TY - JOUR T1 - Cardiac Alternans: From Bedside to Bench and Back. AU - Qu,Zhilin, AU - Weiss,James N, Y1 - 2023/01/05/ PY - 2023/1/5/entrez PY - 2023/1/6/pubmed PY - 2023/1/10/medline KW - Brugada syndrome KW - atrial fibrillation KW - cardiovascular diseases KW - long QT syndrome KW - myocardial ischemia KW - torsades de pointes KW - ventricular fibrillation SP - 127 EP - 149 JF - Circulation research JO - Circ Res VL - 132 IS - 1 N2 - Cardiac alternans arises from dynamical instabilities in the electrical and calcium cycling systems of the heart, and often precedes ventricular arrhythmias and sudden cardiac death. In this review, we integrate clinical observations with theory and experiment to paint a holistic portrait of cardiac alternans: the underlying mechanisms, arrhythmic manifestations and electrocardiographic signatures. We first summarize the cellular and tissue mechanisms of alternans that have been demonstrated both theoretically and experimentally, including 3 voltage-driven and 2 calcium-driven alternans mechanisms. Based on experimental and simulation results, we describe their relevance to mechanisms of arrhythmogenesis under different disease conditions, and their link to electrocardiographic characteristics of alternans observed in patients. Our major conclusion is that alternans is not only a predictor, but also a causal mechanism of potentially lethal ventricular and atrial arrhythmias across the full spectrum of arrhythmia mechanisms that culminate in functional reentry, although less important for anatomic reentry and focal arrhythmias. SN - 1524-4571 UR - https://www.unboundmedicine.com/prime/citation/36603066/Cardiac_Alternans:_From_Bedside_to_Bench_and_Back. DB - PRIME DP - Unbound Medicine ER -