Atrial fibrillation(AF) is a common arrhythmia with rising incidence.Obstructive sleep apnea(OSA) is prevalent among patients with AF.This observation has prompted significant research in understanding the relationshi...Atrial fibrillation(AF) is a common arrhythmia with rising incidence.Obstructive sleep apnea(OSA) is prevalent among patients with AF.This observation has prompted significant research in understanding the relationship between OSA and AF.Multiple studies support a role of OSA in the initiation and progression of AF.This association has been independent of obesity,body mass index and hypertension.Instability of autonomic tone and wide swings in intrathoracic pressure are seen in OSA.These have been mechanistically linked to initiation of AF in OSA patients by lowering atrial effective refractory period,promoting pulmonary vein discharges and atrial dilation.OSA not only promotes initiation of AF but also makes management of AF difficult.Drug therapy and electrical cardioversion for AF are less successful in presence of OSA.There has been higher rate of early and overall recurrence after catheter ablation of AF in patients with OSA.Treatment of OSA with continuous positive airway pressure has been shown to improve control of AF.However,additional studies are needed to establish a stronger relationship between OSA treatment and success ofAF therapies.There should be heightened suspicion of OSA in patients with AF.There is a need for guidelines to screen for OSA as a part of AF management.展开更多
Atrial fibrillation (AF) is the most common arrhythmia in the world, and its management relies on restoring sinus rhythm through external electrical shock and controlling the heart rate. This procedure should be perfo...Atrial fibrillation (AF) is the most common arrhythmia in the world, and its management relies on restoring sinus rhythm through external electrical shock and controlling the heart rate. This procedure should be performed under sedation with strict monitoring of blood pressure and saturation after the elimination of thrombus in the left atrium. Objective: The aim of this article is to provide an overview of the impact of anticoagulation and imaging in the periprocedural period, the modalities, and the complications associated with electrical cardioversion (ECV). Research Method: A review of recent literature was conducted using medical databases such as PubMed and Scopus. Searches were performed on articles published between 2003 and 2024, focusing on the new ESC guidelines for 2024. The keywords used included “electrical cardioversion”, “atrial fibrillation”, “orthogonal cardioversion” and “anticoagulation”. Inclusion criteria encompassed clinical trials, meta-analyses, and literature reviews, while studies addressing other treatment forms for AF or lacking information on ECV were excluded. Relevant data were extracted and synthesized to provide an overview of the modalities and complications related to ECV in the context of AF. Results and Conclusion: The use of high-energy biphasic shocks significantly improves rhythm control success and also reduces the incidence of ventricular fibrillation. Furthermore, orthogonal electrical cardioversion (OECV) has proven effective for cases of AF refractory to standard protocols, allowing for a lower defibrillation threshold and promoting better current distribution. However, complications must be considered, particularly thromboembolic events in non-anticoagulated patients. Other complications, such as bradycardia and recurrence of AF, may arise post-procedure. It is therefore crucial to ensure adequate anticoagulation before and after ECV, as well as continuous monitoring, to minimize these risks and optimize clinical outcomes.展开更多
Electrical storm(ES) is a medical emergency characterized by repetitive episodes of sustained ventriculararrhythmias(VAs) in a limited amount of time(at least 3 within a 24-h period) leading to repeated appropriate im...Electrical storm(ES) is a medical emergency characterized by repetitive episodes of sustained ventriculararrhythmias(VAs) in a limited amount of time(at least 3 within a 24-h period) leading to repeated appropriate implantable cardioverter defibrillator therapies. The occurrence of ES represents a major turning point in the natural history of patients with structural heart disease being associated with poor short-and longterm survival particularly in those with compromised left ventricular ejection fraction(LVEF) that can develop hemodynamic decompensation and multi-organ failure. Management of ES is challenging with limited available evidence coming from small retrospective series and a substantial lack of randomized-controlled trials. In general, a multidisciplinary approach including medical therapies such as anti-arrhythmic drugs, sedation, as well as interventional approaches like catheter ablation, may be required. Accurate patient risk stratification at admission for ES is pivotal and should take into account hemodynamic tolerability of VAs as well as comorbidities like low LVEF, advanced NYHA class and chronic pulmonary disease. In high risk patients, prophylactic mechanical circulatory support with left ventricular assistance devices or extracorporeal membrane oxygenation should be considered as bridge to ablation and recovery. In the present manuscript we review the available strategies for management of ES and the evidence supporting them.展开更多
With the acceleration of population aging,heart disease has been a high priority,and cardiac ion channel research has been one of the hot spots in the field,Sodium ion channels,as the most important class,have been wi...With the acceleration of population aging,heart disease has been a high priority,and cardiac ion channel research has been one of the hot spots in the field,Sodium ion channels,as the most important class,have been widely concerned.Therefore,this paper briefly introduces and discusses three aspects of the structure and function of sodium ion channels and the development of drug research.展开更多
Background The rapidly activating delayed rectifier potassium current （/Kr）, whose pore-forming alpha subunit is encoded by the human ether-a-go-go-related gene （hERG）, is a key contributor to the third phase of a...Background The rapidly activating delayed rectifier potassium current （/Kr）, whose pore-forming alpha subunit is encoded by the human ether-a-go-go-related gene （hERG）, is a key contributor to the third phase of action potential repolarization. The aim of this study was to investigate the effect and mechanism of arecoline hydrobromide induced inhibition of hERG K^＋ current （/hERG）. Methods Transient transfection of hERG channel cDNA plasmid pcDNA3.1 into the cultured HEK293 cells was performed using Lipofectamine. A standard whole-cell patch-clamp technique was used to record the /hI=RG before and after the exposure to arecoline. Results Arecoline decreased the amplitude and the density of the /bERG in a concentration-dependent manner （IC5o=9.55 μmol/L）. At test potential of ＋60 mV, the magnitude of lhERG tail at test pulse of -40 mV was reduced from （151.7±6.2） pA/pF to （84.4±7.6） pA/pF （P 〈0.01, n=20） and the magnitude of IhERG tail at test pulse of -110 mV was reduced from （-187.5±9.8） pA/pF to （-97.6±12.6） pA/pF （P 〈0.01, n=20）. The blockade of arecoline in the open and inactivated state was significant in a state-dependent manner. The maximal blockade was achieved in the inactivated state. Studies of gating mechanism showed that the steady-state activation curve of IhERG was significantly negatively shifted by arecoline. Time constants of activation were shortened. Steady-state inactivation curve and time constants of fast inactivation were not significantly affected by arecoline. Furthermore, the inhibition of IhERG by arecoline was characterized markedly by a frequency-dependent manner from 0.03 to 1.00 Hz pulse. Conclusion Arecoline could potently block IhERG in both frequency and state-dependent manner.展开更多
目的:建立用于测定治疗慢性心律失常药物HHY-002的大鼠血浆测定法。方法:流动相为乙腈-0.1%甲酸(65∶35),流速0.200mL/min,色谱柱Phenomenex Luna C18柱(150mm×2.00mm,5μm,5micron),进样量为10μL,柱温35℃,以地西泮为内标。结果:...目的:建立用于测定治疗慢性心律失常药物HHY-002的大鼠血浆测定法。方法:流动相为乙腈-0.1%甲酸(65∶35),流速0.200mL/min,色谱柱Phenomenex Luna C18柱(150mm×2.00mm,5μm,5micron),进样量为10μL,柱温35℃,以地西泮为内标。结果:HHY-002在1.98～1013.50ng/mL的范围内呈良好的线性关系(r=0.998),最低定量限达1.98ng/mL,绝对回收率高于80%,日内和日间误差小于10%,方法回收率大于(81.4±4.5)%,符合生物样品分析要求。结论:建立的LC-MS/MS方法专属性强,灵敏度高,可用于HHY-002的体内定量分析。展开更多
文摘Atrial fibrillation(AF) is a common arrhythmia with rising incidence.Obstructive sleep apnea(OSA) is prevalent among patients with AF.This observation has prompted significant research in understanding the relationship between OSA and AF.Multiple studies support a role of OSA in the initiation and progression of AF.This association has been independent of obesity,body mass index and hypertension.Instability of autonomic tone and wide swings in intrathoracic pressure are seen in OSA.These have been mechanistically linked to initiation of AF in OSA patients by lowering atrial effective refractory period,promoting pulmonary vein discharges and atrial dilation.OSA not only promotes initiation of AF but also makes management of AF difficult.Drug therapy and electrical cardioversion for AF are less successful in presence of OSA.There has been higher rate of early and overall recurrence after catheter ablation of AF in patients with OSA.Treatment of OSA with continuous positive airway pressure has been shown to improve control of AF.However,additional studies are needed to establish a stronger relationship between OSA treatment and success ofAF therapies.There should be heightened suspicion of OSA in patients with AF.There is a need for guidelines to screen for OSA as a part of AF management.
文摘Atrial fibrillation (AF) is the most common arrhythmia in the world, and its management relies on restoring sinus rhythm through external electrical shock and controlling the heart rate. This procedure should be performed under sedation with strict monitoring of blood pressure and saturation after the elimination of thrombus in the left atrium. Objective: The aim of this article is to provide an overview of the impact of anticoagulation and imaging in the periprocedural period, the modalities, and the complications associated with electrical cardioversion (ECV). Research Method: A review of recent literature was conducted using medical databases such as PubMed and Scopus. Searches were performed on articles published between 2003 and 2024, focusing on the new ESC guidelines for 2024. The keywords used included “electrical cardioversion”, “atrial fibrillation”, “orthogonal cardioversion” and “anticoagulation”. Inclusion criteria encompassed clinical trials, meta-analyses, and literature reviews, while studies addressing other treatment forms for AF or lacking information on ECV were excluded. Relevant data were extracted and synthesized to provide an overview of the modalities and complications related to ECV in the context of AF. Results and Conclusion: The use of high-energy biphasic shocks significantly improves rhythm control success and also reduces the incidence of ventricular fibrillation. Furthermore, orthogonal electrical cardioversion (OECV) has proven effective for cases of AF refractory to standard protocols, allowing for a lower defibrillation threshold and promoting better current distribution. However, complications must be considered, particularly thromboembolic events in non-anticoagulated patients. Other complications, such as bradycardia and recurrence of AF, may arise post-procedure. It is therefore crucial to ensure adequate anticoagulation before and after ECV, as well as continuous monitoring, to minimize these risks and optimize clinical outcomes.
文摘Electrical storm(ES) is a medical emergency characterized by repetitive episodes of sustained ventriculararrhythmias(VAs) in a limited amount of time(at least 3 within a 24-h period) leading to repeated appropriate implantable cardioverter defibrillator therapies. The occurrence of ES represents a major turning point in the natural history of patients with structural heart disease being associated with poor short-and longterm survival particularly in those with compromised left ventricular ejection fraction(LVEF) that can develop hemodynamic decompensation and multi-organ failure. Management of ES is challenging with limited available evidence coming from small retrospective series and a substantial lack of randomized-controlled trials. In general, a multidisciplinary approach including medical therapies such as anti-arrhythmic drugs, sedation, as well as interventional approaches like catheter ablation, may be required. Accurate patient risk stratification at admission for ES is pivotal and should take into account hemodynamic tolerability of VAs as well as comorbidities like low LVEF, advanced NYHA class and chronic pulmonary disease. In high risk patients, prophylactic mechanical circulatory support with left ventricular assistance devices or extracorporeal membrane oxygenation should be considered as bridge to ablation and recovery. In the present manuscript we review the available strategies for management of ES and the evidence supporting them.
文摘With the acceleration of population aging,heart disease has been a high priority,and cardiac ion channel research has been one of the hot spots in the field,Sodium ion channels,as the most important class,have been widely concerned.Therefore,this paper briefly introduces and discusses three aspects of the structure and function of sodium ion channels and the development of drug research.
基金This study was supported by the grants from the National Natural Science Foundation of China （No. 81170177 and No. 30770901 ）.Acknowledgment： We would like to thank Prof. Priori, University of Pavia in Italy for generously providing the hERG plasmid.
文摘Background The rapidly activating delayed rectifier potassium current （/Kr）, whose pore-forming alpha subunit is encoded by the human ether-a-go-go-related gene （hERG）, is a key contributor to the third phase of action potential repolarization. The aim of this study was to investigate the effect and mechanism of arecoline hydrobromide induced inhibition of hERG K^＋ current （/hERG）. Methods Transient transfection of hERG channel cDNA plasmid pcDNA3.1 into the cultured HEK293 cells was performed using Lipofectamine. A standard whole-cell patch-clamp technique was used to record the /hI=RG before and after the exposure to arecoline. Results Arecoline decreased the amplitude and the density of the /bERG in a concentration-dependent manner （IC5o=9.55 μmol/L）. At test potential of ＋60 mV, the magnitude of lhERG tail at test pulse of -40 mV was reduced from （151.7±6.2） pA/pF to （84.4±7.6） pA/pF （P 〈0.01, n=20） and the magnitude of IhERG tail at test pulse of -110 mV was reduced from （-187.5±9.8） pA/pF to （-97.6±12.6） pA/pF （P 〈0.01, n=20）. The blockade of arecoline in the open and inactivated state was significant in a state-dependent manner. The maximal blockade was achieved in the inactivated state. Studies of gating mechanism showed that the steady-state activation curve of IhERG was significantly negatively shifted by arecoline. Time constants of activation were shortened. Steady-state inactivation curve and time constants of fast inactivation were not significantly affected by arecoline. Furthermore, the inhibition of IhERG by arecoline was characterized markedly by a frequency-dependent manner from 0.03 to 1.00 Hz pulse. Conclusion Arecoline could potently block IhERG in both frequency and state-dependent manner.
文摘目的:建立用于测定治疗慢性心律失常药物HHY-002的大鼠血浆测定法。方法:流动相为乙腈-0.1%甲酸(65∶35),流速0.200mL/min,色谱柱Phenomenex Luna C18柱(150mm×2.00mm,5μm,5micron),进样量为10μL,柱温35℃,以地西泮为内标。结果:HHY-002在1.98～1013.50ng/mL的范围内呈良好的线性关系(r=0.998),最低定量限达1.98ng/mL,绝对回收率高于80%,日内和日间误差小于10%,方法回收率大于(81.4±4.5)%,符合生物样品分析要求。结论:建立的LC-MS/MS方法专属性强,灵敏度高,可用于HHY-002的体内定量分析。
