Biomedical subjects

Mark Warren

Publications and source records attributed to Mark Warren.

9 recordsLinked to original sources

PubMed2006

Mechanisms of wave fractionation at boundaries of high-frequency excitation in the posterior left atrium of the isolated sheep heart during atrial fibrillation.

BACKGROUND: High-frequency fractionated electrograms recorded during atrial fibrillation (AF) in the posterior left atrium (PLA) and elsewhere are being used as target sites for catheter ablation. We tested the hypothesis that highly periodic electric waves emerging from AF sources at or near the PLA give rise to the most fractionated activity in adjacent locations. METHODS AND RESULTS: Sustained AF was induced in 8 isolated sheep hearts (0.5 micromol/L acetylcholine). Endocardial videoimaging (DI-4-ANEPPS) and electric mapping of the PLA enabled spatial characterization of dominant frequencies (DFs) and a regularity index (ratio of DF to total power). Regularity index showed that fractionation was lowest within the area with the maximal DF (DFmax domain; 0.19+/-0.02) and highest within a band of &3 mm (0.16+/-0.02; P=0.047) at boundaries with lower-frequency domains. The numbers of spatiotemporal periodic episodes (25.9+/-2.3) and rotors per experiment (1.9+/-0.7) were also highest within the DFmax domain. Most commonly, breakthrough waves at the PLA traveled toward the rest of the atria (76.8+/-8.1% outward versus 23.2+/-8.1% inward; P<0.01). In both experiments and simulations with an atrial ionic model, fractionation at DFmax boundaries was associated with increased beat-to-beat variability of conduction velocity and directionality with wavebreak formation. CONCLUSIONS: During stable AF, the PLA harbors regular, fast, and highly organized activity; the outer limit of the DFmax domain is the area where the most propagation pattern variability and fractionated activity occur. These new concepts introduce a new perspective in the clinical use of high-frequency fractionated electrograms to localize sources of AF precisely at the PLA and elsewhere.

Animals↗

PubMed2005

Mechanisms of atrial fibrillation termination by pure sodium channel blockade in an ionically-realistic mathematical model.

The mechanisms by which Na+-channel blocking antiarrhythmic drugs terminate atrial fibrillation (AF) remain unclear. Classical "leading-circle" theory suggests that Na+-channel blockade should, if anything, promote re-entry. We used an ionically-based mathematical model of vagotonic AF to evaluate the effects of applying pure Na+-current (I(Na)) inhibition during sustained arrhythmia. Under control conditions, AF was maintained by 1 or 2 dominant spiral waves, with fibrillatory propagation at critical levels of action potential duration (APD) dispersion. I(Na) inhibition terminated AF increasingly with increasing block, terminating all AF at 65% block. During 1:1 conduction, I(Na) inhibition reduced APD (by 13% at 4 Hz and 60% block), conduction velocity (by 37%), and re-entry wavelength (by 24%). During AF, I(Na) inhibition increased the size of primary rotors and reduced re-entry rate (eg, dominant frequency decreased by 33% at 60% I(Na) inhibition) while decreasing generation of secondary wavelets by wavebreak. Three mechanisms contributed to I(Na) block-induced AF termination in the model: (1) enlargement of the center of rotation beyond the capacity of the computational substrate; (2) decreased anchoring to functional obstacles, increasing meander and extinction at boundaries; and (3) reduction in the number of secondary wavelets that could provide new primary rotors. Optical mapping in isolated sheep hearts confirmed that tetrodotoxin dose-dependently terminates AF while producing effects qualitatively like those of I(Na) inhibition in the mathematical model. We conclude that pure INa inhibition terminates AF, producing activation changes consistent with previous clinical and experimental observations. These results provide insights into previously enigmatic mechanisms of class I antiarrhythmic drug-induced AF termination. The full text of this article is available online at http://circres.ahajournals.org

Algorithms↗

PubMed2005

Effect of remodelling, stretch and ischaemia on ventricular fibrillation frequency and dynamics in a heart failure model.

OBJECTIVE: The dynamics of ventricular fibrillation (VF) in the presence of heart failure (HF) are different from those in the normal heart. This has been attributed solely to HF-induced electrophysiologic remodelling. We hypothesized that acute stretch and ischaemia, which are normally present during VF, might contribute significantly to the altered VF dynamics in HF. METHODS: HF was induced in eight sheep by rapid ventricular pacing for 4-6 weeks. Eight sheep served as controls. Optical mapping of isolated hearts was performed during VF at low intraventricular pressure (0-5 mm Hg), high pressure (25-30 mm Hg, in six HF and six controls), and at low pressure after 5 min of global ischaemia (six HF, five controls). Maximum dominant frequency (DF(max)), singularity point (SP) density and number of SP lasting more than one revolution (rotors) were analyzed. Possible statistical interactions between HF and ischaemia (HF x ischaemia) or stretch (HF x stretch) were evaluated. RESULTS: At low pressure, VF in HF was slower (13% reduction in DF(max)) and more organized than in control: 33% less SPs and 74% less rotors with 20% longer life spans. Acute stretch did not affect DF(max) but increased SP and rotors density similarly in both groups (no interaction HF x stretch). In controls, ischaemia caused a marked decrease in DF(max), SP density and incidence of rotors. However, in HF animals, the ischaemia-induced decrease in SP density was virtually abolished, indicating a significant interaction HF x ischaemia (p<0.005). CONCLUSIONS: HF remodelling decreases VF rate and increases VF organization. Acute stretch partially reverses these effects by a mechanism that is independent of remodelling. The effects of acute ischaemia on VF dynamics are significantly attenuated in HF compared to normal hearts.

Action Potentials↗

PubMed2004

Binding of inorganic oxoanions to macrocyclic ligands: effect of the degree of protonation on supramolecular assemblies formed by phosphate and [18]aneN(6).

Five macrocycle-oxoanion adducts have been isolated from aqueous solutions containing 1,4,7,10,13,16-hexaazacyclooctadecane ([18]aneN(6), L) and phosphoric acid whose pH had been adjusted to selected values in the 1-8 range. Four products, (H(6)L)(H(2)PO(4))(6).2H(3)PO(4) (1), (H(6)L)(H(2)PO(4))(6) (2), (H(4)L)(H(2)PO(4))(4).2H(2)O (4), and (H(4)L)(HPO(4))(2).7H(2)O (5) crystallized from aqueous solutions at pH 1, 3, 6, and 8, respectively, while (H(4)L)(H(2)PO(4))(4) (3) crystallized on diffusion of EtOH into an aqueous reaction mixture at pH 6. Single-crystal X-ray structure determinations enabled an examination of supramolecular interactions between protonated forms of [18]aneN(6), phosphoric acid and its conjugate bases, and water of solvation. The macrocycle adopts a variety of conformations in order to accommodate the supramolecular constructs formed by the oxoanions and solvent molecules as the relative proportions of interacting species are altered. At pH 1 and 3, the fully protonated macrocycle, [LH(6)](6+), is found with six H(2)PO(4)(-) anions. At pH 6 and 8, the tetraprotonated macrocycle, [LH(4)](4+), crystallizes with four H(2)PO(4)(-) and two HPO(4)(2)(-), respectively. Variations in the solute of crystallization are evident, with phosphoric acid being present at the lowest pH and water at pH 6 and 8. In 5, the seven unique water molecules form a string-of-pearls motif within which a new heptameric isomer, consisting of a water pentamer that uses a single water to interact with the other two unique water molecules, is found. Structures 1, 2, 4, and 5 exhibit eta-3 H-bonding of ammonium protons to a single oxygen of the guest phosphates located above and below the macrocyclic ring. In 3, two phosphate oxygens of the cavity anion interact with the macrocycle, one of which participates in eta-2 H-bonding with ammonium groups.

Journal Article↗

PubMed2004

Coordinative flexibility of 1,2-bis[1,4,7-triazacyclonon-1-yl]propan-2-ol in mononuclear and binuclear Ni(II) complexes.

Reaction of 1,2-bis[1,4,7-triazacyclonon-1-yl]propan-2-ol hexabromide (T(2)PrOH.6HBr) with Ni(ClO(4))(2)[middle dot]6H(2)O and adjustment of the pH to 7 resulted in the crystallization of pink and blue products from the one reaction mixture. The analytical data and X-ray structure determinations establish compositions corresponding to [Ni(T(2)PrOH)]Br(ClO(4))xH(2)O (pink crystals) and [Ni(2)(T(2)PrO)(OH(2))(3)Br]Br(ClO(4))x2H(2)O (blue crystals). A repeat synthesis of the latter yielded the diperchlorate monohydrate [Ni(2)(T(2)PrO)(OH(2))(3)Br](ClO(4))(2)xH(2)O. In the mononuclear complex, the 2-propanol group connecting the two 1,4,7-trizacyclononane (tacn) rings is protonated, the six nitrogen donors from the T(2)PrOH ligand coordinating to a single Ni(II) centre in a distorted octahedral geometry. In the binuclear complexes and, three coordination sites on each distorted octahedral Ni(II) centre are occupied fac by three nitrogen donors from the one tacn ring, the two metal centres being linked by an endogenous alkoxo bridge. A notable common feature of the two identical cations is that for one Ni(II) centre the remaining two sites are occupied by two water ligands, while in the other a bromo ligand replaces one ligated water. Similar binuclear systems have been recently defined [Zn(2)(T(2)PrO)X(H(2)O)(2)](ClO(4))(2)(X = Cl, Br), two complexes that exhibit coordination asymmetry with one pseudo-octahedral and one pseudo-square pyramidal Zn(ii) centre. The weak antiferromagnetic coupling in and is discussed and compared to di-phenoxo-bridged Ni(II) examples.

Journal Article↗

PubMed2004

[Ionic currents and ventricular fibrillation dynamics].

Ventricular fibrillation is the principal immediate cause of sudden cardiac death. Yet, in contrast to other arrhythmias, ventricular fibrillation is considered to be inaccessible to pharmacologic therapy because of its characteristic and apparently never-ending disarray of electrical waves that seem to propagate chaotically throughout the ventricles. Its prevention has historically been focused on the suppression of ventricular ectopy, with the idea of eliminating potential triggers of fibrillation, which from a clinical standpoint has proven to be detrimental. During the last decade, the application of the theory of wave propagation in non-linear excitable media to the study of cardiac fibrillation has led to a dramatic increase in our understanding of its mechanisms. It is now clear that fibrillation is generated and maintained by rotors that gyrate at exceedingly high frequencies. From such rotors emanate spiral waves of excitation that propagate throughout the myocardium in very complex ways. Among the most important factors that determine rotor dynamics are the electrophysiological properties of the ventricular cells, established by their underlying transmembrane ionic currents. Thus, in recent years, studies have focused on the roles played by specific ionic mechanisms and their modulation by antiarrhythmic drugs in ventricular fibrillation dynamics. This review article summarizes the main findings of such studies, which pave the way for a better understanding of fibrillation, and for the development of new pharmacological approaches that aim to prevent rotor formation and maintenance rather than to suppress the triggering ectopic event.

Anti-Arrhythmia Agents↗

PubMed2003

Cholinergic atrial fibrillation: I(K,ACh) gradients determine unequal left/right atrial frequencies and rotor dynamics.

OBJECTIVE: We tested the hypothesis that left atrial (LA) myocytes are more sensitive to acetylcholine (ACh) than right atrial (RA) myocytes, which results in a greater dose-dependent increase in LA than RA rotor frequency, increased LA-to-RA frequency gradient and increased incidence of wavelet formation during atrial fibrillation (AF). METHODS AND RESULTS: AF was induced in seven Langendorff-perfused sheep hearts in the presence of ACh (0.1-4.0 microM) and studied using optical mapping and bipolar recordings. Dominant frequencies (DFs) were determined in optical and electrical signals and phase movies were used to identify rotors and quantify their dynamics. DFs in both atria increased monotonically with ACh concentration until saturation, but the LA frequency predominated at all concentrations. Rotors were also seen more often in the LA, and although their life span decreased, their frequency and number of rotations increased. Patch-clamp studies demonstrated that ACh-activated potassium current (I(K,ACh)) density was greater in LA than RA sheep myocytes. Additionally, ribonuclease protection assay demonstrated that Kir3.4 and Kir3.1 mRNAs were more abundant in LA than in RA. CONCLUSIONS: A greater abundance of Kir3.x channels and higher I(K,ACh) density in LA than RA myocytes result in greater ACh-induced speeding-up of rotors in the LA than in the RA, which explains the ACh dose-dependent changes in overall AF frequency and wavelet formation.

Acetylcholine↗

PubMed2003

Intra-atrial pressure increases rate and organization of waves emanating from the superior pulmonary veins during atrial fibrillation.

BACKGROUND: Atrial fibrillation (AF) commonly associates with atrial dilatation by poorly understood mechanisms. We hypothesized that elevation of intra-atrial pressure elicits high-frequency and spatio-temporally organized left atrial (LA) sources emanating from the superior pulmonary veins. METHODS AND RESULTS: We used a stretch-related AF model in the sheep heart to induce stable episodes of AF (>40 minutes) in 9 animals. Video movies of the LA free wall (LAFW) and LA superior pulmonary vein junction (JPV) were obtained by using di-4-ANEPPS. Electrograms from the right atrium were recorded. At intra-atrial pressures >10 cm H2O, the maximum dominant frequency (DFMax) was significantly higher in the JPV than in the LAFW (12.0+/-0.2 and 10.5+/-0.2 Hz, respectively [mean+/-SEM]; P<0.001). Below 10 cm H2O, DFMax was similar in the JPV and LAFW (10.8+/-0.3 versus 10.2+/-0.3 Hz; P=0.6); DFMax in both JPV and LAFW was significantly higher than in the right atrium (7.8+/-0.3 Hz; P<0.001). Analysis of excitation direction in JPV showed positive correlation between intra-atrial pressure and the number of waves emanating from the left superior pulmonary vein (r=0.79, P=0.02) but not from the LAFW (r=0.54, P=0.09). The number of spatio-temporally periodic waves in the JPV correlated with pressure (r=0.92, P=0.002). In 3 cases, JPV rotors were identified with a cycle length equal to 1/DFMax. CONCLUSIONS: We demonstrate for the first time that an increase in intra-atrial pressure increases the rate and organization of waves emanating from the superior pulmonary veins underlying stretch-related AF.

Animals↗

PubMed2003

Blockade of the inward rectifying potassium current terminates ventricular fibrillation in the guinea pig heart.

INTRODUCTION: Stable high-frequency rotors sustain ventricular fibrillation (VF) in the guinea pig heart. We surmised that rotor stabilization in the left ventricle (LV) and fibrillatory conduction toward the right ventricle (RV) result from chamber-specific differences in functional expression of inward rectifier (Kir2.x) channels and unequal IK1 rectification in LV and RV myocytes. Accordingly, selective blockade of IK1 during VF should terminate VF. METHODS AND RESULTS: Relative mRNA levels of Kir2.x channels were measured in LV and RV. In addition, LV (n = 21) and RV (n = 20) myocytes were superfused with BaCl2 (5-50 micromol/L) to study the effects on IK1. Potentiometric dye-fluorescence movies of VF were obtained in the presence of Ba2+ (0-50 micromol/L) in 23 Langendorff-perfused hearts. Dominant frequencies (DFs) were determined by spectral analysis, and singularity points were counted in phase maps to assess VF organization. mRNA levels for Kir2.1 and Kir2.3 were significantly larger in LV than RV. Concurrently, outward IK1 was significantly larger in LV than RV myocytes. Ba2+ decreased IK1 in a dose-dependent manner (LV change > RV change). In baseline control VF, the fastest DF domain (28-40 Hz) was located on the anterior LV wall and a sharp LV-to-RV frequency gradient of 21.2 +/- 4.3 Hz was present. Ba2+ significantly decreased both LV frequency and gradient, and it terminated VF in a dose-dependent manner. At 50 micromol/L, Ba2+ decreased the average number of wavebreaks (1.7 +/- 0.9 to 0.8 +/- 0.6 SP/sec x pixel, P < 0.05) and then terminated VF. CONCLUSION: The results strongly support the hypothesis that IK1 plays an important role in rotor stabilization and VF dynamics.

Animals↗