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Scridon A. Autonomic imbalance and atrial ectopic activity-a pathophysiological and clinical view. Front Physiol 2022; 13:1058427. [PMID: 36531175 PMCID: PMC9755506 DOI: 10.3389/fphys.2022.1058427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/22/2022] [Indexed: 09/29/2023] Open
Abstract
The heart is one of the most richly innervated organs and the impact of the complex cardiac autonomic network on atrial electrophysiology and arrhythmogenesis, including on atrial ectopy, is widely recognized. The aim of this review is to discuss the main mechanisms involved in atrial ectopic activity. An overview of the anatomic and physiological aspects of the cardiac autonomic nervous system is provided as well as a discussion of the main pathophysiological pathways linking autonomic imbalance and atrial ectopic activity. The most relevant data on cardiac neuromodulation strategies are emphasized. Unanswered questions and hotspots for future research are also identified.
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Affiliation(s)
- Alina Scridon
- Physiology Department, Center for Advanced Medical and Pharmaceutical Research, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Târgu Mureș, Romania
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2
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Peng DW, Lai YY, Luo XS, Li X, Deng CY, Guo HM, Zhao JF, Yang H, Liu Y, Wang ZY, Xu YW, Kuang SJ, Wu SL, Xue YM, Rao F. Connexin 43 participates in atrial electrical remodelling through colocalization with calcium channels in atrial myocytes. Clin Exp Pharmacol Physiol 2021; 49:25-34. [PMID: 34438468 DOI: 10.1111/1440-1681.13580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
Atrial fibrillation (AF) is associated with atrial conduction disturbances caused by electrical and/or structural remodelling. In the present study, we hypothesized that connexin might interact with the calcium channel through forming a protein complex and, then, participates in the pathogenesis of AF. Western blot and whole-cell patch clamp showed that protein levels of Cav1.2 and connexin 43 (Cx43) and basal ICa , L were decreased in AF subjects compared to sinus rhythm (SR) controls. In cultured atrium-derived myocytes (HL-1 cells), knocking-down of Cx43 or incubation with 30 mmol/L glycyrrhetinic acid significantly inhibited protein levels of Cav1.2 and Cav3.1 and the current density of ICa , L and ICa , T . Incubation with nifedipine or mibefradil decreased the protein level of Cx43 in HL-1 cells. Moreover, Cx43 was colocalized with Cav1.2 and Cav3.1 in atrial myocytes. Therefore, Cx43 might regulate the ICa , L and ICa , T through colocalization with calcium channel subunits in atrial myocytes, representing a potential pathogenic mechanism in AF.
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Affiliation(s)
- De-Wei Peng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Ying-Yu Lai
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Xue-Shan Luo
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Xin Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Chun-Yu Deng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Hui-Ming Guo
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jun-Fei Zhao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hui Yang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Yang Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Zhao-Yu Wang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Yu-Wen Xu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Su-Juan Kuang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Shu-Lin Wu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Yu-Mei Xue
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Fang Rao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
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3
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Garg PK, Guan W, Nomura S, Weir N, Karger AB, Duprez D, Heckbert SR, Tsai MY. Plasma ω-3 and ω-6 PUFA Concentrations and Risk of Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis. J Nutr 2021; 151:1479-1486. [PMID: 33693794 PMCID: PMC8243886 DOI: 10.1093/jn/nxab016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/13/2020] [Accepted: 01/19/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Current literature examining the prospective relation of circulating omega-3 (n-3) and omega-6 (n-6) PUFAs and atrial fibrillation (AF) is limited to predominantly white populations. OBJECTIVES We investigated the association of circulating n-3 and n-6 PUFAs with incident AF in participants from the Multi-Ethnic Study of Atherosclerosis. METHODS A total of 6229 participants (mean age = 62 y; 53% female; 39% white, 27% black, 22% Hispanic, and 12% Chinese) who were free of baseline AF and with plasma phospholipid PUFAs measured at baseline using GC were prospectively followed for the development of AF. Incident AF was ascertained using International Classification of Diseases-9 codes from hospital discharge records and Medicare claims data with follow-up through 2014. Multivariable Cox proportional hazards regression analysis was performed to determine the risk of incident AF. RESULTS During a median follow-up of 12.9 y, 813 (13%) participants developed AF. Each higher SD increment in arachidonic acid (AA; 20:4n-6) concentrations was associated with an 11% decreased risk of incident AF (HR: 0.89; 95% CI: 0.82, 0.96). Similarly, higher overall n-6 PUFA concentrations were also associated with a reduced AF risk (HR per SD increment: 0.93; 95% CI: 0.87, 1.00). Although no significant overall associations were observed for any individual n-3 PUFAs, higher circulating concentrations of DHA (22:6n-3) and EPA (20:5n-3) were associated with a decreased AF risk in blacks and Hispanics (DHA only) but not whites or Chinese Americans. CONCLUSIONS In a multiethnic cohort of individuals free of baseline cardiovascular disease, higher plasma concentrations of n-6 PUFAs, particularly AA, were associated with a reduced risk of incident AF. Important differences in AF risk were also noted across race/ethnicity for the n-3 PUFAs DHA and EPA.
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Affiliation(s)
| | - Weihua Guan
- Division of Biostatistics, School of Public Health, University
of Minnesota, Minneapolis, MN, USA
| | - Sarah Nomura
- Department of Laboratory Medicine and Pathology, University of
Minnesota, Minneapolis, MN, USA
| | - Natalie Weir
- Department of Laboratory Medicine and Pathology, University of
Minnesota, Minneapolis, MN, USA
| | - Amy B Karger
- Department of Laboratory Medicine and Pathology, University of
Minnesota, Minneapolis, MN, USA
| | - Daniel Duprez
- Division of Cardiology, University of Minnesota,
Minneapolis, MN, USA
| | - Susan R Heckbert
- Department of Epidemiology, University of
Washington, Seattle, WA, USA
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of
Minnesota, Minneapolis, MN, USA
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4
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Abstract
Ion channels are critical for all aspects of cardiac function, including rhythmicity and contractility. Consequently, ion channels are key targets for therapeutics aimed at cardiac pathophysiologies such as atrial fibrillation or angina. At the same time, off-target interactions of drugs with cardiac ion channels can be the cause of unwanted side effects. This manuscript aims to review the physiology and pharmacology of key cardiac ion channels. The intent is to highlight recent developments for therapeutic development, as well as elucidate potential mechanisms for drug-induced cardiac side effects, rather than present an in-depth review of each channel subtype.
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5
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Benefits and risks of oral anticoagulation for stroke prevention in nonvalvular atrial fibrillation. Thromb Res 2012; 129:9-16. [DOI: 10.1016/j.thromres.2011.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 09/12/2011] [Accepted: 09/15/2011] [Indexed: 11/21/2022]
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Rhythm control strategies and the role of antiarrhythmic drugs in the management of atrial fibrillation: focus on clinical outcomes. J Gen Intern Med 2011; 26:531-7. [PMID: 21108047 PMCID: PMC3077493 DOI: 10.1007/s11606-010-1574-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 09/13/2010] [Accepted: 10/20/2010] [Indexed: 10/18/2022]
Abstract
Atrial fibrillation (AF) is a common disorder that significantly impacts the lives of affected patients. The restoration of sinus rhythm may prevent AF progression and reduce the occurrence of negative sequelae; however, available antiarrhythmic drugs (AADs) have largely failed to demonstrate significant benefit relative to rate control with respect to morbidity and mortality outcomes. The review commentary will address current knowledge regarding the pathologic mechanisms of AF, current trials that investigate rate and rhythm strategies, and future therapies that may change treatment approaches based on preliminary evidence suggesting a more favorable safety profile. The observed outcomes are likely a reflection of the limited efficacy plus poor safety and tolerability of available AADS. However, data from patients who attained and maintained sinus rhythm in a number of clinical studies demonstrate that the achievement of normal sinus rhythm can indeed reduce AF-associated morbidity and mortality. Furthermore, the results of trials designed to assess specific morbidity and mortality outcomes such as cardiovascular death hospitalization suggest that the development of safer AF therapies, whether pharmacologic or nonpharmacologic, can potentially improve clinical outcomes.
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7
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Simon H, Simon Demel K, Ritscher G, Turschner O, Brachmann J. [New developments in the antiarrhythmic therapy of atrial fibrillation]. Herzschrittmacherther Elektrophysiol 2010; 21:212-216. [PMID: 21107985 DOI: 10.1007/s00399-010-0093-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Atrial fibrillation, which is associated with a worsening of congestive heart failure symptoms, an increased rate of stoke, and increased mortality, is still difficult to treat. New therapies must not only increase effectiveness, but also have to have an improved safety profile, in order to avoid sodium channel block in the ventricle of older patients with atrial fibrillation, and also prevent electrical and morphological remodeling. Dronedarone is less effective compared to amiodarone, but has a better side effect profile which leads to fewer discontinuations of treatment. The atrial ion channels are specifically blocked by a number of prospective antiarrhythmic substances. The most advanced is the testing of vernakalant (RSD1235), which primarily suppresses the I(Kur) current. Ranolazine is a new antianginal substance which influences the atrial ion channels and leads to a significant reduction of atrial and more specifically ventricular tachyarrhythmias. A number of other drugs are in development. They will lead to a better understanding of which form of atrial fibrillation can be best treated with which antiarrhythmic agent.
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Affiliation(s)
- H Simon
- Kardiopulmonales Zentrum, Klinikum Coburg, Ketschendorferstr. 33, 96450, Coburg, Deutschland.
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8
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Naccarelli GV, Curtis AB. Optimizing the management of atrial fibrillation: focus on current guidelines and the impact of new agents on future recommendations. J Cardiovasc Pharmacol Ther 2010; 15:244-56. [PMID: 20562374 DOI: 10.1177/1074248410370964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in everyday clinical practice. It affects ~2.3 million individuals in the United States, and the prevalence is expected to increase ~2.5-fold over the next 40 years. Atrial fibrillation accounts for more than 2 million hospitalizations each year and contributes to nearly 67 000 deaths. Our understanding of the pathophysiology of AF has increased dramatically over the past few decades. Recent treatment guidelines have heightened our awareness of the challenges involved in the treatment of AF and provided useful recommendations for its diagnosis and management. Because AF is usually associated with multiple comorbid conditions, greater emphasis must be placed on individualizing treatment. This review focuses on current treatment guidelines for patients with AF, assessing the benefits and shortcomings of current pharmacologic options and discussing new agents and trials that may provide better opportunities to improve and individualize patient management.
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Affiliation(s)
- Gerald V Naccarelli
- Division of Cardiology, Penn State Heart & Vascular Institute, Hershey, PA 17033, USA.
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9
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Weeke P, Andersson C, Brendorp B, Torp-Pedersen C. Vernakalant (RSD1235) in the management of atrial fibrillation: a review of pharmacological properties, clinical efficacy and safety. Future Cardiol 2010; 4:559-67. [PMID: 19804350 DOI: 10.2217/14796678.4.6.559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Vernakalant (RSD1235) is a novel antiarrhythmic agent for conversion of rapid onset atrial fibrillation (AF). It is an atria-selective multichannel ion blocker (blocks I(Kur), I(Na), I(Ca, L), I(to) and I(Kr)), with a small effect on ventricular repolarization. In clinical Phase II and III studies, vernakalant was moderately (approximately 50%) effective in converting AF of short duration (< 7 days), and effective (approximately 70-80%) in converting AF of less than 72 h, but was not effective in converting long duration AF (>7 days) or atrial flutter. Vernakalant seems to have only a small proarrhythmic effect, with no reported cases of torsades de pointes in direct relation to vernakalant administration in Phase II and III studies. Overall, there are few reported serious adverse events.
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Affiliation(s)
- Peter Weeke
- Dept Cardiology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
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10
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Drici MD. [New antiarrhythmic drugs for atrial fibrillation]. Ann Cardiol Angeiol (Paris) 2009; 58 Suppl 1:S61-S63. [PMID: 20103186 DOI: 10.1016/s0003-3928(09)73404-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The development of new antiarrhythmic drugs is mainly aimed to treat atrial fibrillation, because of its prevalence and major consequences in terms cerebral vascular thrombosis. Specific blockade of I(Na) et I(K), even if efficacious, have previously shown to be proarrhythmogenic, with a global impairment of the cardiac patient's outcome. This lead to the development of new drugs, selectively targeting atrial currents such as I(Kur) ou I(KAch). The efficacy of amiodarone in treatment of atrial fibrillation has also yielded a whole array of new antiarrhythmic drugs targeting both these atrial currents but also sharing amiodarone pharmacodynamics properties. This renders the Vaughan-Williams classification ill-adapted for such drugs.
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Affiliation(s)
- M-D Drici
- Service de Pharmacologie-Toxicologie, Hôpital Pasteur, 30, Avenue de Voie Romaine, 06002 Nice cedex 01, France.
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11
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Dhein S, Hagen A, Jozwiak J, Dietze A, Garbade J, Barten M, Kostelka M, Mohr FW. Improving cardiac gap junction communication as a new antiarrhythmic mechanism: the action of antiarrhythmic peptides. Naunyn Schmiedebergs Arch Pharmacol 2009; 381:221-34. [PMID: 19943035 DOI: 10.1007/s00210-009-0473-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 11/08/2009] [Indexed: 12/22/2022]
Abstract
Co-ordinated electrical activation of the heart is maintained by intercellular coupling of cardiomyocytes via gap junctional channels located in the intercalated disks. These channels consist of two hexameric hemichannels, docked to each other, provided by either of the adjacent cells. Thus, a complete gap junction channel is made from 12 protein subunits, the connexins. While 21 isoforms of connexins are presently known, cardiomyocytes typically are coupled by Cx43 (most abundant), Cx40 or Cx45. Some years ago, antiarrhythmic peptides were discovered and synthesised, which were shown to increase macroscopic gap junction conductance (electrical coupling) and enhance dye transfer (metabolic coupling). The lead substance of these peptides is AAP10 (H-Gly-Ala-Gly-Hyp-Pro-Tyr-CONH(2)), a peptide with a horseshoe-like spatial structure as became evident from two-dimensional nuclear magnetic resonance studies. A stable D: -amino-acid derivative of AAP10, rotigaptide, as well as a non-peptide analogue, gap-134, has been developed in recent years. Antiarrhythmic peptides act on Cx43 and Cx45 gap junctions but not on Cx40 channels. AAP10 has been shown to enhance intercellular communication in rat, rabbit and human cardiomyocytes. Antiarrhythmic peptides are effective against ventricular tachyarrhythmias, such as late ischaemic (type IB) ventricular fibrillation, CaCl(2) or aconitine-induced arrhythmia. Interestingly, the effect of antiarrhythmic peptides is higher in partially uncoupled cells and was shown to be related to maintained Cx43 phosphorylation, while arrhythmogenic conditions like ischaemia result in Cx43 dephosphorylation and intercellular decoupling. It is still a matter of debate whether these drugs also act against atrial fibrillation. The present review outlines the development of this group of peptides and derivatives, their mode of action and molecular mechanisms, and discusses their possible therapeutic potential.
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Affiliation(s)
- Stefan Dhein
- Clinic for Cardiac Surgery, University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany.
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12
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Gopinathannair R, Sullivan RM, Olshansky B. Update on medical management of atrial fibrillation in the modern era. Heart Rhythm 2009; 6:S17-22. [DOI: 10.1016/j.hrthm.2009.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Indexed: 11/29/2022]
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13
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Abstract
Amiodarone and dronedarone are two clinically important benzofuran derivatives. Amiodarone has been used widely for treating resistant tachyarrhythmias in the past three decades. However amiodarone and its main metabolically active metabolite desethylamiodarone can adversely affect many organs, including the thyroid gland. Amiodarone-induced thyroid disorders are common and often present as a management challenge for endocrinologists. The pathogenesis of amiodarone-induced thyroid dysfunction is complex but the inherent effects of the drug itself as well as its high iodine content appear to play a central role. The non-iodinated dronedarone also exhibits anti-arrhythmic properties but appears to be less toxic to the thyroid. This review describes the biochemistry of benzofuran derivatives, including their pharmacology and the physiology necessary for understanding the cellular mechanisms involved in their actions. The known effects of these compounds on thyroid action are described. Recommendations for management of amiodarone-induced hypothyroidism and thyrotoxicosis are suggested. Dronedarone appears to be an alternative but less-effective anti-arrhythmic agent and it does not have adverse effects on thyroid function. It may have a future role as an alternative agent in patients being considered for amiodarone therapy especially those at high risk of developing thyroid dysfunction but not in severe heart failure.
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Affiliation(s)
- T S Han
- Department of Endocrinology, Royal Free and University College Medical School, Royal Free Hospital, Hampstead, London NW3 2QG, UK
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14
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Abstract
Pharmacologic antiarrhythmic therapy is the most commonly used treatment in most patients with atrial fibrillation (AF), but currently available agents are limited by risks that may offset the benefits of sinus rhythm. The development of antiarrhythmic agents with the potential for fewer adverse ventricular effects and less extracardiac toxicity is a primary aim of current investigations. At present, pharmacologic research is actively focused on developing antiarrhythmic agents with multiple or novel ion channel effects. There are 4 agents that act by simultaneously blocking multiple ion channels that are currently under regulatory review: azimilide dihydrochloride, tedisamil, dronedarone, and vernakalant (RSD-1235). In addition, agents with mechanisms of action that differ from those of existing agents (eg, gap junction modulators) are under review, as is the use of nonantiarrhythmic agents (eg, renin-angiotensin system antagonists, statins, n-3 polyunsaturated fatty acids) to alter the cardiac substrate and suppress AF in some patient subtypes.
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Affiliation(s)
- Emily Conway
- Division of Cardiovascular Diseases, Main Line Health Heart Center, Wynnewood, Pennsylvania 19096, USA
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Atrial Fibrillation and the Expanding Role of Catheter Ablation: Do Antiarrhythmic Drugs Have a Future? J Cardiovasc Pharmacol 2008; 52:203-9. [DOI: 10.1097/fjc.0b013e318175dd73] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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COHEN MARC, NACCARELLI GERALDV. Pathophysiology and Disease Progression of Atrial Fibrillation: Importance of Achieving and Maintaining Sinus Rhythm. J Cardiovasc Electrophysiol 2008; 19:885-90. [DOI: 10.1111/j.1540-8167.2008.01134.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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17
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Hashimoto Y. [Research and development strategy of anti-atrial fibrillation agents]. Nihon Yakurigaku Zasshi 2008; 131:452-456. [PMID: 18552448 DOI: 10.1254/fpj.131.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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18
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Naccarelli GV, Wolbrette DL, Samii S, Banchs JE, Penny-Peterson E, Stevenson R, Gonzalez MD. Vernakalant – a promising therapy for conversion of recent-onset atrial fibrillation. Expert Opin Investig Drugs 2008; 17:805-10. [DOI: 10.1517/13543784.17.5.805] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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