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4.
J Am Coll Cardiol ; 78(23): 2267-2277, 2021 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-34857087

RESUMO

BACKGROUND: The prognosis of exercise-induced premature ventricular contractions (PVCs) in asymptomatic individuals is unclear. OBJECTIVES: This study sought to investigate whether high-grade PVCs during stress testing predict mortality in asymptomatic individuals. METHODS: A cohort of 5,486 asymptomatic individuals who took part in the Lipid Research Clinics prospective cohort had baseline interview, physical examination, blood tests, and underwent Bruce protocol treadmill testing. Adjusted Cox survival models evaluated the association of exercise-induced high-grade PVCs (defined as either frequent (>10 per minute), multifocal, R-on-T type, or ≥2 PVCs in a row) with all-cause and cardiovascular mortality. RESULTS: Mean baseline age was 45.4 ± 10.8 years; 42% were women. During a mean follow-up of 20.2 ± 3.9 years, 840 deaths occurred, including 311 cardiovascular deaths. High-grade PVCs occurred during exercise in 1.8% of individuals, during recovery in 2.4%, and during both in 0.8%. After adjusting for age, sex, diabetes, hypertension, lipids, smoking, body mass index, and family history of premature coronary disease, high-grade PVCs during recovery were associated with cardiovascular mortality (hazard ratio [HR]: 1.82; 95% CI: 1.19-2.79; P = 0.006), which remained significant after further adjusting for exercise duration, heart rate recovery, achieving target heart rate, and ST-segment depression (HR: 1.68; 95% CI: 1.09-2.60; P = 0.020). Results were similar by clinical subgroups. High-grade PVCs occurring during the exercise phase were not associated with increased risk. Recovery PVCs did not improve 20-year cardiovascular mortality risk discrimination beyond clinical variables. CONCLUSIONS: High-grade PVCs occurring during recovery were associated with long-term risk of cardiovascular mortality in asymptomatic individuals, whereas PVCs occurring only during exercise were not associated with increased risk.


Assuntos
Teste de Esforço/efeitos adversos , Exercício Físico/fisiologia , Frequência Cardíaca/fisiologia , Medição de Risco/métodos , Complexos Ventriculares Prematuros/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida/tendências , Complexos Ventriculares Prematuros/mortalidade , Complexos Ventriculares Prematuros/fisiopatologia
8.
Heart Rhythm ; 18(11): 1976-1987, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34371193

RESUMO

BACKGROUND: Sympathetic activation in ischemic heart disease can cause lethal arrhythmias. These often are preceded by premature ventricular complexes (PVCs), which at the cellular level could result from delayed afterdepolarizations. OBJECTIVE: The purpose of this study was to identify and map vulnerable areas for arrhythmia initiation after myocardial infarction (MI) and to explore the link between PVCs and cellular events. METHODS: Anterior-septal wall MI was induced by 120 minutes of coronary occlusion followed by reperfusion (27 MI and 16 sham pigs). After 4 weeks, EnSite™ electroanatomic mapping combined with imaging was performed to precisely locate PVC sites of origin and subsequently record monophasic action potentials. Cardiomyocytes were isolated from different regions to study regional cellular remodeling. Isoproterenol was used as a surrogate for adrenergic stimulation both in vivo and in cardiomyocytes. RESULTS: PVCs originated from the MI border zone (BZ) and occurred at discrete areas with clusters of PVCs within the BZ. At these sites, frequent delayed afterdepolarizations and occasional associated spontaneous action potentials translating to a PVC were present. Cardiomyocytes isolated from the MI BZ exhibited more spontaneous action potentials than cardiomyocytes from remote regions. Sensitivity to adrenergic stimulation was increased in MI, in vivo and in cardiomyocytes. In awake, freely moving MI animals, frequent PVCs, ventricular arrhythmia, and sudden cardiac death occurred spontaneously at moderately elevated heart rates. CONCLUSION: Post-MI, arrhythmias initiate from discrete vulnerable areas within the BZ, where delayed afterdepolarizations, related to increased adrenergic response of BZ cardiomyocytes, can generate PVCs.


Assuntos
Mapeamento Epicárdico , Isquemia Miocárdica/fisiopatologia , Complexos Ventriculares Prematuros/fisiopatologia , Animais , Modelos Animais de Doenças , Isoproterenol , Imagem Cinética por Ressonância Magnética , Isquemia Miocárdica/diagnóstico por imagem , Suínos , Complexos Ventriculares Prematuros/diagnóstico por imagem
9.
Heart Rhythm ; 18(11): 1959-1965, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34375724

RESUMO

BACKGROUND: Electrocardiographic (ECG) criteria have been proposed to localize the site of origin of outflow region ventricular arrhythmias (VAs). Many factors influence the QRS morphology of VAs and may limit the accuracy of these criteria. OBJECTIVE: The purpose of this study was to assess the accuracy of ECG criteria that differentiate right from left outflow region VAs and localize VAs within the aortic sinus of Valsalva (ASV). METHODS: One hundred one patients (mean age 52 ± 16 years; 55 [54%] women) undergoing catheter ablation of right ventricular outflow tract (RVOT) or ASV VAs with a left bundle branch block, inferior axis morphology were studied. ECG measurements including V2 transition ratio, transition zone index, R-wave duration index, R/S amplitude index, V2S/V3R index, V1-3 QRS morphology, R-wave amplitude in the inferior leads were tabulated for all VAs. Comparisons were made between the predicted site of origin using these criteria and the successful ablation site. RESULTS: Patients had successful ablation of 71 RVOT and 38 ASV VAs. For the differentiation of RVOT from ASV VAs, the positive predictive values and negative predictive values for all tested ECG criteria ranged from 42% to 75% and from 71% to 82%, respectively, with the V2S/V3R index having the largest area under the curve of 0.852. Morphological QRS criteria in leads V1 through V3 did not localize ASV VAs. The maximum R-wave amplitude in the inferior leads was the sole criterion demonstrating a significant difference between right ASV, right-left ASV commissure, and left ASV sites. CONCLUSION: ECG criteria for differentiating right from left ventricular outflow region VAs and for localizing ASV VAs have a limited accuracy.


Assuntos
Bloqueio de Ramo/cirurgia , Ablação por Cateter , Eletrocardiografia , Taquicardia Ventricular/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/fisiopatologia , Mapeamento Epicárdico , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taquicardia Ventricular/diagnóstico por imagem , Taquicardia Ventricular/fisiopatologia , Complexos Ventriculares Prematuros/diagnóstico por imagem , Complexos Ventriculares Prematuros/fisiopatologia , Complexos Ventriculares Prematuros/cirurgia
10.
BMC Cardiovasc Disord ; 21(1): 397, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34407753

RESUMO

BACKGROUND: We sought to identify the electrocardiographic and electrophysiological characteristics of ventricular arrhythmias (VAs), including idiopathic ventricular tachycardia (VT) and premature ventricular contractions (PVCs), with acute successful radiofrequency catheter ablation (RFCA) at the superior portion of the mitral annulus (SP-MA). METHODS AND RESULTS: Among 437 consecutive patients who presented with VAs for RFCA, twenty-six patients with acute successful RFCA at the SP-MA were included in this study. The ratio of the amplitude of the first positive peak (if present) versus the nadir in the unipolar electrogram (EGM) was 0.00-0.03 (0.00) at the acute successful RFCA site. The time interval between the QRS onset and the maximum descending slope (D-Max) in the unipolar EGM (QRS-Uni) was 18.8 ± 13.6 ms. With bipolar mapping, the ventricular QRS (V-QRS) interval was 3.75-17.3 (11) ms, 6 (23.1%) patients showed the earliest V-QRS interval of 0 ms, and the other 20 patients (76.9%) showed a V-QRS interval of 10-54 ms. The RFCA start-to-effect time was 14.1 ± 7.2 s in 23 patients (88.5%). In the remaining 3 patients (11.5%), the mean duration of successful RFCA was not well defined due to the infrequent nature of clinical VAs during RFCA. Early (within 3 days) and late (1-year) recurrence rates were 23.1% (6 patients) and 26.9% (7 patients), respectively. VAs disappeared 3 days later due to delayed RFCA efficacy in 2 patients (7.7%). No complications occurred during the RFCA procedure or the one-year follow-up. CONCLUSIONS: SP-MA VAs are a rare but distinct subgroup of VAs. Bipolar and unipolar EGM features can help to determine the optimal RFCA site, and the QRS-Uni interval may serve as a marker that could be used to guide RFCA.


Assuntos
Ablação por Cateter , Valva Mitral/cirurgia , Taquicardia Ventricular/cirurgia , Complexos Ventriculares Prematuros/cirurgia , Adulto , Idoso , Ablação por Cateter/efeitos adversos , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Recidiva , Estudos Retrospectivos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/fisiopatologia
11.
Pacing Clin Electrophysiol ; 44(10): 1781-1785, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34314041

RESUMO

BACKGROUND: Spontaneous ventricular premature contractions (PVCs) and ventricular tachycardia (VT) in the acute post infarct milieu is assumed to be due to automaticity. However, the mechanism has not been studied with intramural mapping. OBJECTIVE: To study the mechanism of spontaneous PVCs with high density intramural mapping in a canine model, and to test the hypothesis that post-infarct PVCs and VT are due to re-entry rather than automaticity. METHODS: In 15 anesthetized dogs, using 768 intramural unipolar electrograms, simultaneous recordings were made. After 20 min of stabilization, recordings were made during the first 10 min of ischemia, and activation maps of individual beats were constructed. Acute ischemia was produced by clamping the left anterior descending coronary artery proximal to the first diagonal branch. RESULTS: In all experiments ST-T alternans was present. Spontaneous ventricular beats occurred in five of 15 dogs where the earliest ectopic activity was manifested in the endocardium, well within the ischemic zone. From there, activity spread rapidly along the subendocardium, with endo-to epicardial spread along the non-ischemic myocardium. Epicardial breakthrough always occurred at the border of the ischemic myocardium. In three dogs, delayed potentials were observed, which were earliest at the ischemic epicardium and extended transmurally with increasing delay towards the endocardium, where they culminated in a premature beat. A similar sequence was observed in VT that followed. CONCLUSION: Graded responses that occur with each sinus beat intramurally, when able to propagate from epicardium to endocardium are the mechanism of PVCs and VT in post-infarct myocardium.


Assuntos
Mapeamento Epicárdico , Isquemia Miocárdica/fisiopatologia , Taquicardia Ventricular/fisiopatologia , Complexos Ventriculares Prematuros/fisiopatologia , Animais , Cães , Eletrocardiografia
12.
Heart Rhythm ; 18(11): 1968-1975, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34214648

RESUMO

BACKGROUND: Clinical studies have suggested that there is a significant correlation between left ventricular (LV) false tendon and premature ventricular complexes (PVCs). OBJECTIVE: This study aimed to investigate the electrophysiological characteristics and the outcome of radiofrequency catheter ablation (RFCA) for this category of PVCs. METHODS: From a total of 2284 patients with idiopathic PVCs who underwent catheter ablation at 6 institutions in China, intracardiac echocardiography (ICE) was used during the procedure in 346 cases; 10 patients (2.9%) with PVCs associated with false tendon were retrospectively reviewed and enrolled in the present study. Activation mapping and pace mapping were performed to localize the origin of PVCs. ICE was used in all patients. If the false tendon was directly visualized and identified, we attempted to identify the distinct relationship with the PVC origin. RESULTS: The PVCs were successfully eliminated by ablation in all patients. The target sites were confirmed to be related to false tendon. The origin of PVCs was located at the attachment of the false tendon to the papillary muscle, LV septum, or LV apex. At the target site, high-frequency Purkinje potentials were observed preceding local ventricular activation in 7 patients. CONCLUSION: LV false tendon can be associated with PVCs, which can be cured by RFCA. An ICE-guided electroanatomical approach should be considered to improve the safety and feasibility of this procedure.


Assuntos
Ablação por Cateter/métodos , Complexos Ventriculares Prematuros/cirurgia , Adulto , China , Ecocardiografia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Complexos Ventriculares Prematuros/fisiopatologia
13.
Am Heart J ; 241: 83-86, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34302751

RESUMO

SARS-CoV-2 infection has been associated with cardiovascular disease in children, but which children need cardiac evaluation is unclear. We describe our experience evaluating 206 children for cardiac disease following SARS-CoV-2 infection (one of whom had ventricular ectopy) and propose a new guideline for management of these children. Routine cardiac screening after SARS-CoV-2 infection in children without any cardiac signs or symptoms does not appear to be high yield.


Assuntos
Assistência ao Convalescente , COVID-19/fisiopatologia , Cardiopatias/diagnóstico , Encaminhamento e Consulta , Adolescente , Assistência Ambulatorial , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Bradicardia/diagnóstico , Bradicardia/etiologia , Bradicardia/fisiopatologia , COVID-19/complicações , Cardiologia , Dor no Peito/fisiopatologia , Criança , Pré-Escolar , Dispneia/fisiopatologia , Ecocardiografia , Eletrocardiografia , Fadiga/fisiopatologia , Feminino , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico , Hipertrofia Ventricular Esquerda/etiologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Hipertrofia Ventricular Direita/diagnóstico , Hipertrofia Ventricular Direita/etiologia , Hipertrofia Ventricular Direita/fisiopatologia , Ciência da Implementação , Masculino , Pediatria , Guias de Prática Clínica como Assunto , SARS-CoV-2 , Índice de Gravidade de Doença , Síncope/fisiopatologia , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/etiologia , Complexos Ventriculares Prematuros/fisiopatologia , Adulto Jovem
16.
Pacing Clin Electrophysiol ; 44(8): 1449-1463, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34081333

RESUMO

Premature ventricular complexes (PVCs) are increasingly recognized, as the use of ECG wearables becomes more widespread. In particular, PVCs arising from both the right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT) comprise the majority of these arrhythmias and form a significant component of an electrophysiology practice. A keen understanding of the correlative anatomy of the outflow tracts, in addition to recognizing key ECG indices illustrating PVC sites of origin, are fundamental in preparing for a successful ablation. Patient selection, incorporating symptomatology, structural disease, and PVC burden can pose a challenge, though tools such as the ABC-VT risk score may help identify those patients with a higher risk of clinical deterioration. Utilizing intracardiac echocardiography to highlight salient anatomic features not visible with fluoroscopy allows for a more precise and safer ablation. Interpretation of intracardiac EGMs, and the careful examination for low amplitude highly fractionated pre-potentials, enhanced by the advent of new developed mapping/ablation catheters, remains crucial. Utilizing these tools will guide the electrophysiologist to an efficient and effective outflow tract PVC ablation.


Assuntos
Ecocardiografia/métodos , Eletrocardiografia/métodos , Mapeamento Epicárdico/métodos , Complexos Ventriculares Prematuros/diagnóstico , Ablação por Cateter , Humanos , Complexos Ventriculares Prematuros/fisiopatologia , Complexos Ventriculares Prematuros/cirurgia
17.
Heart Rhythm ; 18(10): 1709-1716, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34029733

RESUMO

BACKGROUND: Pacemapping (PM) is a useful maneuver for aiding premature ventricular complex (PVC) ablation. Its standalone clinical value is still to be defined. OBJECTIVES: The purpose of this study was to analyze the efficacy of a predefined PM protocol for low-burden PVC ablation, regardless of their site of origin (SOO) and the presence of structural heart disease. METHODS: This was a prospective, nonrandomized, multicenter study. The PM protocol was performed when <1 PVC/min was found. The "target area" was delimited by the 3 best matching points >94% correlation, and 3 radiofreqency (RF) applications were delivered. RESULTS: Of 185 patients, 105 (57%) underwent activation mapping, 60 (32%) were PM-guided, and 20 (11%) were canceled due to absence of PVCs. Baseline QRS, PVC burden, and outflow tract origin were independent predictors of PM-guided ablation. A higher proportion of right ventricular outflow tract SOO in the PM group (52% vs 40%; P = .03) was observed. Mean target area was 0.6 ± 0.9 cm2. Mean 10-ms isochronal area in local activation time (LAT)-guided procedures was higher (1.7 ± 2.3 cm2; P <.001). Mean number of PM matching points acquired was 39 ± 21 (range 6-98). Mean mapping and RF times were similar in both groups. However, significantly shorter procedural (53 ± 24 vs 61 ± 26 minutes; P = .04) as well as RF times (111 ± 51 vs 149 ± 149 seconds; P = .05) were needed in the PM group using the proposed protocol. Global clinical success reached 87% for the PM group and 90% (P = .58) the for LAT mapping group. CONCLUSION: When LAT mapping is precluded, application of a PM-guided ablation protocol directed to >94% matching correlation target area is a more efficient alternative with comparable clinical results.


Assuntos
Mapeamento Potencial de Superfície Corporal/métodos , Ablação por Cateter/métodos , Eletrocardiografia Ambulatorial/métodos , Ventrículos do Coração/fisiopatologia , Volume Sistólico/fisiologia , Complexos Ventriculares Prematuros/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Complexos Ventriculares Prematuros/cirurgia
18.
Pacing Clin Electrophysiol ; 44(6): 1094-1096, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33974711

RESUMO

A 32-year-old lady was evaluated for recurrent episodes of palpitation. During one of the palpitation episodes a regular narrow QRS tachycardia was documented, and it got terminated with the administration of IV adenosine. The baseline 12 lead electrocardiogram (ECG) did not show any manifest preexcitation. There was no evidence of structural heart disease by echocardiogram. Patient underwent an electrophysiology (EP) study after informed consent. Quadripolar catheters were placed at the His region and right ventricular (RV) apex. A decapolar catheter was placed in the coronary sinus (CS) with CS 9, 10 dipoles at CS OS region and CS 1, 2 dipoles at CS distal region. A mapping & ablation catheter was positioned at right atrial (RA) appendage. Baseline atrial and ventricular pacing protocols could not be performed as both atrial and ventricular pacing were easily inducing a regular narrow QRS tachycardia. His refractory premature ventricular beats [PVBs] were delivered from RVRV apex and left ventricular [LV] free wall. Discordant responses were obtained. What is the mechanism?


Assuntos
Sistema de Condução Cardíaco/fisiopatologia , Taquicardia/fisiopatologia , Complexos Ventriculares Prematuros/fisiopatologia , Adulto , Eletrocardiografia , Mapeamento Epicárdico , Feminino , Humanos
19.
Biomed Res Int ; 2021: 5551325, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33997005

RESUMO

BACKGROUND: The study was aimed at exploring the electrophysiological characteristics (EPS) of the optimal ablation site and its relationship with electroanatomic voltage mapping (EVM) in idiopathic premature ventricular contractions (PVCs) originating from the right ventricular outflow tract (RVOT). METHODS: A total of 28 patients with idiopathic RVOT PVCs underwent successful ablation and EVM using a 3D electroanatomical mapping (CARTO) system. RESULTS: Both bipolar and unipolar EVM showed a similar band-like lower-voltage area (LVA) under the pulmonary valve in all the patients; 21.4% of the targets were located in the band-like LVA. 42.9% of the targets were at the border of the band-like LVA on the bipolar voltage map, but unipolar mapping showed that 53.6% of the targets were located in the band-like LVA, and 35.7% of the targets at the border of the band-like LVA. A significant difference was found in both unipolar and bipolar voltage values between the regions within 0-5 mm above the optimal ablation site and the other regions. A similar difference was observed only in unipolar voltage values below the optimal ablation site. At the ablation site, there were frequent occurrences of a fragmented wave and voltage reversion in the bipolar electrograms, frustrated falling limbs, W bottom, and a QS configuration width > 150 ms in the unipolar electrograms. CONCLUSIONS: EVM showed that the band-like LVA was an interesting area for the search of the optimal ablation sites of idiopathic RVOT-PVCs, especially the border area. There was focal microscarring around the ablation targets; some characteristics of EPS proved significant for successful ablation.


Assuntos
Técnicas Eletrofisiológicas Cardíacas , Ventrículos do Coração , Complexos Ventriculares Prematuros , Adulto , Ablação por Cateter , Eletrocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Ventrículos do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complexos Ventriculares Prematuros/diagnóstico por imagem , Complexos Ventriculares Prematuros/fisiopatologia , Complexos Ventriculares Prematuros/cirurgia
20.
Heart Rhythm ; 18(9): 1586-1595, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33845214

RESUMO

BACKGROUND: The mechanisms underlying premature ventricular contraction (PVC)-induced cardiomyopathy (PIC) remain unknown. Transient receptor potential vanilloid-1 (TRPV1) afferent fibers are implicated in the reflex processing of cardiac stress. OBJECTIVE: The purpose of this study was to determine whether cardiac TRPV1 afferent signaling promote PIC. METHODS: A PIC swine model (50% PVC burden) was created via an implanted pacemaker. We selectively depleted cardiac TRPV1 afferent fibers using percutaneous epicardial application of resiniferatoxin (RTX). Animals were randomized to PVC only (n = 11), PVC+RTX (n = 11), or control (n = 6). We examined early-stage (4 weeks after implantation; n = 5) and late-stage PIC (8 weeks after implantation; n = 6). At terminal experimentation, animals underwent echocardiography, serum sampling, and physiological and autonomic reflex testing. RESULTS: Depletion of cardiac TRPV1 afferents by RTX treatment was confirmed by absent sensory fibers and absent functional responses to TRPV1 activators. Left ventricular ejection fraction was worse in late-stage than early-stage PIC (P <.01). At 4 weeks (early stage), left ventricular ejection fraction was higher in PVC+RTX vs PVC animals (51.7% ± 1.6% vs 45.0% ± 2.1%; P = .030), whereas no significant difference between PVC and PVC+RTX was observed at 8 weeks (late stage). Histologic studies demonstrated reduced fibrosis in PVC+RTX vs PVC alone at 4 weeks (2.27% ± 0.14% vs 3.01% ± 0.21%; P = .020), suggesting that RTX mitigated profibrotic pathways induced by persistent PVCs. CONCLUSION: TRPV1 afferent depletion alleviates left ventricular dysfunction in early- but not late-stage PIC. This temporal effect suggests that multiple pathways promote PIC, of which TRPV1 afferents are a part.


Assuntos
Vias Aferentes/fisiopatologia , Cardiomiopatias , Coração/inervação , Transdução de Sinais , Canais de Cátion TRPV/agonistas , Complexos Ventriculares Prematuros , Animais , Cardiomiopatias/etiologia , Cardiomiopatias/patologia , Cardiomiopatias/fisiopatologia , Diterpenos/farmacologia , Ecocardiografia/métodos , Fibrose , Modelos Animais , Neurotoxinas/farmacologia , Volume Sistólico , Suínos , Função Ventricular Esquerda , Complexos Ventriculares Prematuros/complicações , Complexos Ventriculares Prematuros/fisiopatologia
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