Lanters Eva A H, van Marion Denise M S, Kik Charles, Steen Herman, Bogers Ad J J C, Allessie Maurits A, Brundel Bianca J J M, de Groot Natasja M S
Department of Cardiology, Ba 579, Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands.
Department of Clinical Pharmacy and Pharmacology, EB71, University Institute for Drug Exploration (GUIDE), University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30 001, 9700, RB, Groningen, The Netherlands.
J Transl Med. 2015 Nov 5;13:347. doi: 10.1186/s12967-015-0714-7.
Atrial fibrillation is a progressive arrhythmia, the exact mechanism underlying the progressive nature of recurrent AF episodes is still unknown. Recently, it was found that key players of the protein quality control system of the cardiomyocyte, i.e. Heat Shock Proteins, protect against atrial fibrillation progression by attenuating atrial electrical and structural remodeling (electropathology). HALT & REVERSE aims to investigate the correlation between electropathology, as defined by endo- or epicardial mapping, Heat Shock Protein levels and development or recurrence of atrial fibrillation following pulmonary vein isolation, or electrical cardioversion or cardiothoracic surgery.
This study is a prospective observational study. Three separate study groups are defined: (1) cardiothoracic surgery, (2) pulmonary vein isolation and (3) electrical cardioversion. An intra-operative high-resolution epicardial (group 1) or endocardial (group 2) mapping procedure of the atria is performed to study atrial electropathology. Blood samples for Heat Shock Protein determination are obtained at baseline and during the follow-up period at 3 months (group 2), 6 months (groups 1 and 2) and 1 year (group 1 and 2). Tissue samples of the right and left atrial appendages in patients in group 1 are analysed for Heat Shock Protein levels and for tissue characteristics. Early post procedural atrial fibrillation is detected by continuous rhythm monitoring, whereas late post procedural atrial fibrillation is documented by either electrocardiogram or 24-h Holter registration.
HALT & REVERSE aims to identify the correlation between Heat Shock Protein levels and degree of electropathology. The study outcome will contribute to novel diagnostic tools for the early recognition of clinical atrial fibrillation.
Rotterdam Medical Ethical Committee MEC-2014-393, Dutch Trial Registration NTR4658.
心房颤动是一种进行性心律失常，复发性房颤发作的进行性本质背后的确切机制仍不清楚。最近发现，心肌细胞蛋白质质量控制系统的关键参与者，即热休克蛋白，通过减轻心房电重构和结构重构（电病理学）来预防心房颤动的进展。“停止与逆转”（HALT & REVERSE）研究旨在调查由心内膜或心外膜标测所定义的电病理学、热休克蛋白水平与肺静脉隔离、电复律或心胸外科手术后房颤的发生或复发之间的相关性。
本研究为前瞻性观察性研究。定义了三个独立的研究组：（1）心胸外科手术组，（2）肺静脉隔离组，（3）电复律组。对心房进行术中高分辨率心外膜（第1组）或心内膜（第2组）标测程序以研究心房电病理学。在基线时以及随访期的3个月（第2组）、6个月（第1组和第2组）和1年（第1组和第2组）采集用于测定热休克蛋白的血样。对第1组患者的右心耳和左心耳组织样本进行热休克蛋白水平和组织特征分析。术后早期房颤通过连续心律监测进行检测，而术后晚期房颤则通过心电图或24小时动态心电图记录。
“停止与逆转”研究旨在确定热休克蛋白水平与电病理学程度之间的相关性。研究结果将有助于开发用于早期识别临床房颤的新型诊断工具。
鹿特丹医学伦理委员会MEC - 2014 - 393，荷兰试验注册编号NTR4658。
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