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Journal of Internal Medicine Sep 2023
Topics: Humans; Optogenetics; Arrhythmias, Cardiac
PubMed: 37308326
DOI: 10.1111/joim.13680 -
Pacing and Clinical Electrophysiology :... Nov 2023Mexiletine, a class Ib antiarrhythmic drug, exhibits its major antiarrhythmic effect via inhibition of the fast and late Na currents in myocardial tissues that are... (Review)
Review
Mexiletine, a class Ib antiarrhythmic drug, exhibits its major antiarrhythmic effect via inhibition of the fast and late Na currents in myocardial tissues that are dependent on the opening of Na channels for their excitation. Through a comprehensive examination of mexiletine's therapeutic benefits and potential risks, we aim to provide valuable insights that reinforce its role as a vital therapeutic option for patients with ventricular arrhythmias, long QT syndrome, and other heart rhythm disorders. This review will highlight the current understandings of the antiarrhythmic effects and rationales for recent off-label use and address the mortality and proarrhythmic effects of mexiletine utilizing published basic and clinical studies over the past five decades.
Topics: Humans; Anti-Arrhythmia Agents; Mexiletine; Arrhythmias, Cardiac; Long QT Syndrome; Myocardium
PubMed: 37846818
DOI: 10.1111/pace.14846 -
Herzschrittmachertherapie &... Jun 2024
Topics: Humans; Arrhythmias, Cardiac; Germany; Cardiac Electrophysiology; Societies, Medical; Electrophysiologic Techniques, Cardiac
PubMed: 38847858
DOI: 10.1007/s00399-024-01017-x -
Cardiovascular Research May 2024
Topics: Microtubules; Humans; Arrhythmias, Cardiac; Animals; Action Potentials
PubMed: 38637305
DOI: 10.1093/cvr/cvae072 -
Biomedicine & Pharmacotherapy =... Aug 2023Sinus node dysfunction is a common arrhythmia disorder with a high incidence and significant social and economic burden. Currently, there are no effective drugs for... (Review)
Review
Sinus node dysfunction is a common arrhythmia disorder with a high incidence and significant social and economic burden. Currently, there are no effective drugs for treating chronic sinus node dysfunction. The disease is associated with ion channel disturbances caused by aging, fibrosis, inflammation, oxidative stress, and autonomic dysfunction. Natural active substances and Chinese herbal medicines have been widely used and extensively studied in the medical community for the treatment of arrhythmias. Multiple studies have demonstrated that various active ingredients and Chinese herbal medicines, such as astragaloside IV, quercetin, and ginsenosides, exhibit antioxidant effects, reduce fibrosis, and maintain ion channel stability, providing promising drugs for treating sinus node dysfunction. This article summarizes the research progress on natural active ingredients and Chinese herbal formulas that regulate sick sinoatrial node function, providing valuable references for the treatment of sinus node dysfunction.
Topics: Humans; Sick Sinus Syndrome; Sinoatrial Node; Arrhythmias, Cardiac; Aging; Plant Extracts
PubMed: 37229801
DOI: 10.1016/j.biopha.2023.114777 -
Current Cardiology Reports Jun 2024More than a century since its discovery, the pathogenesis of Chagas heart disease (CHD) remains incompletely understood. The role of derangements in the autonomic... (Review)
Review
PURPOSE OF REVIEW
More than a century since its discovery, the pathogenesis of Chagas heart disease (CHD) remains incompletely understood. The role of derangements in the autonomic control of the heart in triggering malignant arrhythmia before the appearance of contractile ventricular impairment was reviewed.
RECENT FINDINGS
Although previous investigations had demonstrated the anatomical and functional consequences of parasympathetic dysautonomia upon the heart rate control, only recently, coronary microvascular disturbances and sympathetic denervation at the ventricular level have been reported in patients and experimental models of CHD, exploring with nuclear medicine methods their impact on the progression of myocardial dysfunction and cardiac arrhythmias. More important than parasympathetic impaired sinus node regulation, recent evidence indicates that myocardial sympathetic denervation associated with coronary microvascular derangements is causally related to myocardial injury and arrhythmia in CHD. Additionally, I-MIBG imaging is a promising tool for risk stratification of progression of ventricular dysfunction and sudden death.
Topics: Humans; Sympathectomy; Chagas Cardiomyopathy; Arrhythmias, Cardiac; Heart; 3-Iodobenzylguanidine; Sympathetic Nervous System
PubMed: 38656586
DOI: 10.1007/s11886-024-02057-y -
Cardiac Electrophysiology Clinics Sep 2023Arrhythmogenic left ventricular cardiomyopathy is characterized by early malignant ventricular arrhythmia associated with varying degrees and times of onset of left... (Review)
Review
Arrhythmogenic left ventricular cardiomyopathy is characterized by early malignant ventricular arrhythmia associated with varying degrees and times of onset of left ventricular dysfunction. Variants in numerous genes have been associated with this phenotype. Here, the authors review the literature on recent cohort studies of patients with variants in desmoplakin, lamin A/C, filamin-C, phospholamban, RBM20, TMEM43, and selected channelopathy genes also associated with structural disease. Unlike traditional sudden cardiac death risk assessment in nonischemic cardiomyopathy, left ventricular systolic function is an insensitive predictor of risk in patients with these genetic diagnoses.
Topics: Humans; Cardiomyopathies; Risk Factors; Death, Sudden, Cardiac; Arrhythmias, Cardiac; Risk Assessment; Arrhythmogenic Right Ventricular Dysplasia
PubMed: 37558308
DOI: 10.1016/j.ccep.2023.04.005 -
JACC. Cardiovascular Interventions Dec 2023
Topics: Humans; Mitral Valve Prolapse; Treatment Outcome; Mitral Valve; Mitral Valve Insufficiency; Arrhythmias, Cardiac
PubMed: 38092493
DOI: 10.1016/j.jcin.2023.11.006 -
Current Heart Failure Reports Aug 2023Despite substantial progress in medical and device-based heart failure (HF) therapy, ventricular arrhythmias (VA) and sudden cardiac death (SCD) remain a major... (Review)
Review
PURPOSE OF REVIEW
Despite substantial progress in medical and device-based heart failure (HF) therapy, ventricular arrhythmias (VA) and sudden cardiac death (SCD) remain a major challenge. Here we review contemporary management of VA in the context of HF with one particular focus on recent advances in imaging and catheter ablation.
RECENT FINDINGS
Besides limited efficacy of antiarrhythmic drugs (AADs), their potentially life-threatening side effects are increasingly acknowledged. On the other hand, with tremendous advances in catheter technology, electroanatomical mapping, imaging, and understanding of arrhythmia mechanisms, catheter ablation has evolved into a safe, efficacious therapy. In fact, recent randomized trials support early catheter ablation, demonstrating superiority over AAD. Importantly, CMR imaging with gadolinium contrast has emerged as a central tool for the management of VA complicating HF: CMR is not only essential for an accurate diagnosis of the underlying entity and subsequent treatment decisions, but also improves risk stratification for SCD prevention and patient selection for ICD therapy. Finally, 3-dimensional characterization of arrhythmogenic substrate by CMR and imaging-guided ablation approaches substantially enhance procedural safety and efficacy. VA management in HF patients is highly complex and should be addressed in a multidisciplinary approach, preferably at specialized centers. While recent evidence supports early catheter ablation of VA, an impact on mortality remains to be demonstrated. Moreover, risk stratification for ICD therapy may have to be reconsidered, taking into account imaging, genetic testing, and other parameters beyond left ventricular function.
Topics: Humans; Heart Failure; Arrhythmias, Cardiac; Death, Sudden, Cardiac; Anti-Arrhythmia Agents; Catheter Ablation; Defibrillators, Implantable
PubMed: 37227669
DOI: 10.1007/s11897-023-00608-y -
Advances in Experimental Medicine and... 2024Inherited forms of cardiac arrhythmias mostly are rare diseases (prevalence <1:2000) and considered to be either "primary electrical heart disorders" due to the absence... (Review)
Review
Inherited forms of cardiac arrhythmias mostly are rare diseases (prevalence <1:2000) and considered to be either "primary electrical heart disorders" due to the absence of structural heart abnormalities or "cardiac ion channel disorders" due to the myocellular structures involved. Precise knowledge of the electrocardiographic features of these diseases and their genetic classification will enable early disease recognition and prevention of cardiac events including sudden cardiac death.The genetic background of these diseases is complex and heterogeneous. In addition to the predominant "private character" of a mutation in each family, locus heterogeneity involving many ion channel genes for the same familial arrhythmia syndrome is typical. Founder pathogenic variants or mutational hot spots are uncommon. Moreover, phenotypes may vary and overlap even within the same family and mutation carriers. For the majority of arrhythmias, the clinical phenotype of an ion channel mutation is restricted to cardiac tissue, and therefore, the disease is nonsyndromic.Recent and innovative methods of parallel DNA analysis (so-called next-generation sequencing, NGS) will enhance further mutation and other variant detection as well as arrhythmia gene identification.
Topics: Humans; Arrhythmias, Cardiac; Mutation; Genetic Predisposition to Disease; Ion Channels; Phenotype; Electrocardiography
PubMed: 38884768
DOI: 10.1007/978-3-031-44087-8_66