Cerebrogenic cardiac arrhythmias:

Oppenheimer, Stephen

doi:10.1007/s10286-006-0276-0

Cited by 248 publications

(76 citation statements)

References 51 publications

(53 reference statements)

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“…ECG abnormalities, including atrial arrhythmia, have been reported in patients with no underlying cardiac disease [19,20]. Moreover, some studies have reported a significantly higher incidence of atrial tachyarrhythmia, particularly in patients with anterior circulation infarction [21]. …”

Section: Discussionmentioning

confidence: 99%

Silent Atrial Fibrillation after Ischemic Stroke or Transient Ischemic Attack: Interest of Continuous ECG Monitoring

Fernández

Béjot²,

Zeller

et al. 2014

Eur Neurol

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Background: Since atrial fibrillation (AF) may be undiagnosed when asymptomatic and paroxysmal, we aimed to investigate the incidence and determinants of silent AF in patients with acute ischemic stroke or transient ischemic attack (TIA). Methods: Consecutive patients admitted to the Stroke Unit of the University Hospital of Dijon, France, for acute ischemic stroke or TIA were prospectively enrolled from March to December 2012. Silent AF was assessed by continuous electrocardiography (ECG) monitoring for 24 h after admission. An echocardiography was performed at day 2 ± 1 to measure left ventricular ejection fraction (LVEF) and left auricular (LA) dimensions. Results: Among the 187 patients included, 19 (10%) developed silent AF. Patients with silent AF were markedly older (76 vs. 66 years, p < 0.002), with lower creatinine levels (90 vs. 80 µmol/l, p = 0.030) and were less often smokers (5 vs. 24%, p = 0.058) than patients without silent AF. They also showed a trend towards more frequent hypertension and a recent history of infection. Patients with silent AF had a larger indexed LA volume (37.4 vs. 30.8 ml/m³, p = 0.057) and LA diameter (23.2 vs. 20.8 mm/m², p = 0.059). LVEF in the two groups was similar. In multivariate analysis, only age remained an independent estimate of silent AF. Conclusion: Silent AF detected by continuous ECG monitoring is common and closely associated with older age. Further studies are needed to investigate the interest of systematically screening for silent AF for secondary prevention after ischemic stroke/TIA.

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Section: Discussionmentioning

confidence: 99%

Silent Atrial Fibrillation after Ischemic Stroke or Transient Ischemic Attack: Interest of Continuous ECG Monitoring

Fernández

Béjot²,

Zeller

et al. 2014

Eur Neurol

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“…14, 15 The efficacy of ART such as cardiac afferent denervation after myocardial infarction 16 and sympathectomy to treat ventricular tachycardia (VT) storm could be due to a reduction of these conflicts between levels of the cardiac nervous system. 17, 18 In these settings it is very likely that the intrinsic nervous system of the heart is able to provide the neural coordination and ensure electrical stability without the interference of central input.…”

Section: Pathophysiologymentioning

confidence: 99%

Cardiac Innervation and Sudden Cardiac Death

Fukuda

Kanazawa

Aizawa

et al. 2015

Circulation Research

330

317

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Afferent and efferent cardiac neurotransmission via the cardiac nerves intricately modulates nearly all physiological functions of the heart (chronotropy, dromotropy, lusitropy and inotropy). Afferent information from the heart is transmitted to higher levels of the nervous system for processing (intrinsic cardiac nervous system, extracardiac-intrathoracic ganglia, spinal cord, brain stem and higher centers) which ultimately results in efferent cardiomotor neural impulses (via the sympathetic and parasympathetic nerves). This system forms interacting feedback loops that provide physiological stability for maintaining normal rhythm and life-sustaining circulation. This system also ensures that there is fine-tuned regulation of sympathetic-parasympathetic balance in the heart under normal and stressed states in the short (beat to beat), intermediate (minutes-hours) and long term (days-years). This important neurovisceral /autonomic nervous system also plays a major role in the pathophysiology and progression of heart disease, including heart failure and arrhythmias leading to sudden cardiac death (SCD). Transdifferentiation of neurons in heart failure, functional denervation, cardiac and extra-cardiac neural remodeling have also been identified and characterized during the progression of disease. Recent advances in understanding the cellular and molecular processes governing innervation and the functional control of the myocardium in health and disease provides a rational mechanistic basis for development of neuraxial therapies for preventing SCD and other arrhythmias. Advances in cellular, molecular, and bioengineering realms have underscored the emergence of this area as an important avenue of scientific inquiry and therapeutic intervention.

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“…The locus coeruleus provides adrenergic innervation and important components of arousal and attention selection (Aston-Jones & Cohen 2005), while the raphé, in addition to its mood and temperature roles, also assists in modulation of upper airway muscle tone (Kubin et al 1992). The medullary injury in OSA and CCHS is principally unilateral, which poses unique concerns for conditions of high sympathetic tone, since asymmetric sympathetic drive predisposes to certain forms of cardiac arrhythmia (Oppenheimer 2006). …”

Section: Pons and Medullamentioning

confidence: 99%

Affective Brain Areas and Sleep-Disordered Breathing

Harper

Kumar

Macey

et al. 2014

Progress in Brain Research

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The neural damage accompanying the hypoxia, reduced perfusion, and other consequences of sleep-disordered breathing found in obstructive sleep apnea, heart failure (HF), and congenital central hypoventilation syndrome (CCHS), appears in areas that serve multiple functions, including emotional drives to breathe, and involve systems that serve affective, cardiovascular, and breathing roles. The damage, assessed with structural magnetic resonance imaging (MRI) procedures, shows tissue loss or water content and diffusion changes indicative of injury, and impaired axonal integrity between structures; damage is preferentially unilateral. Functional MRI responses in affected areas also are time- or amplitude- distorted to ventilatory or autonomic challenges. Among the structures injured are the insular, cingulate, and ventral medial prefrontal cortices, as well as cerebellar deep nuclei and cortex, anterior hypothalamus, raphé, ventrolateral medulla, basal ganglia and, in CCHS, the locus coeruleus. Raphé and locus coeruleus injury may modify serotonergic and adrenergic modulation of upper airway and arousal characteristics. Since both axons and gray matter show injury, the consequences to function, especially to autonomic, cognitive, and mood regulation, are major. Several affected rostral sites, including the insular and cingulate cortices and hippocampus, mediate aspects of dyspnea, especially in CCHS, while others, including the anterior cingulate and thalamus, participate in initiation of inspiration after central breathing pauses, and the medullary injury can impair baroreflex and breathing control. The ancillary injury associated with sleep-disordered breathing to central structures can elicit multiple other distortions in cardiovascular, cognitive, and emotional functions in addition to effects on breathing regulation.

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Cerebrogenic cardiac arrhythmias:

Cited by 248 publications

References 51 publications

Silent Atrial Fibrillation after Ischemic Stroke or Transient Ischemic Attack: Interest of Continuous ECG Monitoring

Silent Atrial Fibrillation after Ischemic Stroke or Transient Ischemic Attack: Interest of Continuous ECG Monitoring

Cardiac Innervation and Sudden Cardiac Death

Affective Brain Areas and Sleep-Disordered Breathing

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