En utilisant la méthode de génétique inverse, la mutation causale d'un bloc de conduction cardiaque familial a été localisée sur le bras long du chromosome 19 en 13.3 dans une grande famille libanaise. Après avoir testé 12 gènes candidats, nous avons trouvé 3 mutations différentes dans trois familles indépendantes de bloc de conduction cardiaque isolé. Les conséquences des 3 mutations ont été explorées par des études électrophysiologiques. Il s'agit dans les 3 cas d'un gain de fonction. Puis, une cohorte de 248 patients atteints de syndrome de Brugada a été étudiée. Onze mutations du gène TRPM4 ont été trouvées chez 20 patients. Les conséquences électrophysiologiques des mutations étaient diverses. Ensuite, des cohortes de patients atteints de syndrome du QT long, de fibrillation auriculaire ou de cardiomyopathie dilaté ont été étudiées. Nous avons également trouvé des mutations ou des variants prédisposants du gène TRPM4 chez ces patients. Une étude électrophysiologique doit être réalisée pour comprendre le rôle de TRPM4 dans ces autres pathologies. Enfin, notre étude immunohistochimique a démontré que TRPM4 est fortement exprimé dans le système de conduction cardiaque mais aussi plus faiblement dans les cardiomyocytes auriculaires et ventriculaires communs. Ce travail a permis d'impliquer pour la première fois le gène TRPM4 dans des maladies humaines. Ce travail donne les bases pour comprendre le rôle du canal TRPM4 dans le fonctionnement cardiaque. C'est le préalable nécessaire avant de pouvoir développer de nouvelles thérapeutiques dans le futur / By using reverse genetics, the causal mutation of a familial cardiac conduction block was localized to the long arm of chromosome 19 in 13.3. After screening 12 candidate genes, we found 3 different mutations in three independent families with isolated cardiac conduction block. The consequences of these 3 mutations were explored by electrophysiological studies. In all 3 mutations it was a gain of function. Then, a cohort of 248 patients with a Brugada syndrome was studied. Eleven mutations were found in the TRPM4 gene in 20 patients. The electrophysiological consequences of these mutations were diverse. Then, cohorts of patients with long QT syndrome, atrial fibrillation, and dilated cardiomyopathy were studied. We found also mutations or predisposing variants in these patients. An electrophysiology study should be conducted to understand the role of TRPM4 in these other pathologies. Finally, our immunohistochemical study showed that TRPM4 is highly expressed in the cardiac conduction system but also although with less intensity in common auricular and ventricular cardiomyocytes. This work implied for the first time the TRPM4 gene in human diseases. This work provides the basis to understand the role of the TRPM4 channel in cardiac function. This is a prerequisite to be able to develop novel therapies in the future

Group of specialized cells that form cardiac conduction system is responsible for generation and coordinated propagation of the electrical impulse in the heart. Changes in its development can be connected with arrhythmias; therefore, a good level of knowledge is necessary and relevant for basic science and clinical practice. For correct development of the conduction system are important genes coding gap junctions proteins, ion channels, transcription factors and other molecules involved in signaling cascades (endothelin, neuregulin). Development of conduction system is determined in addition to genetic factors also by epigenetics and environmental factors. This thesis with its individual papers on which it is based is addressing different aspects of conduction system development, which appears to be a complex process. Another feature which is linking all papers together, is the methodological approach enabling us to study function of the conduction system - optical mapping. In the first publication we studied by the means of in vitro organ culture the impact of work load without interfering hemodynamics on the conduction system maturation in the chick embryonic heart. The phenotype observed during experiments was developmental regression of conduction system maturation together with changes in...

Zymosan-induced peritonitis is a model commonly used to study systemic inflammatory response syndrome and multiple organ dysfunction syndrome. However, effects of zymosan on cardiac function have not been reported. We evaluated cardiac responses to zymosan in mice and the role of β-Glucan and dectin-1 in mediating these responses. Temperature and cardiac function were evaluated before and after intraperitoneal (i.p.) injection of zymosan (100 or 500 mg/kg) or saline. Chronotropic and dromotropic functions were measured using electrocardiograms (ECGs) collected from conscious mice. Cardiac inotropic function was determined by echocardiography. High-dose zymosan caused a rapid and maintained hypothermia along with visual signs of illness. Baseline heart rate (HR) was unaffected but HR variability (HRV) increased, and there was a modest slowing of ventricular conduction. High-dose zymosan also caused prominent decreases in cardiac contractility at 4 and 24 h. Because zymosan is known to cause gastrointestinal tract pathology, peritoneal wash and blood samples were evaluated for bacteria at 24 h after zymosan or saline injection. Translocation of bacterial occurred in all zymosan-treated mice (n=3), and two had bacteremia. Purified β-Glucan (50 and 125 mg/kg, i.p.) had no effect on temperature or ECG parameters. However, deletion of dectin-1 modified the ECG responses to high-dose zymosan; slowing of ventricular conduction and the increase in HRV were eliminated but a marked bradycardia appeared at 24 h after zymosan treatment. Zymosan-treated dectin-1 knockout mice also showed hypothermia and visual signs of illness. Fecal samples from dectin-1 knockout mice contained more bacteria than wild types, but zymosan caused less translocation of bacteria. Collectively, these findings demonstrate that zymosan-induced systemic inflammation causes cardiac dysfunction in mice. The data suggest that dectin-1-dependent and -independent mechanisms are involved. Although zymosan treatment causes translocation of bacteria, this effect does not have a major role in the overall systemic response to zymosan.

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Role of Nkx2.5 on development and electrophysiology of the mouse heart Prague 2015 Bc. Peter Hámor ABSTRACT The objective of this thesis is to investigate the role of Nkx2.5 gene dosage on electrophysiology of the mouse heart in prenatal stage of its development, in which the physiological functions of the heart fail to function properly. The main goal of this work is to search for differences in conduction of electric impulses through the embryonic mouse heart according to their genotype. Special method of capturing the conduction of electric impulse through myocardium was used for this purpose, called optical mapping. Thanks to this method I was able to construct images and videos capturing transition of the impulse with marked beginning of the activation and its direction in the heart. These outputs, or optical maps, help to define anomalies and defects compared with a normal functioning heart. The thesis focuses on the expression of the transcription factor Nkx2.5 and regulatory components related with the correct formation and physiology of the heart until 9.5 days post coitum. Individuals in this developmental stage were optically mapped and compared according to their genotypes - homozygous non-mutant, heterozygote and homozygous mutant mouse embryos exhibited some degree of similarity, while other...

Role of Nkx2.5 in development and electrophysiology of the mouse heart Prague 2016 Peter Hámor, B.S. ABSTRACT The objective of this thesis is to investigate the role of Nkx2.5 gene dosage on electrophysiology of the mouse heart in prenatal stage of its development. The main goal of this work is to search for differences in conduction of electric impulses through the embryonic mouse hearts of different genotype. Special method of capturing the conduction of electric impulse through myocardium, called optical mapping, was used to visualize the electrical activity. Thanks to this method I was able to construct images and videos capturing the spread of the impulse with identification of the beginning of the activation and its direction in the heart. These outputs, or optical maps, help to define anomalies and defects in mutants compared with a normal functioning heart. The thesis focuses on the expression of the transcription factor Nkx2.5 and regulatory components related with the correct formation and physiology of the heart until 9.5 days post coitum. Embryos at this developmental stage were optically mapped and analysed according to their genotype. While the wild type and heterozygote mouse embryos exhibited high degree of similarity, the homozygous mutants were dramatically different. Considering this work...

Atrial fibrillation is one of the most common cardiac rhythm disorders characterized by ever-increasing prevalence and incidence in the Czech Republic and abroad. The incidence of atrial fibrillation is reported at 2-4 % of the population, but due to the often asymptomatic course, the real prevalence is even higher. The aim of this work is to design an algorithm for automatic detection of atrial fibrillation in the ECG record. In the practical part of this work, an algorithm for the detection of atrial fibrillation is proposed. For the detection itself, the k-nearest neighbor method, the support vector method and the multilayer neural network were used to classify ECG signals using features indicating the variability of RR intervals and the presence of the P wave in the ECG recordings. The best detection was achieved by a model using a multilayer neural network classification with two hidden layers. Results of success indicators: Sensitivity 91.23 %, Specificity 99.20 %, PPV 91.23 %, F-measure 91.23 % and Accuracy 98.53 %.