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Balderas-Villalobos J, Medina-Contreras JML, Lynch C, Kabadi R, Ramirez RJ, Tan AY, Kaszala K, Samsó M, Huizar JF, Eltit JM. Alterations of sarcoplasmic reticulum-mediated Ca 2+ uptake in a model of premature ventricular contraction (PVC)-induced cardiomyopathy. Mol Cell Biochem 2023; 478:1447-1456. [PMID: 36350464 PMCID: PMC10685401 DOI: 10.1007/s11010-022-04605-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022]
Abstract
Premature ventricular contractions (PVCs) are the most frequent ventricular arrhythmias in the overall population. PVCs are known to acutely enhance contractility by the post-extrasystolic potentiation phenomenon, but over time persistent PVCs promote PVC-induced cardiomyopathy (PVC-CM), characterized by a reduction of the left ventricular (LV) ejection fraction. Ca2+ cycling in myocytes commands muscle contraction and in this process, SERCA2 leads the Ca2+ reuptake into the sarcoplasmic reticulum (SR) shaping cytosolic Ca2+ signal decay and muscle relaxation. Altered Ca2+ reuptake can contribute to the contractile dysfunction observed in PVC-CM. To better understand Ca2+ handling using our PVC-CM model (canines with 50% PVC burden for 12 weeks), SR-Ca2+ reuptake was investigated by measuring Ca2+ dynamics and analyzing protein expression. Kinetic analysis of Ca2+ reuptake in electrically paced myocytes showed a ~ 21 ms delay in PVC-CM compared to Sham in intact isolated myocytes, along with a ~ 13% reduction in SERCA2 activity assessed in permeabilized myocytes. Although these trends were not statistically significant between groups using hierarchical statistics, relaxation of myocytes following contraction was significantly slower in PVC-CM vs Sham myocytes. Western blot analyses indicate a 22% reduction in SERCA2 expression, a 23% increase in phospholamban (PLN) expression, and a 50% reduction in PLN phosphorylation in PVC-CM samples vs Sham. Computational analysis simulating a 20% decrease in SR-Ca2+ reuptake resulted in a ~ 22 ms delay in Ca2+ signal decay, consistent with the experimental result described above. In conclusion, SERCA2 and PLB alterations described above have a modest contribution to functional adaptations observed in PVC-CM.
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Affiliation(s)
- Jaime Balderas-Villalobos
- Department of Physiology and Biophysics, School of Medicine, Virginia Commonwealth University, 1101 E Marshall St, 3-038H, Richmond, VA, 23298, USA
| | - J M L Medina-Contreras
- Department of Physiology and Biophysics, School of Medicine, Virginia Commonwealth University, 1101 E Marshall St, 3-038H, Richmond, VA, 23298, USA
| | - Christopher Lynch
- Department of Physiology and Biophysics, School of Medicine, Virginia Commonwealth University, 1101 E Marshall St, 3-038H, Richmond, VA, 23298, USA
| | - Rajiv Kabadi
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Rafael J Ramirez
- Department of Physiology and Biophysics, School of Medicine, Virginia Commonwealth University, 1101 E Marshall St, 3-038H, Richmond, VA, 23298, USA
| | - Alex Y Tan
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA
| | - Karoly Kaszala
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA
| | - Montserrat Samsó
- Department of Physiology and Biophysics, School of Medicine, Virginia Commonwealth University, 1101 E Marshall St, 3-038H, Richmond, VA, 23298, USA
| | - Jose F Huizar
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA
| | - Jose M Eltit
- Department of Physiology and Biophysics, School of Medicine, Virginia Commonwealth University, 1101 E Marshall St, 3-038H, Richmond, VA, 23298, USA.
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Huang TC, Lo LW, Chou YH, Lin WL, Chang SL, Lin YJ, Liu SH, Cheng WH, Liu PY, Chen SA. Renal denervation reverses ventricular structural and functional remodeling in failing rabbit hearts. Sci Rep 2023; 13:8664. [PMID: 37248400 DOI: 10.1038/s41598-023-35954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/26/2023] [Indexed: 05/31/2023] Open
Abstract
Renal denervation (RDN) suppresses the activity of the renin-angiotensin-aldosterone system and inflammatory cytokines, leading to the prevention of cardiac remodeling. Limited studies have reported the effects of renal denervation on ventricular electrophysiology. We aimed to use optical mapping to evaluate the effect of RDN on ventricular structural and electrical remodeling in a tachycardia-induced cardiomyopathy rabbit model. Eighteen rabbits were randomized into 4 groups: sham control group (n = 5), renal denervation group receiving RDN (n = 5), heart failure group receiving rapid ventricular pacing for 1 month (n = 4), and RDN-heart failure group (n = 4). Rabbit hearts were harvested for optical mapping. Different cycle lengths were paced (400, 300, 250, 200, and 150 ms), and the results were analyzed. In optical mapping, the heart failure group had a significantly slower epicardial ventricular conduction velocity than the other three groups. The RDN-heart failure, sham control, and RDN groups had similar velocities. We then analyzed the 80% action potential duration at different pacing cycle lengths, which showed a shorter action potential duration as cycle length decreased (P for trend < 0.01), which was consistent across all groups. The heart failure group had a significantly longer action potential duration than the sham control and RDN groups. Action potential duration was shorter in the RDN-heart failure group than the heart failure group (P < 0.05). Reduction of conduction velocity and prolongation of action potential duration are significant hallmarks of heart failure, and RDN reverses these remodeling processes.
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Affiliation(s)
- Ting-Chun Huang
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, 11217, Taipei, Taiwan.
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
| | - Yu-Hui Chou
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, 11217, Taipei, Taiwan
| | - Wei-Lun Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, 11217, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, 11217, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, 11217, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Shin-Huei Liu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, 11217, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Wen-Han Cheng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, 11217, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Ping-Yen Liu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Ann Chen
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- National Chung Hsing University, Taichung, Taiwan
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Renal artery denervation prevents ventricular arrhythmias in long QT rabbit models. Sci Rep 2022; 12:2904. [PMID: 35190635 PMCID: PMC8861097 DOI: 10.1038/s41598-022-06882-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/08/2022] [Indexed: 11/08/2022] Open
Abstract
Long QT syndrome (LQTS) is commonly presented with life-threatening ventricular arrhythmias (VA). Renal artery denervation (RDN) is an alternative antiadrenergic treatment that attenuates sympathetic activity. We aimed to evaluate the efficacy of RDN on preventing VAs in LQTS rabbits induced by drugs. The subtypes of LQTS were induced by infusion of HMR-1556 for LQTS type 1 (LQT1), erythromycin for LQTS type 2 (LQT2), and veratridine for LQTS type 3 (LQT3). Forty-four rabbits were randomized into the LQT1, LQT2, LQT3, LQT1-RDN, LQT2-RDN, and LQT3-RDN groups. All rabbits underwent cardiac electrophysiology studies. The QTc interval of the LQT2-RDN group was significantly shorter than those in the LQT2 group (650.08 ± 472.67 vs. 401.78 ± 42.91 ms, p = 0.011). The QTc interval of the LQT3-RDN group was significantly shorter than those in the LQT3 group (372.00 ± 22.41 vs. 335.70 ± 28.21 ms, p = 0.035). The VA inducibility in all subtypes of the LQT-RDN groups was significantly lower than those in the LQT-RDN groups, respectively (LQT1: 9.00 ± 3.30 vs. 47.44 ± 4.21%, p < 0.001; LQT2: 11.43 ± 6.37 vs. 45.38 ± 5.29%, p = 0.026; LQT3: 10.00 ± 6.32 vs. 32.40 ± 7.19%, p = 0.006). This study demonstrated the neuromodulation of RDN leading to electrical remodeling and reduced VA inducibility of the ventricular substrate in LQT models.
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Lin WL, Lai CT, Yamada S, Liu SH, Cheng WH, Chou YH, Yang CC, Kuo TB, Chen SA, Lo LW. Effects of renal denervation on sleep apnea and arrhythmia in rats with myocardial infarction. Sleep Med 2022; 91:115-123. [DOI: 10.1016/j.sleep.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 11/05/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022]
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Liu SH, Lo LW, Chou YH, Lin WL, Tsai TY, Cheng WH, Lin YJ, Chang SL, Hu YF, Chung FP, Huang HC, Chen SA. Evidence of Ventricular Arrhythmogenicity and Cardiac Sympathetic Hyperinnervation in Early Cirrhotic Cardiomyopathy. Front Physiol 2021; 12:719883. [PMID: 34955871 PMCID: PMC8692789 DOI: 10.3389/fphys.2021.719883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 11/03/2021] [Indexed: 12/29/2022] Open
Abstract
Cirrhotic cardiomyopathy (CMP) is associated with altered cardiac electrophysiological (EP) properties, which leads to the risk of ventricular arrhythmias (VAs). We aimed to evaluate the EP properties, autonomic, and structural remodeling in a rabbit model with early liver cirrhosis (LC). Twelve rabbits were assigned to the sham and LC groups. The early-stage LC was induced by the ligation of the common bile duct. All rabbits received an EP study, VA inducibility test, myocardial, and liver histology staining. Western blot analyses of protein expression and tyrosine hydroxylase stain for sympathetic nerves were performed. The effective refractory period the LC group was significantly longer than the sham group [i.e., left ventricle (LV) 205.56 ± 40.30 vs. 131.36 ± 7.94 ms; right ventricle (RV) 206.78 ± 33.07 vs. 136.79 ± 15.15 ms; left atrium (LA) 140.56 ± 28.75 vs. 67.71 ± 14.29 ms; and right atrium (RA) 133.78 ± 40.58 vs. 65.43 ± 19.49 ms, all p < 0.01], respectively. The VA inducibility was elevated in the LC group when compared with the sham group (i.e., 21.53 ± 7.71 vs. 7.76 ± 2.44%, p = 0.013). Sympathetic innervation (102/μm2/mm2) was increased in all cardiac chambers of the LC group compared with the sham group (i.e., LV 9.11 ± 4.86 vs. 0.17 ± 0.15, p < 0.01; RV 4.36 ± 4.95 vs. 0.18 ± 0.12, p = 0.026; LA 6.79 ± 1.02 vs. 0.44 ± 0.20, p = 0.018; and RA 15.18 ± 5.12 vs. 0.10 ± 0.07, p = 0.014), respectively. Early LC is presented with an increased ventricular vulnerability, structural heterogeneity, and sympathetic innervation. Close monitoring for fatal arrhythmias is warranted in patients with early stages of LC.
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Affiliation(s)
- Shin-Huei Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Hui Chou
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Lun Lin
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tsung-Ying Tsai
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Han Cheng
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hui-Chun Huang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
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van Weperen VYH, Vos MA, Ajijola OA. Autonomic modulation of ventricular electrical activity: recent developments and clinical implications. Clin Auton Res 2021; 31:659-676. [PMID: 34591191 PMCID: PMC8629778 DOI: 10.1007/s10286-021-00823-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/12/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE This review aimed to provide a complete overview of the current stance and recent developments in antiarrhythmic neuromodulatory interventions, focusing on lifethreatening vetricular arrhythmias. METHODS Both preclinical studies and clinical studies were assessed to highlight the gaps in knowledge that remain to be answered and the necessary steps required to properly translate these strategies to the clinical setting. RESULTS Cardiac autonomic imbalance, characterized by chronic sympathoexcitation and parasympathetic withdrawal, destabilizes cardiac electrophysiology and promotes ventricular arrhythmogenesis. Therefore, neuromodulatory interventions that target the sympatho-vagal imbalance have emerged as promising antiarrhythmic strategies. These strategies are aimed at different parts of the cardiac neuraxis and directly or indirectly restore cardiac autonomic tone. These interventions include pharmacological blockade of sympathetic neurotransmitters and neuropeptides, cardiac sympathetic denervation, thoracic epidural anesthesia, and spinal cord and vagal nerve stimulation. CONCLUSION Neuromodulatory strategies have repeatedly been demonstrated to be highly effective and very promising anti-arrhythmic therapies. Nevertheless, there is still much room to gain in our understanding of neurocardiac physiology, refining the current neuromodulatory strategic options and elucidating the chronic effects of many of these strategic options.
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Affiliation(s)
- Valerie Y H van Weperen
- Department of Medical Physiology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
- UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Center, UCLA Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, University of California, 100 Medical Plaza, Suite 660, Westwood Blvd, Los Angeles, CA, 90095-1679, USA
| | - Marc A Vos
- Department of Medical Physiology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Center, UCLA Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, University of California, 100 Medical Plaza, Suite 660, Westwood Blvd, Los Angeles, CA, 90095-1679, USA.
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Liu SH, Lo LW, Chou YH, Lin WL, Tsai TY, Cheng WH, Yamada S, Chen SA. Renal denervation prevents myocardial structural remodeling and arrhythmogenicity in a chronic kidney disease rabbit model. Heart Rhythm 2021; 18:1596-1604. [PMID: 33992732 DOI: 10.1016/j.hrthm.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 04/30/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The electrophysiological (EP) effects and safety of renal artery denervation (RDN) in chronic kidney disease (CKD) are unclear. OBJECTIVE The purpose of this study was to investigate the arrhythmogenicity of RDN in a rabbit model of CKD. METHODS Eighteen New Zealand white rabbits were randomized to control (n = 6), CKD (n = 6), and CKD-RDN (n = 6) groups. A 5/6 nephrectomy was selected for the CKD model. RDN was applied in the CKD-RDN group. All rabbits underwent cardiac EP studies for evaluation. Immunohistochemistry, myocardial fibrosis, and renal catecholamine levels were evaluated. RESULTS The CKD group (34.8% ± 9.2%) had a significantly higher ventricular arrhythmia (VA) inducibility than the control (8.6% ± 3.8%; P <.01) and CKD-RDN (19.5% ± 6.3%; P = .01) groups. In the CKD-RDN group, ventricular fibrosis was significantly decreased compared to the CKD group (7.4% ± 2.0 % vs 10.4% ± 3.7%; P = .02). Sympathetic innervation in the CKD group was significantly increased compared to the control and CKD-RDN groups [left ventricle: 4.1 ± 1.8 vs 0.8 ± 0.5 (102 μm2/mm2), P <.01; 4.1 ± 1.8 vs 0.9± 0.6 (102 μm2/mm2), P <.01; right ventricle: 3.6 ± 1.0 vs 1.0 ± 0.4 (102 μm2/mm2), P <.01; 3.6 ± 1.0 vs 1.0 ± 0.5 (102 μm2/mm2), P <.01]. CONCLUSION Neuromodulation by RDN demonstrated protective effects with less structural and electrical remodeling, leading to attenuated VAs. In a rabbit model of CKD, RDN plays a therapeutic role by lowering the risk of VA caused by autonomic dysfunction.
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Affiliation(s)
- Shin-Huei Liu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Yu-Hui Chou
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Lun Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tseng-Ying Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Han Cheng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shinya Yamada
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
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Huizar JF, Tan AY, Kaszala K, Ellenbogen KA. Clinical and translational insights on premature ventricular contractions and PVC-induced cardiomyopathy. Prog Cardiovasc Dis 2021; 66:17-27. [PMID: 33857575 PMCID: PMC9192164 DOI: 10.1016/j.pcad.2021.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 12/29/2022]
Abstract
The medical community's understanding of the consequences of premature ventricular contractions (PVCs) and PVC-induced cardiomyopathy has been derived mostly from observational and large population-based studies. Due to the difficulty of predicting the development of PVC-cardiomyopathy, the acute and chronic cardiac effects of PVCs and the mechanism of PVC-cardiomyopathy have been derived from pre-clinical studies with large animal models. Recently, these studies have described myocardial substrates that could potentially increase morbidity and mortality in patients with frequent PVCs and PVC-cardiomyopathy. In this paper, we provide an up-to-date comprehensive review of these pre-clinical and clinical studies.
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Affiliation(s)
- Jose F Huizar
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America; Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, United States of America.
| | - Alex Y Tan
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America; Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, United States of America
| | - Karoly Kaszala
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America; Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, United States of America
| | - Kenneth A Ellenbogen
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America
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Corrigendum to "Renal denervation regulates the atrial arrhythmogenic substrates through reverse structural remodeling in heart failure rabbit model" [international journal of cardiology 235(2017),105-113]. Int J Cardiol 2020; 316:188. [PMID: 32534798 DOI: 10.1016/j.ijcard.2020.05.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Yamada S, Lo LW, Chou YH, Lin WL, Chang SL, Lin YJ, Liu SH, Cheng WH, Tsai TY, Chen SA. Renal denervation ameliorates the risk of ventricular fibrillation in overweight and heart failure. Europace 2020; 22:657-666. [DOI: 10.1093/europace/euz335] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 12/02/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
Both obesity and heart failure (HF) are associated with sudden cardiac death. The current study aimed to investigate the effects of overweight and HF on the substrate for ventricular fibrillation (VF), and whether renal denervation (RDN) can protect the heart from sympathetic activation and cardiac remodelling in HF rabbits fed with high-fat diet (HFD).
Methods and results
Twenty-four rabbits randomized into control group fed with regular diet (Control), HFD, HFD-HF, and HFD-HF-RDN groups. Rapid ventricular pacing of 400 b.p.m. for 4 weeks was applied in HFD-HF and HFD-HF-RDN. Surgical and chemical RDNs were approached through bilateral retroperitoneal flank incisions in HFD-HF-RDN. All rabbits received electrophysiological study and a VF inducibility test. The ventricular myocardium was harvested for trichrome stain. After 3 months, mean body weight was heavier in HFD, compared with control (3.5 ± 0.1 kg vs. 2.6 ± 0.1 kg, P < 0.01). No differences in body weight among the three groups fed with HFD were observed. The ventricular refractory periods were longer in HFD-HF and HFD-HF-RDN than in control. An extension of ventricular fibrosis was observed in HFD and HFD-HF compared with control, and the degree of ventricular fibrosis was suppressed in HFD-HF-RDN compared with HFD-HF. The level of tyrosine hydroxylase staining was reduced in HFD-HF-RDN compared with HFD and HFD-HF. Importantly, VF inducibility was lower in HFD-RDN-HF (10 ± 4%), when compared with those in HFD-HF (58 ± 10%, P < 0.01) and HFD (42 ± 5%, P < 0.05), respectively.
Conclusion
Our results suggest that overweight and HF increase sympathetic activity, structural remodelling, and VF inducibility, but RDN prevents them.
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Affiliation(s)
- Shinya Yamada
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Hui Chou
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
| | - Wei-Lun Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shin-Huei Liu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Han Cheng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Tsung-Ying Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
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11
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Zhang WH, Zhou QN, Lu YM, Li YD, Zhang L, Zhang JH, Xing Q, Lv WK, Cheng XC, Zhang GG, Wang XS, Gu Q, Lou X, Guli B, Tang BP, Zhou XH. Renal Denervation Reduced Ventricular Arrhythmia After Myocardial Infarction by Inhibiting Sympathetic Activity and Remodeling. J Am Heart Assoc 2019; 7:e009938. [PMID: 30371294 PMCID: PMC6474949 DOI: 10.1161/jaha.118.009938] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Ventricular arrhythmia after myocardial infarction is the most important risk factor for sudden cardiac death, which poses a serious threat to human health. As the correlation between autonomic nervous systemic dysfunction and heart rhythm abnormality has been gradually revealed, remedies targeting autonomic nervous system dysfunction, especially the sympathetic nerve, have emerged. Among them, renal denervation is noted for its powerful effect on the inhibition of sympathetic nerve activity. We aim to investigate whether renal denervation can reduce ventricular arrhythmia after myocardial infarction and thus decrease the risk of sudden cardiac death. In addition, we explore the potential mechanism with respect to nerve activity and remodeling. Methods and Results Twenty-four beagles were randomized into the control (n=4), renal denervation (n=10), and sham (n=10) groups. Permanent left anterior descending artery ligation was performed to establish myocardial infarction in the latter 2 groups. Animals in the renal denervation group underwent both surgical and chemical renal denervation. Compared with dogs in the sham group, dogs in the renal denervation group demonstrated attenuated effective refractory period shortening and inhomogeneity, flattened restitution curve, increased ventricular threshold, and decreased ventricular arrhythmia. Heart rate variability assessment, catecholamine measurement, and nerve discharge recordings all indicated that renal denervation could reduce whole-body and local tissue sympathetic tone. Tissue analysis revealed a significant decrease in neural remodeling in both the heart and stellate ganglion. Conclusions Surgical and chemical renal denervation decreased whole-body and local tissue sympathetic activity and reversed neural remodeling in the heart and stellate ganglion. Consequently, renal denervation led to beneficial remodeling of the electrophysiological characteristics in the infarction border zone, translating to a decrease in ventricular arrhythmia after myocardial infarction.
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Affiliation(s)
- Wen-Hui Zhang
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Qi-Na Zhou
- 2 Xinjiang Key Laboratory of Medical Animal Model Research Clinical Medical Research Institute The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Yan-Mei Lu
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Yao-Dong Li
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Ling Zhang
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Jiang-Hua Zhang
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Qiang Xing
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Wen-Kui Lv
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Xin-Chun Cheng
- 3 Geriatric Center The People's Hospital of Xinjiang Uygur Autonomous Region Urumqi Xinjiang China
| | - Ge-Ge Zhang
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Xue-Sheng Wang
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Qi Gu
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Xue Lou
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Buajier Guli
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Bao-Peng Tang
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Xian-Hui Zhou
- 1 Cardiac Pacing and Electrophysiological Division The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
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12
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Qian PC, Barry MA, Lu J, Pouliopoulos J, Mina A, Bandodkar S, Alvarez S, James V, Ronquillo J, Varikatt W, Thiagalingam A, Thomas SP. Transvascular Pacing of Aorticorenal Ganglia Provides a Testable Procedural Endpoint for Renal Artery Denervation. JACC Cardiovasc Interv 2019; 12:1109-1120. [DOI: 10.1016/j.jcin.2019.04.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
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13
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Vicera JJB, Lo LW, Shinya Y, Chou YH, Lin YJ, Lo MT, Lin WL, Liu SH, Cheng WH, Tsai TY, Chen SA. Ultra-rapid high-density mapping system with the phase singularity technique is feasible in identifying rotors and focal sources and predicting AF termination. J Cardiovasc Electrophysiol 2019; 30:952-963. [PMID: 30983063 DOI: 10.1111/jce.13952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Phase singularity (PS) mapping provides additional insight into the AF mechanism and is accurate in identifying rotors. The study aimed to evaluate the feasibility of PS mapping in identifying AF rotors using data obtained from an automatic ultra-rapid high-resolution mapping system with a high-density mini-basket catheter. METHODS Twenty-three pigs underwent rapid right atrial (RA) pacing (RAP 480 bpm) for 5 weeks before the experiment. During AF, RA endocardial automatic continuous mappings with a mini-basket catheter were generated using an automatic ultra-rapid mapping system. Both fractionation mapping and waveform similarity measurements using a PS mapping algorithm were applied on the same recording signals to localize substrates maintaining AF. RESULTS Seventeen (74%) pigs developed sustained AF after RAP. Three were excluded because of periprocedural ventricular arrhythmia and corrupted digital data. RA fractionation maps were acquired with 6.17 ± 4.29 minutes mean acquisition time, 13768 ± 12698 acquisition points mapped during AF from 581 ± 387 beats. Fractionation mapping identified extensively distributed (66.7%) RA complex fractionated atrial electrogram (CFAE), whereas the nonlinear analysis identified high similarity index (SI > 0.7) parts in limited areas (23.7%). There was an average of 1.67 ± 0.87 SI sites with 0.43 ± 0.76 rotor/focal source/chamber. AF termination occurred in 11/16 (68.75%) AF events in 14 pigs during ablation targeting max CFAE. There was a higher incidence of rotor/focal source at AF termination sites compared with non-AF termination sites (54.5% vs 0%, P = 0.011). CONCLUSIONS The data obtained from ultra-rapid high-density automatic mapping is feasible and effective in identifying AF rotors/focal sources using PS technique, and those critical substrates were closely related to AF procedural termination.
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Affiliation(s)
- Jennifer Jeanne B Vicera
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yamada Shinya
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yu-Hui Chou
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Men-Tzung Lo
- Department of Biomedical Sciences and Engineering National Central University, Taoyuan, Taiwan
| | - Wei-Lun Lin
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shin-Huei Liu
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Han Cheng
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Tsung-Ying Tsai
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
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14
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The autonomic neural mechanism of right ventricular outflow tract tachycardia. Auton Neurosci 2018; 212:10-16. [DOI: 10.1016/j.autneu.2018.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/18/2018] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
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15
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Yamada S, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Chao TF, Liao JN, Lin CH, Lin CY, Chang YT, Te ALD, Liao YC, Chi PC, Chen SA. Electrocardiographic characteristics for predicting idiopathic right ventricular outflow tract premature ventricular complex-induced cardiomyopathy. J Interv Card Electrophysiol 2018; 53:175-185. [PMID: 29948583 DOI: 10.1007/s10840-018-0384-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/15/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE In spite of several proposed predictors for premature ventricular complex (PVC)-induced cardiomyopathy (PVC-CMP), the specific ECG features of idiopathic right ventricular outflow tract (RVOT) PVC-CMP remain unknown. METHODS A total of 130 patients (49 males, mean age 44 years) with symptomatic and drug-refractory idiopathic RVOT PVCs undergoing radiofrequency catheter ablation (RFCA) were enrolled. The patients were categorized into two groups, including those with and without RVOT PVC-CMP (left ventricular ejection fraction (LVEF) < 50%, n = 25 and LVEF ≥ 50%, n = 105, respectively). The 12-lead PVC morphologies were assessed. RESULTS Patients with RVOT PVC-CMP had a lower LVEF (42 ± 5% vs. 60 ± 7%, P < 0.01) and higher PVC burden (24 ± 14% vs. 15 ± 11%, P = 0.02) when compared to patients without RVOT PVC-CMP. The PVC features in those with PVC-CMP displayed a significantly wider QRS duration (143 ± 14 ms vs. 132 ± 17 ms, P < 0.01) and higher peak deflection index (PDI; 0.60 ± 0.07 vs. 0.55 ± 0.08, P < 0.01). A multivariate analysis demonstrated that the QRS duration (odds ratio (OR) 1.130, 95% confidence interval (CI) 1.020-1.253, P = 0.02) and PDI (OR 1.240, 95% CI 1.004-1.532, P = 0.04) were independently associated with RVOT PVC-CMP. Based on the receiver-operating characteristic analysis, a QRS duration > 139 ms and PDI > 0.57 could predict RVOT PVC-CMP (area under the curve (AUC) 0.710 and AUC 0.690, respectively). The elimination and suppression of PVCs by RFCA resulted in the recovery of the LVEF in RVOT PVC-CMP. CONCLUSIONS The ECG parameters, including a wider QRS duration and higher PDI, could predict the development of RVOT PVC-CMP, which could be effectively treated by RFCA.
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Affiliation(s)
- Shinya Yamada
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Fa-Po Chung
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chung-Hsing Lin
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Internal Medicine, Division of Cardiology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Yao-Ting Chang
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Abigail Louise D Te
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Ying-Chieh Liao
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Po-Ching Chi
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan. .,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
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16
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Linz D, Hohl M, Elliott AD, Lau DH, Mahfoud F, Esler MD, Sanders P, Böhm M. Modulation of renal sympathetic innervation: recent insights beyond blood pressure control. Clin Auton Res 2018; 28:375-384. [PMID: 29429026 DOI: 10.1007/s10286-018-0508-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/29/2018] [Indexed: 02/06/2023]
Abstract
Renal afferent and efferent sympathetic nerves are involved in the regulation of blood pressure and have a pathophysiological role in hypertension. Additionally, several conditions that frequently coexist with hypertension, such as heart failure, obstructive sleep apnea, atrial fibrillation, renal dysfunction, and metabolic syndrome, demonstrate enhanced sympathetic activity. Renal denervation (RDN) is an approach to reduce renal and whole body sympathetic activation. Experimental models indicate that RDN has the potential to lower blood pressure and prevent cardio-renal remodeling in chronic diseases associated with enhanced sympathetic activation. Studies have shown that RDN can reduce blood pressure in drug-naïve hypertensive patients and in hypertensive patients under drug treatment. Beyond its effects on blood pressure, sympathetic modulation by RDN has been shown to have profound effects on cardiac electrophysiology and cardiac arrhythmogenesis. RDN can display anti-arrhythmic effects in a variety of animal models for atrial fibrillation and ventricular arrhythmias. The first non-randomized studies demonstrate that RDN may promote the maintenance of sinus rhythm following catheter ablation in patients with atrial fibrillation. Registry data point towards a beneficial effect of RDN to prevent ventricular arrhythmias in patients with heart failure and electrical storm. Further large randomized placebo-controlled trials are needed to confirm the antihypertensive and anti-arrhythmic effects of RDN. Here, we will review the current literature on anti-arrhythmic effects of RDN with the focus on atrial fibrillation and ventricular arrhythmias. We will discuss new insights from preclinical and clinical mechanistic studies and possible clinical implications of RDN.
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Affiliation(s)
- Dominik Linz
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia. .,Centre for Heart Rhythm Disorders, Department of Cardiology, New Royal Adelaide Hospital, Adelaide, 5000, Australia.
| | - Mathias Hohl
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universität des Saarlandes, Saarbrücken, Germany
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Felix Mahfoud
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universität des Saarlandes, Saarbrücken, Germany.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Murray D Esler
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Michael Böhm
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universität des Saarlandes, Saarbrücken, Germany
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17
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Padmanabhan D, Isath A, Gersh B. Renal Denervation: Paradise Lost? Paradise Regained? US CARDIOLOGY REVIEW 2018. [DOI: 10.15420/usc.2018.1.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Renal denervation is a relatively recent concept whose initial promising results suffered a setback following the SYMPLICITY 3 trial, which did not show a significant blood pressure-lowering effect in comparison to sham. In this review article, we begin with the history including the physiological basis behind the concept of renal denervation. Furthermore, we review the literature in support of renal denervation, including the recently published SPYRAL HTN-OFF MED, which demonstrated significant blood pressure reduction in the absence of antihypertensive medication. We further touch upon the potential pitfalls and possible future directions of renal denervation.
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18
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Affiliation(s)
- Prashant D Bhave
- Divison of Cardiology, Wake Forest University Health Sciences Center, Winston-Salem, NC
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