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Della Rocca DG, Cespón-Fernández M, Keelani A, Raffa S, Pannone L, Almorad A, Ströker E, Borisov G, Bala G, Sieira J, Vetta G, Alothman O, Sorgente A, Audiat C, Overeinder I, Frommhold M, Del Monte A, La Meir M, Natale A, Chierchia GB, Geller JC, de Asmundis C, Sarkozy A. Focal Pulsed Field Ablation for Premature Ventricular Contractions: A Multicenter Experience. Circ Arrhythm Electrophysiol 2024; 17:e012826. [PMID: 39234745 DOI: 10.1161/circep.124.012826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/15/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Pulsed field ablation (PFA) is a novel technology for catheter-based atrial arrhythmia treatment. Evidence of its application for ventricular arrhythmia ablation is still limited. In this study, we describe the feasibility and efficacy of focal PFA for premature ventricular contraction (PVC) ablation. METHODS A prospective cohort of 20 patients referred for PVC ablation at 2 centers was enrolled, regardless of the presence of structural heart disease, PVC morphology, or previous ablation attempts. All procedures were performed using the CENTAURI System in combination with contact force sensing catheters and 3-dimensional electroanatomical mapping systems. Energy output and the number of applications were left to the operator's discretion. RESULTS Eleven (55%) procedures were conducted under general anesthesia, 6 (30%) under deep sedation, and 3 (15%) under light sedation. Muscular contraction was observed in one case (5%). Median procedural and fluoroscopy times were 95.5 and 6.55 minutes, respectively. The median number of PFA applications was 8 with a median contact force of 10g. A statistically significant (76%) reduction was observed in mean peak-to-peak bipolar electrogram voltage before and after ablation (0.707 versus 0.098 mV; P=0.008). Ventricular irritative firing was observed in 11 (55%) patients after PFA. The median follow-up was 120 days. Acute procedural success was achieved in 17 of 20 (85% [95% CI, 0.70-1]) patients. Two of the patients with procedural failure had late success with >80% clinical PVC burden suppression during follow-up, and 2 of 17 patients with acute success had late PVC recurrence, which accounts for a total of 17 of 20 (85% [95% CI, 0.70-1]) patients with chronic success. Transient ST-segment depression occurred in 1 patient, and the right bundle branch block was induced in 2 others (permanently only in one case). CONCLUSIONS PVC ablation using a focal PFA is feasible, effective, and safe, with promising acute and long-term results in several ventricular locations. Irritative firing is frequently observed. Coronary evaluation should be considered when targeting the outflow tract.
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Affiliation(s)
- Domenico Giovanni Della Rocca
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX (D.G.D.R., A.N.)
| | - María Cespón-Fernández
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
- Galicia Sur Health Research Institute, Vigo, Spain (M.C.-F.)
| | - Ahmad Keelani
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
| | - Santi Raffa
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
| | - Luigi Pannone
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Alexandre Almorad
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Erwin Ströker
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Georgi Borisov
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
| | - Gezim Bala
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Juan Sieira
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Giampaolo Vetta
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Obaida Alothman
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
| | - Antonio Sorgente
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Charles Audiat
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Ingrid Overeinder
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Markus Frommhold
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
| | - Alvise Del Monte
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Belgium (M.L.M.)
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX (D.G.D.R., A.N.)
- Division of Cardiology, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy (A.N.)
| | - Gian-Battista Chierchia
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - J Christoph Geller
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
- Faculty of Medicine, Otto-von-Guericke University Magdeburg, Germany (J.C.G.)
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Andrea Sarkozy
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
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Wiedmann F, Jamros M, Herlt V, Paasche A, Kraft M, Beck M, Prüser M, Erkal A, Harder M, Zaradzki M, Soethoff J, Karck M, Frey N, Schmidt C. A porcine large animal model of radiofrequency ablation-induced left bundle branch block. Front Physiol 2024; 15:1385277. [PMID: 38706948 PMCID: PMC11066324 DOI: 10.3389/fphys.2024.1385277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/27/2024] [Indexed: 05/07/2024] Open
Abstract
Background Electrocardiographic (ECG) features of left bundle branch (LBB) block (LBBB) can be observed in up to 20%-30% of patients suffering from heart failure with reduced ejection fraction. However, predicting which LBBB patients will benefit from cardiac resynchronization therapy (CRT) or conduction system pacing remains challenging. This study aimed to establish a translational model of LBBB to enhance our understanding of its pathophysiology and improve therapeutic approaches. Methods Fourteen male pigs underwent radiofrequency catheter ablation of the proximal LBB under fluoroscopy and ECG guidance. Comprehensive clinical assessments (12-lead ECG, bloodsampling, echocardiography, electroanatomical mapping) were conducted before LBBB induction, after 7, and 21 days. Three pigs received CRT pacemakers 7 days after LBB ablation to assess resynchronization feasibility. Results Following proximal LBB ablation, ECGs displayed characteristic LBBB features, including QRS widening, slurring in left lateral leads, and QRS axis changes. QRS duration increased from 64.2 ± 4.2 ms to 86.6 ± 12.1 ms, and R wave peak time in V6 extended from 21.3 ± 3.6 ms to 45.7 ± 12.6 ms. Echocardiography confirmed cardiac electromechanical dyssynchrony, with septal flash appearance, prolonged septal-to-posterior-wall motion delay, and extended ventricular electromechanical delays. Electroanatomical mapping revealed a left ventricular breakthrough site shift and significantly prolonged left ventricular activation times. RF-induced LBBB persisted for 3 weeks. CRT reduced QRS duration to 75.9 ± 8.6 ms, demonstrating successful resynchronization. Conclusion This porcine model accurately replicates the electrical and electromechanical characteristics of LBBB observed in patients. It provides a practical, cost-effective, and reproducible platform to investigate molecular and translational aspects of cardiac electromechanical dyssynchrony in a controlled and clinically relevant setting.
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Affiliation(s)
- Felix Wiedmann
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany
- HCR (Heidelberg Center for Heart Rhythm Disorders), University Hospital Heidelberg, Heidelberg, Germany
| | - Max Jamros
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Valerie Herlt
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Amelie Paasche
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Manuel Kraft
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Moritz Beck
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Merten Prüser
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany
- HCR (Heidelberg Center for Heart Rhythm Disorders), University Hospital Heidelberg, Heidelberg, Germany
| | - Atilla Erkal
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Maren Harder
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Marcin Zaradzki
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jasmin Soethoff
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany
- HCR (Heidelberg Center for Heart Rhythm Disorders), University Hospital Heidelberg, Heidelberg, Germany
| | - Constanze Schmidt
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany
- HCR (Heidelberg Center for Heart Rhythm Disorders), University Hospital Heidelberg, Heidelberg, Germany
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Meininger GR, Neal RE, Hunter DW, Krimsky WS. Absence of Arrhythmogenicity with Biphasic Pulsed Electric Fields Delivered to Porcine Airways. Ann Biomed Eng 2024; 52:1-11. [PMID: 37185926 PMCID: PMC10761461 DOI: 10.1007/s10439-023-03190-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/21/2023] [Indexed: 05/17/2023]
Abstract
Pulsed electric field (PEF) technologies treat many types of tissue. Many systems mandate synchronization to the cardiac cycle to avoid the induction of cardiac arrhythmias. Significant differences between PEF systems make the assessment of cardiac safety from one technology to another challenging. A growing body of evidence suggests that shorter duration biphasic pulses obviate the need for cardiac synchronization, even when delivered in a monopolar fashion. This study theoretically evaluates the risk profile of different PEF parameters. It then tests a monopolar, biphasic, microsecond-scale PEF technology for arrhythmogenic potential. PEF applications of increasing likelihood to induce an arrhythmia were delivered. The energy was delivered throughout the cardiac cycle, including both single and multiple packets, and then with concentrated delivery on the t-wave. There were no sustained changes to the electrocardiogram waveform or to the cardiac rhythm, despite delivering energy during the most vulnerable phase of the cardiac cycle, and delivery of multiple packets of PEF energy across the cardiac cycle. Only isolated premature-atrial contractions (PAC) were observed. This study provides evidence that certain varieties of biphasic, monopolar PEF delivery do not require synchronized energy delivery to prevent harmful arrhythmias.
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Affiliation(s)
| | - Robert E Neal
- Galvanize Therapeutics, 1531 Industrial Road, San Carlos, CA, 94070, USA.
| | - David W Hunter
- Galvanize Therapeutics, 1531 Industrial Road, San Carlos, CA, 94070, USA
| | - William S Krimsky
- Galvanize Therapeutics, 1531 Industrial Road, San Carlos, CA, 94070, USA
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Amoni M, Ingelaere S, Moeyersons J, Wets D, Tanushi A, Van Huffel S, Varon C, Sipido K, Claus P, Willems R. Regional beat-to-beat variability of repolarization increases during ischemia and predicts imminent arrhythmias in a pig model of myocardial infarction. Am J Physiol Heart Circ Physiol 2023; 325:H54-H65. [PMID: 37145956 PMCID: PMC10511165 DOI: 10.1152/ajpheart.00732.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/07/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Abstract
Ventricular arrhythmia (VT/VF) can complicate acute myocardial ischemia (AMI). Regional instability of repolarization during AMI contributes to the substrate for VT/VF. Beat-to-beat variability of repolarization (BVR), a measure of repolarization lability increases during AMI. We hypothesized that its surge precedes VT/VF. We studied the spatial and temporal changes in BVR in relation to VT/VF during AMI. In 24 pigs, BVR was quantified on 12-lead electrocardiogram recorded at a sampling rate of 1 kHz. AMI was induced in 16 pigs by percutaneous coronary artery occlusion (MI), whereas 8 underwent sham operation (sham). Changes in BVR were assessed at 5 min after occlusion, 5 and 1 min pre-VF in animals that developed VF, and matched time points in pigs without VF. Serum troponin and ST deviation were measured. After 1 mo, magnetic resonance imaging and VT induction by programmed electrical stimulation were performed. During AMI, BVR increased significantly in inferior-lateral leads correlating with ST deviation and troponin increase. BVR was maximal 1 min pre-VF (3.78 ± 1.36 vs. 5 min pre-VF, 1.67 ± 1.56, P < 0.0001). After 1 mo, BVR was higher in MI than in sham and correlated with the infarct size (1.43 ± 0.50 vs. 0.57 ± 0.30, P = 0.009). VT was inducible in all MI animals and the ease of induction correlated with BVR. BVR increased during AMI and temporal BVR changes predicted imminent VT/VF, supporting a possible role in monitoring and early warning systems. BVR correlated to arrhythmia vulnerability suggesting utility in risk stratification post-AMI.NEW & NOTEWORTHY The key finding of this study is that BVR increases during AMI and surges before ventricular arrhythmia onset. This suggests that monitoring BVR may be useful for monitoring the risk of VF during and after AMI in the coronary care unit settings. Beyond this, monitoring BVR may have value in cardiac implantable devices or wearables.
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Affiliation(s)
- Matthew Amoni
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals, Leuven, Belgium
| | - Sebastian Ingelaere
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals, Leuven, Belgium
| | - Jonathan Moeyersons
- Department of Electrical Engineering, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Dries Wets
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Aldo Tanushi
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Sabine Van Huffel
- Department of Electrical Engineering, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Carolina Varon
- Department of Electrical Engineering, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
- Microgravity Research Center, Université Libre de Bruxelles, Brussels, Belgium
| | - Karin Sipido
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Piet Claus
- Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Rik Willems
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals, Leuven, Belgium
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Cournoyer A, Cavayas YA. Central venous pressure amplitude: A novel marker of resuscitation quality. Resuscitation 2023; 185:109749. [PMID: 36842673 DOI: 10.1016/j.resuscitation.2023.109749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/26/2023]
Affiliation(s)
- Alexis Cournoyer
- Faculty of Medicine, Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, Québec, Canada; Centre de Recherche de l'Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Department of Emergency Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, Montréal, Québec, Canada; Department of Emergency Medicine, Hôpital Maisonneuve-Rosemont, CIUSSS-EIM, Montréal, Québec, Canada; Corporation d'Urgences-santé, Montréal, Québec, Canada.
| | - Yiorgos Alexandros Cavayas
- Centre de Recherche de l'Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Faculty of Medicine, Department of Medicine, Université de Montréal, Montréal, Québec; Department of Medicine, Service of Intensive Care Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, Montréal, Québec, Canada; Department of Surgery, Service of Intensive Care Medicine, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
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Ripplinger CM, Glukhov AV, Kay MW, Boukens BJ, Chiamvimonvat N, Delisle BP, Fabritz L, Hund TJ, Knollmann BC, Li N, Murray KT, Poelzing S, Quinn TA, Remme CA, Rentschler SL, Rose RA, Posnack NG. Guidelines for assessment of cardiac electrophysiology and arrhythmias in small animals. Am J Physiol Heart Circ Physiol 2022; 323:H1137-H1166. [PMID: 36269644 PMCID: PMC9678409 DOI: 10.1152/ajpheart.00439.2022] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/11/2022] [Accepted: 10/17/2022] [Indexed: 01/09/2023]
Abstract
Cardiac arrhythmias are a major cause of morbidity and mortality worldwide. Although recent advances in cell-based models, including human-induced pluripotent stem cell-derived cardiomyocytes (iPSC-CM), are contributing to our understanding of electrophysiology and arrhythmia mechanisms, preclinical animal studies of cardiovascular disease remain a mainstay. Over the past several decades, animal models of cardiovascular disease have advanced our understanding of pathological remodeling, arrhythmia mechanisms, and drug effects and have led to major improvements in pacing and defibrillation therapies. There exist a variety of methodological approaches for the assessment of cardiac electrophysiology and a plethora of parameters may be assessed with each approach. This guidelines article will provide an overview of the strengths and limitations of several common techniques used to assess electrophysiology and arrhythmia mechanisms at the whole animal, whole heart, and tissue level with a focus on small animal models. We also define key electrophysiological parameters that should be assessed, along with their physiological underpinnings, and the best methods with which to assess these parameters.
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Affiliation(s)
- Crystal M Ripplinger
- Department of Pharmacology, University of California Davis School of Medicine, Davis, California
| | - Alexey V Glukhov
- Department of Medicine, Cardiovascular Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Matthew W Kay
- Department of Biomedical Engineering, The George Washington University, Washington, District of Columbia
| | - Bastiaan J Boukens
- Department Physiology, University Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Medical Biology, University of Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Nipavan Chiamvimonvat
- Department of Pharmacology, University of California Davis School of Medicine, Davis, California
- Department of Internal Medicine, University of California Davis School of Medicine, Davis, California
- Veterans Affairs Northern California Healthcare System, Mather, California
| | - Brian P Delisle
- Department of Physiology, University of Kentucky, Lexington, Kentucky
| | - Larissa Fabritz
- University Center of Cardiovascular Science, University Heart and Vascular Center, University Hospital Hamburg-Eppendorf with DZHK Hamburg/Kiel/Luebeck, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Thomas J Hund
- Department of Internal Medicine, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
- Department of Biomedical Engineering, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
| | - Bjorn C Knollmann
- Vanderbilt Center for Arrhythmia Research and Therapeutics, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Na Li
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Katherine T Murray
- Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Steven Poelzing
- Virginia Tech Carilon School of Medicine, Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech, Roanoke, Virginia
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - T Alexander Quinn
- Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Carol Ann Remme
- Department of Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Stacey L Rentschler
- Cardiovascular Division, Department of Medicine, Washington University in Saint Louis, School of Medicine, Saint Louis, Missouri
| | - Robert A Rose
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Physiology and Pharmacology, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nikki G Posnack
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, District of Columbia
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia
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Klein V, Coll-Font J, Vendramini L, Straney D, Davids M, Ferris NG, Schad LR, Sosnovik DE, Nguyen CT, Wald LL, Guérin B. Measurement of magnetostimulation thresholds in the porcine heart. Magn Reson Med 2022; 88:2242-2258. [PMID: 35906903 PMCID: PMC9420805 DOI: 10.1002/mrm.29382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/26/2022] [Accepted: 06/18/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Powerful MRI gradient systems can surpass the International Electrotechnical Commission (IEC) 60601-2-33 limit for cardiac stimulation (CS), which was determined by simple electromagnetic simulations and electrode stimulation experiments. Only a few canine studies measured magnetically induced CS thresholds in vivo and extrapolating them to human safety limits can be challenging. METHODS We measured cardiac magnetostimulation thresholds in 10 healthy, anesthetized pigs using capacitors discharged into a flat spiral coil to produce damped sinusoidal waveforms with effective stimulus duration ts,eff = 0.45 ms. Electrocardiography (ECG), blood pressure, and peripheral oximetry signals were recorded to determine threshold coil currents yielding cardiac capture. Dixon and CINE MR volumes from each animal were segmented to generate porcine-specific electromagnetic models to calculate dB/dt and E-field values in the porcine heart at threshold. For comparison, we also simulated maximum dB/dt and E-field values created by three MRI gradient systems in the heart of a human body model. RESULTS The average dB/dt threshold estimated in the porcine heart was 1.66 ± 0.23 kT/s, which is 11-fold greater than the IEC dB/dt limit at ts,eff = 0.45 ms, and 31-fold greater than the maximum value created by the investigated MRI gradients in the human heart. The average E-field threshold estimated in the porcine heart was 92.9 ± 13.5 V/m, which is 6-fold greater than the IEC E-field limit at ts,eff = 0.45 ms and 37-fold greater than the maximum gradient-induced E-field in the human heart. CONCLUSION This first measurement of cardiac magnetostimulation thresholds in pigs indicates that the IEC cardiac safety limit is conservative for the investigated stimulus duration (ts,eff = 0.45 ms).
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Affiliation(s)
- Valerie Klein
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Jaume Coll-Font
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Charlestown, MA
| | - Livia Vendramini
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Donald Straney
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Mathias Davids
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Natalie G. Ferris
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
- Harvard Biophysics Graduate Program, Cambridge, MA, United States
| | - Lothar R. Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - David E. Sosnovik
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Charlestown, MA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
| | - Christopher T. Nguyen
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Charlestown, MA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
| | - Lawrence L. Wald
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
- Harvard Biophysics Graduate Program, Cambridge, MA, United States
| | - Bastien Guérin
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
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The impact of a modified anaesthetic protocol on animal survival and the characteristics of ventricular arrhythmias in the course of acute myocardial infarction in a domestic pig model. J Vet Res 2022; 66:435-447. [PMID: 36349138 PMCID: PMC9597936 DOI: 10.2478/jvetres-2022-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/18/2022] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction
Acute myocardial infarction (MI) is one of the most common causes of death in humans in highly developed countries. Among its most frequent complications affecting the patient’s prognosis are cardiac arrhythmias: ventricular tachycardia (VT) and ventricular fibrillation (VF).
Material and Methods
The study aimed to characterise arrhythmias in 19 pigs subjected to experimentally induced MI obtained by occlusion of the proximal left anterior descending (LAD) coronary artery using an angioplasty balloon. The anaesthetic protocol was modified to reduce mortality by including procedures stabilising haemodynamic disorders which develop during episodes of ischaemia and arrhythmia. During 30 min of experimentally induced ischaemia, the heart rhythm was recorded using a 12-lead ECG. The time, frequency, and type of arrhythmias were analysed.
Results
Ventricular arrhythmias were found in 94.74% of the treated pigs. The most common were ventricular premature complexes, reported in 88.89% of pigs with arrhythmia. Ventricular tachycardia was recorded in 66.67% and ventricular fibrillation in 50% of pigs with arrhythmias.
Conclusion
Myocardial infarction due to proximal LAD occlusion is characterised by a high incidence of ventricular arrhythmias, especially VT and VF. Because of the high survival rate, this MI porcine model may serve as a model for research on acute ischaemic ventricular arrhythmias in humans. Additionally, it reduces the total number of animals required for testing while yielding meaningful results, which is in line with the 3R principle.
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Dawes DM, Ho JD, Halperin HR, Fink SJ, Driver BE, Klein LR. A comparison of three conducted electrical weapons in a surrogate swine cardiac safety model. J Forensic Leg Med 2020; 77:102088. [PMID: 33242742 DOI: 10.1016/j.jflm.2020.102088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 10/23/2022]
Abstract
We used a previously described methodology in a swine model to compare the relative cardiac safety of the Axon T7 Conducted Electrical Weapon (CEW), released in October of 2018, to two prior generations of Axon CEWs to include the X2 and the X26E. A total of 5 swine (252 total CEW exposures) were tested by alternating the three weapons at each chest exposure location. Our testing, using systemic hypotension as the quantitative surrogate for cardiac capture, demonstrated that the T7 and X2 were not statistically different. Both were superior, in terms of reduced hypotension during exposure, to the X26E. This study is important as it demonstrates that the newly released weapon is non-inferior to the X2 and superior to the X26E using this surrogate safety model. It is also important because it is the first study to examine the cardiac effects of simultaneous multi-bay exposures. Our prior study compared the X2 to the X26E but examined only single bay exposures from the X2. Lastly, we feel we have improved the methodology for studying the comparative cardiac effects of CEWs.
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Affiliation(s)
| | - Jeffrey D Ho
- Hennepin County Medical Center, Minneapolis, MN, United States.
| | | | - Sarah J Fink
- Johns Hopkins University, Baltimore, MD, United States
| | - Brian E Driver
- Hennepin County Medical Center, Minneapolis, MN, United States
| | - Lauren R Klein
- Hennepin County Medical Center, Minneapolis, MN, United States
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Selective aortic arch perfusion with fresh whole blood or HBOC-201 reverses hemorrhage-induced traumatic cardiac arrest in a lethal model of noncompressible torso hemorrhage. J Trauma Acute Care Surg 2020; 87:263-273. [PMID: 31348400 DOI: 10.1097/ta.0000000000002315] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hemorrhage-induced traumatic cardiac arrest (HiTCA) has a dismal survival rate. Previous studies demonstrated selective aortic arch perfusion (SAAP) with fresh whole blood (FWB) improved the rate of return of spontaneous circulation (ROSC) after HiTCA, compared with resuscitative endovascular balloon occlusion of the aorta and cardiopulmonary resuscitation (CPR). Hemoglobin-based oxygen carriers, such as hemoglobin-based oxygen carrier (HBOC)-201, may alleviate the logistical constraints of using FWB in a prehospital setting. It is unknown whether SAAP with HBOC-201 is equivalent in efficacy to FWB, whether conversion from SAAP to extracorporeal life support (ECLS) is feasible, and whether physiologic derangement post-SAAP therapy is reversible. METHODS Twenty-six swine (79 ± 4 kg) were anesthetized and underwent HiTCA which was induced via liver injury and controlled hemorrhage. Following arrest, swine were randomly allocated to resuscitation using SAAP with FWB (n = 12) or HBOC-201 (n = 14). After SAAP was initiated, animals were monitored for a 20-minute prehospital period prior to a 40-minute damage control surgery and resuscitation phase, followed by 260 minutes of critical care. Primary outcomes included rate of ROSC, survival, conversion to ECLS, and correction of physiology. RESULTS Baseline physiologic measurements were similar between groups. ROSC was achieved in 100% of the FWB animals and 86% of the HBOC-201 animals (p = 0.483). Survival (t = 320 minutes) was 92% (11/12) in the FWB group and 67% (8/12) in the HBOC-201 group (p = 0.120). Conversion to ECLS was successful in 100% of both groups. Lactate peaked at 80 minutes in both groups, and significantly improved by the end of the experiment in the HBOC-201 group (p = 0.001) but not in the FWB group (p = 0.104). There was no significant difference in peak or end lactate between groups. CONCLUSION Selective aortic arch perfusion is effective in eliciting ROSC after HiTCA in a swine model, using either FWB or HBOC-201. Transition from SAAP to ECLS after definitive hemorrhage control is feasible, resulting in high overall survival and improvement in lactic acidosis over the study period.
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Morosawa S, Yamamoto H, Hirano M, Amamizu H, Uzuka H, Ohyama K, Hasebe Y, Nakano M, Fukuda K, Takayama K, Shimokawa H. Development of a Shock-Wave Catheter Ablation System for Ventricular Tachyarrhythmias: Validation Study in Pigs In Vivo. J Am Heart Assoc 2020; 8:e011038. [PMID: 30638120 PMCID: PMC6497350 DOI: 10.1161/jaha.118.011038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Although radiofrequency catheter ablation is the current state‐of‐the‐art treatment for ventricular tachyarrhythmias, it has limited success for several reasons, including insufficient lesion depth, prolonged inflammation with subsequent recurrence, and thromboembolisms due to myoendocardial thermal injury. Because shock waves can be applied to deep lesions without heat, we have been developing a shock‐wave catheter ablation (SWCA) system to overcome these fundamental limitations of radiofrequency catheter ablation. In this study, we evaluated the efficacy and safety of our SWCA system for clinical application to treat ventricular tachyarrhythmia. Methods and Results In 33 pigs, we examined SWCA in vivo for the following 4 protocols. First, in an epicardial substrate model (n=8), endocardial SWCA significantly decreased the sensing threshold (pre‐ versus postablation: 11.4±3.8 versus 6.8±3.6 mV; P<0.05) and increased the pacing threshold (pre‐ versus postablation: 1.6±0.8 versus 2.0±1.1 V; P<0.05), whereas endocardial radiofrequency catheter ablation failed to do so. Second, in a myocardial infarction model (n=3), epicardial SWCA of the border zone of the infarcted lesion was as effective as ablation of the normal myocardium. Third, in a coronary artery application model (n=10), direct application of shock waves to the epicardial coronary arteries caused no adverse effects in either the acute or chronic phase. Fourth, with an epicardial approach (n=8), we found that 90 shots per site provided an ideal therapeutic condition to create deep lesions with less superficial damage. Conclusions These results indicate that our new SWCA system is effective and safe for treatment of ventricular tachyarrhythmias with deep arrhythmogenic substrates.
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Affiliation(s)
- Susumu Morosawa
- 1 Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai Japan
| | - Hiroaki Yamamoto
- 1 Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai Japan
| | - Michinori Hirano
- 1 Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai Japan
| | - Hirokazu Amamizu
- 1 Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai Japan
| | - Hironori Uzuka
- 1 Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai Japan
| | - Kazuma Ohyama
- 1 Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai Japan
| | - Yuhi Hasebe
- 1 Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai Japan
| | - Makoto Nakano
- 1 Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai Japan
| | - Koji Fukuda
- 1 Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai Japan
| | - Kazuyoshi Takayama
- 1 Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai Japan
| | - Hiroaki Shimokawa
- 1 Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai Japan
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Sattler SM, Skibsbye L, Linz D, Lubberding AF, Tfelt-Hansen J, Jespersen T. Ventricular Arrhythmias in First Acute Myocardial Infarction: Epidemiology, Mechanisms, and Interventions in Large Animal Models. Front Cardiovasc Med 2019; 6:158. [PMID: 31750317 PMCID: PMC6848060 DOI: 10.3389/fcvm.2019.00158] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/18/2019] [Indexed: 12/22/2022] Open
Abstract
Ventricular arrhythmia and subsequent sudden cardiac death (SCD) due to acute myocardial infarction (AMI) is one of the most frequent causes of death in humans. Lethal ventricular arrhythmias like ventricular fibrillation (VF) prior to hospitalization have been reported to occur in more than 10% of all AMI cases and survival in these patients is poor. Identification of risk factors and mechanisms for VF following AMI as well as implementing new risk stratification models and therapeutic approaches is therefore an important step to reduce mortality in people with high cardiovascular risk. Studying spontaneous VF following AMI in humans is challenging as it often occurs unexpectedly in a low risk subgroup. Large animal models of AMI can help to bridge this knowledge gap and are utilized to investigate occurrence of arrhythmias, involved mechanisms and therapeutic options. Comparable anatomy and physiology allow for this translational approach. Through experimental focus, using state-of-the-art technologies, including refined electrical mapping equipment and novel pharmacological investigations, valuable insights into arrhythmia mechanisms and possible interventions for arrhythmia-induced SCD during the early phase of AMI are now beginning to emerge. This review describes large experimental animal models of AMI with focus on first AMI-associated ventricular arrhythmias. In this context, epidemiology of first AMI, arrhythmogenic mechanisms and various potential therapeutic pharmacological targets will be discussed.
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Affiliation(s)
- Stefan Michael Sattler
- Department of Cardiology, Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.,Medical Department I, University Hospital Grosshadern, LMU Munich, Munich, Germany
| | - Lasse Skibsbye
- Department of Exploratory Toxicology, H. Lundbeck A/S, Copenhagen, Denmark
| | - Dominik Linz
- Medical Department III, Universitätsklinikum des Saarlandes, Homburg, Germany.,Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Anniek Frederike Lubberding
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Kunz SN, Calkins H, Adamec J, Kroll MW. Cardiac and skeletal muscle effects of electrical weapons. Forensic Sci Med Pathol 2018; 14:358-366. [DOI: 10.1007/s12024-018-9997-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2018] [Indexed: 10/28/2022]
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A comparative brief on conducted electrical weapon safety. Wien Med Wochenschr 2018; 169:185-192. [DOI: 10.1007/s10354-018-0616-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/05/2018] [Indexed: 10/18/2022]
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The Resuscitative and Pharmacokinetic Effects of Humeral Intraosseous Vasopressin in a Swine Model of Ventricular Fibrillation. Prehosp Disaster Med 2017; 32:305-310. [PMID: 28270248 DOI: 10.1017/s1049023x17000140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Introduction The American Heart Association (AHA; Dallas, Texas USA) and European Resuscitation Council (Niel, Belgium) cardiac arrest (CA) guidelines recommend the intraosseous (IO) route when intravenous (IV) access cannot be obtained. Vasopressin has been used as an alternative to epinephrine to treat ventricular fibrillation (VF). Hypothesis/Problem Limited data exist on the pharmacokinetics and resuscitative effects of vasopressin administered by the humeral IO (HIO) route for treatment of VF. The purpose of this study was to evaluate the effects of HIO and IV vasopressin, on the occurrence, odds, and time of return of spontaneous circulation (ROSC) and pharmacokinetic measures in a swine model of VF. METHODS Twenty-seven Yorkshire-cross swine (60 to 80 kg) were assigned randomly to three groups: HIO (n=9), IV (n=9), and a control group (n=9). Ventricular fibrillation was induced and untreated for two minutes. Chest compressions began at two minutes post-arrest and vasopressin (40 U) administered at four minutes post-arrest. Serial blood specimens were collected for four minutes, then the swine were resuscitated until ROSC or 29 post-arrest minutes elapsed. RESULTS Fisher's Exact test determined ROSC was significantly higher in the HIO 5/7 (71.5%) and IV 8/11 (72.7%) groups compared to the control 0/9 (0.0%; P=.001). Odds ratios of ROSC indicated no significant difference between the treatment groups (P=.68) but significant differences between the HIO and control, and the IV and control groups (P=.03 and .01, respectively). Analysis of Variance (ANOVA) indicated the mean time to ROSC for HIO and IV was 621.20 seconds (SD=204.21 seconds) and 554.50 seconds (SD=213.96 seconds), respectively, with no significant difference between the groups (U=11; P=.22). Multivariate Analysis of Variance (MANOVA) revealed the maximum plasma concentration (Cmax) and time to maximum concentration (Tmax) of vasopressin in the HIO and IV groups was 71753.9 pg/mL (SD=26744.58 pg/mL) and 61853.7 pg/mL (SD=22745.04 pg/mL); 111.42 seconds (SD=51.3 seconds) and 114.55 seconds (SD=55.02 seconds), respectively. Repeated measures ANOVA indicated no significant difference in plasma vasopressin concentrations between the treatment groups over four minutes (P=.48). CONCLUSIONS The HIO route delivered vasopressin effectively in a swine model of VF. Occurrence, time, and odds of ROSC, as well as pharmacokinetic measurements of HIO vasopressin, were comparable to IV. Burgert JM , Johnson AD , Garcia-Blanco J , Fulton LV , Loughren MJ . The resuscitative and pharmacokinetic effects of humeral intraosseous vasopressin in a swine model of ventricular fibrillation. Prehosp Disaster Med. 2017;32(3):305-310.
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Brave MA, Lakkireddy DR, Kroll MW, Panescu D. Validity of the small swine model for human electrical safety risks. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2016:2343-2348. [PMID: 28268796 DOI: 10.1109/embc.2016.7591200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Small swine are the most common model now used for electrical safety studies. Because of the significant anatomical and electrophysiological differences and the effect of animal size on the ventricular fibrillation (VF) threshold, there are concerns that these differences may exaggerate the risks of electrical devices to humans. We chose, as an illustrative and relevant example, swine studies of the TASER® conducted electrical weapon (CEW) as it has numerous published VF studies. We reviewed the published electrical swine safety studies for CEWs and compared them to finite element modeling studies, electrical safety standards, and epidemiological experience from field usage. We also compared the body weights of the swine to those of law enforcement arrest-related deaths. Studies of small swine exaggerate the risks of CEWs to humans. This conclusion may be extrapolated to suggest that the use of small swine for electrical safety studies should be questioned in general.
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Burgert JM, Johnson AD, Garcia-Blanco J, Froehle J, Morris T, Althuisius B, Richards J, Castano C. The effects of proximal and distal routes of intraosseous epinephrine administration on short-term resuscitative outcome measures in an adult swine model of ventricular fibrillation: a randomized controlled study. Am J Emerg Med 2016; 34:49-53. [DOI: 10.1016/j.ajem.2015.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 09/09/2015] [Accepted: 09/12/2015] [Indexed: 10/23/2022] Open
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Panescu D, Kroll M, Brave M. Cardiac fibrillation risks with TASER conducted electrical weapons. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:323-329. [PMID: 26736265 DOI: 10.1109/embc.2015.7318365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The TASER(®) conducted electrical weapon (CEW) delivers electrical pulses that can temporarily incapacitate subjects. We analyzed the cardiac fibrillation risk with TASER CEWs. Our risk model accounted for realistic body mass index distributions, used a new model of effects of partial or oblique dart penetration and used recent epidemiological CEW statics.
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