Brief history of arrhythmia in the WPW syndrome – the contribution of George Ralph Mines

Boukens, Bastiaan J.; Janse, Michiel J.

doi:10.1113/jphysiol.2013.259598

Cited by 8 publications

(4 citation statements)

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“…The myocardium of the accessory connection can have a slow conducting nodal (Mahaim) or a fast conducting working myocardial (Öhnell) phenotype [73]. An accessory connection can lead to ventricular preexcitation and AVRT, as seen in patients with the Wolff-Parkinson-White (WPW) syndrome [74,75]. In the presence of atrial fibrillation, preexcitation may cause ventricular fibrillation and sudden death.…”

Section: Re-entry Tachycardias Involving the Atrioventricular Junctionmentioning

confidence: 99%

How Cardiac Embryology Translates into Clinical Arrhythmias

Rivaud

Blok

Jongbloed

et al. 2021

JCDD

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The electrophysiological signatures of the myocardium in cardiac structures, such as the atrioventricular node, pulmonary veins or the right ventricular outflow tract, are established during development by the spatial and temporal expression of transcription factors that guide expression of specific ion channels. Genome-wide association studies have shown that small variations in genetic regions are key to the expression of these transcription factors and thereby modulate the electrical function of the heart. Moreover, mutations in these factors are found in arrhythmogenic pathologies such as congenital atrioventricular block, as well as in specific forms of atrial fibrillation and ventricular tachycardia. In this review, we discuss the developmental origin of distinct electrophysiological structures in the heart and their involvement in cardiac arrhythmias.

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Section: Re-entry Tachycardias Involving the Atrioventricular Junctionmentioning

confidence: 99%

How Cardiac Embryology Translates into Clinical Arrhythmias

Rivaud

Blok

Jongbloed

et al. 2021

JCDD

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“…Mines' concept of anatomic reentry was not only an important theoretical development in cardiac electrophysiology but also had major clinical implications. He was in fact the first to propose atrioventricular reentry as a mechanism of arrhythmia based on Kent's description of muscular atrioventricular connections (Kent, 1913;Mines 1914a), as elegantly reviewed by Boukens & Janse (2013). Today, these observations remain highly relevant and form the basis of the understanding and management of a group of arrhythmias known as the atrioventricular (AV) reentrant tachycardias (AVRTs).…”

Section: Circus Movement Reentrymentioning

confidence: 99%

The pioneering work of George Mines on cardiac arrhythmias: groundbreaking ideas that remain influential in contemporary cardiac electrophysiology

Aguilar

Nattel

2016

The Journal of Physiology

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George Mines was a pioneering physiologist who, despite an extremely short period of professional activity and only primitive experimental methodology, succeeded in formulating concepts that continue to be of great influence today. Here, we review some of his most important discoveries and their impact on contemporary concepts and clinical practice. Mines' greatest contribution was his conceptualization and characterization of circus movement reentry. His observations and ideas about the basis for cardiac reentrant activity underlie how we understand and manage a wide range of important clinical rhythm disturbances today. The notions he introduced regarding the influence of premature extrastimuli on reentry (termination, resetting and entrainment) are central to contemporary assessment of arrhythmia mechanisms in clinical electrophysiology laboratories and modern device therapy of cardiac tachyarrhythmias. Refinements of his model of reentry have led to sophisticated biophysical theories of the mechanisms underlying cardiac fibrillation. His seminal observations on the influence of electrolyte derangements and autonomic tone on the heart are relevant to our understanding of the physiology and pharmacology of arrhythmias caused by cardiac pathology. In this era of advanced technology, it is important to appreciate that ideas of lasting impact come from great minds and do not necessarily require great tools.(Received 22 July 2015; accepted after revision 9 September 2015; first published online 26 November 2015) Corresponding author S. Nattel: 5000 Belanger St. E, Montreal, Quebec, Canada H1T 1C8. Email: stanley.nattel@icm-mhi.org Abstract figure legend Mine's major contribution to the field of cardiac electrophysiology was the notion of circus movement reentry, a concept with far-reaching theoretical and clinical applications that remains highly relevant in modern electrophysiology. His model of cardiac fibrillation based on circus movement reentry paved the way for modern theories of fibrillation such as leading circle and spiral wave reentry. Mines was also instrumental in developing the notion of the vulnerable period of the cardiac cycle, the time window during which an extra-stimulus can trigger fibrillation, which forms the basis of several practical applications (e.g., synchronized cardioversion and pacemaker sensing function). Other noteworthy contributions include the description of the effects of metabolic abnormalities and vagal nerve stimulation on the electrocardiogram. Presently-used practical clinical applications resulting from Mines' discoveries are shown in the grey boxes.

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“…Mines also showed that a circus movement could be produced in rings of cardiac tissue (Mines, 1913(Mines, , 1914. Mines explained: (i) why unidirectional block was required to start up re-entry, (ii) why there was a vulnerable period during which a well-timed stimulus would initiate re-entry, (iii) why the circumference of the ring had J Physiol 594.9 to be shorter than the 'wavelength' of the circulating impulse, and (iv) how a welltimed stimulus could abolish the re-entrant motion (see Boukens & Janse (2013) and Aguilar & Nattel (2016), in this issue, for a review). In the case of circus-movement re-entry taking place in the intact heart, one would have bistability between two periodic rhythms: normal sinus rhythm and the re-entrant rhythm that produces a monomorphic tachycardia.…”

Section: The Vulnerable Period and The Induction Of Re-entrant Rhythmsmentioning

confidence: 99%