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Song T, Hui W, Huang M, Guo Y, Yu M, Yang X, Liu Y, Chen X. Dynamic Changes in Ion Channels during Myocardial Infarction and Therapeutic Challenges. Int J Mol Sci 2024; 25:6467. [PMID: 38928173 PMCID: PMC11203447 DOI: 10.3390/ijms25126467] [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: 04/20/2024] [Revised: 06/02/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
In different areas of the heart, action potential waveforms differ due to differences in the expressions of sodium, calcium, and potassium channels. One of the characteristics of myocardial infarction (MI) is an imbalance in oxygen supply and demand, leading to ion imbalance. After MI, the regulation and expression levels of K+, Ca2+, and Na+ ion channels in cardiomyocytes are altered, which affects the regularity of cardiac rhythm and leads to myocardial injury. Myocardial fibroblasts are the main effector cells in the process of MI repair. The ion channels of myocardial fibroblasts play an important role in the process of MI. At the same time, a large number of ion channels are expressed in immune cells, which play an important role by regulating the in- and outflow of ions to complete intracellular signal transduction. Ion channels are widely distributed in a variety of cells and are attractive targets for drug development. This article reviews the changes in different ion channels after MI and the therapeutic drugs for these channels. We analyze the complex molecular mechanisms behind myocardial ion channel regulation and the challenges in ion channel drug therapy.
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Affiliation(s)
- Tongtong Song
- Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun 130012, China; (T.S.); (W.H.); (M.H.); (Y.G.); (M.Y.); (X.Y.); (Y.L.)
- Department of Anatomy, College of Basic Medical Sciences, Jilin University, Changchun 130012, China
| | - Wenting Hui
- Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun 130012, China; (T.S.); (W.H.); (M.H.); (Y.G.); (M.Y.); (X.Y.); (Y.L.)
| | - Min Huang
- Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun 130012, China; (T.S.); (W.H.); (M.H.); (Y.G.); (M.Y.); (X.Y.); (Y.L.)
| | - Yan Guo
- Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun 130012, China; (T.S.); (W.H.); (M.H.); (Y.G.); (M.Y.); (X.Y.); (Y.L.)
| | - Meiyi Yu
- Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun 130012, China; (T.S.); (W.H.); (M.H.); (Y.G.); (M.Y.); (X.Y.); (Y.L.)
| | - Xiaoyu Yang
- Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun 130012, China; (T.S.); (W.H.); (M.H.); (Y.G.); (M.Y.); (X.Y.); (Y.L.)
| | - Yanqing Liu
- Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun 130012, China; (T.S.); (W.H.); (M.H.); (Y.G.); (M.Y.); (X.Y.); (Y.L.)
| | - Xia Chen
- Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun 130012, China; (T.S.); (W.H.); (M.H.); (Y.G.); (M.Y.); (X.Y.); (Y.L.)
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Iravanian S, Uzelac I, Shah AD, Toye MJ, Lloyd MS, Burke MA, Daneshmand MA, Attia TS, Vega JD, El-Chami MF, Merchant FM, Cherry EM, Bhatia NK, Fenton FH. Complex repolarization dynamics in ex vivo human ventricles are independent of the restitution properties. Europace 2023; 25:euad350. [PMID: 38006390 PMCID: PMC10751849 DOI: 10.1093/europace/euad350] [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: 09/10/2023] [Accepted: 11/13/2023] [Indexed: 11/27/2023] Open
Abstract
AIMS The mechanisms of transition from regular rhythms to ventricular fibrillation (VF) are poorly understood. The concordant to discordant repolarization alternans pathway is extensively studied; however, despite its theoretical centrality, cannot guide ablation. We hypothesize that complex repolarization dynamics, i.e. oscillations in the repolarization phase of action potentials with periods over two of classic alternans, is a marker of electrically unstable substrate, and ablation of these areas has a stabilizing effect and may reduce the risk of VF. To prove the existence of higher-order periodicities in human hearts. METHODS AND RESULTS We performed optical mapping of explanted human hearts obtained from recipients of heart transplantation at the time of surgery. Signals recorded from the right ventricle endocardial surface were processed to detect global and local repolarization dynamics during rapid pacing. A statistically significant global 1:4 peak was seen in three of six hearts. Local (pixel-wise) analysis revealed the spatially heterogeneous distribution of Periods 4, 6, and 8, with the regional presence of periods greater than two in all the hearts. There was no significant correlation between the underlying restitution properties and the period of each pixel. CONCLUSION We present evidence of complex higher-order periodicities and the co-existence of such regions with stable non-chaotic areas in ex vivo human hearts. We infer that the oscillation of the calcium cycling machinery is the primary mechanism of higher-order dynamics. These higher-order regions may act as niduses of instability and may provide targets for substrate-based ablation of VF.
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Affiliation(s)
- Shahriar Iravanian
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA 30322, USA
| | - Ilija Uzelac
- Georgia Institute of Technology, Department of Physics, 837 State St NW, Atlanta, GA 30332, USA
| | - Anand D Shah
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA 30322, USA
| | - Mikael J Toye
- Georgia Institute of Technology, Department of Physics, 837 State St NW, Atlanta, GA 30332, USA
| | - Michael S Lloyd
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA 30322, USA
| | - Michael A Burke
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA 30322, USA
| | - Mani A Daneshmand
- Department of Surgery, Division of Cardiovascular Surgery, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA 30322, USA
| | - Tamer S Attia
- Department of Surgery, Division of Cardiovascular Surgery, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA 30322, USA
| | - John David Vega
- Department of Surgery, Division of Cardiovascular Surgery, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA 30322, USA
| | - Mikhael F El-Chami
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA 30322, USA
| | - Faisal M Merchant
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA 30322, USA
| | - Elizabeth M Cherry
- Georgia Institute of Technology, Department of Physics, 837 State St NW, Atlanta, GA 30332, USA
| | - Neal K Bhatia
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA 30322, USA
| | - Flavio H Fenton
- Georgia Institute of Technology, Department of Physics, 837 State St NW, Atlanta, GA 30332, USA
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Zhang Z, Brugada P, Weiss JN, Qu Z. Phase 2 Re-Entry Without I to: Role of Sodium Channel Kinetics in Brugada Syndrome Arrhythmias. JACC Clin Electrophysiol 2023; 9:2459-2474. [PMID: 37831035 DOI: 10.1016/j.jacep.2023.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/27/2023] [Accepted: 08/23/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND In Brugada syndrome (BrS), phase 2 re-excitation/re-entry (P2R) induced by the transient outward potassium current (Ito) is a proposed arrhythmia mechanism; yet, the most common genetic defects are loss-of-function sodium channel mutations. OBJECTIVES The authors used computer simulations to investigate how sodium channel dysfunction affects P2R-mediated arrhythmogenesis in the presence and absence of Ito. METHODS Computer simulations were carried out in 1-dimensional cables and 2-dimensional tissue using guinea pig and human ventricular action potential models. RESULTS In the presence of Ito sufficient to generate robust P2R, reducing sodium current (INa) peak amplitude alone only slightly potentiated P2R. When INa inactivation kinetics were also altered to simulate reported effects of BrS mutations and sodium channel blockers, however, P2R occurred even in the absence of Ito. These effects could be potentiated by delaying L-type calcium channel activation or increasing ATP-sensitive potassium current, consistent with experimental and clinical findings. INa-mediated P2R also accounted for sex-related, day and night-related, and fever-related differences in arrhythmia risk in BrS patients. CONCLUSIONS Altered INa kinetics synergize powerfully with reduced INa amplitude to promote P2R-induced arrhythmias in BrS in the absence of Ito, establishing a robust mechanistic link between altered INa kinetics and the P2R-mediated arrhythmia mechanism.
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Affiliation(s)
- Zhaoyang Zhang
- Department of Physics, School of Physical Science and Technology, Ningbo University, Ningbo, Zhejiang, China; Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - James N Weiss
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Zhilin Qu
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
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Iravanian S, Uzelac I, Shah AD, Toye MJ, Lloyd MS, Burke MA, Daneshmand MA, Attia TS, Vega JD, El-Chami M, Merchant FM, Cherry EM, Bhatia NK, Fenton FH. Higher-Order Dynamics Beyond Repolarization Alternans in Ex-Vivo Human Ventricles are Independent of the Restitution Properties. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.16.23293853. [PMID: 37662394 PMCID: PMC10473769 DOI: 10.1101/2023.08.16.23293853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background Repolarization alternans, defined as period-2 oscillation in the repolarization phase of the action potentials, provides a mechanistic link between cellular dynamics and ventricular fibrillation (VF). Theoretically, higher-order periodicities (e.g., periods 4, 6, 8,...) are expected but have minimal experimental evidence. Methods We studied explanted human hearts obtained from recipients of heart transplantation at the time of surgery. Optical mapping of the transmembrane potential was performed after staining the hearts with voltage-sensitive fluorescent dyes. Hearts were stimulated at an increasing rate until VF was induced. Signals recorded from the right ventricle endocardial surface prior to induction of VF and in the presence of 1:1 conduction were processed using the Principal Component Analysis and a combinatorial algorithm to detect and quantify higher-order dynamics. Results were correlated to the underlying electrophysiological characteristics as quantified by restitution curves and conduction velocity. Results A prominent and statistically significant global 1:4 peak (corresponding to period-4 dynamics) was seen in three of the six studied hearts. Local (pixel-wise) analysis revealed the spatially heterogeneous distribution of periods 4, 6, and 8, with the regional presence of periods greater than two in all the hearts. There was no significant correlation between the underlying restitution properties and the period of each pixel. Discussion We present evidence of higher-order periodicities and the co-existence of such regions with stable non-chaotic areas in ex-vivo human hearts. We infer from the independence of the period to the underlying restitution properties that the oscillation of the excitation-contraction coupling and calcium cycling mechanisms is the primary mechanism of higher-order dynamics. These higher-order regions may act as niduses of instability that can degenerate into chaotic fibrillation and may provide targets for substrate-based ablation of VF.
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Affiliation(s)
- Shahriar Iravanian
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, GA
| | - Ilija Uzelac
- Georgia Tech, Department of Physics, Atlanta, GA
| | - Anand D Shah
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, GA
| | | | - Michael S. Lloyd
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael A. Burke
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, GA
| | - Mani A Daneshmand
- Division of Cardiovascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Tamer S Attia
- Division of Cardiovascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - J David Vega
- Division of Cardiovascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Michael El-Chami
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, GA
| | - Faisal M. Merchant
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, GA
| | | | - Neal K. Bhatia
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, GA
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Kataoka N, Nagase S, Imamura T, Kinugawa K. Dynamics of unipolar J-ST elevation coupled to bipolar delayed potentials on the epicardium in Brugada syndrome: a case report. Eur Heart J Case Rep 2023; 7:ytad377. [PMID: 37575530 PMCID: PMC10415855 DOI: 10.1093/ehjcr/ytad377] [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: 01/08/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
Background The area of abnormal bipolar potentials in the right ventricular epicardium is recognized as an arrhythmogenic substrate in patients with Brugada syndrome (BrS); however, the correlation between local potentials and Brugada-type surface electrocardiograms (ECGs) remains unclear. Case summary A 49-year-old man with BrS who was hospitalized for refractory ventricular fibrillation underwent an electrocardiographic study with unipolar electrodes with the same bandwidth as surface ECGs. The right ventricular outflow tract epicardium showed abnormal bipolar potentials composed of split sharp and delayed dull components with coved-type J-ST elevation in the unipolar electrodes. The additional stimuli from the atrium gradually decreased the number of unipolar electrodes showing coved-type J-ST elevation along with a shortening of the local bipolar activation time. The pilsicainide provocation test induced a change in unipolar morphology from coved type to convex type and an intermittent local block of the divided and sharp components in bipolar electrodes. Of note, the unipolar J-ST elevation was not changed along with the localized conduction block in bipolar leads. Discussion The unipolar electrode waveforms during sinus rhythm change together with bipolar electrodes, consisting of sharp and blunt components in BrS. However, the convex-type J-ST elevation in unipolar leads persisted irrespective of the local conduction block in bipolar leads after pilsicainide provocation. These findings suggest the complexity of BrS mechanisms.
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Affiliation(s)
- Naoya Kataoka
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Satoshi Nagase
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
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Iravanian S, Uzelac I, Shah AD, Toye MJ, Lloyd MS, Burke MA, Daneshmand MA, Attia TS, Vega JD, Merchant FM, Cherry EM, Bhatia NK, Fenton FH. Beyond Alternans: Detection of Higher-Order Periodicity in Ex-Vivo Human Ventricles Before Induction of Ventricular Fibrillation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.01.539003. [PMID: 37205562 PMCID: PMC10187180 DOI: 10.1101/2023.05.01.539003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Repolarization alternans, defined as period-2 oscillation in the repolarization phase of the action potentials, is one of the cornerstones of cardiac electrophysiology as it provides a mechanistic link between cellular dynamics and ventricular fibrillation (VF). Theoretically, higher-order periodicities (e.g., period-4, period-8,...) are expected but have very limited experimental evidence. Methods We studied explanted human hearts, obtained from the recipients of heart transplantation at the time of surgery, using optical mapping technique with transmembrane voltage-sensitive fluorescent dyes. The hearts were stimulated at an increasing rate until VF was induced. The signals recorded from the right ventricle endocardial surface just before the induction of VF and in the presence of 1:1 conduction were processed using the Principal Component Analysis and a combinatorial algorithm to detect and quantify higher-order dynamics. Results A prominent and statistically significant 1:4 peak (corresponding to period-4 dynamics) was seen in three of the six studied hearts. Local analysis revealed the spatiotemporal distribution of higher-order periods. Period-4 was localized to temporally stable islands. Higher-order oscillations (period-5, 6, and 8) were transient and primarily occurred in arcs parallel to the activation isochrones. Discussion We present evidence of higher-order periodicities and the co-existence of such regions with stable non-chaotic areas in ex-vivo human hearts before VF induction. This result is consistent with the period-doubling route to chaos as a possible mechanism of VF initiation, which complements the concordant to discordant alternans mechanism. The presence of higher-order regions may act as niduses of instability that can degenerate into chaotic fibrillation.
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Wang X, Wei L, Wu Y, Yan J, Zhao L, Yue X, Gao C. ST-segment elevation predicts the occurrence of malignant ventricular arrhythmia events in patients with acute ST-segment elevation myocardial infarction. BMC Cardiovasc Disord 2023; 23:61. [PMID: 36732698 PMCID: PMC9896671 DOI: 10.1186/s12872-023-03099-w] [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: 10/05/2022] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND ST-segment elevation (STE) represents a repolarization dispersion marker underlying arrhythmogenesis in ST-segment elevation myocardial infarction (STEMI); however, its value for predicting malignant ventricular arrhythmia events (MVAEs) remains uncertain. METHODS In total, 285 patients with STEMI and those with or without MVAEs who presented within 6 h of symptom onset were enrolled. The relationships between STE and clinical characteristics of MVAEs (defined as ventricular tachycardia or ventricular fibrillation) were analyzed using t-test, chi-square test, binary multivariate logistic regression, and receiver operating characteristic curve analysis. RESULTS Patients with STEMI and MVAEs had a shorter time from symptom onset to balloon time (p = 0.0285) and greater STE (p < 0.01) than those without MVAEs. The symptom-to-balloon time, age, and STE were associated with MVAEs after stepwise regression analysis in all cases. Only STE was significantly associated with the occurrence of MVAEs (all, p < 0.01). The area under the curve (AUC) of STE for predicting MVAEs was 0.905, and the cut-off value was 4.5 mV. When only infarct-related arteries were included in the analysis, the AUC of the left anterior descending artery was 0.925 with a cut-off value of 4.5 mV, that of the right coronary artery was 0.915 with a cut-off value of 4.5 mV, and that of the left circumflex artery was 0.929 with a cut-off value of 4.0 mV. CONCLUSIONS In patients with STEMI presenting within 6 h of symptom onset, age, symptom-to-balloon time, and STE were the main predictors for MVAEs. However, among these, STE was the strongest predictor for MVAEs and was an index for repolarization dispersion of cardiomyocytes in infarcted and non-infarcted areas.
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Affiliation(s)
- Xianpei Wang
- Department of Cardiology, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou University Central China Fuwai Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou, Henan Province, China.
| | - Lifang Wei
- grid.414011.10000 0004 1808 090XDepartment of Cardiology, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou University Central China Fuwai Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou, Henan Province China
| | - Ying Wu
- grid.414011.10000 0004 1808 090XHenan Provincial Key Lab for Control of Coronary Heart Disease, Zhengzhou University Central China Fuwai Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan Province China
| | - Juanjuan Yan
- grid.414011.10000 0004 1808 090XDepartment of Cardiology, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou University Central China Fuwai Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou, Henan Province China
| | - Linwei Zhao
- grid.414011.10000 0004 1808 090XDepartment of Cardiology, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou University Central China Fuwai Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou, Henan Province China
| | - Xinjie Yue
- grid.414011.10000 0004 1808 090XDepartment of Cardiology, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou University Central China Fuwai Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou, Henan Province China
| | - Chuanyu Gao
- grid.414011.10000 0004 1808 090XDepartment of Cardiology, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou University Central China Fuwai Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou, Henan Province China ,grid.414011.10000 0004 1808 090XHenan Provincial Key Lab for Control of Coronary Heart Disease, Zhengzhou University Central China Fuwai Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan Province China
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Bernikova OG, Tsvetkova AS, Gonotkov MA, Ovechkin AO, Demidova MM, Azarov JE, Platonov PG. Prolonged repolarization in the early phase of ischemia is associated with ventricular fibrillation development in a porcine model. Front Physiol 2023; 14:1035032. [PMID: 36755793 PMCID: PMC9899978 DOI: 10.3389/fphys.2023.1035032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/09/2023] [Indexed: 01/24/2023] Open
Abstract
Background: Repolarization prolongation can be the earliest electrophysiological change in ischemia, but its role in arrhythmogenesis is unclear. The aim of the present study was to evaluate the early ischemic action potential duration (APD) prolongation concerning its causes, expression in ECG and association with early ischemic ventricular fibrillation (phase 1A VF). Methods: Coronary occlusion was induced in 18 anesthetized pigs, and standard 12 lead ECG along with epicardial electrograms were recorded. Local activation time (AT), end of repolarization time (RT), and activation-repolarization interval (ARIc) were determined as dV/dt minimum during QRS-complex, dV/dt maximum during T-wave, and rate-corrected RT-AT differences, respectively. Patch-clamp studies were done in enzymatically isolated porcine cardiomyocytes. IK(ATP) activation and Ito1 inhibition were tested as possible causes of the APD change. Results: During the initial period of ischemia, a total of 11 pigs demonstrated maximal ARIc prolongation >10 ms at 1 and/or 2.5 min of occlusion (8 and 6 cases at 1 and 2.5 min, respectively) followed by typical ischemic ARIc shortening. The maximal ARIc across all leads was associated with VF development (OR 1.024 95% CI 1.003-1.046, p = 0.025) and maximal rate-corrected QT interval (QTc) (B 0.562 95% CI 0.346-0.775, p < 0.001) in logistic and linear regression analyses, respectively. Phase 1A VF incidence was associated with maximal QTc at the 2.5 min of occlusion in ROC curve analysis (AUC 0.867, p = 0.028) with optimal cut-off 456 ms (sensitivity 1.00, specificity 0.778). The pigs having maximal QTc at 2.5 min more and less than 450 ms significantly differed in phase 1A VF incidence in Kaplan-Meier analysis (log-rank p = 0.007). In the patch-clamp experiments, 4-aminopyridine did not produce any effects on the APD; however, pinacidil activated IK(ATP) and caused a biphasic change in the APD with initial prolongation and subsequent shortening. Conclusion: The transiently prolonged repolarization during the initial period of acute ischemia was expressed in the prolongation of the maximal QTc interval in the body surface ECG and was associated with phase 1A VF. IK(ATP) activation in the isolated cardiomyocytes reproduced the biphasic repolarization dynamics observed in vivo, which suggests the probable role of IK(ATP) in early ischemic arrhythmogenesis.
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Affiliation(s)
- Olesya G. Bernikova
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia,Department of Mathematical Physiology, Institute of Immunology and Physiology, Ural Branch, Russian Academy of Sciences, Ekaterinburg, Russia
| | - Alena S. Tsvetkova
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia,Institute of Medicine, Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
| | - Mikhail A. Gonotkov
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia
| | - Alexey O. Ovechkin
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia,Department of Mathematical Physiology, Institute of Immunology and Physiology, Ural Branch, Russian Academy of Sciences, Ekaterinburg, Russia,Institute of Medicine, Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
| | - Marina M. Demidova
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Jan E. Azarov
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia,Department of Mathematical Physiology, Institute of Immunology and Physiology, Ural Branch, Russian Academy of Sciences, Ekaterinburg, Russia,Institute of Medicine, Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia,Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden,*Correspondence: Jan E. Azarov,
| | - Pyotr G. Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden,Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden
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Ferrero JM, Gonzalez-Ascaso A, Matas JFR. The mechanisms of potassium loss in acute myocardial ischemia: New insights from computational simulations. Front Physiol 2023; 14:1074160. [PMID: 36923288 PMCID: PMC10009276 DOI: 10.3389/fphys.2023.1074160] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/13/2023] [Indexed: 03/03/2023] Open
Abstract
Acute myocardial ischemia induces hyperkalemia (accumulation of extracellular potassium), a major perpetrator of lethal reentrant ventricular arrhythmias. Despite considerable experimental efforts to explain this pathology in the last decades, the intimate mechanisms behind hyperkalemia remain partially unknown. In order to investigate these mechanisms, we developed a novel computational model of acute myocardial ischemia which couples a) an electrophysiologically detailed human cardiomyocyte model that incorporates modifications to account for ischemia-induced changes in transmembrane currents, with b) a model of cardiac tissue and extracellular K + transport. The resulting model is able to reproduce and explain the triphasic time course of extracellular K + concentration within the ischemic zone, with values of [ K + ] o close to 14 mmol/L in the central ischemic zone after 30 min. In addition, the formation of a [ K + ] o border zone of approximately 1.2 cm 15 min after the onset of ischemia is predicted by the model. Our results indicate that the primary rising phase of [ K + ] o is mainly due to the imbalance between K + efflux, that increases slightly, and K + influx, that follows a reduction of the NaK pump activity by more than 50%. The onset of the plateau phase is caused by the appearance of electrical alternans (a novel mechanism identified by the model), which cause an abrupt reduction in the K + efflux. After the plateau, the secondary rising phase of [ K + ] o is caused by a subsequent imbalance between the K + influx, which continues to decrease slowly, and the K + efflux, which remains almost constant. Further, the study shows that the modulation of these mechanisms by the electrotonic coupling is the main responsible for the formation of the ischemic border zone in tissue, with K + transport playing only a minor role. Finally, the results of the model indicate that the injury current established between the healthy and the altered tissue is not sufficient to depolarize non-ischemic cells within the healthy tissue.
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Affiliation(s)
- Jose M Ferrero
- Centro de Investigacion e Innovacion en Bioingenieria, Universitat Politecnica de Valencia, Valencia, Spain
| | - Ana Gonzalez-Ascaso
- Centro de Investigacion e Innovacion en Bioingenieria, Universitat Politecnica de Valencia, Valencia, Spain.,Dipartimento di Chimica, Materiali e Ingegneria Chimica "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Jose F Rodriguez Matas
- Dipartimento di Chimica, Materiali e Ingegneria Chimica "Giulio Natta", Politecnico di Milano, Milan, Italy
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10
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Minnebaeva EV, Durkina AV, Azarov JE, Bernikova OG. Myocardial Electrophysiological Response to Ischemia and Reperfusion Depends on the Age of Rats. J EVOL BIOCHEM PHYS+ 2022. [DOI: 10.1134/s0022093022070079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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11
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Verkerk AO, Doszpod IJ, Mengarelli I, Magyar T, Polyák A, Pászti B, Efimov IR, Wilders R, Koncz I. Acetylcholine Reduces L-Type Calcium Current without Major Changes in Repolarization of Canine and Human Purkinje and Ventricular Tissue. Biomedicines 2022; 10:biomedicines10112987. [PMID: 36428555 PMCID: PMC9687254 DOI: 10.3390/biomedicines10112987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
Abstract
Vagal nerve stimulation (VNS) holds a strong basis as a potentially effective treatment modality for chronic heart failure, which explains why a multicenter VNS study in heart failure with reduced ejection fraction is ongoing. However, more detailed information is required on the effect of acetylcholine (ACh) on repolarization in Purkinje and ventricular cardiac preparations to identify the advantages, risks, and underlying cellular mechanisms of VNS. Here, we studied the effect of ACh on the action potential (AP) of canine Purkinje fibers (PFs) and several human ventricular preparations. In addition, we characterized the effects of ACh on the L-type Ca2+ current (ICaL) and AP of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) and performed computer simulations to explain the observed effects. Using microelectrode recordings, we found a small but significant AP prolongation in canine PFs. In the human myocardium, ACh slightly prolonged the AP in the midmyocardium but resulted in minor AP shortening in subepicardial tissue. Perforated patch-clamp experiments on hiPSC-CMs demonstrated that 5 µM ACh caused an ≈15% decrease in ICaL density without changes in gating properties. Using dynamic clamp, we found that under blocked K+ currents, 5 µM ACh resulted in an ≈23% decrease in AP duration at 90% of repolarization in hiPSC-CMs. Computer simulations using the O'Hara-Rudy human ventricular cell model revealed that the overall effect of ACh on AP duration is a tight interplay between the ACh-induced reduction in ICaL and ACh-induced changes in K+ currents. In conclusion, ACh results in minor changes in AP repolarization and duration of canine PFs and human ventricular myocardium due to the concomitant inhibition of inward ICaL and outward K+ currents, which limits changes in net repolarizing current and thus prevents major changes in AP repolarization.
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Affiliation(s)
- Arie O. Verkerk
- Department of Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Illés J. Doszpod
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, 6721 Szeged, Hungary
| | - Isabella Mengarelli
- Department of Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Tibor Magyar
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, 6721 Szeged, Hungary
| | - Alexandra Polyák
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, 6721 Szeged, Hungary
| | - Bence Pászti
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, 6721 Szeged, Hungary
| | - Igor R. Efimov
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, IL 60611, USA
- Department of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Ronald Wilders
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Correspondence: (R.W.); (I.K.)
| | - István Koncz
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, 6721 Szeged, Hungary
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
- Correspondence: (R.W.); (I.K.)
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12
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Andreou AY. Cardiac Arrest in Acute ST-Segment Elevation Myocardial Infarction. Tex Heart Inst J 2022; 49:487587. [PMID: 36227274 PMCID: PMC9632375 DOI: 10.14503/thij-21-7792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Andreas Y. Andreou
- Department of Cardiology, Limassol General Hospital, Limassol, Cyprus
,University of Nicosia Medical School, Nicosia, Cyprus
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13
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Mc Loughlin MJ, Di Diego JM. Pathophysiology of myocardial currents of injury revisited. J Electrocardiol 2022; 74:54-58. [PMID: 35994822 DOI: 10.1016/j.jelectrocard.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/20/2022] [Accepted: 08/08/2022] [Indexed: 12/13/2022]
Affiliation(s)
| | - José M Di Diego
- Lankenau Institute for Medical Research, Wynnewood, PA, United States of America.
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14
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Krahn AD, Behr ER, Hamilton R, Probst V, Laksman Z, Han HC. Brugada Syndrome. JACC Clin Electrophysiol 2022; 8:386-405. [PMID: 35331438 DOI: 10.1016/j.jacep.2021.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 12/15/2022]
Abstract
Brugada syndrome (BrS) is an "inherited" condition characterized by predisposition to syncope and cardiac arrest, predominantly during sleep. The prevalence is ∼1:2,000, and is more commonly diagnosed in young to middle-aged males, although patient sex does not appear to impact prognosis. Despite the perception of BrS being an inherited arrhythmia syndrome, most cases are not associated with a single causative gene variant. Electrocardiogram (ECG) findings support variable extent of depolarization and repolarization changes, with coved ST-segment elevation ≥2 mm and a negative T-wave in the right precordial leads. These ECG changes are often intermittent, and may be provoked by fever or sodium channel blocker challenge. Growing evidence from cardiac imaging, epicardial ablation, and pathology studies suggests the presence of an epicardial arrhythmic substrate within the right ventricular outflow tract. Risk stratification aims to identify those who are at increased risk of sudden cardiac death, with well-established factors being the presence of spontaneous ECG changes and a history of cardiac arrest or cardiogenic syncope. Current management involves conservative measures in asymptomatic patients, including fever management and drug avoidance. Symptomatic patients typically undergo implantable cardioverter defibrillator insertion, with quinidine and epicardial ablation used for patients with recurrent arrhythmia. This review summarizes our current understanding of BrS and provides clinicians with a practical approach to diagnosis and management.
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Affiliation(s)
- Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Robert Hamilton
- Department of Pediatrics (Cardiology), The Labatt Family Heart Centre and Translational Medicine, The Hospital for Sick Children & Research Institute and the University of Toronto, Toronto, Canada
| | - Vincent Probst
- Cardiologic Department and Reference Center for Hereditary Arrhythmic Diseases, Nantes University Hospital, Nantes, France
| | - Zachary Laksman
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hui-Chen Han
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
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15
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Terminal T-wave inversion predicts reperfusion tachyarrhythmias in STEMI. J Electrocardiol 2022; 71:28-31. [PMID: 35026678 DOI: 10.1016/j.jelectrocard.2021.12.008] [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: 09/29/2021] [Revised: 11/15/2021] [Accepted: 12/23/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION A reliable electrocardiographic predictor of ventricular fibrillation (VF) in patients with ST elevation myocardial infarction (STEMI) is lacking so far. Previous experimental/simulation study suggested a terminal T-wave inversion (TTWI) in ischemia-related ECG leads corresponding to anterior infarct localization as an independent predictor of reperfusion VF (rVF). This T-wave characteristic has never been tested as a rVF predictor in clinical settings. The aim of this study was to test if terminal T-wave inversion (TTWI) at admission ECG (before reperfusion) can serve as a predictor of ventricular fibrillation during reperfusion (rVF) in patients with anterior STEMI undergoing primary PCI. METHODS AND RESULTS Study population included consecutive patients with anterior infarct localization admitted for primary PCI (n = 181, age 65 [57; 76] years, 66% male). Of those, 14 patients had rVF (rVF group, age 59 [47; 76] years, 64% male) and patients without rVF comprised the No-rVF group (n = 167, age 65 [57; 76] years, 66% male). Association of TTWI with rVF was analyzed using logistic regression analysis adjusted for relevant clinical and electrocardiographic covariates. The prevalence of TTWI in rVF group was 62% comparing to 23% in the No-rVF group, p = 0.005. TTWI was associated with increased risk of rVF (OR 5.51; 95% CI 1.70-17.89; p = 0.004) and remained a significant predictor after adjustment for age, gender, history of MI prior to index admission, VF before reperfusion, Tpeak-Tend, maximal ST elevation, and QRS duration (OR 23.49; 95% CI 3.14-175.91; p = 0.002). CONCLUSIONS The terminal T-wave inversion in anterior leads before PCI independently predicted rVF in patients with anterior MI thus confirming the previous experimental/simulation findings.
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16
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Kay MW, Jain V, Panjrath G, Mendelowitz D. Targeting Parasympathetic Activity to Improve Autonomic Tone and Clinical Outcomes. Physiology (Bethesda) 2022; 37:39-45. [PMID: 34486396 PMCID: PMC8742722 DOI: 10.1152/physiol.00023.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
In this review we will briefly summarize the evidence that autonomic imbalance, more specifically reduced parasympathetic activity to the heart, generates and/or maintains many cardiorespiratory diseases and will discuss mechanisms and sites, from myocytes to the brain, that are potential translational targets for restoring parasympathetic activity and improving cardiorespiratory health.
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Affiliation(s)
- Matthew W. Kay
- 1Department of Biomedical Engineering, George Washington University, Washington, District of Columbia
| | - Vivek Jain
- 2Division of Pulmonary Medicine, Department of Medicine, George Washington University, Washington, District of Columbia
| | - Gurusher Panjrath
- 3Division of Cardiology, Department of Medicine, George Washington University, Washington, District of Columbia
| | - David Mendelowitz
- 4Department of Pharmacology and Physiology, George Washington University, Washington, District of Columbia
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17
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Kani K, Fujiu K. Electrical Storm. Int Heart J 2021; 62:1195-1198. [PMID: 34853216 DOI: 10.1536/ihj.21-662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kunihiro Kani
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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18
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Zhang L, Dong S, Zhao W, Li J, Cui L, Han Y, Chu Y. Relationship Between an Ischaemic J Wave Pattern and Ventricular Fibrillation in ST-Elevation Myocardial Infarction Patients. Int J Gen Med 2021; 14:8725-8735. [PMID: 34849013 PMCID: PMC8627274 DOI: 10.2147/ijgm.s337638] [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: 09/03/2021] [Accepted: 11/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background This study determined the ischaemic J wave pattern associated with ventricular fibrillation (VF). Methods A total of 262 patients diagnosed with ST-elevation myocardial infarction (STEMI) were recruited from October 2017 to September 2020. All data were collected and analysed, including baseline characteristics, electrocardiogram (ECG), coronary angiography (CAG), and examination outcomes. Results There were 193 STEMI patients with J wave elevation but without an ischaemic J wave (NJ group) and 69 patients with an ischaemic J wave; the latter were then subgrouped into early repolarization pattern (ERP; n=62) and Brugada pattern groups (BrP [anteroseptal ERP]; n=7). Univariate and multivariate logistic regression analyses were used to clarify high-risk factors and characteristics of ischaemic J waves. Multivariate logistic regression analysis revealed that an ischaemic J wave (odds ratio [OR], 9.708; 95% CI, 2.570–36.664; P=0.01) independently predicted VF. In the subgroup analysis, BrP (OR, 31.214; 95% CI, 3.949–246.742; P=0.001), slur morphology of the ERP (OR, 8.15; 95% CI, 1.563–42.558; P<0.05), and the number of leads with an ischaemic J wave > 3 (OR, 16.174; 95% CI, 3.064–85.375; P=0.001) were significantly associated with VF occurrence after adjusting for multiple variables. Conclusion An ischaemic J wave is an independent risk factor for VF in STEMI patients. BrP, slur morphology, and > 3 leads with an ischaemic J wave could increase the incidence of VF.
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Affiliation(s)
- Luyao Zhang
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Shujuan Dong
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Wenbo Zhao
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Jingchao Li
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Luqian Cui
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Yongmei Han
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Yingjie Chu
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
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19
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Zenger B, Good WW, Bergquist JA, Rupp LC, Perez M, Stoddard GJ, Sharma V, MacLeod RS. Transient recovery of epicardial and torso ST-segment ischemic signals during cardiac stress tests: A possible physiological mechanism. J Electrocardiol 2021; 69S:38-44. [PMID: 34384615 PMCID: PMC8664997 DOI: 10.1016/j.jelectrocard.2021.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/24/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute myocardial ischemia has several characteristic ECG findings, including clinically detectable ST-segment deviations. However, the sensitivity and specificity of diagnosis based on ST-segment changes are low. Furthermore, ST-segment deviations have been shown to be transient and spontaneously recover without any indication the ischemic event has subsided. OBJECTIVE Assess the transient recovery of ST-segment deviations on remote recording electrodes during a partial occlusion cardiac stress test and compare them to intramyocardial ST-segment deviations. METHODS We used a previously validated porcine experimental model of acute myocardial ischemia with controllable ischemic load and simultaneous electrical measurements within the heart wall, on the epicardial surface, and on the torso surface. Simulated cardiac stress tests were induced by occluding a coronary artery while simultaneously pacing rapidly or infusing dobutamine to stimulate cardiac function. Postexperimental imaging created anatomical models for data visualization and quantification. Markers of ischemia were identified as deviations in the potentials measured at 40% of the ST-segment. Intramural cardiac conduction speed was also determined using the inverse gradient method. We assessed changes in intramyocardial ischemic volume proportion, conduction speed, clinical presence of ischemia on remote recording arrays, and regional changes to intramyocardial ischemia. We defined the peak deviation response time as the time interval after onset of ischemia at which maximum ST-segment deviation was achieved, and ST-recovery time was the interval when ST deviation returned to below thresholded of ST elevation. RESULTS In both epicardial and torso recordings, the peak ST-segment deviation response time was 4.9±1.1 min and the ST-recovery time was approximately 7.9±2.5 min, both well before the termination of the ischemic stress. At peak response time, conduction speed was reduced by 50% and returned to near baseline at ST-recovery. The overall ischemic volume proportion initially increased, on average, to 37% at peak response time; however, it recovered to only 30% at the ST-recovery time. By contrast, the subepicardial region of the myocardial wall showed 40% ischemic volume at peak response time and recovered much more strongly to 25% as epicardial ST-segment deviations returned to baseline. CONCLUSION Our data show that remote ischemic signal recovery correlates with a recovery of the subepicardial myocardium, whereas subendocardial ischemic development persists.
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Affiliation(s)
- Brian Zenger
- Scientific Computing and Imaging Institute, University of Utah, SLC, UT, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, SLC, UT, USA; Department of Biomedical Engineering, University of Utah, SLC, UT, USA; School of Medicine, University of Utah, SLC, UT, USA.
| | - Wilson W Good
- Scientific Computing and Imaging Institute, University of Utah, SLC, UT, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, SLC, UT, USA; Department of Biomedical Engineering, University of Utah, SLC, UT, USA
| | - Jake A Bergquist
- Scientific Computing and Imaging Institute, University of Utah, SLC, UT, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, SLC, UT, USA; Department of Biomedical Engineering, University of Utah, SLC, UT, USA
| | - Lindsay C Rupp
- Scientific Computing and Imaging Institute, University of Utah, SLC, UT, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, SLC, UT, USA; Department of Biomedical Engineering, University of Utah, SLC, UT, USA
| | - Maura Perez
- Scientific Computing and Imaging Institute, University of Utah, SLC, UT, USA
| | | | - Vikas Sharma
- School of Medicine, University of Utah, SLC, UT, USA
| | - Rob S MacLeod
- Scientific Computing and Imaging Institute, University of Utah, SLC, UT, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, SLC, UT, USA; Department of Biomedical Engineering, University of Utah, SLC, UT, USA
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20
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Li TT, Zhang CH. A Common Electrocardiogram Demonstrating an Uncommon Cause. JAMA Intern Med 2021; 181:1388-1390. [PMID: 34398195 DOI: 10.1001/jamainternmed.2021.3516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ting-Ting Li
- The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Chuan-Hai Zhang
- Department of Cardiology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
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21
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Habedank D, Thieme R, Bublak A, Heinemann F, Spencker S, Atmowihardjo I. Ventricular fibrillation and Takotsubo cardiomyopathy triggered by media panic on COVID‐19: A case report. Clin Case Rep 2021; 9:72-76. [PMID: 33362931 PMCID: PMC7753670 DOI: 10.1002/ccr3.3423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/30/2020] [Accepted: 10/06/2020] [Indexed: 11/16/2022] Open
Abstract
Takotsubo cardiomyopathy has potentially lethal complications and can be caused by a media‐induced diffuse atmosphere of life threatening and panic in preconditioned patients.
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Affiliation(s)
- Dirk Habedank
- DRK Kliniken Berlin Köpenick Medizinische Klinik Kardiologie Berlin Germany
| | - Roland Thieme
- DRK Kliniken Berlin Köpenick Medizinische Klinik Kardiologie Berlin Germany
| | - Angelika Bublak
- DRK Kliniken Berlin Köpenick Medizinische Klinik Kardiologie Berlin Germany
| | - Felix Heinemann
- DRK Kliniken Berlin Köpenick Medizinische Klinik Kardiologie Berlin Germany
| | - Sebastian Spencker
- DRK Kliniken Berlin Köpenick Medizinische Klinik Kardiologie Berlin Germany
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22
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Kalarus Z, Svendsen JH, Capodanno D, Dan GA, De Maria E, Gorenek B, Jędrzejczyk-Patej E, Mazurek M, Podolecki T, Sticherling C, Tfelt-Hansen J, Traykov V, Lip GYH, Fauchier L, Boriani G, Mansourati J, Blomström-Lundqvist C, Mairesse GH, Rubboli A, Deneke T, Dagres N, Steen T, Ahrens I, Kunadian V, Berti S. Cardiac arrhythmias in the emergency settings of acute coronary syndrome and revascularization: an European Heart Rhythm Association (EHRA) consensus document, endorsed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Acute Cardiovascular Care Association (ACCA). Europace 2020; 21:1603-1604. [PMID: 31353412 DOI: 10.1093/europace/euz163] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 12/22/2022] Open
Abstract
Despite major therapeutic advances over the last decades, complex supraventricular and ventricular arrhythmias (VAs), particularly in the emergency setting or during revascularization for acute myocardial infarction (AMI), remain an important clinical problem. Although the incidence of VAs has declined in the hospital phase of acute coronary syndromes (ACS), mainly due to prompt revascularization and optimal medical therapy, still up to 6% patients with ACS develop ventricular tachycardia and/or ventricular fibrillation within the first hours of ACS symptoms. Despite sustained VAs being perceived predictors of worse in-hospital outcomes, specific associations between the type of VAs, arrhythmia timing, applied treatment strategies and long-term prognosis in AMI are vague. Atrial fibrillation (AF) is the most common supraventricular tachyarrhythmia that may be asymptomatic and/or may be associated with rapid haemodynamic deterioration requiring immediate treatment. It is estimated that over 20% AMI patients may have a history of AF, whereas the new-onset arrhythmia may occur in 5% patients with ST elevation myocardial infarction. Importantly, patients who were treated with primary percutaneous coronary intervention for AMI and developed AF have higher rates of adverse events and mortality compared with subjects free of arrhythmia. The scope of this position document is to cover the clinical implications and pharmacological/non-pharmacological management of arrhythmias in emergency presentations and during revascularization. Current evidence for clinical relevance of specific types of VAs complicating AMI in relation to arrhythmia timing has been discussed.
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Affiliation(s)
- Zbigniew Kalarus
- SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland.,Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Davide Capodanno
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Gheorghe-Andrei Dan
- "Carol Davila" University of Medicine, Colentina University Hospital, Bucharest, Romania
| | - Elia De Maria
- Ramazzini Hospital, Cardiology Unit, Carpi (Modena), Italy
| | | | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Michał Mazurek
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Tomasz Podolecki
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Université de Tours, Faculté de Médecine., Tours, France
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | | | - Georges H Mairesse
- Department of Cardiology - Electrophysiology, Cliniques du Sud Luxembourg - Vivalia, Arlon, Belgium
| | - Andrea Rubboli
- Department of Cardiovascular Diseases - AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Thomas Deneke
- Clinic for Electrophysiology, Rhoen-Clinic Campus Bad Neustadt, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Torkel Steen
- Department of Cardiology, Pacemaker- & ICD-Centre, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Ingo Ahrens
- Department of Cardiology & Intensive Care, Augustinerinnen Hospital, Cologne, Germany
| | - Vijay Kunadian
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Berti
- Department of Cardiology, Fondazione C.N.R. Reg. Toscana G. Monasterio, Heart Hospital, Massa, Italy
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Srinivasan NT, Orini M, Providencia R, Dhinoja MB, Lowe MD, Ahsan SY, Chow AW, Hunter RJ, Schilling RJ, Taggart P, Lambiase PD. Prolonged action potential duration and dynamic transmural action potential duration heterogeneity underlie vulnerability to ventricular tachycardia in patients undergoing ventricular tachycardia ablation. Europace 2020; 21:616-625. [PMID: 30500897 PMCID: PMC6452309 DOI: 10.1093/europace/euy260] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 10/16/2018] [Indexed: 12/30/2022] Open
Abstract
Aims Differences of action potential duration (APD) in regions of myocardial scar and their borderzones are poorly defined in the intact human heart. Heterogeneities in APD may play an important role in the generation of ventricular tachycardia (VT) by creating regions of functional block. We aimed to investigate the transmural and planar differences of APD in patients admitted for VT ablation. Methods and results Six patients (median age 53 years, five male); (median ejection fraction 35%), were studied. Endocardial (Endo) and epicardial (Epi) 3D electroanatomic mapping was performed. A bipolar voltage of <0.5 mV was defined as dense scar, 0.5–1.5 mV as scar borderzone, and >1.5 mV as normal. Decapolar catheters were positioned transmurally across the scar borderzone to assess differences of APD and repolarization time (RT) during restitution pacing from Endo and Epi. Epi APD was 173 ms in normal tissue vs. 187 ms at scar borderzone and 210 ms in dense scar (P < 0.001). Endocardial APD was 210 ms in normal tissue vs. 222 ms in the scar borderzone and 238 ms in dense scar (P < 0.01). This resulted in significant transmural RT dispersion (ΔRT 22 ms across dense transmural scar vs. 5 ms in normal transmural tissue, P < 0.001), dependent on the scar characteristics in the Endo and Epi, and the pacing site. Conclusion Areas of myocardial scar have prolonged APD compared with normal tissue. Heterogeneity of regional transmural and planar APD result in localized dispersion of repolarization, which may play an important role in initiating VT.
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Affiliation(s)
- Neil T Srinivasan
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, West Smithfield, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, UK
| | - Rui Providencia
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Mehul B Dhinoja
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Martin D Lowe
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Syed Y Ahsan
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Anthony W Chow
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Ross J Hunter
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Richard J Schilling
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Peter Taggart
- Institute of Cardiovascular Science, University College London, London, UK
| | - Pier D Lambiase
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, West Smithfield, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
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Malignant ventricular arrhythmias in patients with severe acute respiratory distress syndrome due to COVID-19 without significant structural heart disease. HeartRhythm Case Rep 2020; 6:858-862. [PMID: 32864335 PMCID: PMC7446721 DOI: 10.1016/j.hrcr.2020.08.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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25
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Fan J, Yao FJ, Cheng YJ, Ji CC, Chen XM, Wu SH. Early repolarization pattern associated with coronary artery disease and increased the risk of cardiac death in acute myocardium infarction. Ann Noninvasive Electrocardiol 2020; 25:e12768. [PMID: 32364308 PMCID: PMC7679838 DOI: 10.1111/anec.12768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/24/2020] [Accepted: 04/09/2020] [Indexed: 01/14/2023] Open
Abstract
Background Early repolarization pattern (ERP) was associated with sudden cardiac death in recent studies. However, the associations between ERP and coronary artery disease (CAD), and ERP and cardiac death caused by acute myocardial infarction (MI) remains unclear. Methods We retrospectively enrolled consecutive 1,545 CAD patients and 908 non‐CAD subjects as control group which were confirmed by coronary angiograph. The CAD patients include stable CAD, acute MI patients, and old MI patients. Multivariate logistic regression was employed to evaluate the relationship between ERP and CAD, and ERP and cardiac death caused by acute MI. Results Of the 1,545 CAD subjects, there were 1,029 stable CAD patients, 404 acute MI patients, and 112 old MI patients. The incidence of ERP was much higher among patients with CAD than without CAD subjects (20.1% vs. 6.2%, p < .001) after adjusting for major cardiovascular risk factors. No significant correlation was observed between lead region of ERP on 12‐lead ECG and single abnormal artery. Of the 404 acute MI patients, 342 patients survived and 62 patients died. Incidence of ERP was higher in non‐survivor than survivor patients with acute MI (24.2% vs. 17.5%, p = .006) after adjustment for major cardiovascular risk factors. Conclusion The incidence of ERP was higher in CAD patients than subjects without CAD and in non‐survivor patients than survivor patients with acute MI. The lead region of ERP on 12‐lead ECG was not associated with single abnormal coronary artery.
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Affiliation(s)
- Jun Fan
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Feng-Juan Yao
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Yun-Jiu Cheng
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Cheng-Cheng Ji
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Xu-Miao Chen
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Su-Hua Wu
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
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Stoller M, Boehler A, Bloch N, Seiler C, Heg D, Branca M, Roten L. Effect of acute myocardial ischemia on inferolateral early repolarization. Heart Rhythm 2020; 17:922-930. [PMID: 31981736 DOI: 10.1016/j.hrthm.2020.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 01/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Inferolateral early repolarization (ER) is associated with an increase in arrhythmic risk, particularly in the presence of myocardial ischemia. OBJECTIVE The purpose of this study was to determine the effect of myocardial ischemia on ER. METHODS We retrospectively analyzed procedural electrocardiograms (ECGs) of patients with ER undergoing a controlled, 1-minute coronary balloon occlusion for collateral function testing. ECG leads with ER were analyzed immediately before coronary balloon occlusion (PRE), at 60 seconds of coronary balloon occlusion (OCCL), and >30 seconds after balloon deflation. RESULTS Seventy-seven patients with ER in the preprocedural ECG (86% inferior, 20% lateral) underwent 135 coronary balloon occlusions during which a J wave was recorded in 224 leads (ER leads). From PRE to OCCL, ST-segment amplitude (ST) in the ER lead increased in 94 cases (44%) from 0.00 ± 0.03 to 0.05 ± 0.06 mV (P < .0001). In this group, J-wave amplitude (JWA) increased from 0.10 ± 0.07 to 0.13 ± 0.09 mV (P < .0001). ST in the ER lead decreased or was unchanged in 121 cases (56%) from PRE to OCCL (from 0.01 ± 0.05 to -0.02 ± 0.04 mV; P < .0001). In this group, JWA decreased from 0.10 ± 0.05 to 0.08 ± 0.07 mV (P < .0001). The change in JWA was related to the change in ST (linear regression analysis; R2 = 0.34; P < .0001), while there was no relation between the change in R-wave amplitude and the change in ST (R2 = 0.0003; P = .83). CONCLUSION During acute ischemia, JWA mirrors ST-segment changes. This may explain increased arrhythmic vulnerability of patients with ER during myocardial ischemia. It also adds weight to the hypothesis of ER being a phenomenon of repolarization.
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Affiliation(s)
- Michael Stoller
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Alexander Boehler
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Nando Bloch
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christian Seiler
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Dik Heg
- Clinical Trials Unit Bern and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Mattia Branca
- Clinical Trials Unit Bern and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
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Jebberi Z, Marazzato J, De Ponti R, Bagliani G, Leonelli FM, Boveda S. Polymorphic Wide QRS Complex Tachycardia: Differential Diagnosis. Card Electrophysiol Clin 2019; 11:333-344. [PMID: 31084854 DOI: 10.1016/j.ccep.2019.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Polymorphic wide QRS complex tachycardia is defined as a tachyarrhythmia showing variable and frequently alternating morphologies of the QRS complex with irregular R-R intervals. It may present with a specific and reproducible pattern including torsade de pointes and bidirectional ventricular tachycardia or with a nonspecific and very irregular pattern, different from ventricular fibrillation. Polymorphic ventricular tachycardia is a challenging diagnosis and is associated with a high risk for sudden cardiac death. Although rare, preexcited atrial fibrillation over multiple accessory pathways can also generate a polymorphic wide QRS complex tachycardia mimicking polymorphic ventricular tachycardia.
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Affiliation(s)
- Zeynab Jebberi
- Cardiac Arrhythmia Management Department, Clinique Pasteur, BP 27617, 45 Avenue de Lombez, Toulouse 31076, France
| | - Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation, University of Insubria, Viale Borri, 57, Varese 21100, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation, University of Insubria, Viale Borri, 57, Varese 21100, Italy
| | - Giuseppe Bagliani
- Cardiology Department, Arrhythmology Unit, Foligno General Hospital, Foligno, Via Massimo Arcamone, Foligno, Perugia 06034, Italy; Cardiovascular Diseases Department, University of Perugia, Piazza Menghini 1, Perugia 06129, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA
| | - Serge Boveda
- Cardiac Arrhythmia Management Department, Clinique Pasteur, BP 27617, 45 Avenue de Lombez, Toulouse 31076, France.
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28
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Wang X, Zhang L, Gao C, Wu S, Zhu J. ST-segment elevation and the Tpeak-Tend/QT ratio predict the occurrence of malignant arrhythmia events in patients with vasospastic angina. J Electrocardiol 2019; 53:52-56. [DOI: 10.1016/j.jelectrocard.2019.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/15/2018] [Accepted: 01/01/2019] [Indexed: 10/27/2022]
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Wang G, Zhao N, Zhang C, Zhong S, Li X. Lambda-like ST-segment elevation in acute myocardial infarction triggered by coronary spasm may be a new risk predictor for lethal ventricular arrhythmia: A case report. Medicine (Baltimore) 2018; 97:e13561. [PMID: 30544473 PMCID: PMC6310568 DOI: 10.1097/md.0000000000013561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The lambda-like ST-elevation electrocardiography (ECG) pattern is extremely rare in patients with type 2 myocardial infarction (T2MI) triggered by coronary spasm. When this ECG pattern appears, sudden cardiac death (SCD) caused by lethal ventricular arrhythmia may occur because clinicians do not pay sufficient attention to this phenomenon. PATIENT CONCERNS We describe a 41-year-old man who presented with steep down-sloping ST-segment elevation, paroxysmal ventricular tachycardia, severe sinus bradycardia, and intermittent complete atrioventricular block on ECG during the sudden recurrence of clinical symptoms. DIAGNOSIS T2MI complicated with lethal arrhythmia and caused by coronary spasm. INTERVENTIONS The patient received an implantable cardioverter defibrillator (ICD) for SCD caused by lethal ventricular arrhythmia and received long-term calcium-blocker and nitroglycerin therapy. OUTCOMES At a 3-month follow-up, no recurrence was noted. LESSONS The lambda-like ST-elevation pattern is identified with other ST-elevation patterns by geometry and may be a new risk predictor for lethal ventricular arrhythmia on ECG. When this pattern is identified, clinicians should adopt aggressive therapeutic strategies, including ICD implantation and etiological treatment.
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Affiliation(s)
| | - Na Zhao
- Department of Rheumatology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, People's Republic of China
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Wang X, Zhang L, Gao C, Zhu J, Yang X. Tpeak-Tend/QT interval predicts ST-segment resolution and major adverse cardiac events in acute ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention. Medicine (Baltimore) 2018; 97:e12943. [PMID: 30412109 PMCID: PMC6221564 DOI: 10.1097/md.0000000000012943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Elevated ST-segment and increased Tpeak-Tend interval (Tp-e) were prognostic predictors in major adverse cardiac events (MACEs) in ST-segment elevation myocardial infarction (STEMI). The electrophysiologic relationship between them during percutaneous coronary intervention (PCI) needs to elucidate.Patients with STEMI admitted to hospital were prospectively evaluated. ST-segment resolution (STR) (defined as ≥50% reduction as the complete-STR [CSTR] group, <50% as incomplete-STR [ISTR] group), Tp-e interval, and ratio of Tp-e to QT interval (Tp-e/QT) were measured, calculated and analyzed with MACEs.Tp-ec interval (corrected Tp-e interval, P < .001) and Tp-e/QT ratio (P < .001) were significantly increased by myocardial infarction and partly recovered post-PCI. Patients with ISTR showed more increased Tp-ec interval (P < .001) and Tp-e/QT ratio (P < .001) than those in CSTR groups post-PCI. In multivariate analysis and receiver operating characteristic curves analysis, Tp-e/QT was an independent and strongest predictor for STR. STR and electrocardiogram parameters with a cutoff value for predicting STR showed prognostic value for MACE in STEMI in Kaplan-Meier survival analysis.Both STR and change of Tp-e parameters were not only predictors of arrhythmia, but also prognostic factors of MACE in patients with STEMI after PCI.
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Pirkola JM, Konttinen M, Kenttä TV, Holmström LTA, Junttila MJ, Ukkola OH, Huikuri HV, Perkiömäki JS. Prognostic value of T-wave morphology parameters in coronary artery disease in current treatment era. Ann Noninvasive Electrocardiol 2018; 23:e12539. [PMID: 29484764 DOI: 10.1111/anec.12539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/10/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The prognostic value of T-wave morphology parameters in coronary artery disease in the current treatment era is not well established. METHODS The Innovation to reduce Cardiovascular Complications of Diabetes at the Intersection (ARTEMIS) study included 1,946 patients with angiographically verified coronary artery disease (CAD). The study patients underwent thorough examinations including 12-lead digital electrocardiogram (ECG) at baseline. RESULTS During a follow-up period of 73 ± 22 months, a total of 201 (10.3%) patients died. Of the study patients, 95 (4.9%) experienced cardiac death (CD) consisting of 44 (2.3%) sudden cardiac deaths (SCD) and 51 (2.6%) nonsudden cardiac deaths (NSCD), and 106 (5.4%) patients experienced noncardiac death (NCD). T-wave morphology dispersion (TMD), T-wave area dispersion (TWAD), and total cosine R-to-T (TCRT) had a significant association with CD even after adjustment with relevant clinical risk markers in the Cox regression analysis (multivariate HRs: 1.015, 95% CI 1.007-1.023, p = .0003; 0.474, 95% CI 0.305-0.737, p = .0009; 0.598, 95% CI 0.412-0.866, p = .006, respectively). When including these parameters to the clinical risk model for CD, the C-index increased from 0.810 to 0.823 improving the discrimination significantly (integrated discrimination index [IDI] = 0.0118, 95% CI 0.0028-0.0208, p = .01). These parameters were more closely associated with NSCD (multivariate p-values from .016 to .001) than with SCD (univariate/multivariate p-values for TMD .015/.197 and for TCRT .012/.43). CONCLUSION T-wave morphology parameters describing repolarization heterogeneity improve the predictive power of the clinical risk model for CD in patients with CAD in the current treatment era.
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Affiliation(s)
- Joni M Pirkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Maija Konttinen
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Lauri T A Holmström
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Olavi H Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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Fumimoto T, Ueyama T, Shimizu A, Yoshiga Y, Ono M, Kato T, Ishiguchi H, Okamura T, Yamada J, Yano M. Inferior J waves in patients with vasospastic angina might be a risk factor for ventricular fibrillation. J Cardiol 2017; 70:271-277. [DOI: 10.1016/j.jjcc.2016.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/08/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
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Cheng YJ, Li ZY, Yao FJ, Xu XJ, Ji CC, Chen XM, Liu LJ, Lin XX, Yao H, Wu SH. Early repolarization is associated with a significantly increased risk of ventricular arrhythmias and sudden cardiac death in patients with structural heart diseases. Heart Rhythm 2017; 14:1157-1164. [PMID: 28416467 DOI: 10.1016/j.hrthm.2017.04.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Indexed: 10/19/2022]
Abstract
BACKGROUND Early repolarization pattern (ERP) has been proved to increase risk of arrhythmia death in the general population, but its prognostic significance in patients with structural heart disease (SHD) is controversial. OBJECTIVE The purpose of this study was to conduct a meta-analysis of studies assessing the association between ERP and risk of ventricular arrhythmias (VTAs) and sudden cardiac death (SCD) in patients with SHD. METHODS We performed a literature search using MEDLINE (January 1, 1966, to September 25, 2016) and EMBASE (January 1, 1980, to September 25, 2016) with no restrictions. Studies that reported odds ratio (OR) estimates with 95% confidence intervals (CIs) for the associations of interest were included. RESULTS The search yielded 19 observational studies, involving 7268 patients that reported 1127 cases of VTAs or SCD. In the selected studies, the point estimates of the ORs were consistently greater than 1. Compared with those without ERP, patients with ERP experienced a significantly increased risk of developing VTAs or SCD (OR 4.76; 95% CI 3.62-6.26), ventricular fibrillation (OR 7.14; 95% CI 4.31-11.82), and SCD (OR 4.07; 95% CI 1.58-10.51). The results were consistent and statistically significant in all subgroups. ERP with J-point elevation in inferior leads, notching configuration, and horizontal or descending ST segment connote higher risk. CONCLUSION ERP is associated with a significant increased risk of VTAs or SCD in patients with SHD. Future research should attempt to understand the exact mechanisms for the arrhythmia risk and to introduce ERP in the risk stratification in this patient group.
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Affiliation(s)
- Yun-Jiu Cheng
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhu-Yu Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Feng-Juan Yao
- Department of Ultrasonography, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiong-Jun Xu
- Department of Stomatology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Cheng-Cheng Ji
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xu-Miao Chen
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Li-Juan Liu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Xiong Lin
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hao Yao
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Su-Hua Wu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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Intracoronary acetylcholine application as a possible probe inducing J waves in patients with early repolarization syndrome. J Arrhythm 2017; 33:424-429. [PMID: 29021844 PMCID: PMC5634679 DOI: 10.1016/j.joa.2016.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/18/2016] [Accepted: 12/27/2016] [Indexed: 12/11/2022] Open
Abstract
Acetylcholine is widely used for a diagnostic provocation test of coronary spasm in patients with vasospastic angina. Acetylcholine usually induces coronary vasodilatation mediated by muscarinic receptor activation, but sometimes it evokes vasoconstriction of coronary arteries where the endothelium is damaged. Early repolarization syndrome is characterized by a J wave observed at the end of the QRS complex in a surface electrocardiogram. The J wave is attributed to the transmural voltage gradient at the early repolarization phase across the ventricular wall, which stems mainly from prominent transient outward current in the epicardium, but not in the endocardium. Transient high-dose application of acetylcholine into the epicardial coronary arteries provides a unique opportunity to augment net outward current, selectively, in the ventricular epicardium and unmask the J wave, irrespective of the cardiac ischemia based on coronary spasm. Acetylcholine augments cardiac membrane potassium conductance by enhancing acetylcholine-activated potassium current directly and by activating adenosine triphosphate-sensitive potassium current, in addition to the reduced sodium and calcium currents in the setting of severe ischemia due to vasospasm. However, the role of acetylcholine as an arrhythmogenic probe of the J wave induction in patients with suspected early repolarization syndrome warrants future prospective study.
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Nakamura R, Nishizaki M, Lee K, Shimizu M, Fujii H, Yamawake N, Sakurada H, Hiraoka M, Isobe M. Life-Threatening Ventricular Arrhythmia and Brugada-Type ST-Segment Elevation Associated With Acute Ischemia of the Right Ventricular Outflow Tract. Circ J 2017; 81:322-329. [DOI: 10.1253/circj.cj-16-1112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rena Nakamura
- Department of Cardiology, Yokohama Minami Kyosai Hospital
| | | | - Kiko Lee
- Department of Cardiology, Yokohama Minami Kyosai Hospital
| | - Masato Shimizu
- Department of Cardiology, Yokohama Minami Kyosai Hospital
| | - Hiroyuki Fujii
- Department of Cardiology, Yokohama Minami Kyosai Hospital
| | | | - Harumizu Sakurada
- Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital
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Liu G, Liu T, Cohen D, Liu T, Yan GX. How to determine cardiac ion channels targeted by drugs using the isolated rabbit ventricular wedge model. J Pharmacol Toxicol Methods 2016; 81:161-70. [PMID: 27195944 DOI: 10.1016/j.vascn.2016.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/05/2016] [Accepted: 05/15/2016] [Indexed: 12/01/2022]
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A case of Takotsubo cardiomyopathy showing two modes of initiation for ventricular fibrillation: Augmented J-wave and torsade de pointes with QT prolongation. HeartRhythm Case Rep 2016; 2:436-440. [PMID: 28491728 PMCID: PMC5419971 DOI: 10.1016/j.hrcr.2016.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Mercer BN, Begg GA, Page SP, Bennett CP, Tayebjee MH, Mahida S. Early Repolarization Syndrome; Mechanistic Theories and Clinical Correlates. Front Physiol 2016; 7:266. [PMID: 27445855 PMCID: PMC4927622 DOI: 10.3389/fphys.2016.00266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/15/2016] [Indexed: 12/20/2022] Open
Abstract
The early repolarization (ER) pattern on the 12-lead electrocardiogram is characterized by J point elevation in the inferior and/or lateral leads. The ER pattern is associated with an increased risk of ventricular arrhythmias and sudden cardiac death (SCD). Based on studies in animal models and genetic studies, it has been proposed that J point elevation in ER is a manifestation of augmented dispersion of repolarization which creates a substrate for ventricular arrhythmia. A competing theory regarding early repolarization syndrome (ERS) proposes that the syndrome arises as a consequence of abnormal depolarization. In recent years, multiple clinical studies have described the characteristics of ER patients with VF in more detail. The majority of these studies have provided evidence to support basic science observations. However, not all clinical observations correlate with basic science findings. This review will provide an overview of basic science and genetic research in ER and correlate basic science evidence with the clinical phenotype.
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Affiliation(s)
- Ben N. Mercer
- West Yorkshire Arrhythmia Service, Leeds General InfirmaryLeeds, UK
| | - Gordon A. Begg
- West Yorkshire Arrhythmia Service, Leeds General InfirmaryLeeds, UK
| | - Stephen P. Page
- West Yorkshire Arrhythmia Service, Leeds General InfirmaryLeeds, UK
- Regional Inherited Cardiovascular Conditions Service, Leeds General InfirmaryLeeds, UK
| | | | | | - Saagar Mahida
- West Yorkshire Arrhythmia Service, Leeds General InfirmaryLeeds, UK
- Regional Inherited Cardiovascular Conditions Service, Leeds General InfirmaryLeeds, UK
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Abstract
Fatal arrhythmias in asymptomatic Kawasaki disease patients with normal left ventricular function have rarely been reported. In this study, we report the cases of two adult patients with largely unpredictable sudden cardiac arrest, despite almost-normal left ventricular function even after the diagnosis of presumed Kawasaki disease, as well as consider the mechanisms involved with reference to the literature.
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Cao H, Huang C, Wang X. Allicin inhibits transient outward potassium currents in mouse ventricular myocytes. Exp Ther Med 2016; 11:1896-1900. [PMID: 27168824 DOI: 10.3892/etm.2016.3116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 01/14/2016] [Indexed: 11/05/2022] Open
Abstract
Allicin is the active constituent of garlic, a widely used spice and food. The remedial properties of garlic have also been extensively researched and it has been demonstrated that allicin is able to inhibit the transient outward potassium current (Ito) in atrial myocytes. However, the direct effect of allicin on Ito in ventricular myocytes has yet to be elucidated. In the present study, the effects of allicin on Ito in ventricular myocytes isolated from mice were investigated, using the whole-cell patch recording technique. The results revealed that Ito current was not significantly suppressed by allicin in the low-dose group (10 µmol/l; P>0.05). However, Ito was significantly inhibited by higher doses of allicin (30, 100 and 300 µmol/l; P<0.05 vs. control; n=6) in a concentration-dependent manner (IC50=41.6 µmol/l). In addition, a high concentration of allicin (≥100 µmol/l) was able to accelerate the voltage-dependent inactivation of Ito in mouse ventricular myocytes. In conclusion, the present study revealed that allicin inhibited the Ito in mouse ventricular myocytes, which may be the mechanism through which allicin exerts its antiarrhythmic effect.
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Affiliation(s)
- Hong Cao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060, P.R. China; Department of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Congxin Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Xin Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060, P.R. China
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Notching early repolarization pattern in inferior leads increases risk of ventricular tachyarrhythmias in patients with acute myocardial infarction: a meta-analysis. Sci Rep 2015; 5:15845. [PMID: 26521690 PMCID: PMC4629141 DOI: 10.1038/srep15845] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/01/2015] [Indexed: 01/09/2023] Open
Abstract
The aim of this of this meta-analysis was to examine the potential association between certain early repolarization (ER) characteristics and ventricular tachyarrhythmias (VTAs) in patients with acute myocardial infarction (AMI). We searched PubMed, Embase and Web of Science databases for records published until December 2014. Of the 658 initially identified records, 7 studies with a total of 1,565 patients (299 with ER and 1,266 without ER) were finally analyzed. Overall, patients with ER displayed a higher risk of VTAs following AMI compared to patients without ER [odds ratio (OR): 3.75, 95% CI: 2.62–5.37, p < 0.00001]. Subgroup analyses showed that the diagnosis of ER prior to AMI onset is a better predictor of VTAs (OR: 5.70, p < 0.00001) compared to those diagnosed after AMI onset (OR: 2.60, p = 0.00001). Remarkably, a notching morphology was a significant predictor of VTAs compared to slurring morphology (OR: 3.85, p = 0.002). Finally, an inferior ER location (OR: 8.85, p < 0.00001) was significantly associated with increased risk of VTAs in AMI patients. In conclusion, our meta-analysis suggests that ER pattern is associated with greater risk of VTAs in patients with AMI. A notched ER pattern located in inferior leads confers the highest risk for VTAs in AMI.
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Álvarez-Álvarez B, Bouzas-Cruz N, Abu-Assi E, Raposeiras-Roubin S, López-López A, González Cambeiro MC, Peña-Gil C, García-Acuña JM, González-Juanatey JR. Impacto de la fibrilación ventricular que complica el curso de un síndrome coronario agudo en la incidencia a largo plazo de muerte súbita cardiaca. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Álvarez-Álvarez B, Bouzas-Cruz N, Abu-Assi E, Raposeiras-Roubin S, López-López A, González Cambeiro MC, Peña-Gil C, García-Acuña JM, González-Juanatey JR. Impact of Acute Coronary Syndrome Complicated by Ventricular Fibrillation on Long-term Incidence of Sudden Cardiac Death. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2015; 68:878-884. [PMID: 25800166 DOI: 10.1016/j.rec.2014.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/03/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES There is little information on the effect of acute coronary syndrome complicated by ventricular fibrillation on the long-term incidence of sudden cardiac death. We analyzed this effect in a contemporary cohort of patients with acute coronary syndrome. METHODS We studied 5302 consecutive patients with acute coronary syndrome between December 2003 and December 2012. We compared mortality during and after hospitalization according to the presence or absence of ventricular fibrillation. RESULTS Ventricular fibrillation was observed in 163 (3.1%) patients, and was early onset in 72.4% of these patients. In-hospital mortality was 36.2% in the group with ventricular fibrillation and 4.7% in the group without (p<.001). After a mean follow-up of 4.7 years (standard deviation, 2.6 years), mortality was 30.7% in the ventricular fibrillation group and 24.7% in the other group (P=.23). After adjusting for confounding variables, the presence of ventricular fibrillation was not associated with an increased risk of death in the follow-up period (hazard ratio=1.29; 95% confidence interval, 0.90-1.87). The cause of death was established in 72% of patients. The incidence of sudden death was 12.9% in the ventricular fibrillation group and 11.9% in the other group (P=.71). Cardiovascular-cause mortality was also similar between the 2 groups (35.5% and 34.4%, respectively. CONCLUSIONS Patients with acute coronary syndrome complicated by ventricular fibrillation who survive the in-hospital phase do not appear to be at an increased risk of sudden cardiac death or other cardiovascular-cause death.
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Affiliation(s)
- Belén Álvarez-Álvarez
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| | - Noelia Bouzas-Cruz
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Emad Abu-Assi
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Sergio Raposeiras-Roubin
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Andrea López-López
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - María Cristina González Cambeiro
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Carlos Peña-Gil
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - José María García-Acuña
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - José Ramón González-Juanatey
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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SHULMAN ERIC, AAGAARD PHILIP, KARGOLI FARAJ, HOCH ETHAN, BIASE LUIGIDI, FISHER JOHN, GROSS JAY, KIM SOO, PALMA EUGEN, FERRICK KEVINJ, KRUMERMAN ANDREW. The Prognostic Value of Early Repolarization with ST-Segment Elevation by Age and Gender in the Hispanic Population. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1396-404. [DOI: 10.1111/pace.12730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/22/2015] [Accepted: 07/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- ERIC SHULMAN
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - PHILIP AAGAARD
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - FARAJ KARGOLI
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - ETHAN HOCH
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - LUIGI DI BIASE
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - JOHN FISHER
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - JAY GROSS
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - SOO KIM
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - EUGEN PALMA
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - KEVIN J. FERRICK
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - ANDREW KRUMERMAN
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
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Batchvarov VN, Behr ER. QRS-ST-T triangulation with repolarization shortening as a precursor of sustained ventricular tachycardia during acute myocardial ischemia. J Arrhythm 2015; 31:118-20. [PMID: 26336543 DOI: 10.1016/j.joa.2014.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/08/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022] Open
Abstract
We present segments from a 24-hour 12-lead digital Holter recording in a 48-year-old man demonstrating transient ST elevations in the inferior leads that triggered sustained ventricular tachycardia/ventricular fibrillation (VT/VF) requiring cardioversion. The onset of VT was preceded by a gradual increase in the ST with marked QRS broadening that lacked distinction between the end of the QRS and the beginning of the ST (QRS-ST-T "triangulation"), and shortening of the QT interval not caused by an increased heart rate. This is a relatively rare documentation of the mechanisms immediately triggering sustained ventricular arrhythmias during acute myocardial ischemia obtained with 12-lead ECG.
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Affiliation(s)
- Velislav N Batchvarov
- Cardiovascular and Cell Sciences Research Institute, St. George׳s University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
| | - Elijah R Behr
- Cardiovascular and Cell Sciences Research Institute, St. George׳s University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
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Ma SF, Luo Y, Ding YJ, Chen Y, Pu SX, Wu HJ, Wang ZF, Tao BB, Wang WW, Zhu YC. Hydrogen Sulfide Targets the Cys320/Cys529 Motif in Kv4.2 to Inhibit the Ito Potassium Channels in Cardiomyocytes and Regularizes Fatal Arrhythmia in Myocardial Infarction. Antioxid Redox Signal 2015; 23:129-47. [PMID: 25756524 PMCID: PMC4492614 DOI: 10.1089/ars.2014.6094] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS The mechanisms underlying numerous biological roles of hydrogen sulfide (H2S) remain largely unknown. We have previously reported an inhibitory role of H2S in the L-type calcium channels in cardiomyocytes. This prompts us to examine the mechanisms underlying the potential regulation of H2S on the ion channels. RESULTS H2S showed a novel inhibitory effect on Ito potassium channels, and this effect was blocked by mutation at the Cys320 and/or Cys529 residues of the Kv4.2 subunit. H2S broke the disulfide bridge between a pair of oxidized cysteine residues; however, it did not modify single cysteine residues. H2S extended action potential duration in epicardial myocytes and regularized fatal arrhythmia in a rat model of myocardial infarction. H2S treatment significantly increased survival by ∼1.4-fold in the critical 2-h time window after myocardial infarction with a protection against ventricular premature beats and fatal arrhythmia. However, H2S did not change the function of other ion channels, including IK1 and INa. INNOVATION AND CONCLUSION H2S targets the Cys320/Cys529 motif in Kv4.2 to regulate the Ito potassium channels. H2S also shows a potent regularizing effect against fatal arrhythmia in a rat model of myocardial infarction. The study provides the first piece of evidence for the role of H2S in regulating Ito potassium channels and also the specific motif in an ion channel labile for H2S regulation.
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Affiliation(s)
- Shan-Feng Ma
- 1 Shanghai Key Laboratory of Bioactive Small Molecules and Research Center on Aging and Medicine, Department of Physiology and Pathophysiology, Fudan University Shanghai Medical College , Shanghai, China .,2 Department of Physiology, Bengbu Medical College , Bengbu, China
| | - Yan Luo
- 1 Shanghai Key Laboratory of Bioactive Small Molecules and Research Center on Aging and Medicine, Department of Physiology and Pathophysiology, Fudan University Shanghai Medical College , Shanghai, China
| | - Ying-Jiong Ding
- 1 Shanghai Key Laboratory of Bioactive Small Molecules and Research Center on Aging and Medicine, Department of Physiology and Pathophysiology, Fudan University Shanghai Medical College , Shanghai, China
| | - Ying Chen
- 1 Shanghai Key Laboratory of Bioactive Small Molecules and Research Center on Aging and Medicine, Department of Physiology and Pathophysiology, Fudan University Shanghai Medical College , Shanghai, China
| | - Shi-Xin Pu
- 1 Shanghai Key Laboratory of Bioactive Small Molecules and Research Center on Aging and Medicine, Department of Physiology and Pathophysiology, Fudan University Shanghai Medical College , Shanghai, China
| | - Hang-Jing Wu
- 3 Institutes of Brain Science, Institute of Neurobiology and State Key Laboratory of Medical Neurobiology, Fudan University Shanghai Medical College , Shanghai, China
| | - Zhong-Feng Wang
- 3 Institutes of Brain Science, Institute of Neurobiology and State Key Laboratory of Medical Neurobiology, Fudan University Shanghai Medical College , Shanghai, China
| | - Bei-Bei Tao
- 1 Shanghai Key Laboratory of Bioactive Small Molecules and Research Center on Aging and Medicine, Department of Physiology and Pathophysiology, Fudan University Shanghai Medical College , Shanghai, China
| | - Wen-Wei Wang
- 1 Shanghai Key Laboratory of Bioactive Small Molecules and Research Center on Aging and Medicine, Department of Physiology and Pathophysiology, Fudan University Shanghai Medical College , Shanghai, China
| | - Yi-Chun Zhu
- 1 Shanghai Key Laboratory of Bioactive Small Molecules and Research Center on Aging and Medicine, Department of Physiology and Pathophysiology, Fudan University Shanghai Medical College , Shanghai, China
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Inamura Y, Nishizaki M, Shimizu M, Fujii H, Yamawake N, Suzuki M, Sakurada H, Hiraoka M, Isobe M. Early repolarization and positive T-wave alternans as risk markers for life-threatening arrhythmias in patients with vasospastic angina. Int J Cardiol 2015; 196:7-13. [PMID: 26070177 DOI: 10.1016/j.ijcard.2015.05.147] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/21/2015] [Accepted: 05/26/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several arrhythmogenic markers have been suggested as predictors for risk of life-threatening arrhythmias during symptom-free periods in vasospastic angina (VSA), but no definite conclusion has been drawn. OBJECTIVE To investigate prevalence of fatal ventricular tachyarrhythmia in VSA and its relation to appearance of early repolarization (ER) and positive T wave alternans (p-TWA) in patients with VSA during symptom-free periods. METHODS We studied 116 consecutive patients with chest pain who underwent an acetylcholine provocation test for VSA diagnosis. Patients were divided into two groups with positive (VSA group; 66 cases) and negative (control group; 50 cases) provocation test results. The presence of ER on electrocardiogram and the modified moving average analysis of TWA during symptom-free periods were explored. RESULTS The incidences of ER and p-TWA were higher in the VSA than in the control group (P=0.001 and P=0.006, respectively). Multivariate analysis revealed that ER and p-TWA were independent predictors of VSA (odds ratio, 5.65 and 4.94; 95% confidence interval: 1.11-28.9 and 1.22-19.9, respectively). The incidence of coexisting baseline ER and p-TWA was significantly higher in VSA patients with life-threatening arrhythmic events (3/3 vs. 6/38; P<0.001) than in those without. CONCLUSIONS VSA patients with arrhythmic events showed a high incidence of ER and p-TWA during symptom-free periods. Therefore, baseline ER and p-TWA may help to identify VSA patients at high risk for life-threatening arrhythmias.
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Affiliation(s)
- Yukihiro Inamura
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan; Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan.
| | | | - Masato Shimizu
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Hiroyuki Fujii
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Noriyosi Yamawake
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Makoto Suzuki
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Harumizu Sakurada
- Division of Cardiology, Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Tokyo, Japan
| | - Masayasu Hiraoka
- Department of Health Examination, Toride Kitasoma Medical Center Hospital, Ibaraki, Japan; Tokyo Medical and Dental University, Tokyo, Japan
| | - Mitsuaki Isobe
- Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
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Abstract
OBJECTIVE The objective was to provide a brief history of J wave syndromes and to summarize our current understanding of their molecular, ionic, cellular mechanisms, and clinical features. We will also discuss the existing debates and further direction in basic and clinical research for J wave syndromes. DATA SOURCES The publications on key words of "J wave syndromes", "early repolarization syndrome (ERS)", "Brugada syndrome (BrS)" and "ST-segment elevation myocardial infarction (STEMI)" were comprehensively reviewed through search of the PubMed literatures without restriction on the publication date. STUDY SELECTION Original articles, reviews and other literatures concerning J wave syndromes, ERS, BrS and STEMI were selected. RESULTS J wave syndromes were firstly defined by Yan et al. in a Chinese journal a decade ago, which represent a spectrum of variable phenotypes characterized by appearance of prominent electrocardiographic J wave including ERS, BrS and ventricular fibrillation (VF) associated with hypothermia and acute STEMI. J wave syndromes can be inherited or acquired and are mechanistically linked to amplification of the transient outward current (I to )-mediated J waves that can lead to phase 2 reentry capable of initiating VF. CONCLUSIONS J wave syndromes are a group of newly highlighted clinical entities that share similar molecular, ionic and cellular mechanism and marked by amplified J wave on the electrocardiogram and a risk of VF. The clinical challenge ahead is to identify the patients with J wave syndromes who are at risk for sudden cardiac death and determine the alternative therapeutic strategies to reduce mortality.
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Affiliation(s)
- Guo-Liang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi 710061, China
| | - Lin Yang
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi 710061, China
| | - Chang-Cong Cui
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi 710061, China
| | - Chao-Feng Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi 710061, China
| | - Gan-Xin Yan
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi 710061, China
- Department of Cardiovascular Medicine, Lankenau Medical Center and Lankenau Institute of Medical Research, PA, USA
- Department of Cardiovascular Medicine, Jefferson Medical College of Thomas Jefferson University, PA, USA
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50
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Qu Z, Weiss JN. Mechanisms of ventricular arrhythmias: from molecular fluctuations to electrical turbulence. Annu Rev Physiol 2014; 77:29-55. [PMID: 25340965 DOI: 10.1146/annurev-physiol-021014-071622] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Ventricular arrhythmias have complex causes and mechanisms. Despite extensive investigation involving many clinical, experimental, and computational studies, effective biological therapeutics are still very limited. In this article, we review our current understanding of the mechanisms of ventricular arrhythmias by summarizing the state of knowledge spanning from the molecular scale to electrical wave behavior at the tissue and organ scales and how the complex nonlinear interactions integrate into the dynamics of arrhythmias in the heart. We discuss the challenges that we face in synthesizing these dynamics to develop safe and effective novel therapeutic approaches.
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Affiliation(s)
- Zhilin Qu
- Departments of 1Medicine (Cardiology) and
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