Temporal patterns of progression and regression of electrical and mechanical remodeling of the atrium

Kinebuchi, Osamu; Mitamura, Hideo; Shiroshita-Takeshita, Akiko; Kurita, Yasuo; Ohashi, Narutaka; Tanimoto, Kojiro; Fukuda, Yukiko; Ieda, Masaki; Sato, Toshiaki; Hara, Motoki; Takatsuki, Seiji; Ogawa, Satoshi

doi:10.1016/j.ijcard.2004.01.016

Cited by 10 publications

(10 citation statements)

References 30 publications

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“…[9][10][11][12][13] Other studies have demonstrated that AF-induced electrical and mechanical dysfunction can be reduced by pretreatment with a Ca blocker, verapamil; [14][15][16][17] however, the long-term effects of verapamil on both electrical and mechanical remodeling remain controversial. We recently reported that atrial electrical remodeling is, to at least some degree, positively correlated with mechanical remodeling in a canine rapid atrial pacing model 18 and the purpose of the present study was to demonstrate whether verapamil can prevent both electrical and mechanical atrial remodeling in a canine rapid pacing model.…”

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confidence: 84%

Oral Verapamil Attenuates the Progression of Pacing-Induced Electrical and Mechanical Remodeling of the Atrium

Kinebuchi

Mitamura

Shiroshita-Takeshita

et al. 2004

Circ J

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apid atrial excitation, as seen during atrial fibrillation (AF), modifies the electrophysiological and mechanical functions of the chamber, thereby promoting the perpetuation of arrhythmias and clot formation. Even brief periods of atrial tachycardia can shorten the atrial effective refractory period (ERP), with loss of rate adaptation 1-6 and development of contractile abnormalities. 7,8 Several experimental and clinical studies have suggested that Ca overload plays a major role in the electrical and mechanical remodeling caused by prolonged rapid atrial excitation. [9][10][11][12][13] Other studies have demonstrated that AF-induced electrical and mechanical dysfunction can be reduced by pretreatment with a Ca blocker, verapamil; 14-17 however, the long-term effects of verapamil on both electrical and mechanical remodeling remain controversial. We recently reported that atrial electrical remodeling is, to at least some degree, positively correlated with mechanical remodeling in a canine rapid atrial pacing model 18 and the purpose of the present study was to demonstrate whether verapamil can prevent both electrical and mechanical atrial remodeling in a canine rapid pacing model. Methods Animal PreparationThe study protocol was approved by the institutional scientific review committee. For this study, we used 16 adult mongrel dogs of either sex weighing 9-15 kg (average, 12 kg). The dogs were anesthetized with an intravenous injection of pentobarbital sodium (20 mg/kg iv) and ketamine chloride (15 mg/kg iv), then intubated and placed on mechanical ventilation with a volume-cycled ventilator (Model 607 Ventilator Harvard Apparatus). The heart was exposed via a right fifth intercostal thoracotomy and suspended in a pericardial cradle with continuous surface electrocardiographic (ECG) monitoring. A custom-designed set of electrodes, comprising a pair of electrodes with a distal hook for pacing and 2 pairs of electrodes with an interelectrode distance of 15 mm aligned proximally serving for recording, was sutured to the epicardial surface of the ridge of the right atrial appendage (RAA). Each pair of electrodes was positioned with interpolar distance of 2 mm. After closure of the thorax, the distal ends of these electrode leads were tunneled subcutaneously and exposed at the back, and then connected to a pacemaker (Nihon Kohden, output of 5 V with 0.7 ms pulse duration) in the jacket. The pacemaker was programmed to provide rapid atrial pacing at 400 ppm. This rate was maintained except for a brief period for measurement of electrophysiological and mechanical parameters. Following the surgical procedure, all dogs were administered oral antibiotics during the 5-day recovery period.

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confidence: 84%

Oral Verapamil Attenuates the Progression of Pacing-Induced Electrical and Mechanical Remodeling of the Atrium

Kinebuchi

Mitamura

Shiroshita-Takeshita

et al. 2004

Circ J

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“…Disappearance of structural and functional changes generally lags behind the reversal of electrical remodeling [29,30]. However, although reversal of electrical remodeling can be rapidly achieved [28,29], the chance of AF recurrence may also depend on the underlying structural abnormalities [25].…”

Section: Does Maintenance Of Sr During 3-month Treatment With Amiodarmentioning

confidence: 99%

“…However, although reversal of electrical remodeling can be rapidly achieved [28,29], the chance of AF recurrence may also depend on the underlying structural abnormalities [25]. Abbreviation of the P-wave and prolongation of the atrial refractory period, accompanied with reduced susceptibility to AF are the primary manifestations of reverse electrophysiological remodeling.…”

Section: Does Maintenance Of Sr During 3-month Treatment With Amiodarmentioning

confidence: 99%

Short-term amiodarone therapy after reversion of persistent atrial fibrillation reduces recurrences at 18 months

et al. 2014

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“…208,209 Reversal of electrical remodeling can usually be rapidly achieved, 210,211 but vulnerability to the recurrence of AF depends on the amount of atrial fibrosis and the size of the LA. 204 Normalization of atrial structure and function generally lags behind the reversal of electrical remodeling .…”

Section: Electrical Cardioversionmentioning

confidence: 99%

“…204 Normalization of atrial structure and function generally lags behind the reversal of electrical remodeling . 211 …”

Section: Electrical Cardioversionmentioning

confidence: 99%

Atrial Remodeling And Atrial Fibrillation: Mechanistic Interactions And Clinical Implications

Hassan¹,

Al‐Ghamdi²

2009

J.A.F.I.B

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Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. The prevalence of AF increases dramatically with age and is seen in as high as 9% of individuals by the age of 80 years. In high-risk patients, the thromboembolic stroke risk can be as high as 9% per year and is associated with a 2-fold increase in mortality. Although the pathophysiological mechanism underlying the genesis of AF has been the focus of many studies, it remains only partially understood. Conventional theories focused on the presence of multiple re-entrant circuits originating in the atria that are asynchronous and conducted at various velocities through tissues with various refractory periods. Recently, rapidly firing atrial activity in the muscular sleeves at the pulmonary veins ostia or inside the pulmonary veins have been described as potential mechanism,. AF results from a complex interaction between various initiating triggers and development of abnormal atrial tissue substrate. The development of AF leads to structural and electrical changes in the atria, a process known as remodeling. To have effective surgical or catheter ablation of AF good understanding of the possible mechanism(s) is crucial.Once initiated, AF alters atrial electrical and structural properties that promote its maintenance and recurrence. The role of atrial remodeling (AR) in the development and maintenance of AF has been the subject of many animal and human studies over the past 10-15 years. This review will discuss the mechanisms of AR, the structural, electrophysiologic, and neurohormonal changes associated with AR and it is role in initiating and maintaining AF. We will also discuss briefly the role of inflammation in AR and AF initiation and maintenance, as well as, the possible therapeutic interventions to prevent AR, and hence AF, based on the current understanding of the interaction between AF and AR.

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Temporal patterns of progression and regression of electrical and mechanical remodeling of the atrium

Cited by 10 publications

References 30 publications

Oral Verapamil Attenuates the Progression of Pacing-Induced Electrical and Mechanical Remodeling of the Atrium

Oral Verapamil Attenuates the Progression of Pacing-Induced Electrical and Mechanical Remodeling of the Atrium

Short-term amiodarone therapy after reversion of persistent atrial fibrillation reduces recurrences at 18 months

Atrial Remodeling And Atrial Fibrillation: Mechanistic Interactions And Clinical Implications

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