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Meo M, Denis A, Sacher F, Duchâteau J, Cheniti G, Puyo S, Bear L, Jaïs P, Hocini M, Haïssaguerre M, Bernus O, Dubois R. Insights Into the Spatiotemporal Patterns of Complexity of Ventricular Fibrillation by Multilead Analysis of Body Surface Potential Maps. Front Physiol 2020; 11:554838. [PMID: 33071814 PMCID: PMC7538856 DOI: 10.3389/fphys.2020.554838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/12/2020] [Indexed: 12/12/2022] Open
Abstract
Background Ventricular fibrillation (VF) is the main cause of sudden cardiac death, but its mechanisms are still unclear. We propose a noninvasive approach to describe the progression of VF complexity from body surface potential maps (BSPMs). Methods We mapped 252 VF episodes (16 ± 10 s) with a 252-electrode vest in 110 patients (89 male, 47 ± 18 years): 50 terminated spontaneously, otherwise by electrical cardioversion (DCC). Changes in complexity were assessed between the onset (“VF start”) and the end (“VF end”) of VF by the nondipolar component index (NDIBSPM), measuring the fraction of energy nonpreserved by an equivalent 3D dipole from BSPMs. Higher NDI reflected lower VF organization. We also examined other standard body surface markers of VF dynamics, including fibrillatory wave amplitude (ABSPM), surface cycle length (BsCLBSPM) and Shannon entropy (ShEnBSPM). Differences between patients with and without structural heart diseases (SHD, 32 vs. NSHD, 78) were also tested at those stages. Electrocardiographic features were validated with simultaneous endocardium cycle length (CL) in a subset of 30 patients. Results All BSPM markers measure an increase in electrical complexity during VF (p < 0.0001), and more significantly in NSHD patients. Complexity is significantly higher at the end of sustained VF episodes requiring DCC. Intraepisode intracardiac CL shortening (VF start 197 ± 24 vs. VF end 169 ± 20 ms; p < 0.0001) correlates with an increase in NDI, and decline in surface CL, f-wave amplitude, and entropy (p < 0.0001). In SHD patients VF is initially more complex than in NSHD patients (NDIBSPM, p = 0.0007; ShEnBSPM, p < 0.0001), with moderately slower (BsCLBSPM, p = 0.06), low-amplitude f-waves (ABSPM, p < 0.0001). In this population, lower NDI (p = 0.004) and slower surface CL (p = 0.008) at early stage of VF predict self-termination. In the NSHD group, a more abrupt increase in VF complexity is quantified by all BSPM parameters during sustained VF (p < 0.0001), whereas arrhythmia evolution is stable during self-terminating episodes, hinting at additional mechanisms driving VF dynamics. Conclusion Multilead BSPM analysis underlines distinct degrees of VF complexity based on substrate characteristics.
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Affiliation(s)
- Marianna Meo
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.,Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France.,Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France
| | - Arnaud Denis
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France
| | - Frédéric Sacher
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France
| | - Josselin Duchâteau
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.,Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France.,Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France
| | - Ghassen Cheniti
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France
| | - Stéphane Puyo
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France
| | - Laura Bear
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.,Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France.,Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France
| | - Pierre Jaïs
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.,Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France.,Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France
| | - Mélèze Hocini
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.,Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France.,Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France
| | - Michel Haïssaguerre
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.,Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France.,Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France
| | - Olivier Bernus
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.,Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France.,Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France
| | - Rémi Dubois
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.,Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France.,Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France
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Genovés P, Arias-Mutis ÓJ, Parra G, Such-Miquel L, Zarzoso M, Del Canto I, Soler C, Díaz A, Blanch E, Alberola A, Such L, Chorro FJ. Development and Long-Term Follow-Up of an Experimental Model of Myocardial Infarction in Rabbits. Animals (Basel) 2020; 10:ani10091576. [PMID: 32899601 PMCID: PMC7552163 DOI: 10.3390/ani10091576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/21/2020] [Accepted: 09/01/2020] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Ischemic heart disease is one of the leading causes of death. A series of processes occur during acute myocardial infarction that contribute to the development of ventricular dysfunction, with subsequent heart failure and ventricular arrhythmias, which account for most episodes of sudden cardiac death in these patients. These complications are associated with the adverse cardiac remodeling that occurs during the healing process following an acute episode. The remodeling causes the appearance of a substrate that can trigger life-threatening arrhythmias, such as tachycardia and/or ventricular fibrillation. The development of experimental models for analyzing the basic mechanisms involved in the pathophysiology of myocardial infarction enables the study of different therapeutic approaches aimed at improving the patient´s prognosis. The present study describes the methodology and the results obtained in a 5-week chronic infarction (one hour followed by reperfusion) in a rabbit model. The viability of the model, the care provided, the characteristics and extent of the lesions, the inducibility of arrhythmias, and the reproducibility of the methods and results have been analyzed. Abstract A chronic model of acute myocardial infarction was developed to study the mechanisms involved in adverse postinfarction ventricular remodeling. In an acute myocardial infarction (AMI), the left circumflex coronary artery of New Zealand White rabbits (n = 9) was occluded by ligature for 1 h, followed by reperfusion. A specific care protocol was applied before, during, and after the intervention, and the results were compared with those of a sham operated group (n = 7). After 5 weeks, programmed stimulation and high-resolution mapping were performed on isolated and perfused hearts using the Langendorff technique. The infarct size determined by 2,3,5-triphenyltetrazolium chloride inside of the area at risk (thioflavin-S) was then determined. The area at risk was similar in both groups (54.33% (experimental infarct group) vs. 58.59% (sham group), ns). The infarct size was 73.16% as a percentage of the risk area. The experimental infarct group had a higher inducibility of ventricular arrhythmias (100% vs. 43% in the sham group, p = 0.009). A reproducible chronic experimental model of myocardial infarction is presented in which the extent and characteristics of the lesions enable the study of the vulnerability to develop ventricular arrhythmias because of the remodeling process that occurs during cardiac tissue repair.
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Affiliation(s)
- Patricia Genovés
- INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (P.G.); (Ó.J.A.-M.); (G.P.); (I.D.C.)
- Department of Physiology, Universitat de València, 46010 Valencia, Spain; (C.S.); (A.A.); (L.S.)
| | - Óscar J. Arias-Mutis
- INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (P.G.); (Ó.J.A.-M.); (G.P.); (I.D.C.)
- Department of Physiology, Universitat de València, 46010 Valencia, Spain; (C.S.); (A.A.); (L.S.)
| | - Germán Parra
- INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (P.G.); (Ó.J.A.-M.); (G.P.); (I.D.C.)
- Department of Physiology, Universitat de València, 46010 Valencia, Spain; (C.S.); (A.A.); (L.S.)
| | - Luis Such-Miquel
- Department of Physiotherapy, Universitat de València, 46010 Valencia, Spain; (L.S.-M.); (M.Z.)
- CIBERCV, Carlos III Health Institute, 28029 Madrid, Spain
| | - Manuel Zarzoso
- Department of Physiotherapy, Universitat de València, 46010 Valencia, Spain; (L.S.-M.); (M.Z.)
| | - Irene Del Canto
- INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (P.G.); (Ó.J.A.-M.); (G.P.); (I.D.C.)
- CIBERCV, Carlos III Health Institute, 28029 Madrid, Spain
- Electronic Engineering Department, Universitat Politècnica de València, 46022 Valencia, Spain
| | - Carlos Soler
- Department of Physiology, Universitat de València, 46010 Valencia, Spain; (C.S.); (A.A.); (L.S.)
| | - Ana Díaz
- UCIM, Universitat de València, 46010 Valencia, Spain; (A.D.); (E.B.)
| | - Eva Blanch
- UCIM, Universitat de València, 46010 Valencia, Spain; (A.D.); (E.B.)
| | - Antonio Alberola
- Department of Physiology, Universitat de València, 46010 Valencia, Spain; (C.S.); (A.A.); (L.S.)
- CIBERCV, Carlos III Health Institute, 28029 Madrid, Spain
| | - Luis Such
- Department of Physiology, Universitat de València, 46010 Valencia, Spain; (C.S.); (A.A.); (L.S.)
- CIBERCV, Carlos III Health Institute, 28029 Madrid, Spain
| | - Francisco J. Chorro
- INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (P.G.); (Ó.J.A.-M.); (G.P.); (I.D.C.)
- CIBERCV, Carlos III Health Institute, 28029 Madrid, Spain
- Cardiology Department, Hospital Clinico Universitario, Universitat de València, Avda. Blasco Ibañez 17, 46010 Valencia, Spain
- Correspondence:
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