Cardiac conduction diseases: understanding the molecular mechanisms to uncover targets for future treatments.

Publisher: Informa Healthcare Country of Publication: England NLM ID: 101127833 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1744-7631 (Electronic) Linking ISSN: 14728222 NLM ISO Abbreviation: Expert Opin Ther Targets Subsets: MEDLINE

Publication: London : Informa Healthcare
Original Publication: London : Ashley Publications, c2001-

Heart Conduction System*/physiopathology ; Cardiac Conduction System Disease*/physiopathology ; Cardiac Conduction System Disease*/therapy ; Cardiac Conduction System Disease*/drug therapy ; Molecular Targeted Therapy*; Humans ; Animals ; Mutation ; Drug Development ; Heart Failure/physiopathology ; Heart Failure/therapy ; Heart Failure/drug therapy ; Epigenesis, Genetic ; Sinoatrial Node/physiopathology

Introduction: The cardiac conduction system (CCS) is crucial for maintaining adequate cardiac frequency at rest and modulation during exercise. Furthermore, the atrioventricular node and His-Purkinje system are essential for maintaining atrioventricular and interventricular synchrony and consequently maintaining an adequate cardiac output.
Areas Covered: In this review article, we examine the anatomy, physiology, and pathophysiology of the CCS. We then discuss in detail the most common genetic mutations and the molecular mechanisms of cardiac conduction disease (CCD) and provide our perspectives on future research and therapeutic opportunities in this field.
Expert Opinion: Significant advancement has been made in understanding the molecular mechanisms of CCD, including the recognition of the heterogeneous signaling at the subcellular levels of sinoatrial node, the involvement of inflammatory and autoimmune mechanisms, and the potential impact of epigenetic regulations on CCD. However, the current treatment of CCD manifested as bradycardia still relies primarily on cardiovascular implantable electronic devices (CIEDs). On the other hand, an I f specific inhibitor was developed to treat inappropriate sinus tachycardia and sinus tachycardia in heart failure patients with reduced ejection fraction. More work is needed to translate current knowledge into pharmacologic or genetic interventions for the management of CCDs.

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R01 HL136389 United States HL NHLBI NIH HHS; R01 HL147108 United States HL NHLBI NIH HHS; R01 HL163277 United States HL NHLBI NIH HHS; R01 HL164838 United States HL NHLBI NIH HHS

Keywords: Cardiac conduction disease; atrioventricular node; his-purkinje system; pacemaker; sinoatrial node

Date Created: 20240503 Date Completed: 20240620 Latest Revision: 20240914

20240914

PMC11395937

10.1080/14728222.2024.2351501

38700451