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Dan GA, Martinez-Rubio A, Agewall S, Boriani G, Borggrefe M, Gaita F, van Gelder I, Gorenek B, Kaski JC, Kjeldsen K, Lip GYH, Merkely B, Okumura K, Piccini JP, Potpara T, Poulsen BK, Saba M, Savelieva I, Tamargo JL, Wolpert C, Sticherling C, Ehrlich JR, Schilling R, Pavlovic N, De Potter T, Lubinski A, Svendsen JH, Ching K, Sapp JL, Chen-Scarabelli C, Martinez F. Antiarrhythmic drugs–clinical use and clinical decision making: a consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group on Cardiovascular Pharmacology, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and International Society of Cardiovascular Pharmacotherapy (ISCP). Europace 2018; 20:731-732an. [DOI: 10.1093/europace/eux373] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/11/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Gheorghe-Andrei Dan
- Colentina University Hospital, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | - Antoni Martinez-Rubio
- University Hospital of Sabadell (University Autonoma of Barcelona), Plaça Cívica, Campus de la UAB, Barcelona, Spain
| | - Stefan Agewall
- Oslo University Hospital Ullevål, Norway
- Institute of Clinical Sciences, University of Oslo, Søsterhjemmet, Oslo, Norway
| | - Giuseppe Boriani
- Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Martin Borggrefe
- Universitaetsmedizin Mannheim, Medizinische Klinik, Mannheim, Germany
| | - Fiorenzo Gaita
- Department of Medical Sciences, University of Turin, Citta' della Salute e della Scienza Hospital, Turin, Italy
| | - Isabelle van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bulent Gorenek
- Department of Cardiology, Eskisehir Osmangazi University, Büyükdere Mahallesi, Odunpazarı/Eskişehir, Turkey
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
| | - Keld Kjeldsen
- Copenhagen University Hospital (Holbæk Hospital), Holbæk, Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Centre For Cardiovascular Sciences, City Hospital, Birmingham, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ken Okumura
- Saiseikai Akumamoto Hospital, Kumamoto, Japan
| | | | - Tatjana Potpara
- School of Medicine, Belgrade University; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Magdi Saba
- Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
| | - Irina Savelieva
- Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
| | - Juan L Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense Madrid, Madrid, Spain
| | - Christian Wolpert
- Department of Medicine - Cardiology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | | | - Joachim R Ehrlich
- Medizinische Klinik I-Kardiologie, Angiologie, Pneumologie, Wiesbaden, Germany
| | - Richard Schilling
- Barts Heart Centre, Trustee Arrhythmia Alliance and Atrial Fibrillation Association, London, UK
| | - Nikola Pavlovic
- Department of Cardiology, University Hospital Centre Sestre milosrdnice, Croatia
| | | | - Andrzej Lubinski
- Uniwersytet Medyczny w Łodzi, Kierownik Kliniki Kardiologii Interwencyjnej, i Zaburzeń Rytmu Serca, Kierownik Katedry Chorób Wewnętrznych i Kardiologii, Uniwersytecki Szpital Kliniczny im WAM-Centralny Szpital Weteranów, Poland
| | | | - Keong Ching
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | | | - Felipe Martinez
- Instituto DAMIC/Fundacion Rusculleda, Universidad Nacional de Córdoba, Córdoba, Argentina
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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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Tanaka H, Matsuyama TA, Takamatsu T. Towards an integrated understanding of cardiac arrhythmogenesis − Growing roles of experimental pathology. Pathol Int 2016; 67:8-16. [DOI: 10.1111/pin.12487] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/20/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Hideo Tanaka
- Department of Pathology and Cell Regulation; Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Taka-aki Matsuyama
- Department of Pathology and Cell Regulation; Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Tetsuro Takamatsu
- Department of Medical Photonics; Kyoto Prefectural University of Medicine; Kyoto Japan
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Satoh A, Niwano S, Niwano H, Kishihara J, Aoyama Y, Oikawa J, Fukaya H, Tamaki H, Ako J. Aliskiren suppresses atrial electrical and structural remodeling in a canine model of atrial fibrillation. Heart Vessels 2016; 32:90-100. [PMID: 27401739 DOI: 10.1007/s00380-016-0874-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 07/01/2016] [Indexed: 12/19/2022]
Abstract
Aliskiren, a direct renin inhibitor is expected to achieve sufficient suppression of renin-angiotensin system. We evaluated the effect of aliskiren on the electrical and structural remodeling in a canine atrial fibrillation (AF) model. Twenty-eight dogs were divided into three groups: (1) pacing control group (n = 12), with continuous atrial rapid pacing for 3 or 6 weeks, (2) pacing + aliskiren group (n = 12), with oral aliskiren (30 mg/kg/day), and (3) sham group (n = 4), no pacing nor drug administration. Electrophysiological properties and AF inducibility were evaluated every week. After the protocol, the left atrial tissue was sampled for the further histological and mRNA analysis. The electrical remodeling, AF inducibility, the left atrial enlargement and interstitial fibrosis were observed in pacing control group and were more prominent in the 6-week protocol (vs. 3 week, p < 0.05). The mRNA expressions of matricellular proteins exhibited upregulation in 3-week pacing control, but these upregulations became insignificant in 6 weeks. In contrast, collagen type 3 exhibited significant upregulation in 6 week but not in 3-week protocol. These changes were suppressed in the pacing + aliskiren group. Aliskiren suppressed the atrial remodeling in a canine AF model. This effect was accompanied by the suppression of tissue fibrosis.
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Affiliation(s)
- Akira Satoh
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0329, Japan.
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0329, Japan
| | - Hiroe Niwano
- Department of Education, Tamagawa University, College of Education, Machida, Japan
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0329, Japan
| | - Yuya Aoyama
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0329, Japan
| | - Jun Oikawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0329, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0329, Japan
| | - Hideaki Tamaki
- Department of Anatomy, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0329, Japan
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5
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Moreno C, Macías A, Prieto A, de la Cruz A, González T, Valenzuela C. Effects of n-3 Polyunsaturated Fatty Acids on Cardiac Ion Channels. Front Physiol 2012; 3:245. [PMID: 22934003 PMCID: PMC3429023 DOI: 10.3389/fphys.2012.00245] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 06/14/2012] [Indexed: 12/20/2022] Open
Abstract
Dietary n−3 polyunsaturated fatty acids (PUFAs) have been reported to exhibit antiarrhythmic properties, and these effects have been attributed to their capability to modulate ion channels. In the present review, we will focus on the effects of PUFAs on a cardiac sodium channel (Nav1.5) and two potassium channels involved in cardiac atrial and ventricular repolarization (Kv) (Kv1.5 and Kv11.1). n−3 PUFAs of marine (docosahexaenoic, DHA and eicosapentaenoic acid, EPA) and plant origin (alpha-linolenic acid, ALA) block Kv1.5 and Kv11.1 channels at physiological concentrations. Moreover, DHA and EPA decrease the expression levels of Kv1.5, whereas ALA does not. DHA and EPA also decrease the magnitude of the currents elicited by the activation of Nav1.5 and calcium channels. These effects on sodium and calcium channels should theoretically shorten the cardiac action potential duration (APD), whereas the blocking actions of n−3 PUFAs on Kv channels would be expected to produce a lengthening of cardiac action potential. Indeed, the effects of n−3 PUFAs on the cardiac APD and, therefore, on cardiac arrhythmias vary depending on the method of application, the animal model, and the underlying cardiac pathology.
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Affiliation(s)
- Cristina Moreno
- Instituto de Investigaciones Biomédicas "Alberto Sols" (CSIC-UAM) Madrid, Spain
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6
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Cao HM, Wang Q, You HY, Li J, Yang ZY. Stabilizing Microtubules Decreases Myocardial Ischaemia-Reperfusion Injury. J Int Med Res 2011; 39:1713-9. [PMID: 22117971 DOI: 10.1177/147323001103900513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Microtubules are important components of the cytoskeleton that forms the backbone of myocardial architecture, sustaining its form and size. This study investigated whether stabilizing microtubules with paclitaxel (0.1 or 1 μM) could decrease myocardial ischaemia-reperfusion injury, and reduce myocardial infarct size and the incidence of ischaemic ventricular arrhythmia. Isolated rat hearts were used, with arrhythmia induced by regional ischaemia and myocardial infarcts induced by ischaemia-reperfusion. In these ex vivo rat models, paclitaxel decreased myocardial ischaemia-reperfusion injury, significantly reducing the incidence and severity of ischaemic ventricular arrhythmia and significantly decreasing infarct size.
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Affiliation(s)
- H-M Cao
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Q Wang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - H-Y You
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - J Li
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Z-Y Yang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
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7
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Boink GJJ, Rosen MR. Regenerative therapies in electrophysiology and pacing: introducing the next steps. J Interv Card Electrophysiol 2010; 31:3-16. [PMID: 21161675 DOI: 10.1007/s10840-010-9529-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 11/04/2010] [Indexed: 12/27/2022]
Abstract
The morbidity and mortality of cardiac arrhythmias are major international health concerns. Drug and device therapies have made inroads but alternative approaches are still being sought. For example, gene and cell therapies have been explored for treatment of brady- and tachyarrhythmias, and proof of concept has been obtained for both biological pacing in the setting of heart block and gene therapy for ventricular tachycardias. This paper reviews the state of the art developments with regard to gene and cell therapies for cardiac arrhythmias and discusses next steps.
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Affiliation(s)
- Gerard J J Boink
- Heart Failure Research Center, Academic Medical Center, Amsterdam, Netherlands
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Yamashita T, Inoue H, Okumura K, Kodama I, Aizawa Y, Atarashi H, Ohe T, Ohtsu H, Kato T, Kamakura S, Kumagai K, Kurachi Y, Koretsune Y, Saikawa T, Sakurai M, Sato T, Sugi K, Nakaya H, Hirai M, Hirayama A, Fukatani M, Mitamura H, Yamazaki T, Watanabe E, Ogawa S, Katoh T, Igawa O, Matsumoto N, Yamashita T, Kaneko Y, Watanabe E, Ogawa S, Osaka T, Fujii E, Niwano S, Yoshioka K, Kato M, Okazaki O, Kusano K, Okuyama Y, Furushima H, Suzuki M, Noda T, Kawara T, Sato T, Kamakura S, Endoh Y, Kumagai K, Hiyoshi Y, Ishiyama T, Ohtsuka T, Matsumoto M, Chishaki A, Shinohara T, Shirayama T, Koretsune Y, Yokoyama E, Ajiki K, Fujio K, Sugi K, Yamakawa T, Yusu S, Inoue H, Kawamura Y, Hayano M, Date T, Mizusawa Y, Kobayashi Y, Satomi K, Imai Y, Atarashi H, Fukunami M, Yokoshiki H, Betsuyaku T, Okumura K, Takeda H, Matsumoto K, Okishige K, Tagawa M, Hirai M, Okazaki H. Randomized trial of angiotensin II-receptor blocker vs. dihydropiridine calcium channel blocker in the treatment of paroxysmal atrial fibrillation with hypertension (J-RHYTHM II Study). Europace 2010; 13:473-9. [DOI: 10.1093/europace/euq439] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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10
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Hazari MS, Haykal-Coates N, Winsett DW, Costa DL, Farraj AK. A single exposure to particulate or gaseous air pollution increases the risk of aconitine-induced cardiac arrhythmia in hypertensive rats. Toxicol Sci 2009; 112:532-42. [PMID: 19748997 DOI: 10.1093/toxsci/kfp214] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Epidemiological studies demonstrate an association between arrhythmias and air pollution. Aconitine-induced cardiac arrhythmia is widely used experimentally to examine factors that alter the risk of arrhythmogenesis. In this study, Wistar-Kyoto (WKY) and spontaneously hypertensive (SH) rats acutely exposed to synthetic residual oil fly ash (s-ROFA) particles (450 mug/m(3)) were "challenged" with aconitine to examine whether a single exposure could predispose to arrhythmogenesis. Separately, SH rats were exposed to varied particulate matter (PM) concentrations (0.45, 1.0, or 3.5 mg/m(3) s-ROFA), or the irritant gas acrolein (3 ppm), to better assess the generalization of this challenge response. Rather than directly cause arrhythmias, we hypothesized that inhaled air pollutants sensitize the heart to subsequent dysrhythmic stimuli. Twenty-four hour postexposure, urethane-anesthetized rats were monitored for heart rate (HR), electrocardiogram, and blood pressure (BP). SH rats had higher baseline HR and BP and significantly longer PR intervals, QRS duration, QTc, and JTc than WKY rats. PM exposure caused a significant increase in the PR interval, QRS duration, and QTc in WKY rats but not in SH rats. Heart rate variability was significantly decreased in WKY rats after PM exposure but increased in SH rats. Cumulative dose of aconitine that triggered arrhythmias in air-exposed SH rats was lower than WKY rats and even lower for each strain postexposure. SH rats exposed to varied concentrations of PM or acrolein developed arrhythmia at significantly lower doses of aconitine than controls; however, there was no PM concentration-dependent response. In conclusion, a single exposure to air pollution may increase the sensitivity of cardiac electrical conduction to disruption. Moreover, there seem to be host factors (e.g., cardiovascular disease) that increase vulnerability to triggered arrhythmias regardless of the pollutant or its concentration.
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Affiliation(s)
- Mehdi S Hazari
- Environmental Public Health Division, U.S. Environmental Protection Agency, 109 Alexander Drive, B143-01, Research Triangle Park, NC 27711, USA.
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Yamashita T. [Ideal future antiarrhythmic therapy: a view from Japanese physicians]. Nihon Yakurigaku Zasshi 2008; 131:457-61. [PMID: 18552449 DOI: 10.1254/fpj.131.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Yamashita T, Ogawa S, Aizawa Y, Atarashi H, Inoue H, Ohe T, Okumura K, Ohtsu H, Kato T, Kamakura S, Kumagai K, Kurachi Y, Kodama I, Koretsune Y, Saikawa T, Sakurai M, Sugi K, Nakaya H, Hirai M, Hirayama A, Fukatani M, Mitamura H, Yamazaki T, Watanabe E. Randomized Study of Angiotensin II Type 1 Receptor Blocker vs Dihydropiridine Calcium Antagonist for the Treatment of Paroxysmal Atrial Fibrillation in Patients With Hypertension The J-RHYTHM II Study Design for the Investigation of Upstream Therapy for Atrial Fibrillation. Circ J 2006; 70:1318-21. [PMID: 16998266 DOI: 10.1253/circj.70.1318] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Mega trials of rhythm vs rate control could not demonstrate the usefulness of available antiarrhythmic drugs, so a more effective and safer therapy for atrial fibrillation (AF) is now required. One candidate is the so-called "upstream therapy", which refers to the blockade of upstream modifying elements (renin - angiotensin system, cathecholamines, oxidative stress etc) that contribute to the arrhythmogenic substrate. METHODS AND RESULTS The Japanese Rhythm Management Trial II for Atrial Fibrillation (J-RHYTHM II study) is a randomized comparative evaluation of an angiotensin II type 1 blocker (candesartan) and a dihydropiridine calcium blocker (amlodipine), both combined with antithrombotic therapy, as an antiarrhythmic therapy for the treatment of paroxysmal AF (PAF) associated with hypertension. To test the usefulness of this therapy, this study will reveal the recurrence rate of asymptomatic as well as symptomatic PAF during 1-year of treatment with candesartan or amlodipine, using daily transtelephonic monitoring. CONCLUSIONS The J-RHYTHM II study will follow 400 patients with PAF and hypertension who were treated at approximately 50 sites throughout Japan, and will provide clinically important information.
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Affiliation(s)
- Takeshi Yamashita
- J-RHYTHM II Clinical Trial Center, The Cardiovascular Institute, Roppongi, Tokyo, Japan
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Glaaser IW, Clancy CE. Cardiac Na+ channels as therapeutic targets for antiarrhythmic agents. Handb Exp Pharmacol 2006:99-121. [PMID: 16610342 DOI: 10.1007/3-540-29715-4_4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
There are many factors that influence drug block of voltage-gated Na+ channels (VGSC). Pharmacological agents vary in conformation, charge, and affinity. Different drugs have variable affinities to VGSC isoforms, and drug efficacy is affected by implicit tissue properties such as resting potential, action potential morphology, and action potential frequency. The presence of polymorphisms and mutations in the drug target can also influence drug outcomes. While VGSCs have been therapeutic targets in the management of cardiac arrhythmias, their potential has been largely overshadowed by toxic side effects. Nonetheless, many VGSC blockers exhibit inherent voltage- and use-dependent properties of channel block that have recently proven useful for the diagnosis and treatment of genetic arrhythmias that arise from defects in Na+ channels and can underlie idiopathic clinical syndromes. These defective channels suggest themselves as prime targets of disease and perhaps even mutation specific pharmacological interventions.
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Affiliation(s)
- I W Glaaser
- Department of Pharmacology, College of Physicians and Surgeons of Columbia University, 630 W. 168th St., New York, NY 10032, USA
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14
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Affiliation(s)
- Glenn I Fishman
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York 10016, USA.
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15
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Demir SS. Computational modeling of cardiac ventricular action potentials in rat and mouse: review. ACTA ACUST UNITED AC 2005; 54:523-30. [PMID: 15760484 DOI: 10.2170/jjphysiol.54.523] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Little is known about the ionic mechanisms underlying the action potential heterogeneity in ventricle-associated healthy and disease conditions, even though five decades of histological, electrophysiological, pharmacological, and biochemical investigations exist. The computational modeling in murine ventricular myocytes can complement our knowledge of the experimental data and provide us with more quantitative descriptions in understanding different conditions related to normal and disease conditions. This paper initially reviews the theoretical modeling for cardiac ventricular action potentials of various species and the related experimental work. It then presents the progress of the computational modeling of cardiac ventricular cells for normal, diabetic, and spontaneously hypertensive rats. The paper also introduces recent modeling efforts for the action potential heterogeneity in mouse ventricular cells. The computational insights gained into the ionic mechanisms in rodents will continue to enhance our understanding of the heart and provide us with new knowledge for future studies to treat cardiac diseases in children and adults. Because the dissemination of computational models is very important, we continue to disseminate these models by iCell, the interactive cell modeling resource. iCell (http://ssd1.bme.memphis.edu/icell/) has been developed as a simulation-based teaching and learning tool for electrophysiology and contains JAVA applets that present models of various cardiac cells and neurons and simulation data of their bioelectric activities at cellular level.
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Affiliation(s)
- Semahat S Demir
- Biomedical Engineering & Research to Aid Persons with Disabilities Program, Division of Bioengineering and Environmental Systems, National Science Foundation, Arlington, VA, USA.
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Clancy CE, Kass RS. Inherited and acquired vulnerability to ventricular arrhythmias: cardiac Na+ and K+ channels. Physiol Rev 2005; 85:33-47. [PMID: 15618477 DOI: 10.1152/physrev.00005.2004] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Mutations in cardiac Na(+) and K(+) channels can disrupt the precise balance of ionic currents that underlies normal cardiac excitation and relaxation. Disruption of this equilibrium can result in arrhythmogenic phenotypes leading to syncope, seizures, and sudden cardiac death. Congenital defects result in an unpredictable expression of phenotypes with variable penetrance, even within single families. Additionally, phenotypically opposite and overlapping cardiac arrhythmogenic syndromes can stem from one mutation. A number of these defects have been characterized experimentally with the aim of understanding mechanisms of mutation-induced arrhythmia. Improving understanding of abnormalities may provide a basis for the development of therapeutic approaches.
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Affiliation(s)
- Colleen E Clancy
- Department of Physiology and Biophysics, Institute for Computational Biomedicine, Weill Medical College of Cornell University, New York, New York 10021, USA.
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Clancy CE, Kass RS. Theoretical investigation of the neuronal Na+ channel SCN1A: abnormal gating and epilepsy. Biophys J 2004; 86:2606-14. [PMID: 15041696 PMCID: PMC1304107 DOI: 10.1016/s0006-3495(04)74315-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Epilepsy is a paroxysmal neurological disorder resulting from abnormal cellular excitability and is a common cause of disability. Recently, some forms of idiopathic epilepsy have been causally related to genetic mutations in neuronal ion channels. To understand disease mechanisms, it is crucial to understand how a gene defect can disrupt channel gating, which in turn can affect complex cellular dynamic processes. We develop a theoretical Markovian model of the neuronal Na+ channel NaV1.1 to explore and explain gating mechanisms underlying cellular excitability and physiological and pathophysiological mechanisms of abnormal neuronal excitability in the context of epilepsy. Genetic epilepsy has been shown to result from both mutations that give rise to a gain of channel function and from those that reduce the Na+ current. These data may suggest that abnormal excitation can result from both hyperexcitability and hypoexcitability, the mechanisms of which are presumably distinct, and as yet elusive. Revelation of the molecular origins will allow for translation into targeted pharmacological interventions that must be developed to treat syndromes resulting from divergent mechanisms. This work represents a first step in developing a comprehensive theoretical model to investigate the molecular mechanisms underlying runaway excitation that cause epilepsy.
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Affiliation(s)
- Colleen E Clancy
- Department of Pharmacology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
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van Brakel TJ, Hermans JJR, Janssen BJ, van Essen H, Botterhuis N, Smits JFM, Maessen JG. Intrapericardial Delivery Enhances Cardiac Effects of Sotalol and Atenolol. J Cardiovasc Pharmacol 2004; 44:50-6. [PMID: 15175557 DOI: 10.1097/00005344-200407000-00007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Targeting drugs to the heart by intrapericardial (i.p.c.) delivery may be a promising strategy to obtain higher drug efficiencies with lesser side effects. We examined whether i.p.c. delivery of sotalol and atenolol in rats offers advantages over intravenous (i.v.) application. Following sustained IPC infusion of sotalol or atenolol, pericardial fluid levels exceeded plasma levels 97 and 134 times respectively (P < 0.01) resulting in 3.8 and 4.7 times higher overall left ventricular tissue drug levels (P < 0.05). In a second experiment, the effects of the i.p.c. or i.v. beta-blocker infusions on nitroprusside-induced tachycardia were studied in conscious rats. For both drugs, i.p.c. infusion of 0.03 mg/kg.h produced similar antitachycardiac effects as the 1 mg/kg.h i.v. dose. In a third set of studies, dP/dt max challenged by dobutamine infusion was assessed to study ventricular contractile function after i.v. and i.p.c. sotalol in anesthetized rats. i.p.c. sotalol infusion attenuated the dobutamine response curve to a greater extent than i.v. (P < 0.01). In conclusion, i.p.c. infusion of sotalol and atenolol results in high cardiac tissue concentrations with low systemic drug levels. Similar antitachycardiac effects can be obtained at a 10- to 30-fold lower dose compared with i.v. delivery. Also, depression of ventricular contractility is acquired at a substantially lower i.p.c. sotalol dose. Thus, beta-blocking properties of sotalol and atenolol can be greatly enhanced by applying them i.p.c.
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Affiliation(s)
- Thomas J van Brakel
- Cardiovascular Research Institute Maastricht, Department of Cardio-thoracic Surgery, University Hospital and University Maastricht, Maastricht, The Netherlands.
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19
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Demir SS. The significance of computational modelling in murine cardiac ventricular cells. Appl Bionics Biomech 2004. [DOI: 10.1533/abib.2004.1.2.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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20
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Liu H, Clancy C, Cormier J, Kass R. Mutations in cardiac sodium channels: clinical implications. AMERICAN JOURNAL OF PHARMACOGENOMICS : GENOMICS-RELATED RESEARCH IN DRUG DEVELOPMENT AND CLINICAL PRACTICE 2004; 3:173-9. [PMID: 12814325 DOI: 10.2165/00129785-200303030-00003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Voltage-gated sodium channels (VGSCs) are critical transmembrane proteins responsible for the rapid action potential upstroke in most excitable cells. Recently discovered mutations in VGSCs, which underlie idiopathic clinical disease, have emphasized the importance of these channels in tissues such as skeletal muscle, nervous system, and myocardium. Mutations in the gene encoding the cardiac sodium channel isoform (SCN5A) have been linked to at least three abnormal phenotypes: variant 3 of the Long QT syndrome (LQT-3); Brugada's syndrome (BrS); and isolated cardiac conduction disease (ICCD). Mutations in SCN5A manifest as one or more of these clinical phenotypes - the precise distinction between these diseases is increasingly subtle. Clinical management of LQT-3 and diagnosis of BrS with the local anesthetic flecainide has proven promising. Channels associated with LQT-3 (D1790G) and BrS (Y1795H) both show more sensitivity to flecainide than wild-type (WT) channels, while lidocaine sensitivity is unchanged. One plausible explanation for differential drug sensitivity is that mutant channels may allow more access to a receptor site compared with WT through altered protein allosteric changes during an action potential. The high affinity binding site for local anesthetic block has been identified in the pore region of the channel. This region is not water accessible during the closed state, thus requiring channel opening for charged drug (flecainide and mexiletine) access and block. Channel mutations which disrupt inactivation biophysics lead to increased drug binding by altering the time the binding site is accessible during an action potential. Neutral drugs (lidocaine) which are not dependent on channel opening for binding site access will not be sensitive to mutations that alter channel inactivation properties. Interestingly another LQT-3 mutant (Y1795C) shows no change in flecainide sensitivity, suggesting that although drug effects of SCN5A mutations cross disease boundaries, clinical management with flecainide will be beneficial to patients in a mutation-specific manner.
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Affiliation(s)
- Huajun Liu
- Department of Pharmacology, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA
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21
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Abstract
A precise balance of ionic currents underlies normal cardiac excitation and relaxation. Disruption of this equilibrium by genetic defects, polymorphisms, therapeutic intervention, and structural abnormalities can cause arrhythmogenic phenotypes leading to syncope, seizures, and sudden cardiac death. Congenital defects result in an unpredictable expression of phenotypes with variable penetrance, even within single families. Additionally, phenotypically opposite and overlapping cardiac arrhythmogenic syndromes can even stem from the same mutation. Accordingly, the relationship between genetic mutations and clinical syndromes is becoming increasingly complex.
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Affiliation(s)
- Ian W Glaaser
- Department of Pharmacology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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22
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Rhodus NL, Little JW. Dental management of the patient with cardiac arrhythmias: an update. ACTA ACUST UNITED AC 2003; 96:659-68. [PMID: 14676755 DOI: 10.1016/s1079-2104(03)00380-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Nelson L Rhodus
- Division of Oral Medicine, University of Minnesota, Minneapolis 55455, USA.
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23
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Lüderitz B. A. John Camm. Clin Cardiol 2003; 26:251-3. [PMID: 12769256 PMCID: PMC6654611 DOI: 10.1002/clc.4960260512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2003] [Accepted: 01/10/2003] [Indexed: 11/07/2022] Open
Affiliation(s)
- Berndt Lüderitz
- Department of Medicine/Cardiology, University of Bonn, Bonn, Germany
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24
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Mbai M, Rajamani S, Delisle BP, Anson BD, Anderson C, Makielski JC, January CT. Genetic basis for the origin of cardiac arrhythmias: implications for therapy. Curr Cardiol Rep 2002; 4:411-7. [PMID: 12169238 DOI: 10.1007/s11886-002-0041-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The recognition of the role that genetic abnormalities play in the generation of cardiac arrhythmias and sudden cardiac death has evolved enormously over the past decade. One result is new insight into underlying physiologic and pathophysiologic mechanisms. New therapies based on this evolving insight are being developed. This review summarizes recent discoveries with a focus on the genetic basis of cardiac arrhythmias and their implications for new therapies.
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Affiliation(s)
- Mackenzi Mbai
- University of Wisconsin Hospitals and Clinics, Section of Cardiovascular Medicine, Room H6/354 CSC (3248), 600 Highland Avenue, Madison, WI 53792, USA
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Fozzard HA, Kyle JW. Do Defects in Ion Channel Glycosylation Set the Stage for Lethal Cardiac Arrhythmias? Sci Signal 2002. [DOI: 10.1126/scisignal.1302002pe19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Fozzard HA, Kyle JW. Do defects in ion channel glycosylation set the stage for lethal cardiac arrhythmias? SCIENCE'S STKE : SIGNAL TRANSDUCTION KNOWLEDGE ENVIRONMENT 2002; 2002:pe19. [PMID: 11983936 DOI: 10.1126/stke.2002.130.pe19] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Many ion channels are modified by the addition of carbohydrate residues. Fozzard and Kyle discuss evidence that sialic acid residues on glycosylated cardiac sodium and potassium channels may be important for preventing early after-depolarizations that can result in cardiac arrhythmias.
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Affiliation(s)
- Harry A Fozzard
- Cardiac Electrophysiology Laboratories, Departments of Medicine and of Neurobiology, Pharmacology, and Physiology, University of Chicago, Chicago, IL 60637, USA.
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