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Park DY, McLean B, Akman Z, Li DK, Babapour G, Nanna MG. Contemporary Use and Clinical Significance of Initial Triple Versus Double Therapy After Percutaneous Coronary Intervention for Myocardial Infarction in Patients With Atrial Fibrillation. J Am Heart Assoc 2025:e038589. [PMID: 40401606 DOI: 10.1161/jaha.124.038589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 12/23/2024] [Indexed: 05/23/2025]
Abstract
BACKGROUND Patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) have traditionally received triple therapy (dual antiplatelet therapy and anticoagulation). More recent randomized trial evidence supports a strategy of double therapy (anticoagulant plus single antiplatelet agent), albeit after a brief triple therapy course. The safety of initiating double therapy immediately post-PCI remains unclear. METHODS AND RESULTS This study analyzed real-world prescribing patterns and outcomes of immediate double therapy versus initial triple therapy in patients with atrial fibrillation post-PCI using the Vizient Clinical Database. Patients with atrial fibrillation undergoing PCI for myocardial infarction (2016-2023) were categorized into 2 groups: triple therapy (aspirin, P2Y12 [purinergic receptor P2Y, G-protein coupled, 12 protein] inhibitor, and anticoagulant) or double therapy (anticoagulant and 1 antiplatelet agent) on day 1 post-PCI. The primary outcome was in-hospital mortality. Secondary outcomes included stent thrombosis, major bleeding, intracranial hemorrhage, and net clinical adverse events. Multivariable logistic regression and inverse probability of treatment weighting were used to compare outcomes. Among 29 226 patients, 16.3% received immediate double therapy on day 1 post-PCI, whereas 83.7% received triple therapy. Adjusted analyses showed no significant differences in in-hospital mortality (9.4% versus 9.2%, adjusted odds ratio [aOR], 1.05 [95% CI, 0.93-1.18]), major bleeding, intracranial hemorrhage, or net clinical adverse events. However, immediate double therapy was associated with higher odds of stent thrombosis (1.1% versus 0.8%; aOR, 1.48 [95% CI, 1.08-2.03]), particularly in patients with ST-segment-elevation myocardial infarction (2.0% versus 1.3%; aOR, 1.46 [95% CI, 1.001-2.13]). CONCLUSIONS Immediate double therapy post-PCI is frequently used and appears safe for most patients with atrial fibrillation. Further studies are needed to identify high-risk subgroups, including those with ST-segment-elevation myocardial infarction, who may benefit from an initial short course of triple therapy.
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Affiliation(s)
- Dae Yong Park
- Section of Cardiovascular Medicine Yale School of Medicine New Haven CT USA
| | - Bianca McLean
- Department of Medicine Yale School of Medicine New Haven CT USA
| | - Zafer Akman
- Department of Medicine Yale School of Medicine New Haven CT USA
| | - Darrick K Li
- Section of Digestive Diseases Yale School of Medicine New Haven CT USA
| | - Golsa Babapour
- Section of Cardiovascular Medicine Yale School of Medicine New Haven CT USA
| | - Michael G Nanna
- Section of Cardiovascular Medicine Yale School of Medicine New Haven CT USA
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Zhang A, Dong X, Yu F, Ding L, Mi L, Zhang H, Shi L, Li X, Jiang H, Tang M. Distribution Variance of Focal Atrial Tachycardia Foci and Long-Term Outcomes After Ablation: Experience From Two Chinese Centers. J Cardiovasc Electrophysiol 2025; 36:1003-1013. [PMID: 40098315 DOI: 10.1111/jce.16595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 01/20/2025] [Accepted: 01/22/2025] [Indexed: 03/19/2025]
Abstract
INTRODUCTION The distribution of the origin of focal atrial tachycardia (FAT) in patients with different ages have not been clearly elucidated. We aimed to evaluate age differences in foci and factors influencing recurrence after radiofrequency catheter ablation in adult and juvenile patients with FAT. METHODS AND RESULTS A total of 323 consecutive FAT patients who underwent electrophysiological study and radiofrequency catheter ablation between January 2011 and March 2023 were selected for this study. We divided the patients into three groups according to the age of FAT onset: juvenile (< 18 years), young adult (≥ 18 and < 45 years), and middle-aged and old adult (≥ 45 years). Juvenile had a higher proportion of FAT originating from the left atrial appendage, the right atrial appendage, and the free or posterior wall of the right atrium. FAT in middle-aged and old adult patients was more likely to originate from the crista terminalis, tricuspid annulus, non-coronary cusp, and para-His. Young adults had a higher proportion of FAT originating from the superior vena cava and pulmonary veins. After a mean follow-up of 47.2 months, FAT recurred in 57 patients. Multivariate Cox regression analysis suggested that multifocal ablation (HR: 3.055, 95% CI: 1.476-6.323) and NT-proBNP (per standard deviation, HR: 1.367, 95% CI: 1.157-1.614) were independently associated with arrhythmia recurrence after ablation. CONCLUSION Significant age differences were observed in the distribution of FAT foci. Multifocal AT and elevated NT-proBNP independently predicted FAT recurrence after ablation.
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Affiliation(s)
- Aikai Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Cardiovascular Institute, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Xiaonan Dong
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Cardiovascular Institute, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Fengyuan Yu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Cardiovascular Institute, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Lei Ding
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Cardiovascular Institute, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Lijie Mi
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Cardiovascular Institute, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Hongda Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Cardiovascular Institute, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Lin Shi
- Department of Cardiology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Xiaomei Li
- Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing, China
| | - He Jiang
- Department of Cardiology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Min Tang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Cardiovascular Institute, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
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Mészáros H, Nagy R, Fehérvári P, Hegyi P, Pomozi E, Simon Z, Molnár AÁ, Nardai S, Merkely BP, Ábrahám P. Decreased peak atrial longitudinal strain and left atrial contraction strain rate values may predict atrial fibrillation in patients in sinus rhythm at baseline: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL OPEN 2025; 5:oeaf024. [PMID: 40444217 PMCID: PMC12120665 DOI: 10.1093/ehjopen/oeaf024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 12/13/2024] [Accepted: 02/10/2025] [Indexed: 06/02/2025]
Abstract
Despite the broadening spectrum of heart rhythm-monitoring techniques, the most appropriate modality and duration to detect atrial fibrillation (AF) are not consensual. Two-dimensional speckle tracking for left atrial strain analysis seems feasible to detect atrial cardiomyopathy, which represents a substrate for AF. We aimed to perform a systematic review and meta-analysis on peak atrial longitudinal strain (PALS) and contraction strain rate (pLAct) differences as primary outcomes measured in sinus rhythm (SR) between patients with and without future AF during follow-up (FU). Random-effect model was used. For continuous outcomes, we calculated weighted mean differences (WMD) to compare the two groups We identified eight eligible articles consisting of 1230 patients. Six articles were eligible for quantitative PALS analysis, while three were eligible regarding pLAct. The baseline parameters of the future AF and SR patients were comparable in most of the papers. The PALS value in patients developing future AF was significantly lower compared to patients with no AF (WMD: -5.55% 95% CI -7.06 to -4.03%). Pooled WMD of pLAct between the groups was -0.44 1/s, 95% CI: -0.56 to -0.33 1/s. Baseline PALS and pLAct values of future AF patients were significantly lower than those who remained in SR during FU. PALS and pLAct seem to be sensitive parameters which can be implemented in a predictive model for AF enabling us to find patients who need prolonged heart rhythm-monitoringand it can be also a guidance for oral anticoagulation indication setting.
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Affiliation(s)
- Henriette Mészáros
- Heart and Vascular Centre of Semmelweis University, Városmajor Street 68, 1122 Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Baross Street 22, 1085 Budapest, Hungary
| | - Rita Nagy
- Centre for Translational Medicine, Semmelweis University, Baross Street 22, 1085 Budapest, Hungary
- Heim Pál National Pediatric Institute, Üllői Way 86, 1089 Budapest, Hungary
- Institute for Translational Medicine, University of Pécs, Szigeti Way 12, 7624 Pécs, Hungary
| | - Péter Fehérvári
- Centre for Translational Medicine, Semmelweis University, Baross Street 22, 1085 Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Baross Street 22, 1085 Budapest, Hungary
- Institute for Translational Medicine, University of Pécs, Szigeti Way 12, 7624 Pécs, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Tömő Street 25-29, 1083 Budapest, Hungary
| | - Enikő Pomozi
- Heart and Vascular Centre of Semmelweis University, Városmajor Street 68, 1122 Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Baross Street 22, 1085 Budapest, Hungary
| | - Zsombor Simon
- Centre for Translational Medicine, Semmelweis University, Baross Street 22, 1085 Budapest, Hungary
| | - Andrea Ágnes Molnár
- Heart and Vascular Centre of Semmelweis University, Városmajor Street 68, 1122 Budapest, Hungary
| | - Sándor Nardai
- Heart and Vascular Centre of Semmelweis University, Városmajor Street 68, 1122 Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Baross Street 22, 1085 Budapest, Hungary
- Centre for Neurosurgery and Neurointervention, Semmelweis University, Laky Adolf Street 44, 1145 Budapest, Hungary
| | - Béla Péter Merkely
- Heart and Vascular Centre of Semmelweis University, Városmajor Street 68, 1122 Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Baross Street 22, 1085 Budapest, Hungary
| | - Pál Ábrahám
- Heart and Vascular Centre of Semmelweis University, Városmajor Street 68, 1122 Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Baross Street 22, 1085 Budapest, Hungary
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Agrawal A, Arockiam AD, Haroun E, Dong T, Dahdah JE, Majid M, Alamer M, Sorathia S, Grimm RA, Collier P, Rodriguez LL, Popovic ZB, Griffin BP, Wang TKM. Normal ranges of right atrial strain by contemporary echocardiography software: a prospective comparative cohort study. J Echocardiogr 2025:10.1007/s12574-025-00689-9. [PMID: 40268844 DOI: 10.1007/s12574-025-00689-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2025] [Revised: 03/17/2025] [Accepted: 04/05/2025] [Indexed: 04/25/2025]
Abstract
BACKGROUND Right atrial (RA) strains (RASr, RAScd, and RASct) are increasingly used in clinical and research settings, such as heart failure and pulmonary hypertension, but their feasibility and reference ranges across different strain software vendors are not well established. We aim to evaluate and compare two-dimensional RA strain values, reference ranges, and related factors across four strain software vendors in healthy subjects. METHODS Healthy subjects (n = 100) undergoing echocardiography during January-April 2023 were prospectively studied, with equal numbers by age groups, gender, and GE versus Philips scans. RA strains were quantified using TomTec version 51.02 (Autostrain LA), EchoPAC version 206 (AFI-LA), Velocity-Vector Imaging (VVI) version 2.00, and Epsilon software (5.0.2.11295) for statistical analyses. RESULTS Overall means and lower limits of normal (LLNs) of each type of RA strain by strain vendor, age group, sex, and scanner vendor were reported. For example, RASr (%) means and LLNs (95% confidence intervals) were 41.2 (38.5, 43.0) and 29.6 (26.5, 32.7) for TomTec, 35.9 (34.4, 37.3) and 27.0 (24.5, 29.5) for EchoPAC, 44.8 (42.3, 47.3) and 27.6 (23.3, 31.9) for VVI, and 38.9 (36.7, 41.0) and 25.5 (21.7, 29.3) for Epsilon, respectively. Linear mixed model regression showed EchoPAC and VVI had significantly lower RASr and higher RAScd magnitude than TomTec, with older age linked to lower RASr and RAScd magnitudes. CONCLUSION TomTec and VVI were vendor-neutral for measuring RA strains, while EchoPAC worked only on GE scans. Normal values, lower limits of normal, and related factors for RA strain measurements by vendor were established for clinical use.
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Affiliation(s)
- Ankit Agrawal
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH, 44195, USA
| | - Aro Daniela Arockiam
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH, 44195, USA
| | - Elio Haroun
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH, 44195, USA
| | - Tiffany Dong
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH, 44195, USA
| | - Joseph El Dahdah
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH, 44195, USA
| | - Muhammad Majid
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH, 44195, USA
| | - Mohammad Alamer
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH, 44195, USA
| | - Sharmeen Sorathia
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH, 44195, USA
| | - Richard A Grimm
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH, 44195, USA
| | - Patrick Collier
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH, 44195, USA
| | - Leonardo L Rodriguez
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH, 44195, USA
| | - Zoran B Popovic
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH, 44195, USA
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH, 44195, USA
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH, 44195, USA.
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Ou W, Liu P, Zhao N, Dong A, Chen S, Wang G, Wu S, Yang X. Association Between Cumulative Body Mass Index Exposure and the Risk of Incident Cardiac Conduction Block. J Am Heart Assoc 2025; 14:e039522. [PMID: 40207481 DOI: 10.1161/jaha.124.039522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 02/28/2025] [Indexed: 04/11/2025]
Abstract
BACKGROUND The relationship between cumulative body mass index (cumBMI) exposure and cardiac conduction block (CCB) is not fully understood. This study aimed to explore the association between cumBMI and the risk of CCB. METHODS AND RESULTS A total of 107 860 participants of the Kailuan Study were included. Participants were then categorized into 4 groups based on their quartile of cumBMI. The association of cumBMI with CCB was estimated using the Cox proportional hazards regression model. During a median follow-up of 8.36 years, 1894 CCBs, 586 atrioventricular blocks (AVBs), 1273 intraventricular blocks, 851 right bundle branch blocks, and 319 any left bundle branch blocks occurred. After adjusting for potential confounders, the hazard ratios for CCB, atrioventricular block, intraventricular block, right bundle branch block, and any left bundle branch block were 1.86 (95% CI, 1.60-2.18), 2.51 (95% CI, 1.90-3.32), 1.55 (95% CI, 1.28-1.87), 2.14 (95% CI, 1.69-2.71), and 1.18 (95% CI, 0.81-1.72) for individuals in the highest quartile of cumBMI compared with those in the second quartile, respectively. Additionally, the subgroup analyses showed significant interactions between age, sex, and cumBMI for developing CCB (P for interaction<0.05). CONCLUSIONS Our findings suggest that higher cumulative BMI exposure significantly increased the risk of CCB, especially atrioventricular block. Monitoring cumulative BMI may help to identify high-risk CCB populations.
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Affiliation(s)
- Wenli Ou
- School of Public Health North China University of Science and Technology Tangshan Hebei China
| | - Peipei Liu
- School of Public Health North China University of Science and Technology Tangshan Hebei China
| | - Naihui Zhao
- School of Public Health North China University of Science and Technology Tangshan Hebei China
| | - Ao Dong
- School of Public Health North China University of Science and Technology Tangshan Hebei China
| | - Shuohua Chen
- Department of Cardiology Kailuan General Hospital Tangshan Hebei China
| | - Guodong Wang
- Department of Cardiology Kailuan General Hospital Tangshan Hebei China
| | - Shouling Wu
- Department of Cardiology Kailuan General Hospital Tangshan Hebei China
| | - Xiuhong Yang
- School of Public Health North China University of Science and Technology Tangshan Hebei China
- Hebei Key Laboratory for Chronic Diseases, Tangshan Key Laboratory for Preclinical and Basic Research on Chronic Diseases, School of Basic Medical Sciences North China University of Science and Technology Tangshan Hebei China
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Matsuoka Y, Sotomi Y, Hikoso S, Sunaga A, Nakatani D, Okada K, Dohi T, Sato T, Kida H, Sakamoto D, Kitamura T, Tanaka N, Masuda M, Watanabe T, Minamiguchi H, Egami Y, Oka T, Miyoshi M, Okada M, Matsuda Y, Kawasaki M, Inoue K, Sakata Y. Extensive ablation for elderly patients with persistent atrial fibrillation: insights from the EARNEST-PVI prospective randomized trial. J Cardiol 2025; 85:301-308. [PMID: 39251131 DOI: 10.1016/j.jjcc.2024.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 08/23/2024] [Accepted: 09/03/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND In patients with persistent atrial fibrillation (AF), extensive ablation for substrate modification, such as linear ablation or complex fractionated atrial electrogram ablation in addition to pulmonary vein isolation (PVI) remains controversial. Previous studies investigating extensive ablation have demonstrated its varying efficacy, suggesting the possible heterogeneity of its efficacy. Aging is a major risk factor for AF and is associated with atrial remodeling. We aimed to compare the efficacy and safety of the extensive ablation strategy compared with PVI alone strategy between young and elderly patients. METHODS This study is a post-hoc analysis of the multicenter, randomized controlled, noninferiority trial investigating the efficacy and safety of PVI-only (PVI-alone arm) compared with extensive ablation (PVI-plus arm) in patients with persistent AF (EARNEST-PVI trial). We divided the overall population into 2 groups based on age and assessed treatment effects. RESULTS In the young group (age <65 years, N = 206), there was no significant difference in the recurrence rate between the PVI-alone group and PVI-plus group [hazard ratio (HR): 1.00, 95 % CI: 0.57-1.73, p = 0.987], whereas the recurrence rate was significantly lower in the PVI-plus group compared to the PVI-alone group in the elderly group (age ≥65 years, N = 291) (HR: 0.47, 95 % CI: 0.29-0.76, p = 0.0021) (p for interaction = 0.0446). There were no fatal procedural complications. CONCLUSION In patients with persistent AF, the extensive ablation strategy was more effective than the PVI-alone strategy in elderly patients, while the effectiveness of both approaches was comparable in young patients. TRIAL REGISTRATION URL: https://clinicaltrials.gov; Unique identifier: NCT03514693. URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000022454 Unique ID issued by UMIN: UMIN000019449.
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Affiliation(s)
- Yuki Matsuoka
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Akihiro Sunaga
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Medical Informatics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoharu Dohi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Taiki Sato
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hirota Kida
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Sakamoto
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Masaharu Masuda
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Tetsuya Watanabe
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | | | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | - Takafumi Oka
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Miwa Miyoshi
- Department of Cardiology, Osaka Hospital, Japan Community Healthcare Organization, Osaka, Japan
| | - Masato Okada
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | | | - Masato Kawasaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Koichi Inoue
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Parrini I, Lucà F, Rao CM, Ceravolo R, Gelsomino S, Ammendolea C, Pezzi L, Ingianni N, Del Sindaco D, Murrone A, Geraci G, Bilato C, Armentaro G, Sciacqua A, Riccio C, Colivicchi F, Grimaldi M, Oliva F, Gulizia MM. Management of Atrial Fibrillation in Elderly Patients: A Whole New Ballgame? J Clin Med 2025; 14:2328. [PMID: 40217779 PMCID: PMC11989488 DOI: 10.3390/jcm14072328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2025] [Revised: 03/17/2025] [Accepted: 03/21/2025] [Indexed: 04/14/2025] Open
Abstract
Atrial fibrillation (AF) is the most prevalent sustained supraventricular arrhythmia, particularly in older adults, with its incidence increasing dramatically with age. This condition is a significant contributor to morbidity and mortality, being closely linked to an elevated risk of heart failure, ischemic stroke, systemic thromboembolism, and dementia. The complexities of managing AF in the elderly arise from age-related physiological changes, comorbidities, frailty, and the challenges of polypharmacy. Therapeutic strategies must balance efficacy and safety, tailoring interventions to the individual's health status, life expectancy, and personal preferences. This review explores the latest evidence-based approaches to managing AF in elderly patients, focusing on the nuanced application of rate and rhythm control strategies, anticoagulation, and emerging insights into the relationship between AF and cognitive impairment.
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Affiliation(s)
- Iris Parrini
- Department of Cardiology, Mauriziano Hospital, 10128 Turin, Italy;
| | - Fabiana Lucà
- Department of Cardiology, Grande Ospedale Metropolitano (GOM) of Reggio Calabria, Bianchi Melacrino Morelli Hospital, 89129 Reggio Calabria, Italy
| | - Carmelo Massimiliano Rao
- Department of Cardiology, Santa Maria degli Ungheresi Hospital, Polistena, 89024 Reggio Calabria, Italy;
| | - Roberto Ceravolo
- Department of Cardiology, San Giovanni Paolo II Hospital, 88046 Lamezia Terme, Italy;
| | - Sandro Gelsomino
- Cardiovascular Department, Maastricht University, 6229HX Maastricht, The Netherlands;
| | - Carlo Ammendolea
- Department of Cardiology, San Martino Hospital, 32100 Belluno, Italy;
| | - Laura Pezzi
- Department of Cardiology, Ospedale Civile dello Spirito Santo, 65100 Pescara, Italy
| | - Nadia Ingianni
- Cardiology, ASP Trapani, Marsala District, 91022 Castelvetrano, Italy;
| | | | - Adriano Murrone
- Cardiology Department, Città di Castello Hospital, 06012 Citta di Castello, Italy;
| | - Giovanna Geraci
- Cardiology Department, Sant’Antonio Abate Hospital ASP Trapani, 91100 Erice, Italy;
| | - Claudio Bilato
- Department of Cardiology, Vicenza Ovest Hospital, Arzignano, 36100 Vicenza, Italy;
| | - Giuseppe Armentaro
- Department of Internal Medicine and UO of Geriatrics, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (G.A.); (A.S.)
| | - Angela Sciacqua
- Department of Internal Medicine and UO of Geriatrics, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (G.A.); (A.S.)
| | - Carmine Riccio
- Cardio-Vascular Department, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy;
| | - Furio Colivicchi
- Department of Emergency and Acceptance, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, 00135 Rome, Italy;
| | - Massimo Grimaldi
- Department of Cardiology, F. Miulli Hospital, Acquaviva delle Fonti, 70021 Bari, Italy;
| | - Fabrizio Oliva
- Department of Cardiology, Niguarda Hospital, 20162 Milano, Italy;
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Amin AM, Elbenawi H, Khan U, Almaadawy O, Turkmani M, Abdelmottaleb W, Essa M, Abuelazm M, Abdelazeem B, Asad ZUA, Deshmukh A, Link MS, DeSimone CV. Impact of Diagnosis to Ablation Time on Recurrence of Atrial Fibrillation and Clinical Outcomes After Catheter Ablation: A Systematic Review and Meta-Analysis With Reconstructed Time-to-Event Data. Circ Arrhythm Electrophysiol 2025; 18:e013261. [PMID: 39895523 DOI: 10.1161/circep.124.013261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 12/30/2024] [Indexed: 02/04/2025]
Abstract
BACKGROUND Current clinical guidelines emphasize the significance of rhythm control with catheter ablation but lack guidance on the timing of atrial fibrillation (AF) ablation relative to the diagnosis time. We aim to investigate the latest evidence on the impact of diagnosis to ablation time (DAT) on clinical outcomes after AF ablation. METHODS We searched PubMed, Web of Science, Scopus, Embase, and Cochrane Central Register of Controlled Trials through August 2024. Pairwise, prognostic, and reconstructed time-to-event data meta-analyses were conducted using R V. 4.3.1. Our primary end point was time to first AF recurrence, with secondary end points of all-cause mortality, tamponade, stroke, and heart failure. RESULTS Our cohort included 23 studies with 43 711 patients. Shorter DAT was significantly associated with reduced AF recurrence across both paroxysmal and persistent AF subgroups (P<0.01). There was a significant decrease in benefit for paroxysmal AF over time and a slight decrease in benefit for persistent AF over time. However, the benefit remained significant in both over time. DAT per year was significantly associated with a 10% increased risk of AF recurrence. Reconstructed Kaplan-Meier analysis showed that DAT >1 year was significantly associated with a 70% increased risk of AF recurrence in paroxysmal AF and 30% in persistent AF. DAT ≤1 year was significantly associated with decreased all-cause mortality (P<0.01) and showed a trend toward an association with a lower incidence of stroke (P=0.08). However, there was no significant difference in heart failure between DAT ≤1 year and DAT >1 year. CONCLUSIONS Early ablation is more beneficial in paroxysmal AF, with a notable decrease in benefit over time, while in persistent AF, the benefit remains significant but slightly decreases over time. Shorter DAT was significantly associated with decreased all-cause mortality and showed a trend toward an association with a lower incidence of stroke. REGISTRATION URL: https://www.crd.york.ac.uk/prospero/display_record.php?; Unique identifier: CRD42024525542.
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Affiliation(s)
| | - Hossam Elbenawi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (H.E., A.D., C.V.D.S.)
| | - Ubaid Khan
- Division of Cardiology, University of Maryland School of Medicine, Baltimore, MD (U.K.)
| | - Omar Almaadawy
- Department of Internal Medicine, MedStar Health, Baltimore, MD (O.A.)
| | - Mustafa Turkmani
- Faculty of Medicine, Michigan State University, East Lansing, MI (M.T.)
- Department of Internal Medicine, McLaren Health Care, Oakland, MI (M.T.)
| | - Wael Abdelmottaleb
- Department of Cardiology, Georgetown University/MedStar Washington Hospital Center, Washington, DC (W.A.)
| | - Mohammed Essa
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (M.E.)
| | | | - Basel Abdelazeem
- Department of Cardiology, West Virginia University, Morgantown, WV (B.A.)
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center (Z.U.A.A.)
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (H.E., A.D., C.V.D.S.)
| | - Mark S Link
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (M.S.L.)
| | - Christopher V DeSimone
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (H.E., A.D., C.V.D.S.)
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9
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Nakasone K, Della Rocca DG, Magnocavallo M, Betancur A, Vetta G, Pannone L, Sorgente A, Audiat C, Rodriguez J, Doundoulakis I, Nekic A, Velagić V, Polselli M, Mohanty S, Marcon L, Sieira J, Ströker E, Bala G, Bianchi S, Almorad A, Combes S, Tsiachris D, Sarkozy A, Natale A, Boveda S, Rossi P, de Asmundis C, Chierchia GB. Pulsed field ablation in the elderly by a pentaspline multielectrode catheter: Safety, efficacy, and comparison with cryoballoon and radiofrequency devices. Heart Rhythm 2025:S1547-5271(25)00094-3. [PMID: 39864479 DOI: 10.1016/j.hrthm.2025.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 12/26/2024] [Accepted: 01/20/2025] [Indexed: 01/28/2025]
Abstract
BACKGROUND Catheter ablation is an effective treatment of atrial fibrillation. Pulsed field ablation (PFA) has emerged as a novel energy modality that relies on high-voltage electric fields to achieve cardiac tissue ablation. Data on its efficacy in the elderly are scarce. OBJECTIVE This study aimed to evaluate the procedural details and clinical outcomes of PFA in patients >75 years old. METHODS Consecutive patients with atrial fibrillation >75 years old undergoing PFA with the Farapulse system were enrolled at 6 high-volume centers. Procedural details and clinical outcomes were compared with those of patients undergoing second-generation cryoballoon ablation (CBA) and radiofrequency ablation (RFA). RESULTS Of 983 patients, 221 underwent PFA, 216 CBA, and 546 RFA. Procedure times were shorter with PFA (72 ± 30 minutes) compared with CBA (77 ± 27 minutes) and RFA (99 ± 23 minutes; P < .001). Extra-pulmonary vein ablation was performed in 74.2% PFA, 9.7% CBA, and 42.1% RFA (P < .001). The major complication rate was 1.01% (n = 10) and was not significantly different between groups (1 PFA, 2 CBA, and 7 RFA; P = .578). Minor complications were observed in 1.4% PFA, 5.1% CBA, and 3.5% RFA (P = .093). The 1-year atrial tachyarrhythmia freedom in the propensity score-matched population was 77.2% with PFA, 80.8% with CBA, and 74.9% with RFA; P = .52). CONCLUSION PFA is a safe and effective option for elderly patients, offering the advantage of enabling extra-pulmonary vein ablation without the concern of thermal injury risk.
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Affiliation(s)
- Kazutaka Nakasone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks GUARD-Heart, Brussels, Belgium; Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Domenico G Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks GUARD-Heart, Brussels, Belgium; Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas; Department of Cardiology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
| | | | - Andres Betancur
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Giampaolo Vetta
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks GUARD-Heart, Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks GUARD-Heart, Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks GUARD-Heart, Brussels, Belgium
| | - Charles Audiat
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks GUARD-Heart, Brussels, Belgium
| | - Jesus Rodriguez
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Ioannis Doundoulakis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks GUARD-Heart, Brussels, Belgium; First Department of Cardiology, National and Kapodistrian University, Hippokration General Hospital, Athens, Greece
| | - Andrija Nekic
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Vedran Velagić
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marco Polselli
- Arrhythmology Unit, Ospedale Isola Tiberina-Gemelli Isola, Rome, Italy
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas
| | - Lorenzo Marcon
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks GUARD-Heart, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks GUARD-Heart, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks GUARD-Heart, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks GUARD-Heart, Brussels, Belgium
| | - Stefano Bianchi
- Arrhythmology Unit, Ospedale Isola Tiberina-Gemelli Isola, Rome, Italy
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks GUARD-Heart, Brussels, Belgium
| | - Stephane Combes
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Dimitrios Tsiachris
- First Department of Cardiology, National and Kapodistrian University, Hippokration General Hospital, Athens, Greece
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks GUARD-Heart, Brussels, Belgium
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Pietro Rossi
- Arrhythmology Unit, Ospedale Isola Tiberina-Gemelli Isola, Rome, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks GUARD-Heart, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks GUARD-Heart, Brussels, Belgium
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10
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Kahle AK, Alken FA, Scherschel K, Zhu E, Gunawardene MA, Metzner A, Willems S, Meyer C. Safety and Outcomes of Catheter Ablation for Consecutive Atrial Tachycardia in Elderly Patients After Previous Cardiac Interventions. J Clin Med 2025; 14:675. [PMID: 39941346 PMCID: PMC11818208 DOI: 10.3390/jcm14030675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2024] [Revised: 01/12/2025] [Accepted: 01/19/2025] [Indexed: 02/16/2025] Open
Abstract
Background: Age is a relevant risk factor for the development of atrial arrhythmias and an independent predictor of adverse cardiovascular outcomes. The incidence of atrial tachycardia (AT) is known to increase with aging, but so far, there are no data on elderly patients with AT. Therefore, we sought to assess the safety and outcomes of AT ablation in patients ≥75 years compared to those <75 years. Methods: A total of 420 consecutive patients undergoing AT ablation after previous cardiac interventions (mean 2.1 ± 0.1 prior ablation procedures) were analyzed. Safety, as well as acute and mid-term outcomes of AT ablation were compared between 140 patients ≥75 years (mean age 78.1 ± 0.2 years, 22.9% aged ≥80 years (range 80-86 years)) and 280 patients <75 years (mean age 62.2 ± 0.6 years). Results: Patients ≥75 years were more often female (54.3% vs. 38.2%; p = 0.0024) and presented with more cardiac comorbidities, including arterial hypertension (85.0% vs. 64.3%; p < 0.0001) and coronary artery disease (33.6% vs. 18.2%; p = 0.0006). Acute success of AT ablation was reached in 96.4% vs. 97.9% of patients (p = 0.5173). Major complications (1.4% vs. 0.7%; p = 0.6035) and duration of hospital stay (2 (IQR 2-4) days vs. 2 (IQR 2-3) days; p = 0.9125) did not differ significantly between groups. During a follow-up of 364 (IQR 183-729.5) days, arrhythmia recurrences occurred in 45.0% vs. 49.3% (p = 0.4684), whereas repeat ablation was less frequently performed in patients ≥75 years (25.7% vs. 36.1%; p = 0.0361). Conclusions: AT ablation in patients ≥75 years after previous cardiac interventions in tertiary arrhythmia centers is safe and effective. Therefore, AT ablation should not be ruled out in elderly patients due to age alone, but should be considered based on arrhythmia burden, symptom severity and concomitant clinical and procedural risk factors.
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Affiliation(s)
- Ann-Kathrin Kahle
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217 Düsseldorf, Germany; (A.-K.K.)
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Fares-Alexander Alken
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217 Düsseldorf, Germany; (A.-K.K.)
| | - Katharina Scherschel
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217 Düsseldorf, Germany; (A.-K.K.)
- Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Ernan Zhu
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217 Düsseldorf, Germany; (A.-K.K.)
| | - Melanie A. Gunawardene
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmühlenstrasse 5, 20099 Hamburg, Germany
- Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 20251 Hamburg, Germany
| | - Andreas Metzner
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 20251 Hamburg, Germany
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmühlenstrasse 5, 20099 Hamburg, Germany
- Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 20251 Hamburg, Germany
| | - Christian Meyer
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217 Düsseldorf, Germany; (A.-K.K.)
- Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
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11
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan N, Chen M, Chen S, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim Y, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak H, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2024; 40:1217-1354. [PMID: 39669937 PMCID: PMC11632303 DOI: 10.1002/joa3.13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 05/15/2024] [Indexed: 12/14/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society.
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Affiliation(s)
| | | | - Jonathan Kalman
- Department of CardiologyRoyal Melbourne HospitalMelbourneAustralia
- Department of MedicineUniversity of Melbourne and Baker Research InstituteMelbourneAustralia
| | - Eduardo B. Saad
- Electrophysiology and PacingHospital Samaritano BotafogoRio de JaneiroBrazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA
| | | | - Jason G. Andrade
- Department of MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular InstituteStanford UniversityStanfordCAUSA
| | - Serge Boveda
- Heart Rhythm Management DepartmentClinique PasteurToulouseFrance
- Universiteit Brussel (VUB)BrusselsBelgium
| | - Hugh Calkins
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | - Ngai‐Yin Chan
- Department of Medicine and GeriatricsPrincess Margaret Hospital, Hong Kong Special Administrative RegionChina
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Shih‐Ann Chen
- Heart Rhythm CenterTaipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General HospitalTaichungTaiwan
| | | | - Ralph J. Damiano
- Division of Cardiothoracic Surgery, Department of SurgeryWashington University School of Medicine, Barnes‐Jewish HospitalSt. LouisMOUSA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center MunichTechnical University of Munich (TUM) School of Medicine and HealthMunichGermany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation DepartmentFondation Bordeaux Université and Bordeaux University Hospital (CHU)Pessac‐BordeauxFrance
| | - Luigi Di Biase
- Montefiore Medical CenterAlbert Einstein College of MedicineBronxNYUSA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart InstituteUniversité de MontréalMontrealCanada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation DepartmentFondation Bordeaux Université and Bordeaux University Hospital (CHU)Pessac‐BordeauxFrance
| | - Young‐Hoon Kim
- Division of CardiologyKorea University College of Medicine and Korea University Medical CenterSeoulRepublic of Korea
| | - Mark la Meir
- Cardiac Surgery DepartmentVrije Universiteit Brussel, Universitair Ziekenhuis BrusselBrusselsBelgium
| | - Jose Luis Merino
- La Paz University Hospital, IdipazUniversidad AutonomaMadridSpain
- Hospital Viamed Santa ElenaMadridSpain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustinTXUSA
- Case Western Reserve UniversityClevelandOHUSA
- Interventional ElectrophysiologyScripps ClinicSan DiegoCAUSA
- Department of Biomedicine and Prevention, Division of CardiologyUniversity of Tor VergataRomeItaly
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ)QuebecCanada
| | - Santiago Nava
- Departamento de ElectrocardiologíaInstituto Nacional de Cardiología ‘Ignacio Chávez’Ciudad de MéxicoMéxico
| | - Takashi Nitta
- Department of Cardiovascular SurgeryNippon Medical SchoolTokyoJapan
| | - Mark O’Neill
- Cardiovascular DirectorateSt. Thomas’ Hospital and King's CollegeLondonUK
| | - Hui‐Nam Pak
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital BernBern University Hospital, University of BernBernSwitzerland
| | - Luis Carlos Saenz
- International Arrhythmia CenterCardioinfantil FoundationBogotaColombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm DisordersUniversity of Adelaide and Royal Adelaide HospitalAdelaideAustralia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum BethanienMedizinische Klinik III, Agaplesion MarkuskrankenhausFrankfurtGermany
| | - Gregory E. Supple
- Cardiac Electrophysiology SectionUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico MonzinoIRCCSMilanItaly
- Department of Biomedical, Surgical and Dental SciencesUniversity of MilanMilanItaly
| | - Atul Verma
- McGill University Health CentreMcGill UniversityMontrealCanada
| | - Elaine Y. Wan
- Department of Medicine, Division of CardiologyColumbia University Vagelos College of Physicians and SurgeonsNew YorkNYUSA
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12
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Guan C, Gong A, Zhao Y, Yin C, Geng L, Liu L, Yang X, Lu J, Xiao B. Interpretable machine learning model for new-onset atrial fibrillation prediction in critically ill patients: a multi-center study. Crit Care 2024; 28:349. [PMID: 39473013 PMCID: PMC11523862 DOI: 10.1186/s13054-024-05138-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 10/18/2024] [Indexed: 11/02/2024] Open
Abstract
BACKGROUND New-onset atrial fibrillation (NOAF) is the most common arrhythmia in critically ill patients admitted to intensive care and is associated with poor prognosis and disease burden. Identifying high-risk individuals early is crucial. This study aims to create and validate a NOAF prediction model for critically ill patients using machine learning (ML). METHODS The data came from two non-overlapping datasets from the Medical Information Mart for Intensive Care (MIMIC), with MIMIC-IV used for training and subset of MIMIC-III used as external validation. LASSO regression was used for feature selection. Eight ML algorithms were employed to construct the prediction model. Model performance was evaluated based on identification, calibration, and clinical application. The SHapley Additive exPlanations (SHAP) method was used for visualizing model characteristics and individual case predictions. RESULTS Among 16,528 MIMIC-IV patients, 1520 (9.2%) developed AF post-ICU admission. A model with 23 variables was built, with XGBoost performing best, achieving an AUC of 0.891 (0.873-0.888) in validation and 0.769 (0.756-0.782) in external validation. Key predictors included age, mechanical ventilation, urine output, sepsis, blood urea nitrogen, percutaneous arterial oxygen saturation, continuous renal replacement therapy and weight. A risk probability greater than 0.6 was defined as high risk. A friendly user interface had been developed for clinician use. CONCLUSION We developed a ML model to predict the risk of NOAF in critically ill patients without cardiac surgery and validated its potential as a clinically reliable tool. SHAP improves the interpretability of the model, enables clinicians to better understand the causes of NOAF, helps clinicians to prevent it in advance and improves patient outcomes.
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Affiliation(s)
- Chengjian Guan
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China
| | - Angwei Gong
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China
| | - Yan Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China
| | - Chen Yin
- Department of Cardiac Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China
| | - Lu Geng
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China
| | - Linli Liu
- Department of Cardiac Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China
| | - Xiuchun Yang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China
| | - Jingchao Lu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China.
| | - Bing Xiao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China.
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13
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Fu Z, Dong R, Zheng H, Wang Z, Cao B, Bai J, Ma M, Song Z, Pan F, Xia L, Wu Y, Zhou S, Deng D. Progress of Conductivity and Conduction Velocity Measured in Human and Animal Hearts. Rev Cardiovasc Med 2024; 25:364. [PMID: 39484125 PMCID: PMC11522836 DOI: 10.31083/j.rcm2510364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/19/2024] [Accepted: 06/11/2024] [Indexed: 11/03/2024] Open
Abstract
Cardiac conduction velocity (CV) is a critical electrophysiological characteristic of the myocardium, representing the speed at which electrical pulses propagate through cardiac tissue. It can be delineated into longitudinal, transverse, and normal components in the myocardium. The CV and its anisotropy ratio are crucial to both normal electrical conduction and myocardial contraction, as well as pathological conditions where it increases the risk of conduction block and reentry. This comprehensive review synthesizes longitudinal and transverse CV values from clinical and experimental studies of human infarct hearts, including findings from the isthmus and outer loop, alongside data derived from animal models. Additionally, we explore the anisotropic ratio of conductivities assessed through both animal and computational models. The review culminates with a synthesis of scientific evidence that guides the selection of CV and its corresponding conductivity in cardiac modeling, particularly emphasizing its application in patient-specific cardiac arrhythmia modeling.
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Affiliation(s)
- Zhenyin Fu
- College of Biomedical Engineering & Instrument Science, Zhejiang University, 310058 Hangzhou, Zhejiang, China
| | - Ruiqing Dong
- Department of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, 215000 Suzhou, Jiangsu, China
| | - Huanyong Zheng
- School of Biomedical Engineering, Dalian University of Technology, 116024 Dalian, Liaoning, China
| | - Zefeng Wang
- Department of Cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, 100029 Beijing, China
| | - Boyang Cao
- College of Biomedical Engineering & Instrument Science, Zhejiang University, 310058 Hangzhou, Zhejiang, China
| | - Jinghui Bai
- Department of General Medicine, Liaoning Cancer Hospital of Dalian University of Technology, 116024 Liaoning, China
| | - Mingxia Ma
- Department of General Medicine, Liaoning Cancer Hospital of Dalian University of Technology, 116024 Liaoning, China
| | - Zhanchun Song
- Department of Cardiology, Fushun Central Hospital, 113006 Liaoning, China
| | - Fuzhi Pan
- Department of General Medicine, Liaoning Cancer Hospital of Dalian University of Technology, 116024 Liaoning, China
| | - Ling Xia
- College of Biomedical Engineering & Instrument Science, Zhejiang University, 310058 Hangzhou, Zhejiang, China
- Research Center for Healthcare Data Science, Zhejiang Lab, 310058 Hangzhou, Zhejiang, China
| | - Yongquan Wu
- Department of Cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, 100029 Beijing, China
| | - Shijie Zhou
- Department of Chemical, Paper and Biomedical Engineering, Miami University, Oxford, OH 45056, USA
| | - Dongdong Deng
- School of Biomedical Engineering, Dalian University of Technology, 116024 Dalian, Liaoning, China
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14
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França MRQ, Morillo CA, Carmo AAL, Mayrink M, Miranda RC, Naback ADN, Nevis I, Silva GA, Ribeiro ALP, Nascimento BR. Efficacy and safety of catheter ablation for atrial fibrillation in elderly patients: a systematic review and meta-analysis. J Interv Card Electrophysiol 2024; 67:1691-1707. [PMID: 38291274 DOI: 10.1007/s10840-024-01755-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Catheter ablation (CA) is a well-established therapy for patients with atrial fibrillation (AF); however, there is paucity of data for elderly patients. We aimed to assess long-term efficacy and safety of CA for elderly patients with AF. METHODS Medline, BVS, Cochrane, and Embase were searched through April 2023 to investigate comparative outcomes between elderly patients > 75 or 80 years, as per-study cutoff, and individuals ≤ 75/80 years, undergoing CA. Primary efficacy and safety endpoints (AF recurrence and procedure-related major complications) were pooled with the Comprehensive Meta-Analysis 3.0 software. Subgroup analyses were performed by age groups and type of procedure (radiofrequency vs. cryoballoon). RESULTS Four thousand eight hundred twenty-nine titles were screened, and 27 studies were included, being 26 observational and 1 randomized trial, comprising 117,869 patients, being 8714 (7.4%) elderly > 75/80 years, with follow-up from 11.7 to 72.3 months. In comparative studies (N = 17 studies), elderly > 75/80 years had a higher risk of AF recurrence compared to those ≤ 75/80: relative risk (RR) 1.16 (95% CI 1.05-1.27, p = 0.002. However, funnel plot indicated publication bias, and after imputation of 5 studies, the groups were similar (RR 1.07 (95% CI 0.97-1.19)). The rates of major complications (N = 14 studies) were higher in elderly > 75/80 years (RR 1.30 (95% CI 1.10-1.54), I2 = 0, p = 0.002), but were similar in cryoablation studies (N = 7) (RR 1.10, 95% CI 0.94-1.29, p = 0.24, I2 = 0.0). Results were similar when individual study arms (N = 27 studies) were pooled. CONCLUSION AF ablation is feasible in elderly patients > 75/80 years, with success rates compared to younger individuals. Complication rates, however, were higher.
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Affiliation(s)
- Marcos Roberto Queiroz França
- Serviço de Cardiologia E Cirurgia Cardiovascular E Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Carlos Arturo Morillo
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - André Assis Lopes Carmo
- Serviço de Cardiologia E Cirurgia Cardiovascular E Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Centro de Tratamento Avançado Em Arritmias, Belo Horizonte, MG, Brazil
| | - Marina Mayrink
- Serviço de Cardiologia E Cirurgia Cardiovascular E Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Centro de Tratamento Avançado Em Arritmias, Belo Horizonte, MG, Brazil
| | | | - André Dias Nassar Naback
- Serviço de Cardiologia E Cirurgia Cardiovascular E Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Gustavo Araújo Silva
- Serviço de Cardiologia E Cirurgia Cardiovascular E Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Centro de Tratamento Avançado Em Arritmias, Belo Horizonte, MG, Brazil
| | - Antonio Luiz Pinho Ribeiro
- Serviço de Cardiologia E Cirurgia Cardiovascular E Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Bruno Ramos Nascimento
- Serviço de Cardiologia E Cirurgia Cardiovascular E Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
- Serviço de Hemodinâmica, Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
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15
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Sekihara T, Oka T, Ozu K, Yoshida A, Sakata Y. Pacing cycle length-dependent electrophysiologic changes in left atrium: Poor validity of using low-voltage area and slow conduction area under specific pacing cycle length as absolute substrates of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)03335-6. [PMID: 39304004 DOI: 10.1016/j.hrthm.2024.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 09/07/2024] [Accepted: 09/12/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Pacing cycle length (PCL)-dependent changes in left atrial (LA) electrophysiologic properties have not been fully elucidated. OBJECTIVE We aimed to elucidate these changes using a high-resolution mapping system. METHODS Forty-eight patients underwent atrial fibrillation ablation with RHYTHMIA HDx. Paired LA maps under a baseline PCL (600 ms) and rapid PCL (300 ms) were acquired after pulmonary vein isolation under right atrial appendage pacing. The PCL-dependent change in the low-voltage area (LVA; area with <0.5 mV bipolar voltage), LA activation time (interval from first LA activation to wavefront collision at lateral wall), regional mean voltage, regional mean wave propagation velocity, and slow conduction area (area with <0.3 m/s wave propagation velocity) were quantitatively analyzed. RESULTS Under the rapid PCL, the total LVA was significantly increased (7.6 ± 9.5 cm2 vs 6.7 ± 7.6 cm2; P = .031), especially in patients with a 10 cm2 LVA on the baseline PCL map (21.5 ± 9.1 cm2 vs 18.1 ± 6.5 cm2; P = .013). The LA activation time was also prolonged (87.9 ± 16.2 ms vs 84.0 ± 14.0 ms; P < .0001). Although the rapid PCL did not decrease the regional mean voltage, it significantly decreased the regional mean wave propagation velocity and increased the slow conduction area in all measured regions. CONCLUSION LVA and slow conduction area can be emphasized by rapid PCL LA mapping. There may be poor validity in using these areas as absolute atrial fibrillation substrates without considering the PCL-dependent changes.
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Affiliation(s)
- Takayuki Sekihara
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takafumi Oka
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Kentaro Ozu
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akira Yoshida
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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16
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024; 21:e31-e149. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society.
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece.
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil; Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France; Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain; Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Case Western Reserve University, Cleveland, OH, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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17
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024; 67:921-1072. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
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Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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18
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Jin L, Hou P. Yixin-Fumai granules modulate autophagy through the PI3K/AKT/FOXO pathway and lead to amelioration of aging mice with sick sinus syndrome. Immun Ageing 2024; 21:46. [PMID: 38971780 PMCID: PMC11227161 DOI: 10.1186/s12979-024-00439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/23/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE By employing network pharmacology alongside molecular docking techniques, we can delve into the intricate workings of Yixin-Fumai granules (YXFMs) and their impact on sick sinus syndrome (SSS) within wrinkles mice. Specifically, we aim to understand how YXFMs enhance autophagy through the PI3K/AKT/FOXO path. METHODS The active ingredients and medicinal uses of Ginseng, ligusticum wallichii, Ophiopogon, Schisandra, salvia, and astragalus were compiled using the BATMAN-TCM database. We also used Genecards, OMIM, and Disgenet files to identify the disease goals. A hierarchical diagram of "disease-drug-key targets" was generated using the Cytoscape programs. In addition, we established a target protein interaction (PPI) network using the STRING database. Then, the Cluster Profiler R package was used to conduct GO functional enrichment evaluation and KEGG pathway enrichment analyses of the targets. Based on the PPI system, we chose the top communicating targets and substances over molecular docking. In vivo studies were performed to validate these selections further. The mouse model was induced to study the damaged sinoatrial node (SAN) in mice with lower heart rates due to age-related changes. Electrocardiogram and Masson staining assessments were performed to obtain the results. The transmission electron microscope was used to assess the autophagy level of SAN cells. Western blot was employed to analyze the impact of YXFMs on protein expression in the PI3K/AKT/FOXO signaling process throughout SSS therapy in aging mice. RESULTS One hundred forty-two active ingredients, 1858 targets, 1226 disease targets, and 266 intersection targets were obtained. The key targets of the PPI network encompassed TP53, AKT1, CTNNB1, INS, and TNF, among others. According to GO functional analysis, the mechanism underlying YXFMs in SSS treatment may primarily be associated with the control of ion transport across membranes, cardiac contraction, regulation of blood circulation, and other biological processes. Based on the results of KEGG pathway enrichment analysis, it was determined that they were mainly enriched in multiple pathways of signaling such as the PI3K-Akt signaling route, MAPK signaling process, AGE-RAGE signaling path, FOXO signaling path, HIF-1 signaling process, and several other paths. Molecular docking demonstrated that five compounds had excellent binding to the key candidate target proteins AKT1 and INS. Through the in vivo studies, we noticed notable effects when administering YXFMs. These effects included the suppression of aging-induced SSS, a decrease in the R-R interval, a rise in heart rate, a reduction in fibrosis, a boost in the autophagy process level, and a spike in the levels of expression of key protein molecules in the PI3K/AKT/FOXO signaling path. CONCLUSION This research has made preliminary predictions about the potential of YXFMs in treating SSS. It suggests that YXFMs may have the ability to target key proteins and critical paths associated with the condition. Further testing has been conducted to discover new findings and evidence of ideas for tackling SSS triggered by aging.
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Affiliation(s)
- Lianzi Jin
- Liaoning University of Traditional Chinese Medicine, Shenyang, 110000, China
| | - Ping Hou
- Department of Cardiology, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, 110000, China.
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19
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Ariyaratnam JP, Elliott AD, Mishima RS, Kadhim K, Emami M, Fitzgerald JL, Middeldorp M, Sanders P. Structural, Functional, and Electrical Remodeling of the Atria With Reduced Cardiorespiratory Fitness: Implications for AF. JACC Clin Electrophysiol 2024; 10:1608-1619. [PMID: 38869505 DOI: 10.1016/j.jacep.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Reduced cardiorespiratory fitness (CRF) is an independent risk factor for the progression of atrial fibrillation (AF). We hypothesized that reduced CRF is associated with structural, functional, and electrical remodeling of the left atrium. OBJECTIVES This study sought to correlate objectively assessed CRF with functional and electrical left atrial (LA) parameters using invasive and noninvasive assessments. METHODS Consecutive patients with symptomatic AF undergoing catheter ablation were recruited. CRF was objectively quantified pre-ablation by using cardiopulmonary exercise testing. Using peak oxygen consumption, participants were classified as preserved CRF (>20 mL/kg/min) or reduced CRF (<20 mL/kg/min). LA stiffness was assessed invasively with hemodynamic monitoring and imaging during high-volume LA saline infusion. LA stiffness was calculated as ΔLA diameter/ΔLA pressure over the course of the infusion. LA function was assessed with echocardiographic measures of LA emptying fraction and LA strain. Electrical remodeling was assessed by using high-density electroanatomical maps for LA voltage and conduction. RESULTS In total, 100 participants were recruited; 43 had reduced CRF and 57 had preserved CRF. Patients with reduced CRF displayed elevated LA stiffness (P = 0.004), reduced LA emptying fraction (P = 0.006), and reduced LA reservoir strain (P < 0.001). Reduced CRF was also associated with reduced LA voltage (P = 0.039) with greater heterogeneity (P = 0.027) and conduction slowing (P = 0.04) with greater conduction heterogeneity (P = 0.02). On multivariable analysis, peak oxygen consumption was independently associated with LA stiffness (P = 0.003) and LA conduction velocities (P = 0.04). CONCLUSIONS Reduced CRF in patients with AF is independently associated with worse LA disease involving functional and electrical changes. Improving CRF may be a target for restoring LA function in AF.
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Affiliation(s)
- Jonathan P Ariyaratnam
- Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Adrian D Elliott
- Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Ricardo S Mishima
- Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Kadhim Kadhim
- Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Mehrdad Emami
- Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - John L Fitzgerald
- Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Melissa Middeldorp
- Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Prashanthan Sanders
- Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
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20
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Li B, Xiong W, Zuo W, Shi Y, Wang T, Chang L, Wu Y, Ma H, Bian Q, Chang ACY. Proximal telomeric decompaction due to telomere shortening drives FOXC1-dependent myocardial senescence. Nucleic Acids Res 2024; 52:6269-6284. [PMID: 38634789 PMCID: PMC11194093 DOI: 10.1093/nar/gkae274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 02/29/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
Telomeres, TTAGGGn DNA repeat sequences located at the ends of eukaryotic chromosomes, play a pivotal role in aging and are targets of DNA damage response. Although we and others have demonstrated presence of short telomeres in genetic cardiomyopathic and heart failure cardiomyocytes, little is known about the role of telomere lengths in cardiomyocyte. Here, we demonstrate that in heart failure patient cardiomyocytes, telomeres are shortened compared to healthy controls. We generated isogenic human induced pluripotent stem cell derived cardiomyocytes (hiPSC-CMs) with short telomeres (sTL-CMs) and normal telomeres (nTL-CMs) as model. Compared to nTL-CMs, short telomeres result in cardiac dysfunction and expression of senescent markers. Using Hi-C and RNASeq, we observe that short telomeres induced TAD insulation decrease near telomeric ends and this correlated with a transcription upregulation in sTL-CMs. FOXC1, a key transcription factor involved in early cardiogenesis, was upregulated in sTL-CMs and its protein levels were negatively correlated with telomere lengths in heart failure patients. Overexpression of FOXC1 induced hiPSC-CM aging, mitochondrial and contractile dysfunction; knockdown of FOXC1 rescued these phenotypes. Overall, the work presented demonstrate that increased chromatin accessibility due to telomere shortening resulted in the induction of FOXC1-dependent expression network responsible for contractile dysfunction and myocardial senescence.
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Affiliation(s)
- Bin Li
- Department of Cardiology and Shanghai Institute of Precision Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Weiyao Xiong
- Department of Cardiology and Shanghai Institute of Precision Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Wu Zuo
- Department of Cardiology and Shanghai Institute of Precision Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Yuanyuan Shi
- Department of Cardiology and Shanghai Institute of Precision Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Teng Wang
- Department of Cardiology and Shanghai Institute of Precision Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Lingling Chang
- Department of Cardiology and Shanghai Institute of Precision Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Yueheng Wu
- Department of Cardiovascular Medicine, Guangdong General Hospital, Guangzhou, Guangdong, China
| | - Heng Ma
- Department of Physiology and Pathophysiology, Fourth Military Medical University, No. 169 Changle West Rd, Xi'an 710032, China
| | - Qian Bian
- Department of Cardiology and Shanghai Institute of Precision Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Alex C Y Chang
- Department of Cardiology and Shanghai Institute of Precision Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
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21
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Ninni S, Algalarrondo V, Brette F, Lemesle G, Fauconnier J. Left atrial cardiomyopathy: Pathophysiological insights, assessment methods and clinical implications. Arch Cardiovasc Dis 2024; 117:283-296. [PMID: 38490844 DOI: 10.1016/j.acvd.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 03/17/2024]
Abstract
Atrial cardiomyopathy is defined as any complex of structural, architectural, contractile or electrophysiological changes affecting atria, with the potential to produce clinically relevant manifestations. Most of our knowledge about the mechanistic aspects of atrial cardiomyopathy is derived from studies investigating animal models of atrial fibrillation and atrial tissue samples obtained from individuals who have a history of atrial fibrillation. Several noninvasive tools have been reported to characterize atrial cardiomyopathy in patients, which may be relevant for predicting the risk of incident atrial fibrillation and its related outcomes, such as stroke. Here, we provide an overview of the pathophysiological mechanisms involved in atrial cardiomyopathy, and discuss the complex interplay of these mechanisms, including aging, left atrial pressure overload, metabolic disorders and genetic factors. We discuss clinical tools currently available to characterize atrial cardiomyopathy, including electrocardiograms, cardiac imaging and serum biomarkers. Finally, we discuss the clinical impact of atrial cardiomyopathy, and its potential role for predicting atrial fibrillation, stroke, heart failure and dementia. Overall, this review aims to highlight the critical need for a clinically relevant definition of atrial cardiomyopathy to improve treatment strategies.
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Affiliation(s)
- Sandro Ninni
- CHU de Lille, Université de Lille, 59000 Lille, France.
| | - Vincent Algalarrondo
- Department of Cardiology, Bichat University Hospital, AP-HP, 75018 Paris, France
| | - Fabien Brette
- PhyMedExp, University of Montpellier, INSERM, CNRS, 34093 Montpellier, France
| | | | - Jérémy Fauconnier
- PhyMedExp, University of Montpellier, INSERM, CNRS, 34093 Montpellier, France
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22
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [Citation(s) in RCA: 175] [Impact Index Per Article: 175.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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23
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Dong H, Chen H, Hidru TH, Xia Y, Yang X. Sinus node dysfunction and stroke risk: a systematic review and meta-analysis. BMJ Open 2023; 13:e076499. [PMID: 37977871 PMCID: PMC10660976 DOI: 10.1136/bmjopen-2023-076499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES The role of cardiac arrhythmia in ischaemic stroke is widely studied, but the size of the stroke risk in patients with sinus node dysfunction (SND) with and without atrial fibrillation (AF) is unclear. This systematic review and meta-analysis aimed to compare the risk of stroke and its associated factors in patients with SND with and without AF. DESIGN A systematic review and meta-analysis was conducted based on the Grading of Recommendations, Assessment, Development and Evaluation approach. DATA SOURCES PubMed, EMBASE and Cochrane Database were searched until December 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies that investigate stroke in patients with SND diagnosed with or without AF/atrial flutter. DATA EXTRACTION AND SYNTHESIS Two independent authors screened studies for inclusion and extracted data. Literature quality assessment was performed using the Newcastle-Ottawa Scale and the Cochrane Collaboration Tool. The overall risk of stroke was estimated using the random-effects model. The generic inverse variance method was used to calculate the pooled estimates of stroke-associated factors. We performed a sensitivity analysis using a fixed-effects model. RESULTS Of the 929 records retrieved, 6 papers (106 163 patients) met the inclusion criteria. The average yearly stroke incidence in patients with SND was 1.542% (95% CI: 1.334% to 1.749%). The stroke incidence was similar between the isolated SND (1.587%; 95% CI: 1.510% to 1.664%) and non-isolated (SND+AF) (1.660%; 95% CI: 0.705% to 2.615%) groups. AF (HR, 95% CI: 1.53 (1.01 to 2.33)), stroke/transient ischaemia attack/other thrombotic events (HR, 95% CI: 2.54 (1.14 to 5.69)), hypertension (HR, 95% CI: 1.51 (1.11 to 2.07)) and heart failure (HR, 95% CI: 1.41 (1.01 to 1.97)) were associated with stroke in the SND population. CONCLUSION Our findings suggest that patients with SND carry a similar risk of stroke to those with combined SND and AF. Future studies are needed to investigate whether interventions targeting stroke prevention, such as anticoagulation therapy, can help to prevent stroke in patients with SND. PROSPERO REGISTRATION NUMBER CRD42023408436.
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Affiliation(s)
- Haoyu Dong
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Hao Chen
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | | | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xiaolei Yang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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24
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Zhang H, Chen C, Liu Y, Chen W, Qi J, Xu Y, Ren L, Yang G, Min D, Liu Z, Cai X, Hao M, Xu G, Hou P. D-galactose causes sinoatrial node dysfunction: from phenotype to mechanism. Aging (Albany NY) 2023; 15:12551-12569. [PMID: 37950730 PMCID: PMC10683603 DOI: 10.18632/aging.205196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/12/2023] [Indexed: 11/13/2023]
Abstract
With the population aging, age-related sinoatrial node dysfunction (SND) has been on the rise. Sinoatrial node (SAN) degeneration is an important factor for the age-related SND development. However, there is no suitable animal modeling method in this field. Here, we investigated whether D-galactose could induce SAN degeneration and explored the associated mechanism. In vivo, twelve C57BL/6 mice were divided into Control and D-galactose group to receive corresponding treatments. Senescence was confirmed by analyzing the hair and weight; cardiac function was evaluated through echocardiography, cerebral blood flux and serum-BNP; the SAN function was evaluated by electrocardiogram; fibrotic change was evaluated by Masson's trichrome staining and oxidative stress was assessed through DHE staining and serum indicators. Mechanism was verified through immunofluorescence-staining and Western blotting. In vitro, mouse-atrial-myocytes were treated with D-galactose, and edaravone was utilized as the ROS scavenger. Senescence, oxidative stress, proliferation ability and mechanism were verified through various methods, and intuitive evidence was obtained through electrophysiological assay. Finally, we concluded that D-galactose can be used to induce age-related SND, in which oxidative stress plays a key role, causing PITX2 ectopic expression and downregulates SHOX2 expression, then through the downstream GATA4/NKX2-5 axis, results in pacing-related ion channels dysfunction, and hence SND development.
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Affiliation(s)
- Heng Zhang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Chen Chen
- Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Yue Liu
- Shenyang Medical College, Shenyang 110034, China
| | - Wei Chen
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 116600, China
| | - Jing Qi
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 116600, China
| | - Yue Xu
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 116600, China
| | - Lu Ren
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 116600, China
| | - Guanlin Yang
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 116600, China
| | - Dongyu Min
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 116600, China
| | - Zhuang Liu
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 116600, China
| | - Xintong Cai
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 116600, China
| | - Miao Hao
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 116600, China
| | - Guanzhen Xu
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 116600, China
| | - Ping Hou
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 116600, China
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25
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Ahn HJ, Cha MJ, Lee E, Lee SR, Choi EK, Han S, Nam GB, Choi JI, Pak HN, Oh IY, Shin DG, On YK, Park SW, Kim YH, Oh S. The higher recurrence rate after catheter ablation in younger patients with atrial fibrillation suggesting different pathophysiology. J Interv Card Electrophysiol 2023; 66:1609-1619. [PMID: 36648614 DOI: 10.1007/s10840-022-01461-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Young atrial fibrillation (AF) patients have been underrepresented in studies of radiofrequency catheter ablation (RFCA) and the outcome of RFCA has not been widely addressed. We investigated age-related differences in clinical features, the recurrence of atrial tachyarrhythmia, and its predictors of patients who underwent RFCA for AF. METHODS This is a multicenter prospective study of 2799 patients who underwent RFCA for AF in 2017-2020. The patients were divided into two groups - group A (age < 60 years, n = 1269) and group B (age ≥ 60 years, n = 1530) - and a recurrence of any atrial tachyarrhythmia 1 year after RFCA following a 90-day blanking period was compared. RESULTS The mean age was 51.6 ± 6.7 and 66.8 ± 5.2 years for groups A and B, respectively. Higher body mass index, smaller left atrium, and more prevalent cardiomyopathy and obstructive sleep apnea were observed in group A. Overall, 1-year atrial tachyarrhythmia-free survival was 85.6% and lower in young patients (83.1% in group A vs. 87.7% in group B, log-rank p < 0.01): adjusted hazard ratio (aHR) of recurrence (95% confidence interval (CI)), 1.45 (1.13-1.86) for group A compared to group B (p < 0.01). The association between younger age and higher recurrence was continuously observed in patients under 60 years. Any non-PV ablation was associated with a lower recurrence of atrial tachyarrhythmia in group B (aHR 0.68 (0.47-0.96), p < 0.05), but not in group A. CONCLUSIONS AF patients younger than 60 years had a higher 1-year AF recurrence after RFCA. Young AF patients might have distinctive pathophysiology of AF requiring more integrated management.
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Affiliation(s)
- Hyo- Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Myung-Jin Cha
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Euijae Lee
- Department of Cardiology, Bucheon Sejong Hospital, Bucheon, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seongwook Han
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Republic of Korea
| | - Gi-Byung Nam
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Il Choi
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Il-Young Oh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong-Gu Shin
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Young Keun On
- Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Weon Park
- Department of Cardiology, Bucheon Sejong Hospital, Bucheon, Republic of Korea
| | - Young-Hoon Kim
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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26
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Segan L, Chieng D, Sugumar H, Voskoboinik A, Ling LH, Costello B, Azzopardi S, Nderitu Z, Parameswaran R, Amerena J, McLellan AJ, Lee G, Morton J, Joseph S, Wong M, Taylor A, Kalman JM, Kistler PM, Prabhu S. The impact of age on ablation outcomes in AF-mediated cardiomyopathy. J Cardiovasc Electrophysiol 2023; 34:2065-2075. [PMID: 37694615 DOI: 10.1111/jce.16052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION The absence of ventricular scar in patients with atrial fibrillation (AF) and systolic heart failure (HF) predicts left ventricular (LV) recovery following AF ablation. It is unknown whether age impacts the degree of LV recovery, reverse remodeling, or AF recurrence following catheter ablation (CA) among this population. OBJECTIVES To evaluate the impact of age on LV recovery and AF recurrence in a population with AF and systolic HF without fibrosis (termed AF-mediated cardiomyopathy) following CA. METHODS Consecutive patients undergoing CA between 2013 and 2021 with LV ejection fraction (LVEF) < 45% and absence of cardiac magnetic resonance imaging (CMR) detected LV myocardial fibrosis were stratified by age (<65 vs. ≥65 years). Following CA, participants underwent remote rhythm monitoring for 12 months with repeat CMR for HF surveillance. RESULTS The study population consisted of 70 patients (10% female, mean LVEF 33 ± 9%), stratified into younger (age < 65 years, 63%) and older (age ≥ 65 years, 37%) cohorts. Baseline comorbidities, LVEF (34 ± 9 vs. 33 ± 8 ≥65 years, p = .686), atrial and ventricular dimensions (left atrial volume index: 55 ± 21 vs. 56 ± 14 mL/m2 age ≥ 65, p = .834; indexed left ventricular end-diastolic volume: 108 ± 40 vs. 104 ± 28 mL/m2 age ≥ 65, p = .681), pharmacotherapy and ablation strategy (pulmonary vein isolation in all; posterior wall isolation in 27% vs. 19% age ≥ 65, p = .448; cavotricuspid isthmus in 9% vs. 11.5% age ≥ 65) were comparable (all p > .05) albeit a higher CHADS2 VASc score in the older cohort (2.7 ± 0.9 vs. 1.6 ± 0.6 age < 65, p < .001). Freedom from AF was comparable (hazard ratio: 0.65, 95% confidence interval: 0.38-1.48, LogRank p = .283) as was AF burden [0% (interquartile range, IQR: 0.0-2.1) vs. age ≥ 65: [0% (IQR 0.0-1.7), p = .516], irrespective of age. There was a significant improvement in LV systolic function in both groups (ΔLVEF + 21 ± 14% vs. +21 ± 12% age ≥ 65, p = .913), with LV recovery in the vast majority (73% vs. 69%, respectively, p = .759) at 13 (IQR: 12-16) months. This was accompanied by comparable improvements in functional status (New York Heart Association class p = .851; 6-min walk distance 50 ± 61 vs. 93 ± 134 m in age ≥ 65, p = .066), biomarkers (ΔN-terminal-pro brain natriuretic peptide -139 ± 246 vs. -168 ± 181 age ≥ 65,p = .629) and HF symptoms (Short Form-36 survey Δphysical component summary p = .483/Δmental component summary, p = .841). CONCLUSION In patients undergoing CA for AF with systolic HF in the absence of ventricular scar, comparable improvements in ventricular function, symptoms, and freedom from AF are achieved irrespective of age.
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Affiliation(s)
- Louise Segan
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Cabrini Hospital, Melbourne, Australia
| | - David Chieng
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Cabrini Hospital, Melbourne, Australia
| | - Hariharan Sugumar
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Cabrini Hospital, Melbourne, Australia
| | - Aleksandr Voskoboinik
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Cabrini Hospital, Melbourne, Australia
- Western Health, Melbourne, Australia
| | - Liang-Han Ling
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Cabrini Hospital, Melbourne, Australia
| | - Ben Costello
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- Western Health, Melbourne, Australia
| | - Sonia Azzopardi
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
| | - Ziporah Nderitu
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
| | - Ramanathan Parameswaran
- University of Melbourne, Melbourne, Australia
- Royal Melbourne Hospital, Melbourne, Australia
- Barwon Health, Geelong, Australia
| | | | - Alex J McLellan
- University of Melbourne, Melbourne, Australia
- Royal Melbourne Hospital, Melbourne, Australia
| | - Geoffrey Lee
- University of Melbourne, Melbourne, Australia
- Royal Melbourne Hospital, Melbourne, Australia
| | - Joseph Morton
- University of Melbourne, Melbourne, Australia
- Royal Melbourne Hospital, Melbourne, Australia
| | | | - Michael Wong
- University of Melbourne, Melbourne, Australia
- Western Health, Melbourne, Australia
- Royal Melbourne Hospital, Melbourne, Australia
| | | | - Jonathan M Kalman
- University of Melbourne, Melbourne, Australia
- Royal Melbourne Hospital, Melbourne, Australia
| | - Peter M Kistler
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Cabrini Hospital, Melbourne, Australia
| | - Sandeep Prabhu
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
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Rossi S, Statello R, Pelà G, Leonardi F, Cabassi A, Foresti R, Rozzi G, Lo Muzio FP, Carnevali L, Sgoifo A, Magnani L, Callegari S, Pastori P, Tafuni A, Corradi D, Miragoli M, Macchi E. Age-related increases in cardiac excitability, refractoriness and impulse conduction favor arrhythmogenesis in male rats. Pflugers Arch 2023; 475:731-745. [PMID: 37022463 DOI: 10.1007/s00424-023-02812-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/17/2023] [Accepted: 04/02/2023] [Indexed: 04/07/2023]
Abstract
The effects of excitability, refractoriness, and impulse conduction have been independently related to enhanced arrhythmias in the aged myocardium in experimental and clinical studies. However, their combined arrhythmic effects in the elderly are not yet completely understood. Hence, the aim of the present work is to relate relevant cardiac electrophysiological parameters to enhanced arrhythmia vulnerability in the in vivo senescent heart. We used multiple-lead epicardial potential mapping in control (9-month-old) and aged (24-month-old) rat hearts. Cardiac excitability and refractoriness were evaluated at numerous epicardial test sites by means of the strength-duration curve and effective refractory period, respectively. During sinus rhythm, durations of electrogram intervals and waves were prolonged in the senescent heart, compared with control, demonstrating a latency in tissue activation and recovery. During ventricular pacing, cardiac excitability, effective refractory period, and dispersion of refractoriness increased in the aged animal. This scenario was accompanied by impairment of impulse propagation. Moreover, both spontaneous and induced arrhythmias were increased in senescent cardiac tissue. Histopathological evaluation of aged heart specimens revealed connective tissue deposition and perinuclear myocytolysis in the atria, while scattered microfoci of interstitial fibrosis were mostly present in the ventricular subendocardium. This work suggests that enhanced arrhythmogenesis in the elderly is a multifactorial process due to the joint increase in excitability and dispersion of refractoriness in association with enhanced conduction inhomogeneity. The knowledge of these electrophysiological changes will possibly contribute to improved prevention of the age-associated increase in cardiac arrhythmias.
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Affiliation(s)
- Stefano Rossi
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43125, Parma, Italy.
- Centro Di Eccellenza Per La Ricerca Tossicologica, CERT, University of Parma, Parma, Italy.
| | - Rosario Statello
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanna Pelà
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43125, Parma, Italy
| | - Fabio Leonardi
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Aderville Cabassi
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43125, Parma, Italy
| | - Ruben Foresti
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43125, Parma, Italy
| | - Giacomo Rozzi
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43125, Parma, Italy
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | | | - Luca Carnevali
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Andrea Sgoifo
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Luca Magnani
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Sergio Callegari
- Centro Di Eccellenza Per La Ricerca Tossicologica, CERT, University of Parma, Parma, Italy
| | - Paolo Pastori
- Division of Cardiology, Ospedale Di Fidenza, Fidenza, Italy
| | - Alessandro Tafuni
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43125, Parma, Italy
| | - Domenico Corradi
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43125, Parma, Italy
- Centro Di Eccellenza Per La Ricerca Tossicologica, CERT, University of Parma, Parma, Italy
| | - Michele Miragoli
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43125, Parma, Italy
- Centro Di Eccellenza Per La Ricerca Tossicologica, CERT, University of Parma, Parma, Italy
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Emilio Macchi
- Centro Di Eccellenza Per La Ricerca Tossicologica, CERT, University of Parma, Parma, Italy
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
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Sinus node dysfunction and atrial fibrillation-Relationships, clinical phenotypes, new mechanisms, and treatment approaches. Ageing Res Rev 2023; 86:101890. [PMID: 36813137 DOI: 10.1016/j.arr.2023.101890] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
Although the anatomical basis of the pathogenesis of sinus node dysfunction (SND) and atrial fibrillation (AF) is located primarily in the left and right atria, increasing evidence suggests a strong correlation between SND and AF, in terms of both clinical presentation and formation mechanisms. However, the exact mechanisms underlying this association are unclear. The relationship between SND and AF may not be causal, but is likely to involve common factors and mechanisms, including ion channel remodeling, gap junction abnormalities, structural remodeling, genetic mutations, neuromodulation abnormalities, the effects of adenosine on cardiomyocytes, oxidative stress, and viral infections. Ion channel remodeling manifests primarily as alterations in the "funny" current (If) and Ca2+ clock associated with cardiomyocyte autoregulation, and gap junction abnormalities are manifested primarily as decreased expression of connexins (Cxs) mediating electrical impulse propagation in cardiomyocytes. Structural remodeling refers primarily to fibrosis and cardiac amyloidosis (CA). Some genetic mutations can also cause arrhythmias, such as SCN5A, HCN4, EMD, and PITX2. The intrinsic cardiac autonomic nervous system (ICANS), a regulator of the heart's physiological functions, triggers arrhythmias.In addition, we discuss arrhythmias caused by viral infections, notably Coronavirus Disease 2019 (COVID-19). Similarly to upstream treatments for atrial cardiomyopathy such as alleviating CA, ganglionated plexus (GP) ablation acts on the common mechanisms between SND and AF, thus achieving a dual therapeutic effect.
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Pozios I, Vouliotis AI, Dilaveris P, Tsioufis C. Electro-Mechanical Alterations in Atrial Fibrillation: Structural, Electrical, and Functional Correlates. J Cardiovasc Dev Dis 2023; 10:jcdd10040149. [PMID: 37103028 PMCID: PMC10141162 DOI: 10.3390/jcdd10040149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Atrial fibrillation is the most common arrhythmia encountered in clinical practice affecting both patients’ survival and well-being. Apart from aging, many cardiovascular risk factors may cause structural remodeling of the atrial myocardium leading to atrial fibrillation development. Structural remodelling refers to the development of atrial fibrosis, as well as to alterations in atrial size and cellular ultrastructure. The latter includes myolysis, the development of glycogen accumulation, altered Connexin expression, subcellular changes, and sinus rhythm alterations. The structural remodeling of the atrial myocardium is commonly associated with the presence of interatrial block. On the other hand, prolongation of the interatrial conduction time is encountered when atrial pressure is acutely increased. Electrical correlates of conduction disturbances include alterations in P wave parameters, such as partial or advanced interatrial block, alterations in P wave axis, voltage, area, morphology, or abnormal electrophysiological characteristics, such as alterations in bipolar or unipolar voltage mapping, electrogram fractionation, endo-epicardial asynchrony of the atrial wall, or slower cardiac conduction velocity. Functional correlates of conduction disturbances may incorporate alterations in left atrial diameter, volume, or strain. Echocardiography or cardiac magnetic resonance imaging (MRI) is commonly used to assess these parameters. Finally, the echocardiography-derived total atrial conduction time (PA-TDI duration) may reflect both atrial electrical and structural alterations.
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Resting membrane potential is less negative in trabeculae from right atrial appendages of women, but action potential duration does not shorten with age. J Mol Cell Cardiol 2023; 176:1-10. [PMID: 36681268 DOI: 10.1016/j.yjmcc.2023.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 01/11/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023]
Abstract
AIMS The incidence of atrial fibrillation (AF) increases with age. Women have a lower risk. Little is known on the impact of age, sex and clinical variables on action potentials (AP) recorded in right atrial tissue obtained during open heart surgery from patients in sinus rhythm (SR) and in longstanding AF. We here investigated whether age or sex have an impact on the shape of AP recorded in vitro from right atrial tissue. METHODS We performed multivariable analysis of individual AP data from trabeculae obtained during heart surgery of patients in SR (n = 320) or in longstanding AF (n = 201). AP were recorded by sharp microelectrodes at 37 °C at 1 Hz. Impact of clinical variables were modeled using a multivariable mixed model regression. RESULTS In SR, AP duration at 90% repolarization (APD90) increased with age. Lower ejection fraction and higher body mass index were associated with smaller action potential amplitude (APA) and maximum upstroke velocity (Vmax). The use of beta-blockers was associated with larger APD90. In tissues from women, resting membrane potential was less negative and APA as well as Vmax were smaller. Besides shorter APD20 in elderly patients, effects of age and sex on atrial AP were lost in AF. CONCLUSION The higher probability to develop AF at advanced age cannot be explained by a shortening in APD90. Less negative RMP and lower upstroke velocity might contribute to lower incidence of AF in women, which may be of clinical relevance.
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Abstract
The global prevalence of atrial fibrillation (AF) has increased substantially over the past three decades and is currently approximately 60 million cases. Incident AF and its clinical consequences are largely the result of risk factors that can be modified by lifestyle changes. In this Review, we provide evidence that the lifetime risk of AF is modified not only by sex and race but also through the clinical risk factor and comorbidity burden of individual patients. We begin by summarizing the epidemiology of AF, focusing on non-modifiable and modifiable risk factors, as well as targets and strategies for the primary prevention of AF. Furthermore, we evaluate the role of modifiable risk factors in the secondary prevention of AF as well as the potential effects of risk factor interventions on the frequency and severity of subsequent AF episodes. We end the Review by proposing strategies that require evaluation as well as global policy changes that are needed for the prevention of incident AF and the management of recurrent episodes in patients already affected by AF.
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Hata Y, Ichimata S, Hirono K, Yamaguchi Y, Oku Y, Ichida F, Nishida N. Pathological and Comprehensive Genetic Investigation of Autopsy Cases of Idiopathic Bradyarrhythmia. Circ J 2022; 87:111-119. [PMID: 36070930 DOI: 10.1253/circj.cj-22-0397] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Idiopathic bradyarrhythmia is considered to be due to pathological degeneration of the cardiac conduction system (CCS) during aging. There appears to have been no comprehensive genetic investigations in patients with idiopathic bradyarrhythmia. METHODS AND RESULTS Ten autopsy cases with advanced bradyarrhythmia (6 men and 4 women; age: 70-94 years, 81.5±6.9 years; 5 cases each of sinus node dysfunction [SND] and complete atrioventricular block [CAVB]) were genetically investigated by using whole-exome sequencing. Morphometric analysis of the CCS was performed with sex-, age- and comorbidity-matched control cases. As a result, severe loss of nodal cells and distal atrioventricular conduction system were found in SND and CAVB, respectively. However, the conduction tissue loss was not significant in either the atrioventricular node or the proximal bundle of His in CAVB cases. A total of 13 heterozygous potential variants were found in 3 CAVB and 2 SND cases. Of these 13 variants, 4 were missense in the known progressive cardiac conduction disease-related genes: GATA4 and RYR2. In the remaining 9 variants, 5 were loss-of-function mutation with highly possible pathogenicity. CONCLUSIONS In addition to degenerative changes of selectively vulnerable areas in the heart during advancing age, the vulnerability of the CCS, which may be associated with "rare variants of small effect," may also be a contributing factor to the degeneration of CCS, leading to "idiopathic" bradyarrhythmia.
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Affiliation(s)
- Yukiko Hata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama
| | - Shojiro Ichimata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama
| | - Keiichi Hirono
- Department of Pediatrics, Faculty of Medicine, University of Toyama
| | - Yoshiaki Yamaguchi
- Department of Legal Medicine, Faculty of Medicine, University of Toyama
- Department of Cardiology, Saiseikai Takaoka Hospital
| | - Yuko Oku
- Department of Legal Medicine, Faculty of Medicine, University of Toyama
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health & Welfare
| | - Naoki Nishida
- Department of Legal Medicine, Faculty of Medicine, University of Toyama
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Lazzeroni D, Villatore A, Souryal G, Pili G, Peretto G. The Aging Heart: A Molecular and Clinical Challenge. Int J Mol Sci 2022; 23:16033. [PMID: 36555671 PMCID: PMC9783309 DOI: 10.3390/ijms232416033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Aging is associated with an increasing burden of morbidity, especially for cardiovascular diseases (CVDs). General cardiovascular risk factors, ischemic heart diseases, heart failure, arrhythmias, and cardiomyopathies present a significant prevalence in older people, and are characterized by peculiar clinical manifestations that have distinct features compared with the same conditions in a younger population. Remarkably, the aging heart phenotype in both healthy individuals and patients with CVD reflects modifications at the cellular level. An improvement in the knowledge of the physiological and pathological molecular mechanisms underlying cardiac aging could improve clinical management of older patients and offer new therapeutic targets.
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Affiliation(s)
| | - Andrea Villatore
- School of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy
- Department of Arrhythmology and Cardiac Electrophysiology, Ospedale San Raffaele, 20132 Milan, Italy
| | - Gaia Souryal
- School of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Gianluca Pili
- School of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Giovanni Peretto
- School of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy
- Department of Arrhythmology and Cardiac Electrophysiology, Ospedale San Raffaele, 20132 Milan, Italy
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Boehmer AA, Rothe M, Zezyk C, Soether CM, Dobre BC, Kaess BM, Ehrlich JR. Persistent Atrial Fibrillation in Elderly Patients: Limited Efficacy of Pulmonary Vein Isolation. J Clin Med 2022; 11:jcm11206070. [PMID: 36294392 PMCID: PMC9604667 DOI: 10.3390/jcm11206070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/02/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Cryoballoon pulmonary vein isolation (cryoPVI) is established for symptomatic paroxysmal atrial fibrillation (AF) treatment, but its value in persistent AF is less clear. In particular, limited data are available on its efficacy in elderly patients (≥75 years) with persistent AF. Age is an important modifier of AF progression and represents a risk-factor for AF recurrence. (2) Methods: Prospective, single-center observational study to evaluate the impact of age on efficacy and safety of cryoPVI in elderly patients. Primary efficacy endpoint was symptomatic AF recurrence after 90-day blanking period. Primary safety endpoints were death from any cause, procedure-associated complications or stroke/transient ischemic attack. Median follow-up was 17 months (range 3−24). (3) Results: We included 268 patients with persistent AF (94 ≥ 75 years of age). Multivariate Cox regression analysis identified age as the only independent factor influencing AF recurrence in the overall cohort (p = 0.006). To minimize confounding bias in efficacy and safety analysis of cryoPVI, we matched younger and elderly patients with respect to baseline characteristics. At 24 months, primary efficacy endpoint occurred in 13/69 patients <75 years and 31/69 patients ≥75 years of age (24 months Kaplan−Meier event-rate estimates, HR 0.34; 95% CI, 0.19 to 0.62; log-rank p = 0.0004). No differences were observed in the occurrence of safety end points. (4) Conclusions: Elderly (≥75 years) patients with persistent AF undergoing cryoPVI had an approximately threefold higher risk of symptomatic AF recurrence than matched younger patients. Accordingly, other treatment modalities may be evaluated in this population.
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Parikh RR, Norby FL, Wang W, Thenappan T, Prins KW, Van't Hof JR, Lutsey PL, Solomon SD, Shah AM, Chen LY. Association of Right Ventricular Afterload With Atrial Fibrillation Risk in Older Adults: The Atherosclerosis Risk in Communities Study. Chest 2022; 162:884-893. [PMID: 35562059 PMCID: PMC9659616 DOI: 10.1016/j.chest.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is widely perceived to originate from the left atrium (LA). Whether increases in right ventricular (RV) afterload in older adults play an etiological role in AF genesis independent of LA and left ventricular (LV) remodeling is unknown. RESEARCH QUESTION Is higher RV afterload associated with greater AF risk independent of LA and LV remodeling? STUDY DESIGN AND METHODS In this observational prospective study, we included 2,246 community-dwelling older adults (mean age, 75 years) without known cardiovascular disease, with LV ejection fraction > 50%, LA volume index < 34 mL/m2, and E/e' ratio < 14 and a measurable functional tricuspid regurgitation jet velocity. From 2D-echocardiograms, we estimated pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR). We ascertained incident AF (through 2018) from hospital discharge codes and death certificates. We estimated hazard ratios (HR) by Cox regression. RESULTS During follow-up (median, 6.3 years; interquartile interval, 5.5-6.9 years), 215 participants developed AF. AF risk was significantly higher in the third (vs first) tertile of PASP (HR, 1.65; 95% CI, 1.08-2.54) and PVR (HR, 1.38; 95% CI, 1.00-2.08) independent of LA and LV structure and function, heart rate, BMI, prevalent sleep apnea, systemic BP, antihypertensive medications, and lung, kidney, and thyroid function. These associations persisted after further exclusion of participants with tricuspid regurgitation jet velocity > 2.8 m/s and lateral and septal mitral annular velocity above age- and sex-specific reference limits. INTERPRETATION In older adults, higher RV afterload is associated with greater AF risk independent of LA and LV remodeling. Future research should focus on confirming this novel association and elucidate underlying mechanisms.
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Affiliation(s)
- Romil R Parikh
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; Center for Cardiac Arrest Prevention, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Thenappan Thenappan
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Kurt W Prins
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Jeremy R Van't Hof
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Lin Yee Chen
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN.
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Magidson PD. The Aged Heart. Emerg Med Clin North Am 2022; 40:637-649. [DOI: 10.1016/j.emc.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Alam AB, Kulshreshtha A, Li L, Subramanya V, Alonso A. Associations of Atrial Fibrillation with Mild Cognitive Impairment and Dementia: An Investigation Using SPRINT Research Materials. J Clin Med 2022; 11:jcm11195800. [PMID: 36233668 PMCID: PMC9572519 DOI: 10.3390/jcm11195800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is linked to increased risk of dementia and cognitive decline, but whether AF and its ascertainment methods affect cognition in patients with hypertension has received less attention. METHODS We studied 8469 participants with elevated systolic blood pressure who were free of stroke and diabetes at baseline enrolled in the Systolic Blood Pressure Intervention Trial. AF was ascertained using three approaches: self-report of AF, AF from a safety event, and study electrocardiogram-determined (ECG) AF. Mild cognitive impairment (MCI) and probable dementia (PD) were ascertained from in-person assessments or telephone interviews from the participant or an informant. We used Cox proportional hazard models to estimate hazard ratios for the association of AF (all three sources) with outcomes of MCI, PD, and a composite MCI/PD outcome. RESULTS During a mean follow-up of 4.6 years, 974 (12%) participants had AF (prevalent or incident), 634 were diagnosed with MCI, and 316 with PD. When comparing those with AF (from any source) to those without, no differences were detected in the risk of MCI or PD. Comparison between AF sources found ECG-AF to be associated with an elevated risk of MCI/PD (hazard ratio (HR) 1.59, 95% confidence interval (95%CI) 1.06, 2.38). Neither AF ascertained through safety events nor self-reported AF were associated with MCI or PD. CONCLUSION The association of AF with incidence of MCI/PD differed by method of AF ascertainment. Case definition of AF and quantification of AF burden are important factors in studies evaluating the link between AF and cognitive dysfunction.
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Affiliation(s)
- Aniqa B. Alam
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
- Correspondence:
| | - Ambar Kulshreshtha
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Linzi Li
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Vinita Subramanya
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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NRF-2/HO-1 Pathway-Mediated SHOX2 Activation Is a Key Switch for Heart Rate Acceleration by Yixin-Fumai Granules. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:8488269. [PMID: 36199421 PMCID: PMC9529460 DOI: 10.1155/2022/8488269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022]
Abstract
Population aging has led to increased sick sinus syndrome (SSS) incidence; however, no effective and safe medical therapy has been reported thus far. Yixin-Fumai granules (YXFMs), a Chinese medicine granule designed for bradyarrhythmia treatment, can effectively increase SSS patients' heart rate. Senescence-induced sinoatrial node (SAN) degeneration is an important part of SSS pathogenesis, and older people often show high levels of oxidative stress; reactive oxygen species (ROS) accumulation in the SAN causes abnormal SAN pacing or conduction functions. The current study observed the protective effects of YXFMs on senescent SAN and explored the relationship between the NRF-2/HO-1 pathway, SHOX2, and T-type calcium channels. We selected naturally senescent C57BL/6 mice with bradycardia to simulate SSS; electrocardiography, Masson's trichrome staining, and DHE staining were used to assess SAN function and tissue damage. Immunofluorescence staining and Western blotting were used to assay related proteins. In vitro, we treated human-induced pluripotent stem cell-derived atrial myocytes (hiPSC-AMs) and mouse atrial myocyte-derived cell line HL-1 with D-galactose to simulate senescent SAN-pacemaker cells. CardioExcyte96 was used to evaluate the pulsatile function of the hiPSC-AMs, and the mechanism was verified by DCFH-DA, immunofluorescence staining, RT-qPCR, and Western blotting. The results demonstrated that YXFMs effectively inhibited senescence-induced SAN hypofunction, and this effect possibly originated from scavenging of ROS and promotion of NRF-2, SHOX2, and T-type calcium channel expression. In vitro experiment results indicated that ML385, si-SHOX2, LDN193189, and Mibefradil reversed YXFMs' effects. Moreover, we, for the first time, found that ROS accumulation may hinder SHOX2 expression; YXFMs can activate SHOX2 through the NRF-2/HO-1 pathway-mediated ROS scavenging and then regulate CACNA1G through the SHOX2/BMP4/GATA4/NKX2-5 axis, improve T-type calcium channel function, and ameliorate the SAN dysfunction. Finally, through network pharmacology and molecular docking, we screened for the most stable YXFMs compound that docks to NRF-2, laying the foundation for future studies.
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Atrial conduction velocity mapping: clinical tools, algorithms and approaches for understanding the arrhythmogenic substrate. Med Biol Eng Comput 2022; 60:2463-2478. [PMID: 35867323 PMCID: PMC9365755 DOI: 10.1007/s11517-022-02621-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/07/2022] [Indexed: 11/02/2022]
Abstract
Characterizing patient-specific atrial conduction properties is important for understanding arrhythmia drivers, for predicting potential arrhythmia pathways, and for personalising treatment approaches. One metric that characterizes the health of the myocardial substrate is atrial conduction velocity, which describes the speed and direction of propagation of the electrical wavefront through the myocardium. Atrial conduction velocity mapping algorithms are under continuous development in research laboratories and in industry. In this review article, we give a broad overview of different categories of currently published methods for calculating CV, and give insight into their different advantages and disadvantages overall. We classify techniques into local, global, and inverse methods, and discuss these techniques with respect to their faithfulness to the biophysics, incorporation of uncertainty quantification, and their ability to take account of the atrial manifold.
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Biendarra‐Tiegs SM, Yechikov S, Shergill B, Brumback B, Takahashi K, Shirure VS, Gonzalez RE, Houshmand L, Zhong D, Weng K, Silva J, Smith TW, Rentschler SL, George SC. An iPS-derived in vitro model of human atrial conduction. Physiol Rep 2022; 10:e15407. [PMID: 36117385 PMCID: PMC9483613 DOI: 10.14814/phy2.15407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/27/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in the United States, affecting approximately 1 in 10 adults, and its prevalence is expected to rise as the population ages. Treatment options for AF are limited; moreover, the development of new treatments is hindered by limited (1) knowledge regarding human atrial electrophysiological endpoints (e.g., conduction velocity [CV]) and (2) accurate experimental models. Here, we measured the CV and refractory period, and subsequently calculated the conduction wavelength, in vivo (four subjects with AF and four controls), and ex vivo (atrial slices from human hearts). Then, we created an in vitro model of human atrial conduction using induced pluripotent stem (iPS) cells. This model consisted of iPS-derived human atrial cardiomyocytes plated onto a micropatterned linear 1D spiral design of Matrigel. The CV (34-41 cm/s) of the in vitro model was nearly five times faster than 2D controls (7-9 cm/s) and similar to in vivo (40-64 cm/s) and ex vivo (28-51 cm/s) measurements. Our iPS-derived in vitro model recapitulates key features of in vivo atrial conduction and may be a useful methodology to enhance our understanding of AF and model patient-specific disease.
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Affiliation(s)
| | - Sergey Yechikov
- Department of Biomedical EngineeringUniversity of California, DavisDavisCaliforniaUSA
| | - Bhupinder Shergill
- Department of Biomedical EngineeringUniversity of California, DavisDavisCaliforniaUSA
| | - Brittany Brumback
- Department of Biomedical EngineeringWashington University in St. LouisSt. LouisMissouriUSA
| | - Kentaro Takahashi
- Department of MedicineWashington University in St. LouisSt. LouisMissouriUSA
| | - Venktesh S. Shirure
- Department of Biomedical EngineeringUniversity of California, DavisDavisCaliforniaUSA
| | - Ruth Estelle Gonzalez
- Department of Biomedical EngineeringUniversity of California, DavisDavisCaliforniaUSA
| | - Laura Houshmand
- Department of Biomedical EngineeringUniversity of California, DavisDavisCaliforniaUSA
| | - Denise Zhong
- Department of Biomedical EngineeringUniversity of California, DavisDavisCaliforniaUSA
| | - Kuo‐Chan Weng
- Department of Biomedical EngineeringWashington University in St. LouisSt. LouisMissouriUSA
| | - Jon Silva
- Department of Biomedical EngineeringWashington University in St. LouisSt. LouisMissouriUSA
| | - Timothy W. Smith
- Department of MedicineWashington University in St. LouisSt. LouisMissouriUSA
| | - Stacey L. Rentschler
- Department of MedicineWashington University in St. LouisSt. LouisMissouriUSA
- Department of Developmental BiologyWashington University in St. LouisSt. LouisMissouriUSA
| | - Steven C. George
- Department of Biomedical EngineeringUniversity of California, DavisDavisCaliforniaUSA
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41
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Cecchini F, Mugnai G, Iacopino S, Abugattas JP, Adriaenssens B, Al-Housari M, Almorad A, Bala G, Bisignani A, de Asmundis C, De Greef Y, Maj R, Osòrio TG, Pannone L, Schwagten B, Sieira J, Sorgente A, Stroker E, Wolf M, Chierchia GB. Safety and long-term efficacy of cryoballoon ablation for atrial fibrillation in octogenarians: a multicenter experience. J Interv Card Electrophysiol 2022; 65:559-571. [DOI: 10.1007/s10840-022-01313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022]
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Assessment of age, gender, and anxiety on ECG waveform morphology in a large population of domestic dogs. Sci Rep 2022; 12:7339. [PMID: 35513697 PMCID: PMC9072377 DOI: 10.1038/s41598-022-11378-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/18/2022] [Indexed: 11/24/2022] Open
Abstract
Cardiovascular diseases are major causes of death in the western world and this incidence increases in the elderly population. With aging, there are physiologic changes to the cardiac structure secondary to adipose tissue deposition, calcification of valve leaflets and changes in the structure of the heart including atrial remodeling. Such changes can make the myocardium more susceptible to stress leading to a higher prevalence of cardiovascular diseases in the aging population. Studies in healthy humans have shown that these structural and molecular changes in the heart are manifested as changes on an electrocardiogram (ECG). Using animal models, similar ECG changes have been found in guinea pigs, rabbits, and mice. No veterinary study has specifically evaluated if comparable aging changes occur in canine species. In this cross-sectional retrospective study, 12,026 ECGs from apparently healthy dogs were obtained and evaluated. Age was observed to have both linear and non-linear associations with multiple ECG variables, including P wave amplitude and duration, R amplitude and QRS duration. This study confirmed that, like humans, there may be ECG changes secondary to normal physiological cardiac aging. Further studies are warranted to confirm and elaborate on these findings as canines may be a useful model for cardiac aging in humans.
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43
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Liu M, Du Z, Sun Y. Prognostic significance of first-degree atrioventricular block in a large Asian population: a prospective cohort study. BMJ Open 2022; 12:e062005. [PMID: 35379649 PMCID: PMC8981319 DOI: 10.1136/bmjopen-2022-062005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To investigate the prognostic significance of first-degree atrioventricular block (AVB) in Asian populations. DESIGN AND SETTING Participants (N=9634) from the Northeast China Rural Cardiovascular Health Study were included. The first-degree AVB was defined as PR (from the beginning of the P wave to the beginning of the QRS complex on an electrocardiogram) interval >200 ms, and primary composite outcome (all events) included new onset cardiovascular disease (CVD) and mortality. Cox regression and restricted cubic spline were used to identify the associations of PR interval or first-degree AVB with end points. Furthermore, the relationship between new-onset CVD and mortality and first-degree AVB was separately evaluated. The value of first-degree AVB for predicting adverse events was evaluated by reclassification and discrimination analyses. RESULTS During a median of 4.65 years follow-up, 524 participants developed CVD and 371 died. Compared with participants with PR ≤200 ms, those with first-degree AVB had an increased risk of all events (HR: 1.84; 95% CI 1.18 to 2.88). Furthermore, first-degree AVB was predictive of incident CVD (1.96, 1.18 to 3.23) and stroke (2.22, 1.27 to 3.90) after adjusting for conventional risk. These statistically significant associations remained unchanged after further stratification by potential confounding factors. Discrimination and reclassification analyses suggested that first-degree AVB addition could improve the conventional model for predicting adverse outcomes within 4 years. CONCLUSIONS Our results indicated that first-degree AVB was an independent risk factor for adverse events, suggesting that it should not be considered as inconsequential factor in general population. These results have potential clinical value for identifying individuals at high risk for adverse outcomes.
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Affiliation(s)
- Moujie Liu
- Department of Cardiovascular Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Zhi Du
- Department of Cardiovascular Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Yingxian Sun
- Department of Cardiovascular Medicine, The First Hospital of China Medical University, Shenyang, China
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44
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Cardiac age detected by machine learning applied to the surface ECG of healthy subjects: Creation of a benchmark. J Electrocardiol 2022; 72:49-55. [DOI: 10.1016/j.jelectrocard.2022.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/10/2022] [Accepted: 03/06/2022] [Indexed: 11/22/2022]
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45
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Kurata N, Masuda M, Kanda T, Asai M, Iida O, Okamoto S, Ishihara T, Nanto K, Tsujimura T, Matsuda Y, Hata Y, Uematsu H, Mano T. Left Atrial Localized Low-Voltage Areas Indicate Whole Left Atrial Electrophysiological Degeneration in Atrial Fibrillation Patients. Circ J 2022; 86:192-199. [PMID: 34707070 DOI: 10.1253/circj.cj-21-0527] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The efficacy of ablation targeting low-voltage areas (LVAs) is controversial, although LVA presence is well known to be associated with atrial fibrillation (AF) recurrence after ablation. AF substrate may not localize within LVAs. METHODS AND RESULTS This observational study enrolled 405 consecutive patients who underwent an initial AF ablation procedure. The left atrial (LA) voltage map was obtained after pulmonary vein isolation. LVAs were defined as areas with voltage <0.5 mV. To estimate whole LA electrophysiological degeneration, mean regional voltage at each of the 6 regions and LA total conduction velocity were measured. LVAs existed in 143 of 405 (35.3%) patients. Patients with LVAs demonstrated lower mean regional voltages throughout all 6 regions compared to those without LVAs (1.3 [1.8, 0.8] vs. 0.6 [1.0, 0.2] mV for the anterior wall, P<0.001). In contrast, LA conduction velocity was lower in patients with LVAs than in those without (0.89 [1.01, 0.74] vs. 0.93 [1.03, 0.87] m/s, P<0.001). Multivariate analysis revealed that low LA total conduction velocity and a higher number of regions with mean voltage reduction were independently associated with AF recurrence, although LVA presence was not. CONCLUSIONS Patients with localized LA LVAs were characterized by whole LA electrophysiological degeneration as assessed by mean regional voltage and conduction velocity. In addition, whole LA electrophysiological degeneration parameters were well associated with AF recurrence.
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Affiliation(s)
| | | | | | | | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center
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46
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Zhang Y, Sun L, Luo F, Li J, Sun Y, Chen Y, Dong J. Result and technique consideration of radiofrequency catheter ablation of tachycardia in patients with dextrocardia. Pacing Clin Electrophysiol 2022; 45:340-347. [PMID: 35044698 DOI: 10.1111/pace.14452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with tachycardia, in the context of pre-existing dextrocardia, could benefit from catheter ablation. However, anatomical complexities hinder effective conduct of this procedure. We aimed to retrospectively summarize the clinical characteristics and the safety and efficiency, and recommended the technique considerations. METHODS Twenty-one cases from 19 patients with tachycardia and dextrocardia, who underwent catheter ablation between 2009 and 2021, were enrolled. All patients underwent echocardiography and computed tomography (CT) to confirm the anatomical malformations. Transseptal puncture was guided by fluoroscopy or intracardiac echocardiography when left atrial access was necessary and the ablation process was guided by three-dimensional mapping. RESULTS Six cases exhibited situs solitus while nine cases exhibited situs inversus. Fourteen cases had atrial fibrillation, seven had atrial flutter, and two had atrioventricular reentrant tachycardia (AVRT); two cases had combined atrial fibrillation and atrial flutter. Acute success was achieved in 18 cases (85.7%, 18/21). The three-dimensional mapping system was not employed in the three cases which failed. During long-term follow-up (20.71 ± 21.86 months), eight cases (72.7%, 8/11) of atrial fibrillation with dextrocardia successfully attained sinus rhythm. None of AVRT cases had recurrence. Half of the atrial flutter cases with dextrocardia, especially those with a history of surgical correction for cardiac malformations, underwent recurrence. One case had cardiac tamponade. CONCLUSIONS Catheter ablation for tachycardia patients with dextrocardia, is safe, efficient, and feasible. It is imperative to integrate echocardiography, cardiac computer tomography, and three-dimensional mapping, and apply three-dimensional reconstruction to facilitate the success of catheter ablation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yuekun Zhang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liping Sun
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fangyuan Luo
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiaju Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yibo Sun
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingwei Chen
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzeng Dong
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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47
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Therapeutic implications of galectin-3 in patients with atrial fibrillation. Sci Rep 2022; 12:784. [PMID: 35039576 PMCID: PMC8764095 DOI: 10.1038/s41598-022-04894-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/20/2021] [Indexed: 11/09/2022] Open
Abstract
Atrial fibrosis can present as an arrhythmogenic substrate that is correlated with higher recurrence after catheter ablation for atrial fibrillation. Galectin-3, a beta-galactoside-binding lectin, is highly expressed and secreted from macrophages and is important in inflammation and fibrosis. We assessed the clinical implications of serum galectin-3 in patients with atrial fibrillation. This was a prospective cohort study of consecutive patients who underwent radiofrequency catheter ablation in a tertiary referral center from February 2017 to September 2017. Intracardiac blood sampling, echocardiographic measurements, magnetic resonance imaging with late gadolinium enhancement, electrophysiologic testing, and endocardial voltage mapping were consistently implemented in 75 patients before the ablation. Serum galectin-3 level was higher in patients with diabetes mellitus and was correlated with values that indicated the left atrial size. During a median 14 months of follow-up, atrial tachyarrhythmia recurred in 27% of patients. In multivariable Cox regression analysis, non-paroxysmal atrial fibrillation (hazard ratio 6.8; 95% confidence interval 1.6–28.9) and higher galectin-3 levels (hazard ratio 1.3; 95% confidence interval 1.0–1.7) were associated with increased risk of recurrence. Serum galectin-3 may be a prognostic biomarker for risk stratification in patients with atrial fibrillation planned catheter ablation.
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48
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Wong GR, Nalliah CJ, Lee G, Voskoboinik A, Chieng D, Prabhu S, Parameswaran R, Sugumar H, Al-Kaisey A, McLellan A, Ling LH, Sanders P, Kistler PM, Kalman JM. Sex-Related Differences in Atrial Remodeling in Patients With Atrial Fibrillation: Relationship to Ablation Outcomes. Circ Arrhythm Electrophysiol 2021; 15:e009925. [PMID: 34937397 DOI: 10.1161/circep.121.009925] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Population studies have demonstrated a range of sex differences including a higher prevalence of atrial fibrillation (AF) in men and a higher risk of AF recurrence in women. However, the underlying reasons for this higher recurrence are unknown. This study evaluated whether sex-based electrophysiological substrate differences exist to account for worse AF ablation outcomes in women. METHODS High-density electroanatomic mapping of the left atrium was performed in 116 consecutive patients with AF. Regional analysis was performed across 6 left atrium segments. High-density maps were created using a multipolar catheter (Biosense Webster) during distal coronary sinus pacing at 600 and 300 ms. Mean voltage and conduction velocity was determined. Complex fractionated signals and double potentials were manually annotated. RESULTS Overall, 42 (36%) were female, mean age was 61±8 years and AF was persistent in 52%. Global mean voltage was significantly lower in females compared with males at 600 ms (1.46±0.17 versus 1.84±0.15 mV, P<0.001) and 300 ms (1.27±0.18 versus 1.57±0.18 mV, P=0.013) pacing. These differences were seen uniformly across the left atrium. Females demonstrated significant conduction velocity slowing (34.9±6.1 versus 44.1±6.9 cm/s, P=0.002) and greater proportion of complex fractionated signals (9.9±1.7% versus 6.0±1.7%, P=0.014). After a median follow-up of 22 months (Q1-Q3: 15-29), females had significantly lower single-procedure (22 [54%] versus 54 [75%], P=0.029) and multiprocedure (24 [59%] versus 60 [83%], P=0.005) arrhythmia-free survival. Female sex and persistent AF were independent predictors of single and multiprocedure arrhythmia recurrence. CONCLUSIONS Female patients demonstrated more advanced atrial remodeling on high-density electroanatomic mapping and greater post-AF ablation arrhythmia recurrence compared with males. These changes may contribute to sex-based differences in the clinical course of females with AF and in part explain the higher risk of recurrence.
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Affiliation(s)
- Geoffrey R Wong
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia (G.R.W., C.J.N., G.L., R.P., A.A.-K., A.M., J.M.K.).,Department of Medicine, University of Melbourne, Australia (G.R.W., C.J.N., R.P., A.A.-K., J.M.K.)
| | - Chrishan J Nalliah
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia (G.R.W., C.J.N., G.L., R.P., A.A.-K., A.M., J.M.K.).,Department of Medicine, University of Melbourne, Australia (G.R.W., C.J.N., R.P., A.A.-K., J.M.K.)
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia (G.R.W., C.J.N., G.L., R.P., A.A.-K., A.M., J.M.K.)
| | - Aleksandr Voskoboinik
- Baker Institute, Melbourne, Australia (A.V., D.C., S.P., H.S., L.-H.L., P.M.K.).,Heart Centre, Alfred Hospital, Melbourne, Australia (A.V., D.C., S.P., L.-H.L., P.M.K.)
| | - David Chieng
- Baker Institute, Melbourne, Australia (A.V., D.C., S.P., H.S., L.-H.L., P.M.K.).,Heart Centre, Alfred Hospital, Melbourne, Australia (A.V., D.C., S.P., L.-H.L., P.M.K.)
| | - Sandeep Prabhu
- Baker Institute, Melbourne, Australia (A.V., D.C., S.P., H.S., L.-H.L., P.M.K.).,Heart Centre, Alfred Hospital, Melbourne, Australia (A.V., D.C., S.P., L.-H.L., P.M.K.)
| | - Ramanathan Parameswaran
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia (G.R.W., C.J.N., G.L., R.P., A.A.-K., A.M., J.M.K.).,Department of Medicine, University of Melbourne, Australia (G.R.W., C.J.N., R.P., A.A.-K., J.M.K.)
| | - Hariharan Sugumar
- Baker Institute, Melbourne, Australia (A.V., D.C., S.P., H.S., L.-H.L., P.M.K.)
| | - Ahmed Al-Kaisey
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia (G.R.W., C.J.N., G.L., R.P., A.A.-K., A.M., J.M.K.).,Department of Medicine, University of Melbourne, Australia (G.R.W., C.J.N., R.P., A.A.-K., J.M.K.)
| | - Alex McLellan
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia (G.R.W., C.J.N., G.L., R.P., A.A.-K., A.M., J.M.K.)
| | - Liang-Han Ling
- Baker Institute, Melbourne, Australia (A.V., D.C., S.P., H.S., L.-H.L., P.M.K.).,Heart Centre, Alfred Hospital, Melbourne, Australia (A.V., D.C., S.P., L.-H.L., P.M.K.)
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, Australia (P.S.)
| | - Peter M Kistler
- Baker Institute, Melbourne, Australia (A.V., D.C., S.P., H.S., L.-H.L., P.M.K.).,Heart Centre, Alfred Hospital, Melbourne, Australia (A.V., D.C., S.P., L.-H.L., P.M.K.)
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia (G.R.W., C.J.N., G.L., R.P., A.A.-K., A.M., J.M.K.).,Department of Medicine, University of Melbourne, Australia (G.R.W., C.J.N., R.P., A.A.-K., J.M.K.)
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49
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Zhu X, Chu H, Li J, Wang C, Li W, Wang Z, Xu Z, Jing Y, Zhao R, Zhong L, Hu N. New Discovery of Left Atrial Macroreentry Tachycardia: Originating from the Spontaneous Scarring of Left Atrial Anterior Wall. J Interv Cardiol 2021; 2021:2829070. [PMID: 34992506 PMCID: PMC8694995 DOI: 10.1155/2021/2829070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/17/2021] [Indexed: 11/18/2022] Open
Abstract
AIMS This study sought to describe left atrial macroreentry tachycardia (LAMRT) originating from the spontaneous scarring of left atrial anterior wall (LAAW) and its clinical and electrophysiological characteristics, mechanisms, and the formation of substrates. METHODS AND RESULTS 9 of 123 patients (89% female, age 79.78 ± 5.59 years) had LAMRT originating from the LAAW with no cardiac surgery or prior left atrial (LA) ablation. The mean tachycardia cycle length (TCL) was 241.67 ± 38.00 milliseconds. Spontaneous scars areas and low voltage areas (LVAs) in the LAAW were found in all patients. Successful ablation of the critical isthmus caused termination of the LAMRT and was not inducible in all patients. Arrhythmogenic substrates of LAMRT were the spontaneous scars of LAAW, which matched with the aorta or/and pulmonary artery contact area. The area under the curve (AUC) of age and combination of gender and age for predicting the LAMRT originating from the LAAW were 0.918 and 0.951, respectively, with a cutoff value of ≥73.5 years of age and gender (female) predicting LAMRT with 88.9% sensitivity and 89% specificity. CONCLUSION Combination of gender and age provides a simple and useful criterion to distinguish LAMRT from cavotricuspid isthmus- (CTI-) dependent atrial tachycardia in macroreentry atrial tachycardia (MRAT) in patients without a history of surgery or ablation. Aorta or/and pulmonary artery contacting LA may be related to spontaneous scars. Ablation the isthmus eliminated LAMRT in all patients.
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Affiliation(s)
- Xuefeng Zhu
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Hongxia Chu
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Jianping Li
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Chunxiao Wang
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Wenjing Li
- Doppler Ultrasonic Department, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Zhen Wang
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Zhiyuan Xu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yanyan Jing
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Ruifu Zhao
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Lin Zhong
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Naibao Hu
- Department of Statistics, Binzhou Medical University, Yantai, China
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50
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What keeps us ticking? Sinoatrial node mechano-sensitivity: the grandfather clock of cardiac rhythm. Biophys Rev 2021; 13:707-716. [PMID: 34777615 DOI: 10.1007/s12551-021-00831-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/17/2021] [Indexed: 01/01/2023] Open
Abstract
The rhythmic and spontaneously generated electrical excitation that triggers the heartbeat originates in the sinoatrial node (SAN). SAN automaticity has been thoroughly investigated, which has uncovered fundamental mechanisms involved in cardiac pacemaking that are generally categorised into two interacting and overlapping systems: the 'membrane' and 'Ca2+ clock'. The principal focus of research has been on these two systems of oscillators, which have been studied primarily in single cells and isolated tissue, experimental preparations that do not consider mechanical factors present in the whole heart. SAN mechano-sensitivity has long been known to be a contributor to SAN pacemaking-both as a driver and regulator of automaticity-but its essential nature has been underappreciated. In this review, following a description of the traditional 'clocks' of SAN automaticity, we describe mechanisms of SAN mechano-sensitivity and its vital role for SAN function, making the argument that the 'mechanics oscillator' is, in fact, the 'grandfather clock' of cardiac rhythm.
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