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Shibata K, Wakabayashi K, Ikeda N, Ishinaga T, Kusakabe Y, Masaki A, Aizawa N, Shimazu S, Furuya T, Nakamura Y, Sato C, Nishikura T, Shiigai M, Mutou M, Honye J, Tanno K. Clinical Implications of Atrial Fibrillation Provoked by Acetylcholine. Circ Arrhythm Electrophysiol 2024; 17:e013015. [PMID: 39166329 DOI: 10.1161/circep.124.013015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
Affiliation(s)
- Keita Shibata
- Division of Cardiology, Cardiovascular Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (K.S., K.W., N.I., T.I., Y.K., A.M., N.A., T.F., C.S., T.N., K.T.)
| | - Kohei Wakabayashi
- Division of Cardiology, Cardiovascular Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (K.S., K.W., N.I., T.I., Y.K., A.M., N.A., T.F., C.S., T.N., K.T.)
| | - Naoko Ikeda
- Division of Cardiology, Cardiovascular Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (K.S., K.W., N.I., T.I., Y.K., A.M., N.A., T.F., C.S., T.N., K.T.)
| | - Tomoyuki Ishinaga
- Division of Cardiology, Cardiovascular Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (K.S., K.W., N.I., T.I., Y.K., A.M., N.A., T.F., C.S., T.N., K.T.)
| | - Yuta Kusakabe
- Division of Cardiology, Cardiovascular Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (K.S., K.W., N.I., T.I., Y.K., A.M., N.A., T.F., C.S., T.N., K.T.)
| | - Asakawa Masaki
- Division of Cardiology, Cardiovascular Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (K.S., K.W., N.I., T.I., Y.K., A.M., N.A., T.F., C.S., T.N., K.T.)
| | - Naoki Aizawa
- Division of Cardiology, Cardiovascular Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (K.S., K.W., N.I., T.I., Y.K., A.M., N.A., T.F., C.S., T.N., K.T.)
| | - Suguru Shimazu
- Division of Cardiology, Showa University Northern Yokohama Hospital, Japan (S.S.)
| | - Takahiro Furuya
- Division of Cardiology, Cardiovascular Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (K.S., K.W., N.I., T.I., Y.K., A.M., N.A., T.F., C.S., T.N., K.T.)
| | - Yuya Nakamura
- Division of Cardiology, Showa University Hospital, Tokyo, Japan (Y.N.)
| | - Chisato Sato
- Division of Cardiology, Cardiovascular Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (K.S., K.W., N.I., T.I., Y.K., A.M., N.A., T.F., C.S., T.N., K.T.)
| | - Tenjin Nishikura
- Division of Cardiology, Cardiovascular Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (K.S., K.W., N.I., T.I., Y.K., A.M., N.A., T.F., C.S., T.N., K.T.)
| | - Masaru Shiigai
- Department of Cardiovascular Medicine, Kikuna Memorial Hospital, Yokohama, Japan (M.S., M.M., J.H.)
| | - Mitsunori Mutou
- Department of Cardiovascular Medicine, Kikuna Memorial Hospital, Yokohama, Japan (M.S., M.M., J.H.)
| | - Junko Honye
- Department of Cardiovascular Medicine, Kikuna Memorial Hospital, Yokohama, Japan (M.S., M.M., J.H.)
| | - Kaoru Tanno
- Division of Cardiology, Cardiovascular Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (K.S., K.W., N.I., T.I., Y.K., A.M., N.A., T.F., C.S., T.N., K.T.)
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Dong XN, Li MT. Inhibitory effect of aloperine on transient outward potassium currents in rat cardiac myocytes. Front Pharmacol 2024; 15:1372973. [PMID: 38606176 PMCID: PMC11007096 DOI: 10.3389/fphar.2024.1372973] [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: 01/19/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
Objective Aloperine (ALO) is an effective quinolizidine alkaloid. Previous research has demonstrated its antiarrhythmic effect by inhibiting voltage-gated sodium currents in rat ventricular myocytes. This study explored its effect on transient outward potassium currents (Ito) in rat atrial myocytes to identify potential targets in the context of ion channel currents. Methods The Ito characteristics in rat atrial myocytes were recorded using a whole-cell patch-clamp technique. Molecular docking was performed to validate ligand-protein binding interactions. Results ALO at concentrations of 3 and 10 μM significantly reduced Ito current densities. Gating kinetics analysis revealed ALO's ability to slow Ito activation, hasten inactivation, and prolong transition from inactive to resting state. Molecular docking revealed that ALO could stably bind to KCND2. Conclusion ALO may inhibit Ito by slowing the activation process, accelerating inactivation, and delaying the recovery time after inactivation, potentially preventing acetylcholine-induced AF.
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Affiliation(s)
- Xiao-Na Dong
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Meng-Ting Li
- Baoying County Traditional Chinese Medicine Hospital, Yangzhou, China
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Celotto C, Sánchez C, Abdollahpur M, Sandberg F, Rodriguez Mstas JF, Laguna P, Pueyo E. The frequency of atrial fibrillatory waves is modulated by the spatiotemporal pattern of acetylcholine release: a 3D computational study. Front Physiol 2024; 14:1189464. [PMID: 38235381 PMCID: PMC10791938 DOI: 10.3389/fphys.2023.1189464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 10/10/2023] [Indexed: 01/19/2024] Open
Abstract
In atrial fibrillation (AF), the ECG P-wave, which represents atrial depolarization, is replaced with chaotic and irregular fibrillation waves (f waves). The f-wave frequency, F f, shows significant variations over time. Cardiorespiratory interactions regulated by the autonomic nervous system have been suggested to play a role in such variations. We conducted a simulation study to test whether the spatiotemporal release pattern of the parasympathetic neurotransmitter acetylcholine (ACh) modulates the frequency of atrial reentrant circuits. Understanding parasympathetic involvement in AF may guide more effective treatment approaches and could help to design autonomic markers alternative to heart rate variability (HRV), which is not available in AF patients. 2D tissue and 3D whole-atria models of human atrial electrophysiology in persistent AF were built. Different ACh release percentages (8% and 30%) and spatial ACh release patterns, including spatially random release and release from ganglionated plexi (GPs) and associated nerves, were considered. The temporal pattern of ACh release, ACh(t), was simulated following a sinusoidal waveform of frequency 0.125 Hz to represent the respiratory frequency. Different mean concentrations ( A C h ¯ ) and peak-to-peak ranges of ACh (ΔACh) were tested. We found that temporal variations in F f, F f(t), followed the simulated temporal ACh(t) pattern in all cases. The temporal mean of F f(t), F ¯ f , depended on the fibrillatory pattern (number and location of rotors), the percentage of ACh release nodes and A C h ¯ . The magnitude of F f(t) modulation, ΔF f, depended on the percentage of ACh release nodes and ΔACh. The spatial pattern of ACh release did not have an impact on F ¯ f and only a mild impact on ΔF f. The f-wave frequency, being indicative of vagal activity, has the potential to drive autonomic-based therapeutic actions and could replace HRV markers not quantifiable from AF patients.
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Affiliation(s)
- Chiara Celotto
- BSICoS Group, I3A and IIS-Aragón, University of Zaragoza, Zaragoza, Spain
- CIBER - Bioingeniería, Biomateriales, y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - Carlos Sánchez
- BSICoS Group, I3A and IIS-Aragón, University of Zaragoza, Zaragoza, Spain
- CIBER - Bioingeniería, Biomateriales, y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | | | - Frida Sandberg
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | | | - Pablo Laguna
- BSICoS Group, I3A and IIS-Aragón, University of Zaragoza, Zaragoza, Spain
- CIBER - Bioingeniería, Biomateriales, y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - Esther Pueyo
- BSICoS Group, I3A and IIS-Aragón, University of Zaragoza, Zaragoza, Spain
- CIBER - Bioingeniería, Biomateriales, y Nanomedicina (CIBER-BBN), Zaragoza, Spain
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4
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Bennett M, Nault I, Koehle M, Wilton S. Air Pollution and Arrhythmias. Can J Cardiol 2023; 39:1253-1262. [PMID: 37023893 DOI: 10.1016/j.cjca.2023.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/17/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
Air pollution is commonly defined as the contamination of the air we breathe by any chemical, physical, or biological agent that is potentially threatening to human and ecosystem health. The common pollutants known to be disease-causing are particulate matter, ground-level ozone, sulphur dioxide, nitrogen dioxide, and carbon monoxide. Although the association between increasing concentrations of these pollutants and cardiovascular disease is now accepted, the association of air pollution and arrhythmias is less well established. In this review we provide an in-depth discussion of the association of acute and chronic air pollution exposure and arrhythmia incidence, morbidity, and mortality, and the purported pathophysiological mechanisms. Increases in concentrations of air pollutants have multiple proarrhythmic mechanisms including systemic inflammation (via increases in reactive oxygen species, tumour necrosis factor, and direct effects from translocated particulate matter), structural remodelling (via an increased risk of atherosclerosis and myocardial infarction or by affecting the cell-to-cell coupling and gap junction function), and mitochondrial and autonomic dysfunction. Furthermore, we describe the associations of air pollution and arrhythmias. There is a strong correlation of acute and chronic air pollutant exposure and the incidence of atrial fibrillation. Acute increases in air pollution increase the risk of emergency room visits and hospital admissions for atrial fibrillation and the risk of stroke and mortality in patients with atrial fibrillation. Similarly, there is a strong correlation of increases of air pollutants and the risk of ventricular arrhythmias, out-of-hospital cardiac arrest, and sudden cardiac death.
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Affiliation(s)
- Matthew Bennett
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Isabelle Nault
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Quebec, Canada
| | - Michael Koehle
- Division of Sport and Exercise Medicine, School of Kinesiology and Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Wilton
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
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5
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Musikantow DR, Reddy VY, Skalsky I, Shaburishvili T, van Zyl M, O'Brien B, Coffey K, Reilly J, Neuzil P, Asirvatham S, de Groot JR. Targeted ablation of epicardial ganglionated plexi during cardiac surgery with pulsed field electroporation (NEURAL AF). J Interv Card Electrophysiol 2023:10.1007/s10840-023-01615-8. [PMID: 37561246 DOI: 10.1007/s10840-023-01615-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/30/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Modulation of the cardiac autonomic nervous system (ANS) is a promising adjuvant therapy in the treatment of atrial fibrillation (AF). In pre-clinical models, pulsed field (PF) energy has the advantage of selectively ablating the epicardial ganglionated plexi (GP) that govern the ANS. This study aims to demonstrate the feasibility and safety of epicardial ablation of the GPs with PF during cardiac surgery with a primary efficacy outcome of prolongation of the atrial effective refractory period (AERP). METHODS In a single-arm, prospective analysis, patients with or without a history of AF underwent epicardial GP ablation with PF during coronary artery bypass grafting (CABG). AERP was determined immediately pre- and post- GP ablation to assess cardiac ANS function. Holter monitors were performed to determine rhythm status and heart rate variability (HRV) at baseline and at 1-month post-procedure. RESULTS Of 24 patients, 23 (96%) received the full ablation protocol. No device-related adverse effects were noted. GP ablation resulted in a 20.7 ± 19.9% extension in AERP (P < 0.001). Post-operative AF was observed in 7 (29%) patients. Holter monitoring demonstrated an increase in mean heart rate (74.0 ± 8.7 vs. 80.6 ± 12.3, P = 0.01). There were no significant changes in HRV. There were no study-related complications. CONCLUSIONS This study demonstrates the safety and feasibility of epicardial ablation of the GP using PF to modulate the ANS during cardiac surgery. Large, randomized analyses are necessary to determine whether epicardial PF ablation can offer a meaningful impact on the cardiac ANS and reduce AF. TRIAL REGISTRATION Clinical trial registration: NCT04775264.
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Affiliation(s)
- Daniel R Musikantow
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, Box 1030, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, Box 1030, One Gustave L. Levy Place, New York, NY, 10029, USA.
- Homolka Hospital, Prague, Czech Republic.
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Celotto C, Sánchez C, Mountris KA, Laguna P, Pueyo E. Steady-state and transient effects of SK channel block and adrenergic stimulation to counteract acetylcholine-induced arrhythmogenic effects in the human atria: A computational study. Comput Biol Med 2023; 157:106719. [PMID: 36907032 DOI: 10.1016/j.compbiomed.2023.106719] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 02/17/2023] [Accepted: 02/26/2023] [Indexed: 03/07/2023]
Abstract
Hyperactivity of the parasympathetic nervous system has been linked to the development of paroxysmal atrial fibrillation (AF). The parasympathetic neurotransmitter acetylcholine (ACh) causes a reduction in action potential (AP) duration (APD) and an increase in resting membrane potential (RMP), both of which contribute to enhance the risk for reentry. Research suggests that small-conductance calcium activated potassium (SK) channels may be an effective target for treating AF. Therapies targeting the autonomic nervous system, either alone or in combination with other drugs, have been explored and have been shown to decrease the incidence of atrial arrhythmias. This study uses computational modeling and simulation to examine the impact of SK channel block (SKb) and β-adrenergic stimulation through Isoproterenol (Iso) on countering the negative effects of cholinergic activity in human atrial cell and 2D tissue models. The steady-state effects of Iso and/or SKb on AP shape, APD at 90% repolarization (APD90) and RMP were evaluated. The ability to terminate stable rotational activity in cholinergically-stimulated 2D tissue models of AF was also investigated. A range of SKb and Iso application kinetics, which reflect varying drug binding rates, were taken into consideration. The results showed that SKb alone prolonged APD90 and was able to stop sustained rotors in the presence of ACh concentrations up to 0.01 μM. Iso terminated rotors under all tested ACh concentrations, but resulted in highly-variable steady-state outcomes depending on baseline AP morphology. Importantly, the combination of SKb and Iso resulted in greater APD90 prolongation and showed promising anti-arrhythmic potential by stopping stable rotors and preventing re-inducibility.
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Affiliation(s)
- Chiara Celotto
- BSICoS Group, I3A and IIS-Aragón, University of Zaragoza, Spain; CIBER - Bioingeniería, Biomateriales, y Nanomedicina (CIBER-BBN), Zaragoza, Spain.
| | - Carlos Sánchez
- BSICoS Group, I3A and IIS-Aragón, University of Zaragoza, Spain; CIBER - Bioingeniería, Biomateriales, y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | | | - Pablo Laguna
- BSICoS Group, I3A and IIS-Aragón, University of Zaragoza, Spain; CIBER - Bioingeniería, Biomateriales, y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - Esther Pueyo
- BSICoS Group, I3A and IIS-Aragón, University of Zaragoza, Spain; CIBER - Bioingeniería, Biomateriales, y Nanomedicina (CIBER-BBN), Zaragoza, Spain
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7
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Butova X, Myachina T, Simonova R, Kochurova A, Bozhko Y, Arkhipov M, Solovyova O, Kopylova G, Shchepkin D, Khokhlova A. Peculiarities of the Acetylcholine Action on the Contractile Function of Cardiomyocytes from the Left and Right Atria in Rats. Cells 2022; 11:cells11233809. [PMID: 36497067 PMCID: PMC9737865 DOI: 10.3390/cells11233809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022] Open
Abstract
Acetylcholine (ACh) is the neurotransmitter of the parasympathetic nervous system that modulates cardiac function, and its high concentrations may induce atrial fibrillation. We compared the ACh action on the mechanical function of single cardiomyocytes from the left atria (LA) and the right atria (RA). We exposed single rat LA and RA cardiomyocytes to 1, 10, and 100 µM ACh for 10-15 min and measured the parameters of sarcomere shortening-relengthening and cytosolic calcium ([Ca2+]i) transients during cell contractions. We also studied the effects of ACh on cardiac myosin function using an in vitro motility assay and analyzed the phosphorylation level of sarcomeric proteins. In LA cardiomyocytes, ACh decreased the time to peak sarcomere shortening, time to 50% relengthening, and time to peak [Ca2+]i transients. In RA cardiomyocytes, ACh affected the time of shortening and relengthening only at 10 µM. In the in vitro motility assay, ACh reduced to a greater extent the sliding velocity of F-actin over myosin from LA cardiomyocytes, which was accompanied by a more pronounced decrease in phosphorylation of the myosin regulatory light chain (RLC) in LA cardiomyocytes than in RA cardiomyocytes. Our findings indicate that ACh plays an important role in modulating the contractile function of LA and RA, provoking more pronounced changes in the time course of sarcomere shortening-relengthening and the kinetics of actin-myosin interaction in LA cardiomyocytes.
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Affiliation(s)
- Xenia Butova
- Institute of Immunology and Physiology, Russian Academy of Sciences, Pervomajskaya Str. 106, 620049 Yekaterinburg, Russia
| | - Tatiana Myachina
- Institute of Immunology and Physiology, Russian Academy of Sciences, Pervomajskaya Str. 106, 620049 Yekaterinburg, Russia
| | - Raisa Simonova
- Institute of Immunology and Physiology, Russian Academy of Sciences, Pervomajskaya Str. 106, 620049 Yekaterinburg, Russia
| | - Anastasia Kochurova
- Institute of Immunology and Physiology, Russian Academy of Sciences, Pervomajskaya Str. 106, 620049 Yekaterinburg, Russia
| | - Yakov Bozhko
- Department of Therapy, Ural State Medical University, Repina Str. 3, 620028 Yekaterinburg, Russia
| | - Michael Arkhipov
- Department of Therapy, Ural State Medical University, Repina Str. 3, 620028 Yekaterinburg, Russia
| | - Olga Solovyova
- Institute of Immunology and Physiology, Russian Academy of Sciences, Pervomajskaya Str. 106, 620049 Yekaterinburg, Russia
- Institute of Natural Sciences and Mathematics, Ural Federal University, Mira 19, 620002 Yekaterinburg, Russia
| | - Galina Kopylova
- Institute of Immunology and Physiology, Russian Academy of Sciences, Pervomajskaya Str. 106, 620049 Yekaterinburg, Russia
| | - Daniil Shchepkin
- Institute of Immunology and Physiology, Russian Academy of Sciences, Pervomajskaya Str. 106, 620049 Yekaterinburg, Russia
| | - Anastasia Khokhlova
- Institute of Immunology and Physiology, Russian Academy of Sciences, Pervomajskaya Str. 106, 620049 Yekaterinburg, Russia
- Institute of Natural Sciences and Mathematics, Ural Federal University, Mira 19, 620002 Yekaterinburg, Russia
- Correspondence:
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8
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Verkerk AO, Doszpod IJ, Mengarelli I, Magyar T, Polyák A, Pászti B, Efimov IR, Wilders R, Koncz I. Acetylcholine Reduces L-Type Calcium Current without Major Changes in Repolarization of Canine and Human Purkinje and Ventricular Tissue. Biomedicines 2022; 10:biomedicines10112987. [PMID: 36428555 PMCID: PMC9687254 DOI: 10.3390/biomedicines10112987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
Abstract
Vagal nerve stimulation (VNS) holds a strong basis as a potentially effective treatment modality for chronic heart failure, which explains why a multicenter VNS study in heart failure with reduced ejection fraction is ongoing. However, more detailed information is required on the effect of acetylcholine (ACh) on repolarization in Purkinje and ventricular cardiac preparations to identify the advantages, risks, and underlying cellular mechanisms of VNS. Here, we studied the effect of ACh on the action potential (AP) of canine Purkinje fibers (PFs) and several human ventricular preparations. In addition, we characterized the effects of ACh on the L-type Ca2+ current (ICaL) and AP of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) and performed computer simulations to explain the observed effects. Using microelectrode recordings, we found a small but significant AP prolongation in canine PFs. In the human myocardium, ACh slightly prolonged the AP in the midmyocardium but resulted in minor AP shortening in subepicardial tissue. Perforated patch-clamp experiments on hiPSC-CMs demonstrated that 5 µM ACh caused an ≈15% decrease in ICaL density without changes in gating properties. Using dynamic clamp, we found that under blocked K+ currents, 5 µM ACh resulted in an ≈23% decrease in AP duration at 90% of repolarization in hiPSC-CMs. Computer simulations using the O'Hara-Rudy human ventricular cell model revealed that the overall effect of ACh on AP duration is a tight interplay between the ACh-induced reduction in ICaL and ACh-induced changes in K+ currents. In conclusion, ACh results in minor changes in AP repolarization and duration of canine PFs and human ventricular myocardium due to the concomitant inhibition of inward ICaL and outward K+ currents, which limits changes in net repolarizing current and thus prevents major changes in AP repolarization.
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Affiliation(s)
- Arie O. Verkerk
- Department of Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Illés J. Doszpod
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, 6721 Szeged, Hungary
| | - Isabella Mengarelli
- Department of Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Tibor Magyar
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, 6721 Szeged, Hungary
| | - Alexandra Polyák
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, 6721 Szeged, Hungary
| | - Bence Pászti
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, 6721 Szeged, Hungary
| | - Igor R. Efimov
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, IL 60611, USA
- Department of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Ronald Wilders
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Correspondence: (R.W.); (I.K.)
| | - István Koncz
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, 6721 Szeged, Hungary
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
- Correspondence: (R.W.); (I.K.)
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9
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Feng Y, Roney CH, Bayer JD, Niederer SA, Hocini M, Vigmond EJ. Detection of focal source and arrhythmogenic substrate from body surface potentials to guide atrial fibrillation ablation. PLoS Comput Biol 2022; 18:e1009893. [PMID: 35312675 PMCID: PMC8970486 DOI: 10.1371/journal.pcbi.1009893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 03/31/2022] [Accepted: 02/02/2022] [Indexed: 11/18/2022] Open
Abstract
Focal sources (FS) are believed to be important triggers and a perpetuation mechanism for paroxysmal atrial fibrillation (AF). Detecting FS and determining AF sustainability in atrial tissue can help guide ablation targeting. We hypothesized that sustained rotors during FS-driven episodes indicate an arrhythmogenic substrate for sustained AF, and that non-invasive electrical recordings, like electrocardiograms (ECGs) or body surface potential maps (BSPMs), could be used to detect FS and AF sustainability. Computer simulations were performed on five bi-atrial geometries. FS were induced by pacing at cycle lengths of 120-270 ms from 32 atrial sites and four pulmonary veins. Self-sustained reentrant activities were also initiated around the same 32 atrial sites with inexcitable cores of radii of 0, 0.5 and 1 cm. FS fired for two seconds and then AF inducibility was tested by whether activation was sustained for another second. ECGs and BSPMs were simulated. Equivalent atrial sources were extracted using second-order blind source separation, and their cycle length, periodicity and contribution, were used as features for random forest classifiers. Longer rotor duration during FS-driven episodes indicates higher AF inducibility (area under ROC curve = 0.83). Our method had accuracy of 90.6±1.0% and 90.6±0.6% in detecting FS presence, and 93.1±0.6% and 94.2±1.2% in identifying AF sustainability, and 80.0±6.6% and 61.0±5.2% in determining the atrium of the focal site, from BSPMs and ECGs of five atria. The detection of FS presence and AF sustainability were insensitive to vest placement (±9.6%). On pre-operative BSPMs of 52 paroxysmal AF patients, patients classified with initiator-type FS on a single atrium resulted in improved two-to-three-year AF-free likelihoods (p-value < 0.01, logrank tests). Detection of FS and arrhythmogenic substrate can be performed from ECGs and BSPMs, enabling non-invasive mapping towards mechanism-targeted AF treatment, and malignant ectopic beat detection with likely AF progression.
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Affiliation(s)
- Yingjing Feng
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac-Bordeaux, France
- Univ. Bordeaux, IMB, UMR 5251, Talence, France
| | - Caroline H. Roney
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Jason D. Bayer
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac-Bordeaux, France
- Univ. Bordeaux, IMB, UMR 5251, Talence, France
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Mélèze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac-Bordeaux, France
- Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, Pessac, France
| | - Edward J. Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac-Bordeaux, France
- Univ. Bordeaux, IMB, UMR 5251, Talence, France
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10
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Gu K, Yan S, Wu X. Effect of anisotropy in myocardial electrical conductivity on lesion characteristics during radiofrequency cardiac ablation: a numerical study. Int J Hyperthermia 2022; 39:120-133. [PMID: 35000495 DOI: 10.1080/02656736.2021.2022220] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Traditional computer simulation studies of radiofrequency catheter ablation (RFCA) usually neglect the anisotropy in myocardial electrical conductivity (MEC), which is likely an essential factor in governing the ablation outcome. Here, a numerical study of lesion characteristics during RFCA based on an anatomy-based model incorporating fiber orientation was performed to investigate the anisotropy in MEC. METHODS A three-dimensional thorax model including atria, blood, connective tissue, muscle, fat, and skin was constructed. The myocardial fiber was established through a rule-based method (RBM) based on the anatomical structure of the heart. The anisotropic MEC were 0.40 and 0.28 S m-1 in longitudinal and transverse directions, respectively. The ablation result was compared with the isotropic scenario where the isotropic MEC was the average of the anisotropic conductivities as 0.34 S m-1. RESULTS The complexity of fiber architecture varied with that of the local anatomical structure. At RF power of 20 W for 30 s, the tissue temperature and lesion volume were reduced by 2.8 ± 0.1% and 6.9 ± 0.5%, respectively, under anisotropic MEC around the ostium of the pulmonary vein and left atrial appendage. Those for the posterior wall and roof of the left atrium, and the inside of the superior vena cava were 1.9 ± 0.3% and 5.6 ± 1.2%, respectively. CONCLUSIONS Anisotropy in MEC has a greater reduction effect on lesion volume than on tissue temperature during RFCA; this effect tends to be restrained at positions with more uniform fiber distributions and can be enhanced where significant variation in fiber architecture occurred.
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Affiliation(s)
- Kaihao Gu
- Centre for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Shengjie Yan
- Centre for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Xiaomei Wu
- Centre for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China.,Academy for Engineering and Technology, Fudan University, Shanghai, China.,Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention (MICCAI) of Shanghai, Fudan University, Shanghai, China.,Shanghai Engineering Research Centre of Assistive Devices, Shanghai, China.,Yiwu Research Institute, Fudan University, Yiwu, China
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11
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Zhang S, Lu W, Wei Z, Zhang H. Air Pollution and Cardiac Arrhythmias: From Epidemiological and Clinical Evidences to Cellular Electrophysiological Mechanisms. Front Cardiovasc Med 2021; 8:736151. [PMID: 34778399 PMCID: PMC8581215 DOI: 10.3389/fcvm.2021.736151] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023] Open
Abstract
Cardiovascular disease is the leading cause of death worldwide and kills over 17 million people per year. In the recent decade, growing epidemiological evidence links air pollution and cardiac arrhythmias, suggesting a detrimental influence of air pollution on cardiac electrophysiological functionality. However, the proarrhythmic mechanisms underlying the air pollution-induced cardiac arrhythmias are not fully understood. The purpose of this work is to provide recent advances in air pollution-induced arrhythmias with a comprehensive review of the literature on the common air pollutants and arrhythmias. Six common air pollutants of widespread concern are discussed, namely particulate matter, carbon monoxide, hydrogen sulfide, sulfur dioxide, nitrogen dioxide, and ozone. The epidemiological and clinical reports in recent years are reviewed by pollutant type, and the recently identified mechanisms including both the general pathways and the direct influences of air pollutants on the cellular electrophysiology are summarized. Particularly, this review focuses on the impaired ion channel functionality underlying the air pollution-induced arrhythmias. Alterations of ionic currents directly by the air pollutants, as well as the alterations mediated by intracellular signaling or other more general pathways are reviewed in this work. Finally, areas for future research are suggested to address several remaining scientific questions.
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Affiliation(s)
- Shugang Zhang
- Computational Cardiology Group, College of Computer Science and Technology, Ocean University of China, Qingdao, China.,Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - Weigang Lu
- Computational Cardiology Group, College of Computer Science and Technology, Ocean University of China, Qingdao, China.,Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - Zhiqiang Wei
- Computational Cardiology Group, College of Computer Science and Technology, Ocean University of China, Qingdao, China
| | - Henggui Zhang
- Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
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12
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Wu Z, Liu Y, Tong L, Dong D, Deng D, Xia L. Current progress of computational modeling for guiding clinical atrial fibrillation ablation. J Zhejiang Univ Sci B 2021; 22:805-817. [PMID: 34636185 DOI: 10.1631/jzus.b2000727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Atrial fibrillation (AF) is one of the most common arrhythmias, associated with high morbidity, mortality, and healthcare costs, and it places a significant burden on both individuals and society. Anti-arrhythmic drugs are the most commonly used strategy for treating AF. However, drug therapy faces challenges because of its limited efficacy and potential side effects. Catheter ablation is widely used as an alternative treatment for AF. Nevertheless, because the mechanism of AF is not fully understood, the recurrence rate after ablation remains high. In addition, the outcomes of ablation can vary significantly between medical institutions and patients, especially for persistent AF. Therefore, the issue of which ablation strategy is optimal is still far from settled. Computational modeling has the advantages of repeatable operation, low cost, freedom from risk, and complete control, and is a useful tool for not only predicting the results of different ablation strategies on the same model but also finding optimal personalized ablation targets for clinical reference and even guidance. This review summarizes three-dimensional computational modeling simulations of catheter ablation for AF, from the early-stage attempts such as Maze III or circumferential pulmonary vein isolation to the latest advances based on personalized substrate-guided ablation. Finally, we summarize current developments and challenges and provide our perspectives and suggestions for future directions.
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Affiliation(s)
- Zhenghong Wu
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Yunlong Liu
- School of Biomedical Engineering, Dalian University of Technology, Dalian 116024, China
| | - Lv Tong
- School of Biomedical Engineering, Dalian University of Technology, Dalian 116024, China
| | - Diandian Dong
- School of Biomedical Engineering, Dalian University of Technology, Dalian 116024, China
| | - Dongdong Deng
- School of Biomedical Engineering, Dalian University of Technology, Dalian 116024, China
| | - Ling Xia
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, China.
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13
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Celotto C, Sánchez C, Mountris KA, Laguna P, Pueyo E. Location of Parasympathetic Innervation Regions From Electrograms to Guide Atrial Fibrillation Ablation Therapy: An in silico Modeling Study. Front Physiol 2021; 12:674197. [PMID: 34456743 PMCID: PMC8385640 DOI: 10.3389/fphys.2021.674197] [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: 02/28/2021] [Accepted: 06/11/2021] [Indexed: 01/18/2023] Open
Abstract
The autonomic nervous system (ANS) plays an essential role in the generation and maintenance of cardiac arrhythmias. The cardiac ANS can be divided into its extrinsic and intrinsic components, with the latter being organized in an epicardial neural network of interconnecting axons and clusters of autonomic ganglia called ganglionated plexi (GPs). GP ablation has been associated with a decreased risk of atrial fibrillation (AF) recurrence, but the accurate location of GPs is required for ablation to be effective. Although GP stimulation triggers both sympathetic and parasympathetic ANS branches, a predominance of parasympathetic activity has been shown. This study aims was to develop a method to locate atrial parasympathetic innervation sites based on measurements from a grid of electrograms (EGMs). Electrophysiological models representative of non-AF, paroxysmal AF (PxAF), and persistent AF (PsAF) tissues were developed. Parasympathetic effects were modeled by increasing the concentration of the neurotransmitter acetylcholine (ACh) in randomly distributed circles across the tissue. Different circle sizes of ACh and fibrosis geometries were considered, accounting for both uniform diffuse and non-uniform diffuse fibrosis. Computational simulations were performed, from which unipolar EGMs were computed in a 16 × 1 6 electrode mesh. Different distances of the electrodes to the tissue (0.5, 1, and 2 mm) and noise levels with signal-to-noise ratio (SNR) values of 0, 5, 10, 15, and 20 dB were tested. The amplitude of the atrial EGM repolarization wave was found to be representative of the presence or absence of ACh release sites, with larger positive amplitudes indicating that the electrode was placed over an ACh region. Statistical analysis was performed to identify the optimal thresholds for the identification of ACh sites. In all non-AF, PxAF, and PsAF tissues, the repolarization amplitude rendered successful identification. The algorithm performed better in the absence of fibrosis or when fibrosis was uniformly diffuse, with a mean accuracy of 0.94 in contrast with a mean accuracy of 0.89 for non-uniform diffuse fibrotic cases. The algorithm was robust against noise and worked for the tested ranges of electrode-to-tissue distance. In conclusion, the results from this study support the feasibility to locate atrial parasympathetic innervation sites from the amplitude of repolarization wave.
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Affiliation(s)
- Chiara Celotto
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Carlos Sánchez
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Konstantinos A. Mountris
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Pablo Laguna
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Esther Pueyo
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
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14
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Ghannam M, Jame S, Jongnarangsin K, Cheng YW, Gunda S, Fadahunsi O, Hughey A, Liu Z, Shantha G, Chokesuwattanaskul R, Yokokawa M, Oral H, Morady F, Chugh A. Catheter ablation of the left and right atrial appendages without isolation in persistent atrial fibrillation. Heart Rhythm 2021; 18:694-701. [PMID: 33429104 DOI: 10.1016/j.hrthm.2021.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/14/2020] [Accepted: 01/03/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Electrical isolation of the left atrial appendage (LAA) improves outcomes of patients with persistent atrial fibrillation (AF) but may increase the risk of thromboembolism. OBJECTIVE The purpose of this study was to describe a method to map and ablate appendage drivers without complete electrical isolation. METHODS One hundred thirteen patients underwent an ablation procedure for persistent AF. The procedure was performed during AF and consisted of pulmonary vein and posterior LA isolation as well as ablation of the LAA. The right atrium (RA) was targeted in patients with a right-to-left gradient in cycle length (CL). The end point of appendage ablation was CL slowing or AF termination but not complete isolation. RESULTS Among the 113 patients (mean age 64.6 ± 8.6 years; ejection fraction 54% ± 13%; LA diameter 46 ± 6.5 mm), radiofrequency ablation terminated AF in 51 patients (45%). RA ablation was performed in 41 patients (36%) at the index or repeat procedure. The mean AF CL in the RA appendage (RAA) was shorter than that in the LAA (160 ± 32 ms vs 186 ± 29 ms; P < .01) in these patients. The most frequent target in the RA was the RAA (CLs approaching 50-60 ms). Discontinuing radiofrequency ablation upon AF termination or conduction slowing prevented LAA isolation. After a mean follow-up of 24 ± 15 months, 89 patients (78%) remained arrhythmia-free without antiarrhythmic medications. CONCLUSION An ablation strategy guided by the AF CL addresses LAA drivers without complete electrical isolation and also helps identify the RAA as a source of persistent AF.
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Affiliation(s)
- Michael Ghannam
- Section of Electrophysiology/Division of Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan
| | - Sina Jame
- Section of Electrophysiology/Division of Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan
| | - Krit Jongnarangsin
- Section of Electrophysiology/Division of Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan
| | - Yuet Wong Cheng
- Section of Electrophysiology/Division of Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan
| | - Sampath Gunda
- Section of Electrophysiology/Division of Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan
| | - Opeyemi Fadahunsi
- Section of Electrophysiology/Division of Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan
| | - Andrew Hughey
- Section of Electrophysiology/Division of Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan
| | - Zhigang Liu
- Section of Electrophysiology/Division of Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan
| | - Ghanshyam Shantha
- Section of Electrophysiology/Division of Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan
| | | | - Miki Yokokawa
- Section of Electrophysiology/Division of Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan
| | - Hakan Oral
- Section of Electrophysiology/Division of Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan
| | - Fred Morady
- Section of Electrophysiology/Division of Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan
| | - Aman Chugh
- Section of Electrophysiology/Division of Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan.
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15
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Celotto C, Sanchez C, Mountris KA, Laguna P, Pueyo E. SK Channel Block and Adrenergic Stimulation Counteract Acetylcholine-Induced Arrhythmogenic Effects in Human Atria. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:2303-2306. [PMID: 33018468 DOI: 10.1109/embc44109.2020.9175886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is increasing evidence on the role of the autonomic nervous system in the pathogenesis of atrial fibrillation. Interventions targeting autonomic modulation of atrial electrical activity have been shown to reduce the incidence of atrial arrhythmias. Additionally, recent investigations have proved that pharmacological therapies inhibiting small-conductance calcium-activated potassium (SK) channels are able to lessen cholinergic effects in the atria.In this study we use computational modeling and simulation to test individual and combined effects of SK channel block and adrenergic stimulation in counteracting detrimental effects induced by the parasympathetic neurotransmitter acetylcholine (ACh) on human atrial electrophysiology. Cell and tissue models are built that incorporate descriptions of SK channels as well as of isoproterenol (Iso)- and ACh-mediated regulation of the atrial action potential (AP). Three different cellular AP models, representing a range of physiological AP shapes, are considered and both homogeneous and heterogeneous ACh distributions in atrial tissue are simulated.At the cellular level, SK channel block is demonstrated to partially revert shortening of AP duration (APD) mediated by ACh at various doses, whereas 1 µM Iso has a variable response depending on the AP shape. The combination of SK block and Iso is in all cases able to take APD back to baseline levels, recovering between 82% and 120% of the APD shortening induced by 0.1 µM ACh. At the tissue level, SK block and Iso alone or in combination do not exert remarkable effects on conduction velocity, but the combination of the two is able to notably prolong the ACh-mediated APD shortening, thus increasing the wavelength for reentry.In conclusion, the results from this study support the combination of SK channel block and adrenergic stimulation as a potential option to counteract parasympathetically-mediated proarrhythmic effects in the human atria.
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