1
|
Koizumi T, Kamada R, Watanabe M, Yokoshiki H, Temma T, Hagiwara H, Koya T, Nakao M, Kadosaka T, Natsui H, Takahashi M, Mizukami K, Mitsuyama H, Anzai T. Predictors of cardiovascular mortality after an electrical storm in patients with structural heart disease. J Cardiol 2022; 80:167-171. [DOI: 10.1016/j.jjcc.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/29/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022]
|
2
|
Moreno A, Walton RD, Bernus O, Vigmond EJ, Bayer JD. Low-energy, single-pulse surface stimulation defibrillates large mammalian ventricles. Heart Rhythm 2021; 19:308-317. [PMID: 34648972 DOI: 10.1016/j.hrthm.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/27/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Strong electric shocks are the gold standard for ventricular defibrillation but are associated with pain and tissue damage. We hypothesized that targeting the excitable gap (EG) of reentry with low-energy surface stimulation is a less damaging and painless alternative for ventricular defibrillation. OBJECTIVE The purpose of this study was to determine the conditions under which low-energy surface stimulation defibrillates large mammalian ventricles. METHODS Low-energy surface stimulation was delivered with five electrodes that were 7 cm long and placed 1-2 cm apart on the endocardial and epicardial surfaces of perfused pig left ventricle (LV). Rapid pacing (>4 Hz) was used to induce reentry from a single electrode. A 2 ms defibrillation pulse ≤0.5 A was delivered from all electrodes with a varied time delay from the end of the induction protocol (0.1-5 seconds). Optical mapping was performed and arrhythmia dynamics analyzed. For mechanistic insight, simulations of the VF induction and defibrillation protocols were performed in silico with an LV model emulating the experimental conditions and electrodes placed 0.25-2 cm apart. RESULTS In living LV, reentry was induced with varying complexity and dominant frequencies ranging between 3.5 to 6.2 Hz over 8 seconds postinitiation. Low-energy defibrillation was achieved with energy <60 mJ and electrode separations up to 2 cm for less complex arrhythmia. In simulations, defibrillation consistently occurred when stimulation captured >75% of the EG, which blocked reentry <2.9 mm in front of the leading reentrant wavefront. CONCLUSION Defibrillation with low-energy, single-pulse surface stimulation is feasible with energies below the human pain threshold (100 mJ). Optimal defibrillation occurs when arrhythmia complexity is minimal and electrodes capture >75% of the EG.
Collapse
Affiliation(s)
- Angel Moreno
- IHU-LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, Bordeaux, France; Centre National De La Recherche Scientifique, Institut de Mathématiques de Bordeaux, UMR5251, Bordeaux, France
| | - Richard D Walton
- IHU-LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, Bordeaux, France; Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, U1045, Bordeaux, France; INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Olivier Bernus
- IHU-LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, Bordeaux, France; Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, U1045, Bordeaux, France; INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Edward J Vigmond
- IHU-LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, Bordeaux, France; Centre National De La Recherche Scientifique, Institut de Mathématiques de Bordeaux, UMR5251, Bordeaux, France
| | - Jason D Bayer
- IHU-LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, Bordeaux, France; Centre National De La Recherche Scientifique, Institut de Mathématiques de Bordeaux, UMR5251, Bordeaux, France.
| |
Collapse
|
3
|
Bodin A, Labas V, Bisson A, Teixeira-Gomes AP, Blasco H, Tomas D, Combes-Soia L, Marcelo P, Miquelestorena-Standley E, Baron C, Angoulvant D, Babuty D, Clementy N. Acute pathophysiological myocardial changes following intra-cardiac electrical shocks using a proteomic approach in a sheep model. Sci Rep 2020; 10:20252. [PMID: 33219330 PMCID: PMC7679418 DOI: 10.1038/s41598-020-77346-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/04/2020] [Indexed: 12/18/2022] Open
Abstract
Implantable cardioverter-defibrillators (ICD) are meant to fight life-threatening ventricular arrhythmias and reduce overall mortality. Ironically, life-saving shocks themselves have been shown to be independently associated with an increased mortality. We sought to identify myocardial changes at the protein level immediately after ICD electrical shocks using a proteomic approach. ICD were surgically implanted in 10 individuals of a healthy male sheep model: a control group (N = 5) without any shock delivery and a shock group (N = 5) with the delivery of 5 consecutive shocks at 41 J. Myocardial tissue samples were collected at the right-ventricle apex near to the lead coil and at the right ventricle basal free wall region. Global quantitative proteomics experiments on myocardial tissue samples were performed using mass spectrometry techniques. Proteome was significantly modified after electrical shock and several mechanisms were associated: protein, DNA and membrane damages due to extreme physical conditions induced by ICD-shock but also due to regulated cell death; metabolic remodeling; oxidative stress; calcium dysregulation; inflammation and fibrosis. These proteome modifications were seen in myocardium both "near" and "far" from electrical shock region. N-term acetylated troponin C was an interesting tissular biomarker, significantly decreased after electrical shock in the "far" region (AUC: 0.93). Our data support an acute shock-induced myocardial tissue injury which might be involved in acute paradoxical deleterious effects such as heart failure and ventricular arrhythmias.
Collapse
Affiliation(s)
- Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France.
- INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France.
| | - Valérie Labas
- INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France
- INRAE, CHU de Tours, Plate-Forme de Chirurgie Et D'Imagerie Pour La Recherche Et L'Enseignement, Université de Tours, 37380, Nouzilly, France
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France
| | | | - Hélène Blasco
- Imagerie Et Cerveau - UMR 1253, Université de Tours, Tours, France
| | - Daniel Tomas
- INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France
- INRAE, CHU de Tours, Plate-Forme de Chirurgie Et D'Imagerie Pour La Recherche Et L'Enseignement, Université de Tours, 37380, Nouzilly, France
| | - Lucie Combes-Soia
- INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France
- INRAE, CHU de Tours, Plate-Forme de Chirurgie Et D'Imagerie Pour La Recherche Et L'Enseignement, Université de Tours, 37380, Nouzilly, France
| | - Paulo Marcelo
- Plate-Forme ICAP, Centre Universitaire de Recherche en Santé, Université de Picardie Jules Verne, 80054, Amiens, France
| | | | - Christophe Baron
- Transplantation, Immunologie et Inflammation T2i - EA 4245, Université de Tours, Tours, France
| | - Denis Angoulvant
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France
- Transplantation, Immunologie et Inflammation T2i - EA 4245, Université de Tours, Tours, France
| | - Dominique Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France
| | - Nicolas Clementy
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France
- Transplantation, Immunologie et Inflammation T2i - EA 4245, Université de Tours, Tours, France
| |
Collapse
|