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Nakasone K, Tanaka K, Del Monte A, Della Rocca DG, Pannone L, Mouram S, Cespón-Fernández M, Doundoulakis I, Marcon L, Audiat C, Vetta G, Scacciavillani R, Overeinder I, Bala G, Sorgente A, Sieira J, Almorad A, Fukuzawa K, Hirata KI, Brugada P, Sarkozy A, Chierchia GB, de Asmundis C, Ströker E. Distance-dependent neuromodulation effect during thermal ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2024; 35:1997-2005. [PMID: 39135364 DOI: 10.1111/jce.16401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/11/2024] [Accepted: 08/01/2024] [Indexed: 10/11/2024]
Abstract
INTRODUCTION Thermal atrial fibrillation (AF) ablation exerts an additive treatment effect on the cardiac autonomic nervous system (CANS). This effect is mainly reported during ablation of the right superior pulmonary vein (RSPV), modulating the right anterior ganglionated plexus (RAGP), which contains parasympathetic innervation to the sinoatrial node in the epicardial fat pad between RSPV and superior vena cava (SVC). However, a variable response to neuromodulation after ablation is observed, with little to no effect in some patients. Our objective was to assess clinical and anatomic predictors of thermal ablation-induced CANS changes, as assessed via variations in heart rate (HR) postablation. METHODS Consecutive paroxysmal AF patients undergoing first-time PV isolation by the cryoballoon (CB) or radiofrequency balloon (RFB) within a 12-month time frame and with preprocedural cardiac computed tomography (CT), were evaluated. Preablation and 24-h postablation electrocardiograms in sinus rhythm were collected and analyzed to assess HR. Anatomic evaluation by CT included the measurement of the shortest distance between the SVC and RSPV ostium (RSPV-SVC distance). RESULTS A total of 97 patients (CB, n = 50 vs. RFB, n = 47) were included, with similar baseline characteristics between both groups. A significant HR increase postablation (ΔHR ≥ 15 bpm) occurred in a total of 37 patients (38.1%), without difference in number of patients between both thermal ablation technologies (CB, 19 [51%]), RFB, 18 [49%]). Independent predictors for increased HR were RSPV-SVC distance (odds ratio [OR]: 0.49, CI: 0.34-0.71, p value < .001), and age (OR: 0.94, CI: 0.89-0.98, p value = .003). CONCLUSIONS Thermal balloon-based PV isolation influences the CANS through its effect on the RAGP, especially in younger patients and patients with shorter RSPV-SVC distance.
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Affiliation(s)
- Kazutaka Nakasone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Alvise Del Monte
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Sahar Mouram
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - María Cespón-Fernández
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Ioannis Doundoulakis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Lorenzo Marcon
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Charles Audiat
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Giampaolo Vetta
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Roberto Scacciavillani
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Koji Fukuzawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
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2
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Zuhair M, Keene D, Kanagaratnam P, Lim PB. Percutaneous Neuromodulation for Atrial Fibrillation. Card Electrophysiol Clin 2024; 16:281-296. [PMID: 39084721 DOI: 10.1016/j.ccep.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Percutaneous neuromodulation is emerging as a promising therapeutic approach for atrial fibrillation (AF). This article explores techniques such as ganglionated plexi (GP) ablation, and vagus nerve stimulation, pinpointing their potential in modulating AF triggers and maintenance. Noninvasive methods, such as transcutaneous low-level tragus stimulation, offer innovative treatment pathways, with early trials indicating a significant reduction in AF burden. GP ablation may address autonomic triggers, and the potential for GP ablation in neuromodulation is discussed. The article stresses the necessity for more rigorous clinical trials to validate the safety, reproducibility, and efficacy of these neuromodulation techniques in AF treatment.
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Affiliation(s)
- Mohamed Zuhair
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK.
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
| | - Prapa Kanagaratnam
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
| | - Phang Boon Lim
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
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3
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Zarębski Ł, Futyma P, Sethia Y, Futyma M, Kułakowski P. Improvement in Atrioventricular Conduction Using Cardioneuroablation Performed Immediately after Pulmonary Vein Isolation. Healthcare (Basel) 2024; 12:728. [PMID: 38610150 PMCID: PMC11011453 DOI: 10.3390/healthcare12070728] [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: 01/19/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
In patients with atrial fibrillation (AF) recurrences after pulmonary vein isolation (PVI), concomitant treatment using anti arrhythmic drugs (AADs) can lead to clinical success. However, patients with atrioventricular (AV) block may not be good candidates for concomitant AAD therapy due to the risk of further worsening of conduction abnormalities. Cardioneuroablation (CNA), as an adjunct to PVI, may offer a solution to this problem. We present a case of a 74-year-old male with paroxysmal AF and first degree AV block in whom CNA following PVI led to PR normalization. The presented case describes an example of CNA utilization in patients with AF undergoing PVI who have concomitant problems with AV conduction and shows that CNA can be sometimes useful in older patients with functional AV block.
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Affiliation(s)
- Łukasz Zarębski
- Medical College, University of Rzeszów, 35-959 Rzeszów, Poland; (Ł.Z.); (Y.S.)
- St. Joseph’s Heart Rhythm Center, 35-623 Rzeszów, Poland; (M.F.); (P.K.)
| | - Piotr Futyma
- Medical College, University of Rzeszów, 35-959 Rzeszów, Poland; (Ł.Z.); (Y.S.)
- St. Joseph’s Heart Rhythm Center, 35-623 Rzeszów, Poland; (M.F.); (P.K.)
| | - Yashvi Sethia
- Medical College, University of Rzeszów, 35-959 Rzeszów, Poland; (Ł.Z.); (Y.S.)
| | - Marian Futyma
- St. Joseph’s Heart Rhythm Center, 35-623 Rzeszów, Poland; (M.F.); (P.K.)
| | - Piotr Kułakowski
- St. Joseph’s Heart Rhythm Center, 35-623 Rzeszów, Poland; (M.F.); (P.K.)
- Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, 04-073 Warsaw, Poland
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4
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Jeong JH, Lee HS, Choi YY, Kim YG, Choi JI, Kim YH, Lim HE, Oh IY, Cha MJ, Lee SR, Kim JY, Kwon CH, Lee SH, Park J, Kim KH, Yang PS, Kim JH, Shim J. Association of typical atrial flutter and cavotricuspid isthmus ablation on clinical recurrence after cryoballoon ablation for atrial fibrillation. Front Cardiovasc Med 2023; 10:1303635. [PMID: 38162135 PMCID: PMC10755020 DOI: 10.3389/fcvm.2023.1303635] [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: 09/28/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Typical atrial flutter commonly occurs in patients with atrial fibrillation (AF). Limited information exists regarding the effects of concurrent atrial flutter on the long-term outcomes of rhythm control. This study investigated the association between concurrent typical atrial flutter and cavotricuspid isthmus (CTI) ablation and the recurrence of atrial arrhythmia. The data were obtained from a multicenter registry of cryoballoon ablation for AF (n = 2,689). Patients who were screened for typical atrial flutter were included in the analysis (n = 1,907). All the patients with typical atrial flutter underwent CTI ablation. The primary endpoint was the late recurrence of atrial arrhythmia, including AF, atrial flutter, and atrial tachycardia. Among the 1,907 patients, typical atrial flutter was detected in 493 patients (25.9%). Patients with concurrent atrial flutter had a lower incidence of persistent AF and a smaller size of the left atrium. Patients with atrial flutter had a significantly lower recurrence rate of atrial arrhythmia (19.7% vs. 29.9%, p < 0.001). In patients with atrial flutter, the recurrence rate of atrial tachycardia or atrial flutter was more frequent (7.3% vs. 4.7%, p = 0.028), but the recurrence rate of AF was significantly lower (17.0% vs. 29.4%, p < 0.001). Atrial flutter has been identified as an independent predictor of the primary endpoint (adjusted hazard ratio, 0.704; 95% confidence interval, 0.548-0.906; p = 0.006). Typical atrial flutter in patients with AF may serve as a positive marker of the recurrence of atrial arrhythmia, and performing CTI ablation in this population is associated with a reduced likelihood of AF recurrence. Performing routine screening and ablation procedures for coexisting atrial flutter may improve the clinical outcomes of AF.
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Affiliation(s)
- Joo Hee Jeong
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hyoung Seok Lee
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Yun Young Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hong Euy Lim
- Division of Cardiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Il-Young Oh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Myung-Jin Cha
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ju Youn Kim
- Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sung Ho Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Junbeom Park
- Department of Cardiology, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Ki-Hun Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Jun-Hyung Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
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5
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Yarkoni M, Rehman WU, Bajwa A, Yarkoni A, Rehman AU. Ganglionated Plexus Ablation Procedures to Treat Vasovagal Syncope. Int J Mol Sci 2023; 24:13264. [PMID: 37686062 PMCID: PMC10487499 DOI: 10.3390/ijms241713264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Vasovagal syncope (VVS) refers to a heterogeneous group of conditions whereby the cardiovascular reflexes normally controlling the circulation are interrupted irregularly in response to a trigger, resulting in vasodilation, bradycardia, or both. VVS affects one-third of the population at least once in their lifetime or by the age of 60, reduces the quality of life, and may cause disability affecting certain routines. It poses a considerable economic burden on society, and, despite its prevalence, there is currently no proven pharmacological treatment for preventing VVS. The novel procedure of ganglionated plexus (GP) ablation has emerged rapidly in the past two decades, and has been proven successful in treating syncope. Several parameters influence the success rate of GP ablation, including specific ablation sites, localization and surgical techniques, method of access, and the integration of other interventions. This review aims to provide an overview of the existing literature on the physiological aspects and clinical effectiveness of GP ablation in the treatment of VVS. Specifically, we explore the association between GPs and VVS and examine the impact of GP ablation procedures as reported in human clinical trials. Our objective is to shed light on the therapeutic significance of GP ablation in eliminating VVS and restoring normal sinus rhythm, particularly among young adults affected by this condition.
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Affiliation(s)
- Merav Yarkoni
- Heart and Vascular Institute, United Health Services, Johnson City, NY 13790, USA; (W.u.R.); (A.B.); (A.Y.); (A.u.R.)
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6
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Oancea AF, Jigoranu RA, Morariu PC, Miftode RS, Trandabat BA, Iov DE, Cojocaru E, Costache II, Baroi LG, Timofte DV, Tanase DM, Floria M. Atrial Fibrillation and Chronic Coronary Ischemia: A Challenging Vicious Circle. Life (Basel) 2023; 13:1370. [PMID: 37374152 DOI: 10.3390/life13061370] [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: 04/12/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Atrial fibrillation, the most frequent arrhythmia in clinical practice and chronic coronary syndrome, is one of the forms of coronary ischemia to have a strong dual relationship. Atrial fibrillation may accelerate atherosclerosis and may increase oxygen consumption in the myocardium, creating a mismatch between supply and demand, thus promoting the development or worsening of coronary ischemia. Chronic coronary syndrome alters the structure and function of gap junction proteins, affecting the conduction of action potential and leading to ischemic necrosis of cardiomyocytes and their replacement with fibrous tissue, in this way sustaining the focal ectopic activity in atrial myocardium. They have many risk factors in common, such as hypertension, obesity, type 2 diabetes mellitus, and dyslipidemia. It is vital for the prognosis of patients to break this vicious circle by controlling risk factors, drug therapies, of which antithrombotic therapy may sometimes be challenging in terms of prothrombotic and bleeding risk, and interventional therapies (revascularization and catheter ablation).
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Affiliation(s)
- Alexandru Florinel Oancea
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Cardiology Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Raul Alexandru Jigoranu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Cardiology Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Paula Cristina Morariu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Internal Medicine Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Radu-Stefan Miftode
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Cardiology Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Bogdan Andrei Trandabat
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Cardiology Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Diana Elena Iov
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Internal Medicine Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Elena Cojocaru
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Department of Morphofunctional Sciences-Pathology, Pediatric Hospital, 700115 Iasi, Romania
| | - Irina Iuliana Costache
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Cardiology Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Livia Genoveva Baroi
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Surgery Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Daniel Vasile Timofte
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Surgery Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Daniela Maria Tanase
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Internal Medicine Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Mariana Floria
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Internal Medicine Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
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Petrungaro M, Fusco L, Cavarretta E, Scarà A, Borrelli A, Romano S, Petroni R, D'Ascenzi F, Sciarra L. Long-Term Sports Practice and Atrial Fibrillation: An Updated Review of a Complex Relationship. J Cardiovasc Dev Dis 2023; 10:jcdd10050218. [PMID: 37233185 DOI: 10.3390/jcdd10050218] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/04/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023] Open
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice, and it is an enormous burden worldwide because of its high morbidity, disability and mortality. It is generally acknowledged that physical activity (PA) is strongly associated with a significant reduction in the risk of cardiovascular (CV) disease and all-cause mortality. Moreover, it has been observed that moderate and regular physical activity has the potential to reduce the risk of AF, in addition to improving overall well-being. Nevertheless, some studies have associated intense physical activity with an increased risk of AF. This paper aims to review the main related literature to investigate the association between PA and AF incidence and draw pathophysiological and epidemiological conclusions.
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Affiliation(s)
- Mattia Petrungaro
- Unit of Electrophysiology, Belcolle Hospital, 01100 Viterbo, Italy
- Cardiology Department, University of Rome Sapienza, 00100 Rome, Italy
| | - Liuba Fusco
- Cardiology Unit, University Hospital of Northamptonshire, Northampton NN1 5BD, UK
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
- Mediterranea Cardiocentro, 80133 Naples, Italy
| | - Antonio Scarà
- Unit of Cardiology and Electrophysiology, San Carlo di Nancy Hospital, 00100 Rome, Italy
| | - Alessio Borrelli
- Unit of Cardiology and Electrophysiology, San Carlo di Nancy Hospital, 00100 Rome, Italy
| | - Silvio Romano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Renata Petroni
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
- Department of Medicine, Di Lorenzo Clinic, 67052 Avezzano, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Luigi Sciarra
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
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8
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Rebecchi M, Fanisio F, Rizzi F, Politano A, De Ruvo E, Crescenzi C, Panattoni G, Squeglia M, Martino A, Sasso S, Golia P, Pugliese G, Del Gigante S, Giamundo D, Desimone P, Grieco D, De Luca L, Giordano I, Barillà F, Perrone MA, Calò L, Iellamo F. The Autonomic Coumel Triangle: A New Way to Define the Fascinating Relationship between Atrial Fibrillation and the Autonomic Nervous System. Life (Basel) 2023; 13:life13051139. [PMID: 37240784 DOI: 10.3390/life13051139] [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: 04/10/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Arrhythmogenic substrate, modulating factors, and triggering factors (the so-called Coumel's triangle concept) play a primary role in atrial fibrillation (AF) pathophysiology. Several years have elapsed since Coumel and co-workers advanced the concept of the relevance of autonomic nervous system (ANS) influences on atrial cells' electrophysiological characteristics. The ANS is not only associated with cardiac rhythm regulation but also exerts an important role in the triggering and maintenance of atrial fibrillation. This review aims to describe in detail the autonomic mechanisms involved in the pathophysiology of atrial fibrillation (AF), starting from the hypothesis of an "Autonomic Coumel Triangle" that stems from the condition of the fundamental role played by the ANS in all phases of the pathophysiology of AF. In this article, we provide updated information on the biomolecular mechanisms of the ANS role in Coumel's triangle, with the molecular pathways of cardiac autonomic neurotransmission, both adrenergic and cholinergic, and the interplay between the ANS and cardiomyocytes' action potential. The heterogeneity of the clinical spectrum of the ANS and AF, with the ANS playing a relevant role in situations that may promote the initiation and maintenance of AF, is highlighted. We also report on drug, biological, and gene therapy as well as interventional therapy. On the basis of the evidence reviewed, we propose that one should speak of an "Autonomic Coumel's Triangle" instead of simply "Coumel's Triangle".
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Affiliation(s)
- Marco Rebecchi
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | | | - Fabio Rizzi
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | | | | | | | | | | | | | - Stefano Sasso
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Paolo Golia
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | - Giulia Pugliese
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Sofia Del Gigante
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Domenico Giamundo
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Pietro Desimone
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Domenico Grieco
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | - Lucia De Luca
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | - Ignazio Giordano
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Francesco Barillà
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Marco Alfonso Perrone
- Department of Clinical Science and Translational Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Leonardo Calò
- Division of Cardiology, PoliclinicoCasilino, 00169 Rome, Italy
| | - Ferdinando Iellamo
- Department of Clinical Science and Translational Medicine, University Tor Vergata, 00133 Rome, Italy
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Rebecchi M, De Ruvo E, Borrelli A, Sette A, Sgueglia M, Grieco D, Canestrelli S, Politano A, Panattoni G, Licciardello C, Latorre M, Panuccio M, Mattatelli A, Calò L. Ganglionated plexi ablation in the right atrium for the treatment of cardioinhibitory syncope. Eur Heart J Suppl 2023; 25:C261-C264. [PMID: 37125307 PMCID: PMC10132630 DOI: 10.1093/eurheartjsupp/suad002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Neurocardiogenic syncope, also called vasovagal syncope, represents one of the clinical manifestations of neurally mediated syncopal syndrome. Generally, the prognosis of the cardioinhibitory form of neurocardiogenic syncope is good, but quality of life is seriously compromised in patients who experience severe forms. Drug therapy has not achieved good clinical results and very heterogeneous data come from studies regarding permanent cardiac pacing. In this scenario, the ganglionated plexi ablation has been proposed as an effective and safe method in patients with cardioinhibitory neurocardiogenic syncope, especially in young patients in order to avoid or prolong, as much as possible, the timing of definitive cardiac pacing. Certainly, making this procedure less extensive and limiting the ablation in the right atrium (avoiding the potential complications of a left atrial approach) and at level of anatomical regions of the most important ganglionated plexy, considered 'gateway' of the sino-atrial and atrio-ventricular node function (through the recognition of specific endocardial potentials), could be very advantageous in this clinical scenario. Finally, randomized, multicentre, clinical trials on a large population are needed to better understand which is the best ablation treatment (right-only or bi-atrial) and provide evidence for syncope guidelines.
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Affiliation(s)
- Marco Rebecchi
- Corresponding author. Tel: +39 0623188406, Fax: +39 0623188410, ;
| | - Ermenegildo De Ruvo
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00100 Rome, Italy
| | - Alessio Borrelli
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00100 Rome, Italy
| | - Antonella Sette
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00100 Rome, Italy
| | - Marianna Sgueglia
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00100 Rome, Italy
| | - Domenico Grieco
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00100 Rome, Italy
| | - Stefano Canestrelli
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00100 Rome, Italy
| | - Alessandro Politano
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00100 Rome, Italy
| | - Germana Panattoni
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00100 Rome, Italy
| | - Claudio Licciardello
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00100 Rome, Italy
| | - Maria Latorre
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00100 Rome, Italy
| | - Marco Panuccio
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00100 Rome, Italy
| | - Antonella Mattatelli
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00100 Rome, Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00100 Rome, Italy
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Rebecchi M, De Ruvo E, Sgueglia M, Lavalle C, Canestrelli S, Politano A, Jacomelli I, Golia P, Crescenzi C, De Luca L, Panuccio M, Fagagnini A, Calò L. Atrial fibrillation and sympatho-vagal imbalance: from the choice of the antiarrhythmic treatment to patients with syncope and ganglionated plexi ablation. Eur Heart J Suppl 2023; 25:C1-C6. [PMID: 37125283 PMCID: PMC10132557 DOI: 10.1093/eurheartjsupp/suad075] [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] [Indexed: 05/02/2023]
Abstract
For several years, the autonomic nervous system has played a central role in the pathophysiological mechanism of atrial fibrillation (AF), so much so that it has been considered one of the cornerstones of Coumel's triangle. The clinical and therapeutic management of AF secondary to sympatho-vagal imbalance represents one of the most important examples of how precision medicine should be applied. Increasing knowledge of this kind of arrhythmias has made it possible to select specific antiarrhythmic drugs and to diversify their use according to vagal or adrenergic AF forms. Ablative strategies, such as cardioneuroablation and non-direct cardiac neuromodulation methods (such as renal denervation and peripheral vagal stimulation), have gradually emerged. In the possibly near future, there will be a development of new acquisitions regarding new pharmacological therapeutic strategies and gene therapy. Finally, finding an AF in patients experiencing syncopal episodes opens a whole chapter regarding interesting, but also complex, diagnostic and therapeutic strategies, ranging from neurally mediated forms to convulsive seizure that could also increase the risk of sudden death.
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Affiliation(s)
- Marco Rebecchi
- Corresponding author. Tel: +390623188406, Fax: +390623188410, ,
| | - Ermenegildo De Ruvo
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
| | | | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico, 155, Rome 00161, Italy
| | - Stefano Canestrelli
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
| | - Alessandro Politano
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
| | - Ilaria Jacomelli
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
| | - Paolo Golia
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
| | - Cinzia Crescenzi
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
| | - Lucia De Luca
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
| | - Marco Panuccio
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
| | - Alessandro Fagagnini
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00100, Italy
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11
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Karatela MF, Fudim M, Mathew JP, Piccini JP. Neuromodulation therapy for atrial fibrillation. Heart Rhythm 2023; 20:100-111. [PMID: 35988908 DOI: 10.1016/j.hrthm.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/07/2022] [Accepted: 08/12/2022] [Indexed: 02/08/2023]
Abstract
Atrial fibrillation has a multifactorial pathophysiology influenced by cardiac autonomic innervation. Both sympathetic and parasympathetic influences are profibrillatory. Innovative therapies targeting the neurocardiac axis include catheter ablation or pharmacologic suppression of ganglionated plexi, renal sympathetic denervation, low-level vagal stimulation, and stellate ganglion blockade. To date, these therapies have variable efficacy. As our understanding of atrial fibrillation and the cardiac nervous system expands, our approach to therapeutic neuromodulation will continue evolving for the benefit of those with AF.
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Affiliation(s)
- Maham F Karatela
- Cardiac Electrophysiology Section, Duke Heart Center and Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Marat Fudim
- Cardiac Electrophysiology Section, Duke Heart Center and Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Joseph P Mathew
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Jonathan P Piccini
- Cardiac Electrophysiology Section, Duke Heart Center and Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
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12
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Aksu T, Skeete JR, Huang HH. Ganglionic Plexus Ablation: A Step-by-step Guide for Electrophysiologists and Review of Modalities for Neuromodulation for the Management of Atrial Fibrillation. Arrhythm Electrophysiol Rev 2023; 12:e02. [PMID: 36845167 PMCID: PMC9945432 DOI: 10.15420/aer.2022.37] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/29/2022] [Indexed: 02/01/2023] Open
Abstract
As the most common sustained arrhythmia, AF is a complex clinical entity which remains a difficult condition to durably treat in the majority of patients. Over the past few decades, the management of AF has focused mainly on pulmonary vein triggers for its initiation and perpetuation. It is well known that the autonomic nervous system (ANS) has a significant role in the milieu predisposing to the triggers, perpetuators and substrate for AF. Neuromodulation of ANS - ganglionated plexus ablation, vein of Marshall ethanol infusion, transcutaneous tragal stimulation, renal nerve denervation, stellate ganglion block and baroreceptor stimulation - constitute an emerging therapeutic approach for AF. The purpose of this review is to summarise and critically appraise the currently available evidence for neuromodulation modalities in AF.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | | | - Henry H Huang
- Department of Cardiology, Rush Medical College, Chicago, IL, US
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13
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Baptiste F, Kalifa J, Durand C, Gitenay E, Bremondy M, Ayari A, Maillot N, Taormina A, Fofana A, Penaranda G, Siame S, Bars C, Seitz J. Right atrial appendage firing in atrial fibrillation. Front Cardiovasc Med 2022; 9:997998. [DOI: 10.3389/fcvm.2022.997998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe role of atrial fibrillation (AF) drivers located at the left atrium, superior vena cava, crista terminalis and coronary sinus (CS) is well established. While these regions are classically targeted during catheter ablation, the role of right atrial appendage (RAA) drivers has been incompletely investigated.ObjectiveTo determine the prevalence and electrophysiological characteristics of AF driver’s arising from the RAA.Materials and methodsWe conducted a retrospective analysis of clinical and procedural data of 317 consecutive patients who underwent an AF ablation procedure after bi-atrial mapping (multipolar catheter). We selected patients who presented with a per-procedural RAA firing (RAAF). RAAF was defined as the recording of a sustained RAA EGM with a cycle length shorter than 120 ms or 120 < RAAF CL ≤ 130 ms and ratio RAA CL/CS CL ≤ 0.75.ResultsRight atrial/atrium appendage firing was found in 22 patients. The prevalence was estimated at 7% (95% CI, 4–10). These patients were mostly men (72%), median age: 66 yo ± 8 without structural heart disease (77%). RAAFs were predominantly found in paroxysmal AF patients (63%, 32%, and 5% for paroxysmal, short standing and long-standing AF, respectively, p > 0.05). RAAF median cycle length was 117 ms ± 7 while CS cycle length was 180 ms ± 10 (p < 0.01).ConclusionIn 317 consecutive AF ablation patients (22 patients, 7%) the presence of a high-voltage short-cycle-length right atrial appendage driver (RAAF) may conclusively be associated with AF termination. This case series exemplifies the not-so-uncommon role of the RAA in the perpetuation of AF.
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14
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Palamà Z, Nesti M, Robles AG, Scarà A, Romano S, Cavarretta E, Penco M, Delise P, Rillo M, Calò L, Sciarra L. Tailoring the Ablative Strategy for Atrial Fibrillation: A State-of-the-Art Review. Cardiol Res Pract 2022; 2022:9295326. [PMID: 35449606 PMCID: PMC9017557 DOI: 10.1155/2022/9295326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/15/2021] [Accepted: 01/29/2022] [Indexed: 12/15/2022] Open
Abstract
In spite of technological progress and the improving skills of operators, atrial fibrillation (AF) ablation results appear to date to be at a plateau. In any case, the superiority of ablation over pharmacological therapy in terms of effectiveness, reduction of hospitalizations, and improvement has been well demonstrated in recent randomized trials. Triggers, substrate, and modulating factors (elements of Coumel's triangle) play different roles in paroxysmal and persistent AF, so induction and perpetuation mechanisms of arrhythmia may be different in each patient. Although effective ablative strategies are available for the treatment of paroxysmal AF triggers and persistent AF substrates, an adequate clinical evaluation of the patient is crucial in order to increase the chances of success. Recognizing triggers allows not only performing an effective ablation but also to avoid unnecessary lesions and at the same time reducing the risk of complications. AF beginning and triggers could be recorded by 12-lead ECG, continuous Holter monitoring, or implantable devices. In case of an unsuccessful noninvasive evaluation, nonpulmonary vein triggers should be investigated with an electrophysiological study. Persistent AF needs more effort to perform an accurate substrate characterization. Among the many methods proposed, recently the use of high-density mapping and multipolar catheters seems of particular benefit in order to clarify the arrhythmia mechanisms. Surgical and hybrid techniques allow to treat regions such as the posterior wall or Bachmann's bundle, which is fundamental for an ablative strategy that goes beyond just pulmonary vein isolation. Too often, patients are referred to electrophysiology laboratories without adequate preprocedural screening and planning in order to submit them to a standard "ready-made" procedure. The accurate search for triggers in paroxysmal AF and the correct recognition of the link between a possible underlying heart disease and the substrate in persistent AF could allow us to tailor the interventional approach in order to overcome the current plateau, increasing ablative procedure success and minimizing complications.
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Affiliation(s)
- Zefferino Palamà
- Electrophysiology Unit, Casa di Cura “Villa Verde”, Via Golfo di Taranto, 22, Taranto, Italy
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Martina Nesti
- Cardiovascular and Neurological Department, Ospedale San Donato, Via Nenni, 20/22, Arezzo, Italy
| | - Antonio Gianluca Robles
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- Cardiology Unit Ospedale “Di Venere”, Bari, Italy
| | - Antonio Scarà
- Cardiology Unit, Policlinico Casilino, Via Casilina, Rome 1049, Italy
| | - Silvio Romano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Elena Cavarretta
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Maria Penco
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Pietro Delise
- U.O. Cardiologia, Ospedale P. Pederzoli, Peschiera Del Garda (VR), Italy
| | - Mariano Rillo
- Electrophysiology Unit, Casa di Cura “Villa Verde”, Via Golfo di Taranto, 22, Taranto, Italy
| | - Leonardo Calò
- Cardiology Unit, Policlinico Casilino, Via Casilina, Rome 1049, Italy
| | - Luigi Sciarra
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- Cardiology Unit, Policlinico Casilino, Via Casilina, Rome 1049, Italy
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15
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Alvarez CK, Swales H, Kluger J. A case report of deglutition triggered atrial fibrillation in a patient with Laing distal myopathy. Eur Heart J Case Rep 2021; 5:ytab430. [PMID: 34926983 PMCID: PMC8672657 DOI: 10.1093/ehjcr/ytab430] [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: 04/13/2021] [Revised: 05/13/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Abstract
Background Deglutition-induced atrial fibrillation is a rare clinical entity with a reported prevalence of 0.6%. Laing distal myopathy is a rare autosomal dominant muscular dystrophy that is the result of mutations within the slow skeletal muscle fibre myosin heavy chain gene (MYH7). Atrial fibrillation has not been previously reported in patients with Laing distal myopathy. We describe the first reported case of deglutition triggered atrial fibrillation in a female with a history of Laing distal myopathy. Case summary A 44-year-old female with a history of Laing distal myopathy diagnosed at age 32, began experiencing intermittent episodes of pre-syncope and palpitations which occurred after deglutition with food. An ambulatory 30-day patient triggered event monitor recorded episodes of atrial fibrillation with rapid ventricular response. Family history was significant for Laing distal myopathy, atrial fibrillation, as well as sudden cardiac death. Laboratory data, transthoracic echocardiogram, cardiac magnetic resonance imaging, and an exercise treadmill SPECT Imaging stress test were normal. An oesophagram revealed a mild oesophageal dysmotility with no other abnormalities. She was started on flecainide 50 mg p.o. every 8 h and verapamil 40 mg p.o. every 8 h with no further episodes of atrial fibrillation. Discussion Given the strong genetic component of this myopathy, one could postulate as to a possible genetic component in the development of atrial fibrillation in our patient. Although we cannot make definite correlation between deglutition-induced atrial fibrillation and Laing myopathy, it is important to report this unusual association which has not been described before.
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Affiliation(s)
- Chikezie K Alvarez
- Cardiovascular Department, Hartford Hospital/University of Connecticut, 80 Seymour St, Hartford, CT 06106, USA
| | - Heather Swales
- Cardiovascular Department, Hartford Hospital/University of Connecticut, 80 Seymour St, Hartford, CT 06106, USA
| | - Jeffrey Kluger
- Cardiovascular Department, Hartford Hospital/University of Connecticut, 80 Seymour St, Hartford, CT 06106, USA
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16
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Nishida T, Takitsume A, Sugiura J, Keshi A, Kanaoka K, Hirai K, Yano H, Hashimoto Y, Ueda T, Nakagawa H, Onoue K, Soeda T, Watanabe M, Kawakami R, Saito Y. Catheter ablation of ganglionated plexi in patients with adenosine triphosphate-induced atrial fibrillation after pulmonary vein isolation. Heart Vessels 2021; 37:854-866. [PMID: 34741632 DOI: 10.1007/s00380-021-01979-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022]
Abstract
Intravenous ATP may induce atrial fibrillation (AF). ATP shares similar receptor-effector coupling systems with acetylcholine. However, the association between an ATP injection and the hyperactivity of the intrinsic cardiac autonomic nervous system, known as ganglionated plexi (GPs), is not well understood. We describe a series of patients with non-pulmonary vein (PV) trigger sites provoked by an ATP injection, and assess the feasibility of a ganglionated plexus (GP) ablation. We retrospectively analyzed 547 patients (69% male; mean age 67.4 ± 10.4 years; 38.5% non-paroxysmal AF) who underwent a total of 604 ablation procedures. Intravenous ATP was administered with an isoproterenol infusion during sinus rhythm after a pulmonary vein isolation in 21.3%, Box isolation in 78.6%, and SVC isolation in 52.0% of the procedures, respectively. We reviewed the incidence, the distribution of the foci, and the ablation outcomes in patients with ATP-induced AF. A total of seven patients (1.3%) had ATP-induced AF. Foci were identified in the coronary sinus (CS) in six patients, right atrial posterior wall (RAPW) adjacent to the interatrial groove in two, mitral annulus in two, ligament of Marshall in one, right septum below the foramen ovale in one and left atrial posterior wall in one, respectively. Among these trigger foci, we confirmed the vagal response by high-frequency stimulation in the CS and RAPW in six and two patients, respectively. After a median RF time of 2.9 min (range 2.5-11.3) targeting these foci, in five of six patients who received a repeat ATP injection, the AF became non-inducible. ATP-provoked trigger foci were distributed among certain sites that overlapped with the distribution of the GPs. The GP ablation was effective for this rare, but challenging situation.
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Affiliation(s)
- Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan.
| | - Akihiro Takitsume
- Department of Cardiology, Nara Prefecture General Medical Center, Kashihara, Japan
| | - Junichi Sugiura
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Ayaka Keshi
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Koshiro Kanaoka
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Kaeko Hirai
- Department of Cardiology, Nara Prefecture Seiwa Medical Center, Kashihara, Japan
| | - Hiroki Yano
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Yukihiro Hashimoto
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Hitoshi Nakagawa
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Rika Kawakami
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
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17
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Mesquita D, Parreira L, Carmo P, Marinheiro R, Cavaco D, Amador P, Vaz E, Costa F, Farinha J, Scanavacca M, Caria R, Adragão PP. Anatomic guided ablation of the atrial right ganglionated plexi is enough for cardiac autonomic modulation in patients with significant bradyarrhythmias. Indian Pacing Electrophysiol J 2021; 21:327-334. [PMID: 34246757 PMCID: PMC8577118 DOI: 10.1016/j.ipej.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/18/2021] [Accepted: 07/07/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Cardiac autonomic system modulation by endocardial ablation targeting atrial ganglionated plexi (GP) is an alternative strategy in selected patients with severe functional bradyarrhythmias, although no consensus exists on the best ablation strategy. The aim of this study was to evaluate if a simplified approach by a purely anatomical guided ablation of just the atrial right GP is enough for the treatment of these patients. METHODS We prospectively enrolled patients with significant functional bradyarrhythmias and performed endocardial ablation purely guided by 3D electroanatomic mapping directed at the atrial right GP and accessed parameters of parasympathetic modulation and recurrence of bradyarrhythmias. RESULTS Thirteen patients enrolled (76.9% male, median age 51, 42-63 years). After ablation, a median RR interval shortening of 28.3 (25.6-40.3)% occurred (1111, 937.5-1395.4 ms to 722.9, 652.2-882.4 ms, p = 0.0002). The AH interval also shortened (19, 10.5-35.7%) significantly after the procedure (115, 105-122 ms to 85, 71-105 ms, p = 0.0023) as well as Wenckebach cycle length (11.1, 5.9-17.8% shortening) from 450, 440-510 ms to 430, 400-460 ms, p = 0.0127. On 24-h Holter monitoring there was significant increase in heart rates (HR) of patients after ablation (minimal HR increased from 34 (26-43)bpm to 49 (43-56)bpm, p = 0,0102 and mean HR from 65 (47-72)bpm to 78 (67-87)bpm, p = 0.0004). No patients had recurrence of symptoms or significant bradyarrhythmias during a median follow-up of 8.4 months. CONCLUSIONS A purely anatomic guided procedure directed only at the atrial right ganglionated plexi seems to be enough as a therapeutic approach for cardioneuroablation in selected patients with significant functional bradyarrhythmias.
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Affiliation(s)
- Dinis Mesquita
- Centro Hospitalar de Setúbal, Hospital de S. Bernardo E.P.E., Setúbal, Portugal, Hospital de São Bernardo, Rua Camilo Castelo Branco, 2910-446, Setúbal, Portugal
- Centro Hospital de Lisboa Ocidental, Hospital de St. Cruz E.P.E., Carnaxide, Portugal, Hospital de Santa Cruz, Avenida Professor Reinaldo dos Santos, 2799-134, Carnaxide, Portugal
| | - Leonor Parreira
- Centro Hospitalar de Setúbal, Hospital de S. Bernardo E.P.E., Setúbal, Portugal, Hospital de São Bernardo, Rua Camilo Castelo Branco, 2910-446, Setúbal, Portugal
- Hospital da Luz, Lisboa, Portugal, Hospital da Luz, Avenida Lusíada 100, 1500-650, Lisboa, Portugal
| | - Pedro Carmo
- Hospital da Luz, Lisboa, Portugal, Hospital da Luz, Avenida Lusíada 100, 1500-650, Lisboa, Portugal
- Centro Hospital de Lisboa Ocidental, Hospital de St. Cruz E.P.E., Carnaxide, Portugal, Hospital de Santa Cruz, Avenida Professor Reinaldo dos Santos, 2799-134, Carnaxide, Portugal
| | - Rita Marinheiro
- Centro Hospitalar de Setúbal, Hospital de S. Bernardo E.P.E., Setúbal, Portugal, Hospital de São Bernardo, Rua Camilo Castelo Branco, 2910-446, Setúbal, Portugal
| | - Diogo Cavaco
- Hospital da Luz, Lisboa, Portugal, Hospital da Luz, Avenida Lusíada 100, 1500-650, Lisboa, Portugal
- Centro Hospital de Lisboa Ocidental, Hospital de St. Cruz E.P.E., Carnaxide, Portugal, Hospital de Santa Cruz, Avenida Professor Reinaldo dos Santos, 2799-134, Carnaxide, Portugal
| | - Pedro Amador
- Centro Hospitalar de Setúbal, Hospital de S. Bernardo E.P.E., Setúbal, Portugal, Hospital de São Bernardo, Rua Camilo Castelo Branco, 2910-446, Setúbal, Portugal
| | - Elisabete Vaz
- Centro Hospital de Lisboa Ocidental, Hospital de St. Cruz E.P.E., Carnaxide, Portugal, Hospital de Santa Cruz, Avenida Professor Reinaldo dos Santos, 2799-134, Carnaxide, Portugal
| | - Francisco Costa
- Hospital da Luz, Lisboa, Portugal, Hospital da Luz, Avenida Lusíada 100, 1500-650, Lisboa, Portugal
- Centro Hospital de Lisboa Ocidental, Hospital de St. Cruz E.P.E., Carnaxide, Portugal, Hospital de Santa Cruz, Avenida Professor Reinaldo dos Santos, 2799-134, Carnaxide, Portugal
| | - José Farinha
- Centro Hospitalar de Setúbal, Hospital de S. Bernardo E.P.E., Setúbal, Portugal, Hospital de São Bernardo, Rua Camilo Castelo Branco, 2910-446, Setúbal, Portugal
| | - Maurício Scanavacca
- Centro Hospital de Lisboa Ocidental, Hospital de St. Cruz E.P.E., Carnaxide, Portugal, Hospital de Santa Cruz, Avenida Professor Reinaldo dos Santos, 2799-134, Carnaxide, Portugal
| | - Rui Caria
- Centro Hospitalar de Setúbal, Hospital de S. Bernardo E.P.E., Setúbal, Portugal, Hospital de São Bernardo, Rua Camilo Castelo Branco, 2910-446, Setúbal, Portugal
| | - Pedro Pulido Adragão
- Hospital da Luz, Lisboa, Portugal, Hospital da Luz, Avenida Lusíada 100, 1500-650, Lisboa, Portugal
- Centro Hospital de Lisboa Ocidental, Hospital de St. Cruz E.P.E., Carnaxide, Portugal, Hospital de Santa Cruz, Avenida Professor Reinaldo dos Santos, 2799-134, Carnaxide, Portugal
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18
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Hanna P, Buch E, Stavrakis S, Meyer C, Tompkins JD, Ardell JL, Shivkumar K. Neuroscientific therapies for atrial fibrillation. Cardiovasc Res 2021; 117:1732-1745. [PMID: 33989382 PMCID: PMC8208752 DOI: 10.1093/cvr/cvab172] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
The cardiac autonomic nervous system (ANS) plays an integral role in normal cardiac physiology as well as in disease states that cause cardiac arrhythmias. The cardiac ANS, comprised of a complex neural hierarchy in a nested series of interacting feedback loops, regulates atrial electrophysiology and is itself susceptible to remodelling by atrial rhythm. In light of the challenges of treating atrial fibrillation (AF) with conventional pharmacologic and myoablative techniques, increasingly interest has begun to focus on targeting the cardiac neuraxis for AF. Strong evidence from animal models and clinical patients demonstrates that parasympathetic and sympathetic activity within this neuraxis may trigger AF, and the ANS may either induce atrial remodelling or undergo remodelling itself to serve as a substrate for AF. Multiple nexus points within the cardiac neuraxis are therapeutic targets, and neuroablative and neuromodulatory therapies for AF include ganglionated plexus ablation, epicardial botulinum toxin injection, vagal nerve (tragus) stimulation, renal denervation, stellate ganglion block/resection, baroreceptor activation therapy, and spinal cord stimulation. Pre-clinical and clinical studies on these modalities have had promising results and are reviewed here.
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Affiliation(s)
- Peter Hanna
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Eric Buch
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 1100 N Lindsay Ave, Oklahoma City, OK 73104, USA
| | - Christian Meyer
- Division of Cardiology, cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EVK Düsseldorf, Teaching Hospital University of Düsseldorf, Kirchfeldstraße 40, 40217 Düsseldorf, Germany
- Institute of Neural and Sensory Physiology, cardiac Neuro- and Electrophysiology Research Consortium (cNEP), University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - John D Tompkins
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Jeffrey L Ardell
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
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19
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Rebecchi M, Panattoni G, Edoardo B, de Ruvo E, Sciarra L, Politano A, Sgueglia M, Ricagni C, Verbena S, Crescenzi C, Sangiorgi C, Borrelli A, De Luca L, Scarà A, Grieco D, Jacomelli I, Martino A, Calò L. Atrial fibrillation and autonomic nervous system: A translational approach to guide therapeutic goals. J Arrhythm 2021; 37:320-330. [PMID: 33850573 PMCID: PMC8022002 DOI: 10.1002/joa3.12512] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/21/2020] [Accepted: 01/15/2021] [Indexed: 12/19/2022] Open
Abstract
The autonomic nervous system (ANS) is known to play an important role in the genesis and maintenance of atrial fibrillation (AF). Biomolecular and genetic mechanisms, anatomical knowledges with recent diagnostic techniques acquisitions, both invasive and non-invasive, have enabled greater therapeutic goals in patients affected by AF related to ANS imbalance. Catheter ablation of ganglionated plexi (GP) in the left and right atrium has been proposed in varied clinical conditions. Moreover interesting results arise from renal sympathetic denervation and vagal nerve stimulation. Despite all this, in the scenario of ANS modulation translational strategies we necessary must consider the treatment or correction of dynamic factors such as obesity, obstructive sleep apnea, lifestyle, food, and stress. Finally, new antiarrhythmic drugs, gene therapy and "ablatogenomic" could be represent exciting future therapeutic perspectives.
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Affiliation(s)
| | | | | | | | - Luigi Sciarra
- Department of CardiologyPoliclinico CasilinoRomeItaly
| | | | | | | | - Sara Verbena
- Department of CardiologyPoliclinico CasilinoRomeItaly
| | | | | | | | - Lucia De Luca
- Department of CardiologyPoliclinico CasilinoRomeItaly
| | - Antonio Scarà
- Department of CardiologyPoliclinico CasilinoRomeItaly
| | | | | | | | - Leonardo Calò
- Department of CardiologyPoliclinico CasilinoRomeItaly
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20
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Wang Y, Sun X. The functions of LncRNA in the heart. Diabetes Res Clin Pract 2020; 168:108249. [PMID: 32531328 DOI: 10.1016/j.diabres.2020.108249] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 12/26/2022]
Abstract
Cardiovascular disease is a major cause of death and disability worldwide. Recently, increasing evidence has demonstrated that various lncRNAs play critical roles in the pathogenesis of cardiovascular diseases, including myocardial ischemia and reperfusion (I/R) injury. LncRNAs are transcripts longer than 200 nucleotides. They are considered a class of dynamic noncoding RNAs known to be involved in physiological and pathological conditions with regulatory and structural roles in numerous biological processes, including genomic imprinting, epigenetic regulation, cell proliferation, development, aging and apoptosis. They are emerging as potential key regulators of a variety of cardiovascular diseases. However, the roles of lncRNAs in the heart function remain largely unknown. The purpose of this review was to summarize the functions of lncRNAs in the heart and discuss the challenges and possible strategies of lncRNA research for cardiovascular disease.
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Affiliation(s)
- Yao Wang
- Shandong Institute of Endocrine and Metabolic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Xianglan Sun
- Department of Geriatrics, Department of Geriatric Endocrinology, ShanDong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
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21
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Hanna P, Zhu C, Shivkumar K, Buch E. Cryoballoon pulmonary vein isolation: Effects on neural control of the heart. Int J Cardiol 2020; 314:77-78. [PMID: 32320787 DOI: 10.1016/j.ijcard.2020.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/13/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Peter Hanna
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Ching Zhu
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Neuroscience Interdepartmental Program, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Eric Buch
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
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22
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Catheter ablation of right atrial ganglionated plexi to treat cardioinhibitory neurocardiogenic syncope: a long-term follow-up prospective study. J Interv Card Electrophysiol 2020; 61:499-510. [DOI: 10.1007/s10840-020-00840-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
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23
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Rattanawong P, Kewcharoen J, S Srivathsan K, Shen WK. Drug Therapy for Vagally-Mediated Atrial Fibrillation and Sympatho-Vagal Balance in the Genesis of Atrial Fibrillation: A Review of the Current Literature. J Atr Fibrillation 2020; 13:2410. [PMID: 33024510 DOI: 10.4022/jafib.2410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/27/2020] [Accepted: 03/28/2020] [Indexed: 12/13/2022]
Abstract
Objective The presence of both sympathetic activation-mediated triggers and parasympathetic activation-mediated substrates are required to initiate and maintain some forms of atrial fibrillation (AF). AF predominantly precipitated by parasympathetic stimulation is known as vagally-mediated AF (VM-AF). The role of novel drugs and molecular targeted gene therapy that modulate the autonomic nervous system are therapeutic options in this unique population with VM-AF. Here, we review the role of the sympatho-vagal balance in the genesis of AF and consider drug therapy for VM-AF. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, literature search was conducted using the keywords "vagal", "vagal nerve", "vagus", "vagus nerve", and "atrial fibrillation". Retrieved citations were first screened independently by 2 reviewers for inclusion and exclusion criteria. Results A total of 14 studies and 3 practice guidelines from 1986-2017 were included. Only two clinical investigations evaluated the effectiveness of disopyramide and sotalol in human subjects with VM-AF. The potential role of antiarrhythmic drugs has been studied in animal models. Conclusions Growing evidence suggests that the autonomic nervous system is integral in the development of VM-AF. Novel medications and genetic targets are undergoing investigation with promising results.
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Affiliation(s)
| | - Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | | | - Win-Kuang Shen
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
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24
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Abstract
Multifocal atrial tachycardia has certain electrocardiographic similarities to atrial fibrillation. The mechanism of atrial fibrillation is heterogenous but in some cases may arise from a single ectopic driver with fibrillatory conduction to the rest of the atria. This has led to the speculation that multifocal atrial tachycardia may have a similar mechanistic unifocal site that disperses through the atrium in a fibrillatory pattern. Ivabradine has been reported to be efficacious in an adult with paroxysmal atrial fibrillation as well as in children with junctional or ectopic atrial tachycardias. This is the first report of successfully using ivabradine, a novel anti-arrhythmic If blocking agent, to convert multifocal atrial tachycardia in a 5-month-old critically ill infant to a pattern indicating a single ectopic atrial focus. This allowed the patient's single atrial focus to be ablated with return to sinus rhythm and decannulation from ventriculoarterial extracorporeal membrane oxygenation. This case suggests that multifocal atrial tachycardia may arise from a single automatic focus with downstream fibrillatory conduction to the atria.
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25
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Hanna P, Shivkumar K. Targeting the Cardiac Ganglionated Plexi for Atrial Fibrillation: Modulate or Destroy? JACC Clin Electrophysiol 2019; 4:1359-1361. [PMID: 30336882 DOI: 10.1016/j.jacep.2018.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Peter Hanna
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, Los Angeles, California; Molecular, Cellular, and Integrative Physiology Program, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, Los Angeles, California; Molecular, Cellular, and Integrative Physiology Program, David Geffen School of Medicine, UCLA, Los Angeles, California.
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26
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Yoshida K, Baba M, Hasebe H, Shinoda Y, Harunari T, Ebine M, Uehara Y, Watabe H, Takeyasu N, Horigome H, Nogami A, Ieda M. Structural relation between the superior vena cava and pulmonary veins in patients with atrial fibrillation. Heart Vessels 2019; 34:2052-2058. [DOI: 10.1007/s00380-019-01431-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/15/2019] [Indexed: 10/26/2022]
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27
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O'Quinn MP, Dormer KJ, Huizar JF, Nguyen KT, Kaszala K, Sima A, Ellenbogen KA, Tan AY. Epicardial injection of nanoformulated calcium into cardiac ganglionic plexi suppresses autonomic nerve activity and postoperative atrial fibrillation. Heart Rhythm 2019; 16:597-605. [PMID: 30929671 PMCID: PMC6446939 DOI: 10.1016/j.hrthm.2018.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Imbalanced activation of the cardiac autonomic nervous system triggers postoperative atrial fibrillation (POAF). Neuronal calcium overload induces apoptosis. We hypothesize that epicardial injection of timed-release nanoformulated CaCl2 (nCaCl2) into left atrial ganglionic plexi (GP) modulates autonomic function and suppresses POAF. OBJECTIVE The purpose of this study was to determine whether nCaCl2 GP therapy suppresses POAF. METHODS We used a novel canine model of POAF with implanted radiotelemetry to record nerve activity (NA) from the left stellate ganglion (SNA), left cardiac vagus nerve, and GP. At week 3, nCaCl2 (n = 7) or vehicle control (sham; n = 3) was injected into left pulmonary vein GP (LGP), followed by right pulmonary vein GP at week 4. Atrial effective refractory period (AERP) and atrial fibrillation vulnerability (AFV) were assessed in vivo. Resting and exercise NA and heart rate (HR) were assessed before and after LGP treatment. RESULTS AERP decreased (P < .0001) and AFV increased (P = .008) at week 3 vs baseline. However, nCaCl2-LGP treatment reversed these changes and restored them to baseline after 1 week (P = .04). Subsequent nCaCl2-right pulmonary vein GP treatment further reduced AFV (P = .03). In contrast, AFV increased (P = .001) and AERP remained decreased (P = .01) 1 week after sham-LGP treatment vs baseline. nCaCl2-LGP treatment reduced NA from GP (P < .02) and NA from the left cardiac vagus nerve (P < .05) and increased SNA (P < .02). Despite increased SNA, HR was decreased (P < .01) with loss of HR-SNA correlation (R = 0.62). After sham-LGP treatment, NA was unchanged and HR-SNA remained correlated (R = 0.95). Histology confirmed nCaCl2-GP colocalization, apoptosis, and loss of immunoreactivity in nCaCl2-treated somas. CONCLUSION Epicardial injection of nCaCl2 into left atrial GP induced neuroapoptosis and modulated autonomic function. This reversed a postoperative reduction in AERP and suppressed POAF.
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Affiliation(s)
- Michael P O'Quinn
- Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VAMC, Richmond, Virginia; Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Kenneth J Dormer
- Liberty University College of Osteopathic Medicine, Lynchburg, Virginia
| | - Jose F Huizar
- Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VAMC, Richmond, Virginia; Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | | | - Karoly Kaszala
- Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VAMC, Richmond, Virginia; Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Adam Sima
- Department of Biostatistics, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Kenneth A Ellenbogen
- Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VAMC, Richmond, Virginia
| | - Alex Y Tan
- Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VAMC, Richmond, Virginia; Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, Virginia.
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28
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Vesela J, Osmancik P, Herman D, Prochazkova R. Changes in heart rate variability in patients with atrial fibrillation after pulmonary vein isolation and ganglionated plexus ablation. Physiol Res 2019; 68:49-57. [PMID: 30433795 DOI: 10.33549/physiolres.933710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Pulmonary vein isolation (PVI) is the cornerstone in the treatment of patients with paroxysmal atrial fibrillation (PAF). Some research has suggested studies have shown that modification of ganglionated plexuses (GP), performed with PVI, could lead to even better outcomes. The aim of this study was to determine the effect of PVI on the autonomic system. Heart rate variability (HRV) was used as a marker of autonomic system activity. Twenty-six PAF patients underwent PVI (PVI group) and twenty patients underwent PVI plus a GP ablation (GP group). In each group, 5 min long ECG signals obtained before and after the electrophysiology EP study were analyzed. Time and frequency domain parameters were evaluated. Vagal responses during ablation were observed in 15 (58 %) patients in the PVI group and in 12 (60 %) patients in the GP group. The change in normalized power in the low frequency (LF) and in the LF/HF ratio, before and after ablation, was statistically significant in both groups (LF/HF 2.6+/-1.6 before vs. 1.4+/-1.7 after ablation in PVI group and LF/HF 3.3+/-2.6 before vs. 1.8+/-1.9 after ablation in the GP group). Relative to heart rate variability parameters, there were no differences between PVI and PVI + plus GP ablation.
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Affiliation(s)
- J Vesela
- Third Internal - Cardiology Clinic, Cardiocenter, University Hospital Kralovske Vinohrady, Prague, Czech Republic.
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29
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Padmanabhan D, Naksuk N, Killu AK, Kapa S, Witt C, Sugrue A, DeSimone CV, Madhavan M, Groot JR, O'Brien B, Rabbette T, Coffey K, Asirvatham SJ. Electroporation of epicardial autonomic ganglia: Safety and efficacy in medium‐term canine models. J Cardiovasc Electrophysiol 2019; 30:607-615. [DOI: 10.1111/jce.13860] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/19/2019] [Accepted: 01/19/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Deepak Padmanabhan
- Department of Cardiovascular MedicineAcademic Medical CenterAmsterdam The Netherlands
| | - Niyada Naksuk
- Department of Cardiovascular MedicineAcademic Medical CenterAmsterdam The Netherlands
| | - Ammar K. Killu
- Department of Cardiovascular MedicineAcademic Medical CenterAmsterdam The Netherlands
| | - Suraj Kapa
- Department of Cardiovascular MedicineAcademic Medical CenterAmsterdam The Netherlands
| | - Chance Witt
- Department of Cardiovascular MedicineAcademic Medical CenterAmsterdam The Netherlands
| | - Alan Sugrue
- Department of Cardiovascular MedicineAcademic Medical CenterAmsterdam The Netherlands
| | | | - Malini Madhavan
- Department of Cardiovascular MedicineAcademic Medical CenterAmsterdam The Netherlands
| | - J. R. Groot
- Heart Center, Department of Cardiology, Academic Medical CenterAmsterdam The Netherlands
| | - Barry O'Brien
- Biomedical engineering, National University of IrelandGalway Ireland
| | - Tadhg Rabbette
- Biomedical engineering, National University of IrelandGalway Ireland
| | - Kenneth Coffey
- Biomedical engineering, National University of IrelandGalway Ireland
| | - Samuel J. Asirvatham
- Division of Pediatric CardiologyAcademic Medical CenterAmsterdam The Netherlands
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30
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Te ALD, Lo LW, Lin YJ, Chang SL, Hu YF, Chung FP, Tuan TC, Chao TF, Liao JN, Chang YT, Lin CY, Yamada S, Chang TY, Salim S, Hoang MQ, Huang TC, Chen SA. Vasovagal responses during cryoballoon pulmonary vein isolation in paroxysmal atrial fibrillation predict favorable mid-term outcomes. Int J Cardiol 2018; 258:115-120. [DOI: 10.1016/j.ijcard.2018.01.111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/27/2017] [Accepted: 01/23/2018] [Indexed: 11/28/2022]
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31
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Kviesulaitis V, Puodziukynas A, Pauza DH, Zabiela V, Kazakevicius T, Vaitkevicius R, Diržinauskas E, Semaška V, Strazdas A, Unikaite R, Rysevaite K, Pauziene N, Zaliunas R. Heart rate variability after radiofrequency ablation of epicardial ganglionated plexuses on the ovine left atrium. BMC Cardiovasc Disord 2017; 17:292. [PMID: 29233092 PMCID: PMC5727886 DOI: 10.1186/s12872-017-0727-7] [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: 03/31/2017] [Accepted: 12/04/2017] [Indexed: 11/16/2022] Open
Abstract
Background Ganglionated plexuses (GP) are terminal parts of cardiac autonomous nervous system (ANS). Radiofrequency ablation (RFA) for atrial fibrillation (AF) possibly affects GP. Changes in heart rate variability (HRV) after RFA can reflect ANS modulation. Methods Epicardial RFA of GP on the left atrium (LA) was performed under the general anesthesia in 15 mature Romanov sheep. HRV was used to assess the alterations in autonomic regulation of the heart. A 24 − hour ECG monitoring was performed before the ablation, 2 days after it and at each of the 12 following months. Ablation sites were evaluated histologically. Results There was an instant change in HRV parameters after the ablation. A standard deviation of all intervals between normal QRS (SDNN), a square root of the mean of the squared differences between successive normal QRS intervals (RMSSD) along with HRV triangular index (TI), low frequency (LF) power and high frequency (HF) power decreased, while LF/HF ratio increased. Both the SDNN, LF power and the HF power changes persisted throughout the 12 − month follow − up. Significant decrease in RMSSD persisted only for 3 months, HRV TI for 6 months and increase in LF/HF ratio for 7 months of the follow − up. Afterwards these three parameters were not different from the preprocedural values. Conclusions Epicardial RFA of GP’s on the ovine left atrium has lasting effect on the main HRV parameters (SDNN, HF power and LF power). The normalization of RMSSD, HRV TI and LF/HF suggests that HRV after epicardial RFA of GPs on the left atrium might restore over time.
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Affiliation(s)
- Vilius Kviesulaitis
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania.
| | - Aras Puodziukynas
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | | | - Vytautas Zabiela
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Tomas Kazakevicius
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | | | - Evaldas Diržinauskas
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Vytenis Semaška
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Antanas Strazdas
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Ruta Unikaite
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Kristina Rysevaite
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Neringa Pauziene
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Remigijus Zaliunas
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
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Kuyumcu MS, Ozeke O, Cay S, Ozcan F, Bayraktar MF, Kara M, Vicdan M, Acar B, Aydogdu S, Topaloglu S, Aras D. The short-term impact of the catheter ablation on noninvasive autonomic nervous system parameters in patients with paroxysmal atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1193-1199. [PMID: 28850690 DOI: 10.1111/pace.13179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/01/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The autonomic nervous system (ANS) is a potentially potent modulator of the initiation and perpetuation of atrial fibrillation (AF), whereas the presence of AF can activate and alter the ANS. The catheter ablation of AF (AFCA) may cause the cardiac ANS dysfunction, whereas restoration of sinus rhythm or sympathovagal imbalance by AFCA can reverse this process. Our principal goal was to investigate the short-term effect of AFCA on ANS functions evaluated by noninvasive chronotropic (CI), resting heart rate (RHR), and heart rate recovery (HRR) indices. METHOD A total of 45 patients were enrolled with symptomatic, drug refractory paroxysmal AF undergoing first cryoballoon (CB) pulmonary vein antrum isolation (PVAI) with one 28-mm CB using single 3-minute freeze techniques without bonus applications. All patients underwent symptom-limited exercise treadmill testing to evaluate noninvasive parameters of ANS before PVAI. For those patients who remained in sinus rhythm, an additional exercise test was repeated after 1 and 3 months after discharge. RESULTS The autonomic CI and RHR/HRR indices were impaired after PVAI and persisted post-PVAI 3 months. However, these parameters were not different in patients with and without recurrence. CONCLUSION This study demonstrated that the successful AFCA might concurrently impair the ANS parameters. The autonomic imbalance between the sympathetic and parasympathetic activity after AFCA could either become antiarrhythmic and/or proarrhythmic based on which of the two components was going to prevail after successful AFCA. The impaired ANS balance after PVAI might also be another hypothetical mechanism for AF recurrence particularly in the absence of PV reconnection.
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Affiliation(s)
- Mevlut Serdar Kuyumcu
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Fırat Ozcan
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Muhammed Fatih Bayraktar
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Meryem Kara
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Murat Vicdan
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Burak Acar
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Sinan Aydogdu
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
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Yoshida K, Hattori A, Tsuneoka H, Tsumagari Y, Yui Y, Kimata A, Ito Y, Ebine M, Uehara Y, Koda N, Misaki M, Abe D, Takeyasu N, Aonuma K, Nogami A. Electrophysiological relation between the superior vena cava and right superior pulmonary vein in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2017; 28:1117-1126. [DOI: 10.1111/jce.13286] [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: 05/22/2017] [Revised: 06/17/2017] [Accepted: 06/26/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Kentaro Yoshida
- Department of Cardiology; Ibaraki Prefectural Central Hospital; Kasama Japan
- Department of Cardiology, Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Ai Hattori
- Department of Cardiology, Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Hidekazu Tsuneoka
- Department of Cardiology; Ibaraki Prefectural Central Hospital; Kasama Japan
| | - Yasuaki Tsumagari
- Department of Cardiology; Ibaraki Prefectural Central Hospital; Kasama Japan
| | - Yoshiaki Yui
- Department of Cardiology, Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Akira Kimata
- Department of Cardiology, Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Yoko Ito
- Department of Cardiology, Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Mari Ebine
- Department of Cardiology; Ibaraki Prefectural Central Hospital; Kasama Japan
| | - Yoshiko Uehara
- Department of Cardiology; Ibaraki Prefectural Central Hospital; Kasama Japan
| | - Naoya Koda
- Department of Cardiology; Ibaraki Prefectural Central Hospital; Kasama Japan
| | - Masako Misaki
- Department of Cardiology; Ibaraki Prefectural Central Hospital; Kasama Japan
| | - Daisuke Abe
- Department of Cardiology; Ibaraki Prefectural Central Hospital; Kasama Japan
| | - Noriyuki Takeyasu
- Department of Cardiology; Ibaraki Prefectural Central Hospital; Kasama Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine; University of Tsukuba; Tsukuba Japan
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Qin M, Zhang Y, Liu X, Jiang WF, Wu SH, Po S. Atrial Ganglionated Plexus Modification: A Novel Approach to Treat Symptomatic Sinus Bradycardia. JACC Clin Electrophysiol 2017; 3:950-959. [PMID: 29759719 DOI: 10.1016/j.jacep.2017.01.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/02/2017] [Accepted: 01/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study sought to determine if anatomic atrial ganglionated plexus (GP) ablation leads to long-term sinus rate (SR) increase and improves quality of life in patients with symptomatic sinus bradycardia (SB). BACKGROUND Atrial GP ablation has been demonstrated to increase SR in our previous study. Atrial GP ablation may also be effective in treating patients with symptomatic SB. METHODS Sixty-two patients with symptomatic SB were recruited: Group A included patients <50 years of age (n = 40); Group B included patients ≥50 years of age (n = 22). All patients underwent anatomic ablation of the main atrial GP, and 24-h Holter monitoring and quality-of-life assessment were performed during 1 year of follow-up. Quality of life was accessed by the Medical Outcomes Study Short-Form 36 Health Survey. RESULTS Although SR markedly increased in all patients after GP ablation, the increase was significantly greater in patients <50 years of age than in patients ≥50 years of age (19.3 ± 9.9 beats/min vs. 10.8 ± 5.4 beats/min; p = 0.001). The right anterior GP and the GP at the junction of the aorta and superior vena cava made the greatest contributions to SR increase among all GP. The mean and minimal SR increased significantly after ablation and remained elevated for 12 months only in Group A patients. Although symptoms and quality of life improved in all patients, 5 of the 8 domains of the Medical Outcomes Study Short-Form 36 Health Survey did not show obvious improvements in patients of Group B at 12 months. CONCLUSIONS Anatomic atrial GP ablation effectively increased SR and improved quality of life in patients <50 years of age with symptomatic SB.
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Affiliation(s)
- Mu Qin
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yu Zhang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xu Liu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
| | - Wei-Feng Jiang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Shao-Hui Wu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Sunny Po
- Department of Medicine and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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35
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Affiliation(s)
- Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Rome, Italy.
| | - Luigi Sciarra
- Division of Cardiology, Policlinico Casilino, Rome, Italy
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36
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Rol de los plexos ganglionares en la génesis y el mantenimiento de la fibrilación auricular y la modulación del sistema nervioso autónomo como parte del tratamiento de la fibrilación auricular. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Madhavan M, Venkatachalam KL, Swale MJ, Desimone CV, Gard JJ, Johnson SB, Suddendorf SH, Mikell SB, Ladewig DJ, Nosbush TG, Danielsen AJ, Knudson M, Asirvatham SJ. Novel Percutaneous Epicardial Autonomic Modulation in the Canine for Atrial Fibrillation: Results of an Efficacy and Safety Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:407-17. [PMID: 26854009 DOI: 10.1111/pace.12824] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/24/2015] [Accepted: 01/28/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Endocardial ablation of atrial ganglionated plexi (GP) has been described for treatment of atrial fibrillation (AF). Our objective in this study was to develop percutaneous epicardial GP ablation in a canine model using novel energy sources and catheters. METHODS Phase 1: The efficacy of several modalities to ablate the GP was tested in an open chest canine model (n = 10). Phase 2: Percutaneous epicardial ablation of GP was done in six dogs using the most efficacious modality identified in phase 1 using two novel catheters. RESULTS Phase 1: Direct current (DC) in varying doses (blocking [7-12 μA], electroporation [300-500 μA], ablation [3,000-7,500 μA]), radiofrequency ablation (25-50 W), ultrasound (1.5 MHz), and alcohol (2-5 mL) injection were successful at 0/8, 4/12, 5/7, 3/8, 1/5, and 5/7 GP sites. DC (500-5,000 μA) along with alcohol irrigation was tested in phase 2. Phase 2: Percutaneous epicardial ablation of the right atrium, oblique sinus, vein of Marshall, and transverse sinus GP was successful in 5/6 dogs. One dog died of ventricular fibrillation during DC ablation at 5,000 μA. Programmed stimulation induced AF in six dogs, preablation and no atrial arrhythmia in three, flutter in one, and AF in one postablation. Heart rate, blood pressure, effective atrial refractory period, and local atrial electrogram amplitude did not change significantly postablation. Microscopic examination showed elimination of GP, and minimal injury to atrial myocardium. CONCLUSION Percutaneous epicardial ablation of GP using DC and novel catheters is safe and feasible and may be used as an adjunct to pulmonary vein isolation in the treatment of AF in order to minimize additional atrial myocardial ablation.
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Affiliation(s)
- Malini Madhavan
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - K L Venkatachalam
- Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Jacksonville, Florida.,Department of Surgical Research, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Susan B Johnson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Scott H Suddendorf
- Department of Research Administrative Services, Mayo Clinic, Rochester, Minnesota
| | - Susan B Mikell
- Department of Research Administrative Services, Mayo Clinic, Rochester, Minnesota
| | - Dorothy J Ladewig
- Department of Research Administrative Services, Mayo Clinic, Rochester, Minnesota
| | | | | | - Mark Knudson
- Mayo Clinic, Rochester, Minnesota.,EnteroMedics, Inc, St. Paul, Minnesota
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Gourraud JB, Andrade JG, Macle L, Mondésert B. Pharmacological Tests in Atrial Fibrillation Ablation. Arrhythm Electrophysiol Rev 2016; 5:170-176. [PMID: 28116081 DOI: 10.15420/aer.2016:27:2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The invasive management of atrial fibrillation (AF) has been considerably changed by the identification of major sites of AF initiation and/or maintenance within the pulmonary vein antra. Percutaneous catheter ablation of these targets has become the standard of care for sustained maintenance of sinus rhythm. Long-term failure of ablation is related to an inability to create a durable transmural lesion or to identify all of the non-pulmonary vein arrhythmia triggers. Pharmacological challenges during catheter ablation have been suggested to improve outcomes in both paroxysmal and persistent AF. Herein we review the mechanism and evidence for the use of pharmacological adjuncts during the catheter ablation of AF.
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Affiliation(s)
- Jean-Baptiste Gourraud
- Electrophysiology Service, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Jason G Andrade
- Electrophysiology Service, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Laurent Macle
- Electrophysiology Service, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Blandine Mondésert
- Electrophysiology Service, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
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39
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Syed FF, Oral H. Electrophysiological Perspectives on Hybrid Ablation of Atrial Fibrillation. J Atr Fibrillation 2015; 8:1290. [PMID: 27957227 DOI: 10.4022/jafib.1290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/05/2015] [Accepted: 12/14/2015] [Indexed: 12/14/2022]
Abstract
To overcome limitations of minimally invasive surgical ablation as a standalone procedure in eliminating atrial fibrillation (AF), hybrid approaches incorporating adjunctive endovascular catheter ablation have been proposed in recent years. The endovascular component targets residual conduction gaps and identifies additional electrophysiological targets with the goal of minimizing recurrent atrial arrhythmia. We performed a systematic review of published studies of hybrid AF ablation, analyzing 432 pooled patients (19% paroxysmal, 29% persistent, 52% long-standing persistent) treated using three different approaches: A. bilateral thoracoscopy with bipolar radiofrequency (RF) clamp-based approach; B. right thoracoscopic suction monopolar RF catheter-based approach; and C. subxiphoid posterior pericardioscopic ("convergent") approach. Freedom from recurrence off antiarrhythmic medications at 12 months was seen in 88.1% [133/151] for A, 73.4% [47/64] for B, and 59.3% [80/135] for C, with no significant difference between paroxysmal (76.9%) and persistent/long-standing persistent AF (73.4%). Death and major surgical complications were reported in 8.5% with A, 0% with B and 8.6% with C. A critical appraisal of hybrid ablation is presented, drawing from experiences and insights published over the years on catheter ablation of AF, with a discussion of the rationale underlying hybrid ablation, its strengths and limitations, where it may have a unique role in clinical management of patients with AF, which questions remain unanswered and areas for further investigation.
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Affiliation(s)
- Faisal F Syed
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI
| | - Hakan Oral
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI
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40
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Aksu T, Golcuk E, Yalin K, Guler TE, Erden I. Simplified Cardioneuroablation in the Treatment of Reflex Syncope, Functional AV Block, and Sinus Node Dysfunction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 39:42-53. [PMID: 26411271 DOI: 10.1111/pace.12756] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/17/2015] [Accepted: 09/20/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardio neuroablation (CNA) is a lesser-known technique for management of patients with excessive vagal activation on the basis of radiofrequency catheter ablation (RFCA) of the areas related to the three main autonomic ganglia around the heart. We investigated the effectiveness of selective and/or stepwise RFCA of these areas via right atrium (RA) and/or left atrium (LA) in the patients with recurrent syncope due to excessive vagal activity. METHODS Twenty-two patients presenting symptomatic functional bradyarrhythmias, neurally mediated reflex syncope (NMS), symptomatic atrioventricular (AV) block, and symptomatic sinus node dysfunction (SND; number = 8, 7, 7, respectively) were enrolled. The three main paracardiac ganglia were targeted via RA and LA in the patients with NMS and SND. The procedure was performed via RA in the patients with AV block, followed by RFCA of all ganglia via LA, if AV conduction disorder persists. The sites showing fragmented potentials were identified by electrical mapping and verified by high-frequency stimulation and ablated until atrial electrical potential was completely eliminated (<0.1 mV). RESULTS The patients with NMS and SND were free from new syncopal episode at a mean 12.3 ± 3.4 months and 9.5 ± 3.1 months follow-up, respectively. Ablation from RA was successful in six of seven patients with AV block. Despite the increased heart rate, the resolution of AV block after the RFCA could not be achieved in one patient who had partial resolution with atropine infusion on admission. CONCLUSION CNA may be an alternative and safe strategy to reduce NMS episodes, and to treat functional AV block and symptomatic SND, especially in young patients.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Derince Education and Research Hospital, Derince, Kocaeli, Turkey
| | - Ebru Golcuk
- Department of Cardiology, Derince Education and Research Hospital, Derince, Kocaeli, Turkey
| | - Kivanç Yalin
- Cardiology Clinic, Bayrampasa Kolan Hospital, Istanbul, Turkey
| | - Tümer Erdem Guler
- Department of Cardiology, Derince Education and Research Hospital, Derince, Kocaeli, Turkey
| | - Ismail Erden
- Department of Cardiology, Derince Education and Research Hospital, Derince, Kocaeli, Turkey
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Simplified Method for Vagal Effect Evaluation in Cardiac Ablation and Electrophysiological Procedures. JACC Clin Electrophysiol 2015; 1:451-460. [DOI: 10.1016/j.jacep.2015.06.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/08/2015] [Accepted: 06/17/2015] [Indexed: 01/24/2023]
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Hasebe H, Yoshida K, Iida M, Hatano N, Muramatsu T, Aonuma K. Right-to-left frequency gradient during atrial fibrillation initiated by right atrial ectopies and its augmentation by adenosine triphosphate: Implications of right atrial fibrillation. Heart Rhythm 2015; 13:354-63. [PMID: 26432585 DOI: 10.1016/j.hrthm.2015.09.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND A left-to-right dominant frequency (DF) gradient commonly exists in paroxysmal atrial fibrillation (AF). AF initiated by right atrial (RA) ectopy (AF-RAE) is rare. OBJECTIVE This study aimed to investigate characteristics of AF-RAE using pharmacological maneuvers and spectral analysis. METHODS Seventy-nine consecutive patients referred for catheter ablation of paroxysmal AF were enrolled. Infusions of isoproterenol and adenosine triphosphate (ATP) were used to induce AF. Patients with AF-RAE and patients with AF initiated only by pulmonary vein (PV) ectopies were classified into the RA-ectopy group (n = 7[9%]) and PV-ectopy group (n = 32[41%]), respectively. ATP was also injected during ongoing AF to unmask the driver of AF. High RA, coronary sinus, and PV-left atrial junction electrograms and electrocardiogram lead V1 underwent spectral analyses. RESULTS Patients in the RA-ectopy group were younger (51 ± 13 years vs 63 ± 7 years; P = .01) and more commonly had a family history of AF (71% vs 9%; P < .001) than patients in the PV-ectopy group. There was a baseline right-to-left DF gradient in the RA-ectopy group (PV-left atrial junction: 6.0 ± 0.4 Hz; coronary sinus: 5.7 ± 0.6 Hz; RA: 7.3 ± 0.8 Hz; P < .05) in contrast to a left-to-right DF gradient in the PV-ectopy group (5.9 ± 0.8, 5.3 ± 0.7, 5.2 ± 0.8 Hz; P < .01). ATP injection predominantly increased the DF of the high RA in the RA-ectopy group and augmented a right-to-left DF gradient (7.9 ± 1.8, 7.6 ± 1.0, 10.7 ± 0.7 Hz; P < .001), whereas it augmented a left-to-right DF gradient in the PV-ectopy group (7.9 ± 1.0, 6.4 ± 0.5, 6.6 ± 1.2 Hz; P < .05). CONCLUSION A rare type of paroxysmal AF initiated by RA ectopy may be maintained by a reentrant driver localized in the RA (so-called RA fibrillation).
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Affiliation(s)
- Hideyuki Hasebe
- Division of Arrhythmology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Kentaro Yoshida
- Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Japan; Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan,.
| | - Masataka Iida
- Division of Clinical Engineering, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Naoki Hatano
- Division of Clinical Engineering, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Toshiro Muramatsu
- Division of Clinical Engineering, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Wang X, Zhang M, Zhang Y, Xie X, Wang W, Li Z, Gao M, Wang Z, Hou Y. Long-Term Effects of Ganglionated Plexi Ablation on Electrophysiological Characteristics and Neuron Remodeling in Target Atrial Tissues in a Canine Model. Circ Arrhythm Electrophysiol 2015; 8:1276-83. [PMID: 26078277 DOI: 10.1161/circep.114.002554] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 06/03/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The long-term effects of ganglionated plexi ablation on electrophysiological characteristics and neuron remodeling in target atrial tissues remain unclear. METHODS AND RESULTS Dogs in group 1 (control, n=8) were not subjected to ganglionated plexi ablation and observed for 1 month, and dogs in groups 2 to 4 (ablation groups, n=8 each) underwent ablation of the right-sided ganglionated plexi and observed for 1, 6, and 12 months, respectively. Atrial electrophysiological characteristics were examined before ablation, immediately and continuously after ablation. Target atrial tissues were subjected to immunohistochemical staining and Western blot analysis. Atrial effective refractory period was significantly prolonged immediately after ablation (P<0.001), and persisted for 1 month (P<0.05). Nerve densities decreased 1 month after ablation (P<0.001). These parameters reverted to preablation levels after 6 and 12 months. In the ablation groups, atrial fibrillation was induced in 5 of 8 dogs after 1 month and in all animals after 6 and 12 months. Atrial fibrillation was not observed in the control group and in the experimental groups immediately after ablation. Moreover, the expression of the growth-associated protein 43 was upregulated after ablation. CONCLUSIONS Ganglionated plexi ablation effectively prolonged atrial effective refractory period for a short period, but the long-term effects on atrial effective refractory period and the suppression of atrial fibrillation induction were not persistent. Targeted atrial neuron remodeling may be an important mechanism underlying the observed electrophysiological changes.
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Affiliation(s)
- Ximin Wang
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Ming Zhang
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Yujiao Zhang
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Xinxing Xie
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Weizong Wang
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zhan Li
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Mei Gao
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zhongsu Wang
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Yinglong Hou
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.
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44
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Moss E, Cardinal R, Yin Y, Pagé P. Biatrial neuroablation attenuates atrial remodeling and vulnerability to atrial fibrillation in canine chronic rapid atrial pacing. Auton Neurosci 2015; 189:43-9. [PMID: 25746009 DOI: 10.1016/j.autneu.2015.02.004] [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: 09/18/2014] [Revised: 12/24/2014] [Accepted: 02/17/2015] [Indexed: 11/26/2022]
Abstract
AIMS We investigated the proposition that an intact cardiac nervous system may contribute to electrophysiological remodeling and increased vulnerability to atrial fibrillation (AF) following chronic rapid atrial pacing (RAP). METHODS AND RESULTS Baseline study was conducted prior to ablating right and left ganglionated plexuses (RAGP, LAGP) in 11 anesthetized canines (Neuroablation group) and in 11 canines without neuroablation (Intact GP). After being subjected to RAP (400 beats/min) for 6 weeks, animals were reanesthetized for terminal study. The ERP shortening typical of chronic RAP was significantly more pronounced in the Intact GP (baseline: 112 ± 12 to terminal: 80 ± 11 ms) than in the Neuroablation group (113 ± 18 to 102 ± 21 ms, p < .001), and AF inducibility (extrastimulus protocol) showed significantly greater increment in the Intact GP (baseline: 23 ± 19% to terminal: 60 ± 17% of trials) than in the Neuroablation group (18 ± 15% to 27 ± 17%, p = 0.029). Negative chronotropic responses to right vagus nerve stimulation were markedly reduced immediately after the neuroablation procedure but had recovered at terminal study. Vagally-evoked repolarization changes (from 191 unipolar electrograms) occurred in a majority of Intact GP animals in the superior, middle and inferior RA free wall, and in the LA appendage. In the Neuroablation group, repolarization changes were restricted to the superior RA free wall but none occurred in the inferior RA and only infrequently in the LA appendage, yielding significantly smaller affected areas in Neuroablation than in Intact GP animals. CONCLUSION Persistent functional denervation in LA and RA regions other than RA pacemaker areas may contribute to prevent the development of a tachycardia-dependent AF substrate.
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Affiliation(s)
- Emmanuel Moss
- Centre de recherche, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada; Department of Surgery, Université de Montréal, Montreal, Canada
| | - René Cardinal
- Centre de recherche, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada; Department of Pharmacology, Université de Montréal, Montreal, Canada
| | - Yalin Yin
- Centre de recherche, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
| | - Pierre Pagé
- Centre de recherche, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada; Department of Surgery, Université de Montréal, Montreal, Canada.
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Wang W, Wang X, Zhang Y, Li Z, Xie X, Wang J, Gao M, Zhang S, Hou Y. Transcriptome Analysis of Canine Cardiac Fat Pads: Involvement of Two Novel Long Non-Coding RNAs in Atrial Fibrillation Neural Remodeling. J Cell Biochem 2015; 116:809-21. [PMID: 25559442 DOI: 10.1002/jcb.25037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 12/11/2014] [Indexed: 02/01/2023]
Affiliation(s)
- Weizong Wang
- Department of Cardiology; Shandong Provincial Qianfoshan Hospital; Shandong University; Jinan 250014 China
| | - Ximin Wang
- Department of Cardiology; Shandong Provincial Qianfoshan Hospital; Shandong University; Jinan 250014 China
| | - Yujiao Zhang
- Department of Cardiology; Shandong Provincial Qianfoshan Hospital; Shandong University; Jinan 250014 China
| | - Zhan Li
- Department of Cardiology; Shandong Provincial Qianfoshan Hospital; Shandong University; Jinan 250014 China
| | - Xinxing Xie
- Department of Cardiology; Shandong Provincial Qianfoshan Hospital; Shandong University; Jinan 250014 China
| | - Jiangrong Wang
- Department of Cardiology; Shandong Provincial Qianfoshan Hospital; Shandong University; Jinan 250014 China
| | - Mei Gao
- Department of Cardiology; Shandong Provincial Qianfoshan Hospital; Shandong University; Jinan 250014 China
| | - Shuyu Zhang
- School of Radiation Medicine and Protection and Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions; Soochow University; Suzhou 215123 China
| | - Yinglong Hou
- Department of Cardiology; Shandong Provincial Qianfoshan Hospital; Shandong University; Jinan 250014 China
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[Interventional treatment for paroxysmal atrial fibrillation : which is the optimal ablation approach?]. Herz 2015; 40:25-30. [PMID: 25585588 DOI: 10.1007/s00059-014-4195-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Atrial fibrillation is one of the most common arrhythmias and effects probably more than 35 million people worldwide. The incidence in patients older than 70 years of age is as high as 10%. One can expect that according to our demographic development this entity will be increasingly important within the next years and decades. Along with the well know and established but at the same time limited opportunities of pharmacological treatment option of this arrhythmia, catheter ablation has evolved as a safe and effective treatment option. Electrical isolation of the pulmonary vein remains the standard of care and results in success rates as high as 80% using modern ablation strategies. Optimization of procedural and ablation techniques has lead to this high success rates. Different energy sources are available, such as radiofrequency, cryoenergy and laser are widely used today to treat patients with symptomatic atrial fibrillation. PV isolation using a so called "single-shot" ablation approach has shown to be effective with a reduced requirement of periprocedural resources and therefore resulting in wider application of this treatment not only in specialized electrophysiological centers. The rapid development in this field leads to the question which approach can be used as the most likely to result in the highest success and least complication rates. This question will be addressed in the following manuscript.
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Yorgun H, Aytemir K, Canpolat U, ahiner L, Kaya EB, Oto A. Additional benefit of cryoballoon-based atrial fibrillation ablation beyond pulmonary vein isolation: modification of ganglionated plexi. Europace 2014; 16:645-651. [PMID: 23954919 DOI: 10.1093/europace/eut240] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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Kosiuk Md J, Pokushalov Md Phd E, Hilbert Md S, Hindricks Md G, Bollmann Md PhD A, S Steinberg Md J. The Role of Renal Sympathetic Denervation in Atrial Fibrillation. J Atr Fibrillation 2014; 6:987. [PMID: 27957040 PMCID: PMC4956128 DOI: 10.4022/jafib.987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/03/2014] [Accepted: 01/04/2014] [Indexed: 11/10/2022]
Abstract
Endocardial catheter ablation is a widely used alternative for the treatment of atrial fibrillation (AF). Despite technical improvements, and increased understanding of mechanism, and acquired technical experience over many years, the results are not yet optimal. This results in an ongoing search for new therapeutic approaches. Because cardiac sympathetic drive is potentially responsible for triggering and sustaining AF, modulation of sympathetic tone has been proposed as a viable treatment objective. The early attempts to test this concept were limited by nature=highly intrusive techniques but new approaches and targets have been recently introduced. Specifically, renal nerve ablation has been introduced and the first attempts to employ this technique for treatment of cardiac arrhythmias give as a promise of new therapeutic avenues in near future. This review focuses on the possible role of renal denervation in treatment of atrial fibrillation, the contemporary evidence supporting this approach, and the ongoing trials to establish its therapeutic role.
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Affiliation(s)
- Jedrzej Kosiuk Md
- Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany
| | | | | | | | | | - Jonathan S Steinberg Md
- Arrhythmia Institute, The Valley Health System and the Mt. Sinai School of Medicine, New York, NY, USA
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Ashton JL, Paton JFR, Trew ML, LeGrice IJ, Smaill BH. A working heart-brainstem preparation of the rat for the study of reflex mediated autonomic influences on atrial arrhythmia development. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:3785-8. [PMID: 24110555 DOI: 10.1109/embc.2013.6610368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Vagal nerve activity has been shown to play a role in the formation and maintenance of atrial fibrillation (AF). Nerves on the atria are now increasingly being targeted using ablation-based therapies for the treatment of paroxysmal AF. In vivo, changes in vagal activity are part of an integrated autonomic profile that invariably involves accompanying modulations in sympathetic activity. To date, it has not been possible to replicate endogenous profiles of autonomic activity with the experimental set-ups used to study the effects of vagal stimulation on AF development. In this paper, we describe an experimental set-up using an in situ preparation that addresses these challenges for the first time. A high resolution surface electrode array has been used to make recordings of atrial electrograms during baroreflex activation from a preparation with intact innervation from brainstem to heart. This provides a novel framework for relating reflex-mediated autonomic activity to altered regional impulse propagation and electrical rhythm in the atria.
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Corradi D, Callegari S, Gelsomino S, Lorusso R, Macchi E. Morphology and pathophysiology of target anatomical sites for ablation procedures in patients with atrial fibrillation. Int J Cardiol 2013; 168:1769-78. [DOI: 10.1016/j.ijcard.2013.06.141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 06/30/2013] [Indexed: 10/26/2022]
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