首页 > 最新文献

Circulation. Arrhythmia and electrophysiology最新文献

英文 中文
Retraction of: Systematic Treatment Approach to Ventricular Tachycardia in Cardiac Sarcoidosis. 撤回:心脏肉样瘤病室性心动过速的系统治疗方法。
IF 8.4 1区 医学 Q1 Medicine Pub Date : 2024-01-01 Epub Date: 2024-01-16 DOI: 10.1161/HAE.0000000000000090
{"title":"Retraction of: Systematic Treatment Approach to Ventricular Tachycardia in Cardiac Sarcoidosis.","authors":"","doi":"10.1161/HAE.0000000000000090","DOIUrl":"https://doi.org/10.1161/HAE.0000000000000090","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139478134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effects of Contact Force on Lesion Size During Pulsed Field Catheter Ablation: Histochemical Characterization of Ventricular Lesion Boundaries. 脉冲场导管消融过程中接触力对病变大小的影响:心室病变边界的组织化学特征。
IF 8.4 1区 医学 Q1 Medicine Pub Date : 2024-01-01 Epub Date: 2023-12-28 DOI: 10.1161/CIRCEP.123.012026
Hiroshi Nakagawa, Quim Castellvi, Robert Neal, Steven Girouard, Jacob Laughner, Atsushi Ikeda, Masafumi Sugawara, Yoshimori An, Ayman A Hussein, Shady Nakhla, Tyler Taigen, Jakub Srounbek, Mohamed Kanj, Pasquale Santangeli, Walid I Saliba, Antoni Ivorra, Oussama M Wazni

Background: Effects of contact force (CF) on lesion formation during pulsed field ablation (PFA) have not been well validated. The purpose of this study was to determine the relationship between average CF and lesion size during PFA using a swine-beating heart model.

Methods: A 7F catheter with a 3.5-mm ablation electrode and CF sensor (TactiCath SE, Abbott) was connected to a PFA system (CENTAURI, Galvanize Therapeutics). In 5 closed-chest swine, biphasic PFA current was delivered between the ablation electrode and a skin patch at 40 separate sites in right ventricle (28 Amp) and 55 separate sites in left ventricle (35 Amp) with 4 different levels of CF: (1) low (CF range of 4-13 g; median, 9.5 g); (2) moderate (15-30 g; median, 21.5 g); (3) high (34-55 g; median, 40 g); and (4) no electrode contact, 2 mm away from the endocardium. Swine were sacrificed at 2 hours after ablation, and lesion size was measured using triphenyl tetrazolium chloride staining. In 1 additional swine, COX (cytochrome c oxidase) staining was performed to examine mitochondrial activity to delineate reversible and irreversible lesion boundaries. Histological examination was performed with hematoxylin and eosin and Masson trichrome staining.

Results: Ablation lesions were well demarcated with triphenyl tetrazolium chloride staining, showing (1) a dark central zone (contraction band necrosis and hemorrhage); (2) a pale zone (no mitochondrial activity and nuclear pyknosis, indicating apoptosis zone); and a hyperstained zone by triphenyl tetrazolium chloride and COX staining (unaffected normal myocardium with preserved mitochondrial activity, consistent with reversible zone). At constant PFA current intensity, lesion depth increased significantly with increasing CF. There were no detectable lesions resulting from ablation without electrode contact.

Conclusions: Acute PFA ventricular lesions show irreversible and reversible lesion boundaries by triphenyl tetrazolium chloride staining. Electrode-tissue contact is required for effective lesion formation during PFA. At the same PFA dose, lesion depth increases significantly with increasing CF.

背景:接触力(CF)对脉冲场消融(PFA)过程中病灶形成的影响尚未得到很好的验证。本研究的目的是使用猪跳动心脏模型确定 PFA 过程中平均 CF 与病灶大小之间的关系:将带有 3.5 毫米消融电极和 CF 传感器(TactiCath SE,雅培)的 7F 导管连接到 PFA 系统(CENTAURI,Galvanize Therapeutics)。在 5 头胸腔闭合的猪中,在右心室 40 个不同部位(28 安培)和左心室 55 个不同部位(35 安培)的消融电极和皮肤贴片之间输送双相 PFA 电流,CF 值分为 4 个不同等级:(1)低(CF 值范围为 4-13 克;中位数为 9.5 g);(2) 中等(15-30 g;中位数,21.5 g);(3) 高(34-55 g;中位数,40 g);(4) 无电极接触,距离心内膜 2 mm。猪在消融后 2 小时处死,并使用三苯基氯化四氮唑染色法测量病变大小。对另外 1 头猪进行 COX(细胞色素 c 氧化酶)染色以检查线粒体活性,从而划定可逆和不可逆病变的界限。组织学检查采用苏木精、伊红和马森三色染色法:用三苯基氯化四氮唑染色法对消融病变进行了很好的分界,显示出:(1) 中央暗区(收缩带坏死和出血);(2) 苍白区(无线粒体活性和细胞核凋亡,表明为细胞凋亡区);以及三苯基氯化四氮唑和 COX 染色法染色的高染色区(未受影响的正常心肌,线粒体活性保留,与可逆区一致)。在 PFA 电流强度不变的情况下,病变深度随 CF 的增加而显著增加。在没有电极接触的情况下,没有发现消融导致的病变:通过氯化三苯四唑染色,急性 PFA 心室病变显示出不可逆和可逆的病变边界。在 PFA 过程中,电极-组织接触是有效病变形成的必要条件。在相同的 PFA 剂量下,病变深度随 CF 的增加而显著增加。
{"title":"Effects of Contact Force on Lesion Size During Pulsed Field Catheter Ablation: Histochemical Characterization of Ventricular Lesion Boundaries.","authors":"Hiroshi Nakagawa, Quim Castellvi, Robert Neal, Steven Girouard, Jacob Laughner, Atsushi Ikeda, Masafumi Sugawara, Yoshimori An, Ayman A Hussein, Shady Nakhla, Tyler Taigen, Jakub Srounbek, Mohamed Kanj, Pasquale Santangeli, Walid I Saliba, Antoni Ivorra, Oussama M Wazni","doi":"10.1161/CIRCEP.123.012026","DOIUrl":"10.1161/CIRCEP.123.012026","url":null,"abstract":"<p><strong>Background: </strong>Effects of contact force (CF) on lesion formation during pulsed field ablation (PFA) have not been well validated. The purpose of this study was to determine the relationship between average CF and lesion size during PFA using a swine-beating heart model.</p><p><strong>Methods: </strong>A 7F catheter with a 3.5-mm ablation electrode and CF sensor (TactiCath SE, Abbott) was connected to a PFA system (CENTAURI, Galvanize Therapeutics). In 5 closed-chest swine, biphasic PFA current was delivered between the ablation electrode and a skin patch at 40 separate sites in right ventricle (28 Amp) and 55 separate sites in left ventricle (35 Amp) with 4 different levels of CF: (1) low (CF range of 4-13 g; median, 9.5 g); (2) moderate (15-30 g; median, 21.5 g); (3) high (34-55 g; median, 40 g); and (4) no electrode contact, 2 mm away from the endocardium. Swine were sacrificed at 2 hours after ablation, and lesion size was measured using triphenyl tetrazolium chloride staining. In 1 additional swine, COX (cytochrome c oxidase) staining was performed to examine mitochondrial activity to delineate reversible and irreversible lesion boundaries. Histological examination was performed with hematoxylin and eosin and Masson trichrome staining.</p><p><strong>Results: </strong>Ablation lesions were well demarcated with triphenyl tetrazolium chloride staining, showing (1) a dark central zone (contraction band necrosis and hemorrhage); (2) a pale zone (no mitochondrial activity and nuclear pyknosis, indicating apoptosis zone); and a hyperstained zone by triphenyl tetrazolium chloride and COX staining (unaffected normal myocardium with preserved mitochondrial activity, consistent with reversible zone). At constant PFA current intensity, lesion depth increased significantly with increasing CF. There were no detectable lesions resulting from ablation without electrode contact.</p><p><strong>Conclusions: </strong>Acute PFA ventricular lesions show irreversible and reversible lesion boundaries by triphenyl tetrazolium chloride staining. Electrode-tissue contact is required for effective lesion formation during PFA. At the same PFA dose, lesion depth increases significantly with increasing CF.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Colchicine to Prevent Atrial Fibrillation Recurrence After Catheter Ablation: A Randomized, Placebo-Controlled Trial. 预防导管消融术后心房颤动复发的秋水仙碱:随机安慰剂对照试验
IF 8.4 1区 医学 Q1 Medicine Pub Date : 2024-01-01 Epub Date: 2023-12-21 DOI: 10.1161/CIRCEP.123.012387
Alexander P Benz, Guy Amit, Stuart J Connolly, Jasrita Singh, Juan G Acosta-Vélez, David Conen, Bishoy Deif, Syamkumar Divakaramenon, William F McIntyre, Viwe Mtwesi, Jason D Roberts, Jorge A Wong, Robin Zhao, Jeff S Healey

Background: Inflammation may promote atrial fibrillation (AF) recurrence after catheter ablation. This study aimed to evaluate a short-term anti-inflammatory treatment with colchicine following ablation of AF.

Methods: Patients scheduled for ablation were randomized to receive colchicine 0.6 mg twice daily or placebo for 10 days. The first dose of the study drug was administered within 4 hours before ablation. Atrial arrhythmia recurrence was defined as AF, atrial flutter, or atrial tachycardia >30 s on two 14-day Holters performed immediately and at 3 months following ablation.

Results: The modified intention-to-treat population included 199 patients (median age, 61 years; 22% female; 70% first procedure) who underwent radiofrequency (79%) or cryoballoon ablation (21%) of AF. Antiarrhythmic drugs were prescribed at discharge in 149 (75%) patients. Colchicine did not prevent atrial arrhythmia recurrence at 2 weeks (31% versus 32%; hazard ratio [HR], 0.98 [95% CI, 0.59-1.61]; P=0.92) or at 3 months following ablation (14% versus 15%; HR, 0.95 [95% CI, 0.45-2.02]; P=0.89). Postablation chest pain consistent with pericarditis was reduced with colchicine (4% versus 15%; HR, 0.26 [95% CI, 0.09-0.77]; P=0.02) and colchicine increased diarrhea (26% versus 7%; HR, 4.74 [95% CI, 1.95-11.53]; P<0.001). During a median follow-up of 1.3 years, colchicine did not reduce a composite of emergency department visit, cardiovascular hospitalization, cardioversion, or repeat ablation (29 versus 25 per 100 patient-years; HR, 1.18 [95% CI, 0.69-1.99]; P=0.55).

Conclusions: Colchicine administered for 10 days following catheter ablation did not reduce atrial arrhythmia recurrence or AF-associated clinical events, but did reduce postablation chest pain and increase diarrhea.

背景:炎症可能会促进导管消融术后房颤(AF)复发。本研究旨在评估房颤消融术后使用秋水仙碱进行短期抗炎治疗的效果:计划接受消融术的患者随机接受秋水仙碱 0.6 毫克,每日两次或安慰剂,为期 10 天。首剂研究药物在消融术前 4 小时内服用。房性心律失常复发的定义是:在消融术后即刻和 3 个月进行的两次 14 天 Holters 测试中,房颤、心房扑动或房性心动过速 >30 秒:修改后的意向治疗人群包括199名房颤患者(中位年龄61岁;22%为女性;70%为首次手术),他们接受了射频消融术(79%)或冷冻球囊消融术(21%)。149名患者(75%)在出院时服用了抗心律失常药物。秋水仙碱不能预防消融术后 2 周(31% 对 32%;危险比 [HR],0.98 [95% CI,0.59-1.61];P=0.92)或 3 个月后的房性心律失常复发(14% 对 15%;HR,0.95 [95% CI,0.45-2.02];P=0.89)。秋水仙碱可减少消融术后心包炎胸痛(4% 对 15%;HR,0.26 [95% CI,0.09-0.77];P=0.02),秋水仙碱可增加腹泻(26% 对 7%;HR,4.74 [95% CI,1.95-11.53];PP=0.55):结论:导管消融术后 10 天内服用秋水仙碱不会减少房性心律失常复发或房颤相关临床事件,但会减轻消融术后胸痛和腹泻。
{"title":"Colchicine to Prevent Atrial Fibrillation Recurrence After Catheter Ablation: A Randomized, Placebo-Controlled Trial.","authors":"Alexander P Benz, Guy Amit, Stuart J Connolly, Jasrita Singh, Juan G Acosta-Vélez, David Conen, Bishoy Deif, Syamkumar Divakaramenon, William F McIntyre, Viwe Mtwesi, Jason D Roberts, Jorge A Wong, Robin Zhao, Jeff S Healey","doi":"10.1161/CIRCEP.123.012387","DOIUrl":"10.1161/CIRCEP.123.012387","url":null,"abstract":"<p><strong>Background: </strong>Inflammation may promote atrial fibrillation (AF) recurrence after catheter ablation. This study aimed to evaluate a short-term anti-inflammatory treatment with colchicine following ablation of AF.</p><p><strong>Methods: </strong>Patients scheduled for ablation were randomized to receive colchicine 0.6 mg twice daily or placebo for 10 days. The first dose of the study drug was administered within 4 hours before ablation. Atrial arrhythmia recurrence was defined as AF, atrial flutter, or atrial tachycardia >30 s on two 14-day Holters performed immediately and at 3 months following ablation.</p><p><strong>Results: </strong>The modified intention-to-treat population included 199 patients (median age, 61 years; 22% female; 70% first procedure) who underwent radiofrequency (79%) or cryoballoon ablation (21%) of AF. Antiarrhythmic drugs were prescribed at discharge in 149 (75%) patients. Colchicine did not prevent atrial arrhythmia recurrence at 2 weeks (31% versus 32%; hazard ratio [HR], 0.98 [95% CI, 0.59-1.61]; <i>P</i>=0.92) or at 3 months following ablation (14% versus 15%; HR, 0.95 [95% CI, 0.45-2.02]; <i>P</i>=0.89). Postablation chest pain consistent with pericarditis was reduced with colchicine (4% versus 15%; HR, 0.26 [95% CI, 0.09-0.77]; <i>P</i>=0.02) and colchicine increased diarrhea (26% versus 7%; HR, 4.74 [95% CI, 1.95-11.53]; <i>P</i><0.001). During a median follow-up of 1.3 years, colchicine did not reduce a composite of emergency department visit, cardiovascular hospitalization, cardioversion, or repeat ablation (29 versus 25 per 100 patient-years; HR, 1.18 [95% CI, 0.69-1.99]; <i>P</i>=0.55).</p><p><strong>Conclusions: </strong>Colchicine administered for 10 days following catheter ablation did not reduce atrial arrhythmia recurrence or AF-associated clinical events, but did reduce postablation chest pain and increase diarrhea.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138828447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Management of Brugada Syndrome: Commentary From the Experts. Brugada 综合征的临床治疗:专家评论。
IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 Epub Date: 2023-12-15 DOI: 10.1161/CIRCEP.123.012072
Michael J Cutler, Lee L Eckhardt, Elizabeth S Kaufman, Elena Arbelo, Elijah R Behr, Pedro Brugada, Marina Cerrone, Lia Crotti, Carlo deAsmundis, Michael H Gollob, Minoru Horie, David T Huang, Andrew D Krahn, Barry London, Steven A Lubitz, Judith A Mackall, Koonlawee Nademanee, Marco V Perez, Vincent Probst, Dan M Roden, Frederic Sacher, Georgia Sarquella-Brugada, Melvin M Scheinman, Wataru Shimizu, Benjamin Shoemaker, Raymond W Sy, Atsuyuki Watanabe, Arthur A M Wilde

Although there is consensus on the management of patients with Brugada Syndrome with high risk for sudden cardiac arrest, asymptomatic or intermediate-risk patients present clinical management challenges. This document explores the management opinions of experts throughout the world for patients with Brugada Syndrome who do not fit guideline recommendations. Four real-world clinical scenarios were presented with commentary from small expert groups for each case. All authors voted on case-specific questions to evaluate the level of consensus among the entire group in nuanced diagnostic and management decisions relevant to each case. Points of agreement, points of controversy, and gaps in knowledge are highlighted.

尽管对心脏骤停高危 Brugada 综合征患者的管理已达成共识,但无症状或中危患者的临床管理仍面临挑战。本文探讨了世界各地专家对不符合指南建议的 Brugada 综合征患者的管理意见。本文介绍了四种真实世界的临床情况,每个病例都附有小型专家组的评论。所有作者就特定病例的问题进行投票,以评估整个小组在与每个病例相关的细微诊断和管理决策方面的共识程度。一致点、争议点和知识差距都得到了强调。
{"title":"Clinical Management of Brugada Syndrome: Commentary From the Experts.","authors":"Michael J Cutler, Lee L Eckhardt, Elizabeth S Kaufman, Elena Arbelo, Elijah R Behr, Pedro Brugada, Marina Cerrone, Lia Crotti, Carlo deAsmundis, Michael H Gollob, Minoru Horie, David T Huang, Andrew D Krahn, Barry London, Steven A Lubitz, Judith A Mackall, Koonlawee Nademanee, Marco V Perez, Vincent Probst, Dan M Roden, Frederic Sacher, Georgia Sarquella-Brugada, Melvin M Scheinman, Wataru Shimizu, Benjamin Shoemaker, Raymond W Sy, Atsuyuki Watanabe, Arthur A M Wilde","doi":"10.1161/CIRCEP.123.012072","DOIUrl":"10.1161/CIRCEP.123.012072","url":null,"abstract":"<p><p>Although there is consensus on the management of patients with Brugada Syndrome with high risk for sudden cardiac arrest, asymptomatic or intermediate-risk patients present clinical management challenges. This document explores the management opinions of experts throughout the world for patients with Brugada Syndrome who do not fit guideline recommendations. Four real-world clinical scenarios were presented with commentary from small expert groups for each case. All authors voted on case-specific questions to evaluate the level of consensus among the entire group in nuanced diagnostic and management decisions relevant to each case. Points of agreement, points of controversy, and gaps in knowledge are highlighted.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10824563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138799626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
MicroRNA-1 Deficiency Is a Primary Etiological Factor Disrupting Cardiac Contractility and Electrophysiological Homeostasis. MicroRNA-1 缺乏是破坏心脏收缩力和电生理平衡的主要病因。
IF 8.4 1区 医学 Q1 Medicine Pub Date : 2024-01-01 Epub Date: 2023-12-21 DOI: 10.1161/CIRCEP.123.012150
Dandan Yang, Xiaoping Wan, Neill Schwieterman, Omer Cavus, Ege Kacira, Xianyao Xu, Kenneth R Laurita, Loren E Wold, Thomas J Hund, Peter J Mohler, Isabelle Deschênes, Ji-Dong Fu

Background: MicroRNA-1 (miR1), encoded by the genes miR1-1 and miR1-2, is the most abundant microRNA in the heart and plays a critical role in heart development and physiology. Dysregulation of miR1 has been associated with various heart diseases, where a significant reduction (>75%) in miR1 expression has been observed in patient hearts with atrial fibrillation or acute myocardial infarction. However, it remains uncertain whether miR1-deficiency acts as a primary etiological factor of cardiac remodeling.

Methods: miR1-1 or miR1-2 knockout mice were crossbred to produce 75%-miR1-knockdown (75%KD; miR1-1+/-:miR1-2-/- or miR1-1-/-:miR1-2+/-) mice. Cardiac pathology of 75%KD cardiomyocytes/hearts was investigated by ECG, patch clamping, optical mapping, transcriptomic, and proteomic assays.

Results: In adult 75%KD hearts, the overall miR1 expression was reduced to ≈25% of the normal wild-type level. These adult 75%KD hearts displayed decreased ejection fraction and fractional shortening, prolonged QRS and QT intervals, and high susceptibility to arrhythmias. Adult 75%KD cardiomyocytes exhibited prolonged action potentials with impaired repolarization and excitation-contraction coupling. Comparatively, 75%KD cardiomyocytes showcased reduced Na+ current and transient outward potassium current, coupled with elevated L-type Ca2+ current, as opposed to wild-type cells. RNA sequencing and proteomics assays indicated negative regulation of cardiac muscle contraction and ion channel activities, along with a positive enrichment of smooth muscle contraction genes in 75%KD cardiomyocytes/hearts. miR1 deficiency led to dysregulation of a wide gene network, with miR1's RNA interference-direct targets influencing many indirectly regulated genes. Furthermore, after 6 weeks of bi-weekly intravenous tail-vein injection of miR1 mimics, the ejection fraction and fractional shortening of 75%KD hearts showed significant improvement but remained susceptible to arrhythmias.

Conclusions: miR1 deficiency acts as a primary etiological factor in inducing cardiac remodeling via disrupting heart regulatory homeostasis. Achieving stable and appropriate microRNA expression levels in the heart is critical for effective microRNA-based therapy in cardiovascular diseases.

背景:由基因 miR1-1 和 miR1-2 编码的微RNA-1(miR1)是心脏中含量最高的微RNA,在心脏发育和生理过程中发挥着关键作用。miR1 的失调与多种心脏疾病有关,在心房颤动或急性心肌梗死患者的心脏中,已观察到 miR1 表达显著减少(>75%)。方法:将 miR1-1 或 miR1-2 基因敲除小鼠杂交,产生 75%-miR1-knockdown (75%KD;miR1-1+/-:miR1-2-/- 或 miR1-1-/-:miR1-2+/-)小鼠。通过心电图、膜片钳、光学图谱、转录组学和蛋白质组学检测研究了75%KD心肌细胞/心脏的心脏病理:结果:在成年 75%KD 心脏中,miR1 的总体表达量减少到正常野生型水平的 25%。这些75%KD成人心脏的射血分数和缩短率下降,QRS和QT间期延长,并极易发生心律失常。成年 75%KD 心肌细胞表现出动作电位延长,复极化和兴奋-收缩耦合受损。与野生型细胞相比,75%KD 心肌细胞的 Na+ 电流和瞬时外向钾电流降低,L 型 Ca2+ 电流升高。RNA 测序和蛋白质组学分析表明,75%KD 心肌细胞/心脏的心肌收缩和离子通道活性受到负调控,平滑肌收缩基因则受到正富集。结论:miR1 缺乏是通过破坏心脏调节平衡诱导心脏重塑的主要病因。在心脏中实现稳定和适当的 microRNA 表达水平对于基于 microRNA 的心血管疾病有效治疗至关重要。
{"title":"MicroRNA-1 Deficiency Is a Primary Etiological Factor Disrupting Cardiac Contractility and Electrophysiological Homeostasis.","authors":"Dandan Yang, Xiaoping Wan, Neill Schwieterman, Omer Cavus, Ege Kacira, Xianyao Xu, Kenneth R Laurita, Loren E Wold, Thomas J Hund, Peter J Mohler, Isabelle Deschênes, Ji-Dong Fu","doi":"10.1161/CIRCEP.123.012150","DOIUrl":"10.1161/CIRCEP.123.012150","url":null,"abstract":"<p><strong>Background: </strong>MicroRNA-1 (miR1), encoded by the genes <i>miR1-1</i> and <i>miR1-2</i>, is the most abundant microRNA in the heart and plays a critical role in heart development and physiology. Dysregulation of miR1 has been associated with various heart diseases, where a significant reduction (>75%) in miR1 expression has been observed in patient hearts with atrial fibrillation or acute myocardial infarction. However, it remains uncertain whether miR1-deficiency acts as a primary etiological factor of cardiac remodeling.</p><p><strong>Methods: </strong><i>miR1-1</i> or <i>miR1-2</i> knockout mice were crossbred to produce 75%-miR1-knockdown (75%KD; <i>miR1-1<sup>+/-</sup>:miR1-2<sup>-/-</sup></i> or <i>miR1-1<sup>-/-</sup>:miR1-2<sup>+/-</sup></i>) mice. Cardiac pathology of 75%KD cardiomyocytes/hearts was investigated by ECG, patch clamping, optical mapping, transcriptomic, and proteomic assays.</p><p><strong>Results: </strong>In adult 75%KD hearts, the overall miR1 expression was reduced to ≈25% of the normal wild-type level. These adult 75%KD hearts displayed decreased ejection fraction and fractional shortening, prolonged QRS and QT intervals, and high susceptibility to arrhythmias. Adult 75%KD cardiomyocytes exhibited prolonged action potentials with impaired repolarization and excitation-contraction coupling. Comparatively, 75%KD cardiomyocytes showcased reduced Na<sup>+</sup> current and transient outward potassium current, coupled with elevated L-type Ca<sup>2+</sup> current, as opposed to wild-type cells. RNA sequencing and proteomics assays indicated negative regulation of cardiac muscle contraction and ion channel activities, along with a positive enrichment of smooth muscle contraction genes in 75%KD cardiomyocytes/hearts. miR1 deficiency led to dysregulation of a wide gene network, with miR1's RNA interference-direct targets influencing many indirectly regulated genes. Furthermore, after 6 weeks of bi-weekly intravenous tail-vein injection of miR1 mimics, the ejection fraction and fractional shortening of 75%KD hearts showed significant improvement but remained susceptible to arrhythmias.</p><p><strong>Conclusions: </strong>miR1 deficiency acts as a primary etiological factor in inducing cardiac remodeling via disrupting heart regulatory homeostasis. Achieving stable and appropriate microRNA expression levels in the heart is critical for effective microRNA-based therapy in cardiovascular diseases.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10842700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138828448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Multicenter, Phase 2, Randomized Controlled Study of the Efficacy and Safety of Etripamil Nasal Spray for the Acute Reduction of Rapid Ventricular Rate in Patients With Symptomatic Atrial Fibrillation (ReVeRA-201). 一项多中心、2期、随机、对照研究:Etripamil鼻喷雾剂对症状性房颤患者急性降低快速室率的有效性和安全性(ReVeRA-201)。
IF 8.4 1区 医学 Q1 Medicine Pub Date : 2023-12-01 Epub Date: 2023-11-11 DOI: 10.1161/CIRCEP.123.012567
A John Camm, Jonathan P Piccini, Marco Alings, Paul Dorian, Gilbert Gosselin, Marie-Claude Guertin, James E Ip, Peter R Kowey, Blandine Mondésert, Fransisco J Prins, Jean-Francois Roux, Bruce S Stambler, Jwm van Eck, Nadea Al Windy, Nathalie Thermil, Silvia Shardonofsky, David B Bharucha, Denis Roy

Background: Despite chronic therapies, atrial fibrillation (AF) leads to rapid ventricular rates (RVR) often requiring intravenous treatments. Etripamil is a fast-acting, calcium-channel blocker administered intranasally affecting the atrioventricular node within minutes.

Methods: Reduction of Ventricular Rate in Patients with Atrial Fibrillation evaluated the efficacy and safety of etripamil for the reduction of ventricular rate (VR) in patients presenting urgently with AF-RVR (VR ≥110 beats per minute [bpm]), was randomized, double-blind, placebo-controlled, and conducted in Canada and the Netherlands. Patients presenting urgently with AF-RVR were randomized (1:1, etripamil nasal spray 70 mg: placebo nasal spray). The primary objective was to demonstrate the effectiveness of etripamil in reducing VR in AF-RVR within 60 minutes of treatment. Secondary objectives assessed achievement of VR <100 bpm, reduction by ≥10% and ≥20%, relief of symptoms and treatment effectiveness; adverse events; and additional measures to 360 minutes.

Results: Sixty-nine patients were randomized, 56 dosed with etripamil (n=27) or placebo (n=29). The median age was 65 years; 39% were female patients; proportions of AF types were similar between groups. The difference of mean maximum reductions in VR over 60 minutes, etripamil versus placebo, adjusting for baseline VR, was -29.91 bpm (95% CI, -40.31 to -19.52; P<0.0001). VR reductions persisted up to 150 minutes. Significantly greater proportions of patients receiving etripamil achieved VR reductions <100 bpm (with longer median duration <100 bpm), or VR reduction by ≥10% or ≥20%, versus placebo. VR reduction ≥20% occurred in 66.7% of patients in the etripamil arm and no patients in placebo. Using the Treatment Satisfaction Questionnaire for Medication-9, there was significant improvement in satisfaction on symptom relief and treatment effectiveness with etripamil versus placebo. Serious adverse events were rare; 1 patient in the etripamil arm experienced transient severe bradycardia and syncope, assessed as due to hypervagotonia.

Conclusions: Intranasal etripamil 70 mg reduced VR and improved symptom relief and treatment satisfaction. These data support further development of self-administered etripamil for the treatment of AF-RVR.

Registration: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT04467905.

背景:尽管慢性治疗,心房颤动(AF)导致心室快速(RVR)往往需要静脉注射治疗。Etripamil是一种快速作用的钙通道阻滞剂,经鼻给药可在几分钟内影响房室结。方法:ReVeRA在加拿大和荷兰进行了一项随机、双盲、安慰剂对照的研究,评估了依tripamil降低急性AF-RVR (VR≥110 bpm)患者心室率(VR)的有效性和安全性。紧急出现AF-RVR的患者随机分组(1:1,依替帕米鼻喷雾剂(NS) 70 mg:安慰剂-NS)。主要目的是证明etripamil在治疗后60分钟内降低AF-RVR患者VR的有效性。结果:69例患者被随机分组,56例患者服用依特里帕米(n=27)或安慰剂(n=29)。年龄中位数为65岁;女性占39%;两组间房颤类型比例相似。依特里帕米与安慰剂在60分钟内VR平均最大降幅的差异,根据基线VR进行调整,为-29.91 bpm(95%可信区间:-40.31,-19.52;p结论:鼻内喷用etripamil 70mg可降低VR,改善症状缓解和治疗满意度。这些数据支持进一步开发自行给药的依特里帕米治疗AF-RVR。临床试验注册:ClinicalTrials.gov;唯一标识符:NCT04467905。
{"title":"Multicenter, Phase 2, Randomized Controlled Study of the Efficacy and Safety of Etripamil Nasal Spray for the Acute Reduction of Rapid Ventricular Rate in Patients With Symptomatic Atrial Fibrillation (ReVeRA-201).","authors":"A John Camm, Jonathan P Piccini, Marco Alings, Paul Dorian, Gilbert Gosselin, Marie-Claude Guertin, James E Ip, Peter R Kowey, Blandine Mondésert, Fransisco J Prins, Jean-Francois Roux, Bruce S Stambler, Jwm van Eck, Nadea Al Windy, Nathalie Thermil, Silvia Shardonofsky, David B Bharucha, Denis Roy","doi":"10.1161/CIRCEP.123.012567","DOIUrl":"10.1161/CIRCEP.123.012567","url":null,"abstract":"<p><strong>Background: </strong>Despite chronic therapies, atrial fibrillation (AF) leads to rapid ventricular rates (RVR) often requiring intravenous treatments. Etripamil is a fast-acting, calcium-channel blocker administered intranasally affecting the atrioventricular node within minutes.</p><p><strong>Methods: </strong>Reduction of Ventricular Rate in Patients with Atrial Fibrillation evaluated the efficacy and safety of etripamil for the reduction of ventricular rate (VR) in patients presenting urgently with AF-RVR (VR ≥110 beats per minute [bpm]), was randomized, double-blind, placebo-controlled, and conducted in Canada and the Netherlands. Patients presenting urgently with AF-RVR were randomized (1:1, etripamil nasal spray 70 mg: placebo nasal spray). The primary objective was to demonstrate the effectiveness of etripamil in reducing VR in AF-RVR within 60 minutes of treatment. Secondary objectives assessed achievement of VR <100 bpm, reduction by ≥10% and ≥20%, relief of symptoms and treatment effectiveness; adverse events; and additional measures to 360 minutes.</p><p><strong>Results: </strong>Sixty-nine patients were randomized, 56 dosed with etripamil (n=27) or placebo (n=29). The median age was 65 years; 39% were female patients; proportions of AF types were similar between groups. The difference of mean maximum reductions in VR over 60 minutes, etripamil versus placebo, adjusting for baseline VR, was -29.91 bpm (95% CI, -40.31 to -19.52; <i>P</i><0.0001). VR reductions persisted up to 150 minutes. Significantly greater proportions of patients receiving etripamil achieved VR reductions <100 bpm (with longer median duration <100 bpm), or VR reduction by ≥10% or ≥20%, versus placebo. VR reduction ≥20% occurred in 66.7% of patients in the etripamil arm and no patients in placebo. Using the Treatment Satisfaction Questionnaire for Medication-9, there was significant improvement in satisfaction on symptom relief and treatment effectiveness with etripamil versus placebo. Serious adverse events were rare; 1 patient in the etripamil arm experienced transient severe bradycardia and syncope, assessed as due to hypervagotonia.</p><p><strong>Conclusions: </strong>Intranasal etripamil 70 mg reduced VR and improved symptom relief and treatment satisfaction. These data support further development of self-administered etripamil for the treatment of AF-RVR.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique Identifier: NCT04467905.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10734780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89717172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Point-by-Point Pulsed Field Ablation Using a Multimodality Generator and a Contact Force-Sensing Ablation Catheter: Comparison With Radiofrequency Ablation in a Remapped Chronic Swine Heart. 使用多模态发生器和接触式力感应消融导管的逐点脉冲场消融:与射频消融在重测慢性猪心脏中的比较。
IF 8.4 1区 医学 Q1 Medicine Pub Date : 2023-12-01 Epub Date: 2023-11-23 DOI: 10.1161/CIRCEP.123.012344
Luigi Di Biase, Jacopo Marazzato, Fengwei Zou, Aung Lin, Vito Grupposo, Nilarun Chowdhuri, Jennifer Maffre, Salman Farshchi-Heydari, Tushar Sharma, Christopher Beeckler, Assaf Govari, Rahul Bhardwaj, Sanghamitra Mohanty, Andrea Natale, Hiroshi Nakagawa, Xiaodong Zhang

Background: Pulsed field ablation (PFA) has emerged as an alternative to radiofrequency ablation. However, data on focal point-by-point PFA are scarce. The aim of this study was to compare lesion durability and collateral damage between focally delivered unipolar/biphasic PFA versus radiofrequency in swine.

Methods: Eighteen swine were randomized to low-dose PFA, high-dose PFA, and radiofrequency using a multimodality generator. Radiofrequency delivered by market-available generator served as control group. A contact force-sensing catheter was used to focally deliver PFA/radiofrequency at the pulmonary veins and other predefined sites in the atria. Animals were remapped postprocedurally and 28 days postablation to test lesion durability followed by gross necroscopy and histology.

Results: All targeted sites were successfully ablated (contact force value, 13.9±4.1 g). Follow-up remapping showed persistent pulmonary vein isolation in all animals (100%) with lesion durability at nonpulmonary vein sites proven in most (98%). Regardless of the energy source used, the lesion size was similar across the study groups. Transmurality was achieved in 95% of targeted sites and 100% at pulmonary veins. On histology, PFA animals showed more mature scar formation than their radiofrequency counterpart without myocardial necrosis or inflammation. Finally, no sign of collateral damage was observed in any of the groups.

Conclusions: In a randomized preclinical study, focally delivered unipolar/biphasic PFA guided by contact force values was associated with durable lesions on chronic remapping and with mature scar formation on histology without signs of collateral injury on necroscopy. Further studies are needed to investigate the long-term feasibility of this new approach to atrial fibrillation treatment.

背景:脉冲场消融(PFA)已成为射频消融的替代方案。然而,关于逐点PFA的数据很少。本研究的目的是比较猪局部单极/双相PFA与射频PFA的损伤持久性和附带损伤。方法:18头猪随机分为低剂量PFA组、高剂量PFA组和多模态发生器射频组。市场上可用的发电机提供的射频作为对照组。使用接触式力感导管在肺静脉和心房其他预定位置局部传递PFA/射频。术后和消融后28天对动物进行重新定位,以测试病变的持久性,然后进行大体坏死镜检查和组织学检查。结果:所有目标部位均成功消融(接触力值,13.9±4.1 g)。随访重测显示所有动物(100%)持续肺静脉分离,大多数动物(98%)证实非肺静脉部位病变持久。无论使用何种能量来源,整个研究组的病变大小都是相似的。95%的靶部位和100%的肺静脉均实现了通透性。在组织学上,PFA动物比射频动物显示更成熟的瘢痕形成,没有心肌坏死或炎症。最后,在任何组中都没有观察到附带损害的迹象。结论:在一项随机临床前研究中,由接触力值引导的局部单极/双相PFA与慢性重定位的持久病变和组织学上的成熟瘢痕形成有关,在坏死镜检查中没有附带损伤的迹象。这种治疗心房颤动的新方法的长期可行性需要进一步的研究。
{"title":"Point-by-Point Pulsed Field Ablation Using a Multimodality Generator and a Contact Force-Sensing Ablation Catheter: Comparison With Radiofrequency Ablation in a Remapped Chronic Swine Heart.","authors":"Luigi Di Biase, Jacopo Marazzato, Fengwei Zou, Aung Lin, Vito Grupposo, Nilarun Chowdhuri, Jennifer Maffre, Salman Farshchi-Heydari, Tushar Sharma, Christopher Beeckler, Assaf Govari, Rahul Bhardwaj, Sanghamitra Mohanty, Andrea Natale, Hiroshi Nakagawa, Xiaodong Zhang","doi":"10.1161/CIRCEP.123.012344","DOIUrl":"10.1161/CIRCEP.123.012344","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) has emerged as an alternative to radiofrequency ablation. However, data on focal point-by-point PFA are scarce. The aim of this study was to compare lesion durability and collateral damage between focally delivered unipolar/biphasic PFA versus radiofrequency in swine.</p><p><strong>Methods: </strong>Eighteen swine were randomized to low-dose PFA, high-dose PFA, and radiofrequency using a multimodality generator. Radiofrequency delivered by market-available generator served as control group. A contact force-sensing catheter was used to focally deliver PFA/radiofrequency at the pulmonary veins and other predefined sites in the atria. Animals were remapped postprocedurally and 28 days postablation to test lesion durability followed by gross necroscopy and histology.</p><p><strong>Results: </strong>All targeted sites were successfully ablated (contact force value, 13.9±4.1 g). Follow-up remapping showed persistent pulmonary vein isolation in all animals (100%) with lesion durability at nonpulmonary vein sites proven in most (98%). Regardless of the energy source used, the lesion size was similar across the study groups. Transmurality was achieved in 95% of targeted sites and 100% at pulmonary veins. On histology, PFA animals showed more mature scar formation than their radiofrequency counterpart without myocardial necrosis or inflammation. Finally, no sign of collateral damage was observed in any of the groups.</p><p><strong>Conclusions: </strong>In a randomized preclinical study, focally delivered unipolar/biphasic PFA guided by contact force values was associated with durable lesions on chronic remapping and with mature scar formation on histology without signs of collateral injury on necroscopy. Further studies are needed to investigate the long-term feasibility of this new approach to atrial fibrillation treatment.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10734778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138294834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Risk Factors for the Development of New-Onset Persistent Atrial Fibrillation: Subanalysis of the VITAL Study. 新发持续性心房颤动发生的危险因素:VITAL研究的亚分析
IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-11-29 DOI: 10.1161/CIRCEP.123.012334
Melissa E Middeldorp, Roopinder K Sandhu, Jessica Mao, Baris Gencer, Jacqueline S Danik, Vinayaga Moorthy, Nancy R Cook, Christine M Albert

Background: Sustained forms of atrial fibrillation (AF) are associated with lower treatment success rates and poorer prognosis compared with paroxysmal AF. Yet, little is known about risk factors that predispose to persistent AF on initial presentation. Our objective was to define risk factors associated with new-onset persistent AF.

Methods: We prospectively examined the differential associations between lifestyle, clinical, and socioeconomic risk factors and AF pattern (persistent versus paroxysmal) at the time of diagnosis among 25 119 participants without a history of cardiovascular disease, AF, or cancer in the VITAL rhythm study (Vitamin D and Omega-3).

Results: During a median follow-up of 5.3 years, 900 participants developed AF and 346 (38.4%) were classified as persistent at the time of diagnosis. In multivariable competing risk models, increasing age, male sex, White race, height, weight, body mass index ≥30 kg/m2, hypertension, current or past smoking, alcohol intake ≥2 drinks/day, postcollege education, and randomized treatment with vitamin D were significantly associated with incident persistent AF. Compared with paroxysmal AF, increasing age, male sex, weight, body mass index ≥30 kg/m2, and postcollege education were more strongly associated with persistent AF in multivariable models regardless of whether interim cardiovascular disease and heart failure events were censored.

Conclusions: In a prospective cohort without baseline AF or cardiovascular disease, over one-third of AF at the time of diagnosis is persistent. Older age, male sex, postcollege education, and obesity were preferentially associated with persistent AF and represent a high-risk AF subset for population-based intervention.

背景:与阵发性房颤相比,持续性房颤(AF)的治疗成功率较低,预后较差。然而,对于初次出现持续性房颤的危险因素知之甚少。我们的目的是确定与新发持续性房颤相关的危险因素。方法:在VITAL节律研究(维生素D和Omega-3)中,我们前瞻性地研究了25119名没有心血管疾病、房颤或癌症史的参与者在诊断时的生活方式、临床和社会经济危险因素与房颤模式(持续性与阵发性)之间的差异。结果:在5.3年的中位随访期间,900名参与者发展为房颤,346名(38.4%)在诊断时被归类为持续性房颤。在多变量竞争风险模型中,年龄、男性、白人、身高、体重、体质指数≥30 kg/m2、高血压、吸烟或既往、酒精摄入量≥2杯/天、大专以上学历、随机服用维生素D与持续性房颤的发生显著相关。与发作性房颤相比,年龄、男性、体重、体质指数≥30 kg/m2、在多变量模型中,无论是否剔除了中期心血管疾病和心力衰竭事件,大学后教育与持续性房颤的相关性更强。结论:在没有基线房颤或心血管疾病的前瞻性队列中,诊断时超过三分之一的房颤是持续性的。年龄较大、男性、大学后教育和肥胖优先与持续性房颤相关,并且在基于人群的干预中代表了房颤的高风险亚群。
{"title":"Risk Factors for the Development of New-Onset Persistent Atrial Fibrillation: Subanalysis of the VITAL Study.","authors":"Melissa E Middeldorp, Roopinder K Sandhu, Jessica Mao, Baris Gencer, Jacqueline S Danik, Vinayaga Moorthy, Nancy R Cook, Christine M Albert","doi":"10.1161/CIRCEP.123.012334","DOIUrl":"10.1161/CIRCEP.123.012334","url":null,"abstract":"<p><strong>Background: </strong>Sustained forms of atrial fibrillation (AF) are associated with lower treatment success rates and poorer prognosis compared with paroxysmal AF. Yet, little is known about risk factors that predispose to persistent AF on initial presentation. Our objective was to define risk factors associated with new-onset persistent AF.</p><p><strong>Methods: </strong>We prospectively examined the differential associations between lifestyle, clinical, and socioeconomic risk factors and AF pattern (persistent versus paroxysmal) at the time of diagnosis among 25 119 participants without a history of cardiovascular disease, AF, or cancer in the VITAL rhythm study (Vitamin D and Omega-3).</p><p><strong>Results: </strong>During a median follow-up of 5.3 years, 900 participants developed AF and 346 (38.4%) were classified as persistent at the time of diagnosis. In multivariable competing risk models, increasing age, male sex, White race, height, weight, body mass index ≥30 kg/m<sup>2</sup>, hypertension, current or past smoking, alcohol intake ≥2 drinks/day, postcollege education, and randomized treatment with vitamin D were significantly associated with incident persistent AF. Compared with paroxysmal AF, increasing age, male sex, weight, body mass index ≥30 kg/m<sup>2</sup>, and postcollege education were more strongly associated with persistent AF in multivariable models regardless of whether interim cardiovascular disease and heart failure events were censored.</p><p><strong>Conclusions: </strong>In a prospective cohort without baseline AF or cardiovascular disease, over one-third of AF at the time of diagnosis is persistent. Older age, male sex, postcollege education, and obesity were preferentially associated with persistent AF and represent a high-risk AF subset for population-based intervention.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10852030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138451063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Genetic Atrial Cardiomyopathies: Common Features, Specific Differences, and Broader Relevance to Understanding Atrial Cardiomyopathy. 遗传性心房心肌病:共同特征,特定差异,以及与理解心房心肌病更广泛的相关性。
IF 8.4 1区 医学 Q1 Medicine Pub Date : 2023-12-01 Epub Date: 2023-11-29 DOI: 10.1161/CIRCEP.123.003750
Edouard Marcoux, Deanna Sosnowski, Sandro Ninni, Martin Mackasey, Julia Cadrin-Tourigny, Jason D Roberts, Morten Salling Olesen, Diane Fatkin, Stanley Nattel

Atrial cardiomyopathy is a condition that causes electrical and contractile dysfunction of the atria, often along with structural and functional changes. Atrial cardiomyopathy most commonly occurs in conjunction with ventricular dysfunction, in which case it is difficult to discern the atrial features that are secondary to ventricular dysfunction from those that arise as a result of primary atrial abnormalities. Isolated atrial cardiomyopathy (atrial-selective cardiomyopathy [ASCM], with minimal or no ventricular function disturbance) is relatively uncommon and has most frequently been reported in association with deleterious rare genetic variants. The genes involved can affect proteins responsible for various biological functions, not necessarily limited to the heart but also involving extracardiac tissues. Atrial enlargement and atrial fibrillation are common complications of ASCM and are often the predominant clinical features. Despite progress in identifying disease-causing rare variants, an overarching understanding and approach to the molecular pathogenesis, phenotypic spectrum, and treatment of genetic ASCM is still lacking. In this review, we aim to analyze the literature relevant to genetic ASCM to understand the key features of this rather rare condition, as well as to identify distinct characteristics of ASCM and its arrhythmic complications that are related to specific genotypes. We outline the insights that have been gained using basic research models of genetic ASCM in vitro and in vivo and correlate these with patient outcomes. Finally, we provide suggestions for the future investigation of patients with genetic ASCM and improvements to basic scientific models and systems. Overall, a better understanding of the genetic underpinnings of ASCM will not only provide a better understanding of this condition but also promises to clarify our appreciation of the more commonly occurring forms of atrial cardiomyopathy associated with ventricular dysfunction.

心房心肌病是一种引起心房电和收缩功能障碍的疾病,通常伴有结构和功能改变。房性心肌病最常与心室功能障碍合并发生,在这种情况下,很难区分继发于心室功能障碍的心房特征和由原发性心房异常引起的心房特征。孤立性心房心肌病(心房选择性心肌病;心房选择性心肌病(心房选择性心肌病,伴有轻微或无心室功能障碍)相对罕见,且常与有害的罕见遗传变异相关。所涉及的基因可以影响负责各种生物功能的蛋白质,不一定局限于心脏,也涉及心外组织。心房扩大和心房颤动是ASCM的常见并发症,往往是主要的临床特征。尽管在识别致病的罕见变异方面取得了进展,但对遗传性ASCM的分子发病机制、表型谱和治疗仍缺乏全面的理解和方法。在这篇综述中,我们旨在分析与遗传性ASCM相关的文献,以了解这种相当罕见的疾病的关键特征,并确定ASCM的独特特征及其与特定基因型相关的心律失常并发症。我们概述了在体外和体内使用遗传ASCM的基础研究模型所获得的见解,并将这些与患者预后相关联。最后,我们对今后遗传性ASCM患者的调查和基础科学模型和系统的完善提出了建议。总的来说,更好地了解ASCM的遗传基础不仅可以更好地了解这种疾病,而且还有望澄清我们对与心室功能障碍相关的更常见的心房心肌病形式的认识。
{"title":"Genetic Atrial Cardiomyopathies: Common Features, Specific Differences, and Broader Relevance to Understanding Atrial Cardiomyopathy.","authors":"Edouard Marcoux, Deanna Sosnowski, Sandro Ninni, Martin Mackasey, Julia Cadrin-Tourigny, Jason D Roberts, Morten Salling Olesen, Diane Fatkin, Stanley Nattel","doi":"10.1161/CIRCEP.123.003750","DOIUrl":"10.1161/CIRCEP.123.003750","url":null,"abstract":"<p><p>Atrial cardiomyopathy is a condition that causes electrical and contractile dysfunction of the atria, often along with structural and functional changes. Atrial cardiomyopathy most commonly occurs in conjunction with ventricular dysfunction, in which case it is difficult to discern the atrial features that are secondary to ventricular dysfunction from those that arise as a result of primary atrial abnormalities. Isolated atrial cardiomyopathy (atrial-selective cardiomyopathy [ASCM], with minimal or no ventricular function disturbance) is relatively uncommon and has most frequently been reported in association with deleterious rare genetic variants. The genes involved can affect proteins responsible for various biological functions, not necessarily limited to the heart but also involving extracardiac tissues. Atrial enlargement and atrial fibrillation are common complications of ASCM and are often the predominant clinical features. Despite progress in identifying disease-causing rare variants, an overarching understanding and approach to the molecular pathogenesis, phenotypic spectrum, and treatment of genetic ASCM is still lacking. In this review, we aim to analyze the literature relevant to genetic ASCM to understand the key features of this rather rare condition, as well as to identify distinct characteristics of ASCM and its arrhythmic complications that are related to specific genotypes. We outline the insights that have been gained using basic research models of genetic ASCM in vitro and in vivo and correlate these with patient outcomes. Finally, we provide suggestions for the future investigation of patients with genetic ASCM and improvements to basic scientific models and systems. Overall, a better understanding of the genetic underpinnings of ASCM will not only provide a better understanding of this condition but also promises to clarify our appreciation of the more commonly occurring forms of atrial cardiomyopathy associated with ventricular dysfunction.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138451062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effects of Intraluminal Content on Esophageal Lesion Formation During Radiofrequency Catheter Ablation: Preliminary Data. 射频导管消融过程中腔内内容物对食管病变形成的影响:初步数据。
IF 8.4 1区 医学 Q1 Medicine Pub Date : 2023-12-01 Epub Date: 2023-11-16 DOI: 10.1161/CIRCEP.123.012404
Fabrizio Assis, Harikrishna Tandri, Rushil Shah, Christopher Batich, Parag Karmarkar, Akhilesh Gonuguntla, Michele Dill, Ekin C Uzunoglu, John N Catanzaro
{"title":"Effects of Intraluminal Content on Esophageal Lesion Formation During Radiofrequency Catheter Ablation: Preliminary Data.","authors":"Fabrizio Assis, Harikrishna Tandri, Rushil Shah, Christopher Batich, Parag Karmarkar, Akhilesh Gonuguntla, Michele Dill, Ekin C Uzunoglu, John N Catanzaro","doi":"10.1161/CIRCEP.123.012404","DOIUrl":"10.1161/CIRCEP.123.012404","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Circulation. Arrhythmia and electrophysiology
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1