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Lenarczyk R, Zeppenfeld K, Tfelt-Hansen J, Heinzel FR, Deneke T, Ene E, Meyer C, Wilde A, Arbelo E, Jędrzejczyk-Patej E, Sabbag A, Stühlinger M, di Biase L, Vaseghi M, Ziv O, Bautista-Vargas WF, Kumar S, Namboodiri N, Henz BD, Montero-Cabezas J, Dagres N. Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC-endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society. Europace 2024; 26:euae049. [PMID: 38584423 PMCID: PMC10999775 DOI: 10.1093/europace/euae049] [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: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/09/2024] Open
Abstract
Electrical storm (ES) is a state of electrical instability, manifesting as recurrent ventricular arrhythmias (VAs) over a short period of time (three or more episodes of sustained VA within 24 h, separated by at least 5 min, requiring termination by an intervention). The clinical presentation can vary, but ES is usually a cardiac emergency. Electrical storm mainly affects patients with structural or primary electrical heart disease, often with an implantable cardioverter-defibrillator (ICD). Management of ES requires a multi-faceted approach and the involvement of multi-disciplinary teams, but despite advanced treatment and often invasive procedures, it is associated with high morbidity and mortality. With an ageing population, longer survival of heart failure patients, and an increasing number of patients with ICD, the incidence of ES is expected to increase. This European Heart Rhythm Association clinical consensus statement focuses on pathophysiology, clinical presentation, diagnostic evaluation, and acute and long-term management of patients presenting with ES or clustered VA.
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Affiliation(s)
- Radosław Lenarczyk
- Medical University of Silesia, Division of Medical Sciences, Department of Cardiology and Electrotherapy, Silesian Center for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- The Department of Forensic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frank R Heinzel
- Cardiology, Angiology, Intensive Care, Städtisches Klinikum Dresden Campus Friedrichstadt, Dresden, Germany
| | - Thomas Deneke
- Clinic for Interventional Electrophysiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
- Clinic for Electrophysiology, Klinikum Nuernberg, University Hospital of the Paracelsus Medical University, Nuernberg, Germany
| | - Elena Ene
- Clinic for Interventional Electrophysiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Christian Meyer
- Division of Cardiology/Angiology/Intensive Care, EVK Düsseldorf, Teaching Hospital University of Düsseldorf, Düsseldorf, Germany
| | - Arthur Wilde
- Department of Cardiology, Amsterdam UMC University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Tel Hashomer, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Markus Stühlinger
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Luigi di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA
| | - Marmar Vaseghi
- UCLA Cardiac Arrythmia Center, Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Ohad Ziv
- Case Western Reserve University, Cleveland, OH, USA
- The MetroHealth System Campus, Cleveland, OH, USA
| | | | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | | | - Benhur Davi Henz
- Instituto Brasilia de Arritmias-Hospital do Coração do Brasil-Rede Dor São Luiz, Brasilia, Brazil
| | - Jose Montero-Cabezas
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Wu Y, Kong XJ, Ji YY, Fan J, Chen XM, Ji CC, Cheng YJ, Wu SH. Correction of I to in human induced pluripotent stem Cell-derived cardiomyocyte carrying DPP6 mutation in early repolarization syndrome by CRISPR/Cas9 genome editing. Exp Cell Res 2024; 435:113929. [PMID: 38272106 DOI: 10.1016/j.yexcr.2024.113929] [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: 11/01/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024]
Abstract
Early repolarization syndrome (ERS) is defined as occurring in patients with early repolarization pattern who have survived idiopathic ventricular fibrillation with clinical evaluation unrevealing for other explanations. The pathophysiologic basis of the ERS is currently uncertain. The objective of the present study was to examine the electrophysiological mechanism of ERS utilizing induced pluripotent stem cells (iPSCs) and CRISPR/Cas9 genome editing. Whole genome sequencing was used to identify the DPP6 (c.2561T > C/p.L854P) variant in four families with sudden cardiac arrest induced by ERS. Cardiomyocytes were generated from iPSCs from a 14-year-old boy in the four families with ERS and an unrelated healthy control subject. Patch clamp recordings revealed more significant prolongation of the action potential duration (APD) and increased transient outward potassium current (Ito) (103.97 ± 18.73 pA/pF vs 44.36 ± 16.54 pA/pF at +70 mV, P < 0.05) in ERS cardiomyocytes compared with control cardiomyocytes. Of note, the selective correction of the causal variant in iPSC-derived cardiomyocytes using CRISPR/Cas9 gene editing normalized the Ito, whereas prolongation of the APD remained unchanged. ERS cardiomyocytes carrying DPP6 mutation increased Ito and lengthen APD, which maybe lay the electrophysiological foundation of ERS.
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Affiliation(s)
- Yang Wu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China.
| | - Xiang-Jun Kong
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Ying-Ying Ji
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Jun Fan
- Department of Cardiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xu-Miao Chen
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Cheng-Cheng Ji
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China.
| | - Yun-Jiu Cheng
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Su-Hua Wu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China.
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3
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Steinberg C. Short-Coupled Ventricular Fibrillation. Card Electrophysiol Clin 2023; 15:331-341. [PMID: 37558303 DOI: 10.1016/j.ccep.2023.05.004] [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: 08/11/2023]
Abstract
Short-coupled ventricular fibrillation (SCVF) is a distinct phenotype among individuals with unexplained cardiac arrest accounting for 7% to 14% of cases of idiopathic ventricular fibrillation (IVF). VF is typically initiated by a trigger premature ventricular contraction with a short-coupling interval of less than 350 milliseconds. In the absence of specific electrocardiographic features or provocative tests, the diagnosis remains challenging and requires documentation of VF onset. Most cases are diagnosed during follow-up at the time of VF recurrence. SCVF is characterized by a high risk of VF recurrence. Insertion of an implantable cardioverter-defibrillator and quinidine are the keystones of SCVF management.
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Affiliation(s)
- Christian Steinberg
- Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ-UL), Laval University, 2725 Chemin Ste-Foy, Quebec, QC, G1V 4G5, Canada.
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4
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Bergeman AT, Hoeksema WF, van der Ree MH, Boersma LVA, Yap SC, Verheul LM, Hassink RJ, van der Crabben SN, Volders PGA, van der Werf C, Wilde AAM, Postema PG. Outcomes in Dutch DPP6 risk haplotype for familial idiopathic ventricular fibrillation: a focused update. Neth Heart J 2023:10.1007/s12471-023-01792-1. [PMID: 37498467 PMCID: PMC10400734 DOI: 10.1007/s12471-023-01792-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND The genetic risk haplotype DPP6 has been linked to familial idiopathic ventricular fibrillation (IVF), but the associated long-term outcomes are unknown. METHODS DPP6 risk haplotype-positive family members (DPP6 cases) and their risk haplotype-negative relatives (DPP6 controls) were included. Clinical follow-up data were collected through March 2023. Implantable cardioverter-defibrillator (ICD) indication was divided in primary or secondary prevention. Cumulative survival and event rates were calculated. RESULTS We included 327 DPP6 cases and 315 DPP6 controls. Median follow-up time was 9 years (interquartile range: 4-12). Of the DPP6 cases, 129 (39%) reached the composite endpoint of appropriate ICD shock, sudden cardiac arrest or death, at a median age of 45 years (range: 15-97). Median overall survival was 83 years and 87 years for DPP6 cases and DPP6 controls, respectively (p < 0.001). In DPP6 cases, median overall survival was shorter for males (74 years) than females (85 years) (p < 0.001). Of the DPP6 cases, 97 (30%) died, at a median age of 50 years. With a prophylactic ICD implantation advise based on risk haplotype, sex and age, 137 (42%) of DPP6 cases received an ICD, for primary prevention (n = 109) or secondary prevention (n = 28). In the primary prevention subgroup, 10 patients experienced a total of 34 appropriate ICD shocks, and there were no deaths during follow-up. DPP6 cases with a secondary prevention ICD experienced a total of 231 appropriate ICD shocks. CONCLUSION Patients with the DPP6 risk haplotype, particularly males, are at an increased risk of IVF and sudden cardiac death. Using a risk stratification approach based on risk haplotype, sex and age, a substantial proportion of patients with a primary prevention ICD experienced appropriate ICD shocks, showing the benefit of prophylactic ICD implantation with this strategy.
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Affiliation(s)
- Auke T Bergeman
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Wiert F Hoeksema
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Martijn H van der Ree
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Lucas V A Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Lisa M Verheul
- Department of Cardiology, Division Heart & Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, Division Heart & Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Saskia N van der Crabben
- Department of Human Genetics, Amsterdam University Medical Centres, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul G A Volders
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Christian van der Werf
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Pieter G Postema
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
- Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
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5
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Bergeman AT, Postema PG, Wilde AAM, van der Werf C. Pharmacological treatment of short-coupled idiopathic ventricular fibrillation: A review. Indian Pacing Electrophysiol J 2023; 23:77-83. [PMID: 36933619 PMCID: PMC10160784 DOI: 10.1016/j.ipej.2023.03.004] [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: 01/21/2023] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 03/18/2023] Open
Abstract
Short-coupled idiopathic ventricular fibrillation (IVF) is a subtype of IVF in which episodes of polymorphic ventricular tachycardia or ventricular fibrillation are initiated by short-coupled premature ventricular contractions (PVCs). Our understanding of the pathophysiology is evolving, with evidence suggesting that these malignant PVCs originate from the Purkinje system. In most cases, the genetic underpinning has not been identified. Whereas the implantation of an implantable cardioverter-defibrillator is uncontroversial, the choice of pharmacological treatment is the subject of discussion. In this review, we summarize the available knowledge on pharmacological therapy in short-coupled IVF and provide our recommendations for management of patients with this syndrome.
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Affiliation(s)
- A T Bergeman
- Heart Centre, Department of Cardiology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - P G Postema
- Heart Centre, Department of Cardiology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - A A M Wilde
- Heart Centre, Department of Cardiology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - C van der Werf
- Heart Centre, Department of Cardiology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands.
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Landra F, Marallo C, Santoro A, Taddeucci S, Tavera MC, Baiocchi C, Palazzuoli A. Moderator Band and Ventricular Tachycardia: Structural or Functional Substrate? J Cardiovasc Dev Dis 2023; 10:jcdd10040159. [PMID: 37103038 PMCID: PMC10141128 DOI: 10.3390/jcdd10040159] [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: 03/15/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023] Open
Abstract
The moderator band (MB) is an intracavitary structure of the right ventricle composed of muscular fibers encompassing specialized Purkinje fibers, separated each other by collagen and adipose tissue. In the last decades, premature ventricular complexes originating within the Purkinje network have been implicated in the genesis of life-threatening arrhythmias. However, right Purkinje network arrhythmias have been much less reported in the literature compared to the left counterpart. The MB has unique anatomical and electrophysiological properties, which may account for its arrhythmogenicity and may be responsible for a significant portion of idiopathic ventricular fibrillation. MB embodies autonomic nervous system cells, with important implications in arrhythmogenesis. Some idiopathic ventricular arrhythmias, defined as the absence of any identifiable structural heart disorder, can begin from this site. Due to these complex structural and functional peculiarities strictly interplayed each other, it is arduous to determine the precise mechanism underlying MB arrhythmias. MB-related arrhythmias should be differentiated from other right Purkinje fibers arrhythmias because of the opportunity for intervention and the unusual site for the ablation poorly described in the literature. In the current paper, we report the characteristics and electrical properties of the MB, their involvement in arrhythmogenesis, clinical and electrophysiological peculiarities of MB-related arrhythmias, and current treatment options.
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Affiliation(s)
- Federico Landra
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Carmine Marallo
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Amato Santoro
- Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| | - Simone Taddeucci
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Maria Cristina Tavera
- Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy
| | - Claudia Baiocchi
- Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy
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7
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Groeneveld SA, Kirkels FP, Cramer MJ, Evertz R, Haugaa KH, Postema PG, Prakken NHJ, Teske AJ, Wilde AAM, Velthuis BK, Nijveldt R, Hassink RJ. Prevalence of Mitral Annulus Disjunction and Mitral Valve Prolapse in Patients With Idiopathic Ventricular Fibrillation. J Am Heart Assoc 2022; 11:e025364. [PMID: 35929463 PMCID: PMC9496286 DOI: 10.1161/jaha.121.025364] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Idiopathic ventricular fibrillation (IVF) is diagnosed in patients with ventricular fibrillation of which the origin is not identified after extensive evaluations. Recent studies suggest an association between mitral annulus disjunction (MAD), mitral valve prolapse (MVP), and ventricular arrhythmias. The prevalence of MAD and MVP in patients with IVF in this regard is not well established. We aimed to explore the prevalence of MAD and MVP in a consecutive cohort of patients with IVF compared with matched controls. Methods and Results In this retrospective, multicenter cohort study, cardiac magnetic resonance images from patients with IVF (ie, negative for ischemia, cardiomyopathy, and channelopathies) and age‐ and sex‐matched control subjects were analyzed for the presence of MAD (≥2 mm) and MVP (>2 mm). In total, 72 patients (mean age 39±14 years, 42% women) and 72 control subjects (mean age 41±11 years, 42% women) were included. MAD in the inferolateral wall was more prevalent in patients with IVF versus healthy controls (7 [11%] versus 1 [1%], P=0.024). MVP was only seen in patients with IVF and not in controls (5 [7%] versus 0 [0%], P=0.016). MAD was observed in both patients with (n=4) and without (n=3) MVP. Conclusions Inferolateral MAD and MVP were significantly more prevalent in patients with IVF compared with healthy controls. The authors advocate that evaluation of the mitral valve region deserves extra attention in the extensive screening of patients with unexplained cardiac arrest. These findings support further exploration of the pathophysiological mechanisms underlying a subset of IVF that associates with MAD and MVP.
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Affiliation(s)
- Sanne A Groeneveld
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Feddo P Kirkels
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Maarten J Cramer
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Reinder Evertz
- Department of Cardiology, Radboudumc Nijmegen the Netherlands
| | - Kristina H Haugaa
- ProCardio Center for Innovation Department of Cardiology Oslo University Hospital Rikshospitalet Oslo Norway.,University of Oslo Oslo Norway
| | - Pieter G Postema
- Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC, Location AMC University of Amsterdam Amsterdam Cardiovascular Sciences Amsterdam the Netherlands.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART) http://guardheart.ern-net.eu
| | - Niek H J Prakken
- Department of Radiology University Medical Center Groningen Groningen the Netherlands
| | - Arco J Teske
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Arthur A M Wilde
- Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC, Location AMC University of Amsterdam Amsterdam Cardiovascular Sciences Amsterdam the Netherlands.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART) http://guardheart.ern-net.eu
| | - Birgitta K Velthuis
- Department of Radiology University Medical Center Utrecht Utrecht the Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboudumc Nijmegen the Netherlands
| | - Rutger J Hassink
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART) http://guardheart.ern-net.eu
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8
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Krahn AD, Tfelt-Hansen J, Tadros R, Steinberg C, Semsarian C, Han HC. Latent Causes of Sudden Cardiac Arrest. JACC Clin Electrophysiol 2022; 8:806-821. [PMID: 35738861 DOI: 10.1016/j.jacep.2021.12.014] [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: 08/27/2021] [Revised: 12/09/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Abstract
Inherited arrhythmia syndromes are a common cause of apparently unexplained cardiac arrest or sudden cardiac death. These include long QT syndrome and Brugada syndrome, with a well-recognized phenotype in most patients with sufficiently severe disease to lead to cardiac arrest. Less common and typically less apparent conditions that may not be readily evident include catecholaminergic polymorphic ventricular tachycardia, short QT syndrome and early repolarization syndrome. In cardiac arrest patients whose extensive testing does not reveal an underlying etiology, a diagnosis of idiopathic ventricular fibrillation or short-coupled ventricular fibrillation is assigned. This review summarizes our current understanding of the less common inherited arrhythmia syndromes and provides clinicians with a practical approach to diagnosis and management.
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Affiliation(s)
- Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Christian Steinberg
- Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ-UL), Laval University, Inherited Arrhythmia Services, Départment of Cardiology and Cardiac Surgery, Québec, Canada
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Hui-Chen Han
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
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9
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Abstract
BACKGROUND The short-coupled variant of torsade de pointes (sc-TdP) is a malignant arrhythmia that frequently presents with ventricular fibrillation (VF) electrical storm. Verapamil is considered the first-line therapy of sc-TdP while catheter ablation is not widely adopted. The aim of this study was to determine the origin of sc-TdP and to assess the outcome of catheter ablation using 3D-mapping. METHODS AND RESULTS We retrospectively analyzed five patients with sc-TdP who underwent 3D-mapping and ablation of sc-TdP at five different institutions. Four patients initially presented with sudden cardiac arrest, one patient experienced recurrent syncope as the first manifestation. All patients demonstrated a monomorphic premature ventricular contraction (PVC) with late transition left bundle branch block pattern, superior axis, and a coupling interval of less than 300 ms. triggering recurrent TdP and VF. In four patients, the culprit PVC was mapped to the free wall insertion of the moderator band (MB) with a preceding Purkinje potential in two patients. Catheter ablation using 3D-mapping and intracardiac echocardiography eliminated sc-TdP in all patients, with no recurrence at mean 2.7 years (range 6 months to 8 years) of follow-up. CONCLUSION 3D-mapping and intracardiac echocardiography demonstrate that sc-TdP predominantly originates from the MB free wall insertion and its Purkinje network. Catheter ablation of the culprit PVC at the MB free wall junction leads to excellent short- and long-term results and should be considered as first-line therapy in recurrent sc-TdP or electrical storm.
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Verberne HJ, Blom MT, Bardai A, Karemaker JM, Tan HL. An inherited sudden cardiac arrest syndrome may be based on primary myocardial and autonomic nervous system abnormalities. Heart Rhythm 2021; 19:244-251. [PMID: 34757187 DOI: 10.1016/j.hrthm.2021.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND A recently discovered sudden cardiac arrest (SCA) syndrome is linked to a risk haplotype that harbors the dipeptidyl-peptidase 6 (DPP6) gene as a plausible culprit. OBJECTIVE Because DPP6 impacts both cardiomyocyte and neuronal function, we hypothesized that ventricular fibrillation (VF) in risk haplotype carriers arises from functional changes in both the heart and autonomic nervous system. METHODS We studied 6 risk haplotype carriers with previous VF (symptomatic), 8 carriers without VF (asymptomatic), and 7 noncarriers (controls). We analyzed supine and standing heart rate variability, baroreflex sensitivity, pre-VF heart rate changes, and myocardial 123I-meta-iodobenzylguanide (123I-mIBG) scintigraphy. RESULTS Carriers had longer interbeat intervals than controls (1.03 ± 0.11 seconds vs 0.81 ± 0.07 seconds; P <.001), lower low-frequency (LF) and higher high-frequency (HF) activity, and lower LF/HF ratio (0.68 ± 0.50 vs 2.11 ± 1.10; P = .013) in the supine position. Upon standing up, carriers had significantly larger decrease in interbeat interval and increase in LF than controls (standing-to-supine ratio: 0.78 ± 0.07 vs 0.90 ± 0.07; P = .002; and 1.94 ± 1.03 vs 1.17 ± 0.34; P = .022, respectively), and nonsignificantly larger decrease in HF (0.62 ± 0.36 vs 0.97 ± 0.42; P = .065) and increase in LF/HF ratio (5.55 ± 6.79 vs 1.62 ± 1.24; P = .054). Sixteen of 17 VF episodes occurred at rest. Heart rate immediately before VF was 110 ± 25 bpm. Symptomatic carriers had less heterogeneous 123I-mIBG distribution in the left ventricle than asymptomatic carriers (single-photon emission computed tomography score ≥3 in 7 asymptomatic and 1 symptomatic carrier; P = .008). CONCLUSION It can be speculated that these data are consistent with more labile autonomic tone in carriers, suggesting that the primary abnormalities may reside in both the heart and the autonomic nervous system.
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Affiliation(s)
- Hein J Verberne
- Department of Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke T Blom
- Department of Cardiology, Heart Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Abdenasser Bardai
- Department of Cardiology, Heart Center, University of Amsterdam, Amsterdam, The Netherlands
| | - John M Karemaker
- Department of Medical Biology, Section Systems Physiology, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Cardiology, Heart Center, University of Amsterdam, Amsterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands.
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11
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[24-year-old man with successful resuscitation due to ventricular fibrillation without evident cause]. Herzschrittmacherther Elektrophysiol 2021; 32:479-483. [PMID: 34648066 DOI: 10.1007/s00399-021-00811-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/21/2021] [Indexed: 01/25/2023]
Abstract
A 24-year-old man was resuscitated successfully after ventricular fibrillation. Structural heart disease and a primary channelopathy could not be identified despite extensive work-up, including molecular genetic testing. Three years after the initial event, ventricular fibrillation recurred and recording of the induction mechanism opened additional therapeutic options.
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12
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Viskin S, Chorin E, Viskin D, Hochstadt A, Schwartz AL, Rosso R. Polymorphic Ventricular Tachycardia: Terminology, Mechanism, Diagnosis, and Emergency Therapy. Circulation 2021; 144:823-839. [PMID: 34491774 DOI: 10.1161/circulationaha.121.055783] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Polymorphic ventricular tachyarrhythmias are highly lethal arrhythmias. Several types of polymorphic ventricular tachycardia have similar electrocardiographic characteristics but have different modes of therapy. In fact, medications considered the treatment of choice for one form of polymorphic ventricular tachycardia, are contraindicated for the other. Yet confusion about terminology, and thus diagnosis and therapy, continues. We present an in-depth review of the different forms of polymorphic ventricular tachycardia and propose a practical step-by-step approach for distinguishing these malignant arrhythmias.
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Affiliation(s)
- Sami Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Ehud Chorin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Dana Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Arie Lorin Schwartz
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
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13
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Steinberg C, Davies B, Mellor G, Tadros R, Laksman ZW, Roberts JD, Green M, Alqarawi W, Angaran P, Healey J, Sanatani S, Leather R, Seifer C, Fournier A, Duff H, Gardner M, McIntyre C, Hamilton R, Simpson CS, Krahn AD. Short-coupled ventricular fibrillation represents a distinct phenotype among latent causes of unexplained cardiac arrest: a report from the CASPER registry. Eur Heart J 2021; 42:2827-2838. [PMID: 34010395 DOI: 10.1093/eurheartj/ehab275] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/14/2021] [Accepted: 04/27/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS The term idiopathic ventricular fibrillation (IVF) describes survivors of unexplained cardiac arrest (UCA) without a specific diagnosis after clinical and genetic testing. Previous reports have described a subset of IVF individuals with ventricular arrhythmia initiated by short-coupled trigger premature ventricular contractions (PVCs) for which the term short-coupled ventricular fibrillation (SCVF) has been proposed. The aim of this article is to establish the phenotype and frequency of SCVF in a large cohort of UCA survivors. METHODS AND RESULTS We performed a multicentre study including consecutive UCA survivors from the CASPER registry. Short-coupled ventricular fibrillation was defined as otherwise unexplained ventricular fibrillation initiated by a trigger PVC with a coupling interval of <350 ms. Among 364 UCA survivors, 24/364 (6.6%) met diagnostic criteria for SCVF. The diagnosis of SCVF was obtained in 19/24 (79%) individuals by documented ventricular fibrillation during follow-up. Ventricular arrhythmia was initiated by a mean PVC coupling interval of 274 ± 32 ms. Electrical storm occurred in 21% of SCVF probands but not in any UCA proband (P < 0.001). The median time to recurrent ventricular arrhythmia in SCVF was 31 months. Recurrent ventricular fibrillation resulted in quinidine administration in 12/24 SCVF (50%) with excellent arrhythmia control. CONCLUSION Short-coupled ventricular fibrillation is a distinct primary arrhythmia syndrome accounting for at least 6.6% of UCA. As documentation of ventricular fibrillation onset is necessary for the diagnosis, most cases are diagnosed at the time of recurrent arrhythmia, thus the true prevalence of SCVF remains still unknown. Quinidine is effective in SCVF and should be considered as first-line treatment for patients with recurrent episodes.
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Affiliation(s)
- Christian Steinberg
- Cardiac Electrophysiology Service, Department of Cardiology and Cardiac Surgery, Institut universitaire de cardiologie et pneumologie de Québec, Laval University, 2725, Chemin Ste-Foy, Quebec, QC G1V 4G5, Canada
| | - Brianna Davies
- Heart Rhythm Services, Department of Medicine, St-Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Greg Mellor
- Cardiac Electrophysiology Service, Royal Papworth Hospital, Cambridge, UK
| | - Rafik Tadros
- Section of Cardiac Electrophysiology, Montreal Heart Institute, University of Montreal, Montreal, QC, Canada
| | - Zachary W Laksman
- Heart Rhythm Services, Department of Medicine, St-Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Martin Green
- Cardiac Electrophysiology Service, Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Wael Alqarawi
- Cardiac Electrophysiology Service, Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Paul Angaran
- Cardiac Arrhythmia Service, St-Michael's Hospital, Toronto, ON, Canada
| | - Jeffrey Healey
- Arrhythmia Services Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Richard Leather
- Cardiac Electrophysiology Service, Royal Jubilee Hospital, Victoria, BC, Canada
| | - Colette Seifer
- St-Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, Department of Pediatrics, Centre Hospitalier Universitaire de Sainte-Justine, Montreal, QC, Canada
| | - Henry Duff
- Division of Cardiology, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Martin Gardner
- Cardiac Electrophysiology Service, QEII Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Ciorsti McIntyre
- Cardiac Electrophysiology Service, QEII Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Robert Hamilton
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Andrew D Krahn
- Heart Rhythm Services, Department of Medicine, St-Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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14
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Groeneveld SA, van der Ree MH, Taha K, de Bruin-Bon RHA, Cramer MJ, Teske AJ, Bouma BJ, Amin AS, Wilde AAM, Postema PG, Hassink RJ. Echocardiographic deformation imaging unmasks global and regional mechanical dysfunction in patients with idiopathic ventricular fibrillation: A multicenter case-control study. Heart Rhythm 2021; 18:1666-1672. [PMID: 34058391 DOI: 10.1016/j.hrthm.2021.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Idiopathic ventricular fibrillation (IVF) is diagnosed in patients with sudden onset of ventricular fibrillation of unidentified origin. New diagnostic tools that can detect subtle abnormalities are needed to diagnose and treat patients with an underlying substrate. OBJECTIVE The purpose of this study was to explore echocardiographic deformation characteristics in IVF patients. METHODS Echocardiograms were analyzed with deformation imaging by 2-dimensional speckle tracking. Global and regional measurements of the left ventricle (LV) and right ventricle (RV) were performed. Regional LV deformation patterns were evaluated for the presence of postsystolic shortening. Regional RV deformation patterns were classified as type I (normal) or type II/III (abnormal). RESULTS In total, 47 IVF patients (mean age 45 years; left ventricular ejection fraction [LVEF] 56%) and 47 healthy controls (mean age 41 years; LVEF 60%) were included. IVF patients showed more global deformation abnormalities as indicated by lower LV global longitudinal strain (18.5% ± 2.6% vs 21.6% ± 1.8%; P <.001) and higher LV mechanical dispersion (41 ± 12 ms vs 26 ± 6 ms; P <.001). In addition, IVF patients showed more regional LV postsystolic shortening compared to healthy controls (50% vs 11%; P <.001). Abnormal RV deformation patterns were observed in 16% of IVF patients and in none of the control subjects (P <.001). CONCLUSION We were able to show both regional and global echocardiographic deformation abnormalities in IVF patients. This study provides evidence that localized myocardial disease is present in a subset of IVF patients.
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Affiliation(s)
- Sanne A Groeneveld
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Martijn H van der Ree
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Karim Taha
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rianne H A de Bruin-Bon
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arco J Teske
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Berto J Bouma
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Ahmad S Amin
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Pieter G Postema
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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15
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Wenric S, Jeff JM, Joseph T, Yee MC, Belbin GM, Owusu Obeng A, Ellis SB, Bottinger EP, Gottesman O, Levin MA, Kenny EE. Rapid response to the alpha-1 adrenergic agent phenylephrine in the perioperative period is impacted by genomics and ancestry. THE PHARMACOGENOMICS JOURNAL 2021; 21:174-189. [PMID: 33168928 PMCID: PMC7997806 DOI: 10.1038/s41397-020-00194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 08/21/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022]
Abstract
The emergence of genomic data in biobanks and health systems offers new ways to derive medically important phenotypes, including acute phenotypes occurring during inpatient clinical care. Here we study the genetic underpinnings of the rapid response to phenylephrine, an α1-adrenergic receptor agonist commonly used to treat hypotension during anesthesia and surgery. We quantified this response by extracting blood pressure (BP) measurements 5 min before and after the administration of phenylephrine. Based on this derived phenotype, we show that systematic differences exist between self-reported ancestry groups: European-Americans (EA; n = 1387) have a significantly higher systolic response to phenylephrine than African-Americans (AA; n = 1217) and Hispanic/Latinos (HA; n = 1713) (31.3% increase, p value < 6e-08 and 22.9% increase, p value < 5e-05 respectively), after adjusting for genetic ancestry, demographics, and relevant clinical covariates. We performed a genome-wide association study to investigate genetic factors underlying individual differences in this derived phenotype. We discovered genome-wide significant association signals in loci and genes previously associated with BP measured in ambulatory settings, and a general enrichment of association in these genes. Finally, we discovered two low frequency variants, present at ~1% in EAs and AAs, respectively, where patients carrying one copy of these variants show no phenylephrine response. This work demonstrates our ability to derive a quantitative phenotype suited for comparative statistics and genome-wide association studies from dense clinical and physiological measures captured for managing patients during surgery. We identify genetic variants underlying non response to phenylephrine, with implications for preemptive pharmacogenomic screening to improve safety during surgery.
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Affiliation(s)
- Stephane Wenric
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Janina M Jeff
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas Joseph
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Muh-Ching Yee
- Stanford Functional Genomics Facility, Stanford, CA, USA
- Invitae Corporation, San Francisco, CA, USA
| | - Gillian M Belbin
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aniwaa Owusu Obeng
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Pharmacy Department, The Mount Sinai Hospital, New York, NY, USA
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephen B Ellis
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erwin P Bottinger
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Omri Gottesman
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew A Levin
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eimear E Kenny
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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16
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Touat-Hamici Z, Blancard M, Ma R, Lin L, Iddir Y, Denjoy I, Leenhardt A, Yuchi Z, Guicheney P. A SPRY1 domain cardiac ryanodine receptor variant associated with short-coupled torsade de pointes. Sci Rep 2021; 11:5243. [PMID: 33664309 PMCID: PMC7970841 DOI: 10.1038/s41598-021-84373-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/03/2021] [Indexed: 12/15/2022] Open
Abstract
Idiopathic ventricular fibrillation (IVF) causes sudden death in young adult patients without structural or ischemic heart disease. Most IVF cases are sporadic and some patients present with short-coupled torsade de pointes, the genetics of which are poorly understood. A man who had a first syncope at the age of 35 presented with frequent short-coupled premature ventricular beats with bursts of polymorphic ventricular tachycardia and then died suddenly. By exome sequencing, we identified three rare variants: p.I784F in the SPRY1 of the ryanodine receptor 2 (RyR2), p.A96S in connexin 40 (Cx40), reported to affect electrical coupling and cardiac conduction, and a nonsense p.R244X in the cardiac-specific troponin I-interacting kinase (TNNI3K). We assessed intracellular Ca2+ handling in WT and mutant human RYR2 transfected HEK293 cells by fluorescent microscopy and an enhanced store overload-induced Ca2+ release in response to cytosolic Ca2+ was observed in RyR2-I784F cells. In addition, crystal structures and thermal melting temperatures revealed a conformational change in the I784F-SPRY1 domain compared to the WT-domain. The novel RyR2-I784F variant in SPRY1 domain causes a leaky channel under non-stress conditions. The presence of several variants affecting Ca2+ handling and cardiac conduction suggests a possible oligogenic origin for the ectopies originating from Purkinje fibres.
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Affiliation(s)
- Zahia Touat-Hamici
- INSERM, UMRS 1166, Faculté de Médecine Sorbonne-Université, Unité de Recherche sur les Maladies Cardiovasculaires et Métaboliques, 91, boulevard de l'Hôpital, 75013, Paris, France
- Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, Paris, France
| | - Malorie Blancard
- INSERM, UMRS 1166, Faculté de Médecine Sorbonne-Université, Unité de Recherche sur les Maladies Cardiovasculaires et Métaboliques, 91, boulevard de l'Hôpital, 75013, Paris, France
- Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, Paris, France
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ruifang Ma
- Tianjin Key Laboratory for Modern Drug Delivery & High-Efficiency, Collaborative Innovation Center of Chemical Science and Engineering, School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China
| | - Lianyun Lin
- Tianjin Key Laboratory for Modern Drug Delivery & High-Efficiency, Collaborative Innovation Center of Chemical Science and Engineering, School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China
| | - Yasmine Iddir
- INSERM, UMRS 1166, Faculté de Médecine Sorbonne-Université, Unité de Recherche sur les Maladies Cardiovasculaires et Métaboliques, 91, boulevard de l'Hôpital, 75013, Paris, France
- Département d'Oncologie Pédiatrique Laboratoire RTOP «Recherche Translationnelle en Oncologie Pédiatrique»-INSERM U830, Institut Curie, Paris, France
| | - Isabelle Denjoy
- Département de Cardiologie et Centre de Référence des Maladies Cardiaques Héréditaires, AP-HP, Hôpital Bichat, 75018, Paris, France
- Université de Paris, INSERM, U1166, 75013, Paris, France
| | - Antoine Leenhardt
- Département de Cardiologie et Centre de Référence des Maladies Cardiaques Héréditaires, AP-HP, Hôpital Bichat, 75018, Paris, France
- Université de Paris, INSERM, U1166, 75013, Paris, France
| | - Zhiguang Yuchi
- Tianjin Key Laboratory for Modern Drug Delivery & High-Efficiency, Collaborative Innovation Center of Chemical Science and Engineering, School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China.
| | - Pascale Guicheney
- INSERM, UMRS 1166, Faculté de Médecine Sorbonne-Université, Unité de Recherche sur les Maladies Cardiovasculaires et Métaboliques, 91, boulevard de l'Hôpital, 75013, Paris, France.
- Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, Paris, France.
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17
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von Alvensleben JC, Etheridge SP, Viskin S, Collins KK. Short-coupled premature ventricular beats leading to ventricular fibrillation in a young patient: A Sudden Arrhythmia Death Syndrome case report and literature review. HeartRhythm Case Rep 2020; 6:815-818. [PMID: 33204612 PMCID: PMC7653467 DOI: 10.1016/j.hrcr.2020.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Susan P Etheridge
- Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - Sami Viskin
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Kathryn K Collins
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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18
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Wang NC, Jain SK, Saba S. Elective implantable cardioverter-defibrillator removal with extraction of leads following catheter ablation of idiopathic ventricular fibrillation and long-term surveillance. HeartRhythm Case Rep 2020; 6:464-468. [PMID: 32695603 PMCID: PMC7361130 DOI: 10.1016/j.hrcr.2020.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Norman C Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sandeep K Jain
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samir Saba
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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19
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Sonoda K, Ohno S, Shimizu Y, Kaitani K, Makiyama T, Nakagawa Y, Horie M. SCN5A
mutation identified in a patient with short‐coupled variant of torsades de pointes. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:456-461. [DOI: 10.1111/pace.13924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/27/2020] [Accepted: 04/19/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Keiko Sonoda
- Department of Bioscience and GeneticsNational Cerebral and Cardiovascular Center Suita Japan
- Department of Cardiovascular MedicineShiga University of Medical Science Shiga Japan
- Department of Cardiovascular Biology and MedicineNiigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Seiko Ohno
- Department of Bioscience and GeneticsNational Cerebral and Cardiovascular Center Suita Japan
- Department of Cardiovascular MedicineShiga University of Medical Science Shiga Japan
- Center for Epidemiologic Research in AsiaShiga University of Medical Science Shiga Japan
| | - Yukiko Shimizu
- Department of Cardiovascular MedicineHyogo Prefectural Amagasaki General Medical Center Amagasaki Japan
| | - Kazuaki Kaitani
- Department of Cardiovascular MedicineJapanese Red Cross Otsu Hospital Otsu Japan
| | - Takeru Makiyama
- Department of Cardiovascular MedicineKyoto University Graduate School of Medicine Kyoto Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular MedicineShiga University of Medical Science Shiga Japan
| | - Minoru Horie
- Department of Cardiovascular MedicineShiga University of Medical Science Shiga Japan
- Center for Epidemiologic Research in AsiaShiga University of Medical Science Shiga Japan
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20
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Barber M, Chinitz J, John R. Arrhythmias from the Right Ventricular Moderator Band: Diagnosis and Management. Arrhythm Electrophysiol Rev 2020; 8:294-299. [PMID: 32685160 PMCID: PMC7358944 DOI: 10.15420/aer.2019.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The moderator band in the right ventricle is being increasingly recognised as a source for arrhythmias in the absence of identifiable structural heart disease. Because it carries part of the conduction system from the right ventricle septum to the free wall, it is a source of Purkinje-mediated ventricular arrhythmias that manifest as premature ventricular contractions (PVC) or repetitive ventricular tachycardia. More importantly, short coupled PVCs triggering polymorphic ventricular tachycardia and VF have been localised to the moderator band and ablation of these Purkinje mediated PVCs can effectively prevent recurrent VF. The exact mechanism of arrhythmogenesis is still debated but stretch, fibrosis and ion channel alterations might be responsible. Arrhythmias originating in this region of the right ventricle may thus be another cause for idiopathic VF that is potentially treatable with catheter-based ablation techniques. Recognition of the typical PVC morphology can point to the moderator band as the source of idiopathic VF and an opportunity for timely intervention. The available data on the anatomy, electrophysiology and management options are reviewed.
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Affiliation(s)
- Megan Barber
- Nassau University Medical Center, Zucker School of Medicine at Hofstra/Northwell, NY, US
| | - Jason Chinitz
- Department of Medicine and Cardiology, Northshore University Hospital, NY, US
| | - Roy John
- Department of Medicine and Cardiology, Northshore University Hospital, NY, US
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21
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Analysis of the genetic variants associated with circulating levels of sgp130. Results from the IMPROVE study. Genes Immun 2020; 21:100-108. [PMID: 31932740 PMCID: PMC7182533 DOI: 10.1038/s41435-019-0090-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/12/2019] [Accepted: 12/23/2019] [Indexed: 01/06/2023]
Abstract
The genes regulating circulating levels of soluble gp130 (sgp130), the antagonist of the inflammatory response in atherosclerosis driven by interleukin 6, are largely unknown. Aims of the present study were to identify genetic loci associated with circulating sgp130 and to explore the potential association between variants associated with sgp130 and markers of subclinical atherosclerosis. The study is based on IMPROVE (n = 3703), a cardiovascular multicentre study designed to investigate the determinants of carotid intima media thickness, a measure of subclinical atherosclerosis. Genomic DNA was genotyped by the CardioMetaboChip and ImmunoChip. About 360,842 SNPs were tested for association with log-transformed sgp130, using linear regression adjusted for age, gender, and population stratification using PLINK v1.07. A p value of 1 × 10−5 was chosen as threshold for significance value. In an exploratory analysis, SNPs associated with sgp130 were tested for association with c-IMT measures. We identified two SNPs significantly associated with sgp130 levels and 24 showing suggestive association with sgp130 levels. One SNP (rs17688225) on chromosome 14 was positively associated with sgp130 serum levels (β = 0.03 SE = 0.007, p = 4.77 × 10−5) and inversely associated with c-IMT (c-IMTmean–maxβ = −0.001 SE = 0.005, p = 0.0342). Our data indicate that multiple loci regulate sgp130 levels and suggest a possible common pathway between sgp130 and c-IMT measures.
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22
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Ji CC, Yao FJ, Cheng YJ, Yao H, Fan J, Chen XM, Zheng ZH, Dong YG, Wu SH. A novel DPP6 variant in Chinese families causes early repolarization syndrome. Exp Cell Res 2019; 384:111561. [PMID: 31476289 DOI: 10.1016/j.yexcr.2019.111561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/15/2019] [Accepted: 08/17/2019] [Indexed: 11/15/2022]
Abstract
Previous studies demonstrated that variants in dipeptidyl aminopeptidase-like protein-6 (DPP6) are involved in idiopathic ventricular fibrillation. However, its role in early repolarization syndrome (ERS) remains largely elusive. The aim of this study is to determine whether the novel DPP6-L747P variant is associated with ERS, and explore the underlying mechanisms. In our study, whole genome sequencing was used to identify a genetic variant in 4 Chinese families with sudden cardiac arrest induced by ERS. Then, wild-type (WT) DPP6 or mutant (c.2240T > C/p.L747P) DPP6 were respectively expressed in HEK293 cells, co-expressed with KV4.3 and KChIP2. Western blotting, immunofluorescence, and whole-cell patch clamp experiments were performed to reveal possible underlying mechanisms. A novel missense variant (c.2240T > C/p.L747P) in DPP6 was identified in the 4 families. Both DPP6-WT and DPP6-L747P were mainly located on the cell membrane. Compared with DPP6-WT, the intensity of DPP6 protein bands was downregulated in DPP6-L747P. Functional experiments showed that macroscopic currents exhibited an increase in DPP6-L747P, and the current intensity of DPP6-L747P was increased more than that of DPP6-WT (63.1 ± 8.2 pA/pF vs.86.5 ± 15.1 pA/pF at +50 mV, P < 0.05). Compared with DPP6-WT, the slope of the activation curve of DPP6-L747P was slightly decreased (15.49 ± 0.56 mV vs. 13.88 ± 0.54 mV, P < 0.05), the slope of the inactivation curve was increased (13.65 ± 1.57 mV, vs. 24.44 ± 2.79 mV, P < 0.05) and the recovery time constant was significantly reduced (216.81 ± 18.59 ms vs. 102.11 ± 32.03 ms, P < 0.05). In conclusion, we identified a novel missense variant (c.2240T > C/p. L747P) in DPP6 in 4 Chinese families with sudden cardiac arrest induced by ERS. Patch clamp experiments revealed that this variant could generate a gain of function of Ito and affect the potassium current. These results demonstrated that changes caused by the variant may be the underlying mechanisms of malignant arrhythmias in the individuals with ERS.
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Affiliation(s)
- Cheng-Cheng Ji
- Department of Cardiology and Department of Medical Ultrasonics (Feng-Juan, Yao), the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Feng-Juan Yao
- Department of Cardiology and Department of Medical Ultrasonics (Feng-Juan, Yao), the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Yun-Jiu Cheng
- Department of Cardiology and Department of Medical Ultrasonics (Feng-Juan, Yao), the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Hao Yao
- Department of Cardiology and Department of Medical Ultrasonics (Feng-Juan, Yao), the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Jun Fan
- Department of Cardiology and Department of Medical Ultrasonics (Feng-Juan, Yao), the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Xu-Miao Chen
- Department of Cardiology and Department of Medical Ultrasonics (Feng-Juan, Yao), the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Zi-Heng Zheng
- Department of Cardiology and Department of Medical Ultrasonics (Feng-Juan, Yao), the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Yu-Gang Dong
- Department of Cardiology and Department of Medical Ultrasonics (Feng-Juan, Yao), the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory of Assisted Circulation, NHC, Guangzhou, China.
| | - Su-Hua Wu
- Department of Cardiology and Department of Medical Ultrasonics (Feng-Juan, Yao), the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory of Assisted Circulation, NHC, Guangzhou, China.
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Abstract
The primary electrical disorders are a group of inherited cardiac ventricular arrhythmias that are a major cause of sudden cardiac death in young individuals. Inherited ventricular arrhythmias result from mutations in genes encoding cardiac ion channels or their modulatory subunits. Advances in genetic screening in the past three decades have led to the assembly of large patient cohorts with these disorders. Studies in these patients, as well as in the general population, have striven to define the prevalence of these inherited arrhythmias and the characteristics of patients with different genetic subtypes of the disease. In this Review, we provide a comprehensive update on the epidemiology of inherited ventricular arrhythmias, focusing on natural history, prevalence and patient demographics. In addition, we summarize the various founder populations (groups of individuals with a disease that is caused by a genetic defect inherited from a common ancestor) that have been identified for some of these disorders and which lead to increased prevalence in some geographical regions. To date, although numerous studies have markedly increased our understanding of the epidemiology of these disorders, demographic data, especially from non-Western countries, remain scarce. Furthermore, defining the true prevalence of these disorders remains challenging. International collaboration will undoubtedly accelerate the collection of demographic information and improve the accuracy of prevalence data.
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Ortmans S, Daval C, Aguilar M, Compagno P, Cadrin-Tourigny J, Dyrda K, Rivard L, Tadros R. Pharmacotherapy in inherited and acquired ventricular arrhythmia in structurally normal adult hearts. Expert Opin Pharmacother 2019; 20:2101-2114. [DOI: 10.1080/14656566.2019.1669561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Staniel Ortmans
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Charline Daval
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Martin Aguilar
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Electrophysiology service, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Pablo Compagno
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Julia Cadrin-Tourigny
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Cardiovascular Genetics Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Katia Dyrda
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Lena Rivard
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Electrophysiology service, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Rafik Tadros
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Cardiovascular Genetics Center, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Physiology and Pharmacology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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25
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Wilde AA, Garan H, Boyden PA. Role of the Purkinje system in heritable arrhythmias. Heart Rhythm 2019; 16:1121-1126. [DOI: 10.1016/j.hrthm.2019.01.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Indexed: 12/28/2022]
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26
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Johnson EK, Springer SJ, Wang W, Dranoff EJ, Zhang Y, Kanter EM, Yamada KA, Nerbonne JM. Differential Expression and Remodeling of Transient Outward Potassium Currents in Human Left Ventricles. Circ Arrhythm Electrophysiol 2019; 11:e005914. [PMID: 29311162 DOI: 10.1161/circep.117.005914] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/30/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Myocardial, transient, outward currents, Ito, have been shown to play pivotal roles in action potential (AP) repolarization and remodeling in animal models. The properties and contribution of Ito to left ventricular (LV) repolarization in the human heart, however, are poorly defined. METHODS AND RESULTS Whole-cell, voltage-clamp recordings, acquired at physiological (35°C to 37°C) temperatures, from myocytes isolated from the LV of nonfailing human hearts identified 2 distinct transient currents, Ito,fast (Ito,f) and Ito,slow (Ito,s), with significantly (P<0.0001) different rates of recovery from inactivation and pharmacological sensitives: Ito,f recovers in ≈10 ms, 100× faster than Ito,s, and is selectively blocked by the Kv4 channel toxin, SNX-482. Current-clamp experiments revealed regional differences in AP waveforms, notably a phase 1 notch in LV subepicardial myocytes. Dynamic clamp-mediated addition/removal of modeled human ventricular Ito,f, resulted in hyperpolarization or depolarization, respectively, of the notch potential, whereas slowing the rate of Ito,f inactivation resulted in AP collapse. AP-clamp experiments demonstrated that changes in notch potentials modified the time course and amplitudes of voltage-gated Ca2+ currents, ICa. In failing LV subepicardial myocytes, Ito,f was reduced and Ito,s was increased, notch and plateau potentials were depolarized (P<0.0001) and AP durations were prolonged (P<0.001). CONCLUSIONS Ito,f and Ito,s are differentially expressed in nonfailing human LV, contributing to regional heterogeneities in AP waveforms. Ito,f regulates notch and plateau potentials and modulates the time course and amplitude of ICa. Slowing Ito,f inactivation results in dramatic AP shortening. Remodeling of Ito,f in failing human LV subepicardial myocytes attenuates transmural differences in AP waveforms.
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Affiliation(s)
- Eric K Johnson
- From the Cardiovascular Division, Department of Medicine (E.K.J., S.J.S., W.W., E.J.D., Y.Z., E.M.K., K.A.Y., J.M.N.) and Department of Developmental Biology (J.M.N.), Washington University School of Medicine, St. Louis, MO
| | - Steven J Springer
- From the Cardiovascular Division, Department of Medicine (E.K.J., S.J.S., W.W., E.J.D., Y.Z., E.M.K., K.A.Y., J.M.N.) and Department of Developmental Biology (J.M.N.), Washington University School of Medicine, St. Louis, MO
| | - Wei Wang
- From the Cardiovascular Division, Department of Medicine (E.K.J., S.J.S., W.W., E.J.D., Y.Z., E.M.K., K.A.Y., J.M.N.) and Department of Developmental Biology (J.M.N.), Washington University School of Medicine, St. Louis, MO
| | - Edward J Dranoff
- From the Cardiovascular Division, Department of Medicine (E.K.J., S.J.S., W.W., E.J.D., Y.Z., E.M.K., K.A.Y., J.M.N.) and Department of Developmental Biology (J.M.N.), Washington University School of Medicine, St. Louis, MO
| | - Yan Zhang
- From the Cardiovascular Division, Department of Medicine (E.K.J., S.J.S., W.W., E.J.D., Y.Z., E.M.K., K.A.Y., J.M.N.) and Department of Developmental Biology (J.M.N.), Washington University School of Medicine, St. Louis, MO
| | - Evelyn M Kanter
- From the Cardiovascular Division, Department of Medicine (E.K.J., S.J.S., W.W., E.J.D., Y.Z., E.M.K., K.A.Y., J.M.N.) and Department of Developmental Biology (J.M.N.), Washington University School of Medicine, St. Louis, MO
| | - Kathryn A Yamada
- From the Cardiovascular Division, Department of Medicine (E.K.J., S.J.S., W.W., E.J.D., Y.Z., E.M.K., K.A.Y., J.M.N.) and Department of Developmental Biology (J.M.N.), Washington University School of Medicine, St. Louis, MO
| | - Jeanne M Nerbonne
- From the Cardiovascular Division, Department of Medicine (E.K.J., S.J.S., W.W., E.J.D., Y.Z., E.M.K., K.A.Y., J.M.N.) and Department of Developmental Biology (J.M.N.), Washington University School of Medicine, St. Louis, MO.
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27
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Belau F, Metzner K, Christ T, Ravens U, Schaefer M, Künzel S, Li W, Wettwer E, Dobrev D, El-Armouche A, Kämmerer S. DPP10 is a new regulator of Nav1.5 channels in human heart. Int J Cardiol 2019; 284:68-73. [DOI: 10.1016/j.ijcard.2018.12.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/14/2018] [Accepted: 12/27/2018] [Indexed: 10/27/2022]
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28
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29
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Nakamura TY, Nakao S, Wakabayashi S. Emerging Roles of Neuronal Ca 2+ Sensor-1 in Cardiac and Neuronal Tissues: A Mini Review. Front Mol Neurosci 2019; 12:56. [PMID: 30886571 PMCID: PMC6409499 DOI: 10.3389/fnmol.2019.00056] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/15/2019] [Indexed: 11/13/2022] Open
Abstract
The EF-hand calcium (Ca2+)-binding protein, neuronal Ca2+ sensor-1 (NCS-1/frequenin), is predominantly expressed in neuronal tissues and plays a crucial role in neuronal functions, including synaptic transmission and plasticity. NCS-1 has diverse functional roles, as elucidated in the past 15 years, which include the regulation of phosphatidylinositol 4-kinase IIIβ (PI-4K-β) and several ion channels such as voltage-gated K+ and Ca2+ channels, the D2 dopamine receptors, and inositol 1,4,5-trisphosphate receptors (InsP3Rs). Functional analyses demonstrated that NCS-1 enhances exocytosis and neuronal survival after injury, as well as promotes learning and memory in mice. NCS-1 is also expressed in the heart including the Purkinje fibers (PFs) of the conduction system. NCS-1 interacts with KV4 K+ channels together with dipeptidyl peptidase-like protein-6 (DPP-6), and this macromolecule then composes the transient outward current in PFs and contributes to the repolarization of PF action potential, thus being responsible for idiopathic arrhythmia. Moreover, NCS-1 expression was reported to be significantly high at the immature stage and at hypertrophy in adults. That report demonstrated that NCS-1 positively regulates cardiac contraction in immature hearts by increasing intracellular Ca2+ signals through interaction with InsP3Rs. With the related signals, NCS-1 activates nuclear Ca2+ signals, which would be a mechanism underlying hormone-induced cardiac hypertrophy. Furthermore, NCS-1 contributes to stress tolerance in cardiomyocytes by activating mitochondrial detoxification pathways, with a key role in Ca2+-dependent pathways. In this review, we will discuss recent findings supporting the functional significance of NCS-1 in the brain and heart and will address possible underlying molecular mechanisms.
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Affiliation(s)
- Tomoe Y Nakamura
- Department of Molecular Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Shu Nakao
- Department of Molecular Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan.,Department of Biomedical Sciences, College of Life Sciences, Ritsumeikan University, Kusatsu, Japan
| | - Shigeo Wakabayashi
- Department of Molecular Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan.,Department of Pharmacology, Osaka Medical College, Takatsuki, Japan
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30
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Ni H, Zhang H, Grandi E, Narayan SM, Giles WR. Transient outward K + current can strongly modulate action potential duration and initiate alternans in the human atrium. Am J Physiol Heart Circ Physiol 2019; 316:H527-H542. [PMID: 30576220 PMCID: PMC6415821 DOI: 10.1152/ajpheart.00251.2018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/27/2018] [Accepted: 08/15/2018] [Indexed: 01/14/2023]
Abstract
Efforts to identify the mechanisms for the initiation and maintenance of human atrial fibrillation (AF) often focus on changes in specific elements of the atrial "substrate," i.e., its electrophysiological properties and/or structural components. We used experimentally validated mathematical models of the human atrial myocyte action potential (AP), both at baseline in sinus rhythm (SR) and in the setting of chronic AF, to identify significant contributions of the Ca2+-independent transient outward K+ current ( Ito) to electrophysiological instability and arrhythmia initiation. First, we explored whether changes in the recovery or restitution of the AP duration (APD) and/or its dynamic stability (alternans) can be modulated by Ito. Recent reports have identified disease-dependent spatial differences in expression levels of the specific K+ channel α-subunits that underlie Ito in the left atrium. Therefore, we studied the functional consequences of this by deletion of 50% of native Ito (Kv4.3) and its replacement with Kv1.4. Interestingly, significant changes in the short-term stability of the human atrial AP waveform were revealed. Specifically, this K+ channel isoform switch produced discontinuities in the initial slope of the APD restitution curve and appearance of APD alternans. This pattern of in silico results resembles some of the changes observed in high-resolution clinical electrophysiological recordings. Important insights into mechanisms for these changes emerged from known biophysical properties (reactivation kinetics) of Kv1.4 versus those of Kv4.3. These results suggest new approaches for pharmacological management of AF, based on molecular properties of specific K+ isoforms and their changed expression during progressive disease. NEW & NOTEWORTHY Clinical studies identify oscillations (alternans) in action potential (AP) duration as a predictor for atrial fibrillation (AF). The abbreviated AP in AF also involves changes in K+ currents and early repolarization of the AP. Our simulations illustrate how substitution of Kv1.4 for the native current, Kv4.3, alters the AP waveform and enhances alternans. Knowledge of this "isoform switch" and related dynamics in the AF substrate may guide new approaches for detection and management of AF.
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Affiliation(s)
- Haibo Ni
- Biological Physics Group, School of Physics and Astronomy, University of Manchester , Manchester , United Kingdom
- Department of Pharmacology, University of California , Davis, California
| | - Henggui Zhang
- Biological Physics Group, School of Physics and Astronomy, University of Manchester , Manchester , United Kingdom
| | - Eleonora Grandi
- Department of Pharmacology, University of California , Davis, California
| | - Sanjiv M Narayan
- Division of Cardiology, Cardiovascular Institute, Stanford University , Stanford, California
| | - Wayne R Giles
- Faculties of Kinesiology and Medicine, University of Calgary , Calgary, Alberta , Canada
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31
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Hou JW, Fei YD, Li W, Chen YH, Wang Q, Xiao Y, Wang YP, Li YG. The transient receptor potential melastatin 4 channel inhibitor 9-phenanthrol modulates cardiac sodium channel. Br J Pharmacol 2018; 175:4325-4337. [PMID: 30153324 DOI: 10.1111/bph.14490] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/06/2018] [Accepted: 08/20/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND PURPOSE 9-Phenanthrol, known as a specific inhibitor of the transient receptor potential melastatin 4 (TRMP4) channel, has been shown to modulate cardiac electrical activity and exert antiarrhythmic effects. However, its pharmacological effects remain to be fully explored. Here, we tested the hypothesis that cardiac sodium current inhibition contributes to the cardioprotective effect of 9-phenanthrol. EXPERIMENTAL APPROACH Single ventricular myocytes (VMs) and Purkinje cells (PCs) were enzymatically isolated from rabbits. Arterially perfused rabbit wedge preparations were also used, and transmural electrocardiogram and endocardial action potentials (APs) were simultaneously recorded. Wild-type and mutated human recombinant SCN5A were expressed in HEK293 cells. Anemonia toxin II (ATX-II) was used to amplify the late sodium current (INaL ) and induce arrhythmias. Whole-cell patch clamp technique was used to record APs and ionic currents. KEY RESULTS 9-Phenanthrol (10-50 μM) stabilized ventricular repolarization and abolished arrhythmias induced by ATX-II in both isolated VMs, PCs and wedge preparations. Further study revealed that 9-phenanthrol modulated the gating properties of cardiac sodium channels and dose-dependently inhibited INaL and peak sodium current (INaP ) in VMs with an IC50 of 18 and 71.5 μM respectively. Its ability to inhibit INaL was further confirmed in PCs and HEK293 cells expressing SCN5A mutations. CONCLUSIONS AND IMPLICATIONS Our results indicate that 9-phenanthrol modulates the gating properties of cardiac sodium channels and inhibits INaL and INaP , which may contribute to its antiarrhythmic and cardioprotective effects.
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Affiliation(s)
- Jian-Wen Hou
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Dong Fei
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-He Chen
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Wang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Xiao
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yue-Peng Wang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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32
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Cheniti G, Vlachos K, Meo M, Puyo S, Thompson N, Denis A, Duchateau J, Takigawa M, Martin C, Frontera A, Kitamura T, Lam A, Bourier F, Klotz N, Derval N, Sacher F, Jais P, Dubois R, Hocini M, Haissaguerre M. Mapping and Ablation of Idiopathic Ventricular Fibrillation. Front Cardiovasc Med 2018; 5:123. [PMID: 30280100 PMCID: PMC6153961 DOI: 10.3389/fcvm.2018.00123] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/20/2018] [Indexed: 01/30/2023] Open
Abstract
Idiopathic ventricular fibrillation (IVF) is the main cause of unexplained sudden cardiac death, particularly in young patients under the age of 35. IVF is a diagnosis of exclusion in patients who have survived a VF episode without any identifiable structural or metabolic causes despite extensive diagnostic testing. Genetic testing allows identification of a likely causative mutation in up to 27% of unexplained sudden deaths in children and young adults. In the majority of cases, VF is triggered by PVCs that originate from the Purkinje network. Ablation of VF triggers in this setting is associated with high rates of acute success and long-term freedom from VF recurrence. Recent studies demonstrate that a significant subset of IVF defined by negative comprehensive investigations, demonstrate in fact subclinical structural alterations. These localized myocardial alterations are identified by high density electrogram mapping, are of small size and are mainly located in the epicardium. As reentrant VF drivers are often colocated with regions of abnormal electrograms, this localized substrate can be shown to be mechanistically linked with VF. Such areas may represent an important target for ablation.
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Affiliation(s)
- Ghassen Cheniti
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France.,Department of Cardiology, Sahloul Hospital, Universite de Sousse, Sousse, Tunisia
| | - Konstantinos Vlachos
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Marianna Meo
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Stephane Puyo
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Nathaniel Thompson
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Arnaud Denis
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Josselin Duchateau
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Masateru Takigawa
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Claire Martin
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France.,Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Antonio Frontera
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Takeshi Kitamura
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Anna Lam
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Felix Bourier
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Nicolas Klotz
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Nicolas Derval
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Frederic Sacher
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Pierre Jais
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Remi Dubois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Meleze Hocini
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Michel Haissaguerre
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
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He BJ, Boyden P, Scheinman M. Ventricular arrhythmias involving the His-Purkinje system in the structurally abnormal heart. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1051-1059. [PMID: 30084120 DOI: 10.1111/pace.13465] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/28/2018] [Accepted: 07/05/2018] [Indexed: 12/01/2022]
Abstract
His-Purkinje-related ventricular arrhythmias are a subset of ventricular tachycardias that use the specialized cardiac conduction system. These arrhythmias can occur in various different forms of structural heart disease. Here, we review the basic science discoveries and their analogous clinical observations that implicate the His-Purkinje system as a crucial component of the arrhythmia circuit. While mutations serve the molecular basis for arrhythmias in the heritable cardiomyopathies, transcriptional and posttranslational changes constitute the adverse remodeling leading to arrhythmias in acquired structural heart disease. Additional studies on the electrical properties of the His-Purkinje network and its interactions with the surrounding myocardium will improve the clinical diagnosis and treatment of these arrhythmias.
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Affiliation(s)
- Beixin Julie He
- Department of Medicine, University of California, San Francisco, California
| | - Penelope Boyden
- Department of Pharmacology, Columbia University, New York city, New York
| | - Melvin Scheinman
- Department of Medicine, University of California, San Francisco, California
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Boyden PA. Purkinje physiology and pathophysiology. J Interv Card Electrophysiol 2018; 52:255-262. [PMID: 30056516 DOI: 10.1007/s10840-018-0414-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/17/2018] [Indexed: 01/08/2023]
Abstract
There has always been an appreciation of the role of Purkinje fibers in the fast conduction of the normal cardiac impulse. Here, we briefly update our knowledge of this important set of cardiac cells. We discuss the anatomy of a Purkinje fiber strand, the importance of longitudinal conduction within a strand, circus movement within a strand, conduction, and excitability properties of Purkinjes. At the cell level, we discuss the important components of the ion channel makeup in the nonremodeled Purkinjes of healthy hearts. Finally, we discuss the role of the Purkinjes in forming the heritable arrhythmogenic substrates such as long QT, heritable conduction slowing, CPVT, sQT, and Brugada syndromes.
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Affiliation(s)
- Penelope A Boyden
- Department of Pharmacology, Columbia University, New York, NY, 10032, USA.
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Boyden PA, Mohler PJ. Treat the Patient, Not Just the Cell! Circ Res 2017; 120:1390-1392. [PMID: 28450361 DOI: 10.1161/circresaha.116.310427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Penelope A Boyden
- From the Department of Pharmacology, Columbia University, New York (P.A.B.); and Dorothy M Davis Heart and Lung Research Institute, Departments of Physiology and Cell Biology and Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (P.J.M.).
| | - Peter J Mohler
- From the Department of Pharmacology, Columbia University, New York (P.A.B.); and Dorothy M Davis Heart and Lung Research Institute, Departments of Physiology and Cell Biology and Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (P.J.M.)
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McKinnon D, Rosati B. Transmural gradients in ion channel and auxiliary subunit expression. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2016; 122:165-186. [PMID: 27702655 DOI: 10.1016/j.pbiomolbio.2016.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/30/2016] [Indexed: 12/11/2022]
Abstract
Evolution has acted to shape the action potential in different regions of the heart in order to produce a maximally stable and efficient pump. This has been achieved by creating regional differences in ion channel expression levels within the heart as well as differences between equivalent cardiac tissues in different species. These region- and species-dependent differences in channel expression are established by regulatory evolution, evolution of the regulatory mechanisms that control channel expression levels. Ion channel auxiliary subunits are obvious targets for regulatory evolution, in order to change channel expression levels and/or modify channel function. This review focuses on the transmural gradients of ion channel expression in the heart and the role that regulation of auxiliary subunit expression plays in generating and shaping these gradients.
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Affiliation(s)
- David McKinnon
- Department of Veterans Affairs Medical Center, Northport, NY, USA; Institute of Molecular Cardiology, Stony Brook University, Stony Brook, NY, USA; Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Barbara Rosati
- Department of Veterans Affairs Medical Center, Northport, NY, USA; Institute of Molecular Cardiology, Stony Brook University, Stony Brook, NY, USA; Department of Physiology and Biophysics, Stony Brook University, Stony Brook, NY, 11794, USA.
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Fujii Y, Itoh H, Ohno S, Murayama T, Kurebayashi N, Aoki H, Blancard M, Nakagawa Y, Yamamoto S, Matsui Y, Ichikawa M, Sonoda K, Ozawa T, Ohkubo K, Watanabe I, Guicheney P, Horie M. A type 2 ryanodine receptor variant associated with reduced Ca 2+ release and short-coupled torsades de pointes ventricular arrhythmia. Heart Rhythm 2016; 14:98-107. [PMID: 27756708 DOI: 10.1016/j.hrthm.2016.10.015] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ventricular fibrillation may be caused by premature ventricular contractions (PVCs) whose coupling intervals are <300 ms, a characteristic of the short-coupled variant of torsades de pointes (scTdP). OBJECTIVE The purpose of this study was to analyze the underlying cardiac ryanodine receptor (RyR2) variants in patients with scTdP. METHODS Seven patients with scTdP (mean age 34 ± 12 years; 4 men and 3 women) were enrolled in this study. The RyR2 gene was screened by targeted gene sequencing methods; variant minor allele frequency was confirmed in 3 databases; and the pathogenicity was investigated in silico analysis using multiple tools. The activity of wild-type and mutant RyR2 channels was evaluated by monitoring Ca2+ signals of HEK293 cells with a [3H]ryanodine binding assay. RESULTS The mean coupling interval of PVCs was 282 ± 13 ms. The 12-lead electrocardiogram had no specific findings except PVCs with an extremely short-coupling interval. Genetic analysis revealed 3 novel RyR2 variants and 1 polymorphism, all located in the cytoplasmic region. p.Ser4938Phe was not detected in 3 databases, and in silico analysis indicated its pathogenicity. In functional analysis, p.Ser4938Phe demonstrated loss of function and impaired RyR2 channel Ca2+ release, while 2 other variants, p.Val1024Ile and p.Ala2673Val, had mild gain-of-function effects but were similar to the polymorphism p.Asn1551Ser. CONCLUSION We identified an RyR2 variant associated with reduced Ca2+ release and short-coupled torsades de pointes ventricular arrhythmia. The mechanisms of arrhythmogenesis remain unclear.
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Affiliation(s)
- Yusuke Fujii
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hideki Itoh
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Seiko Ohno
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takashi Murayama
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nagomi Kurebayashi
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hisaaki Aoki
- Department of Pediatric Cardiology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Malorie Blancard
- INSERM, UMR U1166, ICAN, Paris, France; Sorbonne Universites, UPMC Univ Paris 06, UMR S1166, Paris, France
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Tenriyorozu Hospital, Nara, Japan
| | - Satoshi Yamamoto
- Department of Cardiovascular Medicine, Saiseikai Izumio Hospital, Osaka, Japan
| | - Yumie Matsui
- Department of Cardiovascular Medicine, Saiseikai Izumio Hospital, Osaka, Japan
| | - Mari Ichikawa
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Keiko Sonoda
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tomoya Ozawa
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ichiro Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Pascale Guicheney
- INSERM, UMR U1166, ICAN, Paris, France; Sorbonne Universites, UPMC Univ Paris 06, UMR S1166, Paris, France
| | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
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Visser M, van der Heijden JF, Doevendans PA, Loh P, Wilde AA, Hassink RJ. Idiopathic Ventricular Fibrillation: The Struggle for Definition, Diagnosis, and Follow-Up. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.115.003817. [PMID: 27103090 DOI: 10.1161/circep.115.003817] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/25/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Marloes Visser
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Jeroen F van der Heijden
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Pieter A Doevendans
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Peter Loh
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Arthur A Wilde
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Rutger J Hassink
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.).
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Sudden death and cardiac arrest without phenotype: the utility of genetic testing. Trends Cardiovasc Med 2016; 27:207-213. [PMID: 27692676 DOI: 10.1016/j.tcm.2016.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/15/2016] [Accepted: 08/24/2016] [Indexed: 12/19/2022]
Abstract
Approximately 4% of sudden cardiac deaths are unexplained [the sudden arrhythmic death syndrome (SADS)], and up to 6-10% of survivors of cardiac arrest do not have an identifiable cardiac abnormality after comprehensive clinical evaluation [idiopathic ventricular fibrillation (IVF)]. Genetic testing may be able to play a role in diagnostics and can be targeted to an underlying phenotype present in family members following clinical evaluation. Alternatively, post-mortem genetic testing (the "molecular autopsy") may diagnose the underlying cause if a clearly pathogenic rare variant is found. Limitations include a modest yield, and the high probability of finding a variant of unknown significance (VUS) leading to a low signal-to-noise ratio. Next generation sequencing enables cost-efficient high throughput screening of a larger number of genes but at the expense of increased genetic noise. The yield from genetic testing is even lower in IVF in the absence of any suggestion of another phenotype in the index case or his/her family, and should be actively discouraged at this time. Future improvements in diagnostic utility include optimization of the use of variant-calling pipelines and shared databases as well as patient-specific models of disease to more accurately assign pathogenicity of variants. Studying "trios" of parents and the index case may better assess the yield of sporadic and recessive disease.
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Abstract
Multiple types of voltage-gated K(+) and non-voltage-gated K(+) currents have been distinguished in mammalian cardiac myocytes based on differences in time-dependent and voltage-dependent properties and pharmacologic sensitivities. Many of the genes encoding voltage-gated K(+) (Kv) and non-voltage-gated K(+) (Kir and K2P) channel pore-forming and accessory subunits are expressed in the heart, and a variety of approaches have been, and continue to be, used to define the molecular determinants of native cardiac K(+) channels and to explore the molecular mechanisms controlling the diversity, regulation, and remodeling of these channels in the normal and diseased myocardium.
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Affiliation(s)
- Jeanne M Nerbonne
- Department of Internal Medicine, Washington University Medical School, 660 South Euclid Avenue, Box 8086, St Louis, MO 63110, USA; Department of Developmental Biology, Washington University Medical School, St Louis, MO 63110, USA.
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Abstract
Approximately 80 genes in the human genome code for pore-forming subunits of potassium (K(+)) channels. Rare variants (mutations) in K(+) channel-encoding genes may cause heritable arrhythmia syndromes. Not all rare variants in K(+) channel-encoding genes are necessarily disease-causing mutations. Common variants in K(+) channel-encoding genes are increasingly recognized as modifiers of phenotype in heritable arrhythmia syndromes and in the general population. Although difficult, distinguishing pathogenic variants from benign variants is of utmost importance to avoid false designations of genetic variants as disease-causing mutations.
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Affiliation(s)
- Ahmad S Amin
- Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands; King Abdulaziz University, Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, PO Box 80200, Jeddah 21589, Kingdom of Saudi Arabia.
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Boyden PA, Dun W, Robinson RB. Cardiac Purkinje fibers and arrhythmias; The GK Moe Award Lecture 2015. Heart Rhythm 2016; 13:1172-1181. [PMID: 26775142 DOI: 10.1016/j.hrthm.2016.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Indexed: 02/07/2023]
Abstract
Purkinje fibers/cells continue to be a focus of arrhythmologists. Here we review several new ideas that have emerged in the literature and fold them into important new points. These points include the following: some proteins in Purkinje cells are specific to Purkinjes; pacemaker function in Purkinje may be similar to that of the sinus node cell; sink-source concerns about tracts/sheets of Purkinje fibers; role of Ito in arrhythmias; and genetic lesions in Purkinjes and their high impact on cardiac rhythm. Although new ideas about the remodeled Purkinje cell are not the focus of this review, one can easily imagine how Purkinjes and their function may be altered in diseased hearts.
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Affiliation(s)
- Penelope A Boyden
- Department of Pharmacology, Center for Molecular Therapeutics, Columbia University, New York, New York
| | - Wen Dun
- Department of Pharmacology, Center for Molecular Therapeutics, Columbia University, New York, New York
| | - Richard B Robinson
- Department of Pharmacology, Center for Molecular Therapeutics, Columbia University, New York, New York
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Siebermair J, Sinner MF, Beckmann BM, Laubender RP, Martens E, Sattler S, Fichtner S, Estner HL, Kääb S, Wakili R. Early repolarization pattern is the strongest predictor of arrhythmia recurrence in patients with idiopathic ventricular fibrillation: results from a single centre long-term follow-up over 20 years. Europace 2016; 18:718-25. [DOI: 10.1093/europace/euv301] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 08/10/2015] [Indexed: 11/14/2022] Open
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Ten Sande JN, Postema PG, Boekholdt SM, Tan HL, van der Heijden JF, de Groot NMS, Volders PGA, Zeppenfeld K, Boersma LVA, Nannenberg EA, Christiaans I, Wilde AAM. Detailed characterization of familial idiopathic ventricular fibrillation linked to the DPP6 locus. Heart Rhythm 2015; 13:905-12. [PMID: 26681609 DOI: 10.1016/j.hrthm.2015.12.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Familial idiopathic ventricular fibrillation (IVF) is a severe disease entity and is notoriously difficult to manage because there are no clinical risk indicators for premature cardiac arrest. Previously, we identified a link between familial IVF and a risk haplotype on chromosome 7q36 (involving the arrhythmia gene DPP6). OBJECTIVE The purpose of this study was to expand our knowledge of familial IVF and to discuss its (extended) clinical characteristics. METHODS We studied 601 family members and probands: 286 DPP6 risk-haplotype positive (haplotype-positive) and 315 DPP6 risk-haplotype negative (haplotype-negative) individuals. Clinical parameters, a combination of all-cause mortality and (aborted) cardiac arrest and differences between haplotype-positives and haplotype-negatives, were evaluated. RESULTS There were no differences in electrocardiographic indices between haplotype-positives and haplotype-negatives, or between haplotype-positives with or without events. Cardiac magnetic resonance documented slightly larger ventricular volumes in haplotype-positives compared to controls (P <.05), but these were not clinically useful. Mortality and/or cardiac arrest occurred in 85 haplotype-positives (30%) and 18 haplotype-negatives (6%). Twenty-four haplotype-positives (8% male) were resuscitated from ventricular fibrillation (VF). Documented VF was always elicited by monomorphic short-coupled extrasystoles from the right ventricular apex/lower free wall. Median survival in risk-haplotype haplotype-positives was 70 vs. 93 years for haplotype-negatives (P < .01), with a worse phenotype in males (median survival 63 vs. 83 years in females, P < .01). Implantable cardioverter-defibrillators were implanted in 99 patients (76 [77%] for primary prevention). Two arrhythmic events occurred in the primary prevention group during follow-up (5 ± 3 years). CONCLUSION Despite our extensive analysis, the complexity in identifying asymptomatic IVF family members at risk for future arrhythmias based on clinical parameters is once more demonstrated.
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Affiliation(s)
- Judith N Ten Sande
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter G Postema
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - S Matthijs Boekholdt
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanno L Tan
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Rotterdam, The Netherlands
| | - Paul G A Volders
- Department of Cardiology, Maastricht University Medical Center, The Netherlands, Maastricht, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lucas V A Boersma
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Eline A Nannenberg
- Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Imke Christiaans
- Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia.
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A Genetic Predisposition for Lethal Arrhythmias: No Need for Preventive Treatment? Am J Med Sci 2015; 350:340-1. [DOI: 10.1097/maj.0000000000000542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nagy N, Szél T, Jost N, Tóth A, Gy. Papp J, Varró A. Novel experimental results in human cardiac electrophysiology: measurement of the Purkinje fibre action potential from the undiseased human heart. Can J Physiol Pharmacol 2015; 93:803-10. [DOI: 10.1139/cjpp-2014-0532] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Data obtained from canine cardiac electrophysiology studies are often extrapolated to the human heart. However, it has been previously demonstrated that because of the lower density of its K+ currents, the human ventricular action potential has a less extensive repolarization reserve. Since the relevance of canine data to the human heart has not yet been fully clarified, the aim of the present study was to determine for the first time the action potentials of undiseased human Purkinje fibres (PFs) and to compare them directly with those of dog PFs. All measurements were performed at 37 °C using the conventional microelectrode technique. At a stimulation rate of 1 Hz, the plateau potential of human PFs is more positive (8.0 ± 1.8 vs 8.6 ± 3.4 mV, n = 7), while the amplitude of the spike is less pronounced. The maximal rate of depolarization is significantly lower in human PKs than in canine PFs (406.7 ± 62 vs 643 ± 36 V/s, respectively, n = 7). We assume that the appreciable difference in the protein expression profiles of the 2 species may underlie these important disparities. Therefore, caution is advised when canine PF data are extrapolated to humans, and further experiments are required to investigate the characteristics of human PF repolarization and its possible role in arrhythmogenesis.
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Affiliation(s)
- Norbert Nagy
- MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
| | - Tamás Szél
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Norbert Jost
- MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - András Tóth
- MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Julius Gy. Papp
- MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - András Varró
- MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
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Huo R, Sheng Y, Guo WT, Dong DL. The potential role of Kv4.3 K+ channel in heart hypertrophy. Channels (Austin) 2015; 8:203-9. [PMID: 24762397 DOI: 10.4161/chan.28972] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Transient outward K+ current (I(to)) plays a crucial role in the early phase of cardiac action potential repolarization. Kv4.3 K(+) channel is an important component of I(to). The function and expression of Kv4.3 K(+) channel decrease in variety of heart diseases, especially in heart hypertrophy/heart failure. Int his review, we summarized the changes of cardiac Kv4.3 K(+) channel in heart diseases and discussed the potential role of Kv4.3 K(+) channel in heart hypertrophy/heart failure. In heart hypertrophy/heart failure of mice and rats, down regulation of Kv4.3 K(+) channel leads to prolongation of action potential duration (APD), which is associated with increased [Ca(2+)](I), activation of calcineurin and heart hypertrophy/heart failure.However, in canine and human, Kv4.3 K(+) channel does not play a major role in setting cardiac APD. So, in addition to Kv4.3 K(+) channel/APD/[Ca(2+)](I) pathway, there exits another mechanism of Kv4.3 K(+) channel in heart hypertrophy and heart failure: downregulation of Kv4.3 K(+) channels leads to CaMKII dissociation from Kv4.3–CaMKII complex and subsequent activation of the dissociated CaMKII , which induces heart hypertrophy/heart failure. Upregulation of Kv4.3K(+) channel inhibits CaMKII activation and its related harmful consequences. We put forward a new point-of-view that Kv4.3 K(+) channel is involved in heart hypertrophy/heart failure independently of its electric function, and drugs inhibiting or upregulating Kv4.3 K(+) channel might be potentially harmful or beneficial to hearts through CaMKII.
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Wilde AAM, Viskin S. From whole exome sequencing to patient-specific therapy: another example of how basic research pays off in patient care. J Am Heart Assoc 2015; 4:JAHA.115.002085. [PMID: 26015323 PMCID: PMC4599431 DOI: 10.1161/jaha.115.002085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Arthur A M Wilde
- Heart Center, Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands (A.M.W.) Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Saudi Arabia (A.M.W.)
| | - Sami Viskin
- Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Israel (S.V.)
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Sturm AC, Kline CF, Glynn P, Johnson BL, Curran J, Kilic A, Higgins RSD, Binkley PF, Janssen PML, Weiss R, Raman SV, Fowler SJ, Priori SG, Hund TJ, Carnes CA, Mohler PJ. Use of whole exome sequencing for the identification of Ito-based arrhythmia mechanism and therapy. J Am Heart Assoc 2015; 4:JAHA.114.001762. [PMID: 26015324 PMCID: PMC4599408 DOI: 10.1161/jaha.114.001762] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Identified genetic variants are insufficient to explain all cases of inherited arrhythmia. We tested whether the integration of whole exome sequencing with well-established clinical, translational, and basic science platforms could provide rapid and novel insight into human arrhythmia pathophysiology and disease treatment. METHODS AND RESULTS We report a proband with recurrent ventricular fibrillation, resistant to standard therapeutic interventions. Using whole-exome sequencing, we identified a variant in a previously unidentified exon of the dipeptidyl aminopeptidase-like protein-6 (DPP6) gene. This variant is the first identified coding mutation in DPP6 and augments cardiac repolarizing current (Ito) causing pathological changes in Ito and action potential morphology. We designed a therapeutic regimen incorporating dalfampridine to target Ito. Dalfampridine, approved for multiple sclerosis, normalized the ECG and reduced arrhythmia burden in the proband by >90-fold. This was combined with cilostazol to accelerate the heart rate to minimize the reverse-rate dependence of augmented Ito. CONCLUSIONS We describe a novel arrhythmia mechanism and therapeutic approach to ameliorate the disease. Specifically, we identify the first coding variant of DPP6 in human ventricular fibrillation. These findings illustrate the power of genetic approaches for the elucidation and treatment of disease when carefully integrated with clinical and basic/translational research teams.
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Affiliation(s)
- Amy C Sturm
- The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., C.F.K., P.G., B.L.J., J.C., A.K., R.D.H., P.F.B., P.L.J., R.W., S.V.R., T.J.H., C.A.C., P.J.M.) Department of Internal Medicine, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., P.F.B., R.W., S.V.R., T.J.H., P.J.M.)
| | - Crystal F Kline
- The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., C.F.K., P.G., B.L.J., J.C., A.K., R.D.H., P.F.B., P.L.J., R.W., S.V.R., T.J.H., C.A.C., P.J.M.) Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (C.F.K., J.C., P.L.J., P.J.M.)
| | - Patric Glynn
- The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., C.F.K., P.G., B.L.J., J.C., A.K., R.D.H., P.F.B., P.L.J., R.W., S.V.R., T.J.H., C.A.C., P.J.M.) Department of Surgery, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (P.G., A.K., R.D.H.)
| | - Benjamin L Johnson
- The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., C.F.K., P.G., B.L.J., J.C., A.K., R.D.H., P.F.B., P.L.J., R.W., S.V.R., T.J.H., C.A.C., P.J.M.)
| | - Jerry Curran
- The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., C.F.K., P.G., B.L.J., J.C., A.K., R.D.H., P.F.B., P.L.J., R.W., S.V.R., T.J.H., C.A.C., P.J.M.) Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (C.F.K., J.C., P.L.J., P.J.M.)
| | - Ahmet Kilic
- The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., C.F.K., P.G., B.L.J., J.C., A.K., R.D.H., P.F.B., P.L.J., R.W., S.V.R., T.J.H., C.A.C., P.J.M.) Department of Surgery, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (P.G., A.K., R.D.H.)
| | - Robert S D Higgins
- The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., C.F.K., P.G., B.L.J., J.C., A.K., R.D.H., P.F.B., P.L.J., R.W., S.V.R., T.J.H., C.A.C., P.J.M.) Department of Surgery, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (P.G., A.K., R.D.H.)
| | - Philip F Binkley
- The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., C.F.K., P.G., B.L.J., J.C., A.K., R.D.H., P.F.B., P.L.J., R.W., S.V.R., T.J.H., C.A.C., P.J.M.) Department of Internal Medicine, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., P.F.B., R.W., S.V.R., T.J.H., P.J.M.)
| | - Paul M L Janssen
- The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., C.F.K., P.G., B.L.J., J.C., A.K., R.D.H., P.F.B., P.L.J., R.W., S.V.R., T.J.H., C.A.C., P.J.M.) Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (C.F.K., J.C., P.L.J., P.J.M.)
| | - Raul Weiss
- The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., C.F.K., P.G., B.L.J., J.C., A.K., R.D.H., P.F.B., P.L.J., R.W., S.V.R., T.J.H., C.A.C., P.J.M.) Department of Internal Medicine, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., P.F.B., R.W., S.V.R., T.J.H., P.J.M.)
| | - Subha V Raman
- The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., C.F.K., P.G., B.L.J., J.C., A.K., R.D.H., P.F.B., P.L.J., R.W., S.V.R., T.J.H., C.A.C., P.J.M.) Department of Internal Medicine, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., P.F.B., R.W., S.V.R., T.J.H., P.J.M.)
| | - Steven J Fowler
- Cardiovascular Genetics Program, Clinical Cardiac Electrophysiology, New York University Langone Medical Center, New York, NY (S.J.F., S.G.P.) Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, NY (S.J.F.)
| | - Silvia G Priori
- Cardiovascular Genetics Program, Clinical Cardiac Electrophysiology, New York University Langone Medical Center, New York, NY (S.J.F., S.G.P.) Molecular Cardiology, IRCCS Fondazione Salvatore Maugeri, University of Pavia, Italy (S.G.P.) Department of Cardiology, University of Pavia, Italy (S.G.P.)
| | - Thomas J Hund
- The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., C.F.K., P.G., B.L.J., J.C., A.K., R.D.H., P.F.B., P.L.J., R.W., S.V.R., T.J.H., C.A.C., P.J.M.) Department of Internal Medicine, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., P.F.B., R.W., S.V.R., T.J.H., P.J.M.) Department of Biomedical Engineering, The Ohio State University, Columbus, OH (T.J.H.)
| | - Cynthia A Carnes
- The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., C.F.K., P.G., B.L.J., J.C., A.K., R.D.H., P.F.B., P.L.J., R.W., S.V.R., T.J.H., C.A.C., P.J.M.) College of Pharmacy, Columbus, OH (C.A.C.)
| | - Peter J Mohler
- The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., C.F.K., P.G., B.L.J., J.C., A.K., R.D.H., P.F.B., P.L.J., R.W., S.V.R., T.J.H., C.A.C., P.J.M.) Department of Internal Medicine, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (A.C.S., P.F.B., R.W., S.V.R., T.J.H., P.J.M.) Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, The Ohio State University College of Engineering, Columbus, OH (C.F.K., J.C., P.L.J., P.J.M.)
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