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Kanthasamy V, Schilling R, Zongo O, Khan K, Earley M, Monk V, Hunter R, Mangiafico V, Ang R, Creta A, Aluwhalia N, Honarbakhsh S, Dhinoja M, Gupta D, Finlay M. Feasibility of double-blinded, placebo-controlled interventional study for assessing catheter ablation efficacy in persistent atrial fibrillation: Insights from the ORBITA AF feasibility study. Am Heart J 2024; 269:56-71. [PMID: 38109985 DOI: 10.1016/j.ahj.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/29/2023] [Revised: 11/28/2023] [Accepted: 12/11/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND To date, there are no randomized, double-blinded clinical trials comparing catheter ablation to DC cardioversion (DCCV) with medical therapy in patients with persistent atrial fibrillation (PersAF). Conducting a large-scale trial to address this question presents considerable challenges, including recruitment, blinding, and implementation. We conducted a pilot study to evaluate the feasibility of conducting a definitive placebo-controlled trial. METHODS This prospective trial was carried out at Barts Heart Centre, United Kingdom, employing a randomized, double-blinded, placebo-controlled design. Twenty patients with PersAF (duration <2 years) were recruited, representing 10% of the proposed larger trial as determined by a power calculation. The patients were randomized in a 1:1 ratio to receive either PVI ± DCCV (PVI group) or DCCV + Placebo (DCCV group). The primary endpoint of this feasibility study was to evaluate patient blinding. Patients remained unaware of their treatment allocation until end of study. RESULTS During the study, 35% of patients experienced recurrence of PersAF prior to completion of 12 months follow-up. Blinding was successfully maintained amongst both patients and medical staff. The DCCV group had a trend to higher recurrence and repeat procedure rate compared to the PVI group (recurrence of PersAF 60% vs 30%; p = .07 and repeat procedure 70% vs 40%; p = .4). The quality of life experienced by individuals in the PVI group showed improvement, as evidenced by enhanced scores on the AF specific questionnaire (AF PROMS) (3 [±4] vs 21 [±8]) and SF-12 mental-component raw score (51.4 [±7] vs 43.24 [±15]) in patients who maintained sinus rhythm at 12 months. CONCLUSION This feasibility study establishes the potential for conducting a blinded, placebo-controlled trial to evaluate the efficacy of PVI versus DCCV in patients with PersAF.
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Affiliation(s)
- Vijayabharathy Kanthasamy
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Richard Schilling
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Olivier Zongo
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Kamran Khan
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Mark Earley
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Vivienne Monk
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Ross Hunter
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Valentina Mangiafico
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Richard Ang
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Antonio Creta
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Nikhil Aluwhalia
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Shohreh Honarbakhsh
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Mehul Dhinoja
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Dhiraj Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Malcolm Finlay
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.
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Young WJ, Vyas S, Wragg A, Sporton S, Rosengarten J, Schilling RJ, Ang R. Right coronary artery compromise following radiofrequency catheter ablation for supraventricular tachycardia: cases reports. Eur Heart J Case Rep 2023; 7:ytad411. [PMID: 37743895 PMCID: PMC10516517 DOI: 10.1093/ehjcr/ytad411] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 08/03/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023]
Abstract
Background Coronary compromise is a serious potential complication following catheter ablation; however, procedural details in the literature are often lacking, preventing the identification of learning opportunities. Case summary We report two cases of right coronary compromise following catheter ablation for symptomatic supraventricular tachycardia. After radiofrequency energy delivery at the coronary sinus ostium in both cases, inferior lead ST-elevation was observed. Diagnostic coronary angiography identified an occluded posterior left ventricular branch of the coronary artery, and optical coherence tomography demonstrated a high thrombus burden at this location. Electrocardiographic ST-segments settled with implantation of a drug-eluting stent. Discussion Coronary compromise was likely secondary to energy delivery during catheter ablation. This case series highlights the need for electrophysiologist to understand coronary anatomy relative to anatomical landmarks, to anticipate the risk of vascular injury as physical distance from the site of ablation is likely important. Risk for coronary compromise, while a rare complication, needs to be discussed with patients during the consenting process. We also demonstrate the importance of an efficient multi-disciplinary team process for managing acute procedural complications.
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Affiliation(s)
- William J Young
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Centre for Clinical Pharmacology and Precision Medicine, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Sandip Vyas
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Andrew Wragg
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Simon Sporton
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - James Rosengarten
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Richard J Schilling
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Richard Ang
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
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Kanthasamy V, Breitenstein A, Schilling R, Hofer D, Tiongco B, Ang R, Hunter R, Earley M, Ahsan S, Mangiafico V, Honarbakhsh S, Ahluwalia N, Maclean E, Creta A, Finlay M. Catheter ablation of atrial fibrillation with a multi-electrode radiofrequency balloon; first and early two centre experience in Europe. J Cardiovasc Electrophysiol 2023; 34:1350-1359. [PMID: 36598422 DOI: 10.1111/jce.15799] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/11/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The Heliostar™ ablation system is a novel RF balloon ablation technology with an integrated three-dimensional mapping system. Here, we describe our early experience and procedural outcomes using this technology for atrial fibrillation catheter ablation. METHODS We sought to comprehensively assess the first 60 consecutive patients undergoing pulmonary vein isolation using the novel HELISOTAR™ RF balloon technology including procedural outcomes. A comparison of the workflow between two different anaesthetic modalities (conscious sedation [CS] vs. general anaesthesia [GA]) was made. Procedural data were collected prospectively from two high-volume centers (Barts Heart Centre, UK and University Hospital of Zurich, Zurich). A standardized approach for catheter ablation was employed. RESULTS A total of 35 patients had the procedure under CS and the remaining under GA. Mean procedural and fluoroscopy times were 84 ± 33 min and 1.1 min. The median duration of RF energy application was 7 (5-9.8) mins per patient. All veins were successfully isolated, and the median isolation time was 10 (7-15) seconds. Our cohort's rate of procedural complications was low, with no mortality within 30 days postprocedure. CONCLUSION Our early experience shows that catheter ablation using the Heliostar™ technology can be performed efficiently and safely; however, long-term data is yet to be established. Low fluoroscopy requirements, short learning curves and use of this technology with CS is possible, including the use of an oesophageal temperature probe.
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Affiliation(s)
- Vijayabharathy Kanthasamy
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Richard Schilling
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Daniel Hofer
- Klinik für Kardiologie Herzzentrum, Universitätsspital Zürich, Zürich, Switzerland
| | - Benny Tiongco
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Richard Ang
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Ross Hunter
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Mark Earley
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Syed Ahsan
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Valentina Mangiafico
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Shohreh Honarbakhsh
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Nikhil Ahluwalia
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Edd Maclean
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Antonio Creta
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Malcolm Finlay
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
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Honarbakhsh S, Earley MJ, Martin CA, Creta A, Sohaib A, Ang R, Butcher C, Waddingham PH, Dhinoja M, Lim W, Srinivasan NT, Providencia R, Kanthasamy V, Sporton S, Chow A, Lambiase PD, Schilling RJ, Finlay MC, Hunter RJ. PolarX Cryoballoon metrics predicting successful pulmonary vein isolation: targets for ablation of atrial fibrillation. Europace 2022; 24:1420-1429. [PMID: 35737685 DOI: 10.1093/europace/euac100] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
AIM Evaluate the novel PolarX Cryoballoon in atrial fibrillation (AF) catheter ablation through a propensity-matched comparison with the Arctic Front Advance (AFA). The aim was also to identify cryoablation metrics that are predictive of successful pulmonary vein isolation (PVI) with the PolarX Cryoballoon. METHODS AND RESULTS This prospective multi-centre study included patients that underwent cryoablation for AF. All patients underwent PVI with reconnection assessed after a 30-min waiting period and adenosine. Safety, efficacy, and cryoablation metrics were compared between PolarX and a propensity-matched AFA cohort. Seventy patients were included with 278 veins treated. In total, 359 cryoablations were performed (1.3 ± 0.6 per vein) to achieve initial PVI with 205 (73.7%) veins isolating with a single cryoablation. Independent predictors for achieving initial PVI included temperature at 30 s [odds ratio (OR) 1.26; P = 0.003] and time to reach -40°C (OR 1.88; P < 0.001) with an optimal cut-off of ≤-38.5°C at 30 s [area under the curve (AUC) 0.79; P < 0.001] and ≤-40°C at ≤32.5 s (AUC 0.77; P < 0.001), respectively. Of the 278 veins, 46 (16.5%) veins showed acute reconnection. Temperature at 30 s (≤-39.5°C, OR 1.24; P = 0.002), nadir temperature (≤-53.5°C, OR 1.35; P = 0.003), and time to isolation (≤38.0 s, OR 1.18; P = 0.009) were independent predictors of sustained PVI. Combining two of these three targets was associated with reconnection in only 2-5% of PVs. Efficacy and safety of the PolarX Cryoballoon were comparable to AFA Cryoballoon, however, cryoablation metrics were significantly different. CONCLUSIONS The PolarX Cryoballoon has a different cryoablation profile to AFA Cryoballoon. Prospective testing of these proposed targets in large outcomes studies is required.
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Affiliation(s)
- Shohreh Honarbakhsh
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Mark J Earley
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | | | - Antonio Creta
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Afzal Sohaib
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Richard Ang
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Charles Butcher
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Peter H Waddingham
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Mehul Dhinoja
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Wei Lim
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Neil T Srinivasan
- Circulatory Health Research Group, Medical Technology Research Centre, School of Medicine, Anglia Ruskin University, CM1 1SQ Chelmsford, UK
| | - Rui Providencia
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Vijayabharathy Kanthasamy
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Simon Sporton
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Anthony Chow
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Pier D Lambiase
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Richard J Schilling
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Malcolm C Finlay
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Ross J Hunter
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
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Kanthasamy V, Breitenstein A, Hofer D, Honarbakhsh S, Creta A, mangiafico V, Hunter RJ, Ang R, Earley MJ, Schilling RJ, Finlay MC. PO-711-06 HELIOSTARTM RF BALLOON CATHETER ACHIEVES EXCELLENT ACUTE RESULTS INCLUDING CONSCIOUS SEDATION AND SAME-DAY DISCHARGE; EARLY MULTICENTRE EXPERIENCE IN EUROPE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1131] [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: 11/04/2022]
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Creta A, Earley MJ, Schilling RJ, Finlay M, Sporton S, Dhinoja M, Hunter RJ, Papageorgiou N, Ang R, Chow A, Lowe M, Segal OR, Lambiase PD, Providência R. Ethanol Ablation for Ventricular Arrhythmias: A Systematic Review and Meta-analysis. J Cardiovasc Electrophysiol 2021; 33:510-526. [PMID: 34921464 DOI: 10.1111/jce.15336] [Citation(s) in RCA: 1] [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: 04/26/2021] [Revised: 10/11/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Ethanol ablation (EA) is as an alternative option for subjects with ventricular arrhythmias (VAs) refractory to conventional medical and ablative treatment. However, data on efficacy and safety of EA remain sparse. METHODS A systematic literature search was conducted. The primary outcomes were 1) freedom from the targeted VA and 2) freedom from any VAs post EA. Additional safety outcomes were also analysed. RESULTS Ten studies were selected accounting for a population of 174 patients (62.3±12.5 years, 94% male) undergoing 185 procedures. The overall acute success rate of EA was 72.4% (CI95% 65.6-78.4). After a mean follow-up of 11.3±5.5 months, the incidence of relapse of the targeted VA was 24.4% (CI95% 17.1-32.8), while any VAs post EA occurred in 41.3% (CI95% 33.7-49.1). The overall incidence of procedural complications was 14.1% (CI95% 9.8-19.8), with pericardial complications and complete atrioventricular block being the most frequent. An anterograde transarterial approach was associated with a higher rate of VA recurrences and complications compared to a retrograde transvenous route; however, differences in the baseline population characteristics and in the targeted ventricular areas should be accounted. CONCLUSION EA is a valuable therapeutic option for VAs refractory to conventional treatment and can result in 1-year freedom from VA recurrence in 60 to 75% of the patients. However, anatomical or technical challenges preclude acute success in almost 30% of the candidates and the rate of complication is not insignificant, highlighting the importance of well-informed patient selection. The certainty of the evidence is low, and further research is necessary. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Antonio Creta
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Mark J Earley
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | | | - Malcolm Finlay
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Simon Sporton
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Mehul Dhinoja
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Ross J Hunter
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | | | - Richard Ang
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Anthony Chow
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Martin Lowe
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Oliver R Segal
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Pier D Lambiase
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.,Institute of Cardiovascular Science, University College of London, London, UK
| | - Rui Providência
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.,Institute of Health Informatics Research, University College of London, London, UK
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Maclean E, Simon R, Ang R, Dhillon G, Ahsan S, Khan F, Earley M, Lambiase PD, Rosengarten J, Chow AW, Dhinoja M, Providencia R, Markides V, Wong T, Hunter RJ, Behar JM. A multi-center experience of ablation index for evaluating lesion delivery in typical atrial flutter. Pacing Clin Electrophysiol 2021; 44:1039-1046. [PMID: 33782987 DOI: 10.1111/pace.14228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/18/2021] [Accepted: 03/21/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Anatomical studies demonstrate significant variation in cavotricuspid isthmus (CTI) architecture. METHODS Thirty-eight patients underwent CTI ablation at two tertiary centers. Operators delivered 682 lesions with a target ablation index (AI) of 600 Wgs. Ablation parameters were recorded every 10-20 ms. Post hoc, Visitags were trisected according to CTI position: inferior vena cava (IVC), middle (Mid), or ventricular (V) lesions. RESULTS There were no complications. 92.1% of patients (n = 35) remained in sinus rhythm after 14.6 ± 3.4 months. For the whole CTI, peak AI correlated with mean impedance drop (ID) (R2 = 0.89, p < .0001). However, analysis by anatomical site demonstrated a non-linear relationship Mid CTI (R2 = 0.15, p = .21). Accordingly, while mean AI was highest Mid CTI (IVC: 473.1 ± 122.1 Wgs, Mid: 539.6 ± 103.5 Wgs, V: 486.2 ± 111.8 Wgs, ANOVA p < .0001), mean ID was lower (IVC: 10.7 ± 7.5Ω, Mid: 9.0 ± 6.5Ω, V: 10.9 ± 7.3Ω, p = .011), and rate of ID was slower (IVC: 0.37 ± 0.05 Ω/s, Mid: 0.18 ± 0.08 Ω/s, V: 0.29 ± 0.06 Ω/s, p < .0001). Mean contact force was similar at all sites; however, temporal fluctuations in contact force (IVC: 19.3 ± 12.0 mg/s, Mid: 188.8 ± 92.1 mg/s, V: 102.8 ± 32.3 mg/s, p < .0001) and catheter angle (IVC: 0.42°/s, Mid: 3.4°/s, V: 0.28°/s, p < .0001) were greatest Mid CTI. Use of a long sheath attenuated these fluctuations and improved energy delivery. CONCLUSIONS Ablation characteristics vary across the CTI. At the Mid CTI, higher AI values do not necessarily deliver more effective ablation; this may reflect localized fluctuations in catheter angle and contact force.
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Affiliation(s)
- Edd Maclean
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Ron Simon
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Richard Ang
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Gurpreet Dhillon
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Syed Ahsan
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Fakhar Khan
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Mark Earley
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Pier D Lambiase
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - James Rosengarten
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Anthony W Chow
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Mehul Dhinoja
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Rui Providencia
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Vias Markides
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Tom Wong
- Department of Cardiac Electrophysiology, Royal Brompton Hospital, London, UK
| | - Ross J Hunter
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Jonathan M Behar
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK.,Department of Cardiac Electrophysiology, Royal Brompton Hospital, London, UK
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8
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Srinivasan NT, Garcia J, Schilling RJ, Ahsan S, Babu GG, Ang R, Dhinoja MB, Hunter RJ, Lowe M, Chow AW, Lambiase PD. Multicenter Study of Dynamic High-Density Functional Substrate Mapping Improves Identification of Substrate Targets for Ischemic Ventricular Tachycardia Ablation. JACC Clin Electrophysiol 2020; 6:1783-1793. [PMID: 33357574 PMCID: PMC7769061 DOI: 10.1016/j.jacep.2020.06.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The goal of this study was to evaluate the role of dynamic substrate changes in facilitating conduction delay and re-entry in ventricular tachycardia (VT) circuits. BACKGROUND The presence of dynamic substrate changes facilitate functional block and re-entry in VT but are rarely studied as part of clinical VT mapping. METHODS Thirty patients (age 67 ± 9 years; 27 male subjects) underwent ablation. Mapping was performed with the Advisor HD Grid multipolar catheter. A bipolar voltage map was obtained during sinus rhythm (SR) and right ventricular sense protocol (SP) single extra pacing. SR and SP maps of late potentials (LP) and local abnormal ventricular activity (LAVA) were made and compared with critical sites for ablation, defined as sites of best entrainment or pace mapping. Ablation was then performed to critical sites, and LP/LAVA identified by the SP. RESULTS At a median follow-up of 12 months, 90% of patients were free from antitachycardia pacing (ATP) or implantable cardioverter-defibrillator shocks. SP pacing resulted in a larger area of LP identified for ablation (19.3 mm2 vs. 6.4 mm2) during SR mapping (p = 0.001), with a sensitivity of 87% and a specificity of 96%, compared with 78% and 65%, respectively, in SR. CONCLUSIONS LP and LAVA observed during the SP were able to identify regions critical for ablation in VT with a greater accuracy than SR mapping. This may improve substrate characterization in VT ablation. The combination of ablation to critical sites and SP-derived LP/LAVA requires further assessment in a randomized comparator study.
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Affiliation(s)
- Neil T Srinivasan
- Department of Cardiac Electrophysiology, The Barts Heart Center, St. Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
| | - Jason Garcia
- Department of Cardiac Electrophysiology, The Barts Heart Center, St. Bartholomew's Hospital, London, United Kingdom
| | - Richard J Schilling
- Department of Cardiac Electrophysiology, The Barts Heart Center, St. Bartholomew's Hospital, London, United Kingdom
| | - Syed Ahsan
- Department of Cardiac Electrophysiology, The Barts Heart Center, St. Bartholomew's Hospital, London, United Kingdom
| | - Girish G Babu
- Royal Bournemouth and Christchurch Hospitals, Bournemouth, United Kingdom
| | - Richard Ang
- Department of Cardiac Electrophysiology, The Barts Heart Center, St. Bartholomew's Hospital, London, United Kingdom
| | - Mehul B Dhinoja
- Department of Cardiac Electrophysiology, The Barts Heart Center, St. Bartholomew's Hospital, London, United Kingdom
| | - Ross J Hunter
- Department of Cardiac Electrophysiology, The Barts Heart Center, St. Bartholomew's Hospital, London, United Kingdom
| | - Martin Lowe
- Department of Cardiac Electrophysiology, The Barts Heart Center, St. Bartholomew's Hospital, London, United Kingdom
| | - Anthony W Chow
- Department of Cardiac Electrophysiology, The Barts Heart Center, St. Bartholomew's Hospital, London, United Kingdom
| | - Pier D Lambiase
- Department of Cardiac Electrophysiology, The Barts Heart Center, St. Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
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9
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Kukendrarajah K, Papageorgiou N, Jewell P, Hunter RJ, Ang R, Schilling R, Providencia R. Systematic review and network meta-analysis of atrial fibrillation percutaneous catheter ablation technologies using randomized controlled trials. J Cardiovasc Electrophysiol 2020; 31:2192-2205. [PMID: 32495462 DOI: 10.1111/jce.14598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 01/09/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/16/2022]
Abstract
AIMS We sought out to make comparisons between all atrial fibrillation (AF) catheter ablation technologies using randomized controlled trial data. Our comparisons were freedom from AF, procedural duration, and fluoroscopy duration. METHODS Searches were made of EMBASE, MEDLINE, and CENTRAL databases, and studies were selected which had cryoballoon, conventional radiofrequency (RF), multipolar RF catheters, and laser technology as an arm in the study and were identified as randomized controlled trials (RCTs). These studies were analyzed for direct comparisons using conventional meta-analysis and a combination of indirect and direct comparisons via a network meta-analysis (NMA). RESULTS With respect to freedom from AF both direct comparisons and NMA did not demonstrate any significant difference. However in analysis of procedural and fluoroscopy duration (minutes) for the pulmonary vein ablation catheter (PVAC), both conventional analysis and NMA revealed significantly shorter procedure times, RF vs PVAC (conventional: 61.99 [38.03-85.94], P <.00001; NMA: 54.76 [36.64-72.88], P < .0001) and fluoroscopy times, RF vs PVAC (conventional: 12.96 [6.40-19.53], P = .0001; NMA: 8.89 [3.27-14.51], P < .01). The procedural duration was also shorter for the cryoballoon with NMA, RF vs CRYO (20.56 [3.47-37.65], P = .02). DISCUSSION Our analysis demonstrated that while there was no difference in the efficacy of the individual catheter technologies, there are significant differences in the procedural duration for the PVAC and the cryoballoon. While they may seem an attractive solution for high-volume centers, further RCTs of next-generation technologies should be examined.
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Affiliation(s)
- Kishore Kukendrarajah
- The Farr Institute of Health Informatics Research, University College London, London, UK
| | | | - Paul Jewell
- Department of Critical Care, Royal Free Hospital, London, UK
| | - Ross J Hunter
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Richard Ang
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | | | - Rui Providencia
- The Farr Institute of Health Informatics Research, University College London, London, UK
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10
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Srinivasan N, Garcia J, Schilling RJ, Ahsan S, Babu G, Ang R, Dhinoja MJ, Hunter RJ, Chow AW, Lambiase PD. 126Dynamic high density functional substrate mapping improves outcomes in ventricular tachycardia ablation. Europace 2020. [DOI: 10.1093/europace/euaa162.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Activation and entrainment mapping of VT remains the gold standard for identifying critical sites for ablation of VT, however, this method is limited by poorly tolerated or non-sustained VT. Several substrate guided approaches have been developed, however, outcomes when comparing both methods are similar and overall success can be as low as 47%. A key element in facilitating VT is the presence of dynamic changes within the substrate which may not be evident during sinus rhythm substrate mapping, but may form a critical aspect of the tachycardia mechanism when conduction velocity slows dynamically and tissue refractory periods lengthen. These are rarely studied as part of clinical VT mapping.
Purpose
This study aimed to investigate dynamic substrate changes to local abnormal ventricular activity (LAVA) and late potentials (LP), in relation to critical sites for VT ablation using high resolution mapping of the ventricle with the HD Grid (Abbott, Inc, USA), during short coupled singe extra stimuli from the right ventricle (RV) (Barts Sense Protocol), designed to invoke conduction delay. We hypothesized that the dynamic functional late potential mapping would improve the identification of critical substrate and ablation of these regions would improve outcomes.
Methods
Thirty patients (age 67 +/- 9yrs, 27Male) underwent ablation. Mean ejection fraction was 25% (+/- 10%). Mapping was performed with the AdvisorTM HD Grid multipolar catheter. A bipolar voltage map was obtained during sinus rhythm (SR) and RV Sensed Protocol (SP) single extra pacing. SR and SP late potential (LP) and local abnormal ventricular activity (LAVA) maps were made and compared with critical sites for ablation, defined as sites of best entrainment or pace mapping. Ablation was then performed to critical sites and LP/LAVA identified by the SP.
Results
At a median follow up of 10 months 90% of patients were free from symptomatic ATP or ICD shocks. The median area of late potentials across the 30 patients during sinus rhythm was 6.4mm2 during sinus rhythm mapping and 19.3mm2 during sense protocol pacing (p = 0.001). The functional unmasking of LP and LAVA was seen in 26 patients and showed good correlation to critical regions of the VT circuit (sites of best entrainment or pace map). In 24 patients functionally unmasked late potentials were located within 10mm of critical regions within the mapped VT circuit, with a median distance of 8.5mm, compared to 7 patients during sinus rhythm mapping with a median distance of 22mm (p= <0.001). Figure 1 demonstrates and example of the SP, where increased functional LP are seen along the mapped VT isthmus.
Conclusion
Functional LP and LAVA can be unmasked by the sense protocol enabling better delineation of critical regions for VT ablation which may not be visible during sinus rhythm. This unique delineation of functional substrate changes combined with activation or pacemapping may improve outcomes.
Abstract Figure 1
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Affiliation(s)
- N Srinivasan
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - J Garcia
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - R J Schilling
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - S Ahsan
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - G Babu
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - R Ang
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - M J Dhinoja
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - R J Hunter
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - A W Chow
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - P D Lambiase
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
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11
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Abstract
Sudden cardiac death caused by ventricular arrhythmias is among the leading causes of mortality, with approximately half of all deaths attributed to heart disease worldwide. Periodic repolarization dynamics (PRD) is a novel marker of repolarization instability and strong predictor of death in patients post-myocardial infarction that is believed to occur in association with low-frequency oscillations in sympathetic nerve activity. However, this hypothesis is based on associations of PRD with indices of sympathetic activity that are not directly linked to cardiac function, such as muscle vasoconstrictor activity and the variability of cardiovascular autospectra. In this review article, we critically evaluate existing scientific evidence obtained primarily in experimental animal models, with the aim of identifying the neuronal networks responsible for the generation of low-frequency sympathetic rhythms along the neurocardiac axis. We discuss the functional significance of rhythmic sympathetic activity on neurotransmission efficacy and explore its role in the pathogenesis of ventricular repolarization instability. Most importantly, we discuss important gaps in our knowledge that require further investigation in order to confirm the hypothesis that low frequency cardiac sympathetic oscillations play a causative role in the generation of PRD.
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Affiliation(s)
- Richard Ang
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Nephtali Marina
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom.,Division of Medicine, University College London, London, United Kingdom
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12
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Creta A, Baca M, Sporton S, Ang R. 'Left bundle branch block' in a structurally normal heart: not always due to left bundle branch block. Eur Heart J Case Rep 2019; 3:1-2. [PMID: 31911968 PMCID: PMC6939784 DOI: 10.1093/ehjcr/ytz165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/23/2019] [Accepted: 09/04/2019] [Indexed: 11/23/2022]
Affiliation(s)
- Antonio Creta
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Marco Baca
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Simon Sporton
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Richard Ang
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
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13
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Hosford PS, Christie IN, Niranjan A, Aziz Q, Anderson N, Ang R, Lythgoe MF, Wells JA, Tinker A, Gourine AV. A critical role for the ATP-sensitive potassium channel subunit K IR6.1 in the control of cerebral blood flow. J Cereb Blood Flow Metab 2019; 39:2089-2095. [PMID: 29862863 PMCID: PMC6775590 DOI: 10.1177/0271678x18780602] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 04/20/2018] [Accepted: 05/01/2018] [Indexed: 12/19/2022]
Abstract
KIR6.1 (KCNJ8) is a subunit of ATP sensitive potassium channel (KATP) that plays an important role in the control of peripheral vascular tone and is highly expressed in brain contractile cells (vascular smooth muscle cells and pericytes). This study determined the effect of global deletion of the KIR6.1 subunit on cerebral blood flow, neurovascular coupling and cerebral oxygenation in mice. In KIR6.1 deficient mice resting cerebral blood flow and brain parenchymal partial pressure of oxygen (PO2) were found to be markedly lower compared to that in their wildtype littermates. However, cortical blood oxygen level dependent responses triggered by visual stimuli were not affected in conditions of KIR6.1 deficiency. These data suggest that KATP channels containing KIR6.1 subunit are critically important for the maintenance of normal cerebral perfusion and parenchymal PO2 but play no significant role in the mechanisms underlying functional changes in brain blood flow.
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Affiliation(s)
- Patrick S Hosford
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, UK
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & Pharmacology, University College London, London, UK
| | - Isabel N Christie
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & Pharmacology, University College London, London, UK
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
| | - Arun Niranjan
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
| | - Qadeer Aziz
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - Naomi Anderson
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - Richard Ang
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & Pharmacology, University College London, London, UK
| | - Mark F Lythgoe
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
| | - Jack A Wells
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
| | - Andrew Tinker
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - Alexander V Gourine
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & Pharmacology, University College London, London, UK
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14
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Creta A, Bacà M, Sporton SC, Ang R. Dual ventricular response during atrial extrastimulus—What is the likely mechanism? Pacing Clin Electrophysiol 2019; 42:1246-1247. [DOI: 10.1111/pace.13770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 07/31/2019] [Accepted: 08/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Antonio Creta
- Barts Heart CentreSt Bartholomew's Hospital London UK
| | - Marco Bacà
- Barts Heart CentreSt Bartholomew's Hospital London UK
| | | | - Richard Ang
- Barts Heart CentreSt Bartholomew's Hospital London UK
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15
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Eow J, Duane B, Solaiman A, Hussain U, Lemasney N, Ang R, O'Kelly-Lynch N, Girgis G, Collazo L, Johnston B. What evidence do economic evaluations in dental care provide? A scoping review. Community Dent Health 2019; 36:118-125. [PMID: 31070875 DOI: 10.1922/cdh_4426eow08] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To collate the body of evidence in economic studies of different dental interventions. METHODS Eligible English studies after 1980 were sourced from MEDLINE using MeSH terms and reviewed independently by 4 teams. Studies were grouped according to the type of dental intervention and their quality appraised using Drummond's Checklist. RESULTS The number of dental economic studies increased from 1980 to 2016. A total of 91 studies were identified following the search strategy. Most studies were conducted in the United States (n=23), followed by Germany (n=14), Australia (n=10) and the United Kingdom (n=9). Preventative dental interventions comprised 37% of included studies (n=34), followed by restorative (n=14), prosthodontic (n=13) and periodontal interventions (n=12). Cost effectiveness analyses (n=68) comprise 75% of full economic evaluation (EE) studies, followed by cost-utility (n=17) and cost-benefit (n=6). Quality assessment checklists identified 60 studies as good, 23 as moderate and 8 as poor. Common methodological limitations were identified in EE studies. Comparison of studies identified trends and common findings within each dental intervention. CONCLUSION High quality economic studies are important in directing resources and funding by policy makers. Standardisation of reporting outcome measures will improve the potential for interpretation and comparison between studies. Research adhering to recommended quality assessment checklists will improve the overall quality of evidence to better identify cost-effective treatments for different dental interventions.
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Affiliation(s)
- J Eow
- School of Dental Science, Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - B Duane
- Department of Child and Public Dental Health, Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - A Solaiman
- School of Dental Science, Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - U Hussain
- School of Dental Science, Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - N Lemasney
- School of Dental Science, Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - R Ang
- School of Dental Science, Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - N O'Kelly-Lynch
- School of Dental Science, Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - G Girgis
- School of Dental Science, Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - L Collazo
- School of Dental Science, Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - B Johnston
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
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16
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Ang R, Mastitskaya S, Hosford PS, Basalay M, Specterman M, Aziz Q, Li Y, Orini M, Taggart P, Lambiase PD, Gourine A, Tinker A, Gourine AV. Modulation of Cardiac Ventricular Excitability by GLP-1 (Glucagon-Like Peptide-1). Circ Arrhythm Electrophysiol 2018; 11:e006740. [PMID: 30354404 PMCID: PMC6553567 DOI: 10.1161/circep.118.006740] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/14/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Glucagon-like peptide-1 receptor (GLP-1R) agonists improve cardiovascular outcomes in patients with type 2 diabetes mellitus. However, systemic actions of these agents cause sympathetic activation, which is generally considered to be detrimental in cardiovascular disease. Despite significant research interest in cardiovascular biology of GLP-1, the presence of GLP-1R in ventricular cardiomyocytes remains a controversial issue, and the effects of this peptide on the electrical properties of intact ventricular myocardium are unknown. We sought to determine the effects of GLP-1R agonist exendin-4 (Ex4) on ventricular action potential duration (APD) and susceptibility to ventricular arrhythmia in the rat heart in vivo and ex vivo. METHODS Ventricular monophasic action potentials were recorded in anaesthetized (urethane) rats in vivo and isolated perfused rat hearts during sinus rhythm and ventricular pacing. RESULTS In vivo, systemic administration of Ex4 (5 μg/kg intravenously) increased heart rate, and this effect was abolished by β-adrenoceptor blockade. Despite causing sympathetic activation, Ex4 increased APD at 90% repolarization during ventricular pacing by 7% ( P=0.044; n=6) and reversed the effect of β-adrenoceptor agonist dobutamine on APD at 90% repolarization. In isolated perfused hearts, Ex4 (3 nmol/L) increased APD at 90% repolarization by 14% ( P=0.015; n=6) with no effect on heart rate. Ex4 also reduced ventricular arrhythmia inducibility in conditions of β-adrenoceptor stimulation with isoproterenol. Ex4 effects on APD and ventricular arrhythmia susceptibility were prevented in conditions of muscarinic receptor blockade or inhibition of nitric oxide synthase. CONCLUSIONS These data demonstrate that GLP-1R activation effectively opposes the effects of β-adrenoceptor stimulation on cardiac ventricular excitability and reduces ventricular arrhythmic potential. The effect of GLP-1R activation on the ventricular myocardium is indirect, mediated by acetylcholine and nitric oxide and, therefore, can be explained by stimulation of cardiac parasympathetic (vagal) neurons.
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Affiliation(s)
- Richard Ang
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & Pharmacology, University College London, United Kingdom (R.A., S.M., P.S.H., M.B., A.V.G.)
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom (R.A., M.S., Q.A., Y.L., A.T.)
| | - Svetlana Mastitskaya
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & Pharmacology, University College London, United Kingdom (R.A., S.M., P.S.H., M.B., A.V.G.)
| | - Patrick S. Hosford
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & Pharmacology, University College London, United Kingdom (R.A., S.M., P.S.H., M.B., A.V.G.)
| | - Marina Basalay
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & Pharmacology, University College London, United Kingdom (R.A., S.M., P.S.H., M.B., A.V.G.)
| | - Mark Specterman
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom (R.A., M.S., Q.A., Y.L., A.T.)
| | - Qadeer Aziz
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom (R.A., M.S., Q.A., Y.L., A.T.)
| | - Yiwen Li
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom (R.A., M.S., Q.A., Y.L., A.T.)
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, United Kingdom (M.O., P.T., P.D.L.)
| | - Peter Taggart
- Institute of Cardiovascular Science, University College London, United Kingdom (M.O., P.T., P.D.L.)
| | - Pier D. Lambiase
- Institute of Cardiovascular Science, University College London, United Kingdom (M.O., P.T., P.D.L.)
| | - Andrey Gourine
- Division of Cardiology, Karolinska Institute, Stockholm, Sweden (A.G.)
| | - Andrew Tinker
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom (R.A., M.S., Q.A., Y.L., A.T.)
| | - Alexander V. Gourine
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & Pharmacology, University College London, United Kingdom (R.A., S.M., P.S.H., M.B., A.V.G.)
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17
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Calmont A, Anderson N, Suntharalingham JP, Ang R, Tinker A, Scambler PJ. Defective Vagal Innervation in Murine Tbx1 Mutant Hearts. J Cardiovasc Dev Dis 2018; 5:jcdd5040049. [PMID: 30249045 PMCID: PMC6306933 DOI: 10.3390/jcdd5040049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 02/07/2023] Open
Abstract
Haploinsufficiency of the T-box transcription factor TBX1 is responsible for many features of 22q11.2 deletion syndrome. Tbx1 is expressed dynamically in the pharyngeal apparatus during mouse development and Tbx1 homozygous mutants display numerous severe defects including abnormal cranial ganglion formation and neural crest cell defects. These abnormalities prompted us to investigate whether parasympathetic (vagal) innervation of the heart was affected in Tbx1 mutant embryos. In this report, we used an allelic series of Tbx1 mouse mutants, embryo tissue explants and cardiac electrophysiology to characterise, in detail, the function of Tbx1 in vagal innervation of the heart. We found that total nerve branch length was significantly reduced in Tbx1+/- and Tbx1neo2/- mutant hearts expressing 50% and 15% levels of Tbx1. We also found that neural crest cells migrated normally to the heart of Tbx1+/-, but not in Tbx1neo2 mutant embryos. In addition, we showed that cranial ganglia IXth and Xth were fused in Tbx1neo2/- but neuronal differentiation appeared intact. Finally, we used telemetry to monitor heart response to carbachol, a cholinergic receptor agonist, and found that heart rate recovered more quickly in Tbx1+/- animals versus controls. We speculate that this condition of decreased parasympathetic drive could result in a pro-arrhythmic substrate in some 22q11.2DS patients.
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Affiliation(s)
- Amélie Calmont
- INSERM UMRS 1155, Centre for Kidney Research, 4 Rue de la Chine, 75020 Paris, France.
- UCL Great Ormond Street-Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| | - Naomi Anderson
- UCL Great Ormond Street-Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
- William Harvey Heart Centre, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
| | | | - Richard Ang
- William Harvey Heart Centre, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
- Department of Medicine, Rayne Institute, University College London, London WC1E 6JJ, UK.
| | - Andrew Tinker
- William Harvey Heart Centre, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
- Department of Medicine, Rayne Institute, University College London, London WC1E 6JJ, UK.
| | - Peter J Scambler
- UCL Great Ormond Street-Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
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18
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Marina N, Turovsky E, Christie IN, Hosford PS, Hadjihambi A, Korsak A, Ang R, Mastitskaya S, Sheikhbahaei S, Theparambil SM, Gourine AV. Brain metabolic sensing and metabolic signaling at the level of an astrocyte. Glia 2018; 66:1185-1199. [PMID: 29274121 PMCID: PMC5947829 DOI: 10.1002/glia.23283] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/04/2017] [Accepted: 11/29/2017] [Indexed: 12/18/2022]
Abstract
Astrocytes support neuronal function by providing essential structural and nutritional support, neurotransmitter trafficking and recycling and may also contribute to brain information processing. In this article we review published results and report new data suggesting that astrocytes function as versatile metabolic sensors of central nervous system (CNS) milieu and play an important role in the maintenance of brain metabolic homeostasis. We discuss anatomical and functional features of astrocytes that allow them to detect and respond to changes in the brain parenchymal levels of metabolic substrates (oxygen and glucose), and metabolic waste products (carbon dioxide). We report data suggesting that astrocytes are also sensitive to circulating endocrine signals-hormones like ghrelin, glucagon-like peptide-1 and leptin, that have a major impact on the CNS mechanisms controlling food intake and energy balance. We discuss signaling mechanisms that mediate communication between astrocytes and neurons and consider how these mechanisms are recruited by astrocytes activated in response to various metabolic challenges. We review experimental data suggesting that astrocytes modulate the activities of the respiratory and autonomic neuronal networks that ensure adaptive changes in breathing and sympathetic drive in order to support the physiological and behavioral demands of the organism in ever-changing environmental conditions. Finally, we discuss evidence suggesting that altered astroglial function may contribute to the pathogenesis of disparate neurological, respiratory and cardiovascular disorders such as Rett syndrome and systemic arterial hypertension.
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Affiliation(s)
- Nephtali Marina
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & PharmacologyUniversity College LondonLondonWC1E 6BTUnited Kingdom
- Research Department of Metabolism and Experimental Therapeutics, Division of MedicineUniversity College LondonLondonWC1E 6JJUnited Kingdom
| | - Egor Turovsky
- Laboratory of Intracellular SignallingInstitute of Cell Biophysics, Russian Academy of SciencesPushchinoRussia
| | - Isabel N Christie
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & PharmacologyUniversity College LondonLondonWC1E 6BTUnited Kingdom
| | - Patrick S Hosford
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & PharmacologyUniversity College LondonLondonWC1E 6BTUnited Kingdom
| | - Anna Hadjihambi
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & PharmacologyUniversity College LondonLondonWC1E 6BTUnited Kingdom
| | - Alla Korsak
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & PharmacologyUniversity College LondonLondonWC1E 6BTUnited Kingdom
| | - Richard Ang
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & PharmacologyUniversity College LondonLondonWC1E 6BTUnited Kingdom
| | - Svetlana Mastitskaya
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & PharmacologyUniversity College LondonLondonWC1E 6BTUnited Kingdom
| | - Shahriar Sheikhbahaei
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & PharmacologyUniversity College LondonLondonWC1E 6BTUnited Kingdom
| | - Shefeeq M Theparambil
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & PharmacologyUniversity College LondonLondonWC1E 6BTUnited Kingdom
| | - Alexander V Gourine
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & PharmacologyUniversity College LondonLondonWC1E 6BTUnited Kingdom
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Ang R, Lim P, Hunter RJ, Dhinoja MB, Chow AC, Schilling RJ, Earley MJ, Segal OR. 82Long term outcome following left atrial appendage occlusion: real world experience from a single centre prospective registry. Europace 2017. [DOI: 10.1093/europace/eux283.077] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ang R, Abramowitz J, Birnbaumer L, Gourine AV, Tinker A. The role of GαO-mediated signaling in the rostral ventrolateral medulla oblongata in cardiovascular reflexes and control of cardiac ventricular excitability. Physiol Rep 2017; 4:4/15/e12860. [PMID: 27528004 PMCID: PMC4985541 DOI: 10.14814/phy2.12860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/20/2016] [Indexed: 12/02/2022] Open
Abstract
The heart is controlled by the sympathetic and parasympathetic limbs of the autonomic nervous system with inhibitory signaling mechanisms recruited in both limbs. The aim of this study was to determine the role of inhibitory heterotrimeric G proteins in the central nervous mechanisms underlying autonomic control of the heart and its potential role in arrhythmogenesis. Mice with conditional deletion of the inhibitory heterotrimeric G protein GαO in the presympathetic area of the rostral ventral lateral medulla (RVLM) were generated to determine the role of GαO‐mediated signalling in autonomic control and electrophysiological properties of the heart. GαO deletion within the RVLM was not associated with changes in heart rate (HR) or the arterial blood pressure at rest (home cage, normal behavior). However, exposure to stressful conditions (novel environment, hypoxia, or hypercapnia) in these mice was associated with abnormal HR responses and an increased baroreflex gain when assessed under urethane anesthesia. This was associated with shortening of the ventricular effective refractory period. This phenotype was reversed by systemic beta‐adrenoceptor blockade, suggesting that GαO depletion in the RVLM increases central sympathetic drive. The data obtained support the hypothesis that GαO‐mediated signaling within the presympathetic circuits of the RVLM contributes to the autonomic control of the heart. GαO deficiency in the RVLM has a significant impact on cardiovascular responses to stress, cardiovascular reflexes and electrical properties of the heart.
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Affiliation(s)
- Richard Ang
- William Harvey Heart Centre, Barts & The London School of Medicine and Dentistry, London, UK Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | - Joel Abramowitz
- Division of Intramural Research, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Lutz Birnbaumer
- Division of Intramural Research, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Alexander V Gourine
- William Harvey Heart Centre, Barts & The London School of Medicine and Dentistry, London, UK
| | - Andrew Tinker
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
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Raine D, Begg G, Moore J, Taylor E, Buck R, Honarbakhsh S, Yew Ding W, Redfearn D, Opel A, Opel A, Thomas D, Prakash K, Thomas D, Khokhar A, Honarbakhsh S, Tairova S, Getman N, McAloon C, Honarbakhsh S, Shah M, Al-Lawati K, Al-Lawati K, Ensam B, Collins G, Akbar S, Merghani A, Furniss G, Yones E, Vijayashankar SS, Vijayashankar SS, Shariat H, Moss A, Yeoh A, Sadiq A, Taylor R, Edwards T, Nizam ud Din K, Langley P, Shepherd E, Murray S, Lord S, Bourke J, Plein S, Lip G, Tayebjee MH, Owen N, White S, O'Neill M, Hughes L, Carroll S, Moss-Morris R, Baker V, Kirkby C, Patel K, Robinson G, Antoniou S, Richmond L, Ullah W, Hunter R, Finlay M, Earley M, Whitbread M, Schilling R, Cooper R, Modi S, Somani R, Ng A, Hobson N, Caldwell J, Hadjivassilev S, Ang R, Finlay M, Dhinoja M, Earley M, Sporton S, Schilling R, Hunter R, Hadjivassilev S, Earley M, Lambiase P, Turley A, Child N, Linker N, Owens W, James S, Milner J, Tayebjee M, Sibley J, Griffiths A, Meredith T, Basher Y, Betts T, Rajappan K, Lambiase P, Lowe M, Hunter R, Schilling R, Finlay M, Rakhimbaeva G, Akramova N, Getman T, Hamborg T, O'Hare J, Randeva H, Osman F, Srinivasan N, Kirkby C, Firman E, Tobin L, Murphy C, Lowe M, Hunter R, Finlay M, Schilling R, Lambiase P, Mohan P, Salahia G, Lim H, Lim HS, Batchvarov V, Brennan P, Cox A, Muir A, Behr E, Hamill S, Laventure C, Newell S, Gordon B, Bashir K, Chuen J, Foster W, Yusuf S, Osman F, Hayat S, Panagopoulos D, Davies E, Tomlinson D, Haywood G, Mullan J, Kelland N, Horwood A, Connell N, Odams S, Maloney J, Shetty A, Kyriacou A, Sahu J, Lee J, Uzun O, Wong A, Ashtekar S, Uzun O, Wong A, Ashtekar S, Hashemi J, Gazor S, Redfearn D, Song A, Jenkins J, Glancy J, Wilson D, Sammut E, Diab I, Cripps T, Gill A, Abbas S, Enye J, Wahab A, Elshafie S, Ling K, Carey P, Chatterjee D, Timbrell S, Tufail W, Why H, Martos R, Thornley A, James S, Turley A, Bates M, Linker N, Hassan E, Quick J, Cowell R, Ho E. POSTERS (1)59MULTIPOLAR CONTACT MAPPING GUIDED ABLATION OF TEMPORALLY STABLE HIGH FREQUENCY AND COMPLEX FRACTIONATED ATRIAL ELECTROGRAM SITES IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION60INTRA-CARDIAC AND PERIPHERAL LEVELS OF BIOCHEMICAL MARKERS OF FIBROSES IN PATIENTS UNDERGOING CATHETER ABLATION FOR ATRIAL FIBRILATION61THE DON'T WAIT TO ANTICOAGULATE PROJECT (DWAC) BY THE WEST OF ENGLAND ACADEMIC HEALTH SCIENCE NETWORK (AHSN) OPTIMISES STROKE PREVENTION FOR PATIENTS WITH ATRIAL FIBRILLATION (AF) WITHIN PRIMARY CARE IN LINE WITH NICE CG180 IN THE WEST OF ENGLAND62ILLNESS AND TREATMENT REPRESENTATIONS, COPING AND DISTRESS: VICIOUS CYCLES OF EVERYDAY EXPERIENCES IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION63THE NEEDS OF THE ADOLESCENT LIVING WITH AN INHERITED CARDIAC CONDITION: THE PATIENTS' PERSPECTIVE64SAFETY AND EFFICACY OF PARAMEDIC TREATMENT OF REGULAR SUPRAVENTRICULAR TACHYCARDIA (PARA-SVT)65NATURAL PROGRESSION OF QRS DURATION FOLLOWING IMPLATABLE CARDIOVERTER DEFIBRILLATORS (ICD) - IMPLANTATION66COMPARISON OF EFFICACY OF VOLTAGE DIRECTED CAVOTRICUSPID ISTHMUS ABLATION USING MINI VS CONVENTIONAL ELETRODES67CRYOBALLOON ABLATION (CRYO) FOR ATRIAL FIBRILLATION (AF) CANNOT BE GUIDED BY TEMPERATURE END-POINTS ALONE68MODERATOR BAND ECTOPY UNMASKED BY ADENOSINE AS A CAUSE OF ECTOPIC TRIGGERED IDIOPATHIC VF69EARLY CLINICAL EXPERIENCE WITH TARGETED SITE SELECTION FOR THE WiCS-LV ELECTRODE FOR CRT70DOES VECTOR MAPPING PRIOR TO IMPLANTABLE LOOP RECORDER INSERTION IMPROVE THE DETECTION OF ARRHYTHMIA?71THE ROLE OF SPECKLE TRACKING STRAIN IMAGING IN ASSESSING LEFT VENTRICULAR RESPONSE TO CARDIAC RESYNCHRONISATION THERAPY IN RESPONDERS AND NON-RESPONDERS72EVALUATING PATIENTS' EXPERIENCE AND SATISFACTION OF THE ATRIAL FIBRILLATION ABLATION PROCEDURE: A RETROSPECTIVE ANALYSIS73TROUBLESHOOTING LV LEAD IMPLANTATION - NOVEL “UNIRAIL TECHNIQUE”74SUBCLINICAL ATHEROSCELEROSIS AND COGNITIVE IMPAIRMENT75EFFECT OF LOZARTANE ON DEVELOPMENT OF THE ELECTRICAL INSTABILITY OF THE MYOCARDIUM76THE INTERPLAY BETWEEN BODY COMPOSITION AND LEFT VENTRICULAR REMODELLING IN CARDIAC RESYNCHRONISATION THERAPY77FAMILY SCREENING IN IDIOPATHIC VENTRICULAR FIBRILLATION78MANAGEMENT OF ATRIAL FIBRILLATION IN A LARGE TEACHING HOSPITAL79THE EFFECT OF LEFT VENTRICULAR LEAD POSITION ON SURVIVAL IN PATIENTS WITH BINVENTRICULAR PACEMAKRS/DEFIBRILLATORS80ACUTE DEVICE IMPLANT-RELATED COMPLICATIONS DO NOT INCREASE LATE MORTALITY81ABORTED CARIDAC ARREST AS THE SENTINEL PRESENTATION IN A COHORT OF PATIENTS WITH THE CONCEALED BRUGADA PHENOTYPE82POST-CARDIAC DEVICE IMPLANTATION MOBILISATION ADVICE: A NATIONAL SURVEY83DO RISK SCORES DEVELOPED TO PROTECT ONE-YEAR MORTALITY ACTUALLY HELP IN ACCURATELY SELECTING PATIENTS RECEIVING PRIMARY PREVENTION ICD?84ATRIAL TACHYCARDIA ARISING FROM THE NON-CORONARY AORTIC CUSP85THE EFFECT OF DIFFERENT ATRIAL FIBRILLATION ABLATION STRATEGIES ON SURFACE ECG P WAVE DURATION86PRESCRIBING DRONEDARONE: HOW IS IT DONE ACROSS THE UK AND IS IT SAFE?87A CASE OF WIDE COMPLEX TACHYCARDIA88TRANSITION TO DEDICATED DAY CASE DEVICES - SAFETY AND EFFICACY IN A LARGE VOLUME CENTRE89SEQUENTIAL REGIONAL DOMINANT FREQUENCY MAPPING DURING ATRIAL FIBRILLATION: A NOVEL TEQUNIQUE90ELECTIVE CARDIOVERSION ENERGY PROTOCOLS: A RETROSPECTIVE COMPARISON OF ESCALATION STRATEGIES91THE INCIDENCE OF CLINCALLY RELEVANT HAEMATOMAS WITH PERIOPERATIVE USE OF NEWER P2Y12 INHIBITORS AND INTERRUPTED NOAC THERAPY IN CARDIAC IMPLANTABLE ELECTRONIC DEVICE INSERTION92AN AUDIT OF THE OUTCOMES FOR CHEMICAL AND DIRECT CURRENT CARDIOVERSION FOR ATRIAL FIBRILLATION AT OUR DGH OVER A 3 YEAR DURATION93REAL LIFE ACUTE MANAGEMET OF HAEMODYNAMICALLY TOLERATED MONOMORPHIC VENTRICULAR TACHYCARDIA. ARE WE MAKING EVIDENCE BASED ON DECISIONS?94A SERVICE EVALUATION TO ASSESS THE EFFICACY AND SAFETY OF NOVEL ORAL ANTICOAGULANTS VERSUS WARFARIN FOR ELECTIVE CARDIVERSION IN PATIENTS WITH NON VALVULAR AF IN A NURSE LED CARDIOVERSION SERVICE95PICK UP RATE OF IMPLANTED LOOP RECORDER AT A DISTRICT HOSPITAL. Europace 2016. [DOI: 10.1093/europace/euw273] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Champney F, Maddock L, Welford J, Kemp J, Allan V, Persidskikh Y, Orini M, Ang R, Workman A, Wong L, Honarbakhsh S, Leong K, Silberbauer J, O'Nunain S, Gomes J, McCready J, Bostock J, Shaw K, McKenna C, Bailey J, Honarbakhsh S, Casas J, Wallace J, Hunter R, Schilling R, Perel P, Morley K, Banerjee A, Hemingway H, Mrochak A, Ilyina T, Goncharik D, Chasnoits A, Plashinskaya L, Taggart P, Hayward M, Lambiase P, Hosford P, Kasparov S, Lambiase P, Tinker A, Gourine A, Kettlewell S, Dempster J, Colman M, Rankin A, Myles R, Smith G, Tester D, Jaye A, FitzPatrick D, Evans M, Fleming P, Jeffrey I, Cohen M, Simpson M, Ackerman M, Behr E, Srinivasan N, Kirkby C, Firman E, Tobin L, Murphy C, Lowe M, Hunter RJ, Finlay M, Schilling RJ, Lambiase PD, Ng F, Tomlinson L, Nuthoo S, Cajilog E, Lefroy D, Qureshi N, Koa-Wing M, Whinnett Z, Linton N, Davies D, Lim P, Peters N, Kanagaratnam P, Varnava A. ORAL ABSTRACTS (1)Allied Professionals7CRYOABLATION FOR PAROXYSMAL ATRIAL FIBRILLATION - IS AN EP LAB REQUIRED?8A PATHWAY TO SAFETY - ANTICOAGULATION COMPLIANCE IN CIED PATIENTS WITH AF9UNDERSTANDING THE WAYS IN WHICH OCCUPATION IS AFFECTED BY POSTURAL TACHYCARDIA SYNDROME: A UK OCCUPATIONAL THERAPY PERSPECTIVE10DEVELOPMENT OF AN INTERGRATED SUPPORT PATHWAY FOR PATIENTS FULFILLING NICE CRITERIA FOR AN INTERNAL CARDIOVASCULAR DEBRIBRILLATOR (ICD) IN A DISTRICT GENERAL HOSPITAL11ARE CARDIOVASCULAR RISK FACTORS ALSO ASSOCIATED WITH THE INCIDENCE OF ATRIAL FIBRILLATION? A SYSTEMATIC REVIEW AND FIELD SYNOPSIS OF 23 FACTORS IN 32 INITIALLY HEALTHY COHORTS OF 20 MILLION PARTICIPANTS12BRAIN MRI FINDINGS IN PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING CARDIOVERSIONBasic Science/Sudden Cardiac Death13PRELIMINARY ASSESSMENT OF THE “RE-ENTRY VULNERABILITY INDEX” AS A MARKER OF CARDIAC INSTABILITY IN THE HUMAN HEART USING WHOLE-HEART CONTACT EPICARDIAL MAPPING14OPTOGENETIC STIMULATION OF BRAINSTEM'S VAGAL PREGANGLIONIC NEURONES IS ASSOCIATED WITH NEURONAL NITRIC OXIDE SYNTHASE-DEPENDENT PROLONGATION OF VENTRICULAR EFFECTIVE REFRACTORY PERIOD15A DYNAMIC-CLAMP STUDY OF L-TYPE Ca2+ CURRENT IN RABBIT AND HUMAN ATRIAL MYOCYTES: THE CONTRIBUTION OF WINDOW ICaL TO EARLY AFTERDEPOLARISATIONS16WHOLE EXOME SEQUENCING IN SUDDEN INFANT DEATH SYNDROME17MEDIUM TERM SURVIVAL AND FAMILY SCREENING OUTCOMES IN AN IDIOPATHIC VENTRICULAR FIBRILLATION COHORT - A MULTICENTRE EXPERIENCE18CLINICAL CHARACTERISTICS OF SCD SURVIVORS WITH BRUGADA SYNDROME:- ARE SPONSANEOUS TYPE I ECG AND PREVIOUS SYNCOPE REALLY ASSOCIATED WITH HIGH RISK? Europace 2016. [DOI: 10.1093/europace/euw270] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Furniss G, Opel A, Hussein A, Pearman C, Grace A, Connelly D, Orlowski A, Banerjee A, McNicholas T, Providencia R, Montañes M, Providencia R, Panagopoulos D, Tomlinson D, Dalrymple-Hay M, Haywood G, Butler A, Ang R, Ullah W, Schwartz R, Fannon M, Finlay M, Hunter R, Schilling R, Das M, Asfour I, Morgan M, Ronayne C, Shaw M, Snowdon R, Gupta D, Todd D, King R, Hall M, Modi S, Mediratta N, Gupta D, Reddy V, Neuzil P, Willems S, Verma A, Heck P, Schilling R, Lambiase P, Hall M, Nicholl B, McQueenie R, Jani BD, McKeag N, Gallacher K, Mair F, Heaton D, Macdonald J, Burnell J, Ryan R, Marshall T, Sutton C, O'Callaghan S, Kenny R, Karim N, Srinivasan N, Ferreira M, Goncalves L, Lambiase P, Toledano M, Field E, Walsh H, Maguire K, Cervi E, Kaski J, Perez Tome M, Pantazis A, Elliott P, Lambiase P, Segal O. ORAL ABSTRACTS (3)EP & Ablation31LEFT ATRIAL POSTERIOR WALL ISOLATION (THE “BOX LESION PATTERN”) IN THE TREATMENT OF ATRIAL FIBRILLATION: A SINGLE CENTRE EXPERIENCE32DAY CASE CRYOBLATION (CRYO) FOR PAROXYSMAL ATRIAL FIBRILLATION (pAF) IN THE DISTRICT GENERAL HOSPITAL IS SAFE AND EFFECTIVE IF DONE IN HIGH VOLUME WITH EXPERIENCED OPERATORS33ABLATION INDEX-GUIDED PULMONARY VEIN ISOLATION FOR ATRIAL FIBRILLATION MAY IMPROVE CLINICAL OUTCOMES IN COMPARISON TO CONTACT FORCE-GUIDED ABLATION34THE PROCEDURAL COMPLICATION RATES AND SHORT-TERM SUCCESS RATES OF THORACOSCOPIC AF ABLATION DURING THE INSTITUTIONAL LEARNING CURVE35INITIAL PROCEDURAL RESULTS FROM DDRAMATIC-SVT STUDY: DD MECHANISM IDENTIFICATION AND LOCALISATION USING DIPOLE DENSITY MAPPING TO GUIDE ABLATION STRATEGY36MORBIDITY AND MORTALITY IN MIDDLE-AGED INDIVIDUALS WITH ATRIAL FIBRILLATION: UK BIOBANK DATAClinical EP37THE GM AHSN AF LANDSCAPE TOOL: A SHARED PUBLIC DATA PLATFORM TO PROMOTE QUALITY IMPROVEMENTS AND IDENTIFY OPPORTUNITIES TO PREVENT AF-RELATED STROKE IN THE DEVOLVED GREATER MANCHESTER HEALTH SYSTEM38REAL WORLD PERSISTENCE, ADHERENCE AND SWITCH-OVER ACROSS ANTICOAGULANTS IN ATRIAL FIBRILLATION-A NATIONAL POPULATION-BASED STUDY39ORTHOSTATIC HYPOTENSION AND ATRIAL FIBRILLATION40PREVALENCE OF SHORT QT AND CRITERIA OF SEVERITY IN A YOUNG ASYMPTOMATIC COHORT41SURFACE ELECTROCARDIOGRAPHIC FEATURES AND PREVALENCE OF ARRHYTHMIAS IN PAEDIATRIC FRIEDREICH'S ATAXIA42RISK STRATIFICATION OF TYPE 1 MYOTONIC DYSTROPHY: IS THE ECG ACCURATE ENOUGH TO SELECT PATIENTS AT RISK OF BRADYARRHYTHMIC EVENTS? Europace 2016. [DOI: 10.1093/europace/euw272] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Martin C, Papageorgiou N, Srinivasan N, Luther V, Ang R, Saberwal B, Sawhney V, Martin C, Orini M, Srinivasan N, Bhar-Amato J, Chow A, Lowe M, Simon R, Lambiase P, Providência R, Srinivasan N, Bronis K, Moscoso Costa F, Cavaco D, Adragao P, Tousoulis D, Hunter R, Schilling R, Segal O, Chow A, Rowland E, Lowe M, Lambiase P, Orini M, Providencia R, Simon R, Khan F, Segal O, Ahsan S, Chow A, Lowe M, Schilling R, Taggart P, Lambiase P, Linton N, Jamil-Copley S, Koa-Wing M, Lim P, Qureshi N, Whinnett Z, Davies D, Peters N, Kanagaratnam P, Opel A, Ullah W, Baker V, Finlay M, Dhinoja M, Earley M, Sporton S, Hunter R, Schilling R, Roy A, Perera D, Sporton S, Dhinoja M, Segal O, Lambiase P, Lowe M, Chow A, Hunter R, Rowland E, Khan F, Ezzat V, Providencia R, Earley M, Finlay M, Schilling R, Ahsan S, Bacuetes EB, Wray MW, Dhinoja MD, Earley ME, Schilling RJS, Sporton SS, Curtain J, Gajendragadkar P, Begley D, Fynn S, Grace A, Heck P, Virdee M, Salaunkey K, Agarwal S. MODERATED POSTERS (2)51GLOBAL HIGH DENSITY MAPPING OF RE-ENTRY VULNERABILITY INDEX INDENTIFIES SITES OF RIGHT VENTRICULAR ARRHYTHMIA INITIATION IN BRUGADA SYNDROME AND ARVC52THE ROLE OF ADENOSINE-GUIDED PULMONARY VEIN ISOLATION IN PATIENTS UNDERGOING ATRIAL FIBRILLATION ABLATION:AN UPDATED META-ANALYSIS53FIRST EVIDENT THAT T-PEAK AND TPEAK-TEND CORRELATE WITH RIGHT TO LEFT AND TRANSMURAL DYNAMIC DISPERSION OF REPOLARIZATION IN THE INTACT HUMAN HEART54RIPPLE MAPPING VENTRICULAR SCAR TO CHARACTERIZE CHANNELS SUPPORTING RE-ENTRANT TACHYCARDIA AS A GUIDE TO ABLATION55LONG TERM DURABILITY OF PULMONARY VEIN ISOLATION: INSIGHTS FROM A RANDOMISED TRIAL OF CRYOBALLOON VERSUS RADIOFREQUENCY ABLATION FOR A COMBINED APPROACH56A SINGLE-CENTRE EXPERIENCE OF THE CONVERGENT PROCEDURE FOR THE TREATMENT OF LONG-STANDING PERSISTENT ATRIAL FIBRILLATION57MODERATE SEDATION IN THE CARDIAC ELECTROPHYSIOLOGY LABORATORY: A RETROSPECTIVE ANALYSIS TO ASSESS SAFETY58USE OF GENERAL ANAESTHESIA IN CATHETER ABLATION OF PERSISTENT AF: IMPROVED OUTCOME AND COST EFFECTIVENESS:. Europace 2016. [DOI: 10.1093/europace/euw269] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Catheter ablation is superior to antiarrhythmic drugs in maintaining sinus rhythm for patients with atrial fibrillation (AF). Pulmonary vein (PV) isolation is the cornerstone of any AF ablation procedure. Conventionally, this is achieved by performing point by point lesions using radiofrequency (RF) energy. However, this is technically challenging, time consuming and is associated with a number of complications. Long-term durability of PV isolation is also a concern. To address these issues, 'one-shot' energy delivery systems and alternative energy sources have been developed. The cryoballoon system has emerged as the most commonly used alternative to point by point RF technology. In this paper, we compare the technology, biophysics and clinical data of cryoballoon to conventional RF ablation for AF. The safety and efficacy of cryoballoon compared to RF ablation is critically reviewed. We conclude by looking at future applications of this technology.
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Affiliation(s)
- Richard Ang
- Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust & QMUL, London, EC1A 7BE, UK
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Gowran A, Kulikova T, Lewis FC, Foldes G, Fuentes L, Viiri LE, Spinelli V, Costa A, Perbellini F, Sid-Otmane C, Bax NAM, Pekkanen-Mattila M, Schiano C, Chaloupka A, Forini F, Sarkozy M, De Jager SCA, Vajen T, Glezeva N, Lee HW, Golovkin A, Kucera T, Musikhina NA, Korzhenkov NP, Santuchi MDEC, Munteanu D, Garcia RG, Ang R, Usui S, Kamilova U, Jumeau C, Aberg M, Kostina DA, Brandt MM, Muntean D, Lindner D, Sadaba R, Bacova B, Nikolov A, Sedmera D, Ryabov V, Neto FP, Lynch M, Portero V, Kui P, Howarth FC, Gualdoni A, Prorok J, Diolaiuti L, Vostarek F, Wagner M, Abela MA, Nebert C, Xiang W, Kloza M, Maslenko A, Grechanyk M, Bhattachariya A, Morawietz H, Babaeva AR, Martinez Sanchez SM, Krychtiuk KA, Starodubova J, Fiorelli S, Rinne P, Ozkaramanli Gur D, Hofbauer T, Starodubova J, Stellos K, Pinon P, Tsoref O, Thaler B, Fraga-Silva RA, Fuijkschot WW, Shaaban MNS, Matthaeus C, Deluyker D, Scardigli M, Zahradnikova A, Dominguez A, Kondrat'eva D, Sosorburam T, Murarikova M, Duerr GD, Griecsova L, Portnichenko VI, Smolina N, Duicu OANAM, Elder JM, Zaglia T, Lorenzon A, Ruperez C, Woudstra L, Suffee N, De Lucia C, Tsoref O, Russell-Hallinan A, Menendez-Montes I, Kapelko VI, Emmens RW, Hetman O, Van Der Laarse WJ, Goncharov S, Adao R, Huisamen B, Sirenko O, Kamilova U, Nassiri I, Tserendavaa SUMIYA, Yushko K, Baldan Martin M, Falcone C, Vigorelli V, Nigro P, Pompilio G, Stepanova O, Valikhov M, Samko A, Masenko V, Tereschenko S, Teoh T, Domenjo-Vila E, Theologou T, Field M, Awad W, Yasin M, Nadal-Ginard B, Ellison-Hughes GM, Hellen N, Vittay O, Harding SE, Gomez-Cid L, Fernandez-Santos ME, Suarez-Sancho S, Plasencia V, Climent A, Sanz-Ruiz R, Hedhammar M, Atienza F, Fernandez-Aviles F, Kiamehr M, Oittinen M, Viiri KM, Kaikkonen M, Aalto-Setala K, Diolaiuti L, Laurino A, Sartiani L, Vona A, Zanardelli M, Cerbai E, Failli P, Hortigon-Vinagre MP, Van Der Heyden M, Burton FL, Smith GL, Watson S, Scigliano M, Tkach S, Alayoubi S, Harding SE, Terracciano CM, Ly HQ, Mauretti A, Van Marion MH, Van Turnhout MC, Van Der Schaft DWJ, Sahlgren CM, Goumans MJ, Bouten CVC, Vuorenpaa H, Penttinen K, Sarkanen R, Ylikomi T, Heinonen T, Aalto-Setala K, Grimaldi V, Aprile M, Esposito R, Maiello C, Soricelli A, Colantuoni V, Costa V, Ciccodicola A, Napoli C, Rowe GC, Johnson K, Arany ZP, Del Monte F, D'aurizio R, Kusmic C, Nicolini G, Baumgart M, Groth M, Ucciferri N, Iervasi G, Pitto L, Pipicz M, Gaspar R, Siska A, Foldesi I, Kiss K, Bencsik P, Thum T, Batkai S, Csont T, Haan JJ, Bosch L, Brans MAD, Van De Weg SM, Deddens JC, Lee SJ, Sluijter JPG, Pasterkamp G, Werner I, Projahn D, Staudt M, Curaj A, Soenmez TT, Simsekyilmaz S, Hackeng TM, Von Hundelshausen P, Koenen RR, Weber C, Liehn EA, Santos-Martinez M, Medina C, Watson C, Mcdonald K, Gilmer J, Ledwidge M, Song SH, Lee MY, Park MH, Choi JC, Ahn JH, Park JS, Oh JH, Choi JH, Lee HC, Cha KS, Hong TJ, Kudryavtsev I, Serebryakova M, Malashicheva A, Shishkova A, Zhiduleva E, Moiseeva O, Durisova M, Blaha M, Melenovsky V, Pirk J, Kautzner J, Petelina TI, Gapon LI, Gorbatenko EA, Potolinskaya YV, Arkhipova EV, Solodenkova KS, Osadchuk MA, Dutra MF, Oliveira FCB, Silva MM, Passos-Silva DG, Goncalves R, Santos RAS, Da Silva RF, Gavrilescu CM, Paraschiv CM, Manea P, Strat LC, Gomez JMG, Merino D, Hurle MA, Nistal JF, Aires A, Cortajarena AL, Villar AV, Abramowitz J, Birnbaumer L, Gourine AV, Tinker A, Takamura M, Takashima S, Inoue O, Misu H, Takamura T, Kaneko S, Alieva TOHIRA, Mougenot N, Dufilho M, Hatem S, Siegbahn A, Kostina AS, Uspensky VE, Moiseeva OM, Kostareva AA, Malashicheva AB, Van Dijk CGM, Chrifi I, Verhaar MC, Duncker DJ, Cheng C, Sturza A, Petrus A, Duicu O, Kiss L, Danila M, Baczko I, Jost N, Gotzhein F, Schon J, Schwarzl M, Hinrichs S, Blankenberg S, Volker U, Hammer E, Westermann D, Martinez-Martinez E, Arrieta V, Fernandez-Celis A, Jimenez-Alfaro L, Melero A, Alvarez-Asiain V, Cachofeiro V, Lopez-Andres N, Tribulova N, Wallukat G, Knezl V, Radosinska J, Barancik M, Tsinlikov I, Tsinlikova I, Nicoloff G, Blazhev A, Pesevski Z, Kvasilova A, Stopkova T, Eckhardt A, Buffinton CM, Nanka O, Kercheva M, Suslova T, Gusakova A, Ryabova T, Markov V, Karpov R, Seemann H, Alcantara TC, Santuchi MDEC, Fonseca SG, Da Silva RF, Barallobre-Barreiro J, Oklu R, Fava M, Baig F, Yin X, Albadawi H, Jahangiri M, Stoughton J, Mayr M, Podliesna SP, Veerman CCV, Verkerk AOV, Klerk MK, Lodder EML, Mengarelli IM, Bezzina CRB, Remme CAR, Takacs H, Polyak A, Morvay N, Lepran I, Tiszlavicz L, Nagy N, Ordog B, Farkas A, Forster T, Varro A, Farkas AS, Jayaprakash P, Parekh K, Ferdous Z, Oz M, Dobrzynski H, Adrian TE, Landi S, Bonzanni M, D'souza A, Boyett M, Bucchi A, Baruscotti M, Difrancesco D, Barbuti A, Kui P, Takacs H, Oravecz K, Hezso T, Polyak A, Levijoki J, Pollesello P, Koskelainen T, Otsomaa L, Farkas AS, Papp JGY, Varro A, Toth A, Acsai K, Dini L, Mazzoni L, Sartiani L, Cerbai E, Mugelli A, Svatunkova J, Sedmera D, Deffge C, Baer C, Weinert S, Braun-Dullaeus RC, Herold J, Cassar AC, Zahra GZ, Pllaha EP, Dingli PD, Montefort SM, Xuereb RGX, Aschacher T, Messner B, Eichmair E, Mohl W, Reglin B, Rong W, Nitzsche B, Maibier M, Guimaraes P, Ruggeri A, Secomb TW, Pries AR, Baranowska-Kuczko M, Karpinska O, Kusaczuk M, Malinowska B, Kozlowska H, Demikhova N, Vynnychenko L, Prykhodko O, Grechanyk N, Kuryata A, Cottrill KA, Du L, Bjorck HM, Maleki S, Franco-Cereceda A, Chan SY, Eriksson P, Giebe S, Cockcroft N, Hewitt K, Brux M, Brunssen C, Tarasov AA, Davidov SI, Reznikova EA, Tapia Abellan A, Angosto Bazarra D, Pelegrin Vivancos P, Montoro Garcia S, Kastl SP, Pongratz T, Goliasch G, Gaspar L, Maurer G, Huber K, Dostal E, Pfaffenberger S, Oravec S, Wojta J, Speidl WS, Osipova I, Sopotova I, Eligini S, Cosentino N, Marenzi G, Tremoli E, Rami M, Ring L, Steffens S, Gur O, Gurkan S, Mangold A, Scherz T, Panzenboeck A, Staier N, Heidari H, Mueller J, Lang IM, Osipova I, Sopotova I, Gatsiou A, Stamatelopoulos K, Perisic L, John D, Lunella FF, Eriksson P, Hedin U, Zeiher A, Dimmeler S, Nunez L, Moure R, Marron-Linares G, Flores X, Aldama G, Salgado J, Calvino R, Tomas M, Bou G, Vazquez N, Hermida-Prieto M, Vazquez-Rodriguez JM, Amit U, Landa N, Kain D, Tyomkin D, David A, Leor J, Hohensinner PJ, Baumgartner J, Krychtiuk KA, Maurer G, Huber K, Baik N, Miles LA, Wojta J, Seeman H, Montecucco F, Da Silva AR, Costa-Fraga FP, Anguenot L, Mach FP, Santos RAS, Stergiopulos N, Da Silva RF, Kupreishvili K, Vonk ABA, Smulders YM, Van Hinsbergh VWM, Stooker W, Niessen HWM, Krijnen PAJ, Ashmawy MM, Salama MA, Elamrosy MZ, Juettner R, Rathjen FG, Bito V, Crocini C, Ferrantini C, Gabbrielli T, Silvestri L, Coppini R, Tesi C, Cerbai E, Poggesi C, Pavone FS, Sacconi L, Mackova K, Zahradnik I, Zahradnikova A, Diaz I, Sanchez De Rojas De Pedro E, Hmadcha K, Calderon Sanchez E, Benitah JP, Gomez AM, Smani T, Ordonez A, Afanasiev SA, Egorova MV, Popov SV, Wu Qing P, Cheng X, Carnicka S, Pancza D, Jasova M, Kancirova I, Ferko M, Ravingerova T, Wu S, Schneider M, Marggraf V, Verfuerth L, Frede S, Boehm O, Dewald O, Baumgarten G, Kim SC, Farkasova V, Gablovsky I, Bernatova I, Ravingerova T, Nosar V, Portnychenko A, Drevytska T, Mankovska I, Gogvadze V, Sejersen T, Kostareva A, Sturza A, Wolf A, Privistirescu A, Danila M, Muntean D, O ' Gara P, Sanchez-Alonso JL, Harding SE, Lyon AR, Prando V, Pianca N, Lo Verso F, Milan G, Pesce P, Sandri M, Mongillo M, Beffagna G, Poloni G, Dazzo E, Sabatelli P, Doliana R, Polishchuk R, Carnevale D, Lembo G, Bonaldo P, Braghetta P, Rampazzo A, Cairo M, Giralt M, Villarroya F, Planavila A, Biesbroek PS, Emmens RWE, Juffermans LJM, Van Der Wall AC, Van Rossum AC, Niessen JWM, Krijnen PAJ, Moor Morris T, Dilanian G, Farahmand P, Puceat M, Hatem S, Gambino G, Petraglia L, Elia A, Komici K, Femminella GD, D'amico ML, Pagano G, Cannavo A, Liccardo D, Koch WJ, Nolano M, Leosco D, Ferrara N, Rengo G, Amit U, Landa N, Kain D, Leor J, Neary R, Shiels L, Watson C, Baugh J, Palacios B, Escobar B, Alonso AV, Guzman G, Ruiz-Cabello J, Jimenez-Borreguero LJ, Martin-Puig S, Lakomkin VL, Lukoshkova EV, Abramov AA, Gramovich VV, Vyborov ON, Ermishkin VV, Undrovinas NA, Shirinsky VP, Smilde BJ, Woudstra L, Fong Hing G, Wouters D, Zeerleder S, Murk JL, Van Ham SM, Heymans S, Juffermans LJM, Van Rossum AC, Niessen JWM, Krijnen PAJ, Krakhmalova O, Van Groen D, Bogaards SJP, Schalij I, Portnichenko GV, Tumanovska LV, Goshovska YV, Lapikova-Bryhinska TU, Nagibin VS, Dosenko VE, Mendes-Ferreira P, Maia-Rocha C, Santos-Ribeiro D, Potus F, Breuils-Bonnet S, Provencher S, Bonnet S, Rademaker M, Leite-Moreira AF, Bras-Silva C, Lopes J, Kuryata O, Lusynets T, Alikulov I, Nourddine M, Azzouzi L, Habbal R, Tserendavaa SUMIYA, Enkhtaivan ODKHUU, Enkhtaivan ODKHUU, Shagdar ZORIGO, Shagdar ZORIGO, Malchinkhuu MUNKHZ, Malchinkhuu MUNLHZ, Koval S, Starchenko T, Mourino-Alvarez L, Gonzalez-Calero L, Sastre-Oliva T, Lopez JA, Vazquez J, Alvarez-Llamas G, Ruilope LUISM, De La Cuesta F, Barderas MG, Bozzini S, D'angelo A, Pelissero G. Poster session 3Cell growth, differentiation and stem cells - Heart511The role of the endocannabinoid system in modelling muscular dystrophy cardiac disease with induced pluripotent stem cells.512An emerging role of T lymphocytes in cardiac regenerative processes in heart failure due to dilated cardiomyopathy513Canonical wnt signaling reverses the ‘aged/senescent’ human endogenous cardiac stem cell phenotype514Hippo signalling modulates survival of human induced pluripotent stem cell-derived cardiomyocytes515Biocompatibility of mesenchymal stem cells with a spider silk matrix and its potential use as scaffold for cardiac tissue regeneration516A snapshot of genome-wide transcription in human induced pluripotent stem cell-derived hepatocyte-like cells (iPSC-HLCs)517Can NOS/sGC/cGK1 pathway trigger the differentiation and maturation of mouse embryonic stem cells (ESCs)?518Introduction of external Ik1 to human-induced pluripotent stem cell-derived cardiomyocytes via Ik1-expressing HEK293519Cell therapy of the heart studied using adult myocardial slices in vitro520Enhancement of the paracrine potential of human adipose derived stem cells when cultured as spheroid bodies521Mechanosensitivity of cardiomyocyte progenitor cells: the strain response in 2D and 3D environments522The effect of the vascular-like network on the maturation of the human induced pluripotent stem cell derived cardiomyocytes.Transcriptional control and RNA species - Heart525Gene expression regulation in heart failure: from pathobiology to bioinformatics526Human transcriptome in idiopathic dilated cardiomyopathy - a novel high throughput screening527A high-throghput approach unveils putative miRNA-mediated mitochondria-targeted cardioprotective circuits activated by T3 in the post ischemia reperfusion setting528The effect of uraemia on the expression of miR-212/132 and the calcineurin pathway in the rat heartCytokines and cellular inflammation - Heart531Lack of growth differentiation factor 15 aggravates adverse cardiac remodeling upon pressure-overload in mice532Blocking heteromerization of platelet chemokines ccl5 and cxcl4 reduces inflammation and preserves heart function after myocardial infarction533Is there an association between low-dose aspirin use and clinical outcome in HFPEF? Implications of modulating monocyte function and inflammatory mediator release534N-terminal truncated intracellular matrix metalloproteinase-2 expression in diabetic heart.535Expression of CD39 and CD73 on peripheral T-cell subsets in calcific aortic stenosis536Mast cells in the atrial myocardium of patients with atrial fibrillation: a comparison with patients in sinus rhythm539Characteristics of the inflammatory response in patients with coronary artery disease and arterial hypertension540Pro-inflammatory cytokines as cardiovascular events predictors in rheumatoid arthritis and asymptomatic atherosclerosis541Characterization of FVB/N murinic bone marrow-derived macrophage polarization into M1 and M2 phenotypes542The biological expression and thoracic anterior pain syndromeSignal transduction - Heart545The association of heat shock protein 90 and TGFbeta receptor I is involved in collagen production during cardiac remodelling in aortic-banded mice546Loss of the inhibitory GalphaO protein in the rostral ventrolateral medulla of the brainstem leads to abnormalities in cardiovascular reflexes and altered ventricular excitablitiy547Selenoprotein P regulates pressure overload-induced cardiac remodeling548Study of adenylyl cyclase activity in erythrocyte membranes in patients with chronic heart failure549Direct thrombin inhibitors inhibit atrial myocardium hypertrophy in a rat model of heart failure and atrial remodeling550Tissue factor / FVIIa transactivates the IGF-1R by a Src-dependent phosphorylation of caveolin-1551Notch signaling is differently altered in endothelial and smooth muscle cells of ascending aortic aneurysm patients552Frizzled 5 expression is essential for endothelial proliferation and migration553Modulation of vascular function and ROS production by novel synthetic benzopyran analogues in diabetes mellitusExtracellular matrix and fibrosis - Heart556Cardiac fibroblasts as inflammatory supporter cells trigger cardiac inflammation in heart failure557A role for galectin-3 in calcific aortic valve stenosis558Omega-3 polyunsaturated fatty acids- can they decrease risk for ventricular fibrillation?559Serum levels of elastin derived peptides and circulating elastin-antielastin immune complexes in sera of patients with coronary artery disease560Endocardial fibroelastosis is secondary to hemodynamic alterations in the chick model of hypoplastic left heart syndrome561Dynamics of serum levels of matrix metalloproteinases in primary anterior STEMI patients564Deletion of the alpha-7 nicotinic acetylcholine receptor changes the vascular remodeling induced by transverse aortic constriction in mice.565Extracellular matrix remodelling in response to venous hypertension: proteomics of human varicose veinsIon channels, ion exchangers and cellular electrophysiology - Heart568Microtubule-associated protein RP/EB family member 1 modulates sodium channel trafficking and cardiac conduction569Investigation of electrophysiological abnormalities in a rabbit athlete's heart model570Upregulation of expression of multiple genes in the atrioventricular node of streptozotocin-induced diabetic rat571miR-1 as a regulator of sinoatrial rhythm in endurance training adaptation572Selective sodium-calcium exchanger inhibition reduces myocardial dysfunction associated with hypokalaemia and ventricular fibrillation573Effect of racemic and levo-methadone on action potential of human ventricular cardiomyocytes574Acute temperature effects on the chick embryonic heart functionVasculogenesis, angiogenesis and arteriogenesis577Clinical improvement and enhanced collateral vessel growth after monocyte transplantation in mice578The role of HIF-1 alpha, VEGF and obstructive sleep apnoea in the development of coronary collateral circulation579Initiating cardiac repair with a trans-coronary sinus catheter intervention in an ischemia/reperfusion porcine animal model580Early adaptation of pre-existing collaterals after acute arteriolar and venular microocclusion: an in vivo study in chick chorioallantoic membraneEndothelium583EDH-type responses to the activator of potassium KCa2.3 and KCa3.1 channels SKA-31 in the small mesenteric artery from spontaneously hypertensive rats584The peculiarities of endothelial dysfunction in patients with chronic renocardial syndrome585Endothelial dysfunction, atherosclerosis of the carotid arteries and level of leptin in patient with coronary heart disease in combination with hepatic steatosis depend from body mass index.586Role of non-coding RNAs in thoracic aortic aneurysm associated with bicuspid aortic valve587Cigarette smoke extract abrogates atheroprotective effects of high laminar flow on endothelial function588The prognostic value of anti-connective tissue antibodies in coronary heart disease and asymptomatic atherosclerosis589Novel potential properties of bioactive peptides from spanish dry-cured ham on the endothelium.Lipids592Intermediate density lipoprotein is associated with monocyte subset distribution in patients with stable atherosclerosis593The characteristics of dyslipidemia in rheumatoid arthritisAtherosclerosis596Macrophages differentiated in vitro are heterogeneous: morphological and functional profile in patients with coronary artery disease597Palmitoylethanolamide promotes anti-inflammatory phenotype of macrophages and attenuates plaque formation in ApoE-/- mice598Amiodarone versus esmolol in the perioperative period: an in vitro study of coronary artery bypass grafts599BMPRII signaling of fibrocytes, a mesenchymal progenitor cell population, is increased in STEMI and dyslipidemia600The characteristics of atherogenesis and systemic inflammation in rheumatoid arthritis601Role of adenosine-to-inosine RNA editing in human atherosclerosis602Presence of bacterial DNA in thrombus aspirates of patients with myocardial infarction603Novel E-selectin binding polymers reduce atherosclerotic lesions in ApoE(-/-) mice604Differential expression of the plasminogen receptor Plg-RKT in monocyte and macrophage subsets - possible functional consequences in atherogenesis605Apelin-13 treatment enhances the stability of atherosclerotic plaques606Mast cells are increased in the media of coronary lesions in patients with myocardial infarction and favor atherosclerotic plaque instability607Association of neutrophil to lymphocyte ratio with presence of isolated coronary artery ectasiaCalcium fluxes and excitation-contraction coupling610The coxsackie- and adenovirus receptor (CAR) regulates calcium homeostasis in the developing heart611HMW-AGEs application acutely reduces ICaL in adult cardiomyocytes612Measuring electrical conductibility of cardiac T-tubular systems613Postnatal development of cardiac excitation-contraction coupling in rats614Role of altered Ca2+ homeostasis during adverse cardiac remodeling after ischemia/reperfusion615Experimental study of sarcoplasmic reticulum dysfunction and energetic metabolism in failing myocardium associated with diabetes mellitusHibernation, stunning and preconditioning618Volatile anesthetic preconditioning attenuates ischemic-reperfusion injury in type II diabetic patients undergoing on-pump heart surgery619The effect of early and delayed phase of remote ischemic preconditioning on ischemia-reperfusion injury in the isolated hearts of healthy and diabetic rats620Post-conditioning with 1668-thioate leads to attenuation of the inflammatory response and remodeling with less fibrosis and better left ventricular function in a murine model of myocardial infarction621Maturation-related changes in response to ischemia-reperfusion injury and in effects of classical ischemic preconditioning and remote preconditioningMitochondria and energetics624Phase changes in myocardial mitochondrial respiration caused by hypoxic preconditioning or periodic hypoxic training625Desmin mutations depress mitochondrial metabolism626Methylene blue modulates mitochondrial function and monoamine oxidases-related ROS production in diabetic rat hearts627Doxorubicin modulates the real-time oxygen consumption rate of freshly isolated adult rat and human ventricular cardiomyocytesCardiomyopathies and fibrosis630Effects of genetic or pharmacologic inhibition of the ubiquitin/proteasome system on myocardial proteostasis and cardiac function631Suppression of Wnt signalling in a desmoglein-2 transgenic mouse model for arrhythmogenic cardiomyopathy632Cold-induced cardiac hypertrophy is reversed after thermo-neutral deacclimatization633CD45 is a sensitive marker to diagnose lymphocytic myocarditis in endomyocardial biopsies of living patients and in autopsies634Atrial epicardial adipose tissue derives from epicardial progenitors635Caloric restriction ameliorates cardiac function, sympathetic cardiac innervation and beta-adrenergic receptor signaling in an experimental model of post-ischemic heart failure636High fat diet improves cardiac remodelling and function after extensive myocardial infarction in mice637Epigenetic therapy reduces cardiac hypertrophy in murine models of heart failure638Imbalance of the VHL/HIF signaling in WT1+ Epicardial Progenitors results in coronary vascular defects, fibrosis and cardiac hypertrophy639Diastolic dysfunction is the first stage of the developing heart failure640Colchicine aggravates coxsackievirus B3 infection in miceArterial and pulmonary hypertension642Osteopontin as a marker of pulmonary hypertension in patients with coronary heart disease combined with chronic obstructive pulmonary disease643Myocardial dynamic stiffness is increased in experimental pulmonary hypertension partly due to incomplete relaxation644Hypotensive effect of quercetin is possibly mediated by down-regulation of immunotroteasome subunits in aorta of spontaneously hypertensive rats645Urocortin-2 improves right ventricular function and attenuates experimental pulmonary arterial hypertension646A preclinical evaluation of the anti-hypertensive properties of an aqueous extract of Agathosma (Buchu)Biomarkers648The adiponectin level in hypertensive females with rheumatoid arthritis and its relationship with subclinical atherosclerosis649Markers for identification of renal dysfunction in the patients with chronic heart failure650cardio-hepatic syndromes in chronic heart failure: North Africa profile651To study other biomarkers that assess during myocardial infarction652Interconnections of apelin levels with parameters of lipid metabolism in hypertension patients653Plasma proteomics in hypertension: prediction and follow-up of albuminuria during chronic renin-angiotensin system suppression654Soluble RAGE levels in plasma of patients with cerebrovascular events. Cardiovasc Res 2016. [DOI: 10.1093/cvr/cvw150] [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: 11/12/2022] Open
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Abstract
Atrial fibrillation is driven by spontaneous electrical activation emerging from the pulmonary veins. Catheter ablation using either radiofrequency or cryothermal energy electrically isolates these veins from the left atrium, both reducing the burden of atrial fibrillation episodes and improving the patient's symptoms. Catheter ablation is superior to antiarryhthmic drugs when patients are carefully selected. Underlying medical problems - including obesity, hypertension and obstructive sleep apnoea - should be optimally treated before considering ablation. Although this treatment has the potential to cure patients of their symptoms, they should be aware of the important associated procedural complications.
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Affiliation(s)
- Richard Ang
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Mark J Earley
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
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Ng F, Lane J, Nisbet A, Betts TR, Arathoon N, Hayward C, Opel A, Abozguia K, Behradfar E, Debney M, Nygren A, Hartley A, Lyon A, Efimov I, Vigmond E, Peters N, Montaigne D, Tinker A, Walters T, Wong M, Morton J, Sparks P, Kistler P, Kalman J, Leo M, Panikker S, Kanagaratnam P, Koa-Wing M, Davies D, Hildick-Smith D, Wynne DG, Ormerod O, Segal OR, Chow AW, Todd D, Cabrera Gomes S, Kirkwood GJ, Fox D, Pepper C, Foran J, Wong T, Patel H, Morley-Smith A, Patel K, Lyon A, Ahsan S, Akhtar M, Hadjivassilev S, Ang R, Finlay M, Dhinoja M, Earley M, Schilling R, Hunter R, Sporton S, Cutler M, Johnson J, Rowan S, Lewis W, Costantini O, Natale A, Ziv O. Moderated Posters 251Gap junction uncoupling during ischaemia activates normally quiescent purkinje-myocardial junctions resulting in accelerated and more complex activation patterns52The role of gαi2 signalling in cardiac electrophysiology53Midline atrial tachycardia: mapping and differentiation54A multicentre experience of percutaneous left atrial appendage occlusion using different technologies in the united kingdom55Opportunistic screening for atrial fibrillation during flu clinics56Primary care achievement of anticoagulation in atrial fibrillation: as assessed by the quality and outcomes framework57Is combined ablation for paroxysmal atrial fibrillation using balloon cryoablation and radiofrequency ablation superior to either technique alone? long-term follow up and cost analysis58Impact of voltage mapping to guide whether or not to perform ablation of the posterior wall in patient with persistent atrial fibrillation:. Europace 2016. [DOI: 10.1093/europace/euv328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Heck P, Luther V, Luther V, Williams S, Schricker A, Zaman J, Ang R, Li X, Aziz S, Sugihara C, Grace A, Reddy V, Neuzil P, Linton N, Koa-Wing M, Lim P, Jamil-Copley S, Whinnett Z, Qureshi N, Ng F, Hayat S, Davies D, Peters N, Kanagaratnam P, Jamil-Copley S, Linton N, Koa-Wing M, Lim P, Hayat S, Ng F, Davies D, Peters N, Kanagaratnam P, Chubb H, Harrison J, Whitaker J, Cooklin M, Rinaldi C, Gill J, Wright M, Plank G, Niederer S, O'Neill M, Zaman J, Baykaner T, Lalani G, Hopper K, Moyeda A, Krummen D, Narayan S, Lalani G, Baykaner T, Swerdlow M, Park S, Krummen D, Wang P, Narayan S, Opel A, Ullah W, Baker V, Finlay M, Dhinoja M, Earley M, Sporton S, Schilling R, Hunter R, Chu G, Almeida T, Vanheusden F, Dastagir N, Salinet J, Stafford P, Schlindwein F, Ng G, Chubb H, Harrison J, Williams S, Whitaker J, Wright M, Schaeffter T, Razavi R, O'Neill M, Barlow N, Owens E, Sallomi D, Furniss S, Sulke N. Mapping & Ablation19Novel global ultrasound imaging and continuous dipole density mapping: initial findings in AF patients20Low voltage functional myocardium is critical in determining the substrate of post-ablation atrial tachycardia: results from a prospective study using ripple mapping distinguishing low-voltage scar from conducting tissue21Ripple mapping of post infarct ventricular scar to identify conduction channels and guide substrate based ablation22Effect of chamber geometry and activation pattern on optimal local activation time sampling density for tachycardia diagnosis25Clinical measures of good basket placement predict successful outcome from atrial fibrillation rotor ablation26Unipolar electrogram amplitude is reduced at rotor sites critical to focal termination of human persistent AF27Cryoballoon versus point by point radiofrequency ablation or a novel combined approach: long term follow up and comparison of patterns of pulmonary vein reconnection between different ablation strategies in a randomised controlled trial28Recurrent high dominant frequency patterns in persistent atrial fibrillation29Optimisation of late gadolinium enhanced (LGE) cmr imaging of atrial ablation scar30Hyperacute and chronic changes in cerebral magnetic resonance images after PVAC, NMARQ and epicardial thoracoscopic surgical ablation for paroxysmal atrial fibrillation. Europace 2015. [DOI: 10.1093/europace/euv326] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Behar J, Behar J, Providência R, Cronbach P, Siddiqui S, Brough C, Ara F, Newham W, Ng F, Ayala-Paredes F, Withers K, Hayward C, Chin H, Fearn S, Omerod J, Gamble J, Foley P, Bostock J, Claridge S, Jackson T, Sohal M, Razavi R, Betts T, Herring N, Rinaldi C, Pourmorteza A, McVeigh E, Niederer S, Claridge S, Jackson T, Sohal M, Preston R, Carr-White G, Razavi R, Rajani R, Rinaldi C, Boveda S, Defaye P, Barra S, Babu G, Ang R, Algalarrondo V, Bouzeman A, Ahsan S, Deharo JC, Sporton S, Segal O, Klug D, Lambiase P, Sadoul N, Agarwal S, Piot O, Chow A, Périer M, Fauchier L, Babuty D, Lowe M, Leclercq C, Bordachar P, Marijon E, Wilson D, Panfilo D, Greenhut S, Stegemann B, Morgan J, Nicolson W, Li A, Behr E, Ng G, Raman G, Belchambers S, Rao A, Wright D, John I, Crockford C, Kaba R, Begg G, Tayebjee M, Leong K, Hu M, Kanapeckaite L, Roney C, Lim P, Harding S, Peters N, Varnava A, Kanagaratnam P, Roux JF, Badra M, White J, Lencioni M, Carolan-Rees G, Patrick H, Griffith M, Patel H, Spiesshoefer J, Morley-Smith A, Patel K, Rosen S, DiMario C, Lyon A, Cowie M. Devices & Sudden death. Europace 2015; 17:v10-v13. [PMCID: PMC4892105 DOI: 10.1093/europace/euv331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
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Ang R, Hunter RJ, Baker V, Richmond L, Dhinoja M, Sporton S, Schilling RJ, Pugliese F, Davies C, Earley M. Pulmonary vein measurements on pre-procedural CT/MR imaging can predict difficult pulmonary vein isolation and phrenic nerve injury during cryoballoon ablation for paroxysmal atrial fibrillation. Int J Cardiol 2015; 195:253-8. [DOI: 10.1016/j.ijcard.2015.05.089] [Citation(s) in RCA: 21] [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] [Received: 01/06/2015] [Revised: 03/31/2015] [Accepted: 05/14/2015] [Indexed: 12/21/2022]
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Machhada A, Ang R, Ackland GL, Ninkina N, Buchman VL, Lythgoe MF, Trapp S, Tinker A, Marina N, Gourine AV. Control of ventricular excitability by neurons of the dorsal motor nucleus of the vagus nerve. Heart Rhythm 2015; 12:2285-93. [PMID: 26051529 PMCID: PMC4631809 DOI: 10.1016/j.hrthm.2015.06.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND The central nervous origins of functional parasympathetic innervation of cardiac ventricles remain controversial. OBJECTIVE This study aimed to identify a population of vagal preganglionic neurons that contribute to the control of ventricular excitability. An animal model of synuclein pathology relevant to Parkinson's disease was used to determine whether age-related loss of the activity of the identified group of neurons is associated with changes in ventricular electrophysiology. METHODS In vivo cardiac electrophysiology was performed in anesthetized rats in conditions of selective inhibition of the dorsal vagal motor nucleus (DVMN) neurons by pharmacogenetic approach and in mice with global genetic deletion of all family members of the synuclein protein. RESULTS In rats anesthetized with urethane (in conditions of systemic beta-adrenoceptor blockade), muscarinic and neuronal nitric oxide synthase blockade confirmed the existence of a tonic parasympathetic control of cardiac excitability mediated by the actions of acetylcholine and nitric oxide. Acute DVMN silencing led to shortening of the ventricular effective refractory period (vERP), a lowering of the threshold for triggered ventricular tachycardia, and prolongation of the corrected QT (QTc) interval. Lower resting activity of the DVMN neurons in aging synuclein-deficient mice was found to be associated with vERP shortening and QTc interval prolongation. CONCLUSION Activity of the DVMN vagal preganglionic neurons is responsible for tonic parasympathetic control of ventricular excitability, likely to be mediated by nitric oxide. These findings provide the first insight into the central nervous substrate that underlies functional parasympathetic innervation of the ventricles and highlight its vulnerability in neurodegenerative diseases.
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Affiliation(s)
- Asif Machhada
- Centre for Cardiovascular and Metabolic Neuroscience, Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom; Centre for Advanced Biomedical Imaging, University College London, London, United Kingdom
| | - Richard Ang
- Centre for Cardiovascular and Metabolic Neuroscience, Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom; William Harvey Heart Centre, Barts & The London School of Medicine and Dentistry, London, United Kingdom
| | - Gareth L Ackland
- Department of Medicine, University College London, London, United Kingdom
| | - Natalia Ninkina
- School of Biosciences, University of Cardiff, Cardiff, United Kingdom
| | | | - Mark F Lythgoe
- Centre for Advanced Biomedical Imaging, University College London, London, United Kingdom
| | - Stefan Trapp
- Centre for Cardiovascular and Metabolic Neuroscience, Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Andrew Tinker
- William Harvey Heart Centre, Barts & The London School of Medicine and Dentistry, London, United Kingdom
| | - Nephtali Marina
- Centre for Cardiovascular and Metabolic Neuroscience, Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Alexander V Gourine
- Centre for Cardiovascular and Metabolic Neuroscience, Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom.
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Ang R, Villagraz Tecedor L, Earley MJ. Broad Complex Tachycardia in a Structurally Normal Heart. J Cardiovasc Electrophysiol 2015; 26:1157-9. [PMID: 25929839 DOI: 10.1111/jce.12703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/07/2015] [Revised: 04/24/2015] [Accepted: 04/28/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Richard Ang
- Department of Arrhythmia Services, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Lola Villagraz Tecedor
- Department of Arrhythmia Services, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Mark J Earley
- Department of Arrhythmia Services, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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Marina N, Ang R, Machhada A, Kasymov V, Karagiannis A, Hosford PS, Mosienko V, Teschemacher AG, Vihko P, Paton JFR, Kasparov S, Gourine AV. Brainstem hypoxia contributes to the development of hypertension in the spontaneously hypertensive rat. Hypertension 2015; 65:775-83. [PMID: 25712724 PMCID: PMC4354460 DOI: 10.1161/hypertensionaha.114.04683] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/02/2015] [Indexed: 02/07/2023]
Abstract
Systemic arterial hypertension has been previously suggested to develop as a compensatory condition when central nervous perfusion/oxygenation is compromised. Principal sympathoexcitatory C1 neurons of the rostral ventrolateral medulla oblongata (whose activation increases sympathetic drive and the arterial blood pressure) are highly sensitive to hypoxia, but the mechanisms of this O2 sensitivity remain unknown. Here, we investigated potential mechanisms linking brainstem hypoxia and high systemic arterial blood pressure in the spontaneously hypertensive rat. Brainstem parenchymal PO2 in the spontaneously hypertensive rat was found to be ≈15 mm Hg lower than in the normotensive Wistar rat at the same level of arterial oxygenation and systemic arterial blood pressure. Hypoxia-induced activation of rostral ventrolateral medulla oblongata neurons was suppressed in the presence of either an ATP receptor antagonist MRS2179 or a glycogenolysis inhibitor 1,4-dideoxy-1,4-imino-d-arabinitol, suggesting that sensitivity of these neurons to low PO2 is mediated by actions of extracellular ATP and lactate. Brainstem hypoxia triggers release of lactate and ATP which produce excitation of C1 neurons in vitro and increases sympathetic nerve activity and arterial blood pressure in vivo. Facilitated breakdown of extracellular ATP in the rostral ventrolateral medulla oblongata by virally-driven overexpression of a potent ectonucleotidase transmembrane prostatic acid phosphatase results in a significant reduction in the arterial blood pressure in the spontaneously hypertensive rats (but not in normotensive animals). These results suggest that in the spontaneously hypertensive rat, lower PO2 of brainstem parenchyma may be associated with higher levels of ambient ATP and l-lactate within the presympathetic circuits, leading to increased central sympathetic drive and concomitant sustained increases in systemic arterial blood pressure.
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Affiliation(s)
- Nephtali Marina
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.).
| | - Richard Ang
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Asif Machhada
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Vitaliy Kasymov
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Anastassios Karagiannis
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Patrick S Hosford
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Valentina Mosienko
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Anja G Teschemacher
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Pirkko Vihko
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Julian F R Paton
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Sergey Kasparov
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Alexander V Gourine
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.).
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Ang R, Machhada A, Marina N, Gourine AV. 14 * Acute and chronic withdrawal of dorsal vagal preganglionic activity in the central nervous system predisposes to ventricular arrhythmia. Europace 2014. [DOI: 10.1093/europace/euu237.8] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Aziz Q, Thomas AM, Gomes J, Ang R, Sones WR, Li Y, Ng KE, Gee L, Tinker A. The ATP-Sensitive Potassium Channel Subunit, Kir6.1, in Vascular Smooth Muscle Plays a Major Role in Blood Pressure Control. Hypertension 2014; 64:523-9. [DOI: 10.1161/hypertensionaha.114.03116] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Qadeer Aziz
- From The Heart Centre, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom (Q.A., A.M.T., Y.L., K.-E.N., L.G., A.T.); and Department of Medicine, University College London, London, United Kingdom (J.G., R.A., W.R.S., A.T.)
| | - Alison M. Thomas
- From The Heart Centre, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom (Q.A., A.M.T., Y.L., K.-E.N., L.G., A.T.); and Department of Medicine, University College London, London, United Kingdom (J.G., R.A., W.R.S., A.T.)
| | - John Gomes
- From The Heart Centre, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom (Q.A., A.M.T., Y.L., K.-E.N., L.G., A.T.); and Department of Medicine, University College London, London, United Kingdom (J.G., R.A., W.R.S., A.T.)
| | - Richard Ang
- From The Heart Centre, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom (Q.A., A.M.T., Y.L., K.-E.N., L.G., A.T.); and Department of Medicine, University College London, London, United Kingdom (J.G., R.A., W.R.S., A.T.)
| | - William R. Sones
- From The Heart Centre, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom (Q.A., A.M.T., Y.L., K.-E.N., L.G., A.T.); and Department of Medicine, University College London, London, United Kingdom (J.G., R.A., W.R.S., A.T.)
| | - Yiwen Li
- From The Heart Centre, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom (Q.A., A.M.T., Y.L., K.-E.N., L.G., A.T.); and Department of Medicine, University College London, London, United Kingdom (J.G., R.A., W.R.S., A.T.)
| | - Keat-Eng Ng
- From The Heart Centre, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom (Q.A., A.M.T., Y.L., K.-E.N., L.G., A.T.); and Department of Medicine, University College London, London, United Kingdom (J.G., R.A., W.R.S., A.T.)
| | - Lorna Gee
- From The Heart Centre, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom (Q.A., A.M.T., Y.L., K.-E.N., L.G., A.T.); and Department of Medicine, University College London, London, United Kingdom (J.G., R.A., W.R.S., A.T.)
| | - Andrew Tinker
- From The Heart Centre, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom (Q.A., A.M.T., Y.L., K.-E.N., L.G., A.T.); and Department of Medicine, University College London, London, United Kingdom (J.G., R.A., W.R.S., A.T.)
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Ang R, Birnbaumer L, Gourine AV, Tinker A, Hamilton RM, Strandberg L, Cui X, Rath A, Liu J, Sirigam V, Ackerley C, Jaeggi E, Backx P, Silverman ED, Debney MT, Ng FS, Lyon AR, Peters NS, Opel A, Nobles M, Tinker A, Winter J, Chin SH, Brack KE, Ng GA, Finlay MC, Xu L, Nobles M, Lane J, Lowe M, Ben-Simon R, Bhar-Amato J, Hussain Q, Sebastian S, Taggart P, Tinker A, Lambiase PD, Almeida TP, Salinet J, Chu GS, Schlindwein FS, Ng GA, Williams SE, Linton NWF, Harrison J, Wright M, Plank G, O'Neill MD, Niederer S, Raine DT, Langley P, Shepherd E, Lord S, Murray S, Bourke JP, Chen Z, Hanson B, Sohal M, Child N, Sammut E, Jackson T, Shetty A, Bostock J, Gill J, Carr-White G, Rinaldi CA, Taggart P, Williams SE, Linton NW, Harrison J, Wright M, Rhode K, O'Neill MD, Barrows S, Jones K, Porter N. POSTER SESSION 2, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut320] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ang R, Birnbaumer L, Gourine AV, Tinker A. The role of GalphaO-mediated signalling in the central nervous mechanisms controlling sympathetic outflow to the heart. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5030] [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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Sebastian S, Ang R, Abramowitz J, Weinstein LS, Chen M, Ludwig A, Birnbaumer L, Tinker A. The in vivo regulation of heart rate in the murine sinoatrial node by stimulatory and inhibitory heterotrimeric G proteins. Am J Physiol Regul Integr Comp Physiol 2013; 305:R435-42. [PMID: 23697798 PMCID: PMC4073991 DOI: 10.1152/ajpregu.00037.2013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Reciprocal physiological modulation of heart rate is controlled by the sympathetic and parasympathetic systems acting on the sinoatrial (SA) node. However, there is little direct in vivo work examining the role of stimulatory and inhibitory G protein signaling in the SA node. Thus, we designed a study to examine the role of the stimulatory (Gαs) and inhibitory G protein (Gαi2) in in vivo heart rate regulation in the SA node in the mouse. We studied mice with conditional deletion of Gαs and Gαi2 in the conduction system using cre-loxP technology. We crossed mice in which cre recombinase expression was driven by a tamoxifen-inducible conduction system-specific construct with “Gαs floxed” and “Gαi2 floxed” mice. We studied the heart rate responses of adult mice compared with littermate controls by using radiotelemetry before and after administration of tamoxifen. The mice with conditional deletion of Gαs and Gαi2 had a loss of diurnal variation and were bradycardic or tachycardic, respectively, in the daytime. In mice with conditional deletion of Gαs, there was a selective loss of low-frequency power, while with deletion of Gαi2, there was a loss of high-frequency power in power spectral analysis of heart rate variability. There was no evidence of pathological arrhythmia. Pharmacological modulation of heart rate by isoprenaline was impaired in the Gαs mice, but a muscarinic agonist was still able to slow the heart rate in Gαi2 mice. We conclude that Gαs- and Gαi2-mediated signaling in the sinoatrial node is important in the reciprocal regulation of heart rate through the autonomic nervous system.
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Affiliation(s)
- Sonia Sebastian
- William Harvey Heart Centre, Barts and The London School of Medicine and Dentistry, London, United Kingdom
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Ang R, Marina N, Kasparov S, Gourine A. 196 ATP-MEDIATED SIGNALLING IN THE PRE-SYMPATHETIC AREA OF THE BRAINSTEM IS CRITICAL FOR THE DEVELOPMENT OF HYPERTENSION IN SPONTANEOUSLY HYPERTENSIVE RATS. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ang R. Highlights in basic autonomic neurosciences: remote ischaemic preconditioning as an autonomic reflex--a question of timing and circumstances? Auton Neurosci 2012; 173:1-2. [PMID: 23159165 DOI: 10.1016/j.autneu.2012.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Richard Ang
- Centre for Clinical Pharmacology, Division of Medicine, University College London, 5 University Street, London, United Kingdom.
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Ang R, Tanaka Y, Ieki E, Nakayama K, Sato T, Li LJ, Lu WJ, Sun YP, Takahashi T. Real-space coexistence of the melted Mott state and superconductivity in Fe-substituted 1T-TaS2. Phys Rev Lett 2012; 109:176403. [PMID: 23215208 DOI: 10.1103/physrevlett.109.176403] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Indexed: 06/01/2023]
Abstract
We have performed high-resolution angle-resolved photoemission spectroscopy of layered chalcogenide 1T-Fe(x)Ta(1-x)S(2) which undergoes a superconducting transition in the nearly commensurate charge-density-wave phase (melted Mott phase). We found a single electron pocket at the Brillouin-zone center in the melted Mott phase, which is created by the backfolding of bands due to the superlattice potential of charge-density-wave. This electron pocket appears in the x region where the samples show superconductivity, and is destroyed by the Mott- and Anderson-gap opening. Present results suggest that the melted Mott state and the superconductivity coexist in real space, providing a new insight into the interplay between electron correlation, charge order, and superconductivity.
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Affiliation(s)
- R Ang
- WPI Research Center, Advanced Institute for Materials Research, Tohoku University, Sendai 980-8577, Japan
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Ang R, Opel A, Tinker A. The Role of Inhibitory G Proteins and Regulators of G Protein Signaling in the in vivo Control of Heart Rate and Predisposition to Cardiac Arrhythmias. Front Physiol 2012; 3:96. [PMID: 22783193 PMCID: PMC3390690 DOI: 10.3389/fphys.2012.00096] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 03/27/2012] [Indexed: 12/17/2022] Open
Abstract
Inhibitory heterotrimeric G proteins and the control of heart rate. The activation of cell signaling pathways involving inhibitory heterotrimeric G proteins acts to slow the heart rate via modulation of ion channels. A large number of Regulators of G protein signalings (RGSs) can act as GTPase accelerating proteins to inhibitory G proteins and thus it is important to understand the network of RGS\G-protein interaction. We will review our recent findings on in vivo heart rate control in mice with global genetic deletion of various inhibitory G protein alpha subunits. We will discuss potential central and peripheral contributions to the phenotype and the controversies in the literature.
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Affiliation(s)
- Richard Ang
- Centre for Clinical Pharmacology, Division of Medicine, University College London London, UK
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Kett DH, Breitmeyer JB, Ang R, Royal MA. A Randomized Study of the Efficacy and Safety of Intravenous Acetaminophen vs. Intravenous Placebo for the Treatment of Fever. Clin Pharmacol Ther 2011; 90:32-9. [DOI: 10.1038/clpt.2011.98] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hunter RJ, Ginks M, Ang R, Diab I, Goromonzi FC, Page S, Baker V, Richmond L, Tayebjee M, Sporton S, Earley MJ, Schilling RJ. Impact of variant pulmonary vein anatomy and image integration on long-term outcome after catheter ablation for atrial fibrillation. Europace 2010; 12:1691-7. [PMID: 20823042 DOI: 10.1093/europace/euq322] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ross J Hunter
- Cardiology Research Department, Barts and The London NHS Trust and QMUL, St Bartholomew's Hospital, First Floor Dominion House, 60 Bartholomew Close, West Smithfield, London EC1A 7BE, UK
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Safriel Y, Ali M, Hayt M, Ang R. Gadolinium use in spine procedures for patients with allergy to iodinated contrast--experience of 127 procedures. AJNR Am J Neuroradiol 2006; 27:1194-7. [PMID: 16775262 PMCID: PMC8133924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND AND PURPOSE To review the safety and efficacy of gadolinium as a contrast agent in spine pain management procedures in patients who are at high risk for a contrast reaction and are therefore unacceptable candidates for the use of standard nonionic contrast. METHODS We reviewed our records over a 4-year period of interlaminar and foraminal epidural steroid injections, nerve blocks, facet injections, intercostal blocks, and diskograms in the lumbar, thoracic, and cervical spine for cases in which patients had allergies that made them unsuitable candidates for standard nonionic contrast and where gadolinium was used to confirm needle tip placement before injection of medication. RESULTS Ninety-two patients underwent 127 procedures. A spinal needle was used in all but 7 procedures. All patients were outpatients and all were discharged without complication after 20 to 45 minutes with follow-up instructions. No delayed complications were reported. Gadolinium was visualized by using portable C-arm fluoroscopy in vivo allowing for confirmation of needle tip location. For epidural steroid injection, the gadolinium dose ranged from 1 to 5 mL, nerve blocks from 0.2 to 1 mL per level, facet injections from 0.2 to 0.5 mL per level, intercostal blocks used 0.5 mL, and diskograms from 1.5 to 7.5 mL per level. The highest dose received by 1 patient was an intradiskal 15.83 mL during a 3-level diskogram. CONCLUSION Gadolinium seems to be a safe alternative to standard nonionic contrast in spine pain management procedures in those patients considered to be at high risk for a contrast reaction.
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Affiliation(s)
- Y Safriel
- Center for Diagnostic Imaging, Waite Park, MN, USA
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Abstract
There is considerable evidence to suggest that prostaglandins play an important role in the development and growth of cancer. The enzyme cyclo-oxygenase (COX) catalyses the conversion of arachidonic acid to prostaglandins. In recent years, there has been interest in a possible role for COX inhibitors in the prevention and treatment of malignancy. Cyclo-oxygenase-2 (COX-2) is overexpressed in several epithelial tumours, including breast cancer. Preclinical evidence favours an antitumour role for COX inhibitors in breast cancer. However, the epidemiological evidence for an association is conflicting. Trials are being conducted to study the use of COX inhibitors alone and in combination with other agents in the chemoprevention of breast cancer, and in the neo-adjuvant, adjuvant, and metastatic treatment settings. In evaluating the potential use of these agents particularly in cancer chemoprophylaxis, the safety profile is as important as their efficacy. Concern over the cardiovascular safety of both selective and nonselective COX-inhibitors has recently been highlighted.
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Affiliation(s)
- D Mazhar
- Department of Cancer Medicine, Division of Medicine, Faculty of Medicine, Imperial College London, Room 1014 Garry Weston Centre, Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | - R Ang
- Department of Cancer Medicine, Division of Medicine, Faculty of Medicine, Imperial College London, Room 1014 Garry Weston Centre, Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | - J Waxman
- Department of Cancer Medicine, Division of Medicine, Faculty of Medicine, Imperial College London, Room 1014 Garry Weston Centre, Hammersmith Campus, Du Cane Road, London W12 0NN, UK
- Department of Cancer Medicine, Division of Medicine, Faculty of Medicine, Imperial College London, Room 1014 Garry Weston Centre, Hammersmith Campus, Du Cane Road, London W12 0NN, UK. E-mail:
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Ang R, Wroe S, Manji H, Sharma P. Nicotine replacement therapy and ischaemic stroke. Br J Hosp Med (Lond) 2005; 66:366-7. [PMID: 15974172 DOI: 10.12968/hmed.2005.66.6.18408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A52-year-old right-handed businessman developed sudden onset of non-fluent dysphasia, weakness and sensory disturbance on the right side of his body 3 weeks after starting Nicorette patches (21 mg). He continued to smoke 3–5 cigars a day while on these patches. The patient had a history of depression and excessive alcohol intake. Examination confirmed an expressive dysphasia with verbal fluency limited to five words beginning with ‘C’ or ‘S’ but with no problems in comprehension, naming or praxis. Rapid alternating movements were impaired on the right and reflexes were brisker on the right side, although both planters were flexor. Cardiovascular and general examination was unremarkable. Magnetic resonance imaging (MRI) brain scan confirmed a left anterior cerebral artery territory infarct. The following blood tests were normal or unhelpful: erythrocyte sedimentation rate (ESR), C-reactive protein, protein culture and sensitivity, antithrombin, antiphospholipid coagulant, treponemal serology, thyroid screen and autoantibody screen. The patient was found to have mildly raised triglyceride (2.42 mmol/l) and low density lipoprotein (LDL) cholesterol (4.61 mmo/l). Electrocardiogram (ECG), echocardiography and carotid Dopplers were all normal. Two previous cases of stroke following nicotine patches have been reported by Jackson (1993) and Pierce (1994). In addition, the Medicines and Healthcare products Regulatory Agency (MHRA) have received 12 further cases of cerebrovascular disorders following nicotine replacement (Table 1).
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Affiliation(s)
- Richard Ang
- Hammersmith Hospitals Acute Stroke Unit and Imperial College, London
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Lee CK, Ng KS, Tan SG, Ang R. Effect of different endotracheal suctioning systems on cardiorespiratory parameters of ventilated patients. Ann Acad Med Singap 2001; 30:239-44. [PMID: 11455735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
INTRODUCTION We conducted this prospective randomised cross-over study to evaluate the effect of closed system (CS) versus open system (OS) endotracheal suctioning on heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), oxygen saturation (SpO2) and electrocardiogram (ECG) rhythm of patients on mechanical ventilation. MATERIALS AND METHODS Fourteen adult patients were randomly allocated to receive either CS or OS suctioning in the first instance. For the subsequent suctioning, they were crossed over to the alternate suctioning system. The various cardiorespiratory parameters were recorded at BL1 (baseline 1), S1 (first suction pass), BL2 (baseline 2, i.e. immediately post first suction pass), S2 (second suction pass), T2 (2 minutes post suction) and T5 (5 minutes post suction). RESULTS Compared to CS, OS suctioning was found to result in higher HR at S1 (P < or = 0.05) and S2 (P < or = 0.05); higher MAP at BL2 (P < or = 0.05); lower SpO2 at BL2 (P < or = 0.01) and S2 (P < or = 0.01). There was no significant difference in RR between the two suctioning systems. OS suctioning was also noted to result in a significantly higher incidence of arrhythmia (P < = or 0.05). CONCLUSION Our study shows that OS suctioning results in more adverse changes in cardiorespiratory parameters compared to CS suctioning.
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Affiliation(s)
- C K Lee
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, Coronary Intensive Care Unit (Ward 6A), Tan Tock Seng Hospital, Singapore 308433
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Abstract
In restructuring from a departmental to a program management model, BC Rehab successfully developed the role of professional practice leader to address clinical standards of practice and other concerns related to individual disciplines. A review of the role of professional practice leader is presented. Practice leaders are in a unique position to promote interdisciplinary, client-focused service. Because practice leaders' mandates cross program boundaries, they are able to keep the broad scope and goals of rehabilitation in the forefront, offering a balance to the program-specific perspective. It is imperative for practice leaders to maintain connections to operational and clinical issues to avoid isolation.
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