An Impact Study Of Extracorporeal Shock Wave On Energy Metabolism Of Atrial Myocytes In Atrial Fibrillation

Objective:Atrial fibrillation(Atrial fibrillation,AF)is the most common type of cardiac arrhythmia,it has gradually become one of the most common human health effects of cardiovascular disease in the last 20 years.AF is often accompanied by problems with structural heart disease and other chronic diseases.The development and maintenance mechanisms are multifactorial,which give clinical management many difficulties.The occurrence of atrial fibrillation can cause a patient repeatedly hospitalized,increase thromboembolic events such stroke,which increase patient morbidity and mortality,seriously affect the quality of life.So it is very important to investigate the mechanism of atrial fibrillation,and is necessary to find a more effective treatment or improve the current adjuvant therapy of atrial fibrillation due to the situation that existing means of treatment efficacy is still unsatisfactory.In this study,we use the extracorporeal shock wave to intervene a special cell model that is made by electrical pacing cardiac atrium myocytes in rat to explore the feasibility of extracorporeal shock wave in the treatment of atrial fibrillation Methods:This study was divided into two parts.In the first part,the study enrolled 56 patients(15 patients with sinus rhythm and 41 patients with atrial fibrillation)who underwent cardiac surgery between December 2018 and November 2019 at The First Hospital of China Medical University.All patients with AF were diagnosed by 24-hour ambulatory electrocardiogram.The following variables were recorded: Patient Age,Sex,BMI,Diabetes mellitus,Hypertension,Systolic pressure,Diastolic pressure,Fasting glucose,Serum creatinine,BNP,EF,Early postoperative AF.We quantified the AMPK,PGC-1a,NRF1 and TFAM proteins(Western blot)and TFAM tissue level(Immunohistochemistry)and the ATP level in LAA tissues taken from 41 patients with atrial fibrillation and 15 patients with sinus rhythm who underwent cardiac surgery.The biochemical and histologic results were compared between the group of atrial fibrillation and sinus rhythm.The predictive values of AMPK,PGC-1a,NRF1 and TFAM proteins and early postoperative atrial fibrillation were assessed with the Logistic regression.The second part is to build a cell model of atrial fibrillation,testing related indicators after using shock waves to intervene.After building a successful model cell using extracorporeal shock waves to intervene,to detect indicators of the state of cellular energy metabolism,AMPK / PGC-1a path expression,ATP content,etc.Results:Expression of AMPK,PGC-1a,NRF1 and TFAM was significantly decreased in LAA tissue taken from patients with AF compared with SR(P<0.05);TFAM tissue expression level and the ATP level were markedly lower in LAA tissues taken from AF group than in those form SR group(p<0.05).In addition,Logistic regression revealed that TFAM level is an influence factor for early postoperative atrial fibrillation(P<0.05),low TFAM levels increase the risk of postoperative atrial fibrillation.The mitochondrial shape and quantity changes in atrial muscle cell in patients with atrial fibrillation.Successfully constructed a high activity cell model of atrial fibrillation,after use of extracorporeal shock wave intervention,mitochondrial respiration and the ATP content in cells can be enhanced.Expression of AMPK / PGC-1a signaling pathway increasesd.Conclusion: By detecting the patient's clinical samples,we confirmed that AMPK,PGC-1a,NRF1,TFAM expression in patients with atrial fibrillation were decreased.Energy metabolism of atrial muscle in patients with atrial fibrillation and mitochondrial biogenesis were both impaired.Extracorporeal shock wave through the AMPK / PGC-1a signaling pathway to improve the energy metabolism,increase ATP content and mitochondrial biogenesis of the pacing atrial cell.It provides a new idea for the treatment of atrial fibrillation.