atrioventricular conduction
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Author(s):  
Pietro Enea Lazzerini ◽  
Maurizio Acampa ◽  
Michael Cupelli ◽  
Alessandra Gamberucci ◽  
Ujala Srivastava ◽  
...  

Background Recent data suggest that systemic inflammation can negatively affect atrioventricular conduction, regardless of acute cardiac injury. Indeed, gap‐junctions containing connexin43 coupling cardiomyocytes and inflammation‐related cells (macrophages) are increasingly recognized as important factors regulating the conduction in the atrioventricular node. The aim of this study was to evaluate the acute impact of systemic inflammatory activation on atrioventricular conduction, and elucidate underlying mechanisms. Methods and Results We analyzed: (1) the PR‐interval in patients with inflammatory diseases of different origins during active phase and recovery, and its association with inflammatory markers; (2) the existing correlation between connexin43 expression in the cardiac tissue and peripheral blood mononuclear cells (PBMC), and the changes occurring in patients with inflammatory diseases over time; (3) the acute effects of interleukin(IL)‐6 on atrioventricular conduction in an in vivo animal model, and on connexin43 expression in vitro. In patients with elevated C‐reactive protein levels, atrioventricular conduction indices are increased, but promptly normalized in association with inflammatory markers reduction, particularly IL‐6. In these subjects, connexin43 expression in PBMC, which is correlative of that measured in the cardiac tissue, inversely associated with IL‐6 changes. Moreover, direct IL‐6 administration increased atrioventricular conduction indices in vivo in a guinea pig model, and IL‐6 incubation in both cardiomyocytes and macrophages in culture, significantly reduced connexin43 proteins expression. Conclusions The data evidence that systemic inflammation can acutely worsen atrioventricular conduction, and that IL‐6‐induced down‐regulation of cardiac connexin43 is a mechanistic pathway putatively involved in the process. Though reversible, these alterations could significantly increase the risk of severe atrioventricular blocks during active inflammatory processes.


2021 ◽  
Vol 10 (3) ◽  
pp. 181-189
Author(s):  
José-Ángel Cabrera ◽  
Robert H Anderson ◽  
Andreu Porta-Sánchez ◽  
Yolanda Macías ◽  
Óscar Cano ◽  
...  

Extensive knowledge of the anatomy of the atrioventricular conduction axis, and its branches, is key to the success of permanent physiological pacing, either by capturing the His bundle, the left bundle branch or the adjacent septal regions. The inter-individual variability of the axis plays an important role in underscoring the technical difficulties known to exist in achieving a stable position of the stimulating leads. In this review, the key anatomical features of the location of the axis relative to the triangle of Koch, the aortic root, the inferior pyramidal space and the inferoseptal recess are summarised. In keeping with the increasing number of implants aimed at targeting the environs of the left bundle branch, an extensive review of the known variability in the pattern of ramification of the left bundle branch from the axis is included. This permits the authors to summarise in a pragmatic fashion the most relevant aspects to be taken into account when seeking to successfully deploy a permanent pacing lead.


2021 ◽  
Author(s):  
Kanako Ito-Hagiwara ◽  
Yu-ki Iwasaki ◽  
Yuhi Fujimoto ◽  
Eiichiro Oka ◽  
Hiroshi Hayashi ◽  
...  

2021 ◽  
Author(s):  
Yolanda Macías ◽  
Justin T. Tretter ◽  
Damián Sánchez‐Quintana ◽  
José‐Angel Cabrera ◽  
Diane E. Spicer ◽  
...  

2021 ◽  
Vol 10 (19) ◽  
Author(s):  
Constantin‐Cristian Topriceanu ◽  
James C. Moon ◽  
Rebecca Hardy ◽  
Alun D. Hughes ◽  
Gabriella Captur

Background This study explored the association between childhood bradycardia and later‐life cardiac phenotype using longitudinal data from the 1946 National Survey of Health and Development (NSHD) birth cohort. Methods and Results Resting heart rate was recorded at 6 and 7 years of age to provide the bradycardia exposure defined as a childhood resting heart rate <75 bpm. Three outcomes were studied: (1) echocardiographic data at 60 to 64 years of age, consisting of ejection fraction, left ventricular mass index, myocardial contraction fraction index, and E/e′; (2) electrocardiographic evidence of atrioventricular or ventricular conduction defects by 60 to 64 years of age; and (3) all‐cause and cardiovascular mortality. Generalized linear models or Cox regression models were used, and adjustment was made for relevant demographic and health‐related covariates, and for multiple testing. Mixed generalized linear models and fractional polynomials were used as sensitivity analyses. One in 3 older adults with atrioventricular conduction defects had been bradycardic in childhood, with defects being serious (Mobitz type II second‐degree atrioventricular block or higher) in 12%. In fully adjusted models, childhood bradycardia was associated with 2.91 higher odds of atrioventricular conduction defects (95% CI, 1.59–5.31; P =0.0005). Associations persisted in random coefficients mixed generalized linear models (odds ratio, 2.50; 95% CI, 1.01–4.31). Fractional polynomials confirmed a linear association between the log odds of atrioventricular conduction defects at 60 to 64 years of age and resting heart rate at 7 years of age. There was no association between bradycardia in childhood and mortality outcomes or with echocardiographic parameters and ventricular conduction defects in older age. Conclusions Longitudinal birth cohort data indicate that childhood bradycardia trebles the odds of having atrioventricular conduction defects in older age, 88% of which are benign. In addition, it does not influence mortality or heart size and function. Future research should concentrate on identifying children at risk.


2021 ◽  
Vol 18 (5) ◽  
pp. 15-29
Author(s):  
Dragoș Traian Marius Marcu ◽  
Cătălina Arsenescu-Georgescu

Abstract Introduction. Although cardiovascular disease remains the leading cause of mortality regardless of gender, the female gender has remained an underrepresented population in studies in this field. Sustained initiatives by the European Society of Cardiology have brought to the fore the importance of studying gender differences regarding the safety profile of cardiovascular drugs in women. Common cardiovascular adverse drug reactions include atrioventricular conduction disorders. Materials and methods. The present study followed the clinical and paraclinical features of female patients with a primary diagnosis of bradycardia in relation to bradycardic medication. We included a group of 359 female patients, divided according to the presence or absence of bradycardia medication into a study group (n=206) and a control group (n=153). Results. Patients with associated bradycardic medication frequently required emergency admission (P < 0.001), with prolonged hospitalization (P < 0.001). The main atrioventricular conduction disorders identified were atrial fibrillation with slow ventricular response (P = 0.028), sinus bradycardia (P = 0.009) and sinus pauses (P = 0.009). Among comorbidities, heart failure (P<0.001) and chronic kidney disease (P<0.001), were common in the study group. Echocardiographic parameters of left ventricular (P=0.002) and biatrial (P<0.001) dilatation, as well as severe left ventricular systolic dysfunction (P=0.009), showed statistical significance in this group. The most used drugs were beta-blockers, amiodarone, and digoxin. Conclusions. Our results indicate, as factors associated with medication-related bradyarrhythmias in female gender: heart failure with severe systolic dysfunction, renal dysfunction, atrial fibrillation, and left ventricular dilatation.


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