Delayed Activation of the Left Atrial Appendage Following Catheter Ablation of Persistent Atrial Fibrillation: A Cause for Concern?

Disclosures: Dr. Oral is a co-founder of Ablation Frontiers.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79386/1/j.1540-8159.2010.02752.x.pd

Etude de l’intéraction entre les ros et la voie mtorc1 dans la régulation de la balance énergetique

The mechanistic target of rapamycin complex 1 (mTORC1) pathway is an importanthypothalamic integrator of nutrients and hormones. Nutrient availability also affects thereactive oxygen species (ROS) in propiomelanocortin (POMC) neurons and regulatesneuronal activity. We hypothesize that modulation of mTORC1 activity mediates ROS effectson food intake.To this purpose, C57Bl6J mice or WT mice and their KO littermates either deficient for themTORC1 downstream target S6K1 or for the mTORC1 component raptor specifically inPOMC neurons (POMC-raptor-KO) were treated with an intracerebroventricular (ICV)injection of the ROS producer H2O2 or the ROS scavenger honokiol, alone or in combinationwith the mTOR inhibitor rapamycin or the mTOR activator leptin.ICV H2O2 induced phosphorylation of S6K1 within the hypothalamus, increased expressionof c-fos, a marker of neuronal activity, in the arcuate nucleus and increased ROS in POMCneurons. These effects were associated with a significant decrease in food intake. Theanorexigenic effect of ICV H2O2 was not seen in S6K1-KO mice, in C57Bl6J mice cotreatedwith rapamycin (an mTOR inhibitor) and in POMC-raptor-KO mice.Similarly, ICV honokiol administration combined with a leptin injection blunted theanorexigenic effect of leptin, suggesting that leptin requires ROS formation to reduce FI. ICVadministration of leptin increased ROS in POMC neurons in C57Bl6J and POMC-raptor-WTmice, but not in POMC-raptor-KO mice.Our results demonstrate that ROS modulators require a functional mTORC1 pathway toregulate food intake and that leptin needs an mTORC1-dependent increase in ROS levels inPOMC neurons to decrease food intake.La voie de signalisation mTORC1 hypothalamique (mammalian target of rapamycincomplexe 1) intègre les signaux hormonaux et nutritionnels. La disponibilité des nutrimentsmodule les espèces réactives derivées de l’oxygène (ROS) qui régulent l’activité des neuronesà propiomélanocortine (POMC). La modulation de la prise alimentaire induite par les ROSpourrait impliquer mTORC1.Des souris C57Bl6J et wild-type (WT) ou invalidées pour S6K1 (S6K1-KO), principaleprotéine cible de mTORC1, ou invalidées pour raptor, protéine clé de mTORC1,sélectivement au niveau des neurones anorexigènes POMC (POMC-raptor-KO) ont ététraitées par injections intracérébroventriculaires (ICV) d’H2O2 ou d’honokiol (piégeur deROS), uniques ou combinées avec un inhibiteur de mTOR (rapamycine) ou un activateur demTOR (leptine).L’H2O2 ICV induit une augmentation de l’activité hypothalamique mTORC1, de l’activationneuronale du noyau arqué, de l’expression des ROS dans les neurones POMC, associée à unediminution de la prise alimentaire et du poids. Cet effet anorexigène est diminué chez lessouris S6K1-KO, chez les C57Bl6J après administration de rapamycine, et chez les POMCraptor-KO.L’honokiol ICV bloque l’effet anorexigène de la leptine, suggérant que cet effet soitdépendant des ROS. La leptine ICV entraine une augmentation des ROS dans les neuronesPOMC des souris C57Bl6J et POMC-raptor-WT, mais pas chez les POMC-raptor-KO.Nos résultats montrent que la régulation de la prise alimentaire induite par les ROS nécessiteune voie mTORC1 fonctionnelle et que l’effet anorexigène de la leptine nécessite uneaugmentation de ROS, mTORC1 dépendante, au niveau des neurones POMC

Frontiers in Non-invasive Cardiac Mapping: Rotors in Atrial Fibrillation-Body Surface Frequency-Phase Mapping

[EN] Experimental and clinical data demonstrate that atrial fibrillation (AF) maintenance in animals and groups of patients depends on localized reentrant sources localized primarily to the pulmonary veins (PVs) and the left atrium(LA) posterior wall in paroxysmal AF but elsewhere, including the right atrium (RA), in persistent AF. Moreover, AF can be eliminated by directly ablating AFdriving sources or “rotors,” that exhibit high-frequency, periodic activity. The RADAR-AF randomized trial demonstrated that an ablation procedure based on a more target-specific strategy aimed at eliminating high frequency sites responsible for AF maintenance is as efficacious as and safer than empirically isolating all the PVs. In contrast to the standard ECG, global atrial noninvasive frequency analysis allows non-invasive identification of high-frequency sources before the arrival at the electrophysiology laboratory for ablation. Body surface potential map (BSPM) replicates the endocardial distribution of DFs with localization of the highest DF (HDF) and can identify small areas containing the high-frequency sources. Overall, BSPM had a sensitivity of 75% and specificity of 100% for capturing intracardiac EGMs as having LARA DF gradient. However, raw BSPM data analysis of AF patterns of activity showed incomplete and instable reentrant patterns of activation. Thus, we developed an analysis approach whereby a narrow band-pass filtering allowed selecting the electrical activity projected on the torso at the HDF, which stabilized the projection of rotors that potentially drive AF on the surface. Consequently, driving reentrant patterns (“rotors”) with spatiotemporal stability during >70% of the AF time could be observed noninvasibly after HDFfiltering. Moreover, computer simulations found that the combination of BSPM phase mapping with DF analysis enabled the discrimination of true rotational patterns even during the most complex AF. Altogether, these studies show that the combination of DF analysis with phase maps of HDF-filtered surface ECG recordings allows noninvasive localization of atrial reentries during AF and further a physiologically-based rationale for personalized diagnosis and treatment of patients with AF.Study supported in part by the Spanish Society of Cardiology (Becas Investigacio´ n Clı´nica 2009); the Universitat Polite` cnica de Vale`ncia through its research initiative program; the Generalitat Valenciana Grants (ACIF/2013/021); the Ministerio de Economia y Competividad, Red RIC; the Centro Nacional de Investigaciones Cardiovasculares (proyecto CNIC-13); the Coulter Foundation from the Biomedical Engineering Department (University of Michigan); the Gelman Award from the Cardiovascular Division (University of Michigan); the National Heart, Lung, and Blood Institute grants (P01-HL039707, P01-HL087226 and R01-HL118304), and the Leducq FoundationAtienza, F.; Climent, A.; Guillem Sánchez, MS.; Berenfeld, O. (2015). Frontiers in Non-invasive Cardiac Mapping: Rotors in Atrial Fibrillation-Body Surface Frequency-Phase Mapping. Cardiac Electrophysiology Clinics. 7(1):59-69. https://doi.org/10.1016/j.ccep.2014.11.002S59697

Effects of Partial and Complete Ablation of the Slow Pathway on Fast Pathway Properties in Patients with Atrioventricular Nodal Reentrant Tachycardia

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73520/1/j.1540-8167.1994.tb01187.x.pd

Prevalence of Asymptomatic Recurrences of Atrial Fibrillation After Successful Radiofrequency Catheter Ablation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72183/1/j.1540-8167.2004.04055.x.pd