Regional conduction slowing can explain inferolateral J waves and their attenuation by sodium channel blockers

International audienceJ waves in inferolateral leads are associated with an increased risk for idiopathic ventricular fibrillation. The mechanism behind such J waves is unknown. A similarity with Brugada syndrome (BS) exists but while administration of sodium (Na) channel blockers increases J waves in BS it attenuates inferolateral J waves. We hypothesized that regionally reduced conduction velocity in the lateral wall can explain both inferolateral J waves and their attenuation by Na-channel blockers.METHODS The effects of Na-channel block, reduced coupling, and increased transient outward current were evaluated with computer simulations using a detailed model of the human heart and torso. As far as possible findings were backed up with experiments in explanted pig hearts.RESULTS Reduced Na current in lateral but not in other regions induced inferolateral J waves. Increased transient outward current and cellular uncoupling caused only subthreshold J-point elevations. Administration of Na-channel blockers deformed and prolonged the QRS complex, masking the inferolateral J waves.CONCLUSION Regionally reduced Na current can explain inferolateral J waves. The fact that the lateral region is normally late-activated is crucial for the development of J waves and may explain the special importance of the inferolateral leads. The proposed mechanism also explains attenuation of J waves by Na-channel blockers

Multielectrode Contact Measurement Can Improve Long-Term Outcome of Pulmonary Vein Isolation Using Circular Single-Pulse Electroporation Ablation

Background: Irreversible electroporation (IRE) ablation is generally performed with multielectrode catheters. Electrode-tissue contact is an important predictor for the success of pulmonary vein (PV) isolation; however, contact force is difficult to measure with multielectrode ablation catheters. In a preclinical study, we assessed the feasibility of a multielectrode impedance system (MEIS) as a predictor of long-term success of PV isolation. In addition, we present the first-in-human clinical experience with MEIS. Methods: In 10 pigs, one PV was ablated based on impedance (MEIS group), and the other PV was solely based on local electrogram information (EP group). IRE ablations were performed at 200 J. After 3 months, recurrence of conduction was assessed. Subsequently, in 30 patients undergoing PV isolation with IRE, MEIS was evaluated and MEIS contact values were compared to local electrograms. Results: In the porcine study, 43 IRE applications were delivered in 19 PVs. Acutely, no reconnections were observed in either group. After 3 months, 0 versus 3 (P=0.21) PVs showed conduction recurrence in the MEIS and EP groups, respectively. Results from the clinical study showed a significant linear relation was found between mean MEIS value and bipolar dV/dt (r2=0.49, P<0.001), with a slope of 20.6 mV/s per Ohm. Conclusions: Data from the animal study suggest that MEIS values predict effective IRE applications. For the long-term success of electrical PV isolation with circular IRE applications, no significant difference in efficacy was found between ablation based on the measurement of electrode interface impedance and ablation using the classical EP approach for determining electrode-tissue contact. Experiences of the first clinical use of MEIS were promising and serve as an important basis for future research

Seasonal cycle of CO2 from the sea ice edge to island blooms in the Scotia Sea, Southern Ocean

The Scotia Sea region contains some of the most productive waters of the Southern Ocean. It is also a dynamic region through the interaction of deep water masses with the atmosphere. We present a first seasonally-resolved time series of the fugacity of CO2 (fCO2) from spring 2006, summer 2008, autumn 2009 and winter (potential temperature minimum) along a 1000 km transect from the pack ice to the Polar Front to quantify the effects of biology and temperature on oceanic fCO2. Substantial spring and summer decreases in sea surface fCO2 occurred in phytoplankton blooms that developed in the naturally iron fertilised waters downstream (north) of South Georgia island (54-55S, 36-38W) and following sea ice melt (in the seasonal ice zone). The largest seasonal fCO2 amplitude (fCO2) of 159 uatm was found in the South Georgia bloom. In this region, biological carbon uptake dominated the seasonal signal, reducing the winter maxima in oceanic fCO2 by 257 uatm by the summer. In the Weddell-Scotia Confluence, the southern fringe of the Scotia Sea, the shift from wintertime CO2-rich conditions in ice covered waters to CO2 undersaturation in the spring blooms during and upon sea ice melt created strong seasonality in oceanic fCO2. Temperature effects on oceanic fCO2 ranged from fCO2sst of 55 uatm in the seasonal ice zone to almost double that downstream of South Georgia (98 uatm). The seasonal cycle of surface water fCO2 in the high-nutrient low-chlorophyll region of the central Scotia Sea had the weakest biological control and lowest seasonality. Basin-wide biological processes dominated the seasonal control on oceanic fCO2 (fCO2bio of 159 μatm), partially compensated (43%) by moderate temperature control (fCO2sst of 68 μatm). The patchwork of productivity across the Scotia Sea creates regions of seasonally strong biological uptake of CO2 in the Southern Ocean

Severe Bradycardia Increases the Incidence and Severity of Torsade de Pointes Arrhythmias by Augmenting Preexistent Spatial Dispersion of Repolarization in the CAVB Dog Model

Introduction: Torsade de pointes arrhythmias (TdP) in the chronic atrioventricular block (CAVB) dog model result from proarrhythmic factors, which trigger TdP and/or reinforce the arrhythmic substrate. This study investigated electrophysiological and arrhythmogenic consequences of severe bradycardia for TdP. Methods: Dofetilide (25 μg/kg per 5 min) was administered to eight anesthetized, idioventricular rhythm (IVR) remodeled CAVB dogs in two serial experiments: once under 60 beats per minute (bpm), right ventricular apex paced (RVA60) conditions, once under more bradycardic IVR conditions. Recordings included surface electrocardiogram and short-term variability (STV) of repolarization from endocardial unipolar electrograms. TdP inducibility (three or more episodes within 10 min after start of dofetilide) and arrhythmic activity scores (AS) were established. Mapping experiments in 10 additional dogs determined the effect of lowering rate on STV and spatial dispersion of repolarization (SDR) in baseline. Results: IVR-tested animals had longer baseline RR-interval (1,403 ± 271 ms) and repolarization intervals than RVA60 animals. Dofetilide increased STV similarly under both rhythm strategies. Nevertheless, TdP inducibility and AS were higher under IVR conditions (6/8 and 37 ± 27 vs. 1/8 and 8 ± 12 in RVA60, respectively, both p < 0.05). Mapping: Pacing from high (128 ± 10 bpm) to middle (88 ± 10 bpm) to experimental rate (61 ± 3 bpm) increased all electrophysiological parameters, including interventricular dispersion, due to steeper left ventricular restitution curves, and intraventricular SDR: maximal cubic dispersion from 60 ± 14 (high) to 69 ± 17 (middle) to 84 ± 22 ms (p < 0.05 vs. high and middle rate). Conclusion: In CAVB dogs, severe bradycardia increases the probability and severity of arrhythmic events by heterogeneously causing electrophysiological instability, which is mainly reflected in an increased spatial, and to a lesser extent temporal, dispersion of repolarization

A 50% Reduction of Excitability but Not of Intercellular Coupling Affects Conduction Velocity Restitution and Activation Delay in the Mouse Heart

Computer simulations suggest that intercellular coupling is more robust than membrane excitability with regard to changes in and safety of conduction. Clinical studies indicate that SCN5A (excitability) and/or Connexin43 (Cx43, intercellular coupling) expression in heart disease is reduced by approximately 50%. In this retrospective study we assessed the effect of reduced membrane excitability or intercellular coupling on conduction in mouse models of reduced excitability or intercellular coupling. Epicardial activation mapping of LV and RV was performed on Langendorff-perfused mouse hearts having the following: 1) Reduced excitability: Scn5a haploinsufficient mice; and 2) reduced intercellular coupling: Cx43(CreER(T)/fl) mice, uninduced (50% Cx43) or induced (10% Cx43) with Tamoxifen. Wild type (WT) littermates were used as control. Conduction velocity (CV) restitution and activation delay were determined longitudinal and transversal to fiber direction during S(1)S(1) pacing and S(1)S(2) premature stimulation until the effective refractory period. In both animal models, CV restitution and activation delay in LV were not changed compared to WT. In contrast, CV restitution decreased and activation delay increased in RV during conduction longitudinal but not transverse to fiber direction in Scn5a heterozygous animals compared to WT. In contrast, a 50% reduction of intercellular coupling did not affect either CV restitution or activation delay. A decrease of 90% Cx43, however, resulted in decreased CV restitution and increased activation delay in RV, but not LV. Reducing excitability but not intercellular coupling by 50% affects CV restitution and activation delay in RV, indicating a higher safety factor for intercellular coupling than excitability in R

Arthropod distribution in a tropical rainforest: tackling a four dimensional puzzle

Quantifying the spatio-temporal distribution of arthropods in tropical rainforests represents a first step towards scrutinizing the global distribution of biodiversity on Earth. To date most studies have focused on narrow taxonomic groups or lack a design that allows partitioning of the components of diversity. Here, we consider an exceptionally large dataset (113,952 individuals representing 5,858 species), obtained from the San Lorenzo forest in Panama, where the phylogenetic breadth of arthropod taxa was surveyed using 14 protocols targeting the soil, litter, understory, lower and upper canopy habitats, replicated across seasons in 2003 and 2004. This dataset is used to explore the relative influence of horizontal, vertical and seasonal drivers of arthropod distribution in this forest. We considered arthropod abundance, observed and estimated species richness, additive decomposition of species richness, multiplicative partitioning of species diversity, variation in species composition, species turnover and guild structure as components of diversity. At the scale of our study (2km of distance, 40m in height and 400 days), the effects related to the vertical and seasonal dimensions were most important. Most adult arthropods were collected from the soil/litter or the upper canopy and species richness was highest in the canopy. We compared the distribution of arthropods and trees within our study system. Effects related to the seasonal dimension were stronger for arthropods than for trees. We conclude that: (1) models of beta diversity developed for tropical trees are unlikely to be applicable to tropical arthropods; (2) it is imperative that estimates of global biodiversity derived from mass collecting of arthropods in tropical rainforests embrace the strong vertical and seasonal partitioning observed here; and (3) given the high species turnover observed between seasons, global climate change may have severe consequences for rainforest arthropods1012CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQSolVin-Solvay SA; Smithsonian Institution; Smithsonian Tropical Research Institute; United Nations Environment Programme; Smithsonian Institution; Smithsonian National Museum of Natural History; European Science Foundation (ESF); Global Canopy Programme; Czech Science foundation GACR grant; European Social Fund (ESF); Ministry of Education, Youth & Sports - Czech Republic; French National Research Agency (ANR); Research Council of Norway; Grant Agency of the Czech Republi

Genetic association study of QT interval highlights role for calcium signaling pathways in myocardial repolarization.

The QT interval, an electrocardiographic measure reflecting myocardial repolarization, is a heritable trait. QT prolongation is a risk factor for ventricular arrhythmias and sudden cardiac death (SCD) and could indicate the presence of the potentially lethal mendelian long-QT syndrome (LQTS). Using a genome-wide association and replication study in up to 100,000 individuals, we identified 35 common variant loci associated with QT interval that collectively explain ∼8-10% of QT-interval variation and highlight the importance of calcium regulation in myocardial repolarization. Rare variant analysis of 6 new QT interval-associated loci in 298 unrelated probands with LQTS identified coding variants not found in controls but of uncertain causality and therefore requiring validation. Several newly identified loci encode proteins that physically interact with other recognized repolarization proteins. Our integration of common variant association, expression and orthogonal protein-protein interaction screens provides new insights into cardiac electrophysiology and identifies new candidate genes for ventricular arrhythmias, LQTS and SCD