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Phoon CK, Aristizábal O, Farhoud M, Turnbull DH, Wadghiri YZ. Mouse Cardiovascular Imaging. Curr Protoc 2024; 4:e1116. [PMID: 39222027 PMCID: PMC11371386 DOI: 10.1002/cpz1.1116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
The mouse is the mammalian model of choice for investigating cardiovascular biology, given our ability to manipulate it by genetic, pharmacologic, mechanical, and environmental means. Imaging is an important approach to phenotyping both function and structure of cardiac and vascular components. This review details commonly used imaging approaches, with a focus on echocardiography and magnetic resonance imaging, with brief overviews of other imaging modalities. In this update, we also emphasize the importance of rigor and reproducibility in imaging approaches, experimental design, and documentation. Finally, we briefly outline emerging imaging approaches but caution that reliability and validity data may be lacking. © 2024 Wiley Periodicals LLC.
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Affiliation(s)
- Colin K.L. Phoon
- Division of Pediatric Cardiology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY
| | - Orlando Aristizábal
- Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, & Center for Advanced Imaging Innovation and Research, New York University Grossman School of Medicine, New York, NY
- Preclinical Imaging, Division for Advanced Research Technologies, New York University Grossman School of Medicine, New York, NY
| | | | - Daniel H. Turnbull
- Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, & Center for Advanced Imaging Innovation and Research, New York University Grossman School of Medicine, New York, NY
- Department of Pathology, New York University Grossman School of Medicine, New York, New York
| | - Youssef Z. Wadghiri
- Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, & Center for Advanced Imaging Innovation and Research, New York University Grossman School of Medicine, New York, NY
- Preclinical Imaging, Division for Advanced Research Technologies, New York University Grossman School of Medicine, New York, NY
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2
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Raina A, Tan NY, Fatunde OA, Asirvatham SJ, DeSimone CV. Case report: A case of perinodal atrial tachycardia and review of the relevant clinical anatomy surrounding the retroaortic node. Front Cardiovasc Med 2023; 10:1143409. [PMID: 37273874 PMCID: PMC10235778 DOI: 10.3389/fcvm.2023.1143409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/28/2023] [Indexed: 06/06/2023] Open
Abstract
A 70-year-old female presented with incessant supraventricular tachycardia that was refractory to metoprolol and sotalol. ECG revealed a narrow complex tachycardia with a rate of 163 beats per minute with a short RP relationship. She had salvos of atrial tachycardia which led to a severe reduction in ejection fraction as noted on echocardiography and hemodynamic instability. An electrophysiological study was performed, and findings suggested this to be an atrial tachycardia with earliest activation in the perinodal area. Radiofrequency ablation was carried out along the septum and associated structures to surround this region including the right atrium, non-coronary sinus of Valsalva, and the left atrium (anterior wall outside of the right superior pulmonary vein) to isolate this area and surround the focus with ablation lesions. The patient has done well post-procedure and continues to do well without any recurrence on low-dose flecainide at 8 months.
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Affiliation(s)
- Anvi Raina
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Nicholas Y. Tan
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Olubadewa A. Fatunde
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Phoenix, AZ, United States
| | - Samuel J. Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Christopher V. DeSimone
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
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3
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Landstrom AP, Yang Q, Sun B, Perelli RM, Bidzimou MT, Zhang Z, Aguilar-Sanchez Y, Alsina KM, Cao S, Reynolds JO, Word TA, van der Sangen NM, Wells Q, Kannankeril PJ, Ludwig A, Kim JJ, Wehrens XH. Reduction in Junctophilin 2 Expression in Cardiac Nodal Tissue Results in Intracellular Calcium-Driven Increase in Nodal Cell Automaticity. Circ Arrhythm Electrophysiol 2023; 16:e010858. [PMID: 36706317 PMCID: PMC9974897 DOI: 10.1161/circep.122.010858] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/06/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Spontaneously depolarizing nodal cells comprise the pacemaker of the heart. Intracellular calcium (Ca2+) plays a critical role in mediating nodal cell automaticity and understanding this so-called Ca2+ clock is critical to understanding nodal arrhythmias. We previously demonstrated a role for Jph2 (junctophilin 2) in regulating Ca2+-signaling through inhibition of RyR2 (ryanodine receptor 2) Ca2+ leak in cardiac myocytes; however, its role in pacemaker function and nodal arrhythmias remains unknown. We sought to determine whether nodal Jph2 expression silencing causes increased sinoatrial and atrioventricular nodal cell automaticity due to aberrant RyR2 Ca2+ leak. METHODS A tamoxifen-inducible, nodal tissue-specific, knockdown mouse of Jph2 was achieved using a Cre-recombinase-triggered short RNA hairpin directed against Jph2 (Hcn4:shJph2). In vivo cardiac rhythm was monitored by surface ECG, implantable cardiac telemetry, and intracardiac electrophysiology studies. Intracellular Ca2+ imaging was performed using confocal-based line scans of isolated nodal cells loaded with fluorescent Ca2+ reporter Cal-520. Whole cell patch clamp was conducted on isolated nodal cells to determine action potential kinetics and sodium-calcium exchanger function. RESULTS Hcn4:shJph2 mice demonstrated a 40% reduction in nodal Jph2 expression, resting sinus tachycardia, and impaired heart rate response to pharmacologic stress. In vivo intracardiac electrophysiology studies and ex vivo optical mapping demonstrated accelerated junctional rhythm originating from the atrioventricular node. Hcn4:shJph2 nodal cells demonstrated increased and irregular Ca2+ transient generation with increased Ca2+ spark frequency and Ca2+ leak from the sarcoplasmic reticulum. This was associated with increased nodal cell AP firing rate, faster diastolic repolarization rate, and reduced sodium-calcium exchanger activity during repolarized states compared to control. Phenome-wide association studies of the JPH2 locus identified an association with sinoatrial nodal disease and atrioventricular nodal block. CONCLUSIONS Nodal-specific Jph2 knockdown causes increased nodal automaticity through increased Ca2+ leak from intracellular stores. Dysregulated intracellular Ca2+ underlies nodal arrhythmogenesis in this mouse model.
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Affiliation(s)
- Andrew P. Landstrom
- Dept of Pediatrics, Division of Cardiology, Duke Univ School of Medicine, Durham, NC
- Dept of Cell Biology, Duke Univ School of Medicine, Durham, NC
| | - Qixin Yang
- Dept of Pediatrics, Division of Cardiology, Duke Univ School of Medicine, Durham, NC
- Dept of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang Univ, Hangzhou, China
| | - Bo Sun
- Dept of Pediatrics, Division of Cardiology, Duke Univ School of Medicine, Durham, NC
| | | | | | - Zhushan Zhang
- Dept of Cell Biology, Duke Univ School of Medicine, Durham, NC
| | - Yuriana Aguilar-Sanchez
- Integrative Molecular & Biomedical Sciences Program, Baylor College of Medicine, Houston, TX
| | - Katherina M. Alsina
- Integrative Molecular & Biomedical Sciences Program, Baylor College of Medicine, Houston, TX
| | - Shuyi Cao
- Dept of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX
| | - Julia O. Reynolds
- Dept of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX
| | - Tarah A. Word
- Dept of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX
| | | | - Quinn Wells
- Depts of Medicine, Pharmacology, and Biomedical Informatics, Vanderbilt Univ School of Medicine, Nashville, TN
| | - Prince J. Kannankeril
- Center for Pediatric Precision Medicine, Dept of Pediatrics, Vanderbilt Univ School of Medicine, Nashville, TN
| | - Andreas Ludwig
- Institut für Experimentelle und Klinische Pharmakologie und Toxikologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jeffrey J. Kim
- Dept of Pediatrics, Section of Cardiology, Baylor College of Medicine, Houston, TX
| | - Xander H.T. Wehrens
- Dept of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX
- Dept of Pediatrics, Section of Cardiology, Baylor College of Medicine, Houston, TX
- Depts of Neuroscience & Center for Space Medicine and the Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX
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Hurley M, Kaur S, Walton R, Power A, Haïssaguerre M, Bernus O, Ward ML, White E. Endocardial role in arrhythmias induced by acute ventricular stretch and the involvement of Purkinje fibres, in isolated rat hearts. Curr Res Physiol 2023; 6:100098. [PMID: 36814643 PMCID: PMC9939534 DOI: 10.1016/j.crphys.2023.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/13/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023] Open
Abstract
Purkinje fibres (PFs) play an important role in some ventricular arrhythmias and acute ventricular stretch can evoke mechanically-induced arrhythmias. We tested whether PFs and specifically TRPM4 channels, play a role in these mechanically-induced arrhythmias. Pseudo-ECGs and left ventricular (LV) activation, measured by optical mapping, were recorded in isolated, Langendorff-perfused, rat hearts. The LV endocardial surface was irrigated with experimental agents, via an indwelling catheter. The number and period of ectopic activations was measured during LV lumen inflation via an indwelling fluid-filled balloon (100 μL added over 2 s, maintained for 38 s). Mechanically-induced arrhythmias occurred during balloon inflation: they were multifocal, maximal in the first 5 s and ceased within 20 s. Optical mapping revealed activation patterns indicating PF-mediated and ectopic focal sources. Irrigation of the LV lumen with Lugol solution (IK/I2) for 10s reduced ectopics by 93% (n = 16, P < 0.001); with ablation of endocardial PFs confirmed by histology. Five min irrigation of the LV lumen with 50 μM 9-Phenanthrol, a blocker of TRPM4 channels, reduced ectopics by 39% (n = 15, P < 0.01). Immunohistochemistry confirmed that TRPM4 was more abundant in PFs than myocardium. Our results show that the endocardial surface plays an important role in these mechanically-induced ectopic activations. Ectopic activation patterns indicate a participation of PFs in these arrhythmias, with a potential involvement of TRPM4 channels, shown by the reduction of arrhythmias by 9-Phenanthrol.
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Affiliation(s)
- Miriam Hurley
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Sarbjot Kaur
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Richard Walton
- Université Bordeaux, INSERM Centre de recherche Cardio-Thoracique de Bordeaux, Pessac, Bordeaux, France,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation, Bordeaux Université, Pessac, Bordeaux, France
| | - Amelia Power
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Michel Haïssaguerre
- Université Bordeaux, INSERM Centre de recherche Cardio-Thoracique de Bordeaux, Pessac, Bordeaux, France,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation, Bordeaux Université, Pessac, Bordeaux, France,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, Pessac, France
| | - Olivier Bernus
- Université Bordeaux, INSERM Centre de recherche Cardio-Thoracique de Bordeaux, Pessac, Bordeaux, France,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation, Bordeaux Université, Pessac, Bordeaux, France
| | - Marie-Louise Ward
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Ed White
- School of Biomedical Sciences, University of Leeds, Leeds, UK,Corresponding author. Garstang Building, School of Biomedical Sciences, University of Leeds, LS29JT, Leeds, UK.
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Shi X, Zhang S, Liu Y, Brazile B, Cooley J, Butler JR, McMahan SR, Perez KL, Xu J, Eastep T, Nguyen KT, Bajona P, Peltz M, Gao H, Hong Y, Liao J. Spatial distribution and network morphology of epicardial, endocardial, interstitial, and Purkinje cell-associated elastin fibers in porcine left ventricle. Bioact Mater 2023; 19:348-359. [PMID: 35892002 PMCID: PMC9301607 DOI: 10.1016/j.bioactmat.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/07/2022] [Accepted: 04/18/2022] [Indexed: 11/19/2022] Open
Abstract
Cardiac extracellular matrices (ECM) play crucial functional roles in cardiac biomechanics. Previous studies have mainly focused on collagen, the major structural ECM in heart wall. The role of elastin in cardiac mechanics, however, is poorly understood. In this study, we investigated the spatial distribution and microstructural morphologies of cardiac elastin in porcine left ventricles. We demonstrated that the epicardial elastin network had location- and depth-dependency, and the overall epicardial elastin fiber mapping showed certain correlation with the helical heart muscle fiber architecture. When compared to the epicardial layer, the endocardial layer was thicker and has a higher elastin-collagen ratio and a denser elastin fiber network; moreover, the endocardial elastin fibers were finer and more wavy than the epicardial elastin fibers, all suggesting various interface mechanics. The myocardial interstitial elastin fibers co-exist with the perimysial collagen to bind the cardiomyocyte bundles; some of the interstitial elastin fibers showed a locally aligned, hinge-like structure to connect the adjacent cardiomyocyte bundles. This collagen-elastin combination reflects an optimal design in which the collagen provides mechanical strength and elastin fibers facilitate recoiling during systole. Moreover, cardiac elastin fibers, along with collagen network, closely associated with the Purkinje cells, indicating that this ECM association could be essential in organizing cardiac Purkinje cells into "fibrous" and "branching" morphologies and serving as a protective feature when Purkinje fibers experience large deformations in vivo. In short, our observations provide a structural basis for future in-depth biomechanical investigations and biomimicking of this long-overlooked cardiac ECM component.
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Affiliation(s)
- Xiaodan Shi
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
| | - Song Zhang
- College of Engineering and College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Yue Liu
- School of Engineering, Brown University, Providence, RI, 02912, USA
| | - Bryn Brazile
- College of Engineering and College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Jim Cooley
- College of Engineering and College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - J. Ryan Butler
- College of Engineering and College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Sara R. McMahan
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
| | - Karla L. Perez
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
| | - Jiazhu Xu
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
| | - Timothy Eastep
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
| | - Kytai T. Nguyen
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
| | - Pietro Bajona
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
- Allegheny Health Network-Drexel University College of Medicine, Pittsburgh, PA, 15212, USA
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Huajian Gao
- School of Engineering, Brown University, Providence, RI, 02912, USA
- College of Engineering, Nanyang Technical University, 308232, Singapore
| | - Yi Hong
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
| | - Jun Liao
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
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6
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Kaneko Y, Tamura S, Kobari T, Hasegawa H, Nakajima T, Ishii H. Atrioventricular Ring Tachycardias: Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia and Atrial Tachycardia Share a Common Arrhythmogenic Substrate-A Unifying Proposal. Rev Cardiovasc Med 2022; 23:369. [PMID: 39076194 PMCID: PMC11269071 DOI: 10.31083/j.rcm2311369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/17/2022] [Accepted: 10/09/2022] [Indexed: 07/31/2024] Open
Abstract
Our understanding of the variants of slow pathway (SP) and associated atypical atrioventricular (AV) nodal reentrant tachycardia (NRT) is still growing. We have identified variants extending outside Koch's triangle along the tricuspid annulus, including superior, superoanterior and inferolateral right atrial SP and associated atypical, fast-slow AVNRT. We review the history of each variant, their electrophysiological characteristics and related atypical AVNRT, and their treatment by catheter ablation. We focused our efforts on organizing the published information, as well as some unpublished, reliable data, and show the pitfalls of electrophysiological observations, along with keys to the diagnosis of atypical AVNRT. The superior-type of fast-slow AVNRT mimics adenosine-sensitive atrial tachycardia originating near the AV node and can be successfully treated by ablation of a superior SP form the right side of the perihisian region or from the non-coronary sinus of Valsalva. Fast-slow AVNRT using a superoanterior or inferolateral right atrial SP also mimics atrial tachycardia originating from the tricuspid annulus. We summarize the similarities among these variants of SP, and the origin of the atrial tachycardias, including their anatomical distributions and electrophysiological and pharmacological characteristics. Moreover, based on recent basic research reporting the presence of node-like AV ring tissue encircling the annuli in adult hearts, we propose the term "AV ring tachycardia" to designate the tachycardias that share the AV ring tissue as a common arrhythmogenic substrate. This review should help the readers recognize rare types of SP variants and associated AVNRT, and diagnose and cure these complex tachycardias. We hope, with this proposal of a unified tachycardia designation, to open a new chapter in clinical electrophysiology.
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Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511 Gunma, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511 Gunma, Japan
| | - Takashi Kobari
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511 Gunma, Japan
| | - Hiroshi Hasegawa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511 Gunma, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511 Gunma, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511 Gunma, Japan
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7
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Shen R, Zuo D, Chen K, Yin Y, Tang K, Hou S, Han B, Xu Y, Liu Z, Chen H. K2P1 leak cation channels contribute to ventricular ectopic beats and sudden death under hypokalemia. FASEB J 2022; 36:e22455. [PMID: 35899468 DOI: 10.1096/fj.202200707r] [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: 05/11/2022] [Revised: 06/28/2022] [Accepted: 07/06/2022] [Indexed: 11/11/2022]
Abstract
Hypokalemia causes ectopic heartbeats, but the mechanisms underlying such cardiac arrhythmias are not understood. In reduced serum K+ concentrations that occur under hypokalemia, K2P1 two-pore domain K+ channels change ion selectivity and switch to conduct inward leak cation currents, which cause aberrant depolarization of resting potential and induce spontaneous action potential of human cardiomyocytes. K2P1 is expressed in the human heart but not in mouse hearts. We test the hypothesis that K2P1 leak cation channels contribute to ectopic heartbeats under hypokalemia, by analysis of transgenic mice, which conditionally express induced K2P1 specifically in hearts, mimicking K2P1 channels in the human heart. Conditional expression of induced K2P1 specifically in the heart of hypokalemic mice results in multiple types of ventricular ectopic beats including single and multiple ventricular premature beats as well as ventricular tachycardia and causes sudden death. In isolated mouse hearts that express induced K2P1, sustained ventricular fibrillation occurs rapidly after perfusion with low K+ concentration solutions that mimic hypokalemic conditions. These observed phenotypes occur rarely in control mice or in the hearts that lack K2P1 expression. K2P1-expressing mouse cardiomyocytes of transgenic mice much more frequently fire abnormal single and/or rhythmic spontaneous action potential in hypokalemic conditions, compared to wild type mouse cardiomyocytes without K2P1 expression. These findings confirm that K2P1 leak cation channels induce ventricular ectopic beats and sudden death of transgenic mice with hypokalemia and imply that K2P1 leak cation channels may play a critical role in human ectopic heartbeats under hypokalemia.
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Affiliation(s)
- Rongrong Shen
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Pan-Vascular Research Institute, Heart, Lung, and Blood Center, Tongji University School of Medicine, Shanghai, China
| | - Dongchuan Zuo
- Key Laboratory of Medical Electrophysiology, Institute of Cardiovascular Research, Ministry of Education, Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease, Southwest Medical University, Luzhou, China.,Department of Biological Sciences, University at Albany, State University of New York, Albany, New York, USA
| | - Kuihao Chen
- Department of Biological Sciences, University at Albany, State University of New York, Albany, New York, USA.,Department of Pharmacology, Ningbo University School of Medicine, Ningbo, China
| | - Yiheng Yin
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Pan-Vascular Research Institute, Heart, Lung, and Blood Center, Tongji University School of Medicine, Shanghai, China
| | - Kai Tang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Pan-Vascular Research Institute, Heart, Lung, and Blood Center, Tongji University School of Medicine, Shanghai, China
| | - Shangwei Hou
- Key Laboratory for Translational Research and Innovative Therapeutics of Gastrointestinal Oncology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Han
- Key Laboratory for Translational Research and Innovative Therapeutics of Gastrointestinal Oncology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Pan-Vascular Research Institute, Heart, Lung, and Blood Center, Tongji University School of Medicine, Shanghai, China
| | - Zheng Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Pan-Vascular Research Institute, Heart, Lung, and Blood Center, Tongji University School of Medicine, Shanghai, China.,Cryo-Electron Microscopy Center, Southern University of Science and Technology, Shenzhen, China
| | - Haijun Chen
- Department of Biological Sciences, University at Albany, State University of New York, Albany, New York, USA
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8
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Arshad A, Atkinson AJ. A 21st century view of the anaotmy of the cardiac conduction system. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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9
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Kato Y, Matsuyama TA, Fujishiro M, Hashimoto M, Sone H, Onizuka-Yamochi T. Local Variation and Age-Related Change in Atrial and Ventricular Myocardial Contiguity at the Atrioventricular Junction in Human Hearts. Circ Rep 2022; 4:158-165. [PMID: 35434411 PMCID: PMC8979762 DOI: 10.1253/circrep.cr-22-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/09/2022] Open
Abstract
Background: We explored the histologic patterns of and age-related changes in atrial and ventricular myocardial contiguity at the left and right atrioventricular (AV) junction that could be a target site for catheter ablation. Methods and Results: Twenty-three structurally normal adult hearts obtained at autopsy were studied. The 2 AV annuli were divided into 13 clinically recognized portions in which we measured distance between the atrial and ventricular myocardium at the AV junction. Overall, measured distance was less on the right than left side (mean [±SD] 0.74±0.59 vs. 1.15±0.78 mm, respectively), and distance increased gradually with age. The gap was smallest at the anterolateral portion on the right side and posterolateral portion on the left side. Three specific features were noted, namely extension of the ventricular myocardium (coarse trabeculae) towards the atrium on the right side of the AV junction, extension of the atrial myocardium onto the AV valve leaflets, and a collection of small myocardial cells, perhaps including specialized cells, in the right anterolateral portion. No concealed AV muscular connections were found. Conclusions: Contiguity and separation of the myocardium at the AV junction have specific patterns, and myocardial proximity is influenced by age. These histologic features of the AV junction may prove to be informative for catheter ablation of tachyarrhythmias related to the AV junction.
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Affiliation(s)
- Yuki Kato
- Department of Legal Medicine, Showa University School of Medicine
| | | | - Masaya Fujishiro
- Department of Legal Medicine, Showa University School of Medicine
| | - Mari Hashimoto
- Department of Legal Medicine, Showa University School of Medicine
| | - Hiromoto Sone
- Department of Legal Medicine, Showa University School of Medicine
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10
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Dernovoj B, Nuzhny V, Prosheva V. Seasonal variation of right heart function in elite skiers-racers: an echocardiographic study. Eur J Appl Physiol 2022; 122:1261-1268. [DOI: 10.1007/s00421-022-04907-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
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11
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Kuzmin VS, Malykhina IA, Pustovit KB, Ivanova AD, Kuniewicz M, Walocha J, Atkinson A, Aminu AJ, Dobrzynski H. Inflammatory degranulation of the cardiac resident mast cells suppresses the pacemaking and affects activation pattern in the sinoatrial node. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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12
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Ivanova VV, Milto IV, Serebrjakova ON, Sukhodolo IV. The Rat Heart in the Prenatal and Postnatal Periods of Ontogenesis. Russ J Dev Biol 2021. [DOI: 10.1134/s1062360421050039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Barber F, Langfield P, Lozano M, Garcia-Fernandez I, Duchateau J, Hocini M, Haissaguerre M, Vigmond E, Sebastian R. Estimation of Personalized Minimal Purkinje Systems From Human Electro-Anatomical Maps. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:2182-2194. [PMID: 33856987 DOI: 10.1109/tmi.2021.3073499] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The Purkinje system is a heart structure responsible for transmitting electrical impulses through the ventricles in a fast and coordinated way to trigger mechanical contraction. Estimating a patient-specific compatible Purkinje Network from an electro-anatomical map is a challenging task, that could help to improve models for electrophysiology simulations or provide aid in therapy planning, such as radiofrequency ablation. In this study, we present a methodology to inversely estimate a Purkinje network from a patient's electro-anatomical map. First, we carry out a simulation study to assess the accuracy of the method for different synthetic Purkinje network morphologies and myocardial junction densities. Second, we estimate the Purkinje network from a set of 28 electro-anatomical maps from patients, obtaining an optimal conduction velocity in the Purkinje network of 1.95 ± 0.25 m/s, together with the location of their Purkinje-myocardial junctions, and Purkinje network structure. Our results showed an average local activation time error of 6.8±2.2 ms in the endocardium. Finally, using the personalized Purkinje network, we obtained correlations higher than 0.85 between simulated and clinical 12-lead ECGs.
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14
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Mahmud R, Jamal S, Kukla S, Harris B. Effect of Nonselective His Bundle Pacing on Delayed Myocardial Activation in Left-axis Deviation and Left Bundle Branch Block. J Innov Card Rhythm Manag 2021; 12:4577-4585. [PMID: 34277128 PMCID: PMC8221639 DOI: 10.19102/icrm.2021.120702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/06/2021] [Indexed: 11/06/2022] Open
Abstract
It has been suggested that nonselective His bundle pacing (NS-HBP) corrects terminal conduction delay in right bundle branch block by early excitation of the right ventricular free wall. A similar analysis of NS-HBP, in patients with left bundle branch block (LBBB) and left-axis deviation (LAD) has not been done. Therefore, we compared the baseline QRS parameters in LAD and LBBB during NS-HBP and selective HBP (S-HBP). In LAD patients (n = 16), NS-HBP normalized the QRS axis from −35° ± 10° to 30° ± 34° (p < 0.01) and increased the lead 1 voltage (L1V) from 0.55 ± 0.3 mV to 0.88 ± 0.2 mV (p < 0.001) without increasing the peak lateral wall activation time (PLWAT) (p = not significant). In 23 of 41 LBBB patients, NS-HBP decreased the prolonged PLWAT by 73 ms (p < 0.0001), resolved the mid-QRS notch, normalized the QRS axis, and increased the L1V from 0.5 ± 0.3 mV to 1.15 ± 0.3 mV (p < 0.0001). In the remaining 18 LBBB patients, NS-HBP did not resolve the mid-QRS notch; however, the peak septal activation time decreased by 45 ms (p < 0.0001), PLWAT decreased by 53 ms (p < 0.0001), L1V increased from 0.5 ± 0.3 mV to 0.87 ± 0.4 mV (p < 0.0001), and the QRS axis normalized. All patients who developed S-HBP at lower pacing showed uncorrected LBBB (n = 6) or LAD (n = 7). In conclusion, NS-HBP, which causes myocardial activation in advance of simultaneously initiated S-HBP, results in a paced QRS complex with a normal axis and shorter activation times and restores the L1V in patients with LAD and LBBB. In some patients, a mid-QRS notch was seen with NS-HBP, which suggests fusion with S-HBP, which conducts without LBBB correction. A higher L1V in association with a shorter PLWAT and a normal QRS axis suggests that a more organized degree of left ventricular activation occurs with NS-HBP as compared to LBBB.
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Affiliation(s)
- Rehan Mahmud
- McLaren Bay Region Medical Center, Bay City, MI, USA
| | - Shakeel Jamal
- McLaren Bay Region Medical Center, Bay City, MI, USA
| | - Stacey Kukla
- McLaren Bay Region Medical Center, Bay City, MI, USA
| | - Brenda Harris
- McLaren Bay Region Medical Center, Bay City, MI, USA
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15
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Mantri S, Wu SM, Goodyer WR. Molecular Profiling of the Cardiac Conduction System: the Dawn of a New Era. Curr Cardiol Rep 2021; 23:103. [PMID: 34196831 DOI: 10.1007/s11886-021-01536-w] [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] [Accepted: 05/17/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Recent technological advances have led to an increased ability to define the gene expression profile of the cardiac conduction system (CCS). Here, we review the most salient studies to emerge in recent years and discuss existing gaps in our knowledge as well as future areas of investigation. RECENT FINDINGS Molecular profiling of the CCS spans several decades. However, the advent of high-throughput sequencing strategies has allowed for the discovery of unique transcriptional programs of the many diverse CCS cell types. The CCS, a diverse structure with significant inter- and intra-component cellular heterogeneity, is essential to the normal function of the heart. Progress in transcriptomic profiling has improved the resolution and depth of characterization of these unique and clinically relevant CCS cell types. Future studies leveraging this big data will play a crucial role in improving our understanding of CCS development and function as well as translating these findings into tangible translational tools for the improved detection, prevention, and treatment of cardiac arrhythmias.
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Affiliation(s)
- Sruthi Mantri
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Sean M Wu
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, 94305, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, CA, 94305, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - William R Goodyer
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, 94305, USA. .,Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, CA, 94305, USA. .,Division of Pediatric Cardiology, Electrophysiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Room G1105 Lokey Stem Cell Research Building, 265 Campus Drive, Stanford, CA, 94305, USA.
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16
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Kawashima T, Sato F. First in situ 3D visualization of the human cardiac conduction system and its transformation associated with heart contour and inclination. Sci Rep 2021; 11:8636. [PMID: 33883659 PMCID: PMC8060315 DOI: 10.1038/s41598-021-88109-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/08/2021] [Indexed: 02/07/2023] Open
Abstract
Current advanced imaging modalities with applied tracing and processing techniques provide excellent visualization of almost all human internal structures in situ; however, the actual 3D internal arrangement of the human cardiac conduction system (CCS) is still unknown. This study is the first to document the successful 3D visualization of the CCS from the sinus node to the bundle branches within the human body, based on our specialized physical micro-dissection and its CT imaging. The 3D CCS transformation by cardiac inclination changes from the standing to the lying position is also provided. Both actual dissection and its CT image-based simulation identified that when the cardiac inclination changed from standing to lying, the sinus node shifted from the dorso-superior to the right outer position and the atrioventricular conduction axis changed from a vertical to a leftward horizontal position. In situ localization of the human CCS provides accurate anatomical localization with morphometric data, and it indicates the useful correlation between heart inclination and CCS rotation axes for predicting the variable and invisible human CCS in the living body. Advances in future imaging modalities and methodology are essential for further accurate in situ 3D CCS visualization.
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Affiliation(s)
- Tomokazu Kawashima
- Department of Anatomy, School of Medicine, Toho University, 5-21-16 Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan.
| | - Fumi Sato
- Department of Anatomy, School of Medicine, Toho University, 5-21-16 Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan
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17
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Soattin L, Borbas Z, Caldwell J, Prendergast B, Vohra A, Saeed Y, Hoschtitzky A, Yanni J, Atkinson A, Logantha SJ, Borbas B, Garratt C, Morris GM, Dobrzynski H. Structural and Functional Properties of Subsidiary Atrial Pacemakers in a Goat Model of Sinus Node Disease. Front Physiol 2021; 12:592229. [PMID: 33746765 PMCID: PMC7969524 DOI: 10.3389/fphys.2021.592229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/18/2021] [Indexed: 12/19/2022] Open
Abstract
Background The sinoatrial/sinus node (SAN) is the primary pacemaker of the heart. In humans, SAN is surrounded by the paranodal area (PNA). Although the PNA function remains debated, it is thought to act as a subsidiary atrial pacemaker (SAP) tissue and become the dominant pacemaker in the setting of sinus node disease (SND). Large animal models of SND allow characterization of SAP, which might be a target for novel treatment strategies for SAN diseases. Methods A goat model of SND was developed (n = 10) by epicardially ablating the SAN and validated by mapping of emergent SAP locations through an ablation catheter and surface electrocardiogram (ECG). Structural characterization of the goat SAN and SAP was assessed by histology and immunofluorescence techniques. Results When the SAN was ablated, SAPs featured a shortened atrioventricular conduction, consistent with the location in proximity of atrioventricular junction. SAP recovery time showed significant prolongation compared to the SAN recovery time, followed by a decrease over a follow-up of 4 weeks. Like the SAN tissue, the SAP expressed the main isoform of pacemaker hyperpolarization-activated cyclic nucleotide-gated channel 4 (HCN4) and Na+/Ca2+ exchanger 1 (NCX1) and no high conductance connexin 43 (Cx43). Structural characterization of the right atrium (RA) revealed that the SAN was located at the earliest activation [i.e., at the junction of the superior vena cava (SVC) with the RA] and was surrounded by the paranodal-like tissue, extending down to the inferior vena cava (IVC). Emerged SAPs were localized close to the IVC and within the thick band of the atrial muscle known as the crista terminalis (CT). Conclusions SAN ablation resulted in the generation of chronic SAP activity in 60% of treated animals. SAP displayed development over time and was located within the previously discovered PNA in humans, suggesting its role as dominant pacemaker in SND. Therefore, SAP in goat constitutes a promising stable target for electrophysiological modification to construct a fully functioning pacemaker.
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Affiliation(s)
- Luca Soattin
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Zoltan Borbas
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,Manchester Heart Centre, Central Manchester University Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Jane Caldwell
- Manchester Heart Centre, Central Manchester University Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Hull University Teaching Hospitals, Hull, United Kingdom.,Hull York Medical School, Hull, United Kingdom
| | - Brian Prendergast
- Manchester Heart Centre, Central Manchester University Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Akbar Vohra
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,Manchester Heart Centre, Central Manchester University Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Yawer Saeed
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,Manchester Heart Centre, Central Manchester University Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Andreas Hoschtitzky
- Adult Congenital Heart Disease Unit, Manchester Royal Infirmary, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Royal Brompton Hospital, London, United Kingdom.,Imperial College London, London, United Kingdom
| | - Joseph Yanni
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Andrew Atkinson
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Sunil Jit Logantha
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,Liverpool Centre for Cardiovascular Sciences, Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Balint Borbas
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Clifford Garratt
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,Manchester Heart Centre, Central Manchester University Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Gwilym Matthew Morris
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,Manchester Heart Centre, Central Manchester University Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Halina Dobrzynski
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,Department of Anatomy, Jagiellonian University, Krakow, Poland
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18
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Hassinen M, Dzhumaniiazova I, Abramochkin DV, Vornanen M. Ionic basis of atrioventricular conduction: ion channel expression and sarcolemmal ion currents of the atrioventricular canal of the rainbow trout (Oncorhynchus mykiss) heart. J Comp Physiol B 2021; 191:327-346. [PMID: 33575867 PMCID: PMC7895799 DOI: 10.1007/s00360-021-01344-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/15/2020] [Accepted: 01/18/2021] [Indexed: 12/17/2022]
Abstract
Atrioventricular (AV) nodal tissue synchronizes activities of atria and ventricles of the vertebrate heart and is also a potential site of cardiac arrhythmia, e.g., under acute heat stress. Since ion channel composition and ion currents of the fish AV canal have not been previously studied, we measured major cation currents and transcript expression of ion channels in rainbow trout (Oncorhynchus mykiss) AV tissue. Both ion current densities and expression of ion channel transcripts indicate that the fish AV canal has a characteristic electrophysiological phenotype that differs from those of sinoatrial tissue, atrium and ventricle. Two types of cardiomyocytes were distinguished electrophysiologically in trout AV nodal tissue: the one (transitional cell) is functionally intermediate between working atrial/ventricular myocytes and the other (AV nodal cell) has a less negative resting membrane potential than atrial and ventricular myocytes and is a more similar to the sinoatrial nodal cells in ion channel composition. The AV nodal cells are characterized by a small or non-existent inward rectifier potassium current (IK1), low density of fast sodium current (INa) and relatively high expression of T-type calcium channels (CACNA3.1). Pacemaker channel (HCN4 and HCN2) transcripts were expressed in the AV nodal tissue but If current was not found in enzymatically isolated nodal myocytes. The electrophysiological properties of the rainbow trout nodal cells are appropriate for a slow rate of action potential conduction (small INa) and a moderate propensity for pacemaking activity (absence of IK1).
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Affiliation(s)
- Minna Hassinen
- Department of Environmental and Biological Sciences, University of Eastern Finland, P.O. Box 111, 80101, Joensuu, Finland
| | - Irina Dzhumaniiazova
- Department of Human and Animal Physiology, Lomonosov Moscow State University, Leninskiye Gory, 1, 12, Moscow, Russia
| | - Denis V Abramochkin
- Department of Human and Animal Physiology, Lomonosov Moscow State University, Leninskiye Gory, 1, 12, Moscow, Russia.,Laboratory of Cardiac Electrophysiology, National Medical Research Center for Cardiology, Moscow, Russia.,Department of Physiology, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Matti Vornanen
- Department of Environmental and Biological Sciences, University of Eastern Finland, P.O. Box 111, 80101, Joensuu, Finland.
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19
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Varró A, Tomek J, Nagy N, Virág L, Passini E, Rodriguez B, Baczkó I. Cardiac transmembrane ion channels and action potentials: cellular physiology and arrhythmogenic behavior. Physiol Rev 2020; 101:1083-1176. [PMID: 33118864 DOI: 10.1152/physrev.00024.2019] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cardiac arrhythmias are among the leading causes of mortality. They often arise from alterations in the electrophysiological properties of cardiac cells and their underlying ionic mechanisms. It is therefore critical to further unravel the pathophysiology of the ionic basis of human cardiac electrophysiology in health and disease. In the first part of this review, current knowledge on the differences in ion channel expression and properties of the ionic processes that determine the morphology and properties of cardiac action potentials and calcium dynamics from cardiomyocytes in different regions of the heart are described. Then the cellular mechanisms promoting arrhythmias in congenital or acquired conditions of ion channel function (electrical remodeling) are discussed. The focus is on human-relevant findings obtained with clinical, experimental, and computational studies, given that interspecies differences make the extrapolation from animal experiments to human clinical settings difficult. Deepening the understanding of the diverse pathophysiology of human cellular electrophysiology will help in developing novel and effective antiarrhythmic strategies for specific subpopulations and disease conditions.
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Affiliation(s)
- András Varró
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary.,MTA-SZTE Cardiovascular Pharmacology Research Group, Hungarian Academy of Sciences, Szeged, Hungary
| | - Jakub Tomek
- Department of Computer Science, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Norbert Nagy
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary.,MTA-SZTE Cardiovascular Pharmacology Research Group, Hungarian Academy of Sciences, Szeged, Hungary
| | - László Virág
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Elisa Passini
- Department of Computer Science, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Blanca Rodriguez
- Department of Computer Science, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - István Baczkó
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
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20
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Toward detection of conduction tissue during cardiac surgery: Light at the end of the tunnel? Heart Rhythm 2020; 17:2200-2207. [PMID: 32659372 DOI: 10.1016/j.hrthm.2020.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 11/22/2022]
Abstract
Postoperative conduction block requiring lifetime pacemaker placement continues to be a considerable source of morbidity for patients undergoing repair of congenital heart defects. Damage to the cardiac conduction system (CCS) during surgical procedures is thought to be a major cause of conduction block. Intraoperative identification and avoidance of the CCS is thus a key strategy to improve surgical outcomes. A number of approaches have been developed to avoid conduction tissue damage and mitigate morbidity. Here we review the historical and contemporary approaches for identification of conduction tissue during cardiac surgery. The established approach for intraoperative identification is based on anatomic landmarks established in extensive histologic studies of normal and diseased heart. We focus on landmarks to identify the sinus and atrioventricular nodes during cardiac surgery. We also review technologies explored for intraoperative tissue identification, including electrical impedance measurements and electrocardiography. We describe new optical approaches, in particular, and optical spectroscopy and fiberoptic confocal microscopy (FCM) for identification of CCS regions and working myocardium during surgery. As a template for translation of future technology developments, we describe research and regulatory pathways to translate FCM for cardiac surgery. We suggest that along with more robust approaches to surgeon training, including awareness of fundamental anatomic studies, optical approaches such as FCM show promise in aiding surgeons with repairs of heart defects. In particular, for complex defects, these approaches can complement landmark-based identification of conduction tissue and thus help to avoid injury to the CCS due to surgical procedures.
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21
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Ivanova AD, Samoilova DV, Razumov AA, Kuzmin VS. Rat caval vein myocardium undergoes changes in conduction characteristics during postnatal ontogenesis. Pflugers Arch 2019; 471:1493-1503. [PMID: 31654199 DOI: 10.1007/s00424-019-02320-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/10/2019] [Accepted: 10/07/2019] [Indexed: 01/27/2023]
Abstract
The electrophysiological properties of the superior vena cava (SVC) myocardium, which is considered a minor source of atrial arrhythmias, were studied in this study during postnatal development. Conduction properties were investigated in spontaneously active and electrically paced SVC preparations obtained from 7-60-day-old male Wistar rats using optical mapping and microelectrode techniques. The presence of high-conductance connexin 43 (Cx43) was evaluated in SVC cross-sections using immunofluorescence. It was found that SVC myocardium is excitable, electrically coupled with the atrial tissue, and conducts excitation waves at all stages of postnatal development. However, the conduction velocity (CV) of excitation and action potential (AP) upstroke velocity in SVC were significantly lower in neonatal than in adult animals and increased with postnatal maturation. Connexins Cx43 were identified in both neonatal and adult rat SVC myocardium; however, the abundance of Cx43 was significantly less in neonates. The gap junction uncoupler octanol affected conduction more profound in the neonatal than in adult SVC. We demonstrated for the first time that the conduction characteristics of SVC myocardium change from a slow-conduction (nodal) to a high-conduction (working) phenotype during postnatal ontogenesis. An age-related CV increase may occur due to changes of AP characteristics, electrical coupling, and Cx43 presence in SVC cardiomyocyte membranes. Observed changes may contribute to the low proarrhythmicity of adult caval vein cardiac tissue, while pre- or postnatal developmental abnormalities that delay the establishment of the working conduction phenotype may facilitate SVC proarrhythmia.
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Affiliation(s)
- Alexandra D Ivanova
- Department of Human and Animal Physiology, Biological Faculty, Lomonosov Moscow State University, 1-12 Leninskie Gory, Moscow, Russia, 119234.
| | - Daria V Samoilova
- N. N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - Artem A Razumov
- Ural Federal University, Institute of Natural Sciences and Mathematics, Ekaterinburg, Russia
| | - Vlad S Kuzmin
- Department of Human and Animal Physiology, Biological Faculty, Lomonosov Moscow State University, 1-12 Leninskie Gory, Moscow, Russia, 119234
- Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
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22
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Sinus node-like pacemaker mechanisms regulate ectopic pacemaker activity in the adult rat atrioventricular ring. Sci Rep 2019; 9:11781. [PMID: 31409881 PMCID: PMC6692414 DOI: 10.1038/s41598-019-48276-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 07/02/2019] [Indexed: 01/01/2023] Open
Abstract
In adult mammalian hearts, atrioventricular rings (AVRs) surround the atrial orifices of atrioventricular valves and are hotbed of ectopic activity in patients with focal atrial tachycardia. Experimental data offering mechanistic insights into initiation and maintenance of ectopic foci is lacking. We aimed to characterise AVRs in structurally normal rat hearts, identify arrhythmia predisposition and investigate mechanisms underlying arrhythmogenicity. Extracellular potential mapping and intracellular action potential recording techniques were used for electrophysiology, qPCR for gene and, Western blot and immunohistochemistry for protein expression. Conditions favouring ectopic foci were assessed by simulations. In right atrial preparations, sinus node (SN) was dominant and AVRs displayed 1:1 impulse conduction. Detaching SN unmasked ectopic pacemaking in AVRs and pacemaker action potentials were SN-like. Blocking pacemaker current If, and disrupting intracellular Ca2+ release, prolonged spontaneous cycle length in AVRs, indicating a role for SN-like pacemaker mechanisms. AVRs labelled positive for HCN4, and SERCA2a was comparable to SN. Pacemaking was potentiated by isoproterenol and abolished with carbachol and AVRs had abundant sympathetic nerve endings. β2-adrenergic and M2-muscarinic receptor mRNA and β2-receptor protein were comparable to SN. In computer simulations of a sick SN, ectopic foci in AVR were unmasked, causing transient suppression of SN pacemaking.
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23
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Kaneko Y, Nakajima T, Iizuka T, Tamura S, Kurabayashi M. Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Using a Slow Pathway Extending to the Superoanterior Right Atrium. Int Heart J 2019; 60:756-760. [PMID: 31105156 DOI: 10.1536/ihj.18-528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a case of atypical fast-slow atrioventricular nodal reentrant tachycardia (AVNRT) using a slow pathway variant extending to the superoanterior right atrium. The AVNRT diagnosis was confirmed by using standard electrophysiological criteria that exclude a diagnosis of atrial tachycardia and atrioventricular reentrant tachycardia. The earliest atrial activation during tachycardia was found in the superoanterior right atrium adjacent to the tricuspid annulus, where the first delivery of radiofrequency energy terminated and eliminated the inducibility of the tachycardia.
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Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Takashi Iizuka
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
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24
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Okada M, Tanaka K, Matsunaga-Lee Y, Ninomiya Y, Hirao Y, Oka T, Tanaka N, Inoue H, Iwakura K, Fujii K, Inoue K. Multiple Shifts of the Earliest Retrograde Atrial Activation Site Along the Tricuspid Annulus During the Fast-Slow Form of Atrioventricular Nodal Reentrant Tachycardia by Radiofrequency Modification. Int Heart J 2019; 60:761-767. [PMID: 31105149 DOI: 10.1536/ihj.18-406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 70-year-old woman was admitted for treatment of supraventricular tachycardia. Ventriculoatrial conduction was revealed through programmed ventricular stimulation; the coronary sinus ostium (CSos) was the earliest atrial activation site. The fast-slow forms of atrioventricular nodal reentrant tachycardia (AVNRT) were induced by ventricular extra-stimuli. During tachycardia, the earliest atrial activation site was located at the bottom of CSos. Radiofrequency (RF) energy application to this site resulted in the delay of local electrical potential, prolongation of tachycardia cycle length, and a shift of the earliest retrograde activation site to the roof of CSos. Subsequent ablation induced a similar shift to the inferior tricuspid annulus and to the right posterior septum. Finally, RF energy application to the right posterior septum resulted in the termination of tachycardia, which was not induced afterward. Multiple shifts in the earliest retrograde atrial activation site along the tricuspid annulus after each slow pathway ablation suggested that annular tissue plays a substantial role as a substrate for AVNRT.
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Affiliation(s)
- Masato Okada
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
| | - Koji Tanaka
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
| | - Yasuharu Matsunaga-Lee
- Department of Cardiology, Japan Community Healthcare Organization (JCHO) Hoshigaoka Medical Center
| | | | - Yuko Hirao
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
| | - Takafumi Oka
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
| | | | | | | | - Kenshi Fujii
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
| | - Koichi Inoue
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
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25
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Edling CE, Fazmin IT, Chadda KR, Ahmad S, Valli H, Huang CLH, Jeevaratnam K. Atrial Transcriptional Profiles of Molecular Targets Mediating Electrophysiological Function in Aging and Pgc-1β Deficient Murine Hearts. Front Physiol 2019; 10:497. [PMID: 31068841 PMCID: PMC6491872 DOI: 10.3389/fphys.2019.00497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/08/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Deficiencies in the transcriptional co-activator, peroxisome proliferative activated receptor, gamma, coactivator-1β are implicated in deficient mitochondrial function. The latter accompanies clinical conditions including aging, physical inactivity, obesity, and diabetes. Recent electrophysiological studies reported that Pgc-1β-/- mice recapitulate clinical age-dependent atrial pro-arrhythmic phenotypes. They implicated impaired chronotropic responses to adrenergic challenge, compromised action potential (AP) generation and conduction despite normal AP recovery timecourses and background resting potentials, altered intracellular Ca2+ homeostasis, and fibrotic change in the observed arrhythmogenicity. OBJECTIVE We explored the extent to which these age-dependent physiological changes correlated with alterations in gene transcription in murine Pgc-1β-/- atria. METHODS AND RESULTS RNA isolated from murine atrial tissue samples from young (12-16 weeks) and aged (>52 weeks of age), wild type (WT) and Pgc-1β-/- mice were studied by pre-probed quantitative PCR array cards. We examined genes encoding sixty ion channels and other strategic atrial electrophysiological proteins. Pgc-1β-/- genotype independently reduced gene transcription underlying Na+-K+-ATPase, sarcoplasmic reticular Ca2+-ATPase, background K+ channel and cholinergic receptor function. Age independently decreased Na+-K+-ATPase and fibrotic markers. Both factors interacted to alter Hcn4 channel activity underlying atrial automaticity. However, neither factor, whether independently or interactively, affected transcription of cardiac Na+, voltage-dependent K+ channels, surface or intracellular Ca2+ channels. Nor were gap junction channels, β-adrenergic receptors or transforming growth factor-β affected. CONCLUSION These findings limit the possible roles of gene transcriptional changes in previously reported age-dependent pro-arrhythmic electrophysiologial changes observed in Pgc-1β-/- atria to an altered Ca2+-ATPase (Atp2a2) expression. This directly parallels previously reported arrhythmic mechanism associated with p21-activated kinase type 1 deficiency. This could add to contributions from the direct physiological outcomes of mitochondrial dysfunction, whether through reactive oxygen species (ROS) production or altered Ca2+ homeostasis.
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Affiliation(s)
- Charlotte E. Edling
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Ibrahim T. Fazmin
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom,Physiological Laboratory, University of Cambridge, Cambridge, United Kingdom
| | - Karan R. Chadda
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom,Physiological Laboratory, University of Cambridge, Cambridge, United Kingdom
| | - Shiraz Ahmad
- Physiological Laboratory, University of Cambridge, Cambridge, United Kingdom
| | - Haseeb Valli
- Physiological Laboratory, University of Cambridge, Cambridge, United Kingdom
| | - Christopher L.-H. Huang
- Physiological Laboratory, University of Cambridge, Cambridge, United Kingdom,Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom,Physiological Laboratory, University of Cambridge, Cambridge, United Kingdom,School of Medicine, Perdana University-Royal College of Surgeons in Ireland, Selangor, Malaysia,*Correspondence: Kamalan Jeevaratnam,
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Kaneko Y, Nakajima T, Nogami A, Inden Y, Asakawa T, Morishima I, Mizukami A, Iizuka T, Tamura S, Ota C, Kanzaki Y, Nakagawa K, Suzuki M, Kurabayashi M. Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Utilizing a Slow Pathway Extending to the Inferolateral Right Atrium. Circ Rep 2019; 1:46-54. [PMID: 33693113 PMCID: PMC7890287 DOI: 10.1253/circrep.cr-18-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background:
The existence of atypical fast-slow (F/S) atrioventricular (AV) nodal reentrant tachycardias (NRT) using slow pathway (SP) variants connected to the right atrial (RA) inferolateral (inf) free wall (FW) along the tricuspid annulus (TA), has been neither confirmed nor precisely characterized. Methods and Results:
We studied 7 patients (mean age, 48±16 years; 5 men) with F/S-AVNRT with long RP intervals and an earliest atrial activation at the RA inf-FW along the TA (inf-F/S-AVNRT). AV reentrant tachycardia was excluded on observation of the transition zone criteria in all 7 patients. Atrial tachycardia was excluded on the observation of a V-A-V activation sequence after the induction or entrainment of the tachycardia from the right ventricle in all. During the tachycardia, low-frequency, fractionated potentials (LP) preceding the local atrial electrogram were recorded near the site of the earliest atrial activation in 6 patients. Observations of conduction delay and block of the LP during ventricular entrainment or ablation of the tachycardia indicated that LP reflect retrograde activation via the inf-SP. Retrograde SP conduction was interrupted at the site of earliest atrial activation in 3 patients, and in the right posterior septum in 4 patients. Conclusions:
inf-F/S-AVNRT are distinct supraventricular tachycardia incorporating an SP variant connected to the RA inf-FW along the TA in the retrograde direction, which were eliminated by ablation.
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Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Akihiko Nogami
- Cardiovascular Division, School of Medicine, University of Tsukuba
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | | | | | - Takashi Iizuka
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Chihiro Ota
- Cardiovascular Division, School of Medicine, University of Tsukuba
| | - Yasunori Kanzaki
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | - Makoto Suzuki
- Department of Cardiology, Yokohama Minami Kyosai Hospital
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
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27
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Watanabe T, Hachiya H, Kusa S, Kajiyama T, Yamao K, Miyazaki S, Igarashi M, Nakamura H, Imai Y, Kario K, Iesaka Y. Utility of low-dose adenosine triphosphate sensitivity in slow-fast atrioventricular nodal reentrant tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:267-274. [PMID: 30569491 DOI: 10.1111/pace.13590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/04/2018] [Accepted: 12/09/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Low-dose adenosine triphosphate (LD-ATP) is useful for diagnosing ATP-sensitive atrial tachycardia. However, the clinical implications of the sensitivity of LD-ATP in atrioventricular nodal reentrant tachycardia (AVNRT) still remain unknown. This study aimed to evaluate the mechanism of LD-ATP sensitivity in slow-fast AVNRT. METHODS We estimated the sensitivity of LD-ATP in slow-fast AVNRT by a 2-4-mg ATP intravenous injection during the tachycardia. We evaluated the atrial-His (A-H) interval, tachycardia termination mode, prevalence of a lower common pathway (LCP), and successful ablation site in slow-fast AVNRT with LD-ATP sensitivity. LCPs were defined as His-atrial interval differences of at least 5 ms between that during ventricular pacing at the tachycardia cycle length and that during the tachycardia. RESULTS Twenty-eight patients (mean age = 58 ± 11 years old, 18 females) with slow-fast AVNRT, who underwent catheter ablation of the antegrade slow pathway, were enrolled. Seventeen of 28 (61%) patients had LD-ATP sensitivity defined as termination of the tachycardia and/or a prolongation of the A-H interval of over 30 ms after an LD-ATP injection. The patients with LD-ATP sensitivity had a significantly higher prevalence of an LCP than those without (15/17 vs0/11, P < 0.0001). The successful ablation site in the LD-ATP sensitive group was significantly closer to the His bundle area than that in the LD-ATP nonsensitive group (13.3 ± 3.8 vs 20.5 ± 5.4 mm; distance to His bundle area in the left anterior oblique fluoroscopic view, P < 0.0001). CONCLUSIONS LD-ATP sensitivity in slow-fast AVNRT may suggest the existence of an LCP. The successful ablation site in patients with LD-ATP sensitivity could be closer to the His bundle region.
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Affiliation(s)
- Tomonori Watanabe
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan.,Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Hitoshi Hachiya
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Shigeki Kusa
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | | | - Kazuya Yamao
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | | | - Miyako Igarashi
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | | | - Yasushi Imai
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Yoshito Iesaka
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan
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28
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Chadda KR, Edling CE, Valli H, Ahmad S, Huang CLH, Jeevaratnam K. Gene and Protein Expression Profile of Selected Molecular Targets Mediating Electrophysiological Function in Pgc-1α Deficient Murine Atria. Int J Mol Sci 2018; 19:ijms19113450. [PMID: 30400228 PMCID: PMC6274828 DOI: 10.3390/ijms19113450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 10/25/2018] [Accepted: 10/29/2018] [Indexed: 12/27/2022] Open
Abstract
Increases in the prevalence of obesity, insulin resistance, and metabolic syndrome has led to the increase of atrial fibrillation (AF) cases in the developed world. These AF risk factors are associated with mitochondrial dysfunction, previously modelled using peroxisome proliferator activated receptor-γ (PPARγ) coactivator-1 (Pgc-1)-deficient murine cardiac models. We explored gene and protein expression profiles of selected molecular targets related to electrophysiological function in murine Pgc-1α−/− atria. qPCR analysis surveyed genes related to Na+-K+-ATPase, K+ conductance, hyperpolarisation-activated cyclic nucleotide-gated (Hcn), Na+ channels, Ca2+ channels, and indicators for adrenergic and cholinergic receptor modulation. Western blot analysis for molecular targets specific to conduction velocity (Nav1.5 channel and gap junctions) was performed. Transcription profiles revealed downregulation of molecules related to Na+-K+-ATPase transport, Hcn-dependent pacemaker function, Na+ channel-dependent action potential activation and propagation, Ca2+ current generation, calsequestrin-2 dependent Ca2+ homeostasis, and adrenergic α1D dependent protection from hypertrophic change. Nav1.5 channel protein expression but not gap junction expression was reduced in Pgc-1α−/− atria compared to WT. Nav1.5 reduction reflects corresponding reduction in its gene expression profile. These changes, as well as the underlying Pgc-1α−/− alteration, suggest potential pharmacological targets directed towards either upstream PGC-1 signalling mechanisms or downstream ion channel changes.
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Affiliation(s)
- Karan R Chadda
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, UK.
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge CB2 3EG, UK.
| | - Charlotte E Edling
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, UK.
| | - Haseeb Valli
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge CB2 3EG, UK.
| | - Shiraz Ahmad
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge CB2 3EG, UK.
| | - Christopher L-H Huang
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge CB2 3EG, UK.
- Department of Biochemistry, Hopkins Building, University of Cambridge, Cambridge CB2 1QW, UK.
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, UK.
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge CB2 3EG, UK.
- School of Medicine, Perdana University-Royal College of Surgeons Ireland, Serdang 43400, Malaysia.
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29
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Klimek-Piotrowska W, Krawczyk-Ożóg A, Suski M, Kapusta P, Wołkow PP, Hołda MK. Comparative iTRAQ analysis of protein abundance in the human sinoatrial node and working cardiomyocytes. J Anat 2018; 232:956-964. [PMID: 29484645 DOI: 10.1111/joa.12798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 02/06/2023] Open
Abstract
Our objective was to assess the changes in protein abundance in the human sinoatrial node (SAN) compared with working cardiomyocytes to identify SAN-specific protein signatures. Four pairs of samples (the SAN and working cardiomyocytes) were obtained postmortem from four human donors with no evidence of cardiovascular disease. We performed protein identification and quantitation using two-dimensional chromatography-tandem mass spectrometry with isobaric peptide labeling (iTRAQ). We identified 451 different proteins expressed in both the SAN and working cardiomyocytes, 166 of which were differentially regulated (110 were upregulated in the SAN and 56 in the working cardiomyocytes). We identified sarcomere structural proteins in both tissues, although they were differently distributed among the tested samples. For example, myosin light chain 4, myosin regulatory light chain 2-atrial isoform, and tropomyosin alpha-3 chain levels were twofold higher in the SAN than in working cardiomyocytes, and myosin light chain 3 and myosin regulatory light chain 2-ventricular/cardiac muscle isoform levels were twofold higher in the ventricle tissue than in SAN. We identified many mitochondrial oxidative phosphorylation, β-oxidation, and tricarboxylic acid cycle proteins that were predominantly associated with working cardiomyocytes tissue. We detected upregulation of the fatty acid omega activation pathway proteins in the SAN samples. Some proteins specific for smooth muscle tissue were highly upregulated in the SAN (e.g. transgelin), which indicates that the SAN tissue might act as the bridge between the working myocardium and the smooth muscle. Our results show possible implementation of proteomic strategies to identify in-depth functional differences between various heart sub-structures.
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Affiliation(s)
- Wiesława Klimek-Piotrowska
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Agata Krawczyk-Ożóg
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Maciej Suski
- Department of Pharmacology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Przemysław Kapusta
- Center for Medical Genomics OMICRON, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Paweł P Wołkow
- Center for Medical Genomics OMICRON, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland.,Department of Pharmacology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz K Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
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30
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Stephenson RS, Atkinson A, Kottas P, Perde F, Jafarzadeh F, Bateman M, Iaizzo PA, Zhao J, Zhang H, Anderson RH, Jarvis JC, Dobrzynski H. High resolution 3-Dimensional imaging of the human cardiac conduction system from microanatomy to mathematical modeling. Sci Rep 2017; 7:7188. [PMID: 28775383 PMCID: PMC5543124 DOI: 10.1038/s41598-017-07694-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/03/2017] [Indexed: 12/23/2022] Open
Abstract
Cardiac arrhythmias and conduction disturbances are accompanied by structural remodelling of the specialised cardiomyocytes known collectively as the cardiac conduction system. Here, using contrast enhanced micro-computed tomography, we present, in attitudinally appropriate fashion, the first 3-dimensional representations of the cardiac conduction system within the intact human heart. We show that cardiomyocyte orientation can be extracted from these datasets at spatial resolutions approaching the single cell. These data show that commonly accepted anatomical representations are oversimplified. We have incorporated the high-resolution anatomical data into mathematical simulations of cardiac electrical depolarisation. The data presented should have multidisciplinary impact. Since the rate of depolarisation is dictated by cardiac microstructure, and the precise orientation of the cardiomyocytes, our data should improve the fidelity of mathematical models. By showing the precise 3-dimensional relationships between the cardiac conduction system and surrounding structures, we provide new insights relevant to valvar replacement surgery and ablation therapies. We also offer a practical method for investigation of remodelling in disease, and thus, virtual pathology and archiving. Such data presented as 3D images or 3D printed models, will inform discussions between medical teams and their patients, and aid the education of medical and surgical trainees.
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Affiliation(s)
- Robert S Stephenson
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Andrew Atkinson
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Petros Kottas
- School of Physics and Astronomy, University of Manchester, Manchester, UK
| | - Filip Perde
- National Institute of Legal Medicine, Bucharest, Romania
| | - Fatemeh Jafarzadeh
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mike Bateman
- The Visible Heart Laboratory, University of Minnesota, Minneapolis, USA
| | - Paul A Iaizzo
- The Visible Heart Laboratory, University of Minnesota, Minneapolis, USA
| | - Jichao Zhao
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Henggui Zhang
- School of Physics and Astronomy, University of Manchester, Manchester, UK
| | - Robert H Anderson
- Institute of Genetic Medicine, University of Newcastle, Newcastle, UK
| | - Jonathan C Jarvis
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
| | - Halina Dobrzynski
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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31
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Xu Y, Peng Y, Qu R, Zheng G, Feng F, Feng Y, He L, He S, Li Z, Liu C, Xiao Z, Ouyang J, Dai J. Locating the Human Cardiac Conduction System Using a 3D Model of Its Nutritious Arteries. Sci Rep 2017; 7:344. [PMID: 28336939 PMCID: PMC5428715 DOI: 10.1038/s41598-017-00504-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 02/28/2017] [Indexed: 11/24/2022] Open
Abstract
It is difficult for anatomists to dissect the human cardiac conduction system (CCS) on specimens as well as for cardiovascular clinicians to locate the CCS during cardiac operations. Here, we demonstrate a new method for locating the CCS using a 3D model of its nutritious arteries. First, we perfused the coronary arteries with contrast material and then acquired a set of data of thin computer tomography (CT) scans. Then, we generated a 3D model of the coronary artery and distinguished the arteries that supply the CCS. We then located the CCS on the 3D model via its nutritious arteries and dissected the CCS. Finally, the structures that were dissected were removed for histological and immunofluorescent staining. The results of histological and immunofluorescence examination proved the structure to be the CCS. Thus, we successfully located the CCS using a 3D model of its nutritious arteries. We suggest that with this new method, cardiac surgeons can locate a patient’s CCS during cardiac surgeries such as transcatheter aortic valve implantation (TAVI) or radiofrequency catheter ablation (RFCA).
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Affiliation(s)
- Yu Xu
- First Clinical School, Southern Medical University, Guangzhou, China
| | - Yukun Peng
- First Clinical School, Southern Medical University, Guangzhou, China
| | - Rongmei Qu
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Guangzhou, China
| | - Guorong Zheng
- Department of Radiology, Guangdong No. 2 Provincial People's Hospital, Guangzhou, China
| | - Feiyan Feng
- First Clinical School, Southern Medical University, Guangzhou, China
| | - Yan Feng
- Department of Electrocardiogram, Xinjiang Uygur Autonomous Region People's Hospital, Urumqi, China
| | - Linying He
- Second Clinical School, Southern Medical University, Guangzhou, China
| | - Shanli He
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Guangzhou, China
| | - Zeyu Li
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Guangzhou, China
| | - Chang Liu
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Guangzhou, China
| | - Zhaoming Xiao
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Guangzhou, China
| | - Jun Ouyang
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Guangzhou, China.
| | - Jingxing Dai
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Guangzhou, China.
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32
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Roshanbinfar K, Hilborn J, Varghese OP, Oommen OP. Injectable and thermoresponsive pericardial matrix derived conductive scaffold for cardiac tissue engineering. RSC Adv 2017. [DOI: 10.1039/c7ra03780e] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Scaffolds derived from decellularized cardiac tissue offer an enormous advantage for cardiac applications as they recapitulate biophysical and cardiac specific cues.
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Affiliation(s)
- Kaveh Roshanbinfar
- Experimental Renal and Cardiovascular Research
- Department of Nephropathology
- Institute of Pathology
- Friedrich-Alexander-Universitaet Erlangen-Nuernberg (FAU)
- Erlangen
| | - Jöns Hilborn
- Department of Chemistry
- Angstrom Laboratory
- Uppsala University
- SE 75121 Uppsala
- Sweden
| | - Oommen P. Varghese
- Department of Chemistry
- Angstrom Laboratory
- Uppsala University
- SE 75121 Uppsala
- Sweden
| | - Oommen P. Oommen
- Department of Chemistry
- Angstrom Laboratory
- Uppsala University
- SE 75121 Uppsala
- Sweden
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33
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Innervation of sinoatrial nodal cells in the rabbit. Ann Anat 2016; 205:113-21. [DOI: 10.1016/j.aanat.2016.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 02/12/2016] [Accepted: 03/21/2016] [Indexed: 11/23/2022]
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34
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Watanabe M, Rollins AM, Polo-Parada L, Ma P, Gu S, Jenkins MW. Probing the Electrophysiology of the Developing Heart. J Cardiovasc Dev Dis 2016; 3:jcdd3010010. [PMID: 29367561 PMCID: PMC5715694 DOI: 10.3390/jcdd3010010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 12/14/2022] Open
Abstract
Many diseases that result in dysfunction and dysmorphology of the heart originate in the embryo. However, the embryonic heart presents a challenging subject for study: especially challenging is its electrophysiology. Electrophysiological maturation of the embryonic heart without disturbing its physiological function requires the creation and deployment of novel technologies along with the use of classical techniques on a range of animal models. Each tool has its strengths and limitations and has contributed to making key discoveries to expand our understanding of cardiac development. Further progress in understanding the mechanisms that regulate the normal and abnormal development of the electrophysiology of the heart requires integration of this functional information with the more extensively elucidated structural and molecular changes.
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Affiliation(s)
- Michiko Watanabe
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.
- Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Andrew M Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Luis Polo-Parada
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO 65201, USA.
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO 65201, USA.
| | - Pei Ma
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Shi Gu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Michael W Jenkins
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.
- Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH 44106, USA.
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35
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van der Heyden MA, Jespersen T. Pharmacological exploration of the resting membrane potential reserve: Impact on atrial fibrillation. Eur J Pharmacol 2016; 771:56-64. [DOI: 10.1016/j.ejphar.2015.11.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/06/2015] [Accepted: 11/16/2015] [Indexed: 12/24/2022]
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36
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Prosheva VI, Kaseva NN. Location and functional characterization of the right atrioventricular pacemaker ring in the adult avian heart. J Morphol 2015; 277:363-9. [DOI: 10.1002/jmor.20502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/22/2015] [Accepted: 11/15/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Valentina I. Prosheva
- Institute of Physiology; Komi Science Centre, The Russian Academy of Sciences; 50 Pervomayskaya Street, 167982 GSP-2 Syktyvkar Komi Republic Russia
| | - Natalya N. Kaseva
- Institute of Physiology; Komi Science Centre, The Russian Academy of Sciences; 50 Pervomayskaya Street, 167982 GSP-2 Syktyvkar Komi Republic Russia
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37
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Chen AX, Nishimoto K, Nanba K, Rainey WE. Potassium channels related to primary aldosteronism: Expression similarities and differences between human and rat adrenals. Mol Cell Endocrinol 2015; 417:141-8. [PMID: 26375812 PMCID: PMC4646165 DOI: 10.1016/j.mce.2015.09.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 08/18/2015] [Accepted: 09/10/2015] [Indexed: 11/26/2022]
Abstract
Three potassium channels have been associated with primary aldosteronism (PA) in rodents and humans: KCNK3 (TASK-1), KCNK9 (TASK-3), and KCNJ5 (Kir3.4). Mice with deficiency in Kcnk3 and Kcnk9 have elevated aldosterone production and blood pressure. In humans, adrenal tumors with somatic mutations in KCNJ5 cause PA. However, there are very few reports on the expression patterns of these genes in humans versus rodents. Herein, we compared human and rat mRNA expression (by quantitative real-time polymerase chain reaction (qPCR) and protein levels (by immunohistochemistry) across three tissues (adrenal, brain, heart) and two laser-captured adrenal zones (zona glomerulosa, zona fasciculata). Our findings show that expression patterns of KCNK3, KCNK9, and KCNJ5 are inconsistent between rats and humans across both tissues and adrenal zones. Thus, species variation in the expression of PA-related potassium channels indicates an evolutionary divergence in their role in regulating adrenal aldosterone production.
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Affiliation(s)
- Andrew X Chen
- Department of Molecular and Integrative Physiology, University of Michigan, 1150 W. Medical Center Dr, Ann Arbor, MI 48109, USA; Department of Internal Medicine, University of Michigan, 1150 W. Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Koshiro Nishimoto
- Department of Molecular and Integrative Physiology, University of Michigan, 1150 W. Medical Center Dr, Ann Arbor, MI 48109, USA; Department of Internal Medicine, University of Michigan, 1150 W. Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Kazutaka Nanba
- Department of Molecular and Integrative Physiology, University of Michigan, 1150 W. Medical Center Dr, Ann Arbor, MI 48109, USA; Department of Internal Medicine, University of Michigan, 1150 W. Medical Center Dr, Ann Arbor, MI 48109, USA
| | - William E Rainey
- Department of Molecular and Integrative Physiology, University of Michigan, 1150 W. Medical Center Dr, Ann Arbor, MI 48109, USA; Department of Internal Medicine, University of Michigan, 1150 W. Medical Center Dr, Ann Arbor, MI 48109, USA.
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Pap R, Makai A, Szilágyi J, Klausz G, Bencsik G, Forster T, Sághy L. Should the Aortic Root Be the Preferred Route for Ablation of Focal Atrial Tachycardia Around the AV Node?: Support From Intracardiac Echocardiography. JACC Clin Electrophysiol 2015; 2:193-199. [PMID: 29766869 DOI: 10.1016/j.jacep.2015.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/19/2015] [Accepted: 10/22/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the optimal approach to focal atrial tachycardia originating from around the atrioventricular node. BACKGROUND Focal atrial tachycardia (FAT) demonstrating earliest activation around the atrioventricular (AV) node during right atrial (RA) mapping has been eliminated by ablation at the RA para-Hisian region, from the left atrium (LA) or the noncoronary aortic cusp (NCC). However the optimal approach has not been determined. METHODS We conducted a retrospective analysis of a consecutive series of 148 patients undergoing catheter ablation for FAT between 2006 and 2014 in our institution. RESULTS Earliest activation was recorded in the peri-AV nodal region during RA mapping in 34 patients (23%). Of these, 7 patients (20.5%) had successful ablation at the RA septum, using either radiofrequency (n = 4) or cryoenergy (n = 3). Seven FATs (20.5%) were ablated from the LA at the region of the aortomitral continuity, and 20 patients (59%) had successful ablation in the NCC, including 1 patient with a recurrence after a temporarily successful cryoablation from the RA. The proportion of the 3 approaches in this series showed a significant temporal evolution and overall frequency favoring ablation in the NCC (p = 0.011 for time trend and 0.013 for actual vs. expected frequencies). Intracardiac echocardiography proved superior catheter stability with the NCC approach. There were 2 cases of atrioventricular block and 1 recurrence after RA ablation versus no complications or recurrent FAT with NCC and LA approaches. CONCLUSIONS Most peri-AV nodal FATs can be safely and effectively ablated from the NCC. The strategy of preferential NCC approach avoids RA para-Hisian ablation with the accompanying risk of AV block.
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Affiliation(s)
- Robert Pap
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary.
| | - Attila Makai
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Judit Szilágyi
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Gergely Klausz
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Gábor Bencsik
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Tamás Forster
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - László Sághy
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
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39
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Nikolaidou T, Cai XJ, Stephenson RS, Yanni J, Lowe T, Atkinson AJ, Jones CB, Sardar R, Corno AF, Dobrzynski H, Withers PJ, Jarvis JC, Hart G, Boyett MR. Congestive Heart Failure Leads to Prolongation of the PR Interval and Atrioventricular Junction Enlargement and Ion Channel Remodelling in the Rabbit. PLoS One 2015; 10:e0141452. [PMID: 26509807 PMCID: PMC4624927 DOI: 10.1371/journal.pone.0141452] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 10/08/2015] [Indexed: 01/31/2023] Open
Abstract
Heart failure is a major killer worldwide. Atrioventricular conduction block is common in heart failure; it is associated with worse outcomes and can lead to syncope and bradycardic death. We examine the effect of heart failure on anatomical and ion channel remodelling in the rabbit atrioventricular junction (AVJ). Heart failure was induced in New Zealand rabbits by disruption of the aortic valve and banding of the abdominal aorta resulting in volume and pressure overload. Laser micro-dissection and real-time polymerase chain reaction (RT-PCR) were employed to investigate the effects of heart failure on ion channel remodelling in four regions of the rabbit AVJ and in septal tissues. Investigation of the AVJ anatomy was performed using micro-computed tomography (micro-CT). Heart failure animals developed first degree heart block. Heart failure caused ventricular myocardial volume increase with a 35% elongation of the AVJ. There was downregulation of HCN1 and Cx43 mRNA transcripts across all regions and downregulation of Cav1.3 in the transitional tissue. Cx40 mRNA was significantly downregulated in the atrial septum and AVJ tissues but not in the ventricular septum. mRNA abundance for ANP, CLCN2 and Navβ1 was increased with heart failure; Nav1.1 was increased in the inferior nodal extension/compact node area. Heart failure in the rabbit leads to prolongation of the PR interval and this is accompanied by downregulation of HCN1, Cav1.3, Cx40 and Cx43 mRNAs and anatomical enlargement of the entire heart and AVJ.
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Affiliation(s)
- Theodora Nikolaidou
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
- * E-mail:
| | - Xue J. Cai
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Robert S. Stephenson
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Joseph Yanni
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Tristan Lowe
- The Manchester Henry Moseley X-ray Imaging Facility, University of Manchester, Manchester, United Kingdom
| | - Andrew J. Atkinson
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Caroline B. Jones
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Rida Sardar
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Antonio F. Corno
- School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerian, Malaysia
| | - Halina Dobrzynski
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Philip J. Withers
- The Manchester Henry Moseley X-ray Imaging Facility, University of Manchester, Manchester, United Kingdom
| | - Jonathan C. Jarvis
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - George Hart
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Mark R. Boyett
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
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40
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Li N, Csepe TA, Hansen BJ, Dobrzynski H, Higgins RSD, Kilic A, Mohler PJ, Janssen PML, Rosen MR, Biesiadecki BJ, Fedorov VV. Molecular Mapping of Sinoatrial Node HCN Channel Expression in the Human Heart. Circ Arrhythm Electrophysiol 2015; 8:1219-27. [PMID: 26304511 DOI: 10.1161/circep.115.003070] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/04/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The hyperpolarization-activated current, If, plays an important role in sinoatrial node (SAN) pacemaking. Surprisingly, the distribution of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels in human SAN has only been investigated at the mRNA level. Our aim was to define the expression pattern of HCN proteins in human SAN and different atrial regions. METHODS AND RESULTS Entire SAN complexes were isolated from failing (n=5) and nonfailing (n=9) human hearts cardioplegically arrested in the operating room. Three-dimensional intramural SAN structure was identified as the fibrotic compact region around the SAN artery with Connexin 43-negative pacemaker cardiomyocytes visualized in Masson's trichrome and immunostained cryosections. SAN protein was precisely isolated from the adjacent frozen SAN tissue blocks using a 16G biopsy needle. The purity of the SAN protein was confirmed by Connexin 43 immunoblot. All 3 HCN isoform proteins were detected in SAN. HCN1 was predominantly distributed in the human SAN with a 125.1±40.2 (n=12) expression ratio of SAN to right atrium. HCN2 and HCN4 expression levels were higher in SAN than in atria, with SAN to right atrium ratios of 6.1±0.9 and 4.6±0.6 (n=12), respectively. CONCLUSIONS This is the first study to conduct precise 3D molecular mapping of the human SAN by isolating pure pacemaker SAN tissue. All 3 cardiac HCN isoforms had higher expression in the SAN than in the atria. HCN1 was almost exclusively expressed in SAN, emphasizing its utility as a new specific molecular marker of the human SAN and as a potential target of specific treatments intended to modify sinus rhythm.
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Affiliation(s)
- Ning Li
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Thomas A Csepe
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Brian J Hansen
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Halina Dobrzynski
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Robert S D Higgins
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Ahmet Kilic
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Peter J Mohler
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Paul M L Janssen
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Michael R Rosen
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Brandon J Biesiadecki
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.)
| | - Vadim V Fedorov
- From the Department of Physiology & Cell Biology and Dorothy M. Davis Heart & Lung Research Institute (N.L., T.A.C., B.J.H., P.J.M., P.M.L.J., B.J.B., V.V.F.), Department of Surgery and Dorothy M. Davis Heart & Lung Research Institute (R.S.D.H., A.K.), The Ohio State University Wexner Medical Center, Columbus; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (H.D.); and Departments of Pharmacology and Pediatrics, Columbia University, New York, NY (M.R.R.).
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Abstract
Optimal cardiac function depends on proper timing of excitation and contraction in various regions of the heart, as well as on appropriate heart rate. This is accomplished via specialized electrical properties of various components of the system, including the sinoatrial node, atria, atrioventricular node, His-Purkinje system, and ventricles. Here we review the major regionally determined electrical properties of these cardiac regions and present the available data regarding the molecular and ionic bases of regional cardiac function and dysfunction. Understanding these differences is of fundamental importance for the investigation of arrhythmia mechanisms and pharmacotherapy.
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Affiliation(s)
- Daniel C Bartos
- Department of Pharmacology, University of California Davis, Davis, California, USA
| | - Eleonora Grandi
- Department of Pharmacology, University of California Davis, Davis, California, USA
| | - Crystal M Ripplinger
- Department of Pharmacology, University of California Davis, Davis, California, USA
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42
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Csepe TA, Kalyanasundaram A, Hansen BJ, Zhao J, Fedorov VV. Fibrosis: a structural modulator of sinoatrial node physiology and dysfunction. Front Physiol 2015; 6:37. [PMID: 25729366 PMCID: PMC4325882 DOI: 10.3389/fphys.2015.00037] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/24/2015] [Indexed: 01/01/2023] Open
Abstract
Heart rhythm is initialized and controlled by the Sinoatrial Node (SAN), the primary pacemaker of the heart. The SAN is a heterogeneous multi-compartment structure characterized by clusters of specialized cardiomyocytes enmeshed within strands of connective tissue or fibrosis. Intranodal fibrosis is emerging as an important modulator of structural and functional integrity of the SAN pacemaker complex. In adult human hearts, fatty tissue and fibrosis insulate the SAN from the hyperpolarizing effect of the surrounding atria while electrical communication between the SAN and right atrium is restricted to discrete SAN conduction pathways. The amount of fibrosis within the SAN is inversely correlated with heart rate, while age and heart size are positively correlated with fibrosis. Pathological upregulation of fibrosis within the SAN may lead to tachycardia-bradycardia arrhythmias and cardiac arrest, possibly due to SAN reentry and exit block, and is associated with atrial fibrillation, ventricular arrhythmias, heart failure and myocardial infarction. In this review, we will discuss current literature on the role of fibrosis in normal SAN structure and function, as well as the causes and consequences of SAN fibrosis upregulation in disease conditions.
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Affiliation(s)
- Thomas A Csepe
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center Columbus, OH, USA
| | - Anuradha Kalyanasundaram
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center Columbus, OH, USA
| | - Brian J Hansen
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center Columbus, OH, USA
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland Auckland, New Zealand
| | - Vadim V Fedorov
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center Columbus, OH, USA
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