Evidence of Ventricular Arrhythmogenicity and Cardiac Sympathetic Hyperinnervation in Early Cirrhotic Cardiomyopathy

Liu, Shin-Huei; Lo, Li‐Wei; Chou, Yu-Bai; Lin, Wei-Lun; Tsai, Tsung‐Ying; Cheng, Wen‐Han; Lin, Yenn‐Jiang; Chang, Shih‐Lin; Hu, Yu‐Feng; Huang, Hui‐Chun; Chen, Shih‐Ann

doi:10.3389/fphys.2021.719883

Cited by 3 publications

(6 citation statements)

References 26 publications

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“…Further, there was a reduction of the transient outward current I to and of the delayed rectifier potassium current I Kr which can be appreciated on the surface electrocardiogram as QTc prolongation 43 . These findings were confirmed in a cirrhotic rabbit model where a significant prolongation of both atrial and ventricular effective refractory periods was noted together with increased sympathetic innervation upon histological assessment 44 . Hence, this confirms increased electrical vulnerability for inducing arrhythmias.…”

Section: Atrial Fibrillation In Cirrhosismentioning

confidence: 61%

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Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension

Vandenberk

Altieri

Liu

et al. 2022

Aliment Pharmacol Ther

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Summary Background Atrial fibrillation (AF) is the most common arrhythmia and its management in cirrhosis can be challenging due to the altered hepatic metabolism of medications and increased risk of bleeding. Aims To provide a comprehensive overview of the diagnosis, pathophysiology and management of AF in patients with cirrhosis from both a cardiology and a hepatology perspective. Methods An extensive literature search was performed using the terms ‘atrial fibrillation’ and ‘cirrhosis’. Guideline documents and consensus statements were explored. Results The prevalence of AF in patients with cirrhosis ranges between 6.6% and 14.2%, while the incidence of new‐onset AF in the post‐operative period after liver transplant ranged between 6.8% and 10.2%. AF in patients with cirrhosis is associated with adverse outcomes in both pre‐transplant and post‐transplant settings, including an increased risk of stroke when compared to the general population. We review the pathogenesis of AF in general and in cirrhosis. This review also provides guidance on the management of AF, including the use of anticoagulation and rate versus rhythm control. In the absence of strict contraindications, all patients with cirrhosis and AF should be anticoagulated. The use of DOACs is preferred over vitamin K antagonists. In patients with a high bleeding risk, a DOAC with an approved antidote may be preferred. Conclusions Atrial fibrillation is increased in patients with cirrhosis. AF management requires careful consideration of treatment options. Since patients with cirrhosis were excluded from all major randomised clinical trials, dedicated research on the pathophysiology and management of AF in cirrhosis is needed.

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Section: Atrial Fibrillation In Cirrhosismentioning

confidence: 61%

“…43 These findings were confirmed in a cirrhotic rabbit model where a significant prolongation of both atrial and ventricular effective refractory periods was noted together with increased sympathetic innervation upon histological assessment. 44 Hence, this confirms increased electrical vulnerability for inducing arrhythmias.…”

Section: Electrical Remodellingmentioning

confidence: 67%

Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension

Vandenberk

Altieri

Liu

et al. 2022

Aliment Pharmacol Ther

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“…Furthermore, patients undergoing LT can experience an acute release of inflammatory cytokines days after surgery, potentially leading to cardiac dysfunction and arrhythmias due to over-activation of the autonomic nervous system [ 37 – 39 ]. Nevertheless, our patient’s rapid onset of pulmonary congestion and CA, occurring within 6 hours and 21 hours post-LT, respectively, suggests a limited role of surgery-related stress in the development of her ES and aligns more closely with the characteristics of CCM [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 84%

“…It is defined by an impaired cardiac response to stress, a hyperdynamic circulatory state, both diastolic and systolic dysfunctions, and QT prolongation [ 21 , 22 ]. Additionally, other complications of CCM are pulmonary congestion and arrhythmia [ 23 , 24 ]. After transplantation, our patient’s pulmonary function deteriorated, and she experienced ES.…”

Section: Discussionmentioning

confidence: 99%

Life-Threatening Electrical Storm Following Liver Transplantation: A Case Report

Araujo Coelho,

Oliveira da Luz,

Teixeira Basto

et al. 2023

Am J Case Rep

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Patient: Female, 61-year-old Final Diagnosis: Electrical storm Symptoms: Cardiac arrest • ventricular fibrillation Clinical Procedure: — Specialty: Cardiology • Critical Care Medicine • Gastroenterology and Hepatology • Transplantology Objective: Unknown etiology Background: Electrical storm is a rare but potentially life-threatening syndrome characterized by recurrent ventricular arrhythmias. Liver transplant recipients are at increased risk of developing electrical storms due to conditions that prolong QT intervals, such as cirrhotic cardiomyopathy. However, limited information exists on electrical storms in this specific population. This case report presents a patient who experienced 13 cardiac arrests during ventricular fibrillation following liver transplantation. Case Report: A 61-year-old woman with a medical history of diabetes, obesity, and cirrhosis due to non-alcoholic fatty liver disease underwent liver transplantation using a deceased donor’s liver. Following the procedure, she developed a deterioration in her respiratory function, necessitating orotracheal intubation. Approximately 21 hours post-surgery, she experienced cardiac arrest during ventricular fibrillation, which was rapidly reversed with electrical defibrillation. However, the patient entered a state of electrical storm. Management involved antiar-rhythmic medications and temporary transvenous cardiac pacing. She remained stable for 40 hours, but a dislodgment of the device triggered another episode of ventricular fibrillation, leading to her death. Conclusions: This case report highlights the clinical presentation and challenges in managing electrical storms in liver transplant recipients. We hypothesize that cirrhotic cardiomyopathy could be the cause of her recurrent ventricular arrhythmias. Further studies are needed to better understand the underlying mechanisms and risk factors of this life-threatening syndrome in this population, which may enhance risk stratification and enable earlier intervention.

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“…Contrary to our expectation, it was found that during CPB overexpression of Sig-1R in PVN deteriorated heart damage with augmented neuroin ammation and increased sympathetic tone. To con rm this, another heart disease model in which sympathetic nerve changes were involved [19] was used. Our nding highlighted the important role of Sig-1R in PVN in regulating sympathetic out ow and provided a new light on therapeutic strategy for treating heart disease.…”

Section: Discussionmentioning

confidence: 99%

Sigma-1R overexpression in PVN deteriorated heart injury by upregulating sympathetic nerve tone

Chen

et al. 2022

Preprint

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Sympathetic nerve tone chronically maintains at high level is harmful to heart. However, little is known how to control sympathetic nerve tone. It has been reported that sigma-1 receptors played a multi-functional role in central nervous system diseases, but little is known about the function for adjusting sympathetic tone of sigma-1 receptors within paraventricular nucleus (PVN). We examined the effects of sigma-1 receptor within PVN on heart by two models: cardiopulmonary bypass model (CPB) and cirrhotic cardiomyopathy (CCM) induced by bile duct ligation. It was found that sigma-1R overexpression in PVN aggravated brain inflammation and increased sympathetic output with more serious heart change. Right stellate ganglion block alleviated the cardiac damage caused by Sigma-1R overexpression in PVN during CPB. In CCM model, it was found that overexpression of sigma-1 receptor in PVN promoted occurrence of fibrosis and senescence in heart. These findings suggest that sigma-1R overexpression in PVN deteriorate heart injury by upregulating sympathetic nerve tone.

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Evidence of Ventricular Arrhythmogenicity and Cardiac Sympathetic Hyperinnervation in Early Cirrhotic Cardiomyopathy

Cited by 3 publications

References 26 publications

Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension

Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension

Life-Threatening Electrical Storm Following Liver Transplantation: A Case Report

Sigma-1R overexpression in PVN deteriorated heart injury by upregulating sympathetic nerve tone

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