was reduced in AT1R mice at 50 days and 6 months. These changes were associated with delayed atrial conduction time, as evidenced by prolonged P‐wave duration.
Conclusions
Chronic AT1R activation leads to slower atrial conduction caused by reduced
I
Na
density and connexin 40 expression.
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Affiliation(s)
- Julie Demers
- Research Center Montreal Heart Institute Montréal Québec Canada
- Faculty of Pharmacy Université de Montréal Montréal Québec Canada
| | - Anh‐Tuan Ton
- Research Center Montreal Heart Institute Montréal Québec Canada
- Faculty of Pharmacy Université de Montréal Montréal Québec Canada
| | - François Huynh
- Research Center Montreal Heart Institute Montréal Québec Canada
- Faculty of Pharmacy Université de Montréal Montréal Québec Canada
| | - Simon Thibault
- Research Center Montreal Heart Institute Montréal Québec Canada
- Faculty of Pharmacy Université de Montréal Montréal Québec Canada
| | - Anique Ducharme
- Research Center Montreal Heart Institute Montréal Québec Canada
- Faculty of Medicine Université de Montréal Montréal Québec Canada
| | | | | | - Céline Fiset
- Research Center Montreal Heart Institute Montréal Québec Canada
- Faculty of Pharmacy Université de Montréal Montréal Québec Canada
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28
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Tan TS, Korkmaz K, Akbulut IM, Akin K, Yamanturk YY, Kurklu HA, Kozluca V, Esenboga K, Dincer I. Association between CHARGE-AF risk score and LA mechanics: LA reservoir strain can be a single parameter for predicting AF risk. Acta Cardiol 2022; 78:311-319. [PMID: 35400310 DOI: 10.1080/00015385.2022.2059852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
AIMS Atrial fibrillation (AF) is a prevalent arrhythmia and the leading preventable cause of cardioembolic stroke. Scoring systems for predicting AF risk do not use imaging modalities. We sought to determine whether LA longitudinal strain could be used as a single parameter for predicting the risk of AF. METHODS AND RESULTS Consecutive patients diagnosed with diastolic dysfunction between December 2019 and March 2020 were included. Two-dimensional, colour flow, continuous pulse-wave, and tissue Doppler transthoracic echocardiography (TTE) were performed using a Vivid E9 imaging system (GE Medical Systems, Chicago, USA). Measurements were obtained in the standard manner recommended by the American Society of Echocardiography. Moreover, LA longitudinal strain was measured using 2D speckle tracking echocardiography in the four-chamber view to evaluate left atrial function. The CHARGE-AF scoring system was used to predict AF risk.A total of 148 patients (mean age: 57.6 ± 11.9; male: 53%) with feasible views for LA strain measurement were divided into two groups based on a 10% CHARGE-AF cut-off score. The >10% group (48 patients; 32%) was defined as having a predicted 5-year AF risk >10%, and the ≤10% group (100 patients; 68%) was defined as having a predicted risk <10%. In the multivariate analysis, LA reservoir strain (LASr) was independently associated with CHARGE-AF score. Furthermore, using the Pearson correlation method, LASr was found to be highly correlated with CHARGE-AF score (r = -0.74, p < 0.0001). CONCLUSIONS LASr was highly correlated with CHARGE-AF risk score and may be used as a parameter to predict atrial myopathy and hence AF risk.
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Affiliation(s)
- Turkan Seda Tan
- Department of Cardiovascular Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Kubra Korkmaz
- Department of Cardiovascular Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Irem Muge Akbulut
- Department of Cardiovascular Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Kaan Akin
- Department of Cardiovascular Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Yakup Yunus Yamanturk
- Department of Cardiovascular Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Haci Ali Kurklu
- Department of Cardiovascular Medicine, Lokman Hekim University School of Medicine, Akay Hospital, Ankara, Turkey
| | - Volkan Kozluca
- Department of Cardiovascular Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Kerim Esenboga
- Department of Cardiovascular Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Irem Dincer
- Department of Cardiovascular Medicine, Ankara University School of Medicine, Ankara, Turkey
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29
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Emerging Antiarrhythmic Drugs for Atrial Fibrillation. Int J Mol Sci 2022; 23:ijms23084096. [PMID: 35456912 PMCID: PMC9029767 DOI: 10.3390/ijms23084096] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF), the most common cardiac arrhythmia worldwide, is driven by complex mechanisms that differ between subgroups of patients. This complexity is apparent from the different forms in which AF presents itself (post-operative, paroxysmal and persistent), each with heterogeneous patterns and variable progression. Our current understanding of the mechanisms responsible for initiation, maintenance and progression of the different forms of AF has increased significantly in recent years. Nevertheless, antiarrhythmic drugs for the management of AF have not been developed based on the underlying arrhythmia mechanisms and none of the currently used drugs were specifically developed to target AF. With the increased knowledge on the mechanisms underlying different forms of AF, new opportunities for developing more effective and safer AF therapies are emerging. In this review, we provide an overview of potential novel antiarrhythmic approaches based on the underlying mechanisms of AF, focusing both on the development of novel antiarrhythmic agents and on the possibility of repurposing already marketed drugs. In addition, we discuss the opportunity of targeting some of the key players involved in the underlying AF mechanisms, such as ryanodine receptor type-2 (RyR2) channels and atrial-selective K+-currents (IK2P and ISK) for antiarrhythmic therapy. In addition, we highlight the opportunities for targeting components of inflammatory signaling (e.g., the NLRP3-inflammasome) and upstream mechanisms targeting fibroblast function to prevent structural remodeling and progression of AF. Finally, we critically appraise emerging antiarrhythmic drug principles and future directions for antiarrhythmic drug development, as well as their potential for improving AF management.
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30
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Klumm MJ, Heim C, Fiegle DJ, Weyand M, Volk T, Seidel T. Long-Term Cultivation of Human Atrial Myocardium. Front Physiol 2022; 13:839139. [PMID: 35283779 PMCID: PMC8905341 DOI: 10.3389/fphys.2022.839139] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
Organotypic culture of human ventricular myocardium is emerging in basic and translational cardiac research. However, few institutions have access to human ventricular tissue, whereas atrial tissue is more commonly available and important for studying atrial physiology. This study presents a method for long-term cultivation of beating human atrial myocardium. After written informed consent, tissues from the right-atrial appendage were obtained from patients with sinus rhythm undergoing open heart surgery with cardiopulmonary bypass. Trabeculae (pectinate muscles) prepared from the samples were installed into cultivation chambers at 37°C with a diastolic preload of 500 μN. After 2 days with 0.5 Hz pacing, stimulation frequency was set to 1 Hz. Contractile force was monitored continuously. Beta-adrenergic response, refractory period (RP) and maximum captured frequency (fmax) were assessed periodically. After cultivation, viability and electromechanical function were investigated, as well as the expression of several genes important for intracellular Ca2+ cycling and electrophysiology. Tissue microstructure was analyzed by confocal microscopy. We cultivated 19 constantly beating trabeculae from 8 patient samples for 12 days and 4 trabeculae from 3 specimen for 21 days. Functional parameters were compared directly after installation (0 d) with those after 12 d in culture. Contraction force was 384 ± 69 μN at 0 d and 255 ± 90 μN at 12 d (p = 0.8, n = 22), RP 480 ± 97 ms and 408 ± 78 ms (p = 0.3, n = 9), fmax 3.0 ± 0.5 Hz and 3.8 ± 0.5 Hz (p = 0.18, n = 9), respectively. Application of 100 nM isoprenaline to 11 trabeculae at 7 d increased contraction force from 168 ± 35 μN to 361 ± 60 μN (p < 0.01), fmax from 6.4 ± 0.6 Hz to 8.5 ± 0.4 Hz (p < 0.01) and lowered RP from 319 ± 22 ms to 223 ± 15 ms. CACNA1c (L-type Ca2+ channel subunit) and GJA1 (connexin-43) mRNA expressions were not significantly altered at 12 d vs 0 d, while ATP2A (SERCA) and KCNJ4 (Kir2.3) were downregulated, and KCNJ2 (Kir2.1) was upregulated. Simultaneous Ca2+ imaging and force recording showed preserved excitation-contraction coupling in cultivated trabeculae. Confocal microscopy indicated preserved cardiomyocyte structure, unaltered amounts of extracellular matrix and gap junctions. MTT assays confirmed viability at 12 d. We established a workflow that allows for stable cultivation and functional analysis of beating human atrial myocardium for up to 3 weeks. This method may lead to novel insights into the physiology and pathophysiology of human atrial myocardium.
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Affiliation(s)
- Maximilian J Klumm
- Institute of Cellular and Molecular Physiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christian Heim
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dominik J Fiegle
- Institute of Cellular and Molecular Physiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Weyand
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Tilmann Volk
- Institute of Cellular and Molecular Physiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Seidel
- Institute of Cellular and Molecular Physiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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31
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Yamaguchi T, Otsubo T, Takahashi Y, Nakashima K, Fukui A, Hirota K, Ishii Y, Shinzato K, Osako R, Tahara M, Kawano Y, Kawaguchi A, Aishima S, Takahashi N, Node K. Atrial Structural Remodeling in Patients With Atrial Fibrillation Is a Diffuse Fibrotic Process: Evidence From High-Density Voltage Mapping and Atrial Biopsy. J Am Heart Assoc 2022; 11:e024521. [PMID: 35261287 PMCID: PMC9075313 DOI: 10.1161/jaha.121.024521] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Low‐voltage areas (LVAs) in the atria of patients with atrial fibrillation are considered local fibrosis. We hypothesized that voltage reduction in the atria is a diffuse process associated with fibrosis and that the presence of LVAs reflects a global voltage reduction. Methods and Results We examined 140 patients with atrial fibrillation and 13 patients with a left accessory pathway (controls). High‐density bipolar voltage mapping was performed using a grid‐mapping catheter during high right atrial pacing. Global left atrial (LA) voltage (VGLA) in the whole LA and regional LA voltage (VRLA) in 6 anatomic regions were evaluated with the mean of the highest voltage at a sampling density of 1 cm2. Patients with atrial fibrillation were categorized into quartiles by VGLA. LVAs were evaluated at voltage cutoffs of 0.1, 0.5, 1.0, and 1.5 mV. Twenty‐eight patients with atrial fibrillation also underwent right atrial septum biopsy, and the fibrosis extent was quantified. Voltage at the biopsy site (Vbiopsy) was recorded. VGLA results by category were Q1 (<4.2 mV), Q2 (4.2–5.6 mV), Q3 (5.7–7.0 mV), and Q4 (≥7.1 mV). VRLA at any region was reduced as VGLA decreased. VGLA and VRLA did not differ between Q4 and controls. The presence of LVAs increased as VGLA decreased at any voltage cutoff. Biopsies revealed 11±6% fibrosis, which was inversely correlated with both Vbiopsy and VGLA (r=–0.71 and –0.72, respectively). Vbiopsy was correlated with VGLA (r=0.82). Conclusions Voltage reduction in the LA is a diffuse process associated with fibrosis. Presence of LVAs reflects diffuse voltage reduction of the LA.
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Affiliation(s)
- Takanori Yamaguchi
- Department of Cardiovascular Medicine Saga University Saga Japan.,Department of Advanced Management of Cardiac Arrhythmia Saga University Saga Japan
| | - Toyokazu Otsubo
- Department of Cardiovascular Medicine Saga University Saga Japan.,Department of Advanced Management of Cardiac Arrhythmia Saga University Saga Japan
| | - Yuya Takahashi
- Department of Cardiovascular Medicine Saga University Saga Japan
| | - Kana Nakashima
- Department of Cardiovascular Medicine Saga University Saga Japan
| | - Akira Fukui
- Department of Cardiology and Clinical Examination Faculty of Medicine Oita University Yufu Japan
| | - Kei Hirota
- Department of Cardiology and Clinical Examination Faculty of Medicine Oita University Yufu Japan
| | - Yumi Ishii
- Department of Cardiology and Clinical Examination Faculty of Medicine Oita University Yufu Japan
| | - Kodai Shinzato
- Department of Cardiovascular Medicine Saga University Saga Japan
| | - Ryosuke Osako
- Department of Cardiovascular Medicine Saga University Saga Japan
| | - Mai Tahara
- Department of Cardiovascular Medicine Saga University Saga Japan
| | - Yuki Kawano
- Division of Cardiology Saiseikai Futsukaichi Hospital Fukuoka Japan
| | - Atsushi Kawaguchi
- Education and Research Center for Community Medicine Saga University Saga Japan
| | - Shinichi Aishima
- Department of Pathology and Microbiology Saga University Saga Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination Faculty of Medicine Oita University Yufu Japan
| | - Koichi Node
- Department of Cardiovascular Medicine Saga University Saga Japan
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32
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Secondhand smoke exposure is associated with abnormal P-wave axis. Public Health 2022; 205:79-82. [PMID: 35247863 PMCID: PMC8995340 DOI: 10.1016/j.puhe.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Secondhand smoke exposure (SHSE) is associated with increased risk of cerebrovascular accident (CVA). Abnormal P-wave axis (aPWA) is a marker for atriopathy that is also associated with CVA risk. We hypothesized that SHSE is associated with aPWA. METHODS This analysis included 5986 non-smokers (age 61.7 ± 13.8 years, 45.8% men, 77.4% Whites) from the Third National Health and Nutrition Examination Survey. SHSE was defined as serum cotinine ≥1 ng/ml aPWA was defined as any P-wave axis outside of 0-75°. Multivariable logistic regression was used to examine the association between SHSE and aPWA, overall and among subgroups stratified by demographics and comorbidities. RESULTS About 18.5% (n = 1109) of the participants had SHSE. aPWA was more prevalent among those with SHSE than those without (23.9% versus 19.8%, respectively, P-value = 0.003). In a model adjusted for sociodemographic and potential confounders, presence (versus absence) of SHSE was associated with increased odds of aPWA (odds ratio [95% confidence interval]: 1.28 [1.09, 1.50]; P-value = 0.003). This association was stronger among Whites vs non-Whites (interaction P-value = 0.04) and non-obese versus obese (interaction P-value = 0.04). Higher levels of serum cotinine were associated with increased odds of aPWA. Compared with serum cotinine level <1 ng/ml, serum cotinine ≥3 ng/ml and ≥6 ng/ml were associated with 35% (P-value = 0.002) and 38% (P-value = 0.002) increased odds of aPWA, respectively. CONCLUSIONS SHSE is associated with abnormal atrial conduction, measured as aPWA, with possible effect modification by ethnicity and obesity. These findings underscore the harmful effects of SHSE on cardiovascular health which merits a personalized risk assessment when counseling patients on SHSE.
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33
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Stassen J, Butcher SC, Namazi F, Marsan NA, Bax JJ, Delgado V. Left atrial deformation imaging and atrial fibrillation in patients with rheumatic mitral stenosis. J Am Soc Echocardiogr 2021; 35:486-494.e2. [PMID: 34954048 DOI: 10.1016/j.echo.2021.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/20/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a frequent complication of rheumatic mitral stenosis (MS) and is associated with worse outcomes. Prediction of new-onset AF by assessing left atrial (LA) mechanics with speckle tracking echocardiography might be useful for risk stratification and guiding therapeutic strategies. Therefore, the aim of this study was to assess the association of left atrial reservoir strain (LASr) and strain rate (LASRr) with AF at follow-up in patients with rheumatic MS. METHODS LASr and LASRr, measured by speckle-tracking echocardiography, were assessed in 125 patients (mean age 50 ±15 years, 80.8% female) with rheumatic MS and without a history of prior AF. Patients were followed-up for the occurrence of a first episode of AF after the index echocardiogram. RESULTS During a median follow-up of 32 (9.5 - 70) months, 41 patients (32.8%) developed new-onset AF. Patients who developed AF had significantly more impaired LASr (13.4±5.2% vs 18.9±8.2%, p<0.001) and LASRr (0.72±0.26 s-1 vs 0.98±0.36 s-1, p<0.001) compared to patients who remained in sinus rhythm. On multivariable Cox regression analysis, LASr <21% and LASRr <0.8 s-1 were independently associated with the development of AF at follow-up (hazard ratio [HR] 7.03, 95% confidence interval [CI] 2.08-23.77, p=0.002 and HR 3.42, 95% CI 1.59-7.34, p=0.002, respectively). CONCLUSIONS LASr and LASRr are impaired in patients with rheumatic MS and the degree of impairment is associated with new-onset AF at follow-up.
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Affiliation(s)
- Jan Stassen
- Department of Cardiology, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Farnaz Namazi
- Department of Cardiology, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, 2300RC Leiden, The Netherlands.
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34
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Gottlieb LA, Belterman C, van Amersfoorth S, Loyer V, Constantin M, Hocini M, Dekker LRC, Coronel R. Profibrillatory Structural and Functional Properties of the Atrial-Pulmonary Junction in the Absence of Remodeling. Front Physiol 2021; 12:748203. [PMID: 34899379 PMCID: PMC8654241 DOI: 10.3389/fphys.2021.748203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Sole pulmonary vein (PV) isolation by ablation therapy prevents atrial fibrillation (AF) in patients with short episodes of AF and without comorbidities. Since incomplete PV isolation can be curative, we tested the hypothesis that the PV in the absence of remodeling and comorbidities contains structural and functional properties that are proarrhythmic for AF initiation by reentry. Methods: We performed percutaneous transvenous in vivo endocardial electrophysiological studies and quantitative histological analysis of PV from healthy sheep. Results: The proximal PV contained more myocytes than the distal PV and a higher percentage of collagen and fat tissue relative to myocytes than the left atrium. Local fractionated electrograms occurred in both the distal and proximal PVs, but a large local activation (>0.75 mV) was more often present in the proximal PV than in the distal PV (86 vs. 50% of electrograms, respectively, p = 0.017). Atrial arrhythmias (run of premature atrial complexes) occurred more often following the premature stimulation in the proximal PV than in the distal PV (p = 0.004). The diastolic stimulation threshold was higher in the proximal PV than in the distal PV (0.7 [0.3] vs. 0.4 [0.2] mA, (median [interquartile range]), p = 0.004). The refractory period was shorter in the proximal PV than in the distal PV (170 [50] vs. 248 [52] ms, p < 0.001). A linear relation existed between the gradient in refractoriness (distal-proximal) and atrial arrhythmia inducibility in the proximal PV. Conclusion: The structural and functional properties of the native atrial-PV junction differ from those of the distal PV. Atrial arrhythmias in the absence of arrhythmia-induced remodeling are caused by reentry in the atrial-PV junction. Ablative treatment of early paroxysmal AF, rather than complete isolation of focal arrhythmia, may be limited to inhibition of reentry.
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Affiliation(s)
- Lisa A Gottlieb
- Department of Experimental Cardiology, Location Academic Medical Centre, Amsterdam University Medical Centre, Amsterdam, Netherlands.,IHU Liryc, University of Bordeaux, Bordeaux, France
| | - Charly Belterman
- Department of Experimental Cardiology, Location Academic Medical Centre, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Shirley van Amersfoorth
- Department of Experimental Cardiology, Location Academic Medical Centre, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | | | | | | | - Lukas R C Dekker
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.,Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Ruben Coronel
- Department of Experimental Cardiology, Location Academic Medical Centre, Amsterdam University Medical Centre, Amsterdam, Netherlands.,IHU Liryc, University of Bordeaux, Bordeaux, France
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35
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Gottlieb LA, Al Jefairi N, El Hamrani D, Naulin J, Lamy J, Kachenoura N, Constantin M, Quesson B, Cochet H, Coronel R, Dekker LR. Reduction in left atrial and pulmonary vein dimensions after ablation therapy is mediated by scar. IJC HEART & VASCULATURE 2021; 37:100894. [PMID: 34746362 PMCID: PMC8554268 DOI: 10.1016/j.ijcha.2021.100894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Ablative pulmonary vein isolation (PVI) decreases pulmonary vein (PV) and left atrial (LA) dimensions in atrial fibrillation (AF) patients. These changes are attributed to reverse structural remodeling following sinus rhythm restoration but evidence is lacking. We hypothesized that the downsizing is directly caused by the ablative energy and subsequent scar formation. METHODS We studied cardiac magnetic resonance imaging in 21 paroxysmal AF patients before and 3 months after successful PVI and in healthy sheep (n = 12) before and after PVI of the right PV only. RESULTS PVI decreased the PV diameter in patients and sheep by 11.0(10.3) and 9.2(11.0)%, (p < 0.001 and p = 0.020), respectively. The control left PV in sheep were unchanged. A linear correlation existed between the extent of PV scar and PVI-induced decrease in PV diameter in patients.After PVI, the LA volume decreased (103(38) vs. 92(31)ml, pre- vs. post-ablation, respectively, p = 0.006), while the right atrial (RA) volume was unchanged in patients. A decrease in active emptying fraction after ablation (26.5(10.7) vs. 21.8(10.6)%, pre- vs. post-ablation, p = 0.031) was associated with reduced contractility of the PV walls (p = 0.004). The contractility of the LA walls was unaltered (p = 0.749). CONCLUSION The ablation-induced PV diameter reduction was similar in patients with AF and healthy sheep without AF and was associated with PV scar extent. The volume only decreased in LA and not RA after PVI, and wall contractility decreased only in ablated sites. Therefore, the PVI-induced atrial downsizing is caused by the ablative energy and subsequent scar formation.
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Affiliation(s)
- Lisa A. Gottlieb
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
- Department of Experimental Cardiology, AUMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Nora Al Jefairi
- Department of Cardiac Pacing and Electrophysiology, University Hospital, Bordeaux, Pessac, France
| | - Dounia El Hamrani
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
| | - Jérôme Naulin
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
| | - Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, USA
| | - Nadjia Kachenoura
- Sorbonne Université, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, LIB, Paris, France
| | - Marion Constantin
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
| | - Bruno Quesson
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
| | - Hubert Cochet
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
| | - Ruben Coronel
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
- Department of Experimental Cardiology, AUMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Lukas R.C. Dekker
- Department of Electrical Engineering, University of Technology, Eindhoven, the Netherlands
- Cardiology Department, Catharina Hospital, Eindhoven, the Netherlands
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Jain R, Aggarwal P, Jha MJ, Pandit BN, Gupta P, Isser HS. Trans-esophageal Echocardiographic Assessment of Left Atrial and Left Atrial Appendage Function in Atrial Fibrillation and Rheumatic Heart Disease. Cureus 2021; 13:e18653. [PMID: 34790439 PMCID: PMC8583362 DOI: 10.7759/cureus.18653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Rheumatic heart disease (RHD) is one of the most typical causes of atrial fibrillation in developing countries like India. The left atrial and left atrial appendage structure and function are deranged in atrial fibrillation and are a major source of thromboembolism. The goal of this study was to assess the left atrial and left atrial appendage function by transesophageal echocardiography in patients with atrial fibrillation and their comparison in patients with or without RHD. Methods: A total of 172 consecutive patients with atrial fibrillation with or without RHD were subjected to trans-esophageal echocardiography to assess and compare left atrial (LA) and left atrial appendage (LAA) function. Results: Out of 172 patients with atrial fibrillation, 100 were female (58.1%) and 72 were male (48.9%). The mean age was 54.11±12.3 years, and rheumatic heart disease (RHD) was the commonest cause of atrial fibrillation found in 121 (70.3%) patients. The mean left atrium diameter was significantly higher in RHD patients than in Non-RHD patients (52.08±10.13 vs. 46.67±6.78 mm, p=0.001). Mean left atrial ejection fraction was significantly lower in RHD patients as compared to Non-RHD patients (33.53±5.06 vs. 35.49±5.40%, p=0.024). The mean LAA orifice area of RHD patients was significantly higher than the Non-RHD patients (7.52±1.22 vs 6.94±1.17 mm2, p=0.005). Mean LAA emptying velocity was significantly lower in RHD patients than Non-RHD (20.49±3.95 vs. 22.8±5.96 ml/s, p=0.002). Conclusion: Rheumatic heart disease is still a common cause of atrial fibrillation in developing countries. LA and LAA function is impaired in atrial fibrillation, more in patients with rheumatic heart disease.
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Affiliation(s)
- Rajat Jain
- Cardiology, Healing Touch Superspeciality Hospital, Ambala, IND
| | - Puneet Aggarwal
- Cardiology, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia (RML) Hospital, Delhi, IND
| | - Mukesh J Jha
- Cardiology, Sri Aurobindo Institute of Medical Sciences, Indore, IND
| | - Bhagya Narayan Pandit
- Cardiology, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia (RML) Hospital, Delhi, IND
| | - Preeti Gupta
- Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, IND
| | - Hermohander S Isser
- Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, IND
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Impact of maze procedure in patients with severe tricuspid regurgitation and persistent atrial fibrillation. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01535-X. [PMID: 34872766 DOI: 10.1016/j.jtcvs.2021.10.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients with severe tricuspid regurgitation and persistent atrial fibrillation may not be good candidates for maze procedure due to preoperative atrial remodeling and various comorbidities. We attempted to evaluate the rhythm and clinical outcomes of maze procedure in these patients. METHODS Patients with severe tricuspid regurgitation and persistent atrial fibrillation who underwent tricuspid valve surgery between January 1994 and December 2017 at a single tertiary center were analyzed. The primary end point was sinus rhythm restoration. The key secondary end point was major adverse cardiovascular and cerebrovascular event rate, which is the composite event of stroke, cardiac death, major bleeding, and readmission for heart failure. Propensity score matching analysis was used. RESULTS A total of 388 patients underwent tricuspid valve surgery, and among them 172 patients (44%) underwent concomitant maze procedure. The maze group had sinus rhythm restoration rate of 56% in 9 years. Further, in the matched cohort, the maze group had higher freedom from major adverse cardiovascular and cerebrovascular event rate at 10 years than the nonmaze group (55.6% vs 36.2%; P = .047). Preoperative left atrial diameter (hazard ratio, 1.022; 95% CI, 1.012-1.033; P < .001) and right atrial diameter (hazard ratio, 1.012; 95% CI, 1.003-1.022; P = .013) were independent risk factors for failure of sinus rhythm. CONCLUSIONS Maze procedure in severe tricuspid regurgitation and persistent atrial fibrillation had acceptable rates of sinus rhythm restoration and reduced major adverse cardiovascular and cerebrovascular events in the long-term. Careful patient selection considering preoperative atrial diameters is needed to enhance maze success rate and long-term clinical outcomes.
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Kalpana SR, Shenthar J, Padmanabhan D, Rai MK, Singh A, Banavalikar B, Kalyani RN, Kamalapurkar G. A histological study of the atria in patients with isolated rheumatic mitral regurgitation with and without atrial fibrillation. J Cardiovasc Electrophysiol 2021; 33:32-39. [PMID: 34741568 DOI: 10.1111/jce.15286] [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: 05/07/2021] [Revised: 08/09/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a high incidence of atrial fibrillation (AF) in patients with isolated rheumatic mitral regurgitation (MR). The histopathologic changes in the atria of patients with isolated rheumatic MR with and without AF are unknown. OBJECTIVES We aimed to determine the histological findings in patients with isolated severe rheumatic MR with and without AF. METHODS Patients with severe isolated rheumatic MR undergoing valve replacement surgeries underwent endocardial biopsies from right atrial appendage, left atrial appendage, right free wall, left free wall, left posterior wall, and mitral valve. Group I consisted of patients in sinus rhythm (SR), and Group II included patients with AF. We analyzed and compared these 10 histological features in the biopsies of patients in Groups I and II. RESULTS Of the 25 patients, 12 were in Group I and 13 in Group II. In Group I, patients had severe myocyte hypertrophy (60% vs. 18%, p = .04) that was significantly more in the right atrium (22.7% vs. 11.4%, p = .059). Interstitial adipose tissue deposition was more common in Group I (30% vs. 25%, p = .06). Interstitial fibrosis was evenly distributed at all sites without significant difference between the two groups. Group II patients had a higher prevalence and severity of vacuolar degeneration (91% vs. 60%, p = .09). CONCLUSIONS Patients with isolated severe rheumatic MR and AF have more vacuolar degeneration in the atrial tissue. Patients with SR have myocyte hypertrophy and interstitial adipose tissue deposition. Interstitial fibrosis is uniformly distributed in patients in SR and AF.
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Affiliation(s)
- Saligrama R Kalpana
- Department of Pathology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Jayaprakash Shenthar
- Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Deepak Padmanabhan
- Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Maneesh K Rai
- Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Ankit Singh
- Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Bharatraj Banavalikar
- Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Ravikumar N Kalyani
- Department of Cardiothoracic Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Giridhar Kamalapurkar
- Department of Cardiothoracic Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
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Qian L, Gong J, Ma W, Sun Y, Hong J, Xu D, Chu M. Circulating S100A4 as a prognostic biomarker for patients with nonparoxysmal atrial fibrillation after catheter ablation. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1400. [PMID: 34733952 PMCID: PMC8506725 DOI: 10.21037/atm-21-1101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/14/2021] [Indexed: 11/06/2022]
Abstract
Background Atrial fibrosis is involved in non-paroxysmal atrial fibrillation (NPAF) and is mainly mediated by the calcium-binding protein S100A4. This study aimed to verify the role of circulating S100A4 in the diagnosis of atrial fibrosis and the prognosis of NPAF. Methods Consecutive NPAF patients undergoing catheter ablation were selected. Patients with low voltage amplitudes (<0.40 mV) in the left atrium (LA), defined as low voltage zones (LVZs), were grouped in the scar group by electroanatomic mapping (EAM). Circulating S100A4 was detected by a human enzyme-linked immunosorbent assay (ELISA). The role of S100A4 in atrial fibrosis was further evaluated by Masson's trichrome staining and immunochemistry (IHC) in NPAF (atrial pacing) and control dogs. The prognostic value of the circulating S100A4 was evaluated by Cox regression analyses, the Kaplan-Meier (KM) method, and receiver operating characteristic (ROC) curves. Results We enrolled a total of 101 NPAF patients (age 60±8 years) who underwent EAM, including 53 patients with scars and 48 patients without scars at 1-year follow-up. The scar group showed a higher serum level of S100A4 (3.4±1.7 vs. 2.5±1.4 ng/mL, P<0.001) than the non-scar group. In the canine model, scar size matched the larger location of interstitial fibrosis in the NPAF group determined by Masson's trichrome staining. The expression of α-SMA and S100A4 was elevated in the NPAF group as determined by IHC compared to the control group (P<0.001). The clinical recurrence rate was markedly elevated in the scar group (27.1% vs. 8.9%, P<0.001), and the area under the ROC curve was high (0.865, 95% CI: 0.750-0.981) in predicting clinical recurrence of NPAF with the circulating S100A4 model. Conclusions Circulating S100A4 plays a role in atrial fibrosis in NPAF patients following ablation. The level of serum S100A4 can predict the clinical recurrence of NPAF.
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Affiliation(s)
- Lijun Qian
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jinlong Gong
- Department of Cardiology, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, Yangzhou, China
| | - Wenjie Ma
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Sun
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Hong
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Di Xu
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ming Chu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Palacio LC, Ugarte JP, Saiz J, Tobón C. The Effects of Fibrotic Cell Type and Its Density on Atrial Fibrillation Dynamics: An In Silico Study. Cells 2021; 10:cells10102769. [PMID: 34685750 PMCID: PMC8534881 DOI: 10.3390/cells10102769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/03/2021] [Accepted: 10/12/2021] [Indexed: 12/12/2022] Open
Abstract
Remodeling in atrial fibrillation (AF) underlines the electrical and structural changes in the atria, where fibrosis is a hallmark of arrhythmogenic structural alterations. Fibrosis is an important feature of the AF substrate and can lead to abnormal conduction and, consequently, mechanical dysfunction. The fibrotic process comprises the presence of fibrotic cells, including fibroblasts, myofibroblasts and fibrocytes, which play an important role during fibrillatory dynamics. This work assesses the effect of the diffuse fibrosis density and the intermingled presence of the three types of fibrotic cells on the dynamics of persistent AF. For this purpose, the three fibrotic cells were electrically coupled to cardiomyocytes in a 3D realistic model of human atria. Low (6.25%) and high (25%) fibrosis densities were implemented in the left atrium according to a diffuse fibrosis representation. We analyze the action potential duration, conduction velocity and fibrillatory conduction patterns. Additionally, frequency analysis was performed in 50 virtual electrograms. The tested fibrosis configurations generated a significant conduction velocity reduction, where the larger effect was observed at high fibrosis density (up to 82% reduction in the fibrocytes configuration). Increasing the fibrosis density intensifies the vulnerability to multiple re-entries, zigzag propagation, and chaotic activity in the fibrillatory conduction. The most complex propagation patterns were observed at high fibrosis densities and the fibrocytes are the cells with the largest proarrhythmic effect. Left-to-right dominant frequency gradients can be observed for all fibrosis configurations, where the fibrocytes configuration at high density generates the most significant gradients (up to 4.5 Hz). These results suggest the important role of different fibrotic cell types and their density in diffuse fibrosis on the chaotic propagation patterns during persistent AF.
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Affiliation(s)
- Laura C. Palacio
- Materiales Nanoestructurados y Biomodelación (MATBIOM), Universidad de Medellín, Medellín 050032, Colombia;
| | - Juan P. Ugarte
- Grupo de Investigación en Modelamiento y Simulación Computacional (GIMSC), Universidad de San Buenaventura, Medellín 050010, Colombia;
| | - Javier Saiz
- Centro de Investigación e Innovación en Bioingeniería (CIB), Universitat Politècnica de València, 46022 Valencia, Spain;
| | - Catalina Tobón
- Materiales Nanoestructurados y Biomodelación (MATBIOM), Universidad de Medellín, Medellín 050032, Colombia;
- Correspondence:
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Ni L, Lahiri SK, Nie J, Pan X, Abu-Taha I, Reynolds JO, Campbell HM, Wang H, Kamler M, Schmitz W, Müller FU, Li N, Wei X, Wang DW, Dobrev D, Wehrens XHT. Genetic inhibition of Nuclear Factor of Activated T-cell c2 (NFATc2) prevents atrial fibrillation in CREM transgenic mice. Cardiovasc Res 2021; 118:2805-2818. [PMID: 34648001 PMCID: PMC9586567 DOI: 10.1093/cvr/cvab325] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 10/11/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Abnormal intracellular calcium handling contributes to the progressive nature of atrial fibrillation (AF), the most common sustained cardiac arrhythmia. Evidence in mouse models suggests that activation of the nuclear factor of activated T-cell (NFAT) signaling pathway contributes to atrial remodeling. Our aim was to determine the role of NFATc2 in AF in humans and mouse models. METHODS AND RESULTS Expression levels of NFATc1-c4 isoforms were assessed by quantitative reverse transcription-polymerase chain reaction in right atrial appendages from patients with chronic AF. NFATc1 and NFATc2 mRNA levels were elevated in chronic AF (cAF) patients compared with those in sinus rhythm (SR). Western blotting revealed increased cytosolic and nuclear levels of NFATc2 in AF patients. Similar findings were obtained in CREM-IbΔC-X transgenic (CREM) mice, a model of progressive AF. Telemetry ECG recordings revealed age-dependent spontaneous AF in CREM mice, which was prevented by NFATc2 knockout in CREM: NFATc2-/- mice. Programmed electrical stimulation revealed that CREM: NFATc2-/- mice lacked an AF substrate. Morphometric analysis and histology revealed increased atrial weight and atrial fibrosis in CREM mice compared with WT controls, which was reversed in CREM: NFATc2-/- mice. Confocal microscopy showed an increased Ca2+ spark frequency despite a reduced sarcoplasmic reticulum (SR) Ca2+ load in CREM mice compared with controls, whereas these abnormalities were normalized in CREM: NFATc2-/- mice. Western blotting revealed that genetic inhibition of Ca2+/calmodulin-dependent protein kinase II-mediated phosphorylation of S2814 on RyR2 in CREM: RyR2-S2814A mice suppressed NFATc2 activation observed in CREM mice, suggesting that NFATc2 is activated by excessive SR Ca2+ leak via RyR2. Finally, chromatin immunoprecipitation sequencing from AF patients identified Ras And EF-Hand Domain-Containing Protein (RASEF) as a direct target of NFATc2 mediated transcription. CONCLUSION Our findings reveal activation of the NFAT signaling pathway in patients of Chinese and European descent. NFATc2 knockout prevents the progression of AF in the CREM mouse model. TRANSLATIONAL PERSPECTIVE Atrial fibrillation (AF) is a progressive disease characterized by electrical and structural remodeling which promotes atrial arrhythmias. This study provides evidence for increased 'nuclear factor of activated T-cell' (NFAT) signaling in patients with chronic AF. Studies in the CREM transgenic model of progressive AF revealed that the NFATc2 isoform mediates atrial remodeling associated with AF substrate development. Chromatin immunoprecipitation sequencing of atrial biopsies from AF patients identified 'Ras And EF-Hand Domain-Containing Protein' (RASEF) as a downstream target of NFATc2-mediated transcription, suggesting that targeting these factors might be beneficial for curtailing AF progression.
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Affiliation(s)
- Li Ni
- Division of Cardiology, Department of Internal Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Satadru K Lahiri
- Cardiovascular Research Institute.,Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Jiali Nie
- Division of Cardiology, Department of Internal Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Xiaolu Pan
- Cardiovascular Research Institute.,Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Issam Abu-Taha
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Julia O Reynolds
- Cardiovascular Research Institute.,Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Hannah M Campbell
- Cardiovascular Research Institute.,Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Haihao Wang
- Division of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Markus Kamler
- Cardiac Surgery II Essen-Huttrop, University Hospital, West German Heart Center, University of Essen, Germany
| | - Wilhelm Schmitz
- Institute of Pharmacology and Toxicology, University of Münster, Germany
| | | | - Na Li
- Cardiovascular Research Institute.,Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, USA.,Institute of Pharmacology and Toxicology, University of Münster, Germany
| | - Xiang Wei
- Division of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Xander H T Wehrens
- Cardiovascular Research Institute.,Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, USA.,Department of Medicine (Section of Cardiovascular Research), Baylor College of Medicine, Houston, TX, 77030 USA.,Department of Medicine (Cardiology), Baylor College of Medicine, Houston, TX, 77030 USA.,Department of Pediatrics, Center for Space Medicine, Baylor College of Medicine, Houston, TX, 77030 USA
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Remodeling of Cardiac Gap Junctional Cell-Cell Coupling. Cells 2021; 10:cells10092422. [PMID: 34572071 PMCID: PMC8465208 DOI: 10.3390/cells10092422] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 12/29/2022] Open
Abstract
The heart works as a functional syncytium, which is realized via cell-cell coupling maintained by gap junction channels. These channels connect two adjacent cells, so that action potentials can be transferred. Each cell contributes a hexameric hemichannel (=connexon), formed by protein subuntis named connexins. These hemichannels dock to each other and form the gap junction channel. This channel works as a low ohmic resistor also allowing the passage of small molecules up to 1000 Dalton. Connexins are a protein family comprising of 21 isoforms in humans. In the heart, the main isoforms are Cx43 (the 43 kDa connexin; ubiquitous), Cx40 (mostly in atrium and specific conduction system), and Cx45 (in early developmental states, in the conduction system, and between fibroblasts and cardiomyocytes). These gap junction channels are mainly located at the polar region of the cardiomyocytes and thus contribute to the anisotropic pattern of cardiac electrical conductivity. While in the beginning the cell–cell coupling was considered to be static, similar to an anatomically defined structure, we have learned in the past decades that gap junctions are also subject to cardiac remodeling processes in cardiac disease such as atrial fibrillation, myocardial infarction, or cardiomyopathy. The underlying remodeling processes include the modulation of connexin expression by e.g., angiotensin, endothelin, or catecholamines, as well as the modulation of the localization of the gap junctions e.g., by the direction and strength of local mechanical forces. A reduction in connexin expression can result in a reduced conduction velocity. The alteration of gap junction localization has been shown to result in altered pathways of conduction and altered anisotropy. In particular, it can produce or contribute to non-uniformity of anisotropy, and thereby can pre-form an arrhythmogenic substrate. Interestingly, these remodeling processes seem to be susceptible to certain pharmacological treatment.
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O’Neill L, Wielandts JY, Gillis K, Hilfiker G, Le Polain De Waroux JB, Tavernier R, Duytschaever M, Knecht S. Catheter Ablation in Persistent AF, the Evolution towards a More Pragmatic Strategy. J Clin Med 2021; 10:jcm10184060. [PMID: 34575173 PMCID: PMC8467025 DOI: 10.3390/jcm10184060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/27/2021] [Accepted: 09/04/2021] [Indexed: 11/16/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and represents a heterogeneous disorder with a complex pathological basis. While significant technological advances have taken place over the last decade in the field of catheter ablation of AF, response to ablation varies and long-term success rates in those with persistent AF remain modest. Mechanistic studies have highlighted potentially different sustaining factors for AF in the persistent AF population with substrate-driven focal and re-entrant sources in the body of the atria identified on invasive and non-invasive mapping studies. Translation to clinical practice, however, remains challenging and the application of such mapping techniques to clinical ablation has yet to demonstrate a significant benefit beyond pulmonary vein isolation (PVI) alone in the persistent AF cohort. Recent advances in catheter and ablation technology have centered on improving the durability of ablation lesions at index procedure and although encouraging results have been demonstrated with early studies, large-scale trials are awaited. Further meaningful improvement in clinical outcomes in the persistent AF population requires ongoing advancement in the understanding of AF mechanisms, coupled with continuing progress in catheter technology capable of delivering durable transmural lesions.
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Gottlieb LA, El Hamrani D, Naulin J, Sanchez Y. Blanco L, Lamy J, Kachenoura N, Quesson B, Cochet H, Coronel R, Dekker LRC. A left lateral body position increases pulmonary vein stress in healthy humans. Physiol Rep 2021; 9:e15022. [PMID: 34558216 PMCID: PMC8461032 DOI: 10.14814/phy2.15022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 02/01/2023] Open
Abstract
Pulmonary vein (PV) stretch is proarrhythmic for atrial fibrillation (AF). AF patients often report that a left lateral (LL) body position can trigger arrhythmia symptoms. Because the PV myocardium is thought to trigger AF, we hypothesized that the LL compared to the supine body position increases PV wall stress. Functional cardiac magnetic resonance imaging was performed in supine and LL recumbent body position in awake condition in healthy human volunteers (n = 20). Following a change from supine to LL position, the heart moved in an anterior-LL direction in the thorax. The right superior PV diameter was increased by 19% (24.6 ± 3.1 vs. 20.7 ± 3.2 mm, p = 0.009) and left atrial (LA) volume was larger by 17% (61.7[15.4] vs. 51.0[17.8] ml, p = 0.015) in LL than supine position, respectively. The passive LA conduit fraction (normalized difference between maximum and pre-contraction LA volume) increased by 25% in LL compared to supine position (19.6 ± 9.0 vs. 15.7 ± 7.6%, respectively, p = 0.016). Local wall stress in the PV regions increased in LL compared to supine position (overall mean: 1.01 ± 0.12 vs. 1.10 ± 0.10 arb. unit, LL vs. supine, position effect p = 0.041), whereas this was not the case in the LA walls (overall mean: 1.18 ± 0.31 vs. 1.21 ± 0.21 arb. unit, LL vs. supine, position effect p = 0.381). In conclusion, a left lateral body position increases PV myocardial stress during the atrial relaxation phase of healthy volunteers. These results have implications for the mechanisms of posture-triggered AF.
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Affiliation(s)
- Lisa A. Gottlieb
- IHU LirycUniversity of BordeauxPessacFrance
- AUMCAcademic Medical CenterAmsterdamthe Netherlands
| | | | | | | | - Jérôme Lamy
- Department of Radiology and Biomedical ImagingYale UniversityNew HavenUSA
| | - Nadjia Kachenoura
- Laboratoire d’Imagerie BiomédicaleSorbonne UniversitéCNRSINSERMLIBParisFrance
| | | | - Hubert Cochet
- IHU LirycUniversity of BordeauxPessacFrance
- Department of Cardiovascular ImagingUniversity HospitalBordeaux, PessacFrance
| | - Ruben Coronel
- IHU LirycUniversity of BordeauxPessacFrance
- AUMCAcademic Medical CenterAmsterdamthe Netherlands
| | - Lukas RC Dekker
- University of TechnologyEindhoventhe Netherlands
- Cardiology DepartmentCatharina HospitalEindhoventhe Netherlands
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Wittig C, Szulcek R. Extracellular Matrix Protein Ratios in the Human Heart and Vessels: How to Distinguish Pathological From Physiological Changes? Front Physiol 2021; 12:708656. [PMID: 34421650 PMCID: PMC8371527 DOI: 10.3389/fphys.2021.708656] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/14/2021] [Indexed: 12/03/2022] Open
Abstract
Cardiovascular pathology is often accompanied by changes in relative content and/or ratios of structural extracellular matrix (ECM) proteins within the heart and elastic vessels. Three of these proteins, collagen-I, collagen-III, and elastin, make up the bulk of the ECM proteins in these tissues, forming a microenvironment that strongly dictates the tissue biomechanical properties and effectiveness of cardiac and vascular function. In this review, we aim to elucidate how the ratios of collagen-I to collagen-III and elastin to collagen are altered in cardiovascular diseases and the aged individuum. We elaborate on these major cardiovascular ECM proteins in terms of structure, tissue localization, turnover, and physiological function and address how their ratios change in aging, dilated cardiomyopathy, coronary artery disease with myocardial infarction, atrial fibrillation, aortic aneurysms, atherosclerosis, and hypertension. To the end of guiding in vitro modeling approaches, we focus our review on the human heart and aorta, discuss limitations in ECM protein quantification methodology, examine comparability between studies, and highlight potential in vitro applications. In summary, we found collagen-I relative concentration to increase or stay the same in cardiovascular disease, resulting in a tendency for increased collagen-I/collagen-III and decreased elastin/collagen ratios. These ratios were found to fall on a continuous scale with ranges defining distinct pathological states as well as a significant difference between the human heart and aortic ECM protein ratios.
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Affiliation(s)
- Corey Wittig
- Laboratory of in vitro Modeling Systems of Pulmonary Diseases, Institute of Physiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Robert Szulcek
- Laboratory of in vitro Modeling Systems of Pulmonary Diseases, Institute of Physiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Wu Y, Tang Z, Li B, Firmin D, Yang G. Recent Advances in Fibrosis and Scar Segmentation From Cardiac MRI: A State-of-the-Art Review and Future Perspectives. Front Physiol 2021; 12:709230. [PMID: 34413789 PMCID: PMC8369509 DOI: 10.3389/fphys.2021.709230] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/28/2021] [Indexed: 12/03/2022] Open
Abstract
Segmentation of cardiac fibrosis and scars is essential for clinical diagnosis and can provide invaluable guidance for the treatment of cardiac diseases. Late Gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has been successful in guiding the clinical diagnosis and treatment reliably. For LGE CMR, many methods have demonstrated success in accurately segmenting scarring regions. Co-registration with other non-contrast-agent (non-CA) modalities [e.g., balanced steady-state free precession (bSSFP) cine magnetic resonance imaging (MRI)] can further enhance the efficacy of automated segmentation of cardiac anatomies. Many conventional methods have been proposed to provide automated or semi-automated segmentation of scars. With the development of deep learning in recent years, we can also see more advanced methods that are more efficient in providing more accurate segmentations. This paper conducts a state-of-the-art review of conventional and current state-of-the-art approaches utilizing different modalities for accurate cardiac fibrosis and scar segmentation.
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Affiliation(s)
- Yinzhe Wu
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.,Department of Bioengineering, Faculty of Engineering, Imperial College London, London, United Kingdom
| | - Zeyu Tang
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.,Department of Bioengineering, Faculty of Engineering, Imperial College London, London, United Kingdom
| | - Binghuan Li
- Department of Bioengineering, Faculty of Engineering, Imperial College London, London, United Kingdom
| | - David Firmin
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.,Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom
| | - Guang Yang
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.,Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom
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Liu Z, Xia Y, Guo C, Li X, Fang P, Yin X, Yang X. Low-Voltage Zones as the Atrial Fibrillation Substrates: Relationship With Initiation, Perpetuation, and Termination. Front Cardiovasc Med 2021; 8:705510. [PMID: 34409078 PMCID: PMC8365032 DOI: 10.3389/fcvm.2021.705510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Low-voltage zones (LVZs) were usually targeted for ablation in atrial fibrillation (AF). However, its relationship with AF initiation, perpetuation, and termination remains to be studied. This study aimed to explore such relationships. Methods: A total of 126 consecutive AF patients were enrolled, including 71 patients for AF induction protocol and 55 patients for AF termination protocol. Inducible and sustainable AF were defined as induced AF lasting over 30 and 300 s, respectively. Terminable AF was defined as those that could be terminated into sinus rhythm within 1 h after ibutilide administration. Voltage mapping was performed in sinus rhythm for all patients. LVZ was quantified as the percentage of the LVZ area (LVZ%) to the left atrium surface area. Results: The rates of inducible, sustainable, and terminable AF were 29.6, 18.3, and 38.2%, respectively. Inducible AF patients had no significant difference in overall LVZ% compared with uninducible AF patients (10.2 ± 11.8 vs. 8.5 ± 12.6, p = 0.606), while sustainable and interminable AF patients had larger overall LVZ% than unsustainable (16.2 ± 11.5 vs. 0.5 ± 0.7, p < 0.001) and terminable AF patients (44.6 ± 26.4 vs. 26.3 ± 22.3, p < 0.05), respectively. The segmental LVZ distribution pattern was diverse in the different stages of AF. Segmental LVZ% difference was initially observed in the anterior wall for patients with inducible AF, and the septum was further affected in those with sustainable AF, and the roof, posterior wall, and floor were finally affected in those with interminable AF. Conclusions: The associations between LVZ with AF initiation, perpetuation, and termination were different depending on its size and distribution.
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Affiliation(s)
- Zheng Liu
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yu Xia
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changyan Guo
- Department of Cardiology, Xilin Gol League Central Hospital, Inner Mongolia, Xilinhot, China
| | - Xiaofeng Li
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pihua Fang
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiandong Yin
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xinchun Yang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Oliveira ÍMD, Silva Júnior ELD, Martins YDO, Rocha HAL, Scanavacca MI, Gutierrez PS. Cardiac Autonomic Nervous System Remodeling May Play a Role in Atrial Fibrillation: A Study of the Autonomic Nervous System and Myocardial Receptors. Arq Bras Cardiol 2021; 117:999-1007. [PMID: 34406322 PMCID: PMC8682090 DOI: 10.36660/abc.20200725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/25/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The primary factors that originate and perpetuate atrial fibrillation (AF) are electrical and anatomical substrate alterations. However, the central mechanisms governing AF perpetuation have not been elucidated yet, which is reflected on the modest results of the treatment in patients with long persistent AF. OBJECTIVE To evaluate if human intrinsic cardiac autonomic nervous system (ICANS) remodeling, including nervous system fibers and muscarinic and β-adrenergic receptors, play a role in permanent AF. METHODS Heart necropsy samples from thirteen patients with heart disease and permanent AF and thirteen controls without AF were used. By using immunoperoxidase and histomorphometry quantification, we identified the following: the density of all fibers of the ICANS, sympathetic and parasympathetic fibers; and the percentage of myocardium positive for β-adrenergic receptors 1, 2 and 3; G protein-coupled receptor kinase-5 (GRK-5); and muscarinic receptors M1 to M5. The results were compared using ANOVA and nested ANOVA and were adjusted according to the left atrium volume for all variables, and β-blocker use to evaluate the expression of β-receptors and GRK-5. RESULTS There was an overall increase in the density of fibers of the ICANS (p=0.006), especially in atrial sympathetic nerve fibers (p=0.017). Only M1 muscarinic receptors were increased (5.87 vs 2.35, p=0.032). For adrenergic receptors, the results were positive for increased expression of β-3 (37.41 vs 34.18, p=0.039) and GRK-5 (51.16 vs 47.66; p<0.001). β-blocker use had no impact on β-receptor expression. CONCLUSION Increased ICANS innervation and remodeling receptor expression in regions prone to triggering AF may play a role in permanent AF.
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Affiliation(s)
- Ítalo Martins de Oliveira
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil.,Hospital Messejana de Coração e Pulmão Dr. Carlos Alberto Studart Gomes , Fortaleza , CE - Brasil
| | - Evilásio Leobino da Silva Júnior
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil.,Hospital Messejana de Coração e Pulmão Dr. Carlos Alberto Studart Gomes , Fortaleza , CE - Brasil
| | | | | | - Maurício Ibrahim Scanavacca
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Paulo Sampaio Gutierrez
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
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Celotto C, Sánchez C, Mountris KA, Laguna P, Pueyo E. Location of Parasympathetic Innervation Regions From Electrograms to Guide Atrial Fibrillation Ablation Therapy: An in silico Modeling Study. Front Physiol 2021; 12:674197. [PMID: 34456743 PMCID: PMC8385640 DOI: 10.3389/fphys.2021.674197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/11/2021] [Indexed: 01/18/2023] Open
Abstract
The autonomic nervous system (ANS) plays an essential role in the generation and maintenance of cardiac arrhythmias. The cardiac ANS can be divided into its extrinsic and intrinsic components, with the latter being organized in an epicardial neural network of interconnecting axons and clusters of autonomic ganglia called ganglionated plexi (GPs). GP ablation has been associated with a decreased risk of atrial fibrillation (AF) recurrence, but the accurate location of GPs is required for ablation to be effective. Although GP stimulation triggers both sympathetic and parasympathetic ANS branches, a predominance of parasympathetic activity has been shown. This study aims was to develop a method to locate atrial parasympathetic innervation sites based on measurements from a grid of electrograms (EGMs). Electrophysiological models representative of non-AF, paroxysmal AF (PxAF), and persistent AF (PsAF) tissues were developed. Parasympathetic effects were modeled by increasing the concentration of the neurotransmitter acetylcholine (ACh) in randomly distributed circles across the tissue. Different circle sizes of ACh and fibrosis geometries were considered, accounting for both uniform diffuse and non-uniform diffuse fibrosis. Computational simulations were performed, from which unipolar EGMs were computed in a 16 × 1 6 electrode mesh. Different distances of the electrodes to the tissue (0.5, 1, and 2 mm) and noise levels with signal-to-noise ratio (SNR) values of 0, 5, 10, 15, and 20 dB were tested. The amplitude of the atrial EGM repolarization wave was found to be representative of the presence or absence of ACh release sites, with larger positive amplitudes indicating that the electrode was placed over an ACh region. Statistical analysis was performed to identify the optimal thresholds for the identification of ACh sites. In all non-AF, PxAF, and PsAF tissues, the repolarization amplitude rendered successful identification. The algorithm performed better in the absence of fibrosis or when fibrosis was uniformly diffuse, with a mean accuracy of 0.94 in contrast with a mean accuracy of 0.89 for non-uniform diffuse fibrotic cases. The algorithm was robust against noise and worked for the tested ranges of electrode-to-tissue distance. In conclusion, the results from this study support the feasibility to locate atrial parasympathetic innervation sites from the amplitude of repolarization wave.
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Affiliation(s)
- Chiara Celotto
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Carlos Sánchez
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Konstantinos A. Mountris
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Pablo Laguna
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Esther Pueyo
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
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50
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van Schie MS, Starreveld R, Bogers AJJC, de Groot NMS. Sinus rhythm voltage fingerprinting in patients with mitral valve disease using a high-density epicardial mapping approach. Europace 2021; 23:469-478. [PMID: 33432326 PMCID: PMC7947572 DOI: 10.1093/europace/euaa336] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/06/2020] [Indexed: 12/03/2022] Open
Abstract
Aims Unipolar voltage (UV) mapping is increasingly used for guiding ablative therapy of atrial fibrillation (AF) as unipolar electrograms (U-EGMs) are independent of electrode orientation and atrial wavefront direction. This study was aimed at constructing individual, high-resolution sinus rhythm (SR) UV fingerprints to identify low-voltage areas and study the effect of AF episodes in patients with mitral valve disease (MVD). Methods and results Intra-operative epicardial mapping (interelectrode distance 2 mm) of the right and left atrium, Bachmann’s bundle (BB), and pulmonary vein area was performed in 67 patients (27 male, 67 ± 11 years) with or without a history of paroxysmal AF (PAF). In all patients, there were considerable regional variations in voltages. UVs at BB were lower in patients with PAF compared with those without [no AF: 4.94 (3.56–5.98) mV, PAF: 3.30 (2.25–4.57) mV, P = 0.006]. A larger number of low-voltage potentials were recorded at BB in the PAF group [no AF: 2.13 (0.52–7.68) %, PAF: 12.86 (3.18–23.59) %, P = 0.001]. In addition, areas with low-voltage potentials were present in all patients, yet we did not find any predilection sites for low-voltage potentials to occur. Conclusion Even in SR, advanced atrial remodelling in MVD patients shows marked inter-individual and regional variation. Low UVs are even present during SR in patients without a history of AF indicating that low UVs should carefully be used as target sites for ablative therapy.
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Affiliation(s)
- Mathijs S van Schie
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, 3015GD Rotterdam, The Netherlands
| | - Roeliene Starreveld
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, 3015GD Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, 3015GD Rotterdam, The Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, 3015GD Rotterdam, The Netherlands
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