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Article ; Online: Vagus Nerve Stimulation and Inflammation in Cardiovascular Disease: A State-of-the-Art Review.

Bazoukis, George / Stavrakis, Stavros / Armoundas, Antonis A

Journal of the American Heart Association

2023 Volume 12, Issue 19, Page(s) e030539

Abstract: Vagus nerve stimulation (VNS) has been found to exert anti-inflammatory effects in different clinical settings and has been associated with improvement of clinical outcomes. However, evidence on the mechanistic link between the potential association of ... ...

Abstract	Vagus nerve stimulation (VNS) has been found to exert anti-inflammatory effects in different clinical settings and has been associated with improvement of clinical outcomes. However, evidence on the mechanistic link between the potential association of inflammatory status with clinical outcomes following VNS is scarce. This review aims to summarize the existing knowledge linking VNS with inflammation and its potential link with major outcomes in cardiovascular diseases, in both preclinical and clinical studies. Existing data show that in the setting of myocardial ischemia and reperfusion, VNS seems to reduce inflammation resulting in reduced infarct size and reduced incidence of ventricular arrhythmias during reperfusion. Furthermore, VNS has a protective role in vascular function following myocardial ischemia and reperfusion. Atrial fibrillation burden has also been reduced by VNS, whereas suppression of inflammation may be a potential mechanism for this effect. In the setting of heart failure, VNS was found to improve systolic function and reverse cardiac remodeling. In summary, existing experimental data show a reduction in inflammatory markers by VNS, which may cause improved clinical outcomes in cardiovascular diseases. However, more data are needed to evaluate the association between the inflammatory status with the clinical outcomes following VNS.
MeSH term(s)	Humans ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/therapy ; Cardiovascular Diseases/complications ; Myocardial Infarction ; Vagus Nerve Stimulation/methods ; Myocardial Ischemia ; Arrhythmias, Cardiac ; Coronary Artery Disease ; Inflammation ; Vagus Nerve
Language	English
Publishing date	2023-09-18
Publishing country	England
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.123.030539
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Autonomic Nervous System and Cardiac Metabolism: Links Between Autonomic and Metabolic Remodeling in Atrial Fibrillation.

Chakraborty, Praloy / Farhat, Kassem / Po, Sunny S / Armoundas, Antonis A / Stavrakis, Stavros

JACC. Clinical electrophysiology

2023 Volume 9, Issue 7 Pt 2, Page(s) 1196–1206

Abstract: Simultaneous activation of the sympathetic and parasympathetic nervous systems is crucial for the initiation of paroxysmal atrial fibrillation (AF). However, unbalanced activation of the sympathetic system is characteristic of autonomic remodeling in ... ...

Abstract	Simultaneous activation of the sympathetic and parasympathetic nervous systems is crucial for the initiation of paroxysmal atrial fibrillation (AF). However, unbalanced activation of the sympathetic system is characteristic of autonomic remodeling in long-standing persistent AF. Moreover, the adrenergic activation-induced metabolic derangements provide a milieu for acute AF and promote the transition from the paroxysmal to the persistent phase of AF. On the other hand, cholinergic activation ameliorates the maladaptive metabolic remodeling in the face of metabolic challenges. Selective inhibition of the sympathetic system and restoration of the balance of the cholinergic system by neuromodulation is emerging as a novel nonpharmacologic strategy for managing AF. This review explores the link between cardiac autonomic and metabolic remodeling and the potential roles of different autonomic modulation strategies on atrial metabolic aberrations in AF.
MeSH term(s)	Humans ; Atrial Fibrillation ; Autonomic Nervous System ; Heart Atria ; Heart Rate/physiology
Language	English
Publishing date	2023-04-19
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2846739-5
ISSN	2405-5018 ; 2405-500X ; 2405-500X
ISSN (online)	2405-5018 ; 2405-500X
ISSN	2405-500X
DOI	10.1016/j.jacep.2023.02.019
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Article ; Online: RespiCo: A novel, flexible, and stand-alone electronic respiratory coaching device.

Kulkarni, Kanchan / Nichols, John H / Armoundas, Antonis A / Roberts, Jesse D

HardwareX

2022 Volume 12, Page(s) e00335

Abstract: Conscious respiratory pattern and rate control is desired by patients with some forms of pulmonary disease that are undergoing respiratory muscle conditioning and rehabilitation, by practitioners of meditation hoping to improve mindfulness and wellbeing, ...

Abstract	Conscious respiratory pattern and rate control is desired by patients with some forms of pulmonary disease that are undergoing respiratory muscle conditioning and rehabilitation, by practitioners of meditation hoping to improve mindfulness and wellbeing, by athletes striving to obtain breathing control in order to increase competitiveness, and by engineers and scientists that wish to use the data from breathing subjects to test hypotheses and develop physiological monitoring systems. Although prerecorded audio sources and computer applications are available that guide breathing exercises, they often suffer from being inflexible and allow only limited customization of the breathing cues. Here we describe a small, lightweight, battery-powered, microprocessor-based respiratory coaching device (RespiCo), which through wireless or wired connections, can be easily customized to precisely guide subjects to breathe at desired respiratory rates using specific breathing patterns through visual, auditory, or haptic cues. Digital signals can also be captured from the device to document the breathing cues provided by the device for research purposes. It is anticipated that this device will have important utility for those who wish to be guided to breathe in a precise manner or in research and development of physiologic monitoring systems.
Language	English
Publishing date	2022-07-16
Publishing country	England
Document type	Journal Article
ISSN	2468-0672
ISSN (online)	2468-0672
DOI	10.1016/j.ohx.2022.e00335
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Article ; Online: Utility of a Smartphone-Based System (cvrPhone) in Estimating Minute Ventilation from Electrocardiographic Signals.

Kulkarni, Kanchan / Awasthi, Navchetan / Roberts, Jesse D / Armoundas, Antonis A

Telemedicine journal and e-health : the official journal of the American Telemedicine Association

2021 Volume 27, Issue 12, Page(s) 1433–1439

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Animals ; Electrocardiography ; Smartphone ; Swine
Language	English
Publishing date	2021-03-15
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2035659-6
ISSN	1556-3669 ; 1530-5627
ISSN (online)	1556-3669
ISSN	1530-5627
DOI	10.1089/tmj.2020.0507
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Zs.A 4576: Show issues

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Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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Jg. 1995 - 2021: Lesesall (2.OG)
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Article ; Online: Fractal dynamics of individual mitochondrial oscillators measure local inter-mitochondrial coupling.

Kurz, Felix T / Aon, Miguel A / Schlemmer, Heinz-Peter / Jende, Johann M E / O'Rourke, Brian / Armoundas, Antonis A

Biophysical journal

2023 Volume 122, Issue 8, Page(s) 1459–1469

Abstract: Mitochondrial inner membrane potentials in cardiomyocytes may oscillate in cycles of depolarization/repolarization when the mitochondrial network is exposed to metabolic or oxidative stress. The frequencies of such oscillations are dynamically changing ... ...

Abstract	Mitochondrial inner membrane potentials in cardiomyocytes may oscillate in cycles of depolarization/repolarization when the mitochondrial network is exposed to metabolic or oxidative stress. The frequencies of such oscillations are dynamically changing while clusters of weakly coupled mitochondrial oscillators adjust to a common phase and frequency. Across the cardiac myocyte, the averaged signal of the mitochondrial population follows self-similar or fractal dynamics; however, fractal properties of individual mitochondrial oscillators have not yet been examined. We show that the largest synchronously oscillating cluster exhibits a fractal dimension, D, that is indicative of self-similar behavior with D=1.27±0.11, in contrast to the remaining network mitochondria whose fractal dimension is close to that of Brownian noise, D=1.58±0.10. We further demonstrate that fractal behavior is correlated with local coupling mechanisms, whereas it is only weakly linked to measures of functional connections between mitochondria. Our findings suggest that individual mitochondrial fractal dimensions may serve as a simple measure of local mitochondrial coupling.
MeSH term(s)	Fractals ; Mitochondria ; Oxidative Stress ; Membrane Potential, Mitochondrial ; Mitochondrial Membranes
Language	English
Publishing date	2023-03-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	218078-9
ISSN	1542-0086 ; 0006-3495
ISSN (online)	1542-0086
ISSN	0006-3495
DOI	10.1016/j.bpj.2023.03.011
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Zs.A 235: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 2: Show issues

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Article ; Online: The inclusion of augmented intelligence in medicine: A framework for successful implementation.

Bazoukis, George / Hall, Jennifer / Loscalzo, Joseph / Antman, Elliott Marshall / Fuster, Valentín / Armoundas, Antonis A

Cell reports. Medicine

2022 Volume 3, Issue 1, Page(s) 100485

Abstract: Artificial intelligence (AI) algorithms are being applied across a large spectrum of everyday life activities. The implementation of AI algorithms in clinical practice has been met with some skepticism and concern, mainly because of the uneasiness that ... ...

Abstract	Artificial intelligence (AI) algorithms are being applied across a large spectrum of everyday life activities. The implementation of AI algorithms in clinical practice has been met with some skepticism and concern, mainly because of the uneasiness that stems, in part, from a lack of understanding of how AI operates, together with the role of physicians and patients in the decision-making process; uncertainties regarding the reliability of the data and the outcomes; as well as concerns regarding the transparency, accountability, liability, handling of personal data, and monitoring and system upgrades. In this viewpoint, we take these issues into consideration and offer an integrated regulatory framework to AI developers, clinicians, researchers, and regulators, aiming to facilitate the adoption of AI that rests within the FDA's pathway, in research, development, and clinical medicine.
MeSH term(s)	Algorithms ; Artificial Intelligence ; Clinical Decision-Making ; Humans ; Medicine ; Physicians ; Reproducibility of Results
Language	English
Publishing date	2022-01-18
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
ISSN	2666-3791
ISSN (online)	2666-3791
DOI	10.1016/j.xcrm.2021.100485
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Article: Microvolt T-Wave Alternans Is Modulated by Acute Low-Level Tragus Stimulation in Patients With Ischemic Cardiomyopathy and Heart Failure.

Kulkarni, Kanchan / Stavrakis, Stavros / Elkholey, Khaled / Singh, Jagmeet P / Parks, Kimberly A / Armoundas, Antonis A

Frontiers in physiology

2021 Volume 12, Page(s) 707724

Abstract: Aims: ...

Abstract	Aims:
Language	English
Publishing date	2021-07-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564217-0
ISSN	1664-042X
ISSN	1664-042X
DOI	10.3389/fphys.2021.707724
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Article ; Online: Clinical Potential of Beat-to-Beat Diastolic Interval Control in Preventing Cardiac Arrhythmias.

Kulkarni, Kanchan / Walton, Richard D / Armoundas, Antonis A / Tolkacheva, Elena G

Journal of the American Heart Association

2021 Volume 10, Issue 11, Page(s) e020750

Abstract: Life-threatening ventricular arrhythmias and sudden cardiac death are often preceded by cardiac alternans, a beat-to-beat oscillation in the T-wave morphology or duration. However, given the spatiotemporal and structural complexity of the human heart, ... ...

Abstract	Life-threatening ventricular arrhythmias and sudden cardiac death are often preceded by cardiac alternans, a beat-to-beat oscillation in the T-wave morphology or duration. However, given the spatiotemporal and structural complexity of the human heart, designing algorithms to effectively suppress alternans and prevent fatal rhythms is challenging. Recently, an antiarrhythmic constant diastolic interval pacing protocol was proposed and shown to be effective in suppressing alternans in 0-, 1-, and 2-dimensional in silico studies as well as in ex vivo whole heart experiments. Herein, we provide a systematic review of the electrophysiological conditions and mechanisms that enable constant diastolic interval pacing to be an effective antiarrhythmic pacing strategy. We also demonstrate a successful translation of the constant diastolic interval pacing protocol into an ECG-based real-time control system capable of modulating beat-to-beat cardiac electrical activity and preventing alternans. Furthermore, we present evidence of the clinical utility of real-time alternans suppression in reducing arrhythmia susceptibility in vivo. We provide a comprehensive overview of this promising pacing technique, which can potentially be translated into a clinically viable device that could radically improve the quality of life of patients experiencing abnormal cardiac rhythms.
MeSH term(s)	Algorithms ; Arrhythmias, Cardiac/physiopathology ; Arrhythmias, Cardiac/prevention & control ; Cardiac Pacing, Artificial/methods ; Diastole ; Electrocardiography ; Heart Rate/physiology ; Humans
Language	English
Publishing date	2021-05-22
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S. ; Systematic Review
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.121.020750
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Article ; Online: Investigating Electrophysiological Markers of Arrhythmogenesis in a Chronic Myocardial Infarction Ovine Model.

Kulkarni, Kanchan / Pallares-Lupon, Nestor / Armoundas, Antonis A / Pasdois, Philippe / Bernus, Olivier / Walton, Richard D

Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference

2022 Volume 2022, Page(s) 657–661

Abstract: Cardiac alternans has been associated with an increased propensity to lethal tachyarrhythmias such as ventricular tachycardia and fibrillation (VT/VF). Myocardial infarction (MI), resulting from restricted oxygen supply to the heart, is a known substrate ...

Abstract	Cardiac alternans has been associated with an increased propensity to lethal tachyarrhythmias such as ventricular tachycardia and fibrillation (VT/VF). Myocardial infarction (MI), resulting from restricted oxygen supply to the heart, is a known substrate for VT/VF. Here, we investigate the utility of cardiac alternans as a predictor of tachyarrhythmias in a chronic MI ovine model. In-vivo electrophysiological studies were performed to assess the change in microvolt T-wave alternans (TWA) with induction of acute ischemia following coronary artery occlusion. 24-hour telemetry was performed in an ambulatory animal for 6 weeks to monitor the progression of TWA with chronic MI. At 6 weeks, ex-vivo optical mapping experiments were performed to assess the spatiotemporal evolution of alternans in sham (n=5) and chronic MI hearts (n=8). Our results demonstrate that chronic MI leads to significant electrophysiological changes in the cardiac substrate. Significant increase in TWA is observed post occlusion and a steady rise in alternans is seen with progression of chronic MI. Compared to sham, chronic MI hearts show significant presence of localized action potential amplitude alternans, which spatially evolve with an increase in pacing frequency. Clinical Relevance - Our results demonstrate that localized alternans underlie arrhythmogenesis in chronic MI hearts and microvolt TWA can serve as a biomarker of disease progression during chronic MI.
MeSH term(s)	Animals ; Arrhythmias, Cardiac ; Biomarkers ; Myocardial Infarction/complications ; Myocardial Infarction/diagnosis ; Sheep ; Sheep, Domestic ; Tachycardia, Ventricular/diagnosis ; Tachycardia, Ventricular/etiology
Chemical Substances	Biomarkers
Language	English
Publishing date	2022-09-09
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	2694-0604
ISSN (online)	2694-0604
DOI	10.1109/EMBC48229.2022.9871496
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Article ; Online: Cardiac contractility modulation in patients with heart failure - A review of the literature.

Bazoukis, George / Saplaouras, Athanasios / Efthymiou, Polyxeni / Yiannikourides, Andronicos / Liu, Tong / Letsas, Konstantinos P / Efremidis, Michael / Lampropoulos, Konstantinos / Xydonas, Sotirios / Tse, Gary / Armoundas, Antonis A

Heart failure reviews

2024 Volume 29, Issue 3, Page(s) 689–705

Abstract: Experimental in vivo and in vitro studies showed that electric currents applied during the absolute refractory period can modulate cardiac contractility. In preclinical studies, cardiac contractility modulation (CCM) was found to improve calcium handling, ...

Abstract	Experimental in vivo and in vitro studies showed that electric currents applied during the absolute refractory period can modulate cardiac contractility. In preclinical studies, cardiac contractility modulation (CCM) was found to improve calcium handling, reverse the foetal myocyte gene programming associated with heart failure (HF), and facilitate reverse remodeling. Randomized control trials and observational studies have provided evidence about the safety and efficacy of CCM in patients with HF. Clinically, CCM therapy is indicated to improve the 6-min hall walk, quality of life, and functional status of HF patients who remain symptomatic despite guideline-directed medical treatment without an indication for cardiac resynchronization therapy (CRT) and have a left ventricular ejection fraction (LVEF) ranging from 25 to 45%. Although there are promising results about the role of CCM in HF patients with preserved LVEF (HFpEF), further studies are needed to elucidate the role of CCM therapy in this population. Late gadolinium enhancement (LGE) assessment before CCM implantation has been proposed for guiding the lead placement. Furthermore, the optimal duration of CCM application needs further investigation. This review aims to present the existing evidence regarding the role of CCM therapy in HF patients and identify gaps and challenges that require further studies.
MeSH term(s)	Humans ; Heart Failure/physiopathology ; Heart Failure/therapy ; Myocardial Contraction/physiology ; Stroke Volume/physiology ; Ventricular Function, Left/physiology ; Cardiac Resynchronization Therapy/methods ; Quality of Life
Language	English
Publishing date	2024-02-23
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	1336499-6
ISSN	1573-7322 ; 1382-4147
ISSN (online)	1573-7322
ISSN	1382-4147
DOI	10.1007/s10741-024-10390-1
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Zs.A 5212: Show issues

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Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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ab Jg. 2022: Lesesaal (EG)

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