1
|
Laurita KR, Piktel JS, Irish L, Nassal M, Cheng A, McCauley M, Pawlowski G, Dennis AT, Suen Y, Almahameed S, Ziv O, Gourdie RG, Wilson LD. Spontaneous Repolarization Alternans Causes VT/VF Rearrest That Is Suppressed by Preserving Gap Junctions. JACC Clin Electrophysiol 2024; 10:1271-1286. [PMID: 38752959 DOI: 10.1016/j.jacep.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/01/2024] [Accepted: 03/07/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Ventricular tachycardia (VT)/ventricular fibrillation (VF) rearrest after successful resuscitation is common, and survival is poor. A mechanism of VT/VF, as demonstrated in ex vivo studies, is when repolarization alternans becomes spatially discordant (DIS ALT), which can be enhanced by impaired gap junctions (GJs). However, in vivo spontaneous DIS ALT-induced VT/VF has never been demonstrated, and the effects of GJ on DIS ALT and VT/VF rearrest are unknown. OBJECTIVES This study aimed to determine whether spontaneous VT/VF rearrest induced by DIS ALT occurs in vivo, and if it can be suppressed by preserving Cx43-mediated GJ coupling and/or connectivity. METHODS We used an in vivo porcine model of resuscitation from ischemia-induced cardiac arrest combined with ex vivo optical mapping in porcine left ventricular wedge preparations. RESULTS In vivo, DIS ALT frequently preceded VT/VF and paralleled its incidence at normal (37°C, n = 9) and mild hypothermia (33°C, n = 8) temperatures. Maintaining GJs in vivo with rotigaptide (n = 10) reduced DIS ALT and VT/VF incidence, especially during mild hypothermia, by 90% and 60%, respectively (P < 0.001; P < 0.013). Ex vivo, both rotigaptide (n = 5) and αCT11 (n = 7), a Cx43 mimetic peptide that promotes GJ connectivity, significantly reduced DIS ALT by 60% and 100%, respectively (P < 0.05; P < 0.005), and this reduction was associated with reduced intrinsic heterogeneities of action potential duration rather than changes in conduction velocity restitution. CONCLUSIONS These results provide the strongest in vivo evidence to date suggesting a causal relationship between spontaneous DIS ALT and VT/VF in a clinically realistic scenario. Furthermore, our results suggest that preserving GJs during resuscitation can suppress VT/VF rearrest.
Collapse
Affiliation(s)
- Kenneth R Laurita
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Joseph S Piktel
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA; Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Laken Irish
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Michelle Nassal
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Aurelia Cheng
- Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Matthew McCauley
- Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Gary Pawlowski
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Adrienne T Dennis
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yi Suen
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA; Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Soufian Almahameed
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ohad Ziv
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Robert G Gourdie
- Fralin Biomedical Research Institute, Virginia Tech University, Roanoke, Virginia, USA
| | - Lance D Wilson
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA; Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
2
|
Wisløff‐Aase K, Skulstad H, Haugaa K, Lingaas PS, Beitnes JO, Halvorsen PS, Espinoza A. Myocardial electrophysiological and mechanical changes caused by moderate hypothermia-A clinical study. Physiol Rep 2022; 10:e15259. [PMID: 35439365 PMCID: PMC9017970 DOI: 10.14814/phy2.15259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023] Open
Abstract
Moderate hypothermia has been used to improve outcomes in comatose out-of-hospital cardiac arrest survivors during the past two decades, although the effects remain controversial. We have recently shown in an experimental study that myocardial electrophysiological and mechanical relationships were altered during moderate hypothermia. Electromechanical window positivity increased, and electrical dispersion of repolarization decreased, both of which are changes associated with decreased arrhythmogenicity in clinical conditions. Mechanical dispersion, a parameter also linked to arrhythmic risk, remained unaltered. Whether corresponding electrophysiological and mechanical changes occur in humans during moderate hypothermia, has not been previously explored. Twenty patients with normal left ventricular function were included. Measurements were obtained at 36 and 32°C prior to ascending aortic repair while on partial cardiopulmonary bypass and at 36°C after repair. Registrations were performed in the presence of both spontaneous and comparable paced heart rate during standardized loading conditions. The following electrical and mechanical parameters were explored: (1) Electromechanical window, measured as time difference between mechanical and electrical systole, (2) dispersion of repolarization from ECG T-wave, and (3) mechanical dispersion, measured as segmental variation in time to peak echocardiographic strain. At moderate hypothermia, mechanical systolic prolongation (425 ± 43-588 ± 67 ms, p < 0.001) exceeded electrical systolic prolongation (397 ± 49-497 ± 79 ms, p < 0.001), whereby, electromechanical window positivity increased (29 ± 30-86 ± 50 ms, p < 0.001). Dispersion of repolarization and mechanical dispersion remained unchanged. Corresponding electrophysiological and mechanical relationships were present at comparable paced heart rates. After rewarming, the increased electromechanical window was reversed in the presence of both spontaneous and paced heart rates. Moderate hypothermia increased electromechanical window positivity, while dispersion of repolarization and mechanical dispersion remained unchanged. This impact of hypothermia may be clinically relevant for selected groups of patients after cardiac arrest.
Collapse
Affiliation(s)
- Kristin Wisløff‐Aase
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway
- Departments of Research and DevelopmentDivision of Emergencies and Critical CareOslo University HospitalOsloNorway
| | - Helge Skulstad
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway
- ProCardio Centre for InnovationDepartment of CardiologyOslo University HospitalOsloNorway
- The Intervention CentreOslo University HospitalOsloNorway
| | - Kristina Haugaa
- ProCardio Centre for InnovationDepartment of CardiologyOslo University HospitalOsloNorway
- Karolinska Institute and Cardiovascular DivisionFaculty of MedicineKarolinska University HospitalStockholmSweden
| | | | - Jan Otto Beitnes
- ProCardio Centre for InnovationDepartment of CardiologyOslo University HospitalOsloNorway
| | - Per Steinar Halvorsen
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway
- The Intervention CentreOslo University HospitalOsloNorway
| | | |
Collapse
|
3
|
Electro-anatomical computational cardiology in humans and experimental animal models. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
4
|
Daimi H, Lozano-Velasco E, Aranega A, Franco D. Genomic and Non-Genomic Regulatory Mechanisms of the Cardiac Sodium Channel in Cardiac Arrhythmias. Int J Mol Sci 2022; 23:1381. [PMID: 35163304 PMCID: PMC8835759 DOI: 10.3390/ijms23031381] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/30/2021] [Accepted: 01/06/2022] [Indexed: 12/19/2022] Open
Abstract
Nav1.5 is the predominant cardiac sodium channel subtype, encoded by the SCN5A gene, which is involved in the initiation and conduction of action potentials throughout the heart. Along its biosynthesis process, Nav1.5 undergoes strict genomic and non-genomic regulatory and quality control steps that allow only newly synthesized channels to reach their final membrane destination and carry out their electrophysiological role. These regulatory pathways are ensured by distinct interacting proteins that accompany the nascent Nav1.5 protein along with different subcellular organelles. Defects on a large number of these pathways have a tremendous impact on Nav1.5 functionality and are thus intimately linked to cardiac arrhythmias. In the present review, we provide current state-of-the-art information on the molecular events that regulate SCN5A/Nav1.5 and the cardiac channelopathies associated with defects in these pathways.
Collapse
Affiliation(s)
- Houria Daimi
- Biochemistry and Molecular Biology Laboratory, Faculty of Pharmacy, University of Monastir, Monastir 5000, Tunisia
| | - Estefanía Lozano-Velasco
- Department of Experimental Biology, University of Jaen, 23071 Jaen, Spain; (E.L.-V.); (A.A.); (D.F.)
- Medina Foundation, Technology Park of Health Sciences, Av. del Conocimiento, 34, 18016 Granada, Spain
| | - Amelia Aranega
- Department of Experimental Biology, University of Jaen, 23071 Jaen, Spain; (E.L.-V.); (A.A.); (D.F.)
- Medina Foundation, Technology Park of Health Sciences, Av. del Conocimiento, 34, 18016 Granada, Spain
| | - Diego Franco
- Department of Experimental Biology, University of Jaen, 23071 Jaen, Spain; (E.L.-V.); (A.A.); (D.F.)
- Medina Foundation, Technology Park of Health Sciences, Av. del Conocimiento, 34, 18016 Granada, Spain
| |
Collapse
|
5
|
Lee HL, Chang PC, Wo HT, Liu HT, Wen MS, Chou CC. Beneficial Electrophysiological Effects of Rotigaptide Are Unable to Suppress Therapeutic Hypothermia-Provoked Ventricular Fibrillation in Failing Rabbit Hearts With Acute Ischemia-Reperfusion Injury. Front Physiol 2021; 12:726389. [PMID: 34588996 PMCID: PMC8473906 DOI: 10.3389/fphys.2021.726389] [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: 07/06/2021] [Accepted: 08/18/2021] [Indexed: 11/26/2022] Open
Abstract
Aims: Whether therapeutic hypothermia (TH) is proarrhythmic in preexisting failing hearts with acute ischemia–reperfusion (IR) injury is unknown. Additionally, the effectiveness of rotigaptide on improving conduction slowing in hearts with IR injury is ambiguous. We investigated the electrophysiological effects of TH and rotigaptide in failing rabbit hearts with acute IR injury and determined the underlying molecular mechanisms. Methods and Results: Heart failure was induced by right ventricular pacing (320 beats/min, 4 weeks). Rabbits with pacing-induced heart failure were randomly divided into TH (n = 14) and non-TH (n = 7) groups. The IR rabbit model was created by ligating the coronary artery for 60 min, followed by reperfusion for 15 min in vivo. Then, the hearts were excised quickly and Langendorff-perfused for simultaneous voltage and intracellular Ca2+ (Cai) optical mapping. Electrophysiological studies were conducted, and vulnerability to ventricular fibrillation (VF) was evaluated using pacing protocols. TH (33°C) was instituted after baseline studies, and electrophysiological studies were repeated. Rotigaptide (300 nM) was infused for 20 min, and electrophysiological studies were repeated under TH. Cardiac tissues were sampled for Western blotting. TH increased the dispersion and beat-to-beat variability of action potential duration (APD), aggravated conduction slowing, and prolonged Cai decay to facilitate spatially discordant alternans (SDA) and VF induction. Rotigaptide reduced the dispersion and beat-to-beat variability of APD and improved slowed conduction to defer the onset of arrhythmogenic SDA by dynamic pacing and elevate the pacing threshold of VF during TH. However, the effect of rotigaptide on TH-enhanced VF inducibility was statistically insignificant. TH attenuated IR-induced dysregulation of protein expression, but its functional role remained uncertain. Conclusion: Therapeutic hypothermia is proarrhythmic in failing hearts with acute IR injury. Rotigaptide improves TH-induced APD dispersion and beat-to-beat variability and conduction disturbance to defer the onset of arrhythmogenic SDA and elevate the VF threshold by dynamic pacing, but these beneficial electrophysiological effects are unable to suppress TH-enhanced VF inducibility significantly.
Collapse
Affiliation(s)
- Hui-Ling Lee
- Department of Anesthesia, Chang Gung Memorial Hospital, Taipei City, Taiwan
| | - Po-Cheng Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Hung-Ta Wo
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Hao-Tien Liu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Ming-Shien Wen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chung-Chuan Chou
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| |
Collapse
|
6
|
Mullen I, Abella BS. Practical considerations for postarrest targeted temperature management. Turk J Emerg Med 2020; 20:157-162. [PMID: 33089022 PMCID: PMC7549514 DOI: 10.4103/2452-2473.297466] [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: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 11/04/2022] Open
Abstract
Out-of-hospital cardiac arrest remains a major challenge worldwide, with survival to discharge rates of <20% in the great majority of countries. Advancements in prehospital care, including increasing deployment of automated external defibrillators and improvements in bystander cardiopulmonary resuscitation, have led to more victims achieving return of spontaneous circulation (ROSC), yet the majority of patients with ROSC suffer in-hospital mortality or significant neurologic injuries that persist after discharge. This postarrest morbidity and mortality is largely due to a complex syndrome of mitochondrial dysfunction, inflammatory cascades and cellular injuries known as the postcardiac arrest syndrome (PCAS). The management of PCAS represents a formidable task for emergency and critical care providers. A cornerstone of PCAS treatment is the use of aggressive core body temperature control using thermostatically controlled devices, known as targeted temperature management (TTM). This therapy, demonstrated to be effective in improving both survival and neurologic recovery by several randomized controlled trials nearly 20 years ago, remains a major topic of clinical investigation. Important practical questions about TTM remain: How soon must providers initiate the therapy? What TTM goal temperature maximizes benefit while limiting potential adverse effects? How long should TTM therapy be continued in patients following resuscitation? In this review, we will address these issues and summarize clinical research over the past decade that has added to our fund of knowledge surrounding this important treatment of patients following cardiac arrest.
Collapse
Affiliation(s)
- Isabelle Mullen
- Department of Emergency Medicine, The Center for Resuscitation Science, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin S Abella
- Department of Emergency Medicine, The Center for Resuscitation Science, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
7
|
Choy JS, Berwick ZC, Kalasho BD, Fu L, Bhatt DL, Navia JA, Kassab GS. Selective Autoretroperfusion Provides Substantial Cardioprotection in Swine: Incremental Improvements With Mild Hypothermia. ACTA ACUST UNITED AC 2020; 5:267-278. [PMID: 32215349 PMCID: PMC7091507 DOI: 10.1016/j.jacbts.2019.12.004] [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: 05/06/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 11/28/2022]
Abstract
SARP of coronary veins alone or in combination with focal MH-SARP provided cardioprotection following occlusion of the left anterior descending artery. Significant reduction in infarct size was achieved with MH-SARP and SARP with preservation of myocardial function and cell integrity. MH-SARP or SARP may provide a clinically relevant percutaneous short-term option of cardiac support to high-risk patients undergoing percutaneous coronary intervention.
Mild hypothermia (MH) and retroperfusion are 2 techniques proposed to reduce infarct size due to myocardial infarction. The authors evaluated the effects of focal MH combined with selective coronary venous autoretroperfusion (SARP) as an acute cardioprotective modality before percutaneous coronary intervention (PCI) in a swine model of left ventricular myocardial infarction. Significant reduction in infarct size with preservation of cardiac function and cardiomyocyte viability were achieved. The authors propose that SARP alone or in combination with MH may provide a clinically relevant percutaneous short-term option of cardiac support to high-risk patients undergoing PCI.
Collapse
Key Words
- AMI, acute myocardial infarction
- EF, ejection fraction
- GCV, great cardiac vein
- IABP, intra-aortic balloon pump
- LAD, left anterior descending coronary artery
- LV, left ventricle/ventricular
- MH, mild hypothermia
- PCI, percutaneous coronary intervention
- PO2, partial pressure of oxygen
- SARP, selective autoretroperfusion
- STEMI, ST-segment elevation myocardial infarction
- acute myocardial infarction
- cTnI, cardiac troponin I
- cardioprotection
- focal mild-hypothermia
- miR, microRNA
- selective autoretroperfusion
Collapse
Affiliation(s)
- Jenny S Choy
- California Medical Innovations Institute, San Diego, California
| | | | | | - Lijuan Fu
- California Medical Innovations Institute, San Diego, California
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Jose A Navia
- Department of Surgery, Austral University, Buenos Aires, Argentina
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, California.,3DT Holdings, San Diego, California
| |
Collapse
|
8
|
Lindsey ML, Gray GA, Wood SK, Curran-Everett D. Statistical considerations in reporting cardiovascular research. Am J Physiol Heart Circ Physiol 2018; 315:H303-H313. [PMID: 30028200 PMCID: PMC6139626 DOI: 10.1152/ajpheart.00309.2018] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The problem of inadequate statistical reporting is long standing and widespread in the biomedical literature, including in cardiovascular physiology. Although guidelines for reporting statistics have been available in clinical medicine for some time, there are currently no guidelines specific to cardiovascular physiology. To assess the need for guidelines, we determined the type and frequency of statistical tests and procedures currently used in the American Journal of Physiology-Heart and Circulatory Physiology. A PubMed search for articles published in the American Journal of Physiology-Heart and Circulatory Physiology between January 1, 2017, and October 6, 2017, provided a final sample of 146 articles evaluated for methods used and 38 articles for indepth analysis. The t-test and ANOVA accounted for 71% (212 of 300 articles) of the statistical tests performed. Of six categories of post hoc tests, Bonferroni and Tukey tests were used in 63% (62 of 98 articles). There was an overall lack in details provided by authors publishing in the American Journal of Physiology-Heart and Circulatory Physiology, and we compiled a list of recommended minimum reporting guidelines to aid authors in preparing manuscripts. Following these guidelines could substantially improve the quality of statistical reports and enhance data rigor and reproducibility.
Collapse
Affiliation(s)
- Merry L Lindsey
- Mississippi Center for Heart Research, Department of Physiology and Biophysics, University of Mississippi Medical Center , Jackson, Mississippi.,Research Service, G. V. (Sonny) Montgomery Veterans Affairs Medical Center , Jackson, Mississippi
| | - Gillian A Gray
- British Heart Foundation/University Centre for Cardiovascular Science, Edinburgh Medical School, University of Edinburgh , Edinburgh , United Kingdom
| | - Susan K Wood
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine , Columbia, South Carolina
| | - Douglas Curran-Everett
- Division of Biostatistics and Bioinformatics, National Jewish Health , Denver, Colorado.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver , Denver, Colorado
| |
Collapse
|
9
|
|
10
|
Brooks HL, Lindsey ML. Guidelines for authors and reviewers on antibody use in physiology studies. Am J Physiol Heart Circ Physiol 2018; 314:H724-H732. [PMID: 29351459 PMCID: PMC6048465 DOI: 10.1152/ajpheart.00512.2017] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Antibody use is a critical component of cardiovascular physiology research, and antibodies are used to monitor protein abundance (immunoblot analysis) and protein expression and localization (in tissue by immunohistochemistry and in cells by immunocytochemistry). With ongoing discussions on how to improve reproducibility and rigor, the goal of this review is to provide best practice guidelines regarding how to optimize antibody use for increased rigor and reproducibility in both immunoblot analysis and immunohistochemistry approaches. Listen to this article’s corresponding podcast at http://ajpheart.podbean.com/e/guidelines-on-antibody-use-in-physiology-studies/.
Collapse
Affiliation(s)
- Heddwen L Brooks
- Department of Physiology, Pharmacology and Medicine, Sarver Heart Center, College of Medicine, University of Arizona , Tucson, Arizona
| | - Merry L Lindsey
- Mississippi Center for Heart Research, Department of Physiology and Biophysics, University of Mississippi Medical Center , Jackson, Mississippi.,Research Service, G.V. (Sonny) Montgomery Veterans Affairs Medical Center , Jackson, Mississippi
| |
Collapse
|
11
|
Fukaya H, Piktel JS, Wan X, Plummer BN, Laurita KR, Wilson LD. Arrhythmogenic Delayed Afterdepolarizations Are Promoted by Severe Hypothermia But Not Therapeutic Hypothermia. Circ J 2018; 82:62-70. [DOI: 10.1253/circj.cj-17-0145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hidehira Fukaya
- The Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Joseph S. Piktel
- The Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University
- Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University
| | - Xiaoping Wan
- The Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University
| | - Bradley N. Plummer
- The Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University
| | - Kenneth R. Laurita
- The Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University
| | - Lance D. Wilson
- The Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University
- Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University
| |
Collapse
|
12
|
Piktel JS, Cheng A, McCauley M, Dale Z, Nassal M, Maleski D, Pawlowski G, Laurita KR, Wilson LD. Hypothermia Modulates Arrhythmia Substrates During Different Phases of Resuscitation From Ischemic Cardiac Arrest. J Am Heart Assoc 2017; 6:JAHA.117.006472. [PMID: 29150491 PMCID: PMC5721747 DOI: 10.1161/jaha.117.006472] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background We designed an innovative porcine model of ischemia‐induced arrest to determine dynamic arrhythmia substrates during focal infarct, global ischemia from ventricular tachycardia or fibrillation (VT/VF) and then reperfusion to determine the effect of therapeutic hypothermia (TH) on dynamic arrhythmia substrates and resuscitation outcomes. Methods and Results Anesthetized adult pigs underwent thoracotomy and regional plunge electrode placement in the left ventricle. Subjects were then maintained at either control (CT; 37°C, n=9) or TH (33°C, n=8). The left anterior descending artery (LAD) was occluded and ventricular fibrillation occurred spontaneously or was induced after 30 minutes. Advanced cardiac life support was started after 8 minutes, and LAD reperfusion occurred 60 minutes after occlusion. Incidences of VF/VT and survival were compared with ventricular ectopy, cardiac alternans, global dispersion of repolarization during LAD occlusion, and LAD reperfusion. There was no difference in incidence of VT/VF between groups during LAD occlusion (44% in CT versus 50% in TH; P=1s). During LAD occlusion, ectopy was increased in CT and suppressed in TH (33±11 ventricular ectopic beats/min versus 4±6 ventricular ectopic beats/min; P=0.009). Global dispersion of repolarization and cardiac alternans were similar between groups. During LAD reperfusion, TH doubled the incidence of cardiac alternans compared with CT, with a marked increase in VF/VT (100% in TH versus 17% in CT; P=0.004). Ectopy and global dispersion of repolarization were similar between groups during LAD reperfusion. Conclusions TH alters arrhythmia substrates in a porcine translational model of resuscitation from ischemic cardiac arrest during the complex phases of resuscitation. TH worsens cardiac alternans, which was associated with an increase in spontaneous VT/VF during reperfusion.
Collapse
Affiliation(s)
- Joseph S Piktel
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OH
| | - Aurelia Cheng
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OH
| | - Matthew McCauley
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OH
| | - Zack Dale
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OH
| | - Michelle Nassal
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OH
| | - Danielle Maleski
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OH
| | - Gary Pawlowski
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OH
| | - Kenneth R Laurita
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OH
| | - Lance D Wilson
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OH
| |
Collapse
|