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Cheng W, Yao M, Zhai B, Wang P. Contact force sensors in minimally invasive catheters: current and future applications. Expert Rev Med Devices 2021; 18:445-455. [PMID: 33886427 DOI: 10.1080/17434440.2021.1917372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Advances in catheter design for minimally invasive surgery have brought about the incorporation of contact force (CF) sensors in catheters. Two main approaches to achieve CF sensing at the catheter end-effector consist of fiber optic or magnetic solutions. CF sensing feedback can be used to assist in ablation procedures, mapping cardiac regions, identifying tissue characteristics, and enhancing robotic catheter control. AREAS COVERED This review covers the technological and clinical aspects of CFS in catheters. Contact force and force-time integral thresholds for ablation procedures, procedural complications, and electroanatomical mapping strategies are discussed. Future applications of improving catheter control, minimizing complications, and enhancing mapping techniques through CF are examined. EXPERT OPINION Fiber optic CF catheters may be more desirable compared to magnetic modalities due to the lower cost, compactness, and higher accuracy. In ablation procedures, complications due to higher ablation duration, power, contact force, and force time can be reduced through practical experience and informed training for catheter operators. Future prospects consist of the incorporation of CF sensors with remote catheter systems to assist in catheter control. We propose that CF can also be used in machine learning decision-making algorithms to prevent complications or improve tissue characterization.
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Affiliation(s)
- Weyland Cheng
- Department of Orthopaedic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China.,Henan Provincial Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China
| | - Manye Yao
- Department of Orthopaedic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China
| | - Bo Zhai
- Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China
| | - Penggao Wang
- Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China
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2
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Kucukseymen S, Yavin H, Barkagan M, Jang J, Shapira-Daniels A, Rodriguez J, Shim D, Pashakhanloo F, Pierce P, Botzer L, Manning WJ, Anter E, Nezafat R. Discordance in Scar Detection Between Electroanatomical Mapping and Cardiac MRI in an Infarct Swine Model. JACC Clin Electrophysiol 2020; 6:1452-1464. [DOI: 10.1016/j.jacep.2020.08.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/29/2020] [Accepted: 08/11/2020] [Indexed: 12/18/2022]
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3
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Lin CY, Chung FP, Lin YJ, Chen YY, Chang SL, Lo LW, Hu YF, Liao JN, Tuan TC, Chao TF, Te ALD, Yamada S, Kuo L, Vicera JJB, Chang TY, Salim S, Huang TC, Liu CM, Wu CI, Chen SA. Dynamic unipolar voltage criteria of right ventricular septum for identifying left ventricular septal scar. J Interv Card Electrophysiol 2019; 57:353-359. [PMID: 30694424 DOI: 10.1007/s10840-019-00512-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 01/15/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The right ventricular (RV) septal unipolar voltage (UV) for predicting left ventricular (LV) septal scar wall thickness (WT) remains to be elucidated. METHODS From 2013 to 2015, data obtained from RV and LV electroanatomic maps of 28 patients (mean age, 53 ± 16 years; 19 men [67.9%]) with/without identified LV septal scars were reviewed. Patients with an RV septal scar were excluded (n = 90). Direct measurement of septal WT was conducted (mean distance, 10.4 ± 3.3 mm). Patients in group 1 had a normal LV substrate, while those in group 2 had an LV septal scar. Fisher's linear discriminant formula was used to determine the dynamic UV criteria. RESULTS A total of 552 points were collected: 323 in 12 patients from group 1 and 229 in 16 patients from group 2. The UV of the RV septum is capable of identifying the opposite LV endocardial bipolar scar and is proportional to the WT of the interventricular septum. In the absence of an RV endocardial scar, the formula of "RV septal cut-off value = 0.736 × WT - 0.117 mV" has better sensitivity and specificity for predicting the LV septal scar (0.96 vs. 0.68 and 0.91 vs. 0.80, respectively) than the predefined fixed criteria of 8.3 mV with a net reclassification improvement of 25.7% (P < 0.001). CONCLUSIONS The combined measurement of UV and WT is more sensitive than the predefined fixed UV criteria for defining deep scars.
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Affiliation(s)
- Chin-Yu Lin
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan
| | - Fa-Po Chung
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan. .,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Yun-Yu Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shih-Lin Chang
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Wei Lo
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Feng Hu
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jo-Nan Liao
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tze-Fan Chao
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Abigail Louise D Te
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shinya Yamada
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ling Kuo
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jennifer Jeanne B Vicera
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ting-Yung Chang
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Simon Salim
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ting-Chung Huang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-I Wu
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Bazan V, Frankel DS, Santangeli P, Garcia FC, Tschabrunn CM, Marchlinski FE. Three-dimensional myocardial scar characterization from the endocardium: Usefulness of endocardial unipolar electroanatomic mapping. J Cardiovasc Electrophysiol 2019; 30:427-437. [PMID: 30614100 DOI: 10.1111/jce.13842] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/26/2018] [Accepted: 12/30/2018] [Indexed: 11/29/2022]
Abstract
Epicardial ablation may be required to eliminate ventricular tachycardia (VT) in patients with underlying structural heart disease. The decision to gain epicardial access is frequently based on the suspicion of an epicardial origin for the VT and/or presence of an arrhythmogenic substrate. Epicardial pathology and VT is frequently present in patients with nonischemic right and/or left cardiomyopathies even in the setting of modest or no endocardial bipolar voltage substrate. In this setting, unipolar voltage mapping from the endocardium serves to help identify midmyocardial and/or epicardial VT substrate. The additional value of endocardial unipolar mapping includes its usefulness to predict the clinical outcome after VT ablation, to determine the irreversibility of myocardial disease, and to guide endomyocardial biopsy procedures to specific areas of intramural scarring. In this review, we aim to provide a guide to the use of endocardial unipolar mapping and its appropriate interpretation in a variety of clinical situations.
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Affiliation(s)
| | - David S Frankel
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pasquale Santangeli
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fermin C Garcia
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cory M Tschabrunn
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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5
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Takigawa M, Martin R, Cheniti G, Kitamura T, Vlachos K, Frontera A, Martin CA, Bourier F, Lam A, Pillois X, Duchateau J, Klotz N, Pambrun T, Denis A, Derval N, Hocini M, Haïssaguerre M, Sacher F, Jaïs P, Cochet H. Detailed comparison between the wall thickness and voltages in chronic myocardial infarction. J Cardiovasc Electrophysiol 2018; 30:195-204. [PMID: 30288836 DOI: 10.1111/jce.13767] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/17/2018] [Accepted: 09/28/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The relationship between the local electrograms (EGMs) and wall thickness (WT) heterogeneity within infarct scars has not been thoroughly described. The relationship between WT and voltages and substrates for ventricular tachycardia (VT) was examined. METHODS In 12 consecutive patients with myocardial infarction and VT, WT, defined by a multidetector computed tomography, and voltage were compared. In multicomponent EGMs, amplitudes of both far- and near-field components were manually measured, and the performance of the three-dimensional-mapping system automatic voltage measurement was assessed. RESULTS Of 15 748 points acquired, 2677 points within 5 mm of the endocardial surface were analyzed. In total, 909 (34.0%) multicomponent EGMs were identified; 785 (86.4%) and 883 (97.1%) were distributed in the WT less than 4 and 5 mm, respectively. Far-field EGM voltages increased linearly from 0.14 mV (0.08-0.28 mV) in the WT: 0 to 1 mm to 0.70 mV (0.43-2.62 mV) in the WT: 4 to 5 mm (ρ = 0.430; P < 0.001), and a significant difference was demonstrated between any two WT-groups (P ≤ 0.001). In contrast, near-field EGM voltages varied from 0.27 mV (0.11-0.44 mV) in the WT: 0 to 1 mm to 0.29 mV (0.17-0.53 mV) in the WT: 4 to 5 mm with a poorer correlation (ρ = 0.062, P = 0.04). The proportion of points where the system automatically measured the voltage on near-field EGMs increased from less than 10% in areas of WT: 4 to 5 mm to 50% in areas less than 2 mm. Of 21 VTs observed, seven hemodynamically stable VTs were mapped and terminated in WT: 1 to 4 mm area. CONCLUSIONS Although far-field voltages gradually increase with the WT, near-field does not. The three-dimensional-mapping system preferentially annotates the near-field components in thinner areas (center of the scar) and the far-field component in thicker areas when building a voltage map. Critical sites of VT are distributed in WT: 1 to 4 mm areas.
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Affiliation(s)
- Masateru Takigawa
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Ruairidh Martin
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France.,Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Ghassen Cheniti
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Takeshi Kitamura
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Konstantinos Vlachos
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Antonio Frontera
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Claire A Martin
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Felix Bourier
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Anna Lam
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Xavier Pillois
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Josselin Duchateau
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Nicolas Klotz
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Thomas Pambrun
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Arnaud Denis
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Nicolas Derval
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Mélèze Hocini
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Michel Haïssaguerre
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Frédéric Sacher
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Pierre Jaïs
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Hubert Cochet
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
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6
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Sramko M, Hoogendoorn JC, Glashan CA, Zeppenfeld K. Advancement in cardiac imaging for treatment of ventricular arrhythmias in structural heart disease. Europace 2018; 21:383-403. [DOI: 10.1093/europace/euy150] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/23/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Marek Sramko
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Jarieke C Hoogendoorn
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Claire A Glashan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands
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7
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Kelesidis I, Desjardins B, Muser D, Santangeli P, Zado ES, Marchlinski FE. Unipolar voltage mapping criteria for right ventricular septum: Influence of the aortic root. J Cardiovasc Electrophysiol 2018; 29:1113-1118. [DOI: 10.1111/jce.13630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/13/2018] [Accepted: 04/27/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Iosif Kelesidis
- Cardiovascular Division; Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Benoit Desjardins
- Cardiovascular Division; Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Daniele Muser
- Cardiovascular Division; Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Pasquale Santangeli
- Cardiovascular Division; Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Erica S. Zado
- Cardiovascular Division; Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Francis E. Marchlinski
- Cardiovascular Division; Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania; Philadelphia PA USA
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8
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Soto-Becerra R, Bazan V, Bautista W, Malavassi F, Altamar J, Ramirez JD, Everth A, Callans DJ, Marchlinski FE, Rodríguez D, García FC, Sáenz LC. Ventricular Tachycardia in the Setting of Chagasic Cardiomyopathy. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004950. [DOI: 10.1161/circep.116.004950] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 09/18/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Richard Soto-Becerra
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Victor Bazan
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - William Bautista
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Federico Malavassi
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Jhancarlo Altamar
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Juan David Ramirez
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Arlen Everth
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - David J. Callans
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Francis E. Marchlinski
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Diego Rodríguez
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Fermin C. García
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Luis C. Sáenz
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
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9
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Kitamura T, Fukamizu S, Miyazawa S, Kawamura I, Hojo R, Aoyama Y, Nishizaki M, Sakurada H, Hiraoka M. Usefulness of epicardial impedance evaluation for epicardial mapping and determination of epicardial ablation site for ventricular tachycardia: A pilot study. J Cardiovasc Electrophysiol 2017; 29:138-145. [DOI: 10.1111/jce.13361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/06/2017] [Accepted: 09/29/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Takeshi Kitamura
- Department of Cardiology; Tokyo Metropolitan Hiroo Hospital; Tokyo Japan
| | - Seiji Fukamizu
- Department of Cardiology; Tokyo Metropolitan Hiroo Hospital; Tokyo Japan
| | - Satoshi Miyazawa
- Department of Cardiology; Tokyo Metropolitan Hiroo Hospital; Tokyo Japan
| | - Iwanari Kawamura
- Department of Cardiology; Tokyo Metropolitan Hiroo Hospital; Tokyo Japan
| | - Rintaro Hojo
- Department of Cardiology; Tokyo Metropolitan Hiroo Hospital; Tokyo Japan
| | - Yuya Aoyama
- Department of Cardiology; Tokyo Metropolitan Hiroo Hospital; Tokyo Japan
| | | | - Harumizu Sakurada
- Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital; Tokyo Japan
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10
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Garbayo E, Gavira JJ, de Yebenes MG, Pelacho B, Abizanda G, Lana H, Blanco-Prieto MJ, Prosper F. Catheter-based Intramyocardial Injection of FGF1 or NRG1-loaded MPs Improves Cardiac Function in a Preclinical Model of Ischemia-Reperfusion. Sci Rep 2016; 6:25932. [PMID: 27184924 PMCID: PMC4868965 DOI: 10.1038/srep25932] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/25/2016] [Indexed: 01/05/2023] Open
Abstract
Cardiovascular protein therapeutics such as neuregulin (NRG1) and acidic-fibroblast growth factor (FGF1) requires new formulation strategies that allow for sustained bioavailability of the drug in the infarcted myocardium. However, there is no FDA-approved injectable protein delivery platform due to translational concerns about biomaterial administration through cardiac catheters. We therefore sought to evaluate the efficacy of percutaneous intramyocardial injection of poly(lactic-co-glycolic acid) microparticles (MPs) loaded with NRG1 and FGF1 using the NOGA MYOSTAR injection catheter in a porcine model of ischemia-reperfusion. NRG1- and FGF1-loaded MPs were prepared using a multiple emulsion solvent-evaporation technique. Infarcted pigs were treated one week after ischemia-reperfusion with MPs containing NRG1, FGF1 or non-loaded MPs delivered via clinically-translatable percutaneous transendocardial-injection. Three months post-treatment, echocardiography indicated a significant improvement in systolic and diastolic cardiac function. Moreover, improvement in bipolar voltage and decrease in transmural infarct progression was demonstrated by electromechanical NOGA-mapping. Functional benefit was associated with an increase in myocardial vascularization and remodeling. These findings in a large animal model of ischemia-reperfusion demonstrate the feasibility and efficacy of using MPs as a delivery system for growth factors and provide strong evidence to move forward with clinical studies using therapeutic proteins combined with catheter-compatible biomaterials.
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Affiliation(s)
- Elisa Garbayo
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Navarra, Pamplona, Spain
- Instituto de Investigacion Sanitaria de Navarra (IDISNA), Pamplona, Spain
| | - Juan José Gavira
- Instituto de Investigacion Sanitaria de Navarra (IDISNA), Pamplona, Spain
- Hematology, Cardiology and Cell Therapy, Clínica Universidad de Navarra and Foundation for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Manuel Garcia de Yebenes
- Instituto de Investigacion Sanitaria de Navarra (IDISNA), Pamplona, Spain
- Hematology, Cardiology and Cell Therapy, Clínica Universidad de Navarra and Foundation for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Beatriz Pelacho
- Instituto de Investigacion Sanitaria de Navarra (IDISNA), Pamplona, Spain
- Hematology, Cardiology and Cell Therapy, Clínica Universidad de Navarra and Foundation for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Gloria Abizanda
- Instituto de Investigacion Sanitaria de Navarra (IDISNA), Pamplona, Spain
- Hematology, Cardiology and Cell Therapy, Clínica Universidad de Navarra and Foundation for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Hugo Lana
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Navarra, Pamplona, Spain
- Instituto de Investigacion Sanitaria de Navarra (IDISNA), Pamplona, Spain
| | - María José Blanco-Prieto
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Navarra, Pamplona, Spain
- Instituto de Investigacion Sanitaria de Navarra (IDISNA), Pamplona, Spain
| | - Felipe Prosper
- Instituto de Investigacion Sanitaria de Navarra (IDISNA), Pamplona, Spain
- Hematology, Cardiology and Cell Therapy, Clínica Universidad de Navarra and Foundation for Applied Medical Research, University of Navarra, Pamplona, Spain
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11
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van Slochteren FJ, van Es R, Gyöngyösi M, van der Spoel TIG, Koudstaal S, Leiner T, Doevendans PA, Chamuleau SAJ. Three dimensional fusion of electromechanical mapping and magnetic resonance imaging for real-time navigation of intramyocardial cell injections in a porcine model of chronic myocardial infarction. Int J Cardiovasc Imaging 2016; 32:833-43. [PMID: 26883433 PMCID: PMC4853462 DOI: 10.1007/s10554-016-0852-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/07/2016] [Indexed: 11/15/2022]
Abstract
For cardiac regenerative therapy intramyocardial catheter guided cell transplantations are targeted to the infarct border zone (IBZ) i.e. the closest region of viable myocardium in the vicinity of the infarct area. For optimal therapeutic effect this area should be accurately identified. However late gadolinium enhanced magnetic resonance imaging (LGE-MRI) is the gold standard technique to determine the infarct size and location, electromechanical mapping (EMM) is used to guide percutaneous intramyocardial injections to the IBZ. Since EMM has a low spatial resolution, we aim to develop a practical and accurate technique to fuse EMM with LGE-MRI to guide intramyocardial injections. LGE-MRI and EMM were obtained in 17 pigs with chronic myocardial infarction created by balloon occlusion of LCX and LAD coronary arteries. LGE-MRI and EMM datasets were registered using our in-house developed 3D CartBox image registration software toolbox to assess: (1) the feasibility of the 3D CartBox toolbox, (2) the EMM values measured in the areas with a distinct infarct transmurality (IT), and (3) the highest sensitivity and specificity of the EMM to assess IT and define the IBZ. Registration of LGE-MRI and EMM resulted in a mean error of 3.01 ± 1.94 mm between the LGE-MRI mesh and EMM points. The highest sensitivity and specificity were found for UV <9.4 mV and bipolar voltage <1.2 mV to respectively identify IT of ≥5 and ≥97.5 %. The 3D CartBox image registration toolbox enables registration of EMM data on pre-acquired MRI during the EMM guided procedure and allows physicians to easily guide injections to the most optimal injection location for cardiac regenerative therapy and harness the full therapeutic effect of the therapy.
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Affiliation(s)
- F J van Slochteren
- Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - R van Es
- Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - M Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - T I G van der Spoel
- Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - S Koudstaal
- Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - T Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P A Doevendans
- Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | - S A J Chamuleau
- Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
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12
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Vela D, Gahremanpour A, Buja LM. Method for sectioning and sampling hearts for histologic evaluation after delivery of biological agents by transendocardial injection. Cardiovasc Pathol 2015; 24:304-9. [DOI: 10.1016/j.carpath.2015.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/20/2015] [Accepted: 04/13/2015] [Indexed: 11/26/2022] Open
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13
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Thajudeen A, Jackman WM, Stewart B, Cokic I, Nakagawa H, Shehata M, Amorn AM, Kali A, Liu E, Harlev D, Bennett N, Dharmakumar R, Chugh SS, Wang X. Correlation of scar in cardiac MRI and high-resolution contact mapping of left ventricle in a chronic infarct model. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:663-74. [PMID: 25656924 PMCID: PMC5006837 DOI: 10.1111/pace.12581] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/27/2014] [Accepted: 12/16/2014] [Indexed: 12/04/2022]
Abstract
Background Endocardial mapping for scars and abnormal electrograms forms the most essential component of ventricular tachycardia ablation. The utility of ultra‐high resolution mapping of ventricular scar was assessed using a multielectrode contact mapping system in a chronic canine infarct model. Methods Chronic infarcts were created in five anesthetized dogs by ligating the left anterior descending coronary artery. Late gadolinium‐enhanced magnetic resonance imaging (LGE MRI) was obtained 4.9 ± 0.9 months after infarction, with three‐dimensional (3D) gadolinium enhancement signal intensity maps at 1‐mm and 5‐mm depths from the endocardium. Ultra‐high resolution electroanatomical maps were created using a novel mapping system (Rhythmia Mapping System, Rhythmia Medical/Boston Scientific, Marlborough, MA, USA) Rhythmia Medical, Boston Scientific, Marlborough, MA, USA with an 8.5F catheter with mini‐basket electrode array (64 tiny electrodes, 2.5‐mm spacing, center‐to‐center). Results The maps contained 7,754 ± 1,960 electrograms per animal with a mean resolution of 2.8 ± 0.6 mm. Low bipolar voltage (<2 mV) correlated closely with scar on the LGE MRI and the 3D signal intensity map (1‐mm depth). The scar areas between the MRI signal intensity map and electroanatomic map matched at 87.7% of sites. Bipolar and unipolar voltages, compared in 592 electrograms from four MRI‐defined scar types (endocardial scar, epicardial scar, mottled transmural scar, and dense transmural scar) as well as normal tissue, were significantly different. A unipolar voltage of <13 mV correlated with transmural extension of scar in MRI. Electrograms exhibiting isolated late potentials (ILPs) were manually annotated and ILP maps were created showing ILP location and timing. ILPs were identified in 203 ± 159 electrograms per dog (within low‐voltage areas) and ILP maps showed gradation in timing of ILPs at different locations in the scar. Conclusions Ultra‐high resolution contact electroanatomical mapping accurately localizes ventricular scar and abnormal myocardial tissue in this chronic canine infarct model. The high fidelity electrograms provided clear identification of the very low amplitude ILPs within the scar tissue and has the potential to quickly identify targets for ablation.
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Affiliation(s)
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma, Oklahoma City, Oklahoma
| | - Brian Stewart
- Rhythmia Medical, Boston Scientific, Marlborough, Massachusetts
| | - Ivan Cokic
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma, Oklahoma City, Oklahoma
| | | | | | - Avinash Kali
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California
| | | | - Doron Harlev
- Rhythmia Medical, Boston Scientific, Marlborough, Massachusetts
| | - Nathan Bennett
- Rhythmia Medical, Boston Scientific, Marlborough, Massachusetts
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California
| | - Sumeet S Chugh
- Heart Institute.,David Geffen School of Medicine, University of California, Los Angeles, California
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14
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Utility of high-resolution electroanatomic mapping of the left ventricle using a multispline basket catheter in a swine model of chronic myocardial infarction. Heart Rhythm 2015; 12:144-54. [DOI: 10.1016/j.hrthm.2014.08.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Indexed: 11/19/2022]
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15
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Pavo N, Jakab A, Emmert MY, Strebinger G, Wolint P, Zimmermann M, Ankersmit HJ, Hoerstrup SP, Maurer G, Gyöngyösi M. Comparison of NOGA endocardial mapping and cardiac magnetic resonance imaging for determining infarct size and infarct transmurality for intramyocardial injection therapy using experimental data. PLoS One 2014; 9:e113245. [PMID: 25409528 PMCID: PMC4237404 DOI: 10.1371/journal.pone.0113245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 10/21/2014] [Indexed: 01/16/2023] Open
Abstract
Objectives We compared the accuracy of NOGA endocardial mapping for delineating transmural and non-transmural infarction to the results of cardiac magnetic resonance imaging (cMRI) with late gadolinium enhancement (LE) for guiding intramyocardial reparative substance delivery using data from experimental myocardial infarction studies. Methods Sixty domestic pigs underwent diagnostic NOGA endocardial mapping and cMRI-LE 60 days after induction of closed-chest reperfused myocardial infarction. The infarct size was determined by LE of cMRI and by delineation of the infarct core on the unipolar voltage polar map. The sizes of the transmural and non-transmural infarctions were calculated from the cMRI transmurality map using signal intensity (SI) cut-offs of>75% and>25% and from NOGA bipolar maps using bipolar voltage cut-off values of <0.8 mV and <1.9 mV. Linear regression analysis and Bland-Altman plots were used to determine correlations and systematic differences between the two images. The overlapping ratios of the transmural and non-transmural infarcted areas were calculated. Results Infarct size as determined by 2D NOGA unipolar voltage polar mapping correlated with the 3D cMRI-LE findings (r = 0.504, p<0.001) with a mean difference of 2.82% in the left ventricular (LV) surface between the two images. Polar maps of transmural cMRI and bipolar maps of NOGA showed significant association for determining of the extent of transmural infarction (r = 0.727, p<0.001, overlap ratio of 81.6±11.1%) and non-transmural infarction (r = 0.555, p<0.001, overlap ratio of 70.6±18.5%). NOGA overestimated the transmural scar size (6.81% of the LV surface) but slightly underestimated the size of the non-transmural infarction (−3.04% of the LV surface). Conclusions By combining unipolar and bipolar voltage maps, NOGA endocardial mapping is useful for accurate delineation of the targeted zone for intramyocardial therapy and is comparable to cMRI-LE. This may be useful in patients with contraindications for cMRI who require targeted intramyocardial regenerative therapy.
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Affiliation(s)
- Noemi Pavo
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Andras Jakab
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Maximilian Y. Emmert
- Swiss Centre for Regenerative Medicine, University of Zürich, Zürich, Switzerland
- Division of Surgical Research, University Hospital of Zürich, Zürich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zürich, Zürich, Switzerland
| | - Georg Strebinger
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Petra Wolint
- Swiss Centre for Regenerative Medicine, University of Zürich, Zürich, Switzerland
- Division of Surgical Research, University Hospital of Zürich, Zürich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zürich, Zürich, Switzerland
| | - Matthias Zimmermann
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Hendrik Jan Ankersmit
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Vienna, Austria
| | - Simon P. Hoerstrup
- Swiss Centre for Regenerative Medicine, University of Zürich, Zürich, Switzerland
- Division of Surgical Research, University Hospital of Zürich, Zürich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zürich, Zürich, Switzerland
| | - Gerald Maurer
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
- * E-mail:
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16
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CHOPRA NAGESH, TOKUDA MICHIFUMI, NG JUSTIN, REICHLIN TOBIAS, NOF EYAL, JOHN ROYM, TEDROW USHAB, STEVENSON WILLIAMG. Relation of the Unipolar Low-Voltage Penumbra Surrounding the Endocardial Low-Voltage Scar to Ventricular Tachycardia Circuit Sites and Ablation Outcomes in Ischemic Cardiomyopathy. J Cardiovasc Electrophysiol 2014; 25:602-8. [DOI: 10.1111/jce.12393] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 01/29/2014] [Accepted: 01/31/2014] [Indexed: 11/27/2022]
Affiliation(s)
- NAGESH CHOPRA
- Arrhythmia Service; Division of Cardiovascular Medicine; Brigham and Women's Hospital; Boston Massachusetts USA
| | - MICHIFUMI TOKUDA
- Arrhythmia Service; Division of Cardiovascular Medicine; Brigham and Women's Hospital; Boston Massachusetts USA
| | - JUSTIN NG
- Arrhythmia Service; Division of Cardiovascular Medicine; Brigham and Women's Hospital; Boston Massachusetts USA
| | - TOBIAS REICHLIN
- Arrhythmia Service; Division of Cardiovascular Medicine; Brigham and Women's Hospital; Boston Massachusetts USA
| | - EYAL NOF
- Arrhythmia Service; Division of Cardiovascular Medicine; Brigham and Women's Hospital; Boston Massachusetts USA
| | - ROY M. JOHN
- Arrhythmia Service; Division of Cardiovascular Medicine; Brigham and Women's Hospital; Boston Massachusetts USA
| | - USHA B. TEDROW
- Arrhythmia Service; Division of Cardiovascular Medicine; Brigham and Women's Hospital; Boston Massachusetts USA
| | - WILLIAM G. STEVENSON
- Arrhythmia Service; Division of Cardiovascular Medicine; Brigham and Women's Hospital; Boston Massachusetts USA
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17
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Nussinovitch U, Shinnawi R, Gepstein L. Modulation of cardiac tissue electrophysiological properties with light-sensitive proteins. Cardiovasc Res 2014; 102:176-87. [PMID: 24518144 DOI: 10.1093/cvr/cvu037] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Optogenetics approaches, utilizing light-sensitive proteins, have emerged as unique experimental paradigms to modulate neuronal excitability. We aimed to evaluate whether a similar strategy could be used to control cardiac-tissue excitability. METHODS AND RESULTS A combined cell and gene therapy strategy was developed in which fibroblasts were transfected to express the light-activated depolarizing channel Channelrhodopsin-2 (ChR2). Patch-clamp studies confirmed the development of a robust inward current in the engineered fibroblasts following monochromatic blue-light exposure. The engineered cells were co-cultured with neonatal rat cardiomyocytes (or human embryonic stem cell-derived cardiomyocytes) and studied using a multielectrode array mapping technique. These studies revealed the ability of the ChR2-fibroblasts to electrically couple and pace the cardiomyocyte cultures at varying frequencies in response to blue-light flashes. Activation mapping pinpointed the source of this electrical activity to the engineered cells. Similarly, diffuse seeding of the ChR2-fibroblasts allowed multisite optogenetics pacing of the co-cultures, significantly shortening their electrical activation time and synchronizing contraction. Next, optogenetics pacing in an in vitro model of conduction block allowed the resynchronization of the tissue's electrical activity. Finally, the ChR2-fibroblasts were transfected to also express the light-sensitive hyperpolarizing proton pump Archaerhodopsin-T (Arch-T). Seeding of the ChR2/ArchT-fibroblasts allowed to either optogentically pace the cultures (in response to blue-light flashes) or completely suppress the cultures' electrical activity (following continuous illumination with 624 nm monochromatic light, activating ArchT). CONCLUSIONS The results of this proof-of-concept study highlight the unique potential of optogenetics for future biological pacemaking and resynchronization therapy applications and for the development of novel anti-arrhythmic strategies.
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Affiliation(s)
- Udi Nussinovitch
- Sohnis Family Research Laboratory for Cardiac Electrophysiology and Regenerative Medicine; the Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, PO Box 9649, Haifa 31096, Israel
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18
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Oduneye SO, Pop M, Biswas L, Ghate S, Flor R, Ramanan V, Barry J, Celik H, Crystal E, Wright GA. Postinfarction Ventricular Tachycardia Substrate Characterization: A Comparison Between Late Enhancement Magnetic Resonance Imaging and Voltage Mapping Using an MR-Guided Electrophysiology System. IEEE Trans Biomed Eng 2013; 60:2442-9. [DOI: 10.1109/tbme.2013.2257772] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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19
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Lukács E, Magyari B, Tóth L, Petneházy Ö, Petrási Z, Simor T, Gyöngyösi M, Repa I, Koller Á, Rőth E, Horváth IG. Evaluation of experimental myocardial infarction models via electromechanical mapping and magnetic resonance imaging. Can J Physiol Pharmacol 2013; 91:617-24. [DOI: 10.1139/cjpp-2012-0410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The diagnostic characteristics of electromechanical mapping (EMM) were evaluated in porcine myocardial infarction (MI) models with the parallel application of cardiac magnetic resonance imaging (cMRI) from the aspect of different pathophysiology and localization. Balloon occlusion in the left anterior descending coronary artery (LAD balloon group) or coil deployment in the LAD (LAD coil group) or circumflex artery (Cx coil group) was applied percutaneously in 16 domestic pigs. Regional left ventricular viability data were captured via cMRI and EMM. The unipolar voltage (UV) value was significantly decreased in segments containing transmural and subendocardial late enhancement compared with viable segments in the LAD balloon, LAD coil, and Cx coil groups. Receiver operating characteristic analysis revealed area under the curve values of 0.809 and 0.691 in the LAD infarct territory, and 0.864 and 0.855 in the Cx infarct territory for the UV compared with cMRI viability results as transmural late enhancement or viable tissue and subendocardial late enhancement or viable tissue, respectively. In conclusion, the UV value detected the presence of scar tissue with differential transmural extent and which represented proper diagnostic features both in the reperfused and nonreperfused models. This data could provide additional benefit in the clinical use of EMM for diagnostic purposes.
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Affiliation(s)
- Edit Lukács
- Heart Institute, Medical School, University of Pécs, Ifjúság u. 13, Pécs, Hungary
| | - Balázs Magyari
- Heart Institute, Medical School, University of Pécs, Ifjúság u. 13, Pécs, Hungary
| | - Levente Tóth
- Institute of Diagnostic Imaging and Radiation Oncology, University of Kaposvár, Guba Sándor u. 40, Kaposvár, Hungary
| | - Örs Petneházy
- Institute of Diagnostic Imaging and Radiation Oncology, University of Kaposvár, Guba Sándor u. 40, Kaposvár, Hungary
| | - Zsolt Petrási
- Institute of Diagnostic Imaging and Radiation Oncology, University of Kaposvár, Guba Sándor u. 40, Kaposvár, Hungary
| | - Tamás Simor
- Heart Institute, Medical School, University of Pécs, Ifjúság u. 13, Pécs, Hungary
| | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria
| | - Imre Repa
- Institute of Diagnostic Imaging and Radiation Oncology, University of Kaposvár, Guba Sándor u. 40, Kaposvár, Hungary
| | - Ákos Koller
- Institute of Pathophysiology and Gerontology, Medical School, University of Pécs, Szigeti u. 12, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Ifjúság u. 10, Pécs, Hungary
| | - Erzsébet Rőth
- Department of Surgical Research and Techniques, Medical School, University of Pécs, Kodály Zoltán utca 20, Pécs, Hungary
| | - Iván G. Horváth
- Heart Institute, Medical School, University of Pécs, Ifjúság u. 13, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Ifjúság u. 10, Pécs, Hungary
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20
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Lukács E, Magyari B, Tóth L, Petrási Z, Repa I, Koller A, Horváth I. Overview of large animal myocardial infarction models (review). ACTA ACUST UNITED AC 2013; 99:365-81. [PMID: 23238539 DOI: 10.1556/aphysiol.99.2012.4.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
There are several experimental models for the in vivo investigation of myocardial infarction (MI) in small (mouse, rat) and large animals (dog, pig, sheep and baboons). The application of large animal models raises ethical concerns, the design of experiments needs longer follow-up times, requiring proper breeding and housing conditions, therefore resulting in higher cost, than in vitro or small animal studies. On the other hand, the relevance of large animal models is very important, since they mostly resemble to human physiological and pathophysiological processes. The first main difference among MI models is the method of induction (open or closed chest, e.g. surgical or catheter based); the second main difference is the presence or absence of reperfusion. The former (i.e. reperfused MI) allows the investigation of reperfusion injury and new catheter based techniques during percutaneous coronary interventions, while the latter (i.e. nonreperfused MI) serves as a traditional coronary occlusion model, to test the effects of new pharmacological agents and biological therapies, as cell therapy. The reperfused and nonreperfused myocardial infarction has different outcomes, regarding left ventricular function, remodelling, subsequent heart failure, aneurysm formation and mortality. Our aim was to review the literature and report our findings regarding experimental MI models, regarding the differences among species, methods, reproducibility and interpretation.
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Affiliation(s)
- E Lukács
- University of Pécs Heart Institute, Medical School Pécs Hungary
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21
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Sasaki T, Miller CF, Hansford R, Yang J, Caffo BS, Zviman MM, Henrikson CA, Marine JE, Spragg D, Cheng A, Tandri H, Sinha S, Kolandaivelu A, Zimmerman SL, Bluemke DA, Tomaselli GF, Berger RD, Calkins H, Halperin HR, Nazarian S. Myocardial structural associations with local electrograms: a study of postinfarct ventricular tachycardia pathophysiology and magnetic resonance-based noninvasive mapping. Circ Arrhythm Electrophysiol 2012; 5:1081-90. [PMID: 23149263 DOI: 10.1161/circep.112.970699] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The association of scar on late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) with local electrograms on electroanatomic mapping has been investigated. We aimed to quantify these associations to gain insights regarding LGE-CMR image characteristics of tissues and critical sites that support postinfarct ventricular tachycardia (VT). METHODS AND RESULTS LGE-CMR was performed in 23 patients with ischemic cardiomyopathy before VT ablation. Left ventricular wall thickness and postinfarct scar thickness were measured in each of 20 sectors per LGE-CMR short-axis plane. Electroanatomic mapping points were retrospectively registered to the corresponding LGE-CMR images. Multivariable regression analysis, clustered by patient, revealed significant associations among left ventricular wall thickness, postinfarct scar thickness, and intramural scar location on LGE-CMR, and local endocardial electrogram bipolar/unipolar voltage, duration, and deflections on electroanatomic mapping. Anteroposterior and septal/lateral scar localization was also associated with bipolar and unipolar voltage. Antiarrhythmic drug use was associated with electrogram duration. Critical sites of postinfarct VT were associated with >25% scar transmurality, and slow conduction sites with >40 ms stimulus-QRS time were associated with >75% scar transmurality. CONCLUSIONS Critical sites for maintenance of postinfarct VT are confined to areas with >25% scar transmurality. Our data provide insights into the structural substrates for delayed conduction and VT and may reduce procedural time devoted to substrate mapping, overcome limitations of invasive mapping because of sampling density, and enhance magnetic resonance-based ablation by feature extraction from complex images.
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Affiliation(s)
- Takeshi Sasaki
- Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Tao Q, Milles J, VAN Huls VAN Taxis C, Lamb HJ, Reiber JHC, Zeppenfeld K, VAN DER Geest RJ. Toward magnetic resonance-guided electroanatomical voltage mapping for catheter ablation of scar-related ventricular tachycardia: a comparison of registration methods. J Cardiovasc Electrophysiol 2011; 23:74-80. [PMID: 21914023 DOI: 10.1111/j.1540-8167.2011.02167.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Integration of preprocedural delayed enhanced magnetic resonance imaging (DE-MRI) with electroanatomical voltage mapping (EAVM) may provide additional high-resolution substrate information for catheter ablation of scar-related ventricular tachycardias (VT). Accurate and fast image integration of DE-MRI with EAVM is desirable for MR-guided ablation. METHODS AND RESULTS Twenty-six VT patients with large transmural scar underwent catheter ablation and preprocedural DE-MRI. With different registration models and EAVM input, 3 image integration methods were evaluated and compared to the commercial registration module CartoMerge. The performance was evaluated both in terms of distance measure that describes surface matching, and correlation measure that describes actual scar correspondence. Compared to CartoMerge, the method that uses the translation-and-rotation model and high-density EAVM input resulted in a registration error of 4.32±0.69 mm as compared to 4.84 ± 1.07 (P <0.05); the method that uses the translation model and high-density EAVM input resulted in a registration error of 4.60 ± 0.65 mm (P = NS); and the method that uses the translation model and a single anatomical landmark input resulted in a registration error of 6.58 ± 1.63 mm (P < 0.05). No significant difference in scar correlation was observed between all 3 methods and CartoMerge (P = NS). CONCLUSIONS During VT ablation procedures, accurate integration of EAVM and DE-MRI can be achieved using a translation registration model and a single anatomical landmark. This model allows for image integration in minimal mapping time and is likely to reduce fluoroscopy time and increase procedure efficacy.
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Affiliation(s)
- Qian Tao
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
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23
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Gyöngyösi M, Dib N. Diagnostic and prognostic value of 3D NOGA mapping in ischemic heart disease. Nat Rev Cardiol 2011; 8:393-404. [DOI: 10.1038/nrcardio.2011.64] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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24
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Perin EC, Silva GV, Vela DC, Zheng Y, Baimbridge F, Gahremanpour A, Quan X, Hahn W, Kim J, Wood K, Kitamura M. Human hepatocyte growth factor (VM202) gene therapy via transendocardial injection in a pig model of chronic myocardial ischemia. J Card Fail 2011; 17:601-11. [PMID: 21703533 DOI: 10.1016/j.cardfail.2011.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 02/07/2011] [Accepted: 03/07/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hepatocyte growth factor (HGF) may stimulate angiogenesis. We examined the safety and therapeutic potential of the HGF plasmid (VM202) in pigs with chronic myocardial ischemia. METHODS AND RESULTS We delivered VM202 or vehicle transendocardially to 4 groups of pigs: vehicle control (n = 9); high-dose VM202 (n = 9); low-dose VM202 (n = 3); and normal control (no ischemia; n = 1). Pigs were killed 3, 30, and 60 days after injection. No adverse events were associated with VM202 treatment or delivery. Quantitative polymerase chain reaction indicated that heart injection sites had the highest levels of VM202 (day 3), which became almost undetectable by 30-60 days. Most nontarget tissues showed clearance of VM202 plasmid by day 30. Control and VM202-treated pigs did not differ in global functional data. Dobutamine-stressed myocardial-contrast echocardiogram suggested that VM202 may help preserve microvascular perfusion at 30 days; reperfusion velocity in ischemic myocardium decreased significantly in control (baseline to follow-up, 5.1 ± 1.9 to 2.7 ± 1.0; P = .031) but not in VM202 groups (high-dose: 3.1 ± 1.1 vs 3.1 ± 1.5 [P = .511]; low-dose: 3.8 ± 1.1 vs 3.9 ± 1.5 [P = .559]). Linear local shortening increased significantly from day 0 to 30 in VM202-treated versus control pigs (5.0 ± 4.7% vs 9.2 ± 7.5% vs 0.9 ± 5.8% [high-dose, low-dose, control, respectively]; P = .021). CONCLUSIONS Transendocardial delivery of VM202 was safe and may help to preserve microcirculatory perfusion and improve wall motion.
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Affiliation(s)
- Emerson C Perin
- Stem Cell Center, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA.
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25
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Hutchinson MD, Gerstenfeld EP, Desjardins B, Bala R, Riley MP, Garcia FC, Dixit S, Lin D, Tzou WS, Cooper JM, Verdino RJ, Callans DJ, Marchlinski FE. Endocardial unipolar voltage mapping to detect epicardial ventricular tachycardia substrate in patients with nonischemic left ventricular cardiomyopathy. Circ Arrhythm Electrophysiol 2010; 4:49-55. [PMID: 21131557 DOI: 10.1161/circep.110.959957] [Citation(s) in RCA: 289] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with nonischemic left ventricular cardiomyopathy (LVCM) and ventricular tachycardia (Vt) have complex 3-dimensional substrate with variable involvement of the endocardium (ENDO) and epicardium (EPI). The purpose of this study was to determine whether ENDO unipolar (UNI) mapping with a larger electric field of view could identify EPI low bipolar (BIP) voltage regions in patients with LVCM undergoing Vt ablation. METHODS AND RESULTS The reference value for normal ENDO unipolar voltage was determined from 6 patients without structural heart disease. Consecutive patients undergoing Vt ablation over an 8-year period with detailed (>100 points) LV ENDO and EPI mapping and normal LV ENDO BIP voltage were identified. From this cohort, we compared patients with structurally normal hearts and normal EPI BIP voltage (EPI-, group 1) with patients with LVCM and low LV EPI BIP voltage regions present (EPI+, group 2). Confluent regions of ENDO UNI and EPI BIP low voltage (>2 cm(2)) were measured. The normal signal amplitude was >8.27 mV for LV ENDO UNI electrograms. Detailed LV ENDO-EPI maps in 5 EPI- patients were compared with 11 EPI+ patients. Confluent ENDO UNI low-voltage regions were seen in 9 of 11 (82%) of the EPI+ (group 2) patients compared with none of 5 EPI- (group 1) patients (P<0.001). In all 9 patients with ENDO UNI low voltage, the ENDO UNI low-voltage regions were directly opposite to an area of EPI BIP low voltage (61% ENDO UNI-EPI BIP low-voltage area overlap). CONCLUSIONS EPI arrhythmia substrate can be reliably identified in most patients with LVCM using ENDO UNI voltage mapping in the absence of ENDO BIP abnormalities.
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Affiliation(s)
- Mathew D Hutchinson
- Cardiovascular Division, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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Polin GM, Haqqani H, Tzou W, Hutchinson MD, Garcia FC, Callans DJ, Zado ES, Marchlinski FE. Endocardial unipolar voltage mapping to identify epicardial substrate in arrhythmogenic right ventricular cardiomyopathy/dysplasia. Heart Rhythm 2010; 8:76-83. [PMID: 20933099 DOI: 10.1016/j.hrthm.2010.09.088] [Citation(s) in RCA: 185] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 09/29/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND The risk and success of epicardial substrate ablation for ventricular tachycardia (VT) support the value of techniques identifying the epicardial substrate with endocardial mapping. OBJECTIVE The purpose of this study was to test the hypothesis that endocardial unipolar voltage mapping in patients with right ventricular (RV) VT and preserved endocardial bipolar voltage abnormalities might identify the extent of epicardial bipolar voltage abnormality. METHODS Using a cutoff of < 5.5 mV for normal endocardial unipolar voltage derived from 8 control patients without structural heart disease, 10 patients with known ARVC/D (group 1, retrospective) and 13 patients with RV VT (group 2, prospective) with modest or no endocardial bipolar voltage abnormalities underwent detailed endocardial and epicardial mapping. RESULTS The area of epicardial unipolar voltage abnormality in all 10 group 1 patients with ARVC/D (62 ± 21 cm²) and in 9 of the 13 group 2 patients (8 with criteria for ARVC/D) (53 ± 21 cm²) was on average three times more extensive than the endocardial bipolar abnormality and correlated (r = 0.63, P <.05 and r = 0.81, P <.008, respectively) with the larger area epicardial bipolar abnormality with respect to size (group 1: 82 ± 22 cm²; group 2: 68 ± 41 cm²) and location. In the remaining 4 group 2 patients and 3 additional reference patients without structural heart disease, endocardial bipolar, endocardial unipolar, and, as predicted, epicardial bipolar voltage all were normal. CONCLUSION Endocardial unipolar mapping with cutoff of 5.5 mV identifies more extensive areas of epicardial bipolar signal abnormalities in patients with ARVC/D and limited endocardial VT substrate.
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Affiliation(s)
- Glenn M Polin
- Section of Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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JACOBSON JASONT, HUTCHINSON MATHEWD, COOPER JOSHUAM, WOO YJOSEPH, SHANDLER RICHARDS, CALLANS DAVIDJ. Tissue-Specific Variability in Human Epicardial Impedance. J Cardiovasc Electrophysiol 2010; 22:436-9. [DOI: 10.1111/j.1540-8167.2010.01929.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Wijnmaalen AP, van der Geest RJ, van Huls van Taxis CFB, Siebelink HMJ, Kroft LJM, Bax JJ, Reiber JHC, Schalij MJ, Zeppenfeld K. Head-to-head comparison of contrast-enhanced magnetic resonance imaging and electroanatomical voltage mapping to assess post-infarct scar characteristics in patients with ventricular tachycardias: real-time image integration and reversed registration. Eur Heart J 2010; 32:104-14. [PMID: 20864488 DOI: 10.1093/eurheartj/ehq345] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIMS Substrate-based ablation of ventricular tachycardia (VT) relies on electroanatomical voltage mapping (EAVM). Integration of scar information from contrast-enhanced magnetic resonance imaging (CE-MRI) with EAVM may provide supplementary information. This study assessed the relation between electrogram voltages and CE-MRI scar characteristics using real-time integration and reversed registration. METHODS AND RESULTS Fifteen patients without implantable cardiac defibrillator (14 males, 64 ± 9 years) referred for VT ablation after myocardial infarction underwent CE-MRI. Contours of the CE-MRI were used to create three-dimensional surface meshes of the left ventricle (LV), aortic root, and left main stem (LM). Real-time integration of CE-MRI-derived scar meshes with EAVM of the LV and aortic root was performed using the LM and the CARTO surface registration algorithm. Merging of CE-MRI meshes with EAVM was successful with a registration error of 3.8 ± 0.6 mm. After the procedure, voltage amplitudes of each mapping point were superimposed on the corresponding CE-MRI location using the reversed registration matrix. Infarcts on CE-MRI were categorized by transmurality and signal intensity. Local bipolar and unipolar voltages decreased with increasing scar transmurality and were influenced by scar heterogeneity. Ventricular tachycardia reentry circuit isthmus sites were correlated to CE-MRI scar location. In three patients, VT isthmus sites were located in scar areas not identified by EAVM. CONCLUSION Integration of MRI-derived scar maps with EAVM during VT ablation is feasible and accurate. Contrast-enhanced magnetic resonance imaging identifies non-transmural scars and infarct grey zones not detected by EAVM according to the currently used voltage criteria and may provide important supplementary substrate information in selected patients.
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Assessment of myocardial fibrosis by endoventricular electromechanical mapping in experimental nonischemic cardiomyopathy. Int J Cardiovasc Imaging 2010; 27:25-37. [DOI: 10.1007/s10554-010-9657-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 06/11/2010] [Indexed: 01/02/2023]
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30
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Psaltis PJ, Zannettino ACW, Gronthos S, Worthley SG. Intramyocardial Navigation and Mapping for Stem Cell Delivery. J Cardiovasc Transl Res 2009; 3:135-46. [DOI: 10.1007/s12265-009-9138-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Accepted: 09/28/2009] [Indexed: 01/16/2023]
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31
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Endoventricular Electromechanical Mapping—The Diagnostic and Therapeutic Utility of the NOGA® XP Cardiac Navigation System. J Cardiovasc Transl Res 2008; 2:48-62. [DOI: 10.1007/s12265-008-9080-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 11/04/2008] [Indexed: 01/16/2023]
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32
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Codreanu A, Odille F, Aliot E, Marie PY, Magnin-Poull I, Andronache M, Mandry D, Djaballah W, Régent D, Felblinger J, de Chillou C. Electroanatomic Characterization of Post-Infarct Scars. J Am Coll Cardiol 2008; 52:839-42. [DOI: 10.1016/j.jacc.2008.05.038] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 04/22/2008] [Accepted: 05/20/2008] [Indexed: 11/16/2022]
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Chorro FJ, Guerrero J, Cánoves J, Trapero I, Mainar L, Pelechano F, Blasco E, Such-Miquel L, Ferrero Á, Sanchis J, Bodí V, Cerdá JM, Alberola A, Such L. Modificaciones de las características espectrales de la fibrilación ventricular en las lesiones producidas con radiofrecuencia. Estudio experimental. Rev Esp Cardiol 2008. [DOI: 10.1157/13117731] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rao L, Ling Y, He R, Gilbert AL, Frangogiannis NG, Wang J, Nagueh SF, Khoury DS. Integrated multimodal-catheter imaging unveils principal relationships among ventricular electrical activity, anatomy, and function. Am J Physiol Heart Circ Physiol 2007; 294:H1002-9. [PMID: 18083892 DOI: 10.1152/ajpheart.01297.2006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Multiple imaging modalities are employed independent of one another while managing complex cardiac arrhythmias. To combine electrical, anatomical, and functional imaging in a single catheter system, we developed a balloon catheter that carried 64 electrodes on its surface and an intracardiac echocardiography (ICE) catheter through a central lumen. The catheter system was inserted, and the balloon was inflated inside the left ventricle (LV) of eight dogs with 6-wk-old infarction, created by occlusion in the left anterior descending coronary artery. Anatomy was constructed by ICE imaging (9 MHz) through the balloon. Single-beat noncontact mapping (NCM) was performed via the multielectrode array to reconstruct unipolar endocardial electrograms during sinus rhythm. Standard contact mapping (CM) of the endocardium was also carried out for reference. Myocardial infarction in anterior LV extending from the middle to apical regions was localized both by ICE and NCM and validated by CM and pathology. The overall difference in the activation times between NCM and CM was 3 +/- 1 ms. Unipolar voltage in infarcted middle anterior LV was smaller than the voltage in normal middle inferior LV both by NCM (11 +/- 4 vs. 16 +/- 3 mV; P = 0.002) and CM (11 +/- 3 vs. 20 +/- 4 mV; P < 0.001). Unipolar voltage was also inversely related to infarct transmurality, both by NCM (r = -0.87; P = 0.005) and CM (r = -0.94; P < 0.001). The infarct area by ICE (7.7 +/- 2.9 cm(2)) was in agreement with CM (bipolar voltage, <1 mV; and area, 7.6 +/- 3.3 cm(2); r = 0.80; P = 0.016). Meanwhile, the voltage threshold that depicted the infarct area by NCM was directly related to the smallest unipolar voltage reconstructed within the infarct (r = 0.96; P < 0.001). In conclusion, combining NCM and ICE imaging in a single catheter system is feasible. The preclinical development of such an integrated system and its evaluation in experimental myocardial infarction demonstrate capabilities for single-beat mapping at multiple sites as well as the online assessment of anatomy and myocardial function.
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Affiliation(s)
- Liyun Rao
- Department of Cardiology, Methodist DeBakey Heart Center, The Methodist Hospital Research Institute, Houston, TX 77030, USA
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Abstract
Low-level laser therapy is an irradiation technique that has the ability to induce biological processes using photon energy. There are studies showing proliferation and angiogenesis after irradiation in skeletal muscle post-myocardial infarction tissue cells. Most evidence of efficacy is based on the increase in energy state and the activation of mitochondrial pathways. In the brain, there is similar evidence of cellular activity with laser irradiation. In vivo studies reinforced the efficacy of this technique for a better neurological and functional outcome post-stroke. The evidence is based on in vivo animal studies of various models and one human clinical study. Although the data is very promising, some fundamental questions remain to be answered, such as the exact mechanism along the cascade of post-stroke interconnective molecular disturbance, the optimal technique and time of treatment, and the long-term safety aspects. The answers to these questions are expected to evolve within the next few years.
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Affiliation(s)
- Yair Lampl
- Edith Wolfson Medical Center, Department of Neurology, Holon, Israel.
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Saeed M, Saloner D, Weber O, Martin A, Henk C, Higgins C. MRI in guiding and assessing intramyocardial therapy. Eur Radiol 2005; 15:851-63. [PMID: 15856250 DOI: 10.1007/s00330-004-2622-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2004] [Revised: 12/01/2004] [Accepted: 12/07/2004] [Indexed: 01/12/2023]
Abstract
Cardiovascular intervention, using MRI guidance, is challenging for clinical applications. Real-time imaging sequences with high spatial resolution are needed for monitoring intramyocardial delivery of drug, gene, or stem cell therapies. New generation MR scanners make local intramyocardial and vascular wall therapies feasible. Contrast-enhanced MRI is used for assessing myocardial ischemia, infarction, and scar tissue. Active (microcoils) and passive (T1 and T2* mechanisms) tracking methods have been used for visualization of endovascular catheters. Safety issues related to potential heating of endovascular devices is still a major obstacle for MRI-guided interventions. Fabrication of MRI-compatible interventional devices is limited. Noninvasive imaging strategies will be critical in defining spatial and temporal characteristics of angiogenesis and myocardial repair as well as in assessing the efficacy of new therapies in ischemic heart disease. MRI contrast media improve the capability of MRI by delineating the target and vascular tree. Labeling stem cells enables MRI to trace distribution, differentiation, and survival in myocardium and vascular wall. In the long term, MRI in guiding and assessing intramyocardial therapy may circumvent the limitations of peripherally administered cell therapy, X-ray angiography, and nuclear imaging. MRI represents a highly attractive discipline whose systematic development will foster the implementation of new cardiac and vascular therapies.
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Affiliation(s)
- M Saeed
- Department of Radiology, School of Medicine, University of California-San Francisco, 94143-0628, USA.
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Koch KC, vom Dahl J, Schaefer WM, Nowak B, Kapan S, Hanrath P. Prognostic value of endocardial electromechanical mapping in patients with left ventricular dysfunction undergoing percutaneous coronary intervention. Am J Cardiol 2004; 94:1129-33. [PMID: 15518606 DOI: 10.1016/j.amjcard.2004.07.078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2004] [Revised: 07/28/2004] [Accepted: 07/28/2004] [Indexed: 11/24/2022]
Abstract
Endocardial electromechanical mapping (EEM) has been proposed as a method for myocardial viability assessment. However, the impact of EEM data on clinical outcome has not been studied before. We sought to assess the prognostic value of EEM in patients with left ventricular (LV) dysfunction undergoing percutaneous coronary intervention (PCI). Seventy-five patients with coronary artery disease and LV dysfunction (angiographic LV ejection fraction [EF] 49 +/- 15%) underwent LV EEM for myocardial viability assessment before coronary revascularization. EEM parameters included mean unipolar electrographic amplitude, mean local shortening, LV volumes, LVEF, number of regions with electrographic amplitudes <7.5 mV, number of electromechanical mismatch, and match regions. Cardiac death, nonfatal myocardial infarction, nonfatal stroke, and acute heart failure requiring hospitalization were defined as clinical events. During a follow-up of 3.6 +/- 1.8 years, 20 clinical events occurred. Event-free survival after coronary revascularization was significantly better in patients with a mean unipolar electrographic amplitude of >/=9.5 mV than in patients with a mean unipolar electrographic amplitude of <9.5 mV (88% vs 57%; p <0.005). Cox regression analysis revealed angiographic LVEF, mean electrographic amplitude, number of regions with electrographic amplitudes <7.5 mV, number of electromechanical match regions, and EEM EF as univariate predictors of clinical events. In a multivariate analysis, angiographic LVEF <40% (hazard ratio 4.78, p <0.005) and mean electrographic amplitude <9.5 mV (hazard ratio 2.92, p <0.05) were independent predictors of clinical events. Thus, EEM provides prognostic information in patients with LV dysfunction undergoing coronary revascularization.
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Saeed M, Lee R, Martin A, Weber O, Krombach GA, Schalla S, Lee M, Saloner D, Higgins CB. Transendocardial delivery of extracellular myocardial markers by using combination X-ray/MR fluoroscopic guidance: feasibility study in dogs. Radiology 2004; 231:689-96. [PMID: 15163809 DOI: 10.1148/radiol.2313030683] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To demonstrate the feasibility of using a combination of x-ray fluoroscopic and magnetic resonance (MR) fluoroscopic (ie, x-ray/MR fluoroscopy) guidance for left ventricular (LV) catheterization and transendocardial delivery of extracellular tissue markers. MATERIALS AND METHODS Experiments were performed in six dogs by using an x-ray/MR fluoroscopy system. The arterial guide wire and catheter were advanced into the heart with x-ray fluoroscopic guidance. The dogs were injected with 0.5, 1.0, and 2.0 mL of iohexol. For passive catheter tracking, a steady-state free precession MR imaging sequence was used. A steerable dual-lumen catheter was used to transendocardially inject a mixture of gadodiamide (0.05 mol/L) plus Evans blue dye (3%). An electrocardiographically gated dual-inversion-recovery MR imaging sequence was used to visualize the myocardial delivery of the gadodiamide-blue dye mixture. A high concentration of gadodiamide (0.5 mol/L) was used to demarcate the borders of the area of interest, or "hit the target." Blood pressure, heart rate, and oxygen saturation were measured before and after the intervention. Analysis of variance, Scheffé, and paired Student t tests were used for data analysis. RESULTS LV catheterization via arterial access was feasible with two-dimensional x-ray fluoroscopic and three-dimensional MR fluoroscopic guidance. Delivery of the gadodiamide-blue dye mixture and the consequences of the procedure were monitored with MR imaging. Gadolinium-enhanced regions were bright on T1-weighted MR images, but they varied in size as a function of injectant volume. The mean sizes of these regions were 1.5% +/- 0.6 of the LV after the 0.5-mL injection of the mixture and 7.0% +/- 0.5 of the LV after the 2.0-mL injection (P <.001, Scheffé test). The corresponding mean sizes of the blue dye-enhanced regions were 2.3% +/- 0.6 and 8.3% +/- 0.4, respectively (P <.001). A high concentration of gadodiamide caused signal intensity loss around the gadolinium-enhanced regions. CONCLUSION Transendocardial delivery of potential therapeutic solutions is feasible with x-ray/MR fluoroscopic guidance. The injection catheter can be navigated with MR imaging guidance to hit the target.
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Affiliation(s)
- Maythem Saeed
- Department of Radiology, University of California-San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628, USA.
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Reek S, Geller JC, Mittag A, Grothues F, Hess A, Kaulisch T, Klein HU. Noncontact Mapping of Ventricular Tachycardia in a Closed-Chest Animal Model of Chronic Myocardial Infarction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2003; 26:2253-63. [PMID: 14675009 DOI: 10.1111/j.1540-8159.2003.00356.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Treatment of ventricular tachyarrhythmias in the setting of chronic myocardial infarction requires accurate characterization of the arrhythmia substrate. New mapping technologies have been developed that facilitate identification and ablation of critical areas even in rapid, hemodynamically unstable ventricular tachycardia. A noncontact mapping system was used to analyze induced ventricular tachycardia in a closed-chest sheep model of chronic myocardial infarction. Twelve sheep were studied 96 +/- 10 days after experimental myocardial infarction. During programmed stimulation, 15 different ventricular tachycardias were induced in nine animals. Induced ventricular tachycardia had a mean cycle length of 190 +/- 30 ms. In 12 ventricular tachycardias, earliest endocardial activity was recorded from virtual electrodes, preceding the surface QRS onset by 30 +/- 7 ms. Noncontact mapping identified diastolic activity in ten ventricular tachycardias. Diastolic potentials were recorded over a variable zone, spanning more than 30 mm. Timing of diastolic potentials varied from early to late diastole and could be traced back to the endocardial exit site. Entrainment with overdrive pacing was attempted in nine ventricular tachycardias, with concealed entrainment observed in seven. Abnormal endocardium in the area of chronic myocardial infarction identified by unipolar peak voltage mapping was confirmed by magnetic resonance imaging. These data suggest that induced ventricular tachycardia in the late phase of myocardial infarction in the sheep model is due to macroreentry involving the infarct borderzone. The combination of this animal model with noncontact mapping technology will allow testing of new strategies to cure and prevent ventricular tachycardia in the setting of chronic myocardial infarction.
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Affiliation(s)
- Sven Reek
- Division of Cardiology, University Hospital Magdeburg, Germany.
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Perin EC, Dohmann HFR, Borojevic R, Silva SA, Sousa ALS, Mesquita CT, Rossi MID, Carvalho AC, Dutra HS, Dohmann HJF, Silva GV, Belém L, Vivacqua R, Rangel FOD, Esporcatte R, Geng YJ, Vaughn WK, Assad JAR, Mesquita ET, Willerson JT. Transendocardial, autologous bone marrow cell transplantation for severe, chronic ischemic heart failure. Circulation 2003; 107:2294-302. [PMID: 12707230 DOI: 10.1161/01.cir.0000070596.30552.8b] [Citation(s) in RCA: 842] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study evaluated the hypothesis that transendocardial injections of autologous mononuclear bone marrow cells in patients with end-stage ischemic heart disease could safely promote neovascularization and improve perfusion and myocardial contractility. METHODS AND RESULTS Twenty-one patients were enrolled in this prospective, nonrandomized, open-label study (first 14 patients, treatment; last 7 patients, control). Baseline evaluations included complete clinical and laboratory evaluations, exercise stress (ramp treadmill), 2D Doppler echocardiogram, single-photon emission computed tomography perfusion scan, and 24-hour Holter monitoring. Bone marrow mononuclear cells were harvested, isolated, washed, and resuspended in saline for injection by NOGA catheter (15 injections of 0.2 cc). Electromechanical mapping was used to identify viable myocardium (unipolar voltage > or =6.9 mV) for treatment. Treated and control patients underwent 2-month noninvasive follow-up, and treated patients alone underwent a 4-month invasive follow-up according to standard protocols and with the same procedures used as at baseline. Patient population demographics and exercise test variables did not differ significantly between the treatment and control groups; only serum creatinine and brain natriuretic peptide levels varied in laboratory evaluations at follow-up, being relatively higher in control patients. At 2 months, there was a significant reduction in total reversible defect and improvement in global left ventricular function within the treatment group and between the treatment and control groups (P=0.02) on quantitative single-photon emission computed tomography analysis. At 4 months, there was improvement in ejection fraction from a baseline of 20% to 29% (P=0.003) and a reduction in end-systolic volume (P=0.03) in the treated patients. Electromechanical mapping revealed significant mechanical improvement of the injected segments (P<0.0005) at 4 months after treatment. CONCLUSIONS Thus, the present study demonstrates the relative safety of intramyocardial injections of bone marrow-derived stem cells in humans with severe heart failure and the potential for improving myocardial blood flow with associated enhancement of regional and global left ventricular function.
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Affiliation(s)
- Emerson C Perin
- Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Tex, USA.
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Samady H, Liu YH, Choi CJ, Ragosta M, Pfau SE, Cleman MW, Powers ER, Kramer CM, Wackers FJT, Beller GA, Watson DD. Electromechanical mapping for detecting myocardial viability and ischemia in patients with severe ischemic cardiomyopathy. Am J Cardiol 2003; 91:807-11. [PMID: 12667565 DOI: 10.1016/s0002-9149(03)00013-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This study was designed to evaluate several electromechanical mapping parameters for assessment of myocardial viability and inducible ischemia as defined by dipyridamole single-photon emission computed tomographic (SPECT) imaging at rest in patients with severe ischemic cardiomyopathy. Unipolar voltage, normalized unipolar voltage, bipolar voltage, and fragmentation were compared with tracer uptake at rest and reversibility on stress or rest quantitative technetium-99m sestamibi SPECT imaging in 32 patients with severe ischemic cardiomyopathy (left ventricular ejection fraction 0.24 +/- 0.08). In dysfunctional myocardial segments, logistic regression showed unipolar voltage, normalized unipolar voltage, and bipolar voltage to be predictive of viable myocardium (> or = 60% tracer uptake at rest) and was significantly higher in viable than in nonviable segments (p <0.01). A unipolar voltage of > or = 7.1 mV was the best predictor of viable myocardium. In dysfunctional viable segments, unipolar voltage was significantly higher in reversible than in fixed segments (p <0.001), and a unipolar voltage of > or = 8.5 mV had optimal power for identifying reversibility on dipyridamole SPECT imaging. We conclude that in patients with severe ischemic cardiomyopathy, unipolar voltage can identify viable from nonviable myocardium and reversible from fixed viable defects as defined by dipyridamole technetium-99m sestamibi SPECT imaging.
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Affiliation(s)
- Habib Samady
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville 22908-0158, USA.
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Wiggers H, Bøtker HE, Søgaard P, Kaltoft A, Hermansen F, Kim WY, Krusell L, Thuesen L. Electromechanical mapping versus positron emission tomography and single photon emission computed tomography for the detection of myocardial viability in patients with ischemic cardiomyopathy. J Am Coll Cardiol 2003; 41:843-8. [PMID: 12628732 DOI: 10.1016/s0735-1097(02)02961-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We compared catheter-based electromechanical mapping (NOGA system, Biosense-Webster, Haifa, Israel) with positron emission tomography (PET) and single photon emission computed tomography (SPECT) for prediction of reversibly dysfunctional myocardium (RDM) and irreversibly dysfunctional myocardium (IDM) in patients with severe left ventricular dysfunction. Furthermore, we established the optimal discriminatory value of NOGA measurements for distinction between RDM and IDM. BACKGROUND The NOGA system can detect viable myocardium but has not been used for prediction of post-revascularization contractile function in patients with ischemic cardiomyopathy. METHODS Twenty patients (19 males, age [mean +/- SD] 60 +/- 16 years, ejection fraction [EF] 29 +/- 6%) underwent viability testing with NOGA and PET or SPECT before revascularization. Left ventricular function was studied at baseline and six months after revascularization. RESULTS The EF increased to 34 +/- 13% at six months (p < 0.05 vs. baseline). The 58 RDM and 57 IDM regions differed with regard to unipolar voltage amplitude (UVA) (9.2 +/- 3.9 mV vs. 7.6 +/- 4.0 mV, p < 0.05), normalized UVA (106 +/- 54% vs. 75 +/- 39%, p < 0.05), and tracer uptake (76 +/- 17% vs. 60 +/- 20%, p < 0.05). The NOGA local shortening did not distinguish between RDM and IDM (6.4 +/- 5.8% vs. 5.4 +/- 6.6%). By receiver operating characteristic curve analysis, myocardial tracer uptake had better diagnostic performance than UVA (area under curve [AUC] +/- SE: 0.82 +/- 0.04 vs. 0.63 +/- 0.05, p < 0.05) and normalized UVA (AUC +/- SE: 0.70 +/- 0.05, p < 0.05). Optimal threshold was defined as the value yielding sensitivity = specificity for prediction of RDM. Sensitivity and specificity were 59% at a UVA of 8.4 mV, 65% at a normalized UVA of 83%, and 78% at a tracer uptake of 69%. CONCLUSIONS The NOGA system may discriminate RDM from IDM with optimal discriminatory values for UVA and normalized UVA of 8.4 mV and 83%, respectively. However, the diagnostic performance does not reach the level obtained by PET and SPECT in patients with severe heart failure.
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Affiliation(s)
- Henrik Wiggers
- Department of Cardiology, Skejby Hospital, Aarhus University Hospital, Aarhus, Denmark.
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Left ventricular electromechanical mapping for determination of myocardial function and viability**Editorials published in the Journal of the American College of Cardiology reflect the views of the authors and do not necessarily represent the views of JACC or the American College of Cardiology. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)02114-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Perin EC, Silva GV, Sarmento-Leite R, Sousa ALS, Howell M, Muthupillai R, Lambert B, Vaughn WK, Flamm SD. Assessing myocardial viability and infarct transmurality with left ventricular electromechanical mapping in patients with stable coronary artery disease: validation by delayed-enhancement magnetic resonance imaging. Circulation 2002; 106:957-61. [PMID: 12186800 DOI: 10.1161/01.cir.0000026394.01888.18] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study was designed to define myocardial viability and establish practical cut-off values for differentiating normal myocardial tissue from subendocardial and transmural scar tissue by using electromechanical mapping (EMM). We validated our results by delayed-enhancement cardiac MRI (DE-MRI). METHODS AND RESULTS We prospectively studied 15 ambulatory patients with stable coronary disease who were candidates for cardiac catheterization. Within 48 hours of EMM, DE-MRI was performed. Using EMM software, we created a bull's eye precisely matched to that generated by DE-MRI. Segment by segment, we compared the MRI results to the corresponding unipolar voltage value for that same segment in the EMM bull's eye. Of 300 total segments, 275 were compared. The segments were divided into normal (n=211), subendocardial scar (n=49), and transmural scar (n=15). We found that subendocardial (6.8+/-2.9 mV) and transmural (4.6+/-1.9 mV) scar segments had significantly less unipolar voltage than normal (11.6+/-4.5 mV) segments (P<0.05 for each comparison). When normal myocardium was compared with myocardium with subendocardial scar, the threshold for differentiating between the two areas was 7.9 mV (sensitivity, 80%; specificity, 80%). Comparison of normal tissue to transmural scar yielded a threshold of 6.9 mV (sensitivity, 93%; specificity, 88%). CONCLUSIONS Our results demonstrate that normal myocardium can be accurately distinguished from myocardium with subendocardial or transmural infarcts on the basis of unipolar voltage values obtained through EMM. This is the first study to validate these results by using cardiac DE-MRI in humans.
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Affiliation(s)
- Emerson C Perin
- Department of Adult Cardiology, Texas Heart Institute/St Luke's Episcopal Hospital and Baylor College of Medicine, Houston, Tex, USA.
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Bolotin G, Wolf T, van der Veen FH, Shachner R, Sazbon Y, Reisfeld D, Shofti R, Lorusso R, Ben-Haim S, Uretzky G. Three-dimensional electromechanical mapping: imaging in the operating room of the future. Ann Thorac Surg 2001; 72:S1083-9. [PMID: 11565731 DOI: 10.1016/s0003-4975(01)02938-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Three-dimensional electromechanical mapping has previously been shown to be a clinically important tool for cardiac imaging and intervention. We hypothesized that this technology may be beneficial as an intraoperative modality for assessing cardiac hemodynamics and viability during cardiac surgery. We report here the use of this technology as an imaging modality for intraoperative cardiac surgery. METHODS The tip of a locatable catheter connected to an endocardial mapping and navigating system is accurately localized while simultaneously recording local electrical and mechanical functions. Thus the three-dimensional geometry of the beating cardiac chamber is reconstructed in real time. The system was tested on 6 goats that underwent acute dynamic cardiomyoplasty and on 5 dogs that underwent left anterior descending (LAD) coronary artery ligation. RESULTS The electromechanical mapping system provided an accurate three-dimensional reconstruction of the beating left ventricle during cardiomyoplasty. After the wrapping procedure, significant end-diastolic area reduction was noted in the base and mid parts of the heart (948 +/- 194 mm2 vs 1245 +/- 33 mm2, p = 0.021; and 779 +/- 200 mm2 vs 1011 +/- 80 mm2, p = 0.016). The area of the cross-section of the apex did not change during the operation. Acute infarcted tissue was characterized 3 days after LAD ligation by concomitant deterioration in both electrical and mechanical function. CONCLUSIONS By providing both a clear view of the anatomical changes that occur during cardiac surgery, and an accurate assessment of tissue viability, electroanatomic mapping may serve as an important adjunct tool for imaging and analysis of the heart during cardiac surgery
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Affiliation(s)
- G Bolotin
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Israel.
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