Epicardial electrical heterogeneity after amiodarone treatment increases vulnerability to ventricular arrhythmias under therapeutic hypothermia
Amiodarone is commonly used during therapeutic hypothermia (TH) following cardiac arrest due to ventricular arrhythmias. However, electrophysiological changes and proarrhythmic risk after amiodarone treatment have not yet been explored in TH. Epicardial high-density bi-ventricular mapping was perfor...
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Published in | PloS one Vol. 18; no. 4; p. e0282943 |
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Main Authors | , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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20.04.2023
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ISSN | 1932-6203 1932-6203 |
DOI | 10.1371/journal.pone.0282943 |
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Abstract | Amiodarone is commonly used during therapeutic hypothermia (TH) following cardiac arrest due to ventricular arrhythmias. However, electrophysiological changes and proarrhythmic risk after amiodarone treatment have not yet been explored in TH.
Epicardial high-density bi-ventricular mapping was performed in pigs under baseline temperature (BT), TH (32-34°C), and amiodarone treatment during TH. The total activation time (TAT), conduction velocity (CV), local electrogram (LE) duration, and wavefront propagation from pre-specified segments were analyzed during sinus rhythm (SR) or right ventricular (RV) pacing (RVP), along with tissue expression of connexin 43. The vulnerability to ventricular arrhythmias was assessed.
Compared to BT, TH increased the global TAT, decreased the CV, and generated heterogeneous electrical substrate during SR and RVP. During TH, the CV reduction and LE duration prolongation were greater in the anterior mid RV than in the other areas, which changed the wavefront propagation in all animals. Compared to TH alone, amiodarone treatment during TH further increased the TAT and LE duration and decreased the CV. Heterogeneous conduction was partially attenuated after amiodarone treatment. After TH and amiodarone treatment, the connexin 43 expression in the anterior mid RV was lower than that in the other areas, compatible with the heterogeneous CV reduction. The animals under TH and amiodarone treatment had a higher incidence of inducible ventricular arrhythmias than those under BT or TH without amiodarone.
Electrical heterogeneity during amiodarone treatment and TH was associated with vulnerability to ventricular arrhythmias. |
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AbstractList | Background Amiodarone is commonly used during therapeutic hypothermia (TH) following cardiac arrest due to ventricular arrhythmias. However, electrophysiological changes and proarrhythmic risk after amiodarone treatment have not yet been explored in TH. Methods Epicardial high-density bi-ventricular mapping was performed in pigs under baseline temperature (BT), TH (32–34°C), and amiodarone treatment during TH. The total activation time (TAT), conduction velocity (CV), local electrogram (LE) duration, and wavefront propagation from pre-specified segments were analyzed during sinus rhythm (SR) or right ventricular (RV) pacing (RVP), along with tissue expression of connexin 43. The vulnerability to ventricular arrhythmias was assessed. Results Compared to BT, TH increased the global TAT, decreased the CV, and generated heterogeneous electrical substrate during SR and RVP. During TH, the CV reduction and LE duration prolongation were greater in the anterior mid RV than in the other areas, which changed the wavefront propagation in all animals. Compared to TH alone, amiodarone treatment during TH further increased the TAT and LE duration and decreased the CV. Heterogeneous conduction was partially attenuated after amiodarone treatment. After TH and amiodarone treatment, the connexin 43 expression in the anterior mid RV was lower than that in the other areas, compatible with the heterogeneous CV reduction. The animals under TH and amiodarone treatment had a higher incidence of inducible ventricular arrhythmias than those under BT or TH without amiodarone. Conclusion Electrical heterogeneity during amiodarone treatment and TH was associated with vulnerability to ventricular arrhythmias. Amiodarone is commonly used during therapeutic hypothermia (TH) following cardiac arrest due to ventricular arrhythmias. However, electrophysiological changes and proarrhythmic risk after amiodarone treatment have not yet been explored in TH. Epicardial high-density bi-ventricular mapping was performed in pigs under baseline temperature (BT), TH (32-34°C), and amiodarone treatment during TH. The total activation time (TAT), conduction velocity (CV), local electrogram (LE) duration, and wavefront propagation from pre-specified segments were analyzed during sinus rhythm (SR) or right ventricular (RV) pacing (RVP), along with tissue expression of connexin 43. The vulnerability to ventricular arrhythmias was assessed. Compared to BT, TH increased the global TAT, decreased the CV, and generated heterogeneous electrical substrate during SR and RVP. During TH, the CV reduction and LE duration prolongation were greater in the anterior mid RV than in the other areas, which changed the wavefront propagation in all animals. Compared to TH alone, amiodarone treatment during TH further increased the TAT and LE duration and decreased the CV. Heterogeneous conduction was partially attenuated after amiodarone treatment. After TH and amiodarone treatment, the connexin 43 expression in the anterior mid RV was lower than that in the other areas, compatible with the heterogeneous CV reduction. The animals under TH and amiodarone treatment had a higher incidence of inducible ventricular arrhythmias than those under BT or TH without amiodarone. Electrical heterogeneity during amiodarone treatment and TH was associated with vulnerability to ventricular arrhythmias. Background Amiodarone is commonly used during therapeutic hypothermia (TH) following cardiac arrest due to ventricular arrhythmias. However, electrophysiological changes and proarrhythmic risk after amiodarone treatment have not yet been explored in TH. Methods Epicardial high-density bi-ventricular mapping was performed in pigs under baseline temperature (BT), TH (32–34°C), and amiodarone treatment during TH. The total activation time (TAT), conduction velocity (CV), local electrogram (LE) duration, and wavefront propagation from pre-specified segments were analyzed during sinus rhythm (SR) or right ventricular (RV) pacing (RVP), along with tissue expression of connexin 43. The vulnerability to ventricular arrhythmias was assessed. Results Compared to BT, TH increased the global TAT, decreased the CV, and generated heterogeneous electrical substrate during SR and RVP. During TH, the CV reduction and LE duration prolongation were greater in the anterior mid RV than in the other areas, which changed the wavefront propagation in all animals. Compared to TH alone, amiodarone treatment during TH further increased the TAT and LE duration and decreased the CV. Heterogeneous conduction was partially attenuated after amiodarone treatment. After TH and amiodarone treatment, the connexin 43 expression in the anterior mid RV was lower than that in the other areas, compatible with the heterogeneous CV reduction. The animals under TH and amiodarone treatment had a higher incidence of inducible ventricular arrhythmias than those under BT or TH without amiodarone. Conclusion Electrical heterogeneity during amiodarone treatment and TH was associated with vulnerability to ventricular arrhythmias. Amiodarone is commonly used during therapeutic hypothermia (TH) following cardiac arrest due to ventricular arrhythmias. However, electrophysiological changes and proarrhythmic risk after amiodarone treatment have not yet been explored in TH.BACKGROUNDAmiodarone is commonly used during therapeutic hypothermia (TH) following cardiac arrest due to ventricular arrhythmias. However, electrophysiological changes and proarrhythmic risk after amiodarone treatment have not yet been explored in TH.Epicardial high-density bi-ventricular mapping was performed in pigs under baseline temperature (BT), TH (32-34°C), and amiodarone treatment during TH. The total activation time (TAT), conduction velocity (CV), local electrogram (LE) duration, and wavefront propagation from pre-specified segments were analyzed during sinus rhythm (SR) or right ventricular (RV) pacing (RVP), along with tissue expression of connexin 43. The vulnerability to ventricular arrhythmias was assessed.METHODSEpicardial high-density bi-ventricular mapping was performed in pigs under baseline temperature (BT), TH (32-34°C), and amiodarone treatment during TH. The total activation time (TAT), conduction velocity (CV), local electrogram (LE) duration, and wavefront propagation from pre-specified segments were analyzed during sinus rhythm (SR) or right ventricular (RV) pacing (RVP), along with tissue expression of connexin 43. The vulnerability to ventricular arrhythmias was assessed.Compared to BT, TH increased the global TAT, decreased the CV, and generated heterogeneous electrical substrate during SR and RVP. During TH, the CV reduction and LE duration prolongation were greater in the anterior mid RV than in the other areas, which changed the wavefront propagation in all animals. Compared to TH alone, amiodarone treatment during TH further increased the TAT and LE duration and decreased the CV. Heterogeneous conduction was partially attenuated after amiodarone treatment. After TH and amiodarone treatment, the connexin 43 expression in the anterior mid RV was lower than that in the other areas, compatible with the heterogeneous CV reduction. The animals under TH and amiodarone treatment had a higher incidence of inducible ventricular arrhythmias than those under BT or TH without amiodarone.RESULTSCompared to BT, TH increased the global TAT, decreased the CV, and generated heterogeneous electrical substrate during SR and RVP. During TH, the CV reduction and LE duration prolongation were greater in the anterior mid RV than in the other areas, which changed the wavefront propagation in all animals. Compared to TH alone, amiodarone treatment during TH further increased the TAT and LE duration and decreased the CV. Heterogeneous conduction was partially attenuated after amiodarone treatment. After TH and amiodarone treatment, the connexin 43 expression in the anterior mid RV was lower than that in the other areas, compatible with the heterogeneous CV reduction. The animals under TH and amiodarone treatment had a higher incidence of inducible ventricular arrhythmias than those under BT or TH without amiodarone.Electrical heterogeneity during amiodarone treatment and TH was associated with vulnerability to ventricular arrhythmias.CONCLUSIONElectrical heterogeneity during amiodarone treatment and TH was associated with vulnerability to ventricular arrhythmias. Amiodarone is commonly used during therapeutic hypothermia (TH) following cardiac arrest due to ventricular arrhythmias. However, electrophysiological changes and proarrhythmic risk after amiodarone treatment have not yet been explored in TH. Epicardial high-density bi-ventricular mapping was performed in pigs under baseline temperature (BT), TH (32-34°C), and amiodarone treatment during TH. The total activation time (TAT), conduction velocity (CV), local electrogram (LE) duration, and wavefront propagation from pre-specified segments were analyzed during sinus rhythm (SR) or right ventricular (RV) pacing (RVP), along with tissue expression of connexin 43. The vulnerability to ventricular arrhythmias was assessed. Compared to BT, TH increased the global TAT, decreased the CV, and generated heterogeneous electrical substrate during SR and RVP. During TH, the CV reduction and LE duration prolongation were greater in the anterior mid RV than in the other areas, which changed the wavefront propagation in all animals. Compared to TH alone, amiodarone treatment during TH further increased the TAT and LE duration and decreased the CV. Heterogeneous conduction was partially attenuated after amiodarone treatment. After TH and amiodarone treatment, the connexin 43 expression in the anterior mid RV was lower than that in the other areas, compatible with the heterogeneous CV reduction. The animals under TH and amiodarone treatment had a higher incidence of inducible ventricular arrhythmias than those under BT or TH without amiodarone. Electrical heterogeneity during amiodarone treatment and TH was associated with vulnerability to ventricular arrhythmias. |
Audience | Academic |
Author | Lo, Li-Wei Chao, Tze-Fan Chen, Yi-Jen Chang, Ting-Yung Tuan, Ta-Chuan Lin, Chin-Yu Liao, Jo-Nan Hu, Yu-Feng Hsieh, Yu-Cheng Lin, Yenn-Jiang Yeh, Hung-I Chung, Fa-Po Chang, Shih-Lin Chen, Shih-Ann |
AuthorAffiliation | 2 Department of Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan 3 Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan 6 Department of Medicine, Mackay Medical College, Taipei, Taiwan 5 Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan 7 Department of Medicine, National Chung Hsing University, Taichung, Taiwan Ohio State University, UNITED STATES 1 Department of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan 4 Department of Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan |
AuthorAffiliation_xml | – name: 6 Department of Medicine, Mackay Medical College, Taipei, Taiwan – name: Ohio State University, UNITED STATES – name: 3 Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan – name: 7 Department of Medicine, National Chung Hsing University, Taichung, Taiwan – name: 5 Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan – name: 1 Department of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan – name: 2 Department of Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan – name: 4 Department of Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan |
Author_xml | – sequence: 1 givenname: Chin-Yu orcidid: 0000-0003-3282-7523 surname: Lin fullname: Lin, Chin-Yu – sequence: 2 givenname: Ting-Yung surname: Chang fullname: Chang, Ting-Yung – sequence: 3 givenname: Yu-Feng orcidid: 0000-0001-5715-2070 surname: Hu fullname: Hu, Yu-Feng – sequence: 4 givenname: Yu-Cheng surname: Hsieh fullname: Hsieh, Yu-Cheng – sequence: 5 givenname: Yi-Jen surname: Chen fullname: Chen, Yi-Jen – sequence: 6 givenname: Hung-I surname: Yeh fullname: Yeh, Hung-I – sequence: 7 givenname: Yenn-Jiang surname: Lin fullname: Lin, Yenn-Jiang – sequence: 8 givenname: Shih-Lin surname: Chang fullname: Chang, Shih-Lin – sequence: 9 givenname: Li-Wei surname: Lo fullname: Lo, Li-Wei – sequence: 10 givenname: Tze-Fan surname: Chao fullname: Chao, Tze-Fan – sequence: 11 givenname: Fa-Po surname: Chung fullname: Chung, Fa-Po – sequence: 12 givenname: Jo-Nan surname: Liao fullname: Liao, Jo-Nan – sequence: 13 givenname: Ta-Chuan surname: Tuan fullname: Tuan, Ta-Chuan – sequence: 14 givenname: Shih-Ann surname: Chen fullname: Chen, Shih-Ann |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37079563$$D View this record in MEDLINE/PubMed |
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Snippet | Amiodarone is commonly used during therapeutic hypothermia (TH) following cardiac arrest due to ventricular arrhythmias. However, electrophysiological changes... Background Amiodarone is commonly used during therapeutic hypothermia (TH) following cardiac arrest due to ventricular arrhythmias. However,... Background Amiodarone is commonly used during therapeutic hypothermia (TH) following cardiac arrest due to ventricular arrhythmias. However,... |
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SubjectTerms | Amiodarone Amiodarone - adverse effects Analysis Animals Arrhythmia Arrhythmias, Cardiac Biology and Life Sciences Cardiac arrest Cardiac arrhythmia Catheters Conduction Connexin 43 Connexin 43 - metabolism Diagnosis Electrocardiography Geometry Health aspects Heart Heart Ventricles Heterogeneity Hogs Hypothermia Hypothermia, Induced - adverse effects Laboratory animals Medicine and Health Sciences Morphology Ostomy Potassium Prolongation Reduction Research and Analysis Methods Risk factors Sinuses Substrates Swine Ventricle Wave fronts Wave propagation |
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Title | Epicardial electrical heterogeneity after amiodarone treatment increases vulnerability to ventricular arrhythmias under therapeutic hypothermia |
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