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van Oort MJH, Al Amri I, Bingen BO, Cordoba-Soriano JG, Karalis I, Sanz-Sanchez J, Oliveri F, van der Kley F, Jukema JW, Jurado-Roman A, Montero-Cabezas JM. Procedural and clinical impact of intravascular lithotripsy for the treatment of peri-stent calcification. Cardiovasc Revasc Med 2024; 61:16-23. [PMID: 37923647 DOI: 10.1016/j.carrev.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Use of intravascular lithotripsy (IVL) for treating peri-stent calcification is increasing. However, this indication remains 'off-label'. We aimed to investigate the efficacy and clinical outcomes of in-stent IVL. METHODS Patients from five European centers who underwent in-stent IVL were included between 2019 and 2023. Demographic, clinical, procedural and follow-up data were collected from electronic hospital records. Angiographic and intracoronary imaging (ICI) data were analyzed in a centralized core-laboratory. RESULTS Of 101 patients (71.2 ± 9.2 years), 56(55 %) received in-stent IVL for late stent failure (median 109 days post-PCI) due to calcific neoatherosclerosis or extra-stent calcification(late-IVL), while 45(45 %) underwent bail-out IVL due to stent infraexpasion (immediate-IVL). Both late-IVL and immediate-IVL significantly improved angiographic %diameter stenosis (73.7[59.6-89.8]% to 16.4 [10.4-26.9]%;p < 0.0001 and 28.6[22.5-43.3]% to 14.1[10.3-29.4]%;p < 0.0001, and minimum lumen area (MLA) (3.4 ± 1.2 to 8.6 ± 2.5 mm2;p < 0.002 and 5.4 ± 1.9 to 7.3 ± 1.9;p < 0.0001).Device(98 %) and procedural success(80 %) were high. MACE rates in-hospital (2 %), 30-days (3 %),6-months(5 %) and 1-year(7 %) were low and comparable in both groups. Acute diameter gain was lower in immediate-IVL (2.1 ± 0.7 mm vs. 0.5 ± 0.4 mm;p < 0.0001). This, however, was explained by significant differences in pre-IVL angiographic and ICI parameters (%diameter stenosis 73.7[59.6-89.8] vs. 28.6[22.5-43.3]%; p < 0.0001 and MLA (3.4 ± 1.2 vs 5.4 ± 1.9 mm2; p < 0.0001), whereas post-IVL percentage diameter stenosis (16.4(10.4-26.9) vs. 14.1(10.3-29.4);p = 0.914) and MLA (8.6 ± 2.5vs. 7.4 ± 1.9 mm2;p = 0.064) in late- and immediate-IVL were comparable. CONCLUSIONS IVL in-stent due to peri-stent calcification is an effective strategy, both late and immediately after stent implantation. Overall, MACE rates at short- and mid-term were low and comparable in both groups, although clinical findings should be taken with caution.
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Affiliation(s)
- Martijn J H van Oort
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Ibtihal Al Amri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Brian O Bingen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Juan G Cordoba-Soriano
- Department of Cardiology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Ioannis Karalis
- Department of Cardiology, Hellenic Red Cross Hospital, Athens, Greece.
| | - Jorge Sanz-Sanchez
- Department of Cardiology, Hospital Universitari I Politecnic La Fe, Valencia, Spain
| | - Federico Oliveri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands.
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Bingen BO, Al Amri I, Oliveri F, Cabezas JM. Invasive Angiography in Elucidating Ambiguous Shunt Anatomy: Acquired Bicoronary-to-Right Atrium Fistula. JACC Cardiovasc Interv 2023; 16:2784-2785. [PMID: 38030364 DOI: 10.1016/j.jcin.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Brian O Bingen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Ibtihal Al Amri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Federico Oliveri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, University of Pavia, Pavia, Italy
| | - Jose Montero Cabezas
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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van Oort MJH, Bingen BO, Al Amri I, van der Kley F, Jukema JW, Montero-Cabezas JM. The Effect of Intravascular Lithotripsy on Cardiac Implantable Electronic Device Function. JACC Cardiovasc Interv 2023; 16:1950-1952. [PMID: 37191610 DOI: 10.1016/j.jcin.2023.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/30/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023]
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Montero-Cabezas JM, Al Amri I, van Oort MJH, Bingen BO, Scherptong RWC, van der Kley F. Retrograde Use of Intravascular Lithotripsy in Anterograde Uncrossable In-Stent Chronic Occlusion: "Retrotripsy Technique". JACC Cardiovasc Interv 2023:S1936-8798(23)00857-9. [PMID: 37354167 DOI: 10.1016/j.jcin.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/09/2023] [Indexed: 06/26/2023]
Affiliation(s)
| | - Ibtihal Al Amri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martijn J H van Oort
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Brian O Bingen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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Mousa MAA, Bingen BO, Al Amri I, Mertens BJA, Taha S, Tohamy A, Youssef A, Jukema JW, Montero-Cabezas JM. Efficacy and Safety of Intravascular Lithotripsy Versus Rotational Atherectomy in Balloon-Crossable Heavily Calcified Coronary Lesions. Cardiovasc Revasc Med 2023; 48:1-6. [PMID: 36336588 DOI: 10.1016/j.carrev.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Mohamed A A Mousa
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Assiut University Heart Hospital, Assiut, Egypt
| | - Brian O Bingen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ibtihal Al Amri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - B J A Mertens
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Salma Taha
- Department of Cardiology, Assiut University Heart Hospital, Assiut, Egypt
| | - Aly Tohamy
- Department of Cardiology, Assiut University Heart Hospital, Assiut, Egypt
| | - Amr Youssef
- Department of Cardiology, Assiut University Heart Hospital, Assiut, Egypt
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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Bingen BO, Al Amri I, Montero-Cabezas JM, van der Kley F. Bail out lithotripsy to treat delayed valve-in-valve TAVR-related coronary obstruction. Catheter Cardiovasc Interv 2023; 101:97-101. [PMID: 36385465 PMCID: PMC10099844 DOI: 10.1002/ccd.30483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 08/24/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022]
Abstract
Coronary access difficulty and stent compression by the juxtaposed aortic valve leaflet hamper percutaneous management of delayed coronary artery obstruction (CAO) after valve-in-valve (Edwards Sapien 3 in St. Jude Trifecta) transcatheter aortic valve replacement (TAVR). Here, we present a case of delayed post-TAVR CAO treated with intravascular lithotripsy and multistenting to overcome stent compression by the adjacent calcified leaflet.
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Affiliation(s)
- Brian O Bingen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ibtihal Al Amri
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Bingen BO, Amri IA, Scherptong RWC, Montero Cabezas JM. "Level Crossroads": A Venous Graft Compressing a Left Internal Mammary Graft Presenting as Myocardial Infarction. JACC Cardiovasc Interv 2022; 15:e95-e97. [PMID: 35367175 DOI: 10.1016/j.jcin.2022.01.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Brian O Bingen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ibtihal Al Amri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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Mousa MA, Bingen BO, Amri IA, Digiacomo S, Karalis I, Jukema JW, Montero-Cabezas JM. Bail-out intravascular lithotripsy for the treatment of acutely underexpanded stents in heavily calcified coronary lesions: A case series. Cardiovascular Revascularization Medicine 2022; 40:189-194. [DOI: 10.1016/j.carrev.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 11/03/2022]
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Bingen BO, Askar SFA, Neshati Z, Feola I, Panfilov AV, de Vries AAF, Pijnappels DA. Constitutively Active Acetylcholine-Dependent Potassium Current Increases Atrial Defibrillation Threshold by Favoring Post-Shock Re-Initiation. Sci Rep 2015; 5:15187. [PMID: 26487066 PMCID: PMC4613729 DOI: 10.1038/srep15187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
Electrical cardioversion (ECV), a mainstay in atrial fibrillation (AF) treatment, is unsuccessful in up to 10–20% of patients. An important aspect of the remodeling process caused by AF is the constitutive activition of the atrium-specific acetylcholine-dependent potassium current (IK,ACh → IK,ACh-c), which is associated with ECV failure. This study investigated the role of IK,ACh-c in ECV failure and setting the atrial defibrillation threshold (aDFT) in optically mapped neonatal rat cardiomyocyte monolayers. AF was induced by burst pacing followed by application of biphasic shocks of 25–100 V to determine aDFT. Blocking IK,ACh-c by tertiapin significantly decreased DFT, which correlated with a significant increase in wavelength during reentry. Genetic knockdown experiments, using lentiviral vectors encoding a Kcnj5-specific shRNA to modulate IK,ACh-c, yielded similar results. Mechanistically, failed ECV was attributed to incomplete phase singularity (PS) removal or reemergence of PSs (i.e. re-initiation) through unidirectional propagation of shock-induced action potentials. Re-initiation occurred at significantly higher voltages than incomplete PS-removal and was inhibited by IK,ACh-c blockade. Whole-heart mapping confirmed our findings showing a 60% increase in ECV success rate after IK,ACh-c blockade. This study provides new mechanistic insight into failing ECV of AF and identifies IK,ACh-c as possible atrium-specific target to increase ECV effectiveness, while decreasing its harmfulness.
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Affiliation(s)
- Brian O Bingen
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Saïd F A Askar
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Zeinab Neshati
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Iolanda Feola
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Antoine A F de Vries
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Daniël A Pijnappels
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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Engels MC, Askar SFA, Jangsangthong W, Bingen BO, Feola I, Liu J, Majumder R, Versteegh MIM, Braun J, Klautz RJM, Ypey DL, De Vries AAF, Pijnappels DA. Forced fusion of human ventricular scar cells with cardiomyocytes suppresses arrhythmogenicity in a co-culture model. Cardiovasc Res 2015; 107:601-12. [PMID: 26142215 DOI: 10.1093/cvr/cvv191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 06/26/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Fibrosis increases arrhythmogenicity in myocardial tissue by causing structural and functional disruptions in the cardiac syncytium. Forced fusion of fibroblastic cells with adjacent cardiomyocytes may theoretically resolve these disruptions. Therefore, the electrophysiological effects of such electrical and structural integration of fibroblastic cells into a cardiac syncytium were studied. METHODS AND RESULTS Human ventricular scar cells (hVSCs) were transduced with lentiviral vectors encoding enhanced green fluorescent protein alone (eGFP↑-hVSCs) or together with the fusogenic vesicular stomatitis virus G protein (VSV-G/eGFP↑-hVSCs) and subsequently co-cultured (1:4 ratio) with neonatal rat ventricular cardiomyocytes (NRVMs) in confluent monolayers yielding eGFP↑- and VSV-G/eGFP↑-co-cultures, respectively. Cellular fusion was induced by brief exposure to pH = 6.0 medium. Optical mapping experiments showed eGFP↑-co-cultures to be highly arrhythmogenic [43.3% early afterdepolarization (EAD) incidence vs. 7.7% in control NRVM cultures, P < 0.0001], with heterogeneous prolongation of action potential (AP) duration (APD). Fused VSV-G/eGFP↑-co-cultures displayed markedly lower EAD incidence (4.6%, P < 0.001) than unfused co-cultures, associated with decreases in APD, APD dispersion, and decay time of cytosolic Ca(2+) waves. Heterokaryons strongly expressed connexin43 (Cx43). Also, maximum diastolic potential in co-cultures was more negative after fusion, while heterokaryons exhibited diverse mixed NRVM/hVSC whole-cell current profiles, but consistently showed increased outward Kv currents compared with NRVMs or hVSCs. Inhibition of Kv channels by tetraethylammonium chloride abrogated the anti-arrhythmic effects of fusion in VSV-G/eGFP↑-co-cultures raising EAD incidence from 7.9 to 34.2% (P < 0.001). CONCLUSION Forced fusion of cultured hVSCs with NRVMs yields electrically functional heterokaryons and reduces arrhythmogenicity by preventing EADs, which is, at least partly, attributable to increased repolarization force.
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Affiliation(s)
- Marc C Engels
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, The Netherlands
| | - Saïd F A Askar
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, The Netherlands
| | - Wanchana Jangsangthong
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, The Netherlands
| | - Brian O Bingen
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, The Netherlands
| | - Iolanda Feola
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, The Netherlands
| | - Jia Liu
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, The Netherlands
| | - Rupamanjari Majumder
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, The Netherlands
| | - Michel I M Versteegh
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, The Netherlands Department of Cardiothoracic Surgery, Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Jerry Braun
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, The Netherlands Department of Cardiothoracic Surgery, Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert J M Klautz
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, The Netherlands Department of Cardiothoracic Surgery, Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Dirk L Ypey
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, The Netherlands
| | - Antoine A F De Vries
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, The Netherlands
| | - Daniël A Pijnappels
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, The Netherlands
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Bingen BO, Engels MC, Schalij MJ, Jangsangthong W, Neshati Z, Feola I, Ypey DL, Askar SFA, Panfilov AV, Pijnappels DA, de Vries AAF. Light-induced termination of spiral wave arrhythmias by optogenetic engineering of atrial cardiomyocytes. Cardiovasc Res 2014; 104:194-205. [PMID: 25082848 DOI: 10.1093/cvr/cvu179] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Atrial fibrillation (AF) is the most common cardiac arrhythmia and often involves reentrant electrical activation (e.g. spiral waves). Drug therapy for AF can have serious side effects including proarrhythmia, while electrical shock therapy is associated with discomfort and tissue damage. Hypothetically, forced expression and subsequent activation of light-gated cation channels in cardiomyocytes might deliver a depolarizing force sufficient for defibrillation, thereby circumventing the aforementioned drawbacks. We therefore investigated the feasibility of light-induced spiral wave termination through cardiac optogenetics. METHODS AND RESULTS Neonatal rat atrial cardiomyocyte monolayers were transduced with lentiviral vectors encoding light-activated Ca(2+)-translocating channelrhodopsin (CatCh; LV.CatCh∼eYFP↑) or eYFP (LV.eYFP↑) as control, and burst-paced to induce spiral waves rotating around functional cores. Effects of CatCh activation on reentry were investigated by optical and multi-electrode array (MEA) mapping. Western blot analyses and immunocytology confirmed transgene expression. Brief blue light pulses (10 ms/470 nm) triggered action potentials only in LV.CatCh∼eYFP↑-transduced cultures, confirming functional CatCh-mediated current. Prolonged light pulses (500 ms) resulted in reentry termination in 100% of LV.CatCh∼eYFP↑-transduced cultures (n = 31) vs. 0% of LV.eYFP↑-transduced cultures (n = 11). Here, CatCh activation caused uniform depolarization, thereby decreasing overall excitability (MEA peak-to-peak amplitude decreased 251.3 ± 217.1 vs. 9.2 ± 9.5 μV in controls). Consequently, functional coresize increased and phase singularities (PSs) drifted, leading to reentry termination by PS-PS or PS-boundary collisions. CONCLUSION This study shows that spiral waves in atrial cardiomyocyte monolayers can be terminated effectively by a light-induced depolarizing current, produced by the arrhythmogenic substrate itself, upon optogenetic engineering. These results provide proof-of-concept for shockless defibrillation.
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Affiliation(s)
- Brian O Bingen
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - Marc C Engels
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - Martin J Schalij
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - Wanchana Jangsangthong
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - Zeinab Neshati
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - Iolanda Feola
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - Dirk L Ypey
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - Saïd F A Askar
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | | | - Daniël A Pijnappels
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - Antoine A F de Vries
- Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
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Bingen BO, Neshati Z, Feola I, Ypey DL, Askar SFA, Schalij MJ, De Vries AAF, Pijnappels DA. P113Inward rectifier potassium channels determine cardioversion threshold and successrate by regulating post-shock refibrillation. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu082.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bingen BO, Engels MC, Neshati Z, Feola I, Ypey DL, Panfilov AV, Askar SFA, Schalij MJ, Pijnappels DA, De Vries AAF. 288Termination of reentrant tachyarrhythmias by light: from electroshock towards shockless cardioversion by cardiac optogenetics. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu087.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bingen BO, Neshati Z, Askar SFA, Kazbanov IV, Ypey DL, Panfilov AV, Schalij MJ, de Vries AAF, Pijnappels DA. Atrium-specific Kir3.x determines inducibility, dynamics, and termination of fibrillation by regulating restitution-driven alternans. Circulation 2013; 128:2732-44. [PMID: 24065610 DOI: 10.1161/circulationaha.113.005019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation is the most common cardiac arrhythmia. Ventricular proarrhythmia hinders pharmacological atrial fibrillation treatment. Modulation of atrium-specific Kir3.x channels, which generate a constitutively active current (I(K,ACh-c)) after atrial remodeling, might circumvent this problem. However, it is unknown whether and how I(K,ACh-c) contributes to atrial fibrillation induction, dynamics, and termination. Therefore, we investigated the effects of I(K,ACh-c) blockade and Kir3.x downregulation on atrial fibrillation. METHODS AND RESULTS Neonatal rat atrial cardiomyocyte cultures and intact atria were burst paced to induce reentry. To study the effects of Kir3.x on action potential characteristics and propagation patterns, cultures were treated with tertiapin or transduced with lentiviral vectors encoding Kcnj3- or Kcnj5-specific shRNAs. Kir3.1 and Kir3.4 were expressed in atrial but not in ventricular cardiomyocyte cultures. Tertiapin prolonged action potential duration (APD; 54.7±24.0 to 128.8±16.9 milliseconds; P<0.0001) in atrial cultures during reentry, indicating the presence of I(K,ACh-c). Furthermore, tertiapin decreased rotor frequency (14.4±7.4 to 6.6±2.0 Hz; P<0.05) and complexity (6.6±7.7 to 0.6±0.8 phase singularities; P<0.0001). Knockdown of Kcnj3 or Kcnj5 gave similar results. Blockade of I(K,ACh-c) prevented/terminated reentry by prolonging APD and changing APD and conduction velocity restitution slopes, thereby altering the probability of APD alternans and rotor destabilization. Whole-heart mapping experiments confirmed key findings (e.g., >50% reduction in atrial fibrillation inducibility after I(K,ACh-c) blockade). CONCLUSIONS Atrium-specific Kir3.x controls the induction, dynamics, and termination of fibrillation by modulating APD and APD/conduction velocity restitution slopes in atrial tissue with I(K,ACh-c). This study provides new molecular and mechanistic insights into atrial tachyarrhythmias and identifies Kir3.x as a promising atrium-specific target for antiarrhythmic strategies.
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Affiliation(s)
- Brian O Bingen
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands (B.O.B., Z.N., S.F.A.A., D.L.Y., M.J.S., A.A.V.d.V., D.A.P.); and Department of Physics and Astronomy, Ghent University, Ghent, Belgium (I.V.K., A.V.P.)
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Bingen BO, Askar SFA, Schalij MJ, de Vries AAF, Pijnappels DA. Prolongation of minimal action potential duration in sustained fibrillation decreases complexity by transient destabilization: reply. Cardiovasc Res 2013; 98:156-7. [PMID: 23396603 DOI: 10.1093/cvr/cvt027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bingen BO, Askar SFA, Schalij MJ, Kazbanov IV, Ypey DL, Panfilov AV, Pijnappels DA. Prolongation of minimal action potential duration in sustained fibrillation decreases complexity by transient destabilization. Cardiovasc Res 2012; 97:161-70. [PMID: 22977009 DOI: 10.1093/cvr/cvs288] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Sustained ventricular fibrillation (VF) is maintained by multiple stable rotors. Destabilization of sustained VF could be beneficial by affecting VF complexity (defined by the number of rotors). However, underlying mechanisms affecting VF stability are poorly understood. Therefore, the aim of this study was to correlate changes in arrhythmia complexity with changes in specific electrophysiological parameters, allowing a search for novel factors and underlying mechanisms affecting stability of sustained VF. METHODS AND RESULTS Neonatal rat ventricular cardiomyocyte monolayers and Langendorff-perfused adult rat hearts were exposed to increasing dosages of the gap junctional uncoupler 2-aminoethoxydiphenyl borate (2-APB) to induce arrhythmias. Ion channel blockers/openers were added to study effects on VF stability. Electrophysiological parameters were assessed by optical mapping and patch-clamp techniques. Arrhythmia complexity in cardiomyocyte cultures increased with increasing dosages of 2-APB (n > 38), leading to sustained VF: 0.0 ± 0.1 phase singularities/cm(2) in controls vs. 0.0 ± 0.1, 1.0 ± 0.9, 3.3 ± 3.2, 11.0 ± 10.1, and 54.3 ± 21.7 in 5, 10, 15, 20, and 25 µmol/L 2-APB, respectively. Arrhythmia complexity inversely correlated with wavelength. Lengthening of wavelength during fibrillation could only be induced by agents (BaCl(2)/BayK8644) increasing the action potential duration (APD) at maximal activation frequencies (minimal APD); 123 ± 32%/117 ± 24% of control. Minimal APD prolongation led to transient VF destabilization, shown by critical wavefront collision leading to rotor termination, followed by significant decreases in VF complexity and activation frequency (52%/37%). These key findings were reproduced ex vivo in rat hearts (n = 6 per group). CONCLUSION These results show that stability of sustained fibrillation is regulated by minimal APD. Minimal APD prolongation leads to transient destabilization of fibrillation, ultimately decreasing VF complexity, thereby providing novel insights into anti-fibrillatory mechanisms.
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Affiliation(s)
- Brian O Bingen
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden 2300 RC, The Netherlands
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Askar SFA, Bingen BO, Schalij MJ, Swildens J, Atsma DE, Schutte CI, de Vries AAF, Zeppenfeld K, Ypey DL, Pijnappels DA. Similar arrhythmicity in hypertrophic and fibrotic cardiac cultures caused by distinct substrate-specific mechanisms. Cardiovasc Res 2012; 97:171-81. [PMID: 22977008 DOI: 10.1093/cvr/cvs290] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Cardiac hypertrophy and fibrosis are associated with potentially lethal arrhythmias. As these substrates often occur simultaneously in one patient, distinguishing between pro-arrhythmic mechanisms is difficult. This hampers understanding of underlying pro-arrhythmic mechanisms and optimal treatment. This study investigates and compares arrhythmogeneity and underlying pro-arrhythmic mechanisms of either cardiac hypertrophy or fibrosis in in vitro models. METHODS AND RESULTS Fibrosis was mimicked by free myofibroblast (MFB) proliferation in neonatal rat ventricular monolayers. Cultures with inhibited MFB proliferation were used as control or exposed to phenylephrine to induce hypertrophy. At Day 9, cultures were studied with patch-clamp and optical-mapping techniques and assessed for protein expression. In hypertrophic (n = 111) and fibrotic cultures (n = 107), conduction and repolarization were slowed. Triggered activity was commonly found in these substrates and led to high incidences of spontaneous re-entrant arrhythmias [67.5% hypertrophic, 78.5% fibrotic vs. 2.9% in controls (n = 102)] or focal arrhythmias (39.1, 51.7 vs. 8.8%, respectively). Kv4.3 and Cx43 protein expression levels were decreased in hypertrophy but unaffected in fibrosis. Depolarization of cardiomyocytes (CMCs) was only found in fibrotic cultures (-48 ± 7 vs. -66 ± 7 mV in control, P < 0.001). L-type calcium-channel blockade prevented arrhythmias in hypertrophy, but caused conduction block in fibrosis. Targeting heterocellular coupling by low doses of gap-junction uncouplers prevented arrhythmias by accelerating repolarization only in fibrotic cultures. CONCLUSION Cultured hypertrophic or fibrotic myocardial tissues generated similar focal and re-entrant arrhythmias. These models revealed electrical remodelling of CMCs as a pro-arrhythmic mechanism of hypertrophy and MFB-induced depolarization of CMCs as a pro-arrhythmic mechanism of fibrosis. These findings provide novel mechanistic insight into substrate-specific arrhythmicity.
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Affiliation(s)
- Saïd F A Askar
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
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Askar SF, Bingen BO, Swildens J, Ypey DL, van der Laarse A, Atsma DE, Zeppenfeld K, Schalij MJ, de Vries AA, Pijnappels DA. Connexin43 silencing in myofibroblasts prevents arrhythmias in myocardial cultures: role of maximal diastolic potential. Cardiovasc Res 2011; 93:434-44. [DOI: 10.1093/cvr/cvr351] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Askar SF, Ramkisoensing AA, Schalij MJ, Bingen BO, Swildens J, van der Laarse A, Atsma DE, de Vries AA, Ypey DL, Pijnappels DA. Antiproliferative treatment of myofibroblasts prevents arrhythmias in vitro by limiting myofibroblast-induced depolarization. Cardiovasc Res 2011; 90:295-304. [DOI: 10.1093/cvr/cvr011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ray A, Huisman MV, Tamsma JT, van Asten J, Bingen BO, Broeders EABJ, Hoogeveen ES, van Hout F, Kwee VA, Laman B, Malgo F, Mohammadi M, Nijenhuis M, Rijkée M, van Tellingen MM, Tromp M, Tummers Q, de Vries L. The role of inflammation on atherosclerosis, intermediate and clinical cardiovascular endpoints in type 2 diabetes mellitus. Eur J Intern Med 2009; 20:253-60. [PMID: 19393492 DOI: 10.1016/j.ejim.2008.07.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 06/23/2008] [Accepted: 07/07/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is associated with increased cardiovascular morbidity and mortality. Sub-clinical systemic inflammation is often present in T2DM patients. Systemic inflammation has also been implicated in the pathophysiology of atherosclerosis. This review investigates the direct evidence present in literature for the effect of inflammation on atherosclerosis, specifically in the setting of T2DM. Special emphasis is given to the pathogenesis of atherosclerosis as well as intermediate and clinical cardiovascular endpoints. The important role of deteriorated endothelial function in T2DM was excluded from the analysis. METHODS Extensive literature searches were performed using the PubMed and Web of Science databases. Articles were identified, retrieved and accepted or excluded based on predefined criteria. RESULTS Substantial evidence was found for an important inflammatory component in the pathogenesis of atherosclerosis in T2DM, demonstrated by inflammatory changes in plaque characteristics and macrophage infiltration. Most epidemiologic studies found a correlation between inflammation markers and intermediate cardiovascular endpoints, especially intima-media thickness. Several, but not all clinical trials in T2DM found that reducing sub-clinical inflammation had a beneficial effect on intermediate endpoints. When regarding cardiovascular events however, current literature consistently indicates a strong relationship between inflammation and clinical endpoints in subjects with T2DM. CONCLUSION Current literature provides direct evidence for a contribution of inflammatory responses to the pathogenesis of atherosclerosis in T2DM. The most consistent relation was observed between inflammation and clinical endpoints.
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Affiliation(s)
- A Ray
- Vascular Medicine, Department of General Internal Medicine & Endocrinology, Leiden University Medical Centre, Leiden, The Netherlands.
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