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Hou Q, Feng L, Yang J, Liu Y, You L, Wang L, Zhang Y, Liu Q, Zhao Y, Xie R. The immediate trends in atrial electrical remodeling for paroxysmal atrial fibrillation across different modes of catheter ablation. Clin Cardiol 2021; 44:938-945. [PMID: 34061373 PMCID: PMC8259153 DOI: 10.1002/clc.23617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/28/2021] [Revised: 04/13/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background Catheter ablation has emerged as a major strategy for paroxysmal atrial fibrillation (PAF). Atrial electrical remodeling (AER) plays a critical role in the recurrence of PAF after ablation. Hypothesis To characterize the immediate trends of AER during ablations in patients with PAF, and assess the relationship between immediate trends and recurrence. Methods We performed this prospective observational study of 135 patients to investigate AER following three ablation modes: radiofrequency ablation (RFA), cryoablation (CA) and 3D mapping‐guided cryoablation (3D‐CA). The atrial effective refractory period (AERP) and atrial conduction time (ACT) were measured via electrophysiology before and immediately after ablation, and P‐wave indices were measured via electrocardiography before and within 24 h after ablation. Follow‐up visits were conducted for at least 1 year or until relapse. Results Different approaches of ablation caused a fairly significant increase in the shortest P‐wave duration and AERP in both the proximal coronary sinus (PCS) and distal coronary sinus (DCS) but caused a shortened P‐wave dispersion. No different effect was found at the AERP among the three modes. Compared to patients who received CA, among patients who received RFA, a significant reduction in total ACT and right ACT was seen. Statistically, there was a weakly positive association between changes in total ACT and early recurrence. Conclusions Injury during ablation for PAF was associated with an increase in the AERP but not in the ACT. Total ACT and right ACT were shorter after RFA than after CA. The increase in total ACT were slightly predictive of early recurrence.
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Affiliation(s)
- Qian Hou
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Liang Feng
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jing Yang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yue Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ling You
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lianxia Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yan Zhang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qian Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuliang Zhao
- Department of Otorhinolaryngology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ruiqin Xie
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Abstract
Atrial fibrillation (AF) is the most common of cardiac arrhythmias. Mechanisms such as atrial structural remodeling and electrical remodeling have been implicated in the pathogenesis of AF. The data to date suggest that advanced glycation end products (AGEs) and its cell receptor RAGE (receptor for AGE) and soluble receptor (sRAGE) are involved in the pathogenesis of AF. This review focuses on the role of AGE-RAGE axis in the pathogenesis of AF. Interaction of AGE with RAGE generates reactive oxygen species, cytokines, and vascular cell adhesion molecules. sRAGE is a cytoprotective agent. The data show that serum levels of AGE and sRAGE, and expression of RAGE, are elevated in AF patients. Elevated levels of sRAGE did not protect the development of AF. This might be due to greater elevation of AGE than sRAGE. Measurement of AGE-RAGE stress (AGE/sRAGE) would be appropriate as compared with measurement of AGE or RAGE or sRAGE alone in AF patients. AGE and its interaction with RAGE can induce AF through alteration in cellular protein and extracellular matrix. AGE and its interaction with RAGE induce atrial structural and electrical remodeling. The treatment strategy should be directed toward reduction in AGE levels, suppression of RAGE expression, blocking of binding of AGE to RAGE, and elevation of sRAGE and antioxidants. In conclusion, AGE-RAGE axis is involved in the development of AF through atrial structural and electrical remodeling. The treatment modalities for AF should include lowering of AGE, suppression of RAGE, elevation of sRAGE, and use of antioxidants.
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Affiliation(s)
- Kailash Prasad
- Department of Anatomy, Physiology and Pharmacology, College of Medicine, University of Saskatchewan, Saskatchewan, Saskatoon, Canada
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Lazzerini PE, Laghi‐Pasini F, Acampa M, Srivastava U, Bertolozzi I, Giabbani B, Finizola F, Vanni F, Dokollari A, Natale M, Cevenini G, Selvi E, Migliacci N, Maccherini M, Boutjdir M, Capecchi PL. Systemic Inflammation Rapidly Induces Reversible Atrial Electrical Remodeling: The Role of Interleukin-6-Mediated Changes in Connexin Expression. J Am Heart Assoc 2019; 8:e011006. [PMID: 31423933 PMCID: PMC6759884 DOI: 10.1161/jaha.118.011006] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [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: 09/19/2018] [Accepted: 06/11/2019] [Indexed: 12/17/2022]
Abstract
Background Systemic inflammation is a strong predictor of atrial fibrillation. A key role for electrical remodeling is increasingly recognized, and experimental data suggest that inflammatory cytokines can directly affect connexins resulting in gap-junction dysfunction. We hypothesized that systemic inflammation, regardless of its origin, promotes atrial electric remodeling in vivo, as a result of cytokine-mediated changes in connexin expression. Methods and Results Fifty-four patients with different inflammatory diseases and elevated C-reactive protein were prospectively enrolled, and electrocardiographic P-wave dispersion indices, cytokine levels (interleukin-6, tumor necrosis factor-α, interleukin-1, interleukin-10), and connexin expression (connexin 40, connexin 43) were measured during active disease and after reducing C-reactive protein by >75%. Moreover, peripheral blood mononuclear cells and atrial tissue specimens from an additional sample of 12 patients undergoing cardiac surgery were evaluated for atrial and circulating mRNA levels of connexins. Finally, in vitro effects of interleukin-6 on connexin expression were studied in HL-1 mouse atrial myocytes. In patients with active inflammatory diseases, P-wave dispersion indices were increased but rapidly decreased within days when C-reactive protein normalizes and interleukin-6 levels decline. In inflammatory disease patients, both P-wave dispersion indices and interleukin-6 changes were inversely associated with circulating connexin levels, and a positive correlation between connexin expression in peripheral blood mononuclear cells and atrial tissue was demonstrated. Moreover, interleukin-6 significantly reduced connexin expression in HL-1 cells. Conclusions Our data suggest that regardless of specific etiology and organ localization, systemic inflammation, via interleukin-6 elevation, rapidly induces atrial electrical remodeling by down-regulating cardiac connexins. Although transient, these changes may significantly increase the risk for atrial fibrillation and related complications during active inflammatory processes.
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Affiliation(s)
| | - Franco Laghi‐Pasini
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | | | - Ujala Srivastava
- Cardiovascular Research ProgramVA New York Harbor Healthcare SystemBrooklyn, New YorkNY
- Department of Medicine, Cell Biology and PharmacologyState University of New York Downstate Medical CenterBrooklyn, New YorkNY
| | - Iacopo Bertolozzi
- Cardiology Intensive Therapy UnitDepartment of Internal MedicineHospital of CarraraItaly
| | - Beatrice Giabbani
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | - Francesco Finizola
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | - Francesca Vanni
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | - Aleksander Dokollari
- Department of Cardiac SurgeryUniversity Hospital of SienaItaly
- Department of Cardiovascular SurgerySaint Michael HospitalUniversity of TorontoOntarioCanada
| | - Mariarita Natale
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | | | - Enrico Selvi
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | - Nicola Migliacci
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | | | - Mohamed Boutjdir
- Cardiovascular Research ProgramVA New York Harbor Healthcare SystemBrooklyn, New YorkNY
- Department of Medicine, Cell Biology and PharmacologyState University of New York Downstate Medical CenterBrooklyn, New YorkNY
- Department of MedicineNYU School of MedicineNew YorkNY
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Wang X, Lin Y, Chen L, Liang D, Lin J, Qi G, Tian W. Treatment with verapamil for restoration of sinus rhythm in atrial fibrillation with rapid ventricular response: A case report. Medicine (Baltimore) 2019; 98:e15892. [PMID: 31169698 PMCID: PMC6571401 DOI: 10.1097/md.0000000000015892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Atrial fibrillation (AF) is a common arrhythmia disease that can cause thromboembolic disease and/or heart failure, resulting in increased mortality. Propafenone, amiodarone, and flecainide are recommended for converting AF to sinus rhythm. Beta blockers, verapamil, diltiazem, and digoxin are recommended for controlling AF with fast ventricular rate (VR). In this case report, we found that verapamil successfully converted AF into sinus rhythm. PATIENT CONCERNS A 92-year-old woman presented with fast VR AF with a history of coronary heart disease, hypertension, and diabetes. DIAGNOSES Verapamil can successfully convert AF into sinus rhythm. INTERVENTIONS AND OUTCOMES The patient was treated with amiodarone or propafenone, yet still had AF. After stopping amiodarone and propafenone, the patient was given verapamil to control the VR, and following 9 days of treatment the patient switched to sinus rhythm. When verapamil treatment was stopped, the patient experienced AF recurrence. Upon receiving verapamil again, the AF again converted into sinus rhythm. LESSONS For the treatment of AF, nondihydropyridine calcium antagonists can be tried in the absence of antiarrhythmic drugs.
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Zhou T, Han Z, Gu J, Chen S, Fan Y, Zhang H, Yin Y, Zhang J, Wang C. Angiotensin-converting enzyme-2 overexpression improves atrial electrical remodeling through TRPM7 signaling pathway. Oncotarget 2017; 8:78726-78733. [PMID: 29108260 PMCID: PMC5667993 DOI: 10.18632/oncotarget.20221] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 07/17/2017] [Indexed: 12/30/2022] Open
Abstract
Atrial electrical remodeling is an important factor in the development and persistence of atrial fibrillation. The aim of this study was to examine the effects of atrial angiotensin-converting enzyme-2 overexpression on atrial electrical remodeling and to elucidate the molecular mechanisms underlying these effects. Twenty-eight male and female dogs were randomly divided into the following 4 groups: a sham-operation group, a control group, an adenovirus-enhanced green fluorescent protein (Ad-EGFP) gene group and an Ad-ACE2 gene group. All dogs in the Ad-EGFP and Ad-ACE2 groups were rhythmized at 450 bpm for 14 days. Two weeks later, all the dogs underwent thoracotomy and epicardial gene painting. On day 21 after gene transfer, all the animals were subjected to electrophysiological and molecular studies. AF induction rates and durations were significantly increased in the control and Ad-EGFP groups compared to the sham-operated and Ad-ACE2 groups. Transient receptor potential melastatin 7 (TRPM7) expression levels in the Ad-EGFP and control groups were significantly higher than those in the sham-operated and Ad-ACE2 groups. Basal [Mg2+]i was significantly decreased in siRNA transfected cells compared with control and non-silencing siRNA-transfected cells. Our results suggest that ACE2 overexpression suppresses atrial electrical remodeling and improves atrial function through the TRPM7 signaling pathway.
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Affiliation(s)
- Tingquan Zhou
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Zhihua Han
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jun Gu
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Shaojie Chen
- Department of Cardiology, Shanghai First People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuqi Fan
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Huili Zhang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuehui Yin
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junfeng Zhang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Changqian Wang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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He W, Zhang J, Gan T, Xu G, Tang B. Expression of hyperpolarization-activated cyclic nucleotide-gated channel isoforms in a canine model of atrial fibrillation. Exp Ther Med 2016; 12:433-436. [PMID: 27347074 DOI: 10.3892/etm.2016.3290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/21/2014] [Accepted: 12/17/2014] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to analyze the mRNA and protein expression levels of atrial hyperpolarization-activated cyclic nucleotide-gated (HCN) channel isoforms in the left atrial muscle of dogs with multiple organ failure. A total of 14 beagle dogs with multiple organ failure, including seven cases with sinus rhythm and seven cases with atrial fibrillation (AF), underwent surgery to remove a sample of left atrial appendage tissue. The expression levels of a number of HCN channel subtypes were subsequently measured using quantitative polymerase chain reaction and western blot analysis. The mRNA and protein expression levels of HCN2 and HCN4 increased significantly in the AF group when compared with the sinus rhythm group. However, expression of the HCN1 isoform was not detected. Therefore, increased expression levels of HCN2 and HCN4 may be important molecular mechanisms in the pathogenesis of AF, which were associated with differences in patients with valvular heart disease.
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Affiliation(s)
- Wei He
- Pacing Electrophysiology Division, First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang 830054, P.R. China
| | - Jian Zhang
- Pacing Electrophysiology Division, First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang 830054, P.R. China
| | - Tianyi Gan
- Pacing Electrophysiology Division, First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang 830054, P.R. China
| | - Guojun Xu
- Pacing Electrophysiology Division, First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang 830054, P.R. China
| | - Baopeng Tang
- Pacing Electrophysiology Division, First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang 830054, P.R. China
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Ge M, Shan F, Tang B, Hou XJ. [Effects of docosahexaenoic acid on atrial physiological parameter and TASK-1 protein expression in atrial fibrillation rats]. Zhongguo Ying Yong Sheng Li Xue Za Zhi 2016; 32:128-31. [PMID: 29931863 DOI: 10.13459/j.cnki.cjap.2016.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the effect of docosahexaenoic acid (DHA) on atrial physiological parameter and its related mechanisms in atrial fibrillation rats. METHODS Eighty Sprague-Dawley (SD) rats which were sensitive to acetylcholine-calcium chloride mixture were randomly divided into four groups:control (CTL), control treated with DHA (DHA), atrial fibrillation (AF) and atrial fibrillation treated with DHA (DHA+AF). The duration of atrial fibrillation was measured. The atrial myocyte action potential duration (APD) and TWIK-related acid-sensitive K+ channels-1 (TASK-1) currents were recorded by whole-cell patch-clamp technique. The expression of TASK-1 at protein level in atrial tissue was detected by Western blot method. RESULTS Atrial fibrillation of the rats was induced by acetylcholine-calcium chloride mixture, and the duration time of atrial fibrillation was increased with the drug-induced time prolonged. Compared with control group, the time of atrial myocyte action potential duration at 50% repolarization (APD50) and at 90% repolarization (APD90) were significantly shorten in AF group, TASK-1 current density and TASK-1 protein expression were increased (P<0.05). Compared with AF group, the duration of atrial fibrillation was decreased,the time of atrial myocyte APD50 and APD90 were prolonged, TASK-1 current density and protein expression were significantly reduced in DHA+AF group (P<0.05). CONCLUSIONS DHA can prolong the atrial myocyte APD in atrial fibrillation rats, which may be related to down-regulation of TASK-1 protein expression and decreasing TASK-1 current density in atrial tissue.
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Wang X, Li G. Angiotensin-(1-7) prevent atrial tachycardia induced sodium channel remodeling. Pacing Clin Electrophysiol 2014; 37:1349-56. [PMID: 24861429 DOI: 10.1111/pace.12427] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/12/2014] [Accepted: 04/01/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Activation of the renin-angiotensin system plays an important role in atrial electrical remodeling; angiotensin-(1-7) (Ang-(1-7)) counterbalances the actions of angiotensin II. The aim of this study was to determine the effects of Ang-(1-7) on cardiac sodium current (INa ) in a canine model of atrial tachycardia. METHODS Eighteen dogs were randomly assigned to sham, pacing, or pacing + Ang-(1-7) groups (n = 6 in each group). Rapid atrial pacing (500 beats/min) was maintained for 2 weeks, while the dogs in the sham group were not paced. Ang-(1-7) (6 μg/kg/h) was administered intravenously during pacing. Whole-cell patch clamp techniques were utilized to record INa from canine atrial myocytes. Reverse transcription-polymerase chain reaction was used to assess possible underlying changes in cardiac Na(+) channels (Nav1.5). RESULTS Our results showed that INa density and expression of the Nav1.5 mRNA significantly decreased following pacing (P < 0.05 vs sham); however, the half-activation voltage (V1/2act ) and half-inactivation voltage (V1/2inact ) of INa were not significantly altered (P > 0.05 vs sham). Ang-(1-7) treatment significantly increased INa densities and hyperpolarized V1/2act without concomitant changes in V1/2inact but have no effect on the expression of the Nav1.5 gene. CONCLUSIONS Ang-(1-7) significantly increased INa densities, which contributed to improving intraatrial conduction and decreasing the likelihood of atrial fibrillation maintenance.
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Affiliation(s)
- Xuewen Wang
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
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