scholarly journals Biology of the Sinus Node and its Disease

2015 ◽  
Vol 4 (1) ◽  
pp. 28 ◽  
Author(s):  
Moinuddin Choudhury ◽  
Mark R Boyett ◽  
Gwilym M Morris ◽  
◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Endurance Exercise ◽  
Sinoatrial Node ◽  
Sinus Node ◽  
Current Evidence ◽  
Important Process ◽  
Age Related ◽  
Cell Atrophy

The sinoatrial node (SAN) is the normal pacemaker of the heart and SAN dysfunction (SND) is common, but until recently the pathophysiology was incompletely understood. It was usually attributed to idiopathic age-related fibrosis and cell atrophy or ischaemia. It is now evident that changes in the electrophysiology of the SAN, known as electrical remodelling, is an important process that has been demonstrated in SND associated with heart failure, ageing, diabetes, atrial fibrillation and endurance exercise. Furthermore, familial SND has been identified and mutations have been characterised in key pacemaker genes of the SAN. This review summarises the current evidence regarding SAN function and the pathophysiology of SND.

scholarly journals Clinical Applications of Natriuretic Peptides in Heart Failure and Atrial Fibrillation

2019 ◽  
Vol 20 (11) ◽  
pp. 2824 ◽  
Author(s):  
Masako Baba ◽  
Kentaro Yoshida ◽  
Masaki Ieda
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Natriuretic Peptides ◽  
Clinical Applications ◽  
Current Evidence ◽  
Clinical Prognosis ◽  
Diagnosis And Management ◽  
Artery Disease

Natriuretic peptides (NPs) have become important diagnostic and prognostic biomarkers in cardiovascular diseases, particularly in heart failure (HF). Diagnosis and management of coronary artery disease and atrial fibrillation (AF) can also be guided by NP levels. When interpreting NP levels, however, the caveat is that age, sex, body mass index, renal dysfunction, and race affect the clearance of NPs, resulting in different cut-off values in clinical practice. In AF, NP levels have been associated with incident AF in the general population, recurrences after catheter ablation, prediction of clinical prognosis, and the risk of stroke. In this article, we first review and summarize the current evidence and the roles of B-type NP and atrial NP in HF and coronary artery disease and then focus on the increasing utility of NPs in the diagnosis and management of and the research into AF.

scholarly journals Heart Failure Differentially Modulates Natural (Sinoatrial Node) and Ectopic (Pulmonary Veins) Pacemakers: Mechanism and Therapeutic Implication for Atrial Fibrillation

2019 ◽  
Vol 20 (13) ◽  
pp. 3224 ◽  
Author(s):  
Chao-Shun Chan ◽  
Yung-Kuo Lin ◽  
Yao-Chang Chen ◽  
Yen-Yu Lu ◽  
Shih-Ann Chen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Electrical Activity ◽  
Sinoatrial Node ◽  
Sick Sinus Syndrome ◽  
Pulmonary Veins ◽  
Calcium Handling ◽  
Adrenergic Stimulation ◽  
Therapeutic Implications ◽  
Cardiac Filling

Heart failure (HF) frequently coexists with atrial fibrillation (AF) and dysfunction of the sinoatrial node (SAN), the natural pacemaker. HF is associated with chronic adrenergic stimulation, neurohormonal activation, abnormal intracellular calcium handling, elevated cardiac filling pressure and atrial stretch, and fibrosis. Pulmonary veins (PVs), which are the points of onset of ectopic electrical activity, are the most crucial AF triggers. A crosstalk between the SAN and PVs determines PV arrhythmogenesis. HF has different effects on SAN and PV electrophysiological characteristics, which critically modulate the development of AF and sick sinus syndrome. This review provides updates to improve our current understanding of the effects of HF in the electrical activity of the SAN and PVs as well as therapeutic implications for AF.

scholarly journals HEART FAILURE, ARRHYTHMIAS AND DEMENTIA IN THE “OLDEST OLD” OF SOUTH CENTRAL UNITED STATES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S961-S961
Author(s):  
Brandon Duke ◽  
Gohar Azhar ◽  
Amanda Pangle ◽  
Priya Mendiratta ◽  
Jeanne Wei
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Oldest Old ◽  
Medical Sciences ◽  
South Central ◽  
Age Related ◽  
Central United States ◽  
Diagnosis Of Dementia ◽  
Blood Pressures ◽  
The University

Abstract Heart failure and dementia are common age-related conditions. Heart failure and associated comorbidities of hypertension and arrhythmias may impact cognition. Retrospective data of 311 patients averaging 98 (±3.2) years who received treatment at the University of Arkansas for Medical Sciences were analyzed for diagnoses, prescribed medications and health conditions relevant to heart failure, hypertension, arrhythmias and dementia. 74% of the subjects were white, non-Hispanic, 24% were African American, and 2% were of unknown ethnicity. 83% were women and 17% were men. Only 251 (81%) of the reviewed charts had blood pressures recorded, of whom 43% (n=114) had systolic pressures >140mmHg. Furthermore, 50% (n=156) of patients had heart failure, and 29% (n=89) had dementia. Of those with dementia, 35% had an arrhythmia. For those without a diagnosis of dementia or any treatment for dementia, 25% had an arrhythmia. Heart failure and arrhythmias have not been well studied as an etiological factor for dementias. In our cohort, the presence of heart failure diagnoses was not different in those with dementia versus those without dementia. However, more patients with dementia had arrhythmias versus those without dementia, suggesting that arrhythmias may contribute to cognitive decline, even in the oldest old. Approximately 70% of the arrhythmias were atrial fibrillation. We did not have data on the management of these arrhythmias and whether anticoagulants were being used appropriately, especially for atrial fibrillation. Nevertheless this highlights the importance of close management of arrhythmias for maintaining cognitive health in older adults.

scholarly journals Risk of sick sinus syndrome in patients diagnosed with atrial fibrillation: a population-based cohort

2021 ◽  
Author(s):  
Pil-Sung Yang ◽  
Daehoon Kim ◽  
Eunsun Jang ◽  
Hee Tae Yu ◽  
Tae-Hoon Kim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Elderly Population ◽  
Sick Sinus Syndrome ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Population Based ◽  
Av Block ◽  
Increased Risk ◽  
Observation Period

Background: Sinoatrial node dysfunction and atrial fibrillation (AF) frequently coexist and interact with each other, often to initiate and perpetuate each other. Objective: To determine the effect of AF on the incidence and risk of sick sinus syndrome (SSS). Methods: The association of incident AF with the development of incident SSS was assessed from 2004 to 2013 in 302,229 SSS- and pacemaker-free participants aged ≥60 years in the Korea National Health Insurance Service-Senior cohort. Results: During an observation period of 1,854,800 person-years, incident AF was observed in a total of 12,797 participants (0.69%/year). The incidence of SSS was 0.2 and 3.4 per 1000 person-years in the incident AF and the propensity score matched no-AF groups, respectively. After adjustment, the risk of SSS caused by incident AF was significantly increased, with a hazard ratio (HR) of 13.4 (95% confidence interval [CI]: 8.4–21.4). This finding was consistently observed after censoring for heart failure (HR, 16.0; 95% CI: 9.2–28.0) or heart failure/myocardial infarction (HR, 16.6; 95% CI: 9.3-29.7). Incident AF also was associated with an increased risk of pacemaker implantation related with both SSS (HR, 21.8; 95% CI: 8.7–18.4) and atrioventricular (AV) block (HR, 9.5; 95% CI: 4.9–18.4). These results were consistent regardless of sex and comorbidities. Conclusion: Incident AF was associated with more than ten times increased risk of SSS in an elderly population regardless of comorbidities. Risk of pacemaker implantations related with both sinus node dysfunction and AV block were increased in elderly population with incident AF.

Sinus node disease: pathophysiology and natural history

ESC CardioMed ◽  
2018 ◽  
pp. 1945-1949
Author(s):  
Jonathan M. Kalman ◽  
Gwilym M. Morris
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Natural History ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Atrial Arrhythmia ◽  
Current Understanding ◽  
Exercise Limitation ◽  
Node Disease ◽  
Sinus Node Disease

Sinus node disease is the commonest bradyarrhythmia, often presenting as syncope or exercise limitation and is an important reason for pacemaker implantation. It is usually idiopathic and a disease of ageing with a peak incidence in the seventh decade of life, but may develop secondary to other conditions including heart failure and chronic endurance exercise. The detailed pathophysiology of sinus node disease remains unknown, studies have found evidence of widespread atrial electrical remodelling, and contemporary research suggests that cellular electrical and fibrotic changes may be important mediators of this remodelling. There is an important association between sinus node disease and atrial fibrillation, and the two arrhythmias often coexist, but the nature of this interaction remains a source of debate. This chapter will summarize the current understanding of the natural history and pathophysiology of sinus node disease, with a focus on remodelling and including discussion of theories that may explain the development of coexistent atrial arrhythmia in these patients.

Stroke Prevention in Atrial Fibrillation – The Unmet Need and Morbidity Burden

2011 ◽  
Vol 7 (3) ◽  
pp. 187 ◽  
Author(s):  
A John Camm ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Unmet Need ◽  
Left Ventricular ◽  
Risk Category ◽  
Intermediate Risk ◽  
Thromboembolic Complications ◽  
Thromboembolic Stroke ◽  
Age Related

Atrial fibrillation (AF) occurs in epidemic proportion and is now recognised to occur in about 2 % of the general population. Its prevalence is age-related – about 10 % of 80-year-olds have this arrhythmia with hypertension, valvular disease and heart failure being the most frequent underlying conditions. Up to 10 % of cases of AF may be idiopathic, although genetic, autonomic, inflammatory, infective and toxic causes may account for many of these. AF is associated with serious consequences of which death, sudden death, stroke, heart failure, pulmonary disease and hospitalisation are the most serious. Thromboembolic stroke occurs in about 5 % of AF patients each year, which is approximately five-fold the stroke rate in age and gender-matched patients without AF. AF-related thromboembolic stroke accounts for 15–20 % of all strokes. Risk factors for thromboembolic stroke include clinical factors (such as age, female gender, diabetes, heart failure, hypertension, renal failure and arterial disease), elevated levels of biomarkers (such as troponin, B-type natriuretic peptide, C-reactive protein and micro-albuminuria) and echocardiographic features (such as left ventricular systolic dysfunction, increased left atrial size, left atrial ‘smoke’ and thrombus). There are several clinical risk stratification schemes used to identify AF patients at high risk of thromboembolic stroke. The CHADS2 scheme is popular, but tends to group a high proportion of patients in low and intermediate risk categories. The recently introduced CHA2DS2-VASc scheme identifies truly low-risk patients and avoids placing more than a small proportion in a low or intermediate risk category where there is a guideline mandated choice between anticoagulant, antiplatelet or no therapy. This scheme, which is well validated, has been recommended by the European Society of Cardiology in anticipation of the introduction of new and safer oral anticoagulants. Although warfarin is an effective therapy for the prevention of thromboembolic complications of AF it is inadequately used because of fear of haemorrhagic complications and the difficulties associated with monitoring and maintenance of the correct level of anticoagulation. At present, as few as 20 % of patients who should be anticoagulated are effectively treated. New anticoagulant therapies, which are much easier to use, coupled with more attention to the indications for anticoagulation, should result in more effective anticoagulation and a major reduction in the thromboembolic complications associated with AF.

scholarly journals Atrial fibrillation in acute heart failure: A position statement from the Acute Cardiovascular Care Association and European Heart Rhythm Association of the European Society of Cardiology

2020 ◽  
Vol 9 (4) ◽  
pp. 348-357 ◽  
Author(s):  
Bulent Gorenek (Chair) ◽  
Sigrun Halvorsen ◽  
Gulmira Kudaiberdieva ◽  
Hector Bueno ◽  
Isabelle C Van Gelder ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Heart Failure ◽  
Heart Rhythm ◽  
Underlying Disease ◽  
Position Statement ◽  
Current Evidence ◽  
Team Approach ◽  
European Society Of Cardiology ◽  
Cardiovascular Care

Atrial fibrillation and acute heart failure frequently co-exist and can exacerbate each other. Their combination leads to increased morbidity and mortality. However, the prevalence and significance, as well as the treatment, of atrial fibrillation in acute heart failure are not well studied. Management of atrial fibrillation in acute heart failure requires a multidisciplinary team approach. Treatment of underlying disease(s), identification and treatment of potentially correctable causes and precipitating factors and anticoagulation are crucial. In this article, current evidence on atrial fibrillation in the setting of acute heart failure is summarised. The recommendations on management of atrial fibrillation in the prehospital stage, the treatment of reversible causes, when and how to use rate or rhythm control, maintenance of sinus rhythm, catheter ablation and pacing, anticoagulation, as well as measures on prevention of atrial fibrillation are provided.

Clinical outcomes with ventricular pacing or dual-chamber pacing for sinus-node dysfunction: a nationwide matched control study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
L Fauchier ◽  
A Bodin ◽  
A Bisson ◽  
J Herbert ◽  
V Ah-Fat ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Sinus Node ◽  
Cardiovascular Death ◽  
Sinus Node Dysfunction ◽  
Dual Chamber ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Funding Acknowledgements Type of funding sources: None. Introduction.Evidence from randomized trials suggests that, in patients with sinus-node dysfunction (SND), physiologic pacing (dual-chamber, DDD) may be superior to single-chamber (ventricular, VVI) pacing because it is associated with lower risks of atrial fibrillation and stroke, better exercise capacity and lower risk of pacemaker syndrome. However, benefits on mortality and risk of heart failure have not been demonstrated and these issues have not been fully evaluated in large "real life" analyses. Objective.The aim of our study was to assess and compare clinical outcomes within the first 30 days and during a longer-term follow-up with the two types of pacing at a nationwide level for patients with SND. Methods and results.Using the administrative hospital database in France 2010-2020, 52,974 patients with SND were included in the analysis: 4,069 patients had VVI pacing and 48,905 had DDD pacing. Patients with leadless VVI pacemakers were excluded of the analysis. After propensity score matching 2,213 patients with VVI pacemaker were matched 1:1 with 2,213 patients treated with DDD pacemaker. In the matched analysis, patients with DDD pacemakers had a lower rate of all-cause (hazard ratio HR 0.711, 95%CI 0.61-0.828) and cardiovascular death (HR 0.628, 95%CI 0.48-0.818) within the 30 days after implantation. There were no significant differences for incidence of tamponade (HR 0.666, 95%CI 0.11-3.992), pneumothorax (HR 1.000, 95%CI 0.32-3.105), hemothorax (HR 0.800, 95%CI 0.21-2.982), major bleeding (HR 0.824, 95%CI 0.68-1.005) and transfusion (HR 1.016, 95%CI 0.83-1.243). During subsequent follow-up (mean: 3.0 ± 2.8 years), risk of all-cause death in the matched population was significantly lower in the DDD group than in the VVI pacemaker group (HR 0.683, 95%CI 0.60-0.784). Patients with SND treated DDD pacemakers also had a lower risk of cardiovascular death (HR 0.569, 95%CI 0.44-0.732), new-onset atrial fibrillation (HR 0.638, 95%CI 0.58-0.706), ischemic stroke (HR 0.685, 95%CI 0.53-0.887) and hospitalization for heart failure (HR 0.758, 95%CI 0.68-0.850) than those treated VVI pacemakers, whilst risk of endocarditis was not significantly different (HR 0.986, 95%CI 0.50-1.951).  Conclusion.Patients with SND treated with DDD pacemakers had better clinical outcomes compared to those treated with VVI pacemakers. DDD pacing was associated with lower risks of death, cardiovascular death, new-onset atrial fibrillation, ischemic stroke, hospitalization for heart failure. DDD pacing was neither associated with a higher risk of complication on the short-term nor of endocarditis on the longer-term.

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