Pacing Frequency Research Articles

Rates of and Indications for Subcutaneous ICD Extraction: A Multihospital Healthcare System Analysis

ABSTRACTIntroductionThe subcutaneous implantable cardioverter defibrillator (S‐ICD) is an alternative to a transvenous ICD in patients who meet the criteria for ICD implantation without concurrent need for cardiac pacing. The objective of this study is to examine the rates of and indications for S‐ICD removal and extraction.MethodsA retrospective analysis of all patients who underwent S‐ICD implantation between 2010 and 2022 at a single multihospital healthcare system was performed. The primary endpoint was S‐ICD removal or extraction. Patient and device characteristics were abstracted from the electronic medical record. Univariate and multivariate analyses were completed to determine factors associated with S‐ICD extraction.ResultsA total of 372 patients (69.5% male; 48.6 ± 14.4 years old) underwent S‐ICD implantation during the study period. There were 22 (5.9%) patients (81.8% male; 52.1 ± 13.2 years old) who underwent S‐ICD extraction over a median follow‐up period of 4.4 [2.0−6.5] years. The median length of time between implantation and extraction was 39.6 [8.3−64.6] months. The most common indications for S‐ICD extraction were the need for bradycardia pacing (frequency among extractions, 18.2%), infection (22.7%), and inappropriate shocks due to oversensing (22.7%). A smoking history and higher body mass index were independently associated with S‐ICD extraction.ConclusionsThe overall rate of S‐ICD extraction over 4.4 [2.0−6.5] years was 5.9%, with the most common indications for extraction being the need for bradycardia pacing, infection, and inappropriate shocks due to oversensing. A smoking history and high body mass index are associated with increased rates of S‐ICD extraction. With appropriate patient selection for the S‐ICD, the need to remove the device after implantation is low.

Reconstructing ventricular cardiomyocyte dynamics and parameter estimation using data-assimilation

Cardiac ventricular myocyte action potential dynamics are regulated by intricate and nonlinear interactions between the cell transmembrane potential and ionic currents and concentrations. Present technology limits the ability to measure transmembrane potential and multiple ionic currents simultaneously, which narrows the scope of experiments to provide a complete snapshot of the cardiac myocyte state. This limitation presents an obstacle for understanding how perturbations can trigger arrhythmias and more broadly how the myocyte responds to different conditions, such as changes in pacing rate or responses to drug treatment. In this study, we demonstrate that a data-assimilation approach can successfully reconstruct and predict the dynamics of a heterogeneous virtual cardiac ventricular myocyte population in the presence of parameter uncertainty. A population of heterogeneous cardiac ventricular myocytes is generated by varying ionic current conductance parameters, and additional observational uncertainty is mimicked by the addition of Gaussian noise to the transmembrane potential. We demonstrate that the data-assimilation approach accurately reconstructs transmembrane potential, with error less than the magnitude of the noise. Further, the data-assimilation approach successfully estimates the conductances of ionic currents generally with high accuracy and requiring low computational time. As a proof of concept, we apply the data-assimilation approach to reconstruct action potential dynamics from optical mapping experiments in an ex vivo isolated guinea pig heart. Critically, we demonstrate that the ionic conductance parameters estimated from a recording at one pacing frequency can accurately predict action potential dynamics at different rates.

Computational modeling of cardiac electrophysiology applied to a swine model of Long QT Syndrome

Abstract Background Computational models are pivotal for understanding electrophysiological aspects of cardiac diseases. Despite pigs' increased use in research, limited in vitro porcine data impedes accurate mathematical modeling. In this context, we recently developed a novel knock-in porcine model of long QT syndrome type 8 (LQT8) [1]. Purpose To develop a novel computational model for electrophysiology and Ca2+ handing in wild-type and LQT8 swine ventricular cardiomyocytes. Methods We designed a mathematical model of wild-type swine action potential (AP) based on a wide range of cellular electrophysiological data. Using the ORd model [2] as a foundation, we re-parametrized main ionic currents using the Nelder-Mead algorithm. We then modified the model to simulate LQT8, evaluating its utility in exploring arrhythmogenic mechanisms and pharmacological approaches. For the L-type Ca Channel (LTCC), we replaced the original HH formulation with a Markov model based on [3], which was subsequently modified to account for a population of mutant p.G406R channels. Selected biomarkers for validation were AP duration at 20, 50, and 90% of repolarization, maximum upstroke velocity, AP amplitude and resting membrane potential. To assess the robustness of the model, we generated a random population of 500 models accounting for biological variability by sampling key parameters in the range [-20 to +20%] of their original values, using the Latin Hypercube Sampling. Simulations were executed using MATLAB R2023a. Numerical integration was performed utilizing the MATLAB function ode15s. Results The mathematical model accurately reproduced a wide range of experimental data, including steady-state curves of the main ionic currents, kinetic properties of LTCC, APD rate dependency, maximum upstroke velocity and Ca2+transient morphology. The model successfully simulated AP prolongation in LQT8. Also, it replicated key features of the cellular phenotype such as steeper APD rate adaptation, increased duration and amplitude of the Ca2+ transients, increased CaMKII-mediated late Na+ current, pathologically decreased upstroke velocity with increasing pacing frequency, due to a CaMKII-mediated mechanism. As a proof-of-concept, the model was utilized to investigate arrhythmogenic mechanisms and pharmacological approaches for LQT8. According to model’s prediction, early afterdepolarizations (EADs) in LQT8 can stem from three distinct mechanisms: improper kinetics of late Na+ current, improper kinetics of LTCC, and enhanced late-systolic SR Ca release. Notably, the model also predicts that full CaMKII inhibition effectively eliminates EADs for all three mechanisms, showcasing the potential efficacy of this pharmacological intervention. Conclusions A novel mathematical swine ventricular myocyte model explores arrhythmogenic mechanisms and therapeutic interventions, aiding LQT8 research and clinical translation in cardiac disorders.

Abstract Mo114: Assessing Diastolic Performance in Working Myocardial Slices from ZSF1 Rats

Diastolic dysfunction is a prevalent and therapeutically intractable feature of heart failure which arises from increased ventricular compliance and impaired relaxation. Properly assessing diastolic performance is challenging because it requires simultaneous in-vivo measurement of ventricular pressure and volume. Furthermore, identifying diastolic dysfunction may require the simultaneous application of a stress such as physical exertion. Herein, we demonstrate a preparation that recapitulates the complexity of diastole in working myocardial slices: a force-feedback system providing precision control of pacing frequency, preload, afterload, and a tunable stretch at the end of diastole that mimics late filling driven by atrial systole. We assess the diastolic performance (isovolumic relaxation, early and late filling characteristics) in working myocardial slices from a known model of diastolic dysfunction, ZSF1 Obese rats and their Lean control. We find that parameters relating to myocardial performance such as slice work, stroke length, and twitch force are the same between Lean and Obese animals but parameters of diastolic performance are altered in the Obese rats. Specifically, we observe a decreased separation between peak early and late filling with a reduced diastolic filling interval at the same pacing frequency while we do not observe a difference in isovolumic relaxation time. Taken together, these results indicate that while the work output of myocardium is preserved in ZSF1 Obese rats, a reduction in available filling time and early filling efficiency may indicate a reduced capacity maintain output at higher heart rates.

A simplified method based on improved multiplication factors to assess crowd-induced vertical vibrations of footbridges

Due to the high mechanical performance of new structural materials, modern footbridges are usually slender and lightweight structures. It follows that their natural frequencies often fall within the typical range of pedestrian pacing frequencies, feature that renders them rather sensitive to human-induced vibrations. Special care is therefore needed to avoid excessive levels of swaying, both to safeguard pedestrians from being bothered by the sense of discomfort and to prevent the functionality of footbridges to be compromised. However, in contrast with the single person dynamic force, the characterisation of the crowd-induced loading is rather challenging, time-consuming, and thus scarcely compatible with the design stage needs. This paper proposes an analytical model based on the multiplication factor approach, which allows to predict the vertical crowd-induced response from that of a single pedestrian. The work is based on extensive numerical simulations, carried out in due respect of human-human interaction and pedestrian step forcing variability. Besides, the possibility of managing human-structure effects is also foreseen. The method is meant to handle the vibration serviceability check of a wide range of scenarios, including a broad spectrum of footbridge parameters and crowd densities. For validation purposes, model predictions are compared against regulations and experimental results.

Impulse initiation in engrafted pluripotent stem cell-derived cardiomyocytes can stimulate the recipient heart

Transplantation of pluripotent stem cell-derived cardiomyocytes is a novel promising cell-based therapeutic approach for patients with heart failure. However, engraftment arrhythmias are a predictable life-threatening complication and represent a major hurdle for clinical translation. Thus, we wanted to experimentally study whether impulse generation by transplanted cardiomyocytes can propagate to the host myocardium and overdrive the recipient rhythm. We transplanted human induced pluripotent stem cell-derived cardiomyocytes expressing the optogenetic actuator Bidirectional Pair of Opsins for Light-induced Excitation and Silencing (BiPOLES) in a guinea pig injury model. Eight weeks after transplantation ex vivo, Langendorff perfusion was used to assess electrical coupling. Pulsed photostimulation was applied to specifically activate the engrafted cardiomyocytes. Photostimulation resulted in ectopic pacemaking that propagated to the host myocardium, caused non-sustained arrhythmia, and stimulated the recipient heart with higher pacing frequency (4/9 hearts). Our study demonstrates that transplanted cardiomyocytes can (1) electrically couple to the host myocardium and (2) stimulate the recipient heart. Thus, our results provide experimental evidence for an important aspect of engraftment-induced arrhythmia induction and thereby support the current hypothesis that cardiomyocyte automaticity can serve as a trigger for ventricular arrhythmias.

Right ventricular outflow tract cardiomyocytes possess distinct calcium handling and contractile properties

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Rembrandt Research Grant 2021 Background The right ventricular outflow tract (RVOT) is the predominant site of origin of idiopathic ventricular tachycardia. Idiopathic ventricular tachycardias are typically sensitive to adenosine, consistent with triggered activity caused by delayed afterdepolarizations due to intracellular Ca2+ overload. The distinct properties of RVOT myocytes explaining increased susceptibility to Ca2+ overload and triggered activity are unknown. Purpose To identify distinct RVOT electrophysiological properties including Ca2+ handling and its molecular underpinnings. Methods and Results Experiments were performed using freshly isolated cardiomyocytes from the RVOT and right ventricular (RV) apex of adult rabbit hearts. To identify distinct RVOT electrophysiological properties, we employed the perforated patch clamp methodology and measured action potentials and L-type Ca2+ current. Action potentials of RVOT myocytes were significantly shorter compared to RV myocytes, particularly at lower pacing frequency. L-type Ca2+ current peak density was significantly lower in RVOT myocytes compared to RV myocytes (34.0 ± 9.1% at 0 mV). However, voltage-dependencies of L-type Ca2+ current activation and inactivation were not statistically different. Next we measured intracellular Ca2+ transients using the fluorescent Ca2+ indicator indo-1 and found that Ca2+ transient amplitudes were significantly lower in RVOT myocytes compared to RV myocytes. To investigate a relationship between RVOT myocyte Ca2+ handling and contractility, we performed unloaded sarcomere shortening measurements using the Cytocypher Multicell system. Shortening of relaxation time following increased pacing frequency (1-2 Hz) was significantly larger for RVOT myocytes compared to RV myocytes. To identify molecular factors explaining the distinct properties of RVOT myocytes, we performed RNA-seq analysis of differential gene expression using the DESeq2 method. RVOT and RV transcriptomic profiles consisted of 30 differentially expressed genes (adjusted p ≤ 0.05). One of genes significantly higher expressed by the RV was synaptotagmin (SYT1), a Ca2+ sensor and positive regulator of the cardiac L-type Ca2+ channel through inhibition of syntaxin 1A [Ref. 1, 2]. Conclusion RVOT cardiomyocytes possess distinct electrophysiological and contractile properties, reflected by shorter action potentials, lower Ca2+ transient amplitudes, and larger shortening of relaxation time upon increasing pacing frequency. The RVOT and RV have similar but distinct gene expression signatures. Future experiments will focus on determining the role of SYT1 and other genes in regulation of the L-type Ca2+ current and Ca2+ handling in RVOT myocytes.Distinct properties of RVOT myocytes.Transcriptomic profile of the RVOT.

Loss of protein phosphatase 2A regulatory subunit PPP2R5A is associated with increased incidence of stress-induced proarrhythmia.

Protein phosphatase 2A (PP2A) is a serine/threonine-selective holoenzyme that controls Ca2+ homeostasis and contractility of the heart via dephosphorylation of regulatory proteins. In some genetically modified mouse models with increased arrhythmogenicity, a reduced expression of the regulatory subunit B56α of PP2A was found as a concomitant effect. Whether there is a general correlation between the abundance of B56α and the promotion of cardiac arrhythmogenesis remains unclear. The aim of this study was therefore to investigate the role of PP2A-B56α in the propensity for arrhythmic activity in the heart. The experimental analysis of this question has been addressed by using a mouse model with deletion of the PP2A-B56α gene, PPP2R5A (KO), in comparison to wild-type animals (WT). Evidence for arrhythmogenicity was investigated in whole animal, isolated heart and cardiomyocytes by ECG, recording of monophasic action potential (MAP) induced by programmed electrical stimulation (PES), measurement of Ca2+ transients under increased pacing frequencies and determination of total K+ channel currents (I K). ECG measurements showed a prolongation of QT time in KO vs. WT. KO mice exhibited a higher rate of premature ventricular contractions in the ECG. MAP measurements in Langendorff-perfused KO hearts showed increased episodes of ventricular tachyarrhythmia induced by PES. However, the KO hearts showed values for MAP duration that were similar to those in WT hearts. In contrast, KO showed more myocardial cells with spontaneous arrhythmogenic Ca2+ transient events compared to WT. The whole-cell patch-clamp technique applied to ventricular cardiomyocytes revealed comparable peak potassium channel current densities between KO and WT. These findings support the assumption that a decrease or even the loss of PP2A-B56α leads to an increased propensity of triggered arrhythmias. This could be based on the increased spontaneous Ca2+ tansients observed.

Clinical analysis of temporary pacemaker implantation in 6 children with fulminant myocarditis.

There is little literature on the use of temporary pacemakers in children with fulminant myocarditis. Therefore, we summarized the use of temporary cardiac pacemakers in children with fulminant myocarditis in our hospital. The clinical data of children with fulminant myocarditis treated with temporary pacemakers in Wuhan Children's Hospital from January 2017 to May 2022 were retrospectively analyzed. A total of 6 children were enrolled in the study, including 4 boys and 2 girls, with a median age of 50 months and a median weight of 15kg. The average time from admission to pacemaker placement was 2.75 ± 0.4h. The electrocardiogram showed that all 6 children had third-degree atrioventricular block (III°AVB). The initial pacing voltage, the sensory sensitivity of the ventricle and the pacing frequency were set to 5-10 mV, 5V and 100-120bpm respectively. The sinus rhythm was recovered in 5 patients within 61h (17-134) h, and the median time of using temporary pacemaker was 132h (63-445) h. One of the children had persistent III°AVB after the temporary pacemaker. With parental consent, the child was fitted with a permanent pacemaker on the 12th day of his illness. When fulminant myocarditis leads to severe bradycardia or atrioventricular block in children, temporary pacemakers have the characteristics of high safety to improve the heart function.

Distinct Electrogram Features and Ventricular Arrhythmia Induction Modes Between Repolarization and Conduction Heterogeneities

BackgroundRecent clinical studies have indicated the presence of localized electrical abnormalities in idiopathic ventricular fibrillation and J-wave syndrome patients. ObjectivesThis study aims to characterize the specific electrical signatures of localized repolarization and conduction heterogeneities and their respective role in vulnerability to arrhythmias. MethodsOptical mapping was performed in porcine right ventricles with local: 1) repolarization shortening; 2) conduction slowing; or 3) structural heterogeneity induced by locally perfusing: 1) pinacidil (20 μmol/L, n = 13); or 2) flecainide (2 μmol/L, n = 13) via an epicardial catheter; or 3) by local epicardial tissue destruction (9 radiofrequency lesions n = 12). Electrograms were recorded (n = 5 in each group) and spontaneous and induced arrhythmias were quantified and optically mapped. ResultsElectrograms were normal in (1) but showed local fragmentation in 40% of preparations in (2) with greater effects observed at high pacing frequencies dependent on the wavefront direction. In (3), the structural substrate alone increased the width and number of peaks in the electrograms, and addition of flecainide induced pronounced fragmentation (≥3 peaks and ≥70 ms) in all cases. Occurrence of spontaneous arrhythmias was significantly increased in (1) and (2) (P < 0.0001 and 0.05, respectively, vs baseline) and were triggered by ectopies. Vulnerability to arrhythmias at high pacing frequencies (≥2 Hz) was the lowest in (1) and greatest in (2). ConclusionsMicrostructural substrates have the most pronounced impact on electrograms, especially when combined with sodium channel blockers, whereas local action potential duration shortening does not lead to electrogram fragmentation even though it is associated with the highest prevalence of spontaneous arrhythmias.

Synchronous force and Ca2+ measurements for repeated characterization of excitation-contraction coupling in human myocardium

Dysfunctional Ca2+ signaling affects the myocardial systole and diastole, may trigger arrhythmia and cause transcriptomic and proteomic modifications in heart failure. Thus, synchronous real-time measurement of Ca2+ and force is essential to investigate the relationship between contractility and Ca2+ signaling and the alteration of excitation-contraction coupling (ECC) in human failing myocardium. Here, we present a method for synchronized acquisition of intracellular Ca2+ and contraction force in long-term cultivated slices of human failing myocardium. Synchronous time series of contraction force and intracellular Ca2+ were used to calculate force-calcium loops and to analyze the dynamic alterations of ECC in response to various pacing frequencies, post-pause potentiation, high mechanical preload and pharmacological interventions in human failing myocardium. We provide an approach to simultaneously and repeatedly investigate alterations of contractility and Ca2+ signals in long-term cultured myocardium, which will allow detecting the effects of electrophysiological or pharmacological interventions on human myocardial ECC.

Alterations of local Ca2+ signaling by high pacing frequency and shear stress in right and left atrial myocytes

Alterations of local Ca2+ signaling by high pacing frequency and shear stress in right and left atrial myocytes

Mechanisms of PVP-functionalized silver nanoparticle toxicity in fish: Intravascular exposure disrupts cardiac pacemaker function and inhibits Na+/K+-ATPase activity in heart, but not gill

Polyvinylpyrrolidone-functionalized silver nanoparticles (nAgPVP) are popular in consumer products for their colloidal stability and antimicrobial activity. Whole lake additions of nAgPVP cause long term, ecosystem-scale changes in fish populations but the mechanisms underlying this effect are unclear. We have previously shown that in fish, nAgPVP impairs cardiac contractility and Na+/K+-ATPase (NKA) activity in vitro, raising the possibility that heart dysfunction could underlie population-level exposure effects. The goal of this study was to determine if nAgPVP influences the control of heart rate (fh), blood pressure, or cardiac NKA activity in vivo. First, a dose-response curve for the effects of 5 nm nAgPVP on contractility was completed on isometrically contracting ventricular muscle preparations from Arctic char (Salvelinus alpinus) and showed that force production was lowest at 500 μg L−1 and maximum pacing frequency increased with nAgPVP concentration. Stroke volume, cardiac output, and power output were maintained in isolated working heart preparations from brook char (Salvelinus fontinalis) exposed to 700 μg L−1 nAgPVP. Both fh and blood pressure were elevated after 24 h in brook char injected with 700 μg kg body mass−1 nAgPVP and fh was insensitive to modulation with blockers of β-adrenergic and muscarinic cholinergic receptors. Na+/K+-ATPase activity was significantly lower in heart, but not gill of nAgPVP injected fish. The results indicate that nAgPVP influences cardiac function in vivo by disrupting regulation of the pacemaker and cardiomyocyte ionoregulation. Impaired fh regulation may prevent fish from appropriately responding to environmental or social stressors and affect their ability to survive.

In Silico Modeling and Validation of the Effect of Calcium-Activated Potassium Current on Ventricular Repolarization in Failing Myocytes.

The pathophysiological role of the small conductance calcium-activated potassium (SK) channels in human ventricular myocytes remains unclear. Experimental studies have reported upregulation of in pathological states, potentially contributing to ventricular arrhythmias. In heart failure (HF) patients, the upregulation of SK channels could be an adaptive physiological response to shorten the action potential duration (APD) under conditions of reduced repolarization reserve. In this work, we aimed at uncovering the contribution of SK channels to ventricular repolarization in failing myocytes. We extended an in silico electrophysiological model of human ventricular failing myocytes by including a representation of the SK channel activity. To calibrate the maximal SK current conductance (G SK), we simulated action potentials (APs) at different pacing frequencies and matched the changes in AP duration induced by SK channel inhibition or activation to available experimental data. The optimal value obtained for GSK was 4.288 μ S/ μF in mid-myocardial cells, and 6.4 μS/ μF for endocardial and epicardial cells. The simulated SK block-induced effects were consistent with experimental evidence. 1-D simulations of a transmural ventricular fiber indicated that SK channel block may prolong the QT interval and increase the transmural dispersion of repolarization, potentially increasing the risk of arrhythmia in HF. Our results highlight the importance of considering the SK channels to improve the characterization of HF-induced ventricular remodeling. Simulations across various scenarios in 0-D and 1-D scales suggest that pharmacological SK channel inhibition could lead to adverse effects in failing ventricles.

Electrophysiological mechanisms underlying T wave pseudonormalisation on stress ECGs in hypertrophic cardiomyopathy

BackgroundPseudonormal T waves may be detected on stress electrocardiograms (ECGs) in hypertrophic cardiomyopathy (HCM). Either myocardial ischaemia or purely exercise-induced changes have been hypothesised to contribute to this phenomenon, but the precise electrophysiological mechanisms remain unknown. MethodsComputational models of human HCM ventricles (n = 20) with apical and asymmetric septal hypertrophy phenotypes with variable severities of repolarisation impairment were used to investigate the effects of acute myocardial ischaemia on ECGs with T wave inversions at baseline. Virtual 12-lead ECGs were derived from a total of 520 biventricular simulations, for cases with regionally ischaemic K+ accumulation in hypertrophied segments, global exercise-induced serum K+ increases, and/or increased pacing frequency, to analyse effects on ECG biomarkers including ST segments, T wave amplitudes, and QT intervals. ResultsRegional ischaemic K+ accumulation had a greater impact on T wave pseudonormalisation than exercise-induced serum K+ increases, due to larger reductions in repolarisation gradients. Increases in serum K+ and pacing rate partially corrected T waves in some anatomical and electrophysiological phenotypes. T wave morphology was more sensitive than ST segment elevation to regional K+ increases, suggesting that T wave pseudonormalisation may sometimes be an early, or the only, ECG feature of myocardial ischaemia in HCM. ConclusionsIschaemia-induced T wave pseudonormalisation can occur on stress ECG testing in HCM before significant ST segment changes. Some anatomical and electrophysiological phenotypes may enable T wave pseudonormalisation due to exercise-induced increased serum K+ and pacing rate. Consideration of dynamic T wave abnormalities could improve the detection of myocardial ischaemia in HCM.

The W101C KCNJ5 Mutation Induces Slower Pacing by Constitutively Active GIRK Channels in hiPSC-Derived Cardiomyocytes.

Mutations in the KCNJ5 gene, encoding one of the major subunits of cardiac G-protein-gated inwardly rectifying K+ (GIRK) channels, have been recently linked to inherited forms of sinus node dysfunction. Here, the pathogenic mechanism of the W101C KCNJ5 mutation underlying sinus bradycardia in a patient-derived cellular disease model of sinus node dysfunction (SND) was investigated. A human-induced pluripotent stem cell (hiPSCs) line of a mutation carrier was generated, and CRISPR/Cas9-based gene targeting was used to correct the familial mutation as a control line. Both cell lines were further differentiated into cardiomyocytes (hiPSC-CMs) that robustly expressed GIRK channels which underly the acetylcholine-regulated K+ current (IK,ACh). hiPSC-CMs with the W101C KCNJ5 mutation (hiPSCW101C-CM) had a constitutively active IK,ACh under baseline conditions; the application of carbachol was able to increase IK,ACh, further indicating that not all available cardiac GIRK channels were open at baseline. Additionally, hiPSCW101C-CM had a more negative maximal diastolic potential (MDP) and a slower pacing frequency confirming the bradycardic phenotype. Of note, the blockade of the constitutively active GIRK channel with XAF-1407 rescued the phenotype. These results provide further mechanistic insights and may pave the way for the treatment of SND patients with GIRK channel dysfunction.

Cognitive and gait in Wilson's disease: a cognitive and motor dual-task study.

Cognitive and motor dual-tasks play important roles in daily life. Dual-task interference impacting gait performance has been observed not only in healthy subjects but also in subjects with neurological disorders. Approximately 44-75% of Wilson's disease (WD) patients have gait disturbance. According to our earlier research, 59.7% of WD patients have cognitive impairment. However, there are few studies on how cognition affects the gait in WD. Therefore, this study aims to explore the influence of cognitive impairment on gait and its neural mechanism in WD patients and to provide evidence for the clinical intervention of gait disturbance. We recruited 63 patients who were divided into two groups based on their scores on the Addenbrooke's cognitive examination III (ACE-III) scale: a non-cognitive impairment group and a cognitive impairment group. In addition to performing the timed up and go (TUG) single task and the cognitive and motor dual-task digital calculation and animal naming tests, the Tinetti Balance and Gait Assessment (POMA), Berg Balance Scale (BBS), and brain MRI severity scale of WD (bMRIsc-WD) were evaluated. The dual-task cost (DTC) was also computed. Between the two groups, the results of the enhanced POMA, BBS, and bMRIsc-WD scales, as well as gait performance measures such as TUG step size, pace speed, pace frequency, and DTC value, were compared. (1) Among the 63 patients with WD, 30 (47.6%) patients had gait disturbance, and the single task TUG time was more than 10 s. A total of 43 patients had cognitive impairment, the incidence rate is 44.4%. Furthermore, 28 (44.4%) patients had cognitive impairment, 39 (61.9%) patients had abnormal brain MRI. (2) The Tinetti gait balance scale and Berg balance scale scores of patients with cognitive impairment were lower than those of patients without cognitive impairment (p < 0.05), and the pace, step size, and pace frequency in the single task TUG were slower than those of patients without cognitive impairment (p < 0.05). There was no change in the pace frequency between the dual-task TUG and the non-cognitive impairment group, but the pace speed and step size in the dual-task TUG were smaller than non-cognitive impairment group (p < 0.05). There was no difference in DTC values between cognitive impairment group and non-cognitive impairment group when performing dt-TUG number calculation and animal naming respectively (p > 0.05). However, regardless of cognitive impairment or not, the DTC2 values of number calculation tasks is higher than DTC1 of animal naming tasks in dt-TUG (p < 0.05). (3) Pace speed and step size were related to the total cognitive score, memory, language fluency, language understanding, and visual space factor score of the ACE-III (p < 0.05), and step frequency was correlated with memory and language comprehension factors (p < 0.05). There was no correlation between the attention factor scores of the ACE-III and TUG gait parameters of different tasks (p > 0.05). Brain atrophy, the thalamus, caudate nucleus, and cerebellum were correlated with cognitive impairment (p < 0.05), the lenticular nucleus was related to the step size, brain atrophy was related to the pace speed, and the thalamus, caudate nucleus, and midbrain were involved in step frequency in WD patients (p < 0.05). WD patients had a high incidence of cognitive impairment and gait disorder, the pace speed and step size can reflect the cognitive impairment of WD patients, cognitive impairment affects the gait disorder of WD patients, and the different cognitive and motor dual-tasks were involved in affecting gait parameters. The joint participation of cognitive impairment and lesion brain area may be the principal neural mechanism of gait abnormality in WD patients.

Single-Cell Analysis of Contractile Forces in iPSC-Derived Cardiomyocytes: Paving the Way for Precision Medicine in Cardiovascular Disease.

Induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) hold enormous potential in cardiac disease modeling, drug screening, and regenerative medicine. Furthermore, patient-specific iPSC-CMS can be tested for personalized medicine. To provide a deeper understanding of the contractile force dynamics of iPSC-CMs, we employed Atomic Force Microscopy (AFM) as an advanced detection tool to distinguish the characteristics of force dynamics at a single cell level. We measured normal (vertical) and lateral (axial) force at different pacing frequencies. We found a significant correlation between normal and lateral force. We also observed a significant force-frequency relationship for both types of forces. This work represents the first demonstration of the correlation of normal and lateral force from individual iPSC-CMs. The identification of this correlation is relevant because it validates the comparison across systems and models that can only account for either normal or lateral force. These findings enhance our understanding of iPSC-CM properties, thereby paving the way for the development of therapeutic strategies in cardiovascular medicine.

Local Control Model of a Human Ventricular Myocyte: An Exploration of Frequency-Dependent Changes and Calcium Sparks.

Calcium (Ca2+) sparks are the elementary events of excitation-contraction coupling, yet they are not explicitly represented in human ventricular myocyte models. A stochastic ventricular cardiomyocyte human model that adapts to intracellular Ca2+ ([Ca2+]i) dynamics, spark regulation, and frequency-dependent changes in the form of locally controlled Ca2+ release was developed. The 20,000 CRUs in this model are composed of 9 individual LCCs and 49 RyRs that function as couplons. The simulated action potential duration at 1 Hz steady-state pacing is ~0.280 s similar to human ventricular cell recordings. Rate-dependence experiments reveal that APD shortening mechanisms are largely contributed by the L-type calcium channel inactivation, RyR open fraction, and [Ca2+]myo concentrations. The dynamic slow-rapid-slow pacing protocol shows that RyR open probability during high pacing frequency (2.5 Hz) switches to an adapted "nonconducting" form of Ca2+-dependent transition state. The predicted force was also observed to be increased in high pacing, but the SR Ca2+ fractional release was lower due to the smaller difference between diastolic and systolic [Ca2+]SR. Restitution analysis through the S1S2 protocol and increased LCC Ca2+-dependent activation rate show that the duration of LCC opening helps modulate its effects on the APD restitution at different diastolic intervals. Ultimately, a longer duration of calcium sparks was observed in relation to the SR Ca2+ loading at high pacing rates. Overall, this study demonstrates the spontaneous Ca2+ release events and ion channel responses throughout various stimuli.

Abstract P3127: Atrial Myocytes From Patients With Paroxysmal Atrial Fibrillation Show A Higher Predisposition To Arrhythmogenic Action Potential Alternans

Background: Alternans, the periodic beat-to-beat alternation in electrical and calcium signaling of a cardiac myocyte stimulated at a fixed frequency is well documented to be proarrhythmic. Nonetheless, the involvement of alternans in the processes promoting paroxysmal atrial fibrillation (pAF) is unknown. As such, we set out to ascertain if alternans contribute to the arrhythmogenic mechanisms in pAF. Methods: Simultaneous action potentials (patch-clamp) and [Ca 2+ ] i (Fluo3) were recorded in right atrial myocytes obtained from patients with sinus rhythm (Ctl; n=16) and pAF (n=8). AP and CaT alternans were acquired and analyzed using a custom-written software. Results: AP duration was similar between pAF and Ctl groups over different pacing frequencies, exempting electrical remodeling in pAF. A higher incidence of CaT alternans (46% vs 18%; P =0.08) and AP alternans (82% vs 52%; P &lt;0.05) was observed in myocytes from pAF patients compared with Ctl ( Figure A ). Additionally, the minimum frequency at which AP alternans was detected was significantly lower in pAF (2.4 ± 0.8 vs 4.6 ± 0.6 Hz; n/N=9/6 pAF vs 13/12 Ctl; P &lt;0.05; Figure B ). However, the AP restitution was unchanged in Ctl and pAF myocytes ( Figure C ), thus suggesting CaT alternans as the primary driver of AP alternation ( Figure D ). Conclusion: Atrial myocytes from pAF patients exhibit a higher predisposition to cellular alternans that may alter excitation-propagation in the atria and contribute to the arrhythmogenic substrate in these patients.