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Beer D, Vijayaraman P. Current Role of Conduction System Pacing in Patients Requiring Permanent Pacing. Korean Circ J 2024; 54:427-453. [PMID: 38859643 PMCID: PMC11306426 DOI: 10.4070/kcj.2024.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/11/2024] [Indexed: 06/12/2024] Open
Abstract
His bundle pacing (HBP) and left bundle branch pacing (LBBP) are novel methods of pacing directly pacing the cardiac conduction system. HBP while developed more than two decades ago, only recently moved into the clinical mainstream. In contrast to conventional cardiac pacing, conduction system pacing including HBP and LBBP utilizes the native electrical system of the heart to rapidly disseminate the electrical impulse and generate a more synchronous ventricular contraction. Widespread adoption of conduction system pacing has resulted in a wealth of observational data, registries, and some early randomized controlled clinical trials. While much remains to be learned about conduction system pacing and its role in electrophysiology, data available thus far is very promising. In this review of conduction system pacing, the authors review the emergence of conduction system pacing and its contemporary role in patients requiring permanent cardiac pacing.
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Potyagaylo D, van Dam PM, Kuniewicz M, Dolega-Dolegowski D, Pregowska A, Atkinson A, Dobrzynski H, Proniewska K. Interactive teaching of medical 3D cardiac anatomy: atrial anatomy enhanced by ECG and 3D visualization. Front Med (Lausanne) 2024; 11:1422017. [PMID: 39036097 PMCID: PMC11258796 DOI: 10.3389/fmed.2024.1422017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/19/2024] [Indexed: 07/23/2024] Open
Abstract
The most commonly applied way of teaching students to convey the foundations of human anatomy and physiology involves textbooks and lectures. This way of transmitting knowledge causes difficulties for students, especially in the context of three-dimensional imaging of organ structures, and as a consequence translates into difficulties with imagining them. Even despite the rapid uptake of knowledge dissemination provided by online materials, including courses and webinars, there is a clear need for learning programs featuring first-hand immersive experiences tailored to suit individual study paces. In this paper, we present an approach to enhance a classical study program by combining multi-modality data and representing them in a Mixed Reality (MR)-based environment. The advantages of the proposed approach have been proven by the conducted investigation of the relationship between atrial anatomy, its electrophysiological characteristics, and resulting P wave morphology on the electrocardiogram (ECG). Another part of the paper focuses on the role of the sinoatrial node in ECG formation, while the MR-based visualization of combined micro-computed tomography (micro-CT) data with non-invasive CineECG imaging demonstrates the educational application of these advanced technologies for teaching cardiac anatomy and ECG correlations.
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Affiliation(s)
- Danila Potyagaylo
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, Krakow, Poland
| | - Peter M. van Dam
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Kuniewicz
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
- Department of Electrocardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Agnieszka Pregowska
- Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Poland
| | - Andrew Atkinson
- Division of Cardiovascular and Endocrine Sciences, University of Manchester, Manchester, United Kingdom
| | - Halina Dobrzynski
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
- Division of Cardiovascular and Endocrine Sciences, University of Manchester, Manchester, United Kingdom
| | - Klaudia Proniewska
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, Krakow, Poland
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Krakow, Poland
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Chen W, Rams D, Zając M, Albalawi R, Atkinson AJ, Aminu AJ, Mazur M, Hołda MK, Walocha J, Gil K, Kuniewicz M, Dobrzynski H. Morphology of human sinoatrial node and its surrounding right atrial muscle in the global obesity pandemic-does fat matter? Front Med (Lausanne) 2024; 11:1415065. [PMID: 38966523 PMCID: PMC11223615 DOI: 10.3389/fmed.2024.1415065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/04/2024] [Indexed: 07/06/2024] Open
Abstract
Introduction The sinus node (SN) is the main pacemaker site of the heart, located in the upper right atrium at the junction of the superior vena cava and right atrium. The precise morphology of the SN in the human heart remains relatively unclear especially the SN microscopical anatomy in the hearts of aged and obese individuals. In this study, the histology of the SN with surrounding right atrial (RA) muscle was analyzed from young non-obese, aged non-obese, aged obese and young obese individuals. The impacts of aging and obesity on fibrosis, apoptosis and cellular hypertrophy were investigated in the SN and RA. Moreover, the impact of obesity on P wave morphology in ECG was also analyzed to determine the speed and conduction of the impulse generated by the SN. Methods Human SN/RA specimens were dissected from 23 post-mortem hearts (preserved in 4% formaldehyde solution), under Polish local ethical rules. The SN/RA tissue blocks were embedded in paraffin and histologically stained with Masson's Trichrome. High and low-magnification images were taken, and analysis was done for appropriate statistical tests on Prism (GraphPad, USA). 12-lead ECGs from 14 patients under Polish local ethical rules were obtained. The P wave morphologies from lead II, lead III and lead aVF were analyzed. Results Compared to the surrounding RA, the SN in all four groups has significantly more connective tissue (P ≤ 0.05) (young non-obese individuals, aged non-obese individuals, aged obese individuals and young obese individuals) and significantly smaller nodal cells (P ≤ 0.05) (young non-obese individuals, aged non-obese individuals, aged obese individuals, young obese individuals). In aging, overall, there was a significant increase in fibrosis, apoptosis, and cellular hypertrophy in the SN (P ≤ 0.05) and RA (P ≤ 0.05). Obesity did not further exacerbate fibrosis but caused a further increase in cellular hypertrophy (SN P ≤ 0.05, RA P ≤ 0.05), especially in young obese individuals. However, there was more infiltrating fat within the SN and RA bundles in obesity. Compared to the young non-obese individuals, the young obese individuals showed decreased P wave amplitude and P wave slope in aVF lead. Discussion Aging and obesity are two risk factors for extensive fibrosis and cellular hypertrophy in SN and RA. Obesity exacerbates the morphological alterations, especially hypertrophy of nodal and atrial myocytes. These morphological alterations might lead to functional alterations and eventually cause cardiovascular diseases, such as SN dysfunction, atrial fibrillation, bradycardia, and heart failure.
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Affiliation(s)
- Weixuan Chen
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - Daniel Rams
- Department of Anatomy, Jagiellonian University, Kraków, Poland
| | - Maciej Zając
- Department of Anatomy, Jagiellonian University, Kraków, Poland
| | - Raghad Albalawi
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - Andrew J. Atkinson
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - Abimbola J. Aminu
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | | | - Mateusz K. Hołda
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
- Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University, Kraków, Poland
| | - Krzysztof Gil
- Department of Pathophysiology, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Kuniewicz
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
- Department of Anatomy, Jagiellonian University, Kraków, Poland
| | - Halina Dobrzynski
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
- Department of Anatomy, Jagiellonian University, Kraków, Poland
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4
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Li T, Marashly Q, Kim JA, Li N, Chelu MG. Cardiac conduction diseases: understanding the molecular mechanisms to uncover targets for future treatments. Expert Opin Ther Targets 2024; 28:385-400. [PMID: 38700451 DOI: 10.1080/14728222.2024.2351501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 05/01/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION The cardiac conduction system (CCS) is crucial for maintaining adequate cardiac frequency at rest and modulation during exercise. Furthermore, the atrioventricular node and His-Purkinje system are essential for maintaining atrioventricular and interventricular synchrony and consequently maintaining an adequate cardiac output. AREAS COVERED In this review article, we examine the anatomy, physiology, and pathophysiology of the CCS. We then discuss in detail the most common genetic mutations and the molecular mechanisms of cardiac conduction disease (CCD) and provide our perspectives on future research and therapeutic opportunities in this field. EXPERT OPINION Significant advancement has been made in understanding the molecular mechanisms of CCD, including the recognition of the heterogeneous signaling at the subcellular levels of sinoatrial node, the involvement of inflammatory and autoimmune mechanisms, and the potential impact of epigenetic regulations on CCD. However, the current treatment of CCD manifested as bradycardia still relies primarily on cardiovascular implantable electronic devices (CIEDs). On the other hand, an If specific inhibitor was developed to treat inappropriate sinus tachycardia and sinus tachycardia in heart failure patients with reduced ejection fraction. More work is needed to translate current knowledge into pharmacologic or genetic interventions for the management of CCDs.
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Affiliation(s)
- Tingting Li
- Department of Medicine (Section of Cardiovascular Research), Baylor College of Medicine, Houston, TX, USA
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
| | - Qussay Marashly
- Department of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Jitae A Kim
- Division of CardiovasculMedicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Na Li
- Department of Medicine (Section of Cardiovascular Research), Baylor College of Medicine, Houston, TX, USA
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
| | - Mihail G Chelu
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, TX, USA
- Division of Cardiology, Baylor St. Luke's Medical Center, Houston, TX, USA
- Division of Cardiology, Texas Heart Institute, Houston, TX, USA
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5
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Cottle B, Schriewer K, Tiwari S, Miller D, Kaza A, Hitchcock R, Sachse FB. 3D models of the cardiac conduction system in healthy neonatal human hearts. Cardiovasc Pathol 2024; 70:107626. [PMID: 38458505 PMCID: PMC11081815 DOI: 10.1016/j.carpath.2024.107626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024] Open
Abstract
Iatrogenic damage to the cardiac conduction system (CCS) remains a significant risk during congenital heart surgery. Current surgical best practice involves using superficial anatomical landmarks to locate and avoid damaging the CCS. Prior work indicates inherent variability in the anatomy of the CCS and supporting tissues. This study introduces high-resolution, 3D models of the CCS in normal pediatric human hearts to evaluate variability in the nodes and surrounding structures. Human pediatric hearts were obtained with an average donor age of 2.7 days. A pipeline was developed to excise, section, stain, and image atrioventricular (AVN) and sinus nodal (SN) tissue regions. A convolutional neural network was trained to enable precise multi-class segmentation of whole-slide images, which were subsequently used to generate high- resolution 3D tissue models. Nodal tissue region models were created. All models (10 AVN, 8 SN) contain tissue composition of neural tissue, vasculature, and nodal tissues at micrometer resolution. We describe novel nodal anatomical variations. We found that the depth of the His bundle in females was on average 304 μm shallower than those of male patients. These models provide surgeons with insight into the heterogeneity of the nodal regions and the intricate relationships between the CCS and surrounding structures.
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Affiliation(s)
- Brian Cottle
- Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, MBB 3100, Salt Lake City, UT 84112, USA
| | - Karl Schriewer
- Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, MBB 3100, Salt Lake City, UT 84112, USA
| | - Sarthak Tiwari
- Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, MBB 3100, Salt Lake City, UT 84112, USA
| | - Dylan Miller
- Intermountain Health, 5121 S Cottonwood St. Murray, UT 84107, USA
| | - Aditya Kaza
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Robert Hitchcock
- Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, MBB 3100, Salt Lake City, UT 84112, USA
| | - Frank B Sachse
- Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, MBB 3100, Salt Lake City, UT 84112, USA.
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Sanchez-Quintana D, Cook AC, Macias Y, Spicer DE, Anderson RH. The Atrioventricular Conduction Axis Revisited for the 21st Century. J Cardiovasc Dev Dis 2023; 10:471. [PMID: 37998529 PMCID: PMC10672045 DOI: 10.3390/jcdd10110471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
Although first described in the final decade of the 19th century, the axis responsible for atrioventricular conduction has long been the source of multiple controversies. Some of these continue to reverberate. When first described by His, for example, many doubted the existence of the bundle we now name in his honour, while Kent suggested that multiple pathways crossed the atrioventricular junctions in the normal heart. It was Tawara who clarified the situation, although many of his key definitions have not universally been accepted. In key studies in the third decade of the 20th century, Mahaim then suggested the presence of ubiquitous connections that provided "paraspecific" pathways for atrioventricular conduction. In this review, we show the validity of these original investigations, based on our own experience with a large number of datasets from human hearts prepared by serial histological sectioning. Using our own reconstructions, we show how the atrioventricular conduction axis can be placed back within the heart. We emphasise that newly emerging techniques will be key in providing the resolution to map cellular detail to the gross evidence provided by the serial sections.
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Affiliation(s)
- Damian Sanchez-Quintana
- Department of Human Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, 06006 Badajoz, Spain
| | - Andrew C. Cook
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK;
| | - Yolanda Macias
- Department of Medical and Surgical Therapeutics, Faculty of Veterinary, University of Extremadura, 10071 Cáceres, Spain;
| | - Diane E. Spicer
- Heart Institute, Johns Hopkins All Children’s Hospital, St. Petersburg, FL 33701, USA;
| | - Robert H. Anderson
- Biosciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
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Asjad E, Dobrzynski H. MicroRNAs: Midfielders of Cardiac Health, Disease and Treatment. Int J Mol Sci 2023; 24:16207. [PMID: 38003397 PMCID: PMC10671258 DOI: 10.3390/ijms242216207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
MicroRNAs (miRNAs) are a class of small non-coding RNA molecules that play a role in post-transcriptional gene regulation. It is generally accepted that their main mechanism of action is the negative regulation of gene expression, through binding to specific regions in messenger RNA (mRNA) and repressing protein translation. By interrupting protein synthesis, miRNAs can effectively turn genes off and influence many basic processes in the body, such as developmental and apoptotic behaviours of cells and cardiac organogenesis. Their importance is highlighted by inhibiting or overexpressing certain miRNAs, which will be discussed in the context of coronary artery disease, atrial fibrillation, bradycardia, and heart failure. Dysregulated levels of miRNAs in the body can exacerbate or alleviate existing disease, and their omnipresence in the body makes them reliable as quantifiable markers of disease. This review aims to provide a summary of miRNAs as biomarkers and their interactions with targets that affect cardiac health, and intersperse it with current therapeutic knowledge. It intends to succinctly inform on these topics and guide readers toward more comprehensive works if they wish to explore further through a wide-ranging citation list.
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Affiliation(s)
- Emman Asjad
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
| | - Halina Dobrzynski
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
- Department of Anatomy, Jagiellonian University Medical College, 31-034 Krakow, Poland
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8
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Vijayaraman P, Chelu MG, Curila K, Dandamudi G, Herweg B, Mori S, Jastrzebski M, Sharma PS, Shivkumar K, Tung R, Upadhyay G, Vernooy K, Welter-Frost A, Whinnett Z, Zanon F, Ellenbogen KA. Cardiac Conduction System Pacing: A Comprehensive Update. JACC Clin Electrophysiol 2023; 9:2358-2387. [PMID: 37589646 DOI: 10.1016/j.jacep.2023.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 06/02/2023] [Indexed: 08/18/2023]
Abstract
The field of cardiac pacing has changed rapidly in the last several years. Since the initial description of His bundle pacing targeting the conduction system, recent advances in pacing the left bundle branch and its fascicles have evolved. The field and investigators' knowledge of conduction system pacing including relevant anatomy and physiology has advanced significantly. The aim of this review is to provide a comprehensive update on recent advances in conduction system pacing.
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Affiliation(s)
- Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA.
| | - Mihal G Chelu
- Division of Cardiology, Baylor College of Medicine and Baylor St. Luke's Medical Center and Texas Heart Institute, Houston, Texas, USA
| | - Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Gopi Dandamudi
- Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Bengt Herweg
- University of South Florida Morsani College of Medicine, Department of Cardiovascular Sciences, Tampa, Florida, USA
| | - Shumpei Mori
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Marek Jastrzebski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Parikshit S Sharma
- Department of Cardiology, Rush University School of Medicine, Chicago, Illinois, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Roderick Tung
- Division of Cardiology, University of Arizona College of Medicine-Phoenix, Banner-University Medical Center, Phoenix, Arizona, USA
| | - Gaurav Upadhyay
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kevin Vernooy
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago, Chicago, Illinois, USA
| | - Allan Welter-Frost
- Cleveland Clinic Indian River Hospital, Heart Vascular and Thoracic Institute, Vero Beach, Florida, USA
| | - Zachary Whinnett
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Kenneth A Ellenbogen
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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9
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Berg LA, Rocha BM, Oliveira RS, Sebastian R, Rodriguez B, de Queiroz RAB, Cherry EM, Dos Santos RW. Enhanced optimization-based method for the generation of patient-specific models of Purkinje networks. Sci Rep 2023; 13:11788. [PMID: 37479707 PMCID: PMC10362015 DOI: 10.1038/s41598-023-38653-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023] Open
Abstract
Cardiac Purkinje networks are a fundamental part of the conduction system and are known to initiate a variety of cardiac arrhythmias. However, patient-specific modeling of Purkinje networks remains a challenge due to their high morphological complexity. This work presents a novel method based on optimization principles for the generation of Purkinje networks that combines geometric and activation accuracy in branch size, bifurcation angles, and Purkinje-ventricular-junction activation times. Three biventricular meshes with increasing levels of complexity are used to evaluate the performance of our approach. Purkinje-tissue coupled monodomain simulations are executed to evaluate the generated networks in a realistic scenario using the most recent Purkinje/ventricular human cellular models and physiological values for the Purkinje-ventricular-junction characteristic delay. The results demonstrate that the new method can generate patient-specific Purkinje networks with controlled morphological metrics and specified local activation times at the Purkinje-ventricular junctions.
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Affiliation(s)
- Lucas Arantes Berg
- Graduate Program in Computational Modeling, Federal University of Juiz de Fora, Juiz de Fora, Brazil.
- Department of Computer Science, University of Oxford, Oxford, UK.
| | - Bernardo Martins Rocha
- Graduate Program in Computational Modeling, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Rafael Sachetto Oliveira
- Department of Computer Science, Federal University of São João del-Rei, São João del-Rei, Brazil
| | - Rafael Sebastian
- Department of Computer Science, Universitat de Valencia, Valencia, Spain
| | - Blanca Rodriguez
- Department of Computer Science, University of Oxford, Oxford, UK
| | - Rafael Alves Bonfim de Queiroz
- Graduate Program in Computational Modeling, Federal University of Juiz de Fora, Juiz de Fora, Brazil
- Department of Computer Science, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Elizabeth M Cherry
- School of Computational Science and Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Rodrigo Weber Dos Santos
- Graduate Program in Computational Modeling, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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10
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Ye Y, Lv Y, Mao Y, Li L, Chen X, Zheng R, Hou X, Yu C, Gabriella C, Fu GS. Cardiovascular imaging in conduction system pacing: What does the clinician need? Pacing Clin Electrophysiol 2023; 46:548-557. [PMID: 36516139 DOI: 10.1111/pace.14644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
Permanent pacemakers are used for symptomatic bradycardia and biventricular pacing (BVP)-cardiac resynchronization therapy (BVP-CRT) is established for heart failure (HF) patients traditionally. According to guidelines, patients' selection for CRT is based on QRS duration (QRSd) and morphology by surface electrocardiogram (ECG). Cardiovascular imaging techniques evaluate cardiac structure and function as well as identify pathophysiological substrate changes including the presence of scar. Cardiovascular imaging helps by improving the selection of candidates, guiding left ventricular (LV) lead placement, and optimization devices during the follow-up. Conduction system pacing (CSP) includes His bundle pacing (HBP) and left bundle branch pacing (LBBP) which is screwed into the interventricular septum. CSP maintains and restores ventricular synchrony in patients with native narrow QRSd and left bundle branch block (LBBB), respectively. LBBP is more feasible than HBP due to a wider target area. This review highlights the role of multimodality cardiovascular imaging including fluoroscopy, echocardiography, cardiac magnetic resonance (CMR), myocardial scintigraphy, and computed tomography (CT) in the pre-procedure assessment for CSP, better selection for CSP candidates, the guidance of CSP lead implantation, and the optimization of devices programming after the procedure. We also compare the different characteristics of multimodality imaging and discuss their potential roles in future CSP implantation.
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Affiliation(s)
- Yang Ye
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Yuan Lv
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Yankai Mao
- Department of Diagnostic Ultrasound and Echocardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Lin Li
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xueying Chen
- Shanghai Institution of Cardiovascular Disease, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rujie Zheng
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Xiaofeng Hou
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chan Yu
- Department of Diagnostic Ultrasound and Echocardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Captur Gabriella
- Institute of Cardiovascular Science, University College London, London, UK
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, London, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Guo-Sheng Fu
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
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11
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Burri H, Kozhuharov N, Jastrzebski M. Proximal and distal right bundle branch pacing: insights into conduction system physiology. HeartRhythm Case Rep 2023. [DOI: 10.1016/j.hrcr.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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12
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A new and more effective feticide technique in late termination of pregnancy: potassium chloride injection into the interventricular septum of the fetal heart. Arch Gynecol Obstet 2023; 307:779-787. [PMID: 36271257 DOI: 10.1007/s00404-022-06795-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/12/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study sought to compare the efficacy and outcomes of fetal intracardiac intraventricular and interventricular septal potassium chloride (KCl) injections during the induced fetal demise process in a cohort of pregnant women with severe fetal abnormality who opted for late termination of pregnancy (TOP). MATERIALS AND METHODS This study consisted of 158 pregnant women who requested late TOP for severe fetal abnormality between 22 and 36 weeks of pregnancy. Participants were randomly assigned with the simple randomization procedure to one of two feticide procedure groups: the intraventricular KCl injection group and the interventricular septal KCl administration group. We studied the clinical outcomes of both the feticide procedures. RESULTS The median total dose of strong KCl was significantly lower in the interventricular septal KCl administration group (3 mL) than in the intraventricular KCl injection group (5 mL, p < 0.001). The median time to reach asystole and the median total duration of the procedure was significantly shorter in the interventricular septal KCl administration group (42 s and 85 s, respectively) than in the intraventricular KCl injection group (115 s and 150 s, respectively, p < 0.001). We detected a statistically significant correlation between the gestational week at feticide and the total dose of KCl (r = 0.705, p < 0.001), time to reach asystole (r = 0.653, p < 0.001), and total duration of the procedure (r = 0.683, p < 0.001). CONCLUSION KCl administered directly into the interventricular septum induces immediate and permanent fetal cardiac asystole with a 100% of success rate without comprising maternal safety. We did not observe any maternal complications related to the procedure in our cases. Since the consequences of failed feticide procedure are challenging for both parents and healthcare providers, and providers are also concerned about potential legal implications regarding an unintended live birth, it is crucial to guide a strict protocol to confirm permanent fetal cardiac asystole.
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13
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Curila K, Jurak P, Prinzen F, Jastrzebski M, Waldauf P, Halamek J, Tothova M, Znojilova L, Smisek R, Kach J, Poviser L, Linkova H, Plesinger F, Moskal P, Viscor I, Vondra V, Leinveber P, Osmancik P. Bipolar anodal septal pacing with direct LBB capture preserves physiological ventricular activation better than unipolar left bundle branch pacing. Front Cardiovasc Med 2023; 10:1140988. [PMID: 37034324 PMCID: PMC10073552 DOI: 10.3389/fcvm.2023.1140988] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/23/2023] [Indexed: 04/11/2023] Open
Abstract
Background Left bundle branch pacing (LBBP) produces delayed, unphysiological activation of the right ventricle. Using ultra-high-frequency electrocardiography (UHF-ECG), we explored how bipolar anodal septal pacing with direct LBB capture (aLBBP) affects the resultant ventricular depolarization pattern. Methods In patients with bradycardia, His bundle pacing (HBP), unipolar nonselective LBBP (nsLBBP), aLBBP, and right ventricular septal pacing (RVSP) were performed. Timing of local ventricular activation, in leads V1-V8, was displayed using UHF-ECG, and electrical dyssynchrony (e-DYS) was calculated as the difference between the first and last activation. Durations of local depolarizations were determined as the width of the UHF-QRS complex at 50% of its amplitude. Results aLBBP was feasible in 63 of 75 consecutive patients with successful nsLBBP. aLBBP significantly improved ventricular dyssynchrony (mean -9 ms; 95% CI (-12;-6) vs. -24 ms (-27;-21), ), p < 0.001) and shortened local depolarization durations in V1-V4 (mean differences -7 ms to -5 ms (-11;-1), p < 0.05) compared to nsLBBP. aLBBP resulted in e-DYS -9 ms (-12; -6) vs. e-DYS 10 ms (7;14), p < 0.001 during HBP. Local depolarization durations in V1-V2 during aLBBP were longer than HBP (differences 5-9 ms (1;14), p < 0.05, with local depolarization duration in V1 during aLBBP being the same as during RVSP (difference 2 ms (-2;6), p = 0.52). Conclusion Although aLBBP improved ventricular synchrony and depolarization duration of the septum and RV compared to unipolar nsLBBP, the resultant ventricular depolarization was still less physiological than during HBP.
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Affiliation(s)
- Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
- Correspondence: Karol Curila
| | - Pavel Jurak
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
| | - Frits Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Marek Jastrzebski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Petr Waldauf
- Department of Anesthesia and Intensive Care, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Josef Halamek
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
| | - Marketa Tothova
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Lucie Znojilova
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Radovan Smisek
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
- Faculty of Electrical Engineering and Communication, Department of Biomedical Engineering, Brno University of Technology, Brno, Czech Republic
| | - Jakub Kach
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Lukas Poviser
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Hana Linkova
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Filip Plesinger
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
| | - Pawel Moskal
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Ivo Viscor
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
| | - Vlastimil Vondra
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
| | - Pavel Leinveber
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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14
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Gonzalez-Martin P, Sacco F, Butakoff C, Doste R, Bederian C, Gutierrez Espinosa de los Monteros LK, Houzeaux G, Iaizzo PA, Iles TL, Vazquez M, Aguado-Sierra J. Ventricular anatomical complexity and sex differences impact predictions from electrophysiological computational models. PLoS One 2023; 18:e0263639. [PMID: 36780442 PMCID: PMC9925004 DOI: 10.1371/journal.pone.0263639] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/07/2022] [Indexed: 02/15/2023] Open
Abstract
The aim of this work was to analyze the influence of sex hormones and anatomical details (trabeculations and false tendons) on the electrophysiology of healthy human hearts. Additionally, sex- and anatomy-dependent effects of ventricular tachycardia (VT) inducibility are presented. To this end, four anatomically normal, human, biventricular geometries (two male, two female), with identifiable trabeculations, were obtained from high-resolution, ex-vivo MRI and represented by detailed and smoothed geometrical models (with and without the trabeculations). Additionally one model was augmented by a scar. The electrophysiology finite element model (FEM) simulations were carried out, using O'Hara-Rudy human myocyte model with sex phenotypes of Yang and Clancy. A systematic comparison between detailed vs smooth anatomies, male vs female normal hearts was carried out. The heart with a myocardial infarction was subjected to a programmed stimulus protocol to identify the effects of sex and anatomical detail on ventricular tachycardia inducibility. All female hearts presented QT-interval prolongation however the prolongation interval in comparison to the male phenotypes was anatomy-dependent and was not correlated to the size of the heart. Detailed geometries showed QRS fractionation and increased T-wave magnitude in comparison to the corresponding smoothed geometries. A variety of sustained VTs were obtained in the detailed and smoothed male geometries at different pacing locations, which provide evidence of the geometry-dependent differences regarding the prediction of the locations of reentry channels. In the female phenotype, sustained VTs were induced in both detailed and smooth geometries with RV apex pacing, however no consistent reentry channels were identified. Anatomical and physiological cardiac features play an important role defining risk in cardiac disease. These are often excluded from cardiac electrophysiology simulations. The assumption that the cardiac endocardium is smooth may produce inaccurate predictions towards the location of reentry channels in in-silico tachycardia inducibility studies.
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Affiliation(s)
| | - Federica Sacco
- Barcelona Supercomputing Center, Barcelona, Spain
- Physense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Ruben Doste
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Carlos Bederian
- Instituto de Física Enrique Gaviola - CONICET, Córdoba, Argentina
| | | | | | - Paul A. Iaizzo
- Visible Heart Laboratories, Department of Surgery and the Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Tinen L. Iles
- University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Mariano Vazquez
- Barcelona Supercomputing Center, Barcelona, Spain
- ELEM Biotech S.L., Barcelona, Spain
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15
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Shi X, Zhang S, Liu Y, Brazile B, Cooley J, Butler JR, McMahan SR, Perez KL, Xu J, Eastep T, Nguyen KT, Bajona P, Peltz M, Gao H, Hong Y, Liao J. Spatial distribution and network morphology of epicardial, endocardial, interstitial, and Purkinje cell-associated elastin fibers in porcine left ventricle. Bioact Mater 2023; 19:348-359. [PMID: 35892002 PMCID: PMC9301607 DOI: 10.1016/j.bioactmat.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/07/2022] [Accepted: 04/18/2022] [Indexed: 11/19/2022] Open
Abstract
Cardiac extracellular matrices (ECM) play crucial functional roles in cardiac biomechanics. Previous studies have mainly focused on collagen, the major structural ECM in heart wall. The role of elastin in cardiac mechanics, however, is poorly understood. In this study, we investigated the spatial distribution and microstructural morphologies of cardiac elastin in porcine left ventricles. We demonstrated that the epicardial elastin network had location- and depth-dependency, and the overall epicardial elastin fiber mapping showed certain correlation with the helical heart muscle fiber architecture. When compared to the epicardial layer, the endocardial layer was thicker and has a higher elastin-collagen ratio and a denser elastin fiber network; moreover, the endocardial elastin fibers were finer and more wavy than the epicardial elastin fibers, all suggesting various interface mechanics. The myocardial interstitial elastin fibers co-exist with the perimysial collagen to bind the cardiomyocyte bundles; some of the interstitial elastin fibers showed a locally aligned, hinge-like structure to connect the adjacent cardiomyocyte bundles. This collagen-elastin combination reflects an optimal design in which the collagen provides mechanical strength and elastin fibers facilitate recoiling during systole. Moreover, cardiac elastin fibers, along with collagen network, closely associated with the Purkinje cells, indicating that this ECM association could be essential in organizing cardiac Purkinje cells into "fibrous" and "branching" morphologies and serving as a protective feature when Purkinje fibers experience large deformations in vivo. In short, our observations provide a structural basis for future in-depth biomechanical investigations and biomimicking of this long-overlooked cardiac ECM component.
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Affiliation(s)
- Xiaodan Shi
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
| | - Song Zhang
- College of Engineering and College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Yue Liu
- School of Engineering, Brown University, Providence, RI, 02912, USA
| | - Bryn Brazile
- College of Engineering and College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Jim Cooley
- College of Engineering and College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - J. Ryan Butler
- College of Engineering and College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Sara R. McMahan
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
| | - Karla L. Perez
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
| | - Jiazhu Xu
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
| | - Timothy Eastep
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
| | - Kytai T. Nguyen
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
| | - Pietro Bajona
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
- Allegheny Health Network-Drexel University College of Medicine, Pittsburgh, PA, 15212, USA
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Huajian Gao
- School of Engineering, Brown University, Providence, RI, 02912, USA
- College of Engineering, Nanyang Technical University, 308232, Singapore
| | - Yi Hong
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
| | - Jun Liao
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76010, USA
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16
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Balawender K, Kłosowicz M, Inglot J, Pliszka A, Wawrzyniak A, Olszewska A, Clarke E, Golberg M, Smędra A, Barszcz K, Żytkowski A. Anatomical variants and clinical significance of atrioventricular bundle of His: A narrative review. TRANSLATIONAL RESEARCH IN ANATOMY 2023. [DOI: 10.1016/j.tria.2023.100232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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17
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The Atrioventricular Bundle: A Sesquicentennial Tribute to Professor Sunao Tawara. JACC Clin Electrophysiol 2022; 9:444-447. [PMID: 36752481 DOI: 10.1016/j.jacep.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 01/20/2023]
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18
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Initial Clinical Experience With a Novel 8-Spline High-Resolution Mapping Catheter. JACC Clin Electrophysiol 2022; 8:1067-1076. [PMID: 35780035 DOI: 10.1016/j.jacep.2022.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Octaray (Biosense Webster) is a novel, multispline mapping catheter with 48 closely spaced microelectrodes enabling high-resolution electroanatomical mapping. OBJECTIVES This study sought to report the initial clinical mapping experience with this novel catheter in a variety of cardiac arrhythmias and to compare the mapping performance with the 5-spline Pentaray. METHODS Fifty consecutive procedures among 46 patients were retrospectively analyzed regarding safety, efficacy, and acute procedural success defined as termination or noninducibility of clinical tachycardia, conduction block across an ablation line, or pulmonary vein isolation. In addition, another 10 patients with sustained atrial tachycardia mapped with the 5-spline catheter (2-5-2 spacing) or the novel 8-spline catheter (2-2-2-2-2 spacing) were analyzed. RESULTS Left atrial and ventricular mapping by either transseptal (n = 41) or retroaortic (n = 2) access was feasible without any complications related to the multispline design of the novel catheter. The acute procedural success rate was 94%. In sustained atrial tachycardia compared with the 5-spline catheter, the novel 8-spline catheter recorded more electrograms per map (3,628 ± 714 vs 11,350 ± 1,203; P < 0.001) in a shorter mapping time (13 ± 2 vs 9 ± 1 minutes; P = 0.08) resulting in a higher point density (18 ± 4 vs 59 ± 10 electrograms/cm2; P < 0.01) and point acquisition rate (308 ± 69 vs 1,332 ± 208 electrograms/min.; P < 0.01). CONCLUSIONS In this initial experience, mapping with the novel catheter was safe and efficient with a high electroanatomical resolution. In sustained atrial tachycardia the novel 8-spline catheter demonstrated a marked increase in point density and mapping speed compared with those of the 5-spline catheter. These initial results should be validated in a larger multicenter cohort with longer follow-up.
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19
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Arshad A, Atkinson AJ. A 21st century view of the anaotmy of the cardiac conduction system. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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20
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In Vivo Super-Resolution Cardiac Diffusion Tensor MRI: A Feasibility Study. Diagnostics (Basel) 2022; 12:diagnostics12040877. [PMID: 35453925 PMCID: PMC9028988 DOI: 10.3390/diagnostics12040877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 02/01/2023] Open
Abstract
A super-resolution (SR) technique is proposed for imaging myocardial fiber architecture with cardiac magnetic resonance. Images were acquired with a motion-compensated cardiac diffusion tensor imaging (cDTI) sequence. The heart left ventricle was covered with three stacks of thick slices, in short axis, horizontal and vertical long axes orientations, respectively. The three low-resolution stacks (2 × 2 × 8 mm3) were combined into an isotropic volume (2 × 2 × 2 mm3) by a super-resolution reconstruction. For in vivo measurements, each slice was acquired during a breath-hold period. Bulk motion was corrected by optimizing a similarity metric between intensity profiles from all intersecting slices in the dataset. The benefit of the proposed approach was evaluated using a numerical heart phantom, a physical helicoidal phantom with artificial fibers, and six healthy subjects. The SR technique showed improved results compared to the native scans, in terms of image quality and cDTI metrics. In particular, the myocardial helix angle (HA) was more accurately estimated in the physical phantom (HA = 41.5° ± 1.1°, with the ground truth being 42.0°). In vivo, it resulted in a sharper rate of change of HA across the myocardial wall (−0.993°/% ± 0.007°/% against −0.873°/% ± 0.010°/%).
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21
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Cost IN, Sellers KC, Rozin RE, Spates AT, Middleton KM, Holliday CM. 2D and 3D visualizations of archosaur jaw muscle mechanics, ontogeny and phylogeny using ternary diagrams and 3D modeling. J Exp Biol 2022; 225:274255. [PMID: 35119075 DOI: 10.1242/jeb.243216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/20/2021] [Indexed: 12/16/2022]
Abstract
Comparing patterns of performance and kinematics across behavior, development and phylogeny is crucial to understand the evolution of complex musculoskeletal systems such as the feeding apparatus. However, conveying 3D spatial data of muscle orientation throughout a feeding cycle, ontogenetic pathway or phylogenetic lineage is essential to understanding the function and evolution of the skull in vertebrates. Here, we detail the use of ternary plots for displaying and comparing the 3D orientation of muscle data. First, we illustrate changes in 3D jaw muscle resultants during jaw closing taxa the American alligator (Alligator mississippiensis). Second, we show changes in 3D muscle resultants of jaw muscles across an ontogenetic series of alligators. Third, we compare 3D resultants of jaw muscles of avian-line dinosaurs, including extant (Struthio camelus, Gallus gallus, Psittacus erithacus) and extinct (Tyrannosaurus rex) species to outline the reorganization of jaw muscles that occurred along the line to modern birds. Finally, we compare 3D resultants of jaw muscles of the hard-biting species in our sample (A. mississippiensis, T. rex, P. erithacus) to illustrate how disparate jaw muscle resultants are employed in convergent behaviors in archosaurs. Our findings show that these visualizations of 3D components of jaw muscles are immensely helpful towards identifying patterns of cranial performance, growth and diversity. These tools will prove useful for testing other hypotheses in functional morphology, comparative biomechanics, ecomorphology and organismal evolution.
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Affiliation(s)
- Ian N Cost
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO 65211, USA.,Department of Biology, Albright College, Reading, PA 19612, USA
| | - Kaleb C Sellers
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO 65211, USA.,Department of Clinical Anatomy and OPP, Rocky Vista University, Parker, CO 80134, USA
| | - Rachel E Rozin
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO 65211, USA.,Florida Aquarium, Tampa, FL 33602, USA
| | - Anthony T Spates
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO 65211, USA.,University of Missouri Kansas City School of Dentistry, Kansas City, MO 64108, USA
| | - Kevin M Middleton
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Casey M Holliday
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO 65211, USA
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22
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Aminu AJ, Chen W, Yin Z, Kuniewicz M, Walocha J, Perde F, Molenaar P, Iaizzo PA, Dobrzynski H, Atkinson AJ. Novel micro-computed tomography contrast agents to visualise the human cardiac conduction system and surrounding structures in hearts from normal, aged, and obese individuals. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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23
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Sánchez-Quintana D, Anderson RH, Tretter JT, Cabrera JA, Sternick EB, Farré J. Anatomy of the conduction tissues 100 years on: what have we learned? Heart 2021; 108:1430-1437. [PMID: 34969873 DOI: 10.1136/heartjnl-2021-320304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/30/2021] [Indexed: 11/04/2022] Open
Abstract
Knowledge of the anatomy of the 'conduction tissues' of the heart is a 20th century phenomenon. Although controversies still continue on the topic, most could have been avoided had greater attention been paid to the original descriptions. All cardiomyocytes, of course, have the capacity to conduct the cardiac impulse. The tissues specifically described as 'conducting' first generate the cardiac impulse, and then deliver it in such a fashion that the ventricles contract in orderly fashion. The tissues cannot readily be distinguished by gross inspection. Robust definitions for their recognition had been provided by the end of the first decade of the 20th century. These definitions retain their currency. The sinus node lies as a cigar-shaped structure subepicardially within the terminal groove. There is evidence that it is associated with a paranodal area that may have functional significance. Suggestions of dual nodes, however, are without histological confirmation. The atrioventricular node is located within the triangle of Koch, with significant inferior extensions occupying the atrial vestibules and with septal connections. The conduction axis penetrates the insulating plane of the atrioventricular junctions to continue as the ventricular pathways. Remnants of a ring of cardiomyocytes observed during development are also to be found within the atrial vestibules, particularly a prominent retroaortic remnant, although that their role has still to be determined. Application of the initial criteria for nodes and tracts shows that there are no special 'conducting tissues' in the pulmonary venous sleeves that might underscore the abnormal rhythm of atrial fibrillation.
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Affiliation(s)
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Justin T Tretter
- Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - José Angel Cabrera
- Department of Cardiology, Hospital Universitario Quirón-Madrid, European University of Madrid, Madrid, Spain
| | | | - Jerónimo Farré
- Madrid Autonomous University, Fundación Jiménez Díaz Hospital, Madrid, Spain
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24
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Gillette K, Gsell MAF, Bouyssier J, Prassl AJ, Neic A, Vigmond EJ, Plank G. Automated Framework for the Inclusion of a His-Purkinje System in Cardiac Digital Twins of Ventricular Electrophysiology. Ann Biomed Eng 2021; 49:3143-3153. [PMID: 34431016 PMCID: PMC8671274 DOI: 10.1007/s10439-021-02825-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/26/2021] [Indexed: 11/28/2022]
Abstract
Personalized models of cardiac electrophysiology (EP) that match clinical observation with high fidelity, referred to as cardiac digital twins (CDTs), show promise as a tool for tailoring cardiac precision therapies. Building CDTs of cardiac EP relies on the ability of models to replicate the ventricular activation sequence under a broad range of conditions. Of pivotal importance is the His-Purkinje system (HPS) within the ventricles. Workflows for the generation and incorporation of HPS models are needed for use in cardiac digital twinning pipelines that aim to minimize the misfit between model predictions and clinical data such as the 12 lead electrocardiogram (ECG). We thus develop an automated two stage approach for HPS personalization. A fascicular-based model is first introduced that modulates the endocardial Purkinje network. Only emergent features of sites of earliest activation within the ventricular myocardium and a fast-conducting sub-endocardial layer are accounted for. It is then replaced by a topologically realistic Purkinje-based representation of the HPS. Feasibility of the approach is demonstrated. Equivalence between both HPS model representations is investigated by comparing activation patterns and 12 lead ECGs under both sinus rhythm and right-ventricular apical pacing. Predominant ECG morphology is preserved by both HPS models under sinus conditions, but elucidates differences during pacing.
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Affiliation(s)
- Karli Gillette
- Gottfried Schatz Research Center Biophysics, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Matthias A F Gsell
- Gottfried Schatz Research Center Biophysics, Medical University of Graz, Graz, Austria
| | - Julien Bouyssier
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Anton J Prassl
- Gottfried Schatz Research Center Biophysics, Medical University of Graz, Graz, Austria
| | | | - Edward J Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Gernot Plank
- Gottfried Schatz Research Center Biophysics, Medical University of Graz, Graz, Austria.
- BioTechMed-Graz, Graz, Austria.
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Iop L, Iliceto S, Civieri G, Tona F. Inherited and Acquired Rhythm Disturbances in Sick Sinus Syndrome, Brugada Syndrome, and Atrial Fibrillation: Lessons from Preclinical Modeling. Cells 2021; 10:3175. [PMID: 34831398 PMCID: PMC8623957 DOI: 10.3390/cells10113175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 12/12/2022] Open
Abstract
Rhythm disturbances are life-threatening cardiovascular diseases, accounting for many deaths annually worldwide. Abnormal electrical activity might arise in a structurally normal heart in response to specific triggers or as a consequence of cardiac tissue alterations, in both cases with catastrophic consequences on heart global functioning. Preclinical modeling by recapitulating human pathophysiology of rhythm disturbances is fundamental to increase the comprehension of these diseases and propose effective strategies for their prevention, diagnosis, and clinical management. In silico, in vivo, and in vitro models found variable application to dissect many congenital and acquired rhythm disturbances. In the copious list of rhythm disturbances, diseases of the conduction system, as sick sinus syndrome, Brugada syndrome, and atrial fibrillation, have found extensive preclinical modeling. In addition, the electrical remodeling as a result of other cardiovascular diseases has also been investigated in models of hypertrophic cardiomyopathy, cardiac fibrosis, as well as arrhythmias induced by other non-cardiac pathologies, stress, and drug cardiotoxicity. This review aims to offer a critical overview on the effective ability of in silico bioinformatic tools, in vivo animal studies, in vitro models to provide insights on human heart rhythm pathophysiology in case of sick sinus syndrome, Brugada syndrome, and atrial fibrillation and advance their safe and successful translation into the cardiology arena.
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Affiliation(s)
- Laura Iop
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, I-35124 Padua, Italy; (S.I.); (G.C.)
| | | | | | - Francesco Tona
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, I-35124 Padua, Italy; (S.I.); (G.C.)
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Petkova MA, Dobrzynski H. Do human sinoatrial node cells have t-tubules? TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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27
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Aminu AJ, Petkova M, Atkinson AJ, Yanni J, Morris AD, Simms RT, Chen W, Yin Z, Kuniewicz M, Holda MK, Kuzmin VS, Perde F, Molenaar P, Dobrzynski H. Further insights into the molecular complexity of the human sinus node - The role of 'novel' transcription factors and microRNAs. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2021; 166:86-104. [PMID: 34004232 DOI: 10.1016/j.pbiomolbio.2021.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023]
Abstract
RESEARCH PURPOSE The sinus node (SN) is the heart's primary pacemaker. Key ion channels (mainly the funny channel, HCN4) and Ca2+-handling proteins in the SN are responsible for its function. Transcription factors (TFs) regulate gene expression through inhibition or activation and microRNAs (miRs) do this through inhibition. There is high expression of macrophages and mast cells within the SN connective tissue. 'Novel'/unexplored TFs and miRs in the regulation of ion channels and immune cells in the SN are not well understood. Using RNAseq and bioinformatics, the expression profile and predicted interaction of key TFs and cell markers with key miRs in the adult human SN vs. right atrial tissue (RA) were determined. PRINCIPAL RESULTS 68 and 60 TFs significantly more or less expressed in the SN vs. RA respectively. Among those more expressed were ISL1 and TBX3 (involved in embryonic development of the SN) and 'novel' RUNX1-2, CEBPA, GLI1-2 and SOX2. These TFs were predicted to regulate HCN4 expression in the SN. Markers for different cells: fibroblasts (COL1A1), fat (FABP4), macrophages (CSF1R and CD209), natural killer (GZMA) and mast (TPSAB1) were significantly more expressed in the SN vs. RA. Interestingly, RUNX1-3, CEBPA and GLI1 also regulate expression of these cells. MiR-486-3p inhibits HCN4 and markers involved in immune response. MAJOR CONCLUSIONS In conclusion, RUNX1-2, CSF1R, TPSAB1, COL1A1 and HCN4 are highly expressed in the SN but not miR-486-3p. Their complex interactions can be used to treat SN dysfunction such as bradycardia. Interestingly, another research group recently reported miR-486-3p is upregulated in blood samples from severe COVID-19 patients who suffer from bradycardia.
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Affiliation(s)
- Abimbola J Aminu
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Maria Petkova
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Andrew J Atkinson
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Joseph Yanni
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Alex D Morris
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Robert T Simms
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Weixuan Chen
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Zeyuan Yin
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Marcin Kuniewicz
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz K Holda
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Vladislav S Kuzmin
- Department of Human and Animal Physiology, Lomonosov Moscow State University, Moscow, Russia
| | - Filip Perde
- National Institute of Legal Medicine, Bucharest, Romania
| | - Peter Molenaar
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia; Cardiovascular Molecular & Therapeutics Translational Research Group, University of Queensland, The Prince Charles Hospital, Brisbane, Australia
| | - Halina Dobrzynski
- The Division of Cardiovascular Sciences, University of Manchester, United Kingdom; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
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Mori S, Izawa Y, Nishii T. Simple Stereoscopic Display of 3-Dimensional Living Heart Anatomy Relevant to Electrophysiological Practice. JACC Clin Electrophysiol 2021; 6:1473-1477. [PMID: 33213806 DOI: 10.1016/j.jacep.2020.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
Comprehensive appreciation of the 3-dimensional anatomy of the living heart is essential for accurate diagnosis and establishment of safe interventional treatment by clinical electrophysiologists. Three-dimensional images displayed on a 2-dimensional surface usually undergo distortion and are not considered a real 3-dimensional representation because they cannot provide accurate depth perception. Currently, the availability of 3-dimensional visualization techniques, including 3-dimensional printing, 3-dimensional projectors, 3-dimensional monitors, and virtual reality, is limited owing to their limited user-friendliness and high costs. The authors discuss an alternative conventional approach of a cross-eyed method for viewing stereoscopically displayed images for better appreciation of real 3-dimensional images based on a simple technique.
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Affiliation(s)
- Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tatsuya Nishii
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Barber F, Langfield P, Lozano M, Garcia-Fernandez I, Duchateau J, Hocini M, Haissaguerre M, Vigmond E, Sebastian R. Estimation of Personalized Minimal Purkinje Systems From Human Electro-Anatomical Maps. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:2182-2194. [PMID: 33856987 DOI: 10.1109/tmi.2021.3073499] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The Purkinje system is a heart structure responsible for transmitting electrical impulses through the ventricles in a fast and coordinated way to trigger mechanical contraction. Estimating a patient-specific compatible Purkinje Network from an electro-anatomical map is a challenging task, that could help to improve models for electrophysiology simulations or provide aid in therapy planning, such as radiofrequency ablation. In this study, we present a methodology to inversely estimate a Purkinje network from a patient's electro-anatomical map. First, we carry out a simulation study to assess the accuracy of the method for different synthetic Purkinje network morphologies and myocardial junction densities. Second, we estimate the Purkinje network from a set of 28 electro-anatomical maps from patients, obtaining an optimal conduction velocity in the Purkinje network of 1.95 ± 0.25 m/s, together with the location of their Purkinje-myocardial junctions, and Purkinje network structure. Our results showed an average local activation time error of 6.8±2.2 ms in the endocardium. Finally, using the personalized Purkinje network, we obtained correlations higher than 0.85 between simulated and clinical 12-lead ECGs.
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Magat J, Fouillet A, Constantin M, Haliot K, Naulin J, El Hamrani D, Benoist D, Charron S, Walton R, Bernus O, Quesson B. 3D magnetization transfer (MT) for the visualization of cardiac free-running Purkinje fibers: an ex vivo proof of concept. MAGMA (NEW YORK, N.Y.) 2021; 34:605-618. [PMID: 33484367 PMCID: PMC8338918 DOI: 10.1007/s10334-020-00905-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/02/2020] [Accepted: 12/22/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES We investigate the possibility to exploit high-field MRI to acquire 3D images of Purkinje network which plays a crucial role in cardiac function. Since Purkinje fibers (PF) have a distinct cellular structure and are surrounded by connective tissue, we investigated conventional contrast mechanisms along with the magnetization transfer (MT) imaging technique to improve image contrast between ventricular structures of differing macromolecular content. METHODS Three fixed porcine ventricular samples were used with free-running PFs on the endocardium. T1, T2*, T2, and M0 were evaluated on 2D slices for each sample at 9.4 T. MT parameters were optimized using hard pulses with different amplitudes, offset frequencies and durations. The cardiac structure was assessed through 2D and 3D T1w images with isotropic resolutions of 150 µm. Histology, immunofluorescence, and qPCR were performed to analyze collagen contents of cardiac tissue and PF. RESULTS An MT preparation module of 350 ms duration inserted into the sequence with a B1 = 10 µT and frequency offset = 3000 Hz showed the best contrast, approximately 0.4 between PFs and myocardium. Magnetization transfer ratio (MTR) appeared higher in the cardiac tissue (MTR = 44.7 ± 3.5%) than in the PFs (MTR = 25.2 ± 6.3%). DISCUSSION MT significantly improves contrast between PFs and ventricular myocardium and appears promising for imaging the 3D architecture of the Purkinje network.
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Affiliation(s)
- Julie Magat
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Hopital Xavier Arnozan, Avenue du Haut Lévêque, 33604, Pessac cedex, France.
- Centre de Recherche Cardio-Thoracique de Bordeaux Inserm, U1045, Université de Bordeaux, 33000, Bordeaux, France.
| | - Arnaud Fouillet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Hopital Xavier Arnozan, Avenue du Haut Lévêque, 33604, Pessac cedex, France
- Centre de Recherche Cardio-Thoracique de Bordeaux Inserm, U1045, Université de Bordeaux, 33000, Bordeaux, France
| | - Marion Constantin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Hopital Xavier Arnozan, Avenue du Haut Lévêque, 33604, Pessac cedex, France
- Centre de Recherche Cardio-Thoracique de Bordeaux Inserm, U1045, Université de Bordeaux, 33000, Bordeaux, France
| | - Kylian Haliot
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Hopital Xavier Arnozan, Avenue du Haut Lévêque, 33604, Pessac cedex, France
- Centre de Recherche Cardio-Thoracique de Bordeaux Inserm, U1045, Université de Bordeaux, 33000, Bordeaux, France
| | - Jérôme Naulin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Hopital Xavier Arnozan, Avenue du Haut Lévêque, 33604, Pessac cedex, France
- Centre de Recherche Cardio-Thoracique de Bordeaux Inserm, U1045, Université de Bordeaux, 33000, Bordeaux, France
| | - Dounia El Hamrani
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Hopital Xavier Arnozan, Avenue du Haut Lévêque, 33604, Pessac cedex, France
- Centre de Recherche Cardio-Thoracique de Bordeaux Inserm, U1045, Université de Bordeaux, 33000, Bordeaux, France
| | - David Benoist
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Hopital Xavier Arnozan, Avenue du Haut Lévêque, 33604, Pessac cedex, France
- Centre de Recherche Cardio-Thoracique de Bordeaux Inserm, U1045, Université de Bordeaux, 33000, Bordeaux, France
| | - Sabine Charron
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Hopital Xavier Arnozan, Avenue du Haut Lévêque, 33604, Pessac cedex, France
- Centre de Recherche Cardio-Thoracique de Bordeaux Inserm, U1045, Université de Bordeaux, 33000, Bordeaux, France
| | - Richard Walton
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Hopital Xavier Arnozan, Avenue du Haut Lévêque, 33604, Pessac cedex, France
- Centre de Recherche Cardio-Thoracique de Bordeaux Inserm, U1045, Université de Bordeaux, 33000, Bordeaux, France
| | - Olivier Bernus
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Hopital Xavier Arnozan, Avenue du Haut Lévêque, 33604, Pessac cedex, France
- Centre de Recherche Cardio-Thoracique de Bordeaux Inserm, U1045, Université de Bordeaux, 33000, Bordeaux, France
| | - Bruno Quesson
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Hopital Xavier Arnozan, Avenue du Haut Lévêque, 33604, Pessac cedex, France
- Centre de Recherche Cardio-Thoracique de Bordeaux Inserm, U1045, Université de Bordeaux, 33000, Bordeaux, France
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Mazzella AJ, Arora S, Hendrickson MJ, Sanders M, Vavalle JP, Gehi AK. Evaluation and Management of Heart Block After Transcatheter Aortic Valve Replacement. Card Fail Rev 2021; 7:e12. [PMID: 34386266 PMCID: PMC8353545 DOI: 10.15420/cfr.2021.05] [Citation(s) in RCA: 3] [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: 04/05/2021] [Accepted: 05/28/2021] [Indexed: 11/25/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has developed substantially since its inception. Improvements in valve design, valve deployment technologies, preprocedural imaging and increased operator experience have led to a gradual decline in length of hospitalisation after TAVR. Despite these advances, the need for permanent pacemaker implantation for post-TAVR high-degree atrioventricular block (HAVB) has persisted and has well-established risk factors which can be used to identify patients who are at high risk and advise them accordingly. While most HAVB occurs within 48 hours of the procedure, there is a growing number of patients developing HAVB after initial hospitalisation for TAVR due to the trend for early discharge from hospital. Several observation and management strategies have been proposed. This article reviews major known risk factors for HAVB after TAVR, discusses trends in the timing of HAVB after TAVR and reviews some management strategies for observing transient HAVB after TAVR.
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Affiliation(s)
- Anthony J Mazzella
- Division of Cardiology, Department of Medicine, University of North Carolina Hospitals Chapel Hill, NC, US
| | - Sameer Arora
- Division of Cardiology, Department of Medicine, University of North Carolina Hospitals Chapel Hill, NC, US
| | | | - Mason Sanders
- Department of Medicine, University of North Carolina Hospitals Chapel Hill, NC, US
| | - John P Vavalle
- Division of Cardiology, Department of Medicine, University of North Carolina Hospitals Chapel Hill, NC, US
| | - Anil K Gehi
- Division of Cardiology, Department of Medicine, University of North Carolina Hospitals Chapel Hill, NC, US
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Abstract
The physiological heart function is controlled by a well-orchestrated interplay of different ion channels conducting Na+, Ca2+ and K+. Cardiac K+ channels are key players of cardiac repolarization counteracting depolarizating Na+ and Ca2+ currents. In contrast to Na+ and Ca2+, K+ is conducted by many different channels that differ in activation/deactivation kinetics as well as in their contribution to different phases of the action potential. Together with modulatory subunits these K+ channel α-subunits provide a wide range of repolarizing currents with specific characteristics. Moreover, due to expression differences, K+ channels strongly influence the time course of the action potentials in different heart regions. On the other hand, the variety of different K+ channels increase the number of possible disease-causing mutations. Up to now, a plethora of gain- as well as loss-of-function mutations in K+ channel forming or modulating proteins are known that cause severe congenital cardiac diseases like the long-QT-syndrome, the short-QT-syndrome, the Brugada syndrome and/or different types of atrial tachyarrhythmias. In this chapter we provide a comprehensive overview of different K+ channels in cardiac physiology and pathophysiology.
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Regulation of sinus node pacemaking and atrioventricular node conduction by HCN channels in health and disease. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2021; 166:61-85. [PMID: 34197836 DOI: 10.1016/j.pbiomolbio.2021.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 12/19/2022]
Abstract
The funny current, If, was first recorded in the heart 40 or more years ago by Dario DiFrancesco and others. Since then, we have learnt that If plays an important role in pacemaking in the sinus node, the innate pacemaker of the heart, and more recently evidence has accumulated to show that If may play an important role in action potential conduction through the atrioventricular (AV) node. Evidence has also accumulated to show that regulation of the transcription and translation of the underlying Hcn genes plays an important role in the regulation of sinus node pacemaking and AV node conduction under normal physiological conditions - in athletes, during the circadian rhythm, in pregnancy, and during postnatal development - as well as pathological states - ageing, heart failure, pulmonary hypertension, diabetes and atrial fibrillation. There may be yet more pathological conditions involving changes in the expression of the Hcn genes. Here, we review the role of If and the underlying HCN channels in physiological and pathological changes of the sinus and AV nodes and we begin to explore the signalling pathways (microRNAs, transcription factors, GIRK4, the autonomic nervous system and inflammation) involved in this regulation. This review is dedicated to Dario DiFrancesco on his retirement.
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Poels TT, Stassen R, Kats S, Veenstra L, van Ommen V, Kietselaer B, Houthuizen P, Maessen JG, Prinzen FW. Effective Distance between Aortic Valve and Conduction System Is an Independent Predictor of Persistent Left Bundle Branch Block during Transcatheter Aortic Valve Implantation. ACTA ACUST UNITED AC 2021; 57:medicina57050476. [PMID: 34064932 PMCID: PMC8150689 DOI: 10.3390/medicina57050476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 01/05/2023]
Abstract
Background and objectives: Persistent left bundle branch block (P-LBBB) has been associated with poor clinical outcomes of transcatheter aortic valve implantation (TAVI) procedures. We hypothesized that the distance from the aortic valve to the proximal conduction system, expressed as the effective distance between the aortic valve and conduction system (EDACS), can predict the occurrence of P-LBBB in patients undergoing a TAVI procedure. Materials and methods: In a retrospective study, data from 269 patients were analyzed. EDACS was determined using two longitudinal CT sections. Results: Sixty-four of the patients developed P-LBBB. EDACS ranged between −3 and +18 mm. EDACS was significantly smaller in P-LBBB than in non-P-LBBB patients (4.6 (2.2–7.1) vs. 8.0 (5.8–10.2) mm, median values (interquartile range); p < 0.05). Receiver operating characteristic analysis showed an area under the curve of 0.78 for predicting P-LBBB based on EDACS. In patients with EDACS of ≤3 mm and >10 mm, the chance of developing P-LBBB was ≥50% and <10%, respectively. Conclusions: A small EDACS increases the risk for the development of P-LBBB during TAVI by a factor of >25. As EDACS can be measured pre-procedurally, it may be a valuable additional factor to weigh the risks of transcatheter and surgical aortic valve replacement.
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Affiliation(s)
- Thomas T. Poels
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, P.O. Box 5800, 6229HX Maastricht, The Netherlands; (R.S.); (S.K.); (J.G.M.)
- Correspondence:
| | - Robert Stassen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, P.O. Box 5800, 6229HX Maastricht, The Netherlands; (R.S.); (S.K.); (J.G.M.)
| | - Suzanne Kats
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, P.O. Box 5800, 6229HX Maastricht, The Netherlands; (R.S.); (S.K.); (J.G.M.)
| | - Leo Veenstra
- Department of Cardiology, Maastricht University Medical Center, P.O. Box 5800, 6229HX Maastricht, The Netherlands; (L.V.); (V.v.O.); (B.K.)
| | - Vincent van Ommen
- Department of Cardiology, Maastricht University Medical Center, P.O. Box 5800, 6229HX Maastricht, The Netherlands; (L.V.); (V.v.O.); (B.K.)
| | - Bastiaan Kietselaer
- Department of Cardiology, Maastricht University Medical Center, P.O. Box 5800, 6229HX Maastricht, The Netherlands; (L.V.); (V.v.O.); (B.K.)
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital Eindhoven, P.O. Box 1350, 5623EJ Eindhoven, The Netherlands;
| | - Jos G. Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, P.O. Box 5800, 6229HX Maastricht, The Netherlands; (R.S.); (S.K.); (J.G.M.)
| | - Frits W. Prinzen
- CARIM School for Cardiovascular Diseases, P.O. Box 616, 6229ER Maastricht, The Netherlands;
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A Framework for the generation of digital twins of cardiac electrophysiology from clinical 12-leads ECGs. Med Image Anal 2021; 71:102080. [PMID: 33975097 DOI: 10.1016/j.media.2021.102080] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/15/2021] [Accepted: 04/06/2021] [Indexed: 12/21/2022]
Abstract
Cardiac digital twins (Cardiac Digital Twin (CDT)s) of human electrophysiology (Electrophysiology (EP)) are digital replicas of patient hearts derived from clinical data that match like-for-like all available clinical observations. Due to their inherent predictive potential, CDTs show high promise as a complementary modality aiding in clinical decision making and also in the cost-effective, safe and ethical testing of novel EP device therapies. However, current workflows for both the anatomical and functional twinning phases within CDT generation, referring to the inference of model anatomy and parameters from clinical data, are not sufficiently efficient, robust and accurate for advanced clinical and industrial applications. Our study addresses three primary limitations impeding the routine generation of high-fidelity CDTs by introducing; a comprehensive parameter vector encapsulating all factors relating to the ventricular EP; an abstract reference frame within the model allowing the unattended manipulation of model parameter fields; a novel fast-forward electrocardiogram (Electrocardiogram (ECG)) model for efficient and bio-physically-detailed simulation required for parameter inference. A novel workflow for the generation of CDTs is then introduced as an initial proof of concept. Anatomical twinning was performed within a reasonable time compatible with clinical workflows (<4h) for 12 subjects from clinically-attained magnetic resonance images. After assessment of the underlying fast forward ECG model against a gold standard bidomain ECG model, functional twinning of optimal parameters according to a clinically-attained 12 lead ECG was then performed using a forward Saltelli sampling approach for a single subject. The achieved results in terms of efficiency and fidelity demonstrate that our workflow is well-suited and viable for generating biophysically-detailed CDTs at scale.
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Kawashima T, Sato F. First in situ 3D visualization of the human cardiac conduction system and its transformation associated with heart contour and inclination. Sci Rep 2021; 11:8636. [PMID: 33883659 PMCID: PMC8060315 DOI: 10.1038/s41598-021-88109-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/08/2021] [Indexed: 02/07/2023] Open
Abstract
Current advanced imaging modalities with applied tracing and processing techniques provide excellent visualization of almost all human internal structures in situ; however, the actual 3D internal arrangement of the human cardiac conduction system (CCS) is still unknown. This study is the first to document the successful 3D visualization of the CCS from the sinus node to the bundle branches within the human body, based on our specialized physical micro-dissection and its CT imaging. The 3D CCS transformation by cardiac inclination changes from the standing to the lying position is also provided. Both actual dissection and its CT image-based simulation identified that when the cardiac inclination changed from standing to lying, the sinus node shifted from the dorso-superior to the right outer position and the atrioventricular conduction axis changed from a vertical to a leftward horizontal position. In situ localization of the human CCS provides accurate anatomical localization with morphometric data, and it indicates the useful correlation between heart inclination and CCS rotation axes for predicting the variable and invisible human CCS in the living body. Advances in future imaging modalities and methodology are essential for further accurate in situ 3D CCS visualization.
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Affiliation(s)
- Tomokazu Kawashima
- Department of Anatomy, School of Medicine, Toho University, 5-21-16 Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan.
| | - Fumi Sato
- Department of Anatomy, School of Medicine, Toho University, 5-21-16 Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan
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Bordoni B, Escher AR. Osteopathic Palpation of the Heart. Cureus 2021; 13:e14187. [PMID: 33816036 PMCID: PMC8008978 DOI: 10.7759/cureus.14187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/17/2022] Open
Abstract
In the panorama of scientific literature, there is a paucity of literature on how to palpate the heart area in the osteopathic setting and relevant indications on which palpatory sensations the clinician should perceive during the evaluation. The article reviews the fascial anatomy of the heart area and the heart movements derived from magnetic resonance imaging (MRI) studies and describes the landmarks used by the cardiac surgeon to visualize the mediastinal area. The text sets out possible suggestions for a more adequate osteopathic palpatory evaluation and describes any tactile sensations arising from the patient's chest. To the knowledge of the authors, this is the first article that seeks to lay solid foundations for the improvement of osteopathic manual medicine in the cardiology field.
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Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Allan R Escher
- Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
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Leyssens L, Pestiaux C, Kerckhofs G. A Review of Ex Vivo X-ray Microfocus Computed Tomography-Based Characterization of the Cardiovascular System. Int J Mol Sci 2021; 22:3263. [PMID: 33806852 PMCID: PMC8004599 DOI: 10.3390/ijms22063263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/27/2022] Open
Abstract
Cardiovascular malformations and diseases are common but complex and often not yet fully understood. To better understand the effects of structural and microstructural changes of the heart and the vasculature on their proper functioning, a detailed characterization of the microstructure is crucial. In vivo imaging approaches are noninvasive and allow visualizing the heart and the vasculature in 3D. However, their spatial image resolution is often too limited for microstructural analyses, and hence, ex vivo imaging is preferred for this purpose. Ex vivo X-ray microfocus computed tomography (microCT) is a rapidly emerging high-resolution 3D structural imaging technique often used for the assessment of calcified tissues. Contrast-enhanced microCT (CE-CT) or phase-contrast microCT (PC-CT) improve this technique by additionally allowing the distinction of different low X-ray-absorbing soft tissues. In this review, we present the strengths of ex vivo microCT, CE-CT and PC-CT for quantitative 3D imaging of the structure and/or microstructure of the heart, the vasculature and their substructures in healthy and diseased state. We also discuss their current limitations, mainly with regard to the contrasting methods and the tissue preparation.
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Affiliation(s)
- Lisa Leyssens
- Institute of Mechanics, Materials, and Civil Engineering, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium; (L.L.); (C.P.)
- Institute of Experimental and Clinical Research, Université Catholique de Louvain, 1200 Woluwe-Saint-Lambert, Belgium
| | - Camille Pestiaux
- Institute of Mechanics, Materials, and Civil Engineering, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium; (L.L.); (C.P.)
- Institute of Experimental and Clinical Research, Université Catholique de Louvain, 1200 Woluwe-Saint-Lambert, Belgium
| | - Greet Kerckhofs
- Institute of Mechanics, Materials, and Civil Engineering, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium; (L.L.); (C.P.)
- Institute of Experimental and Clinical Research, Université Catholique de Louvain, 1200 Woluwe-Saint-Lambert, Belgium
- Department of Materials Engineering, Katholieke Universiteit Leuven, 3001 Leuven, Belgium
- Prometheus, Division of Skeletal Tissue Engineering, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
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Martins-Marques T, Hausenloy DJ, Sluijter JPG, Leybaert L, Girao H. Intercellular Communication in the Heart: Therapeutic Opportunities for Cardiac Ischemia. Trends Mol Med 2021; 27:248-262. [PMID: 33139169 DOI: 10.1016/j.molmed.2020.10.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/04/2020] [Accepted: 10/07/2020] [Indexed: 12/15/2022]
Abstract
The maintenance of tissue, organ, and organism homeostasis relies on an intricate network of players and mechanisms that assist in the different forms of cell-cell communication. Myocardial infarction, following heart ischemia and reperfusion, is associated with profound changes in key processes of intercellular communication, involving gap junctions, extracellular vesicles, and tunneling nanotubes, some of which have been implicated in communication defects associated with cardiac injury, namely arrhythmogenesis and progression into heart failure. Therefore, intercellular communication players have emerged as attractive powerful therapeutic targets aimed at preserving a fine-tuned crosstalk between the different cardiac cells in order to prevent or repair some of harmful consequences of heart ischemia and reperfusion, re-establishing myocardial function.
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Affiliation(s)
- Tania Martins-Marques
- Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra, Portugal; Univ Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal; Clinical Academic Centre of Coimbra (CACC), Coimbra, Portugal
| | - Derek J Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore; National Heart Research Institute Singapore, National Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore; The Hatter Cardiovascular Institute, University College London, London, UK; Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan
| | - Joost P G Sluijter
- Laboratory of Experimental Cardiology, UMC Utrecht Regenerative Medicine Center, Circulatory Health Laboratory, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Luc Leybaert
- Department of Basic and Applied Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Henrique Girao
- Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra, Portugal; Univ Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal; Clinical Academic Centre of Coimbra (CACC), Coimbra, Portugal.
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40
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Tissue Chips and Microphysiological Systems for Disease Modeling and Drug Testing. MICROMACHINES 2021; 12:mi12020139. [PMID: 33525451 PMCID: PMC7911320 DOI: 10.3390/mi12020139] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 12/15/2022]
Abstract
Tissue chips (TCs) and microphysiological systems (MPSs) that incorporate human cells are novel platforms to model disease and screen drugs and provide an alternative to traditional animal studies. This review highlights the basic definitions of TCs and MPSs, examines four major organs/tissues, identifies critical parameters for organization and function (tissue organization, blood flow, and physical stresses), reviews current microfluidic approaches to recreate tissues, and discusses current shortcomings and future directions for the development and application of these technologies. The organs emphasized are those involved in the metabolism or excretion of drugs (hepatic and renal systems) and organs sensitive to drug toxicity (cardiovascular system). This article examines the microfluidic/microfabrication approaches for each organ individually and identifies specific examples of TCs. This review will provide an excellent starting point for understanding, designing, and constructing novel TCs for possible integration within MPS.
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Nakao S, Atkinson AJ, Motomochi T, Fukunaga D, Dobrzynski H. Common arterial trunk in a cat: a high-resolution morphological analysis with micro-computed tomography. J Vet Cardiol 2021; 34:8-15. [PMID: 33486210 DOI: 10.1016/j.jvc.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
A 6-month-old female cat presented with respiratory distress. Physical examination showed a grade 5/6 holosystolic murmur with prominent precordial impulse over the left cranial chest wall. Echocardiography revealed bilateral hypertrophy of the ventricular walls, a dilated ascending aorta overriding the interventricular septum, a membranous ventricular septal defect and no obvious pulmonary trunk or pulmonary artery branches. Turbulent blood flow was detected around the ventricular septal defect and ascending aorta. Follow-up assessment, 12 months later, revealed marked and progressive biatrial dilation and biventricular hypertrophy. Four months after that, the cat died of severe congestive heart failure. To make a definitive postmortem diagnosis, we performed contrast enhanced micro-computed tomography (CT) on the ex vivo heart with micron-scale spatial resolution imaging and three-dimensional reconstruction. Micro-computed tomography analysis confirmed a common arterial trunk that bifurcated into the left pulmonary artery and aorta 5-mm distally from the truncal valve. The pulmonary trunk was absent. Slightly distal to the first branching, the common arterial trunk further branched into the right pulmonary artery and ascending aorta, indicating the aortic dominant form. Although CT angiography would be a preferred imaging modality for living animals, micro-computed tomography is a valuable tool for the ex vivo diagnosis of complex cardiac anomaly, such as presented in this cat.
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Affiliation(s)
- S Nakao
- Department of Biomedical Sciences, College of Life Sciences, Ritsumeikan University, Japan; Ritsumeikan Global Innovation Research Organization, Ritsumeikan University, 1-1-1 Noji-higashi, Kusatsu, Shiga 525-8577, Japan; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 46 Grafton Street, Manchester M13 9NT, United Kingdom.
| | - A J Atkinson
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 46 Grafton Street, Manchester M13 9NT, United Kingdom
| | - T Motomochi
- Motomochi Animal Hospital, 22-6 Karahashi-cho, Otsu, Shiga 520-0851, Japan
| | - D Fukunaga
- CREA Animal Hospital, 5-13-21 Aoyama, Otsu, Shiga 520-2101, Japan
| | - H Dobrzynski
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 46 Grafton Street, Manchester M13 9NT, United Kingdom; Department of Anatomy, Jagiellonian University Medical College, Świętej Anny 12, Cracow 31-008, Poland.
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De Almeida MC, Mori S, Anderson RH. Three-dimensional visualization of the bovine cardiac conduction system and surrounding structures compared to the arrangements in the human heart. J Anat 2021; 238:1359-1370. [PMID: 33491213 DOI: 10.1111/joa.13397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/10/2020] [Accepted: 01/05/2021] [Indexed: 12/14/2022] Open
Abstract
In the human heart, the atrioventricular node is located toward the apex of the triangle of Koch, which is also at the apex of the inferior pyramidal space. It is adjacent to the atrioventricular portion of the membranous septum, through which it penetrates to become the atrioventricular bundle. Subsequent to its penetration, the conduction axis is located on the crest of the ventricular septum, sandwiched between the muscular septum and ventricular component of the membranous septum, where it gives rise to the ramifications of the left bundle branch. In contrast, the bovine conduction axis has a long non-branching component, which penetrates into a thick muscular atrioventricular septum having skirted the main cardiac bone and the rightward half of the non-coronary sinus of the aortic root. It commonly gives rise to both right and left bundle branches within the muscular ventricular septum. Unlike the situation in man, the left bundle branch is long and thin before it branches into its fascicles. These differences from the human heart, however, have yet to be shown in three-dimensions relative to the surrounding structures. We have now achieved this goal by injecting contrast material into the insulating sheaths that surround the conduction network, evaluating the results by subsequent computed tomography. The fibrous atrioventricular membranous septum of the human heart is replaced in the ox by the main cardiac bone and the muscular atrioventricular septum. The apex of the inferior pyramidal space, which in the bovine, as in the human, is related to the atrioventricular node, is placed inferiorly relative to the left ventricular outflow tract. The bovine atrioventricular conduction axis, therefore, originates from a node itself located inferiorly compared to the human arrangement. The axis must then skirt the non-coronary sinus of the aortic root prior to penetrating the thicker muscular ventricular septum, thus accounting for its long non-branching course. We envisage that our findings will further enhance comparative anatomical research.
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Affiliation(s)
- Marcos C De Almeida
- Department of Genetics and Morphology, Brasilia's University, Brasilia, Brazil
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
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Incorporating Virtual Reality Technology in Safety Training Solution for Construction Site of Urban Cities. SUSTAINABILITY 2020. [DOI: 10.3390/su13010243] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The lack of experiential training has become the primary cause of incidents that could have been easily avoided in construction areas, and the implementation of experimental training is crucial in minimizing incidents at construction sites. The limitation on the available training tools has made it impossible to build up a real test site or reproduce the constructing scenarios. This research aims to develop an immersive and interactive multiplayer-based training platform that incorporates virtual reality (VR) technology to improve the safety awareness of workers. The developed simulation platform serves as a training solution, enabling the provision of repeatable and flexible procedures within a secure environment. An evaluation survey was conducted to make a comparison between traditional training methods and the proposed VR solution. Promisingly, the results indicate that workers were better trained under the developed immersive environment, and they could memorize critical points more effectively because the implementation of VR technology can allow people to experience hazardous situations without being physically injured, thus creating a safer and more efficient training environment. This study reveals that the nomination of the proposed VR platform could reap many benefits and become an advantageous tool for construction training, as well as stimulate human-machine interaction research.
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44
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Novo Matos J, Garcia-Canadilla P, Simcock IC, Hutchinson JC, Dobromylskyj M, Guy A, Arthurs OJ, Cook AC, Luis Fuentes V. Micro-computed tomography (micro-CT) for the assessment of myocardial disarray, fibrosis and ventricular mass in a feline model of hypertrophic cardiomyopathy. Sci Rep 2020; 10:20169. [PMID: 33214588 PMCID: PMC7678873 DOI: 10.1038/s41598-020-76809-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/02/2020] [Indexed: 01/15/2023] Open
Abstract
Micro-computed tomography (micro-CT) is a high-resolution imaging modality that provides accurate tissue characterization. Hypertrophic cardiomyopathy (HCM) occurs as a spontaneous disease in cats, and is characterized by myocardial hypertrophy, disarray and fibrosis, as in humans. While hypertrophy/mass (LVM) can be objectively measured, fibrosis and myocyte disarray are difficult to assess. We evaluated the accuracy of micro-CT for detection and quantification of myocardial disarray and fibrosis by direct comparison with histopathology. 29 cat hearts (12 normal and 17 HCM hearts) underwent micro-CT and pathologic examination. Myocyte orientation was assessed using structure tensor analysis by determination of helical angle (HA), fractional anisotropy (FA) and myocardial disarray index (MDI). Fibrosis was segmented and quantified based on comparison of gray-scale values in normal and fibrotic myocardium. LVM was obtained by determining myocardial volume. Myocardial segments with low FA, low MDI and disruption of normal HA transmural profile on micro-CT were associated with myocardial disarray on histopathology. FA was consistently lower in HCM than normal hearts. Assessment of fibrosis on micro-CT closely matched the histopathologic evaluation. LVM determined by micro-CT was higher in HCM than normal hearts. Micro-CT can be used to detect and quantify myocardial disarray and fibrosis and determine myocardial mass in HCM.
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Affiliation(s)
- Jose Novo Matos
- Clinical Sciences and Services, Royal Veterinary College, London, UK.
| | - Patricia Garcia-Canadilla
- Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.,Institute of Cardiovascular Science, University College London, London, UK
| | - Ian C Simcock
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - J Ciaran Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | | | - Anna Guy
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Andrew C Cook
- Institute of Cardiovascular Science, University College London, London, UK
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45
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Novo Matos J, Garcia-Canadilla P, Simcock IC, Hutchinson JC, Dobromylskyj M, Guy A, Arthurs OJ, Cook AC, Luis Fuentes V. Micro-computed tomography (micro-CT) for the assessment of myocardial disarray, fibrosis and ventricular mass in a feline model of hypertrophic cardiomyopathy. Sci Rep 2020. [PMID: 33214588 DOI: 10.1038/s41598-020-76809-5.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Micro-computed tomography (micro-CT) is a high-resolution imaging modality that provides accurate tissue characterization. Hypertrophic cardiomyopathy (HCM) occurs as a spontaneous disease in cats, and is characterized by myocardial hypertrophy, disarray and fibrosis, as in humans. While hypertrophy/mass (LVM) can be objectively measured, fibrosis and myocyte disarray are difficult to assess. We evaluated the accuracy of micro-CT for detection and quantification of myocardial disarray and fibrosis by direct comparison with histopathology. 29 cat hearts (12 normal and 17 HCM hearts) underwent micro-CT and pathologic examination. Myocyte orientation was assessed using structure tensor analysis by determination of helical angle (HA), fractional anisotropy (FA) and myocardial disarray index (MDI). Fibrosis was segmented and quantified based on comparison of gray-scale values in normal and fibrotic myocardium. LVM was obtained by determining myocardial volume. Myocardial segments with low FA, low MDI and disruption of normal HA transmural profile on micro-CT were associated with myocardial disarray on histopathology. FA was consistently lower in HCM than normal hearts. Assessment of fibrosis on micro-CT closely matched the histopathologic evaluation. LVM determined by micro-CT was higher in HCM than normal hearts. Micro-CT can be used to detect and quantify myocardial disarray and fibrosis and determine myocardial mass in HCM.
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Affiliation(s)
- Jose Novo Matos
- Clinical Sciences and Services, Royal Veterinary College, London, UK.
| | - Patricia Garcia-Canadilla
- Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.,Institute of Cardiovascular Science, University College London, London, UK
| | - Ian C Simcock
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - J Ciaran Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | | | - Anna Guy
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Andrew C Cook
- Institute of Cardiovascular Science, University College London, London, UK
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46
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Padala SK, Cabrera J, Ellenbogen KA. Anatomy of the cardiac conduction system. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:15-25. [DOI: 10.1111/pace.14107] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/12/2020] [Accepted: 10/25/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Santosh K. Padala
- Division of Cardiology, Pauley Heart Center Virginia Commonwealth University Richmond Virginia
| | - José‐Angel Cabrera
- Unidad de Arritmias, Departamento de Cardiología Hospital Universitario Quirón‐Salud Madrid Madrid Spain
| | - Kenneth A. Ellenbogen
- Division of Cardiology, Pauley Heart Center Virginia Commonwealth University Richmond Virginia
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47
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Petkova M, Atkinson AJ, Yanni J, Stuart L, Aminu AJ, Ivanova AD, Pustovit KB, Geragthy C, Feather A, Li N, Zhang Y, Oceandy D, Perde F, Molenaar P, D’Souza A, Fedorov VV, Dobrzynski H. Identification of Key Small Non-Coding MicroRNAs Controlling Pacemaker Mechanisms in the Human Sinus Node. J Am Heart Assoc 2020; 9:e016590. [PMID: 33059532 PMCID: PMC7763385 DOI: 10.1161/jaha.120.016590] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/27/2020] [Indexed: 01/01/2023]
Abstract
Background The sinus node (SN) is the primary pacemaker of the heart. SN myocytes possess distinctive action potential morphology with spontaneous diastolic depolarization because of a unique expression of ion channels and Ca2+-handling proteins. MicroRNAs (miRs) inhibit gene expression. The role of miRs in controlling the expression of genes responsible for human SN pacemaking and conduction has not been explored. The aim of this study was to determine miR expression profile of the human SN as compared with that of non-pacemaker atrial muscle. Methods and Results SN and atrial muscle biopsies were obtained from donor or post-mortem hearts (n=10), histology/immunolabeling were used to characterize the tissues, TaqMan Human MicroRNA Arrays were used to measure 754 miRs, Ingenuity Pathway Analysis was used to identify miRs controlling SN pacemaker gene expression. Eighteen miRs were significantly more and 48 significantly less abundant in the SN than atrial muscle. The most interesting miR was miR-486-3p predicted to inhibit expression of pacemaking channels: HCN1 (hyperpolarization-activated cyclic nucleotide-gated 1), HCN4, voltage-gated calcium channel (Cav)1.3, and Cav3.1. A luciferase reporter gene assay confirmed that miR-486-3p can control HCN4 expression via its 3' untranslated region. In ex vivo SN preparations, transfection with miR-486-3p reduced the beating rate by ≈35±5% (P<0.05) and HCN4 expression (P<0.05). Conclusions The human SN possesses a unique pattern of expression of miRs predicted to target functionally important genes. miR-486-3p has an important role in SN pacemaker activity by targeting HCN4, making it a potential target for therapeutic treatment of SN disease such as sinus tachycardia.
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Affiliation(s)
- Maria Petkova
- Division of Cardiovascular SciencesUniversity of ManchesterUnited Kingdom
| | - Andrew J. Atkinson
- Division of Cardiovascular SciencesUniversity of ManchesterUnited Kingdom
| | - Joseph Yanni
- Division of Cardiovascular SciencesUniversity of ManchesterUnited Kingdom
| | - Luke Stuart
- Division of Cardiovascular SciencesUniversity of ManchesterUnited Kingdom
| | - Abimbola J. Aminu
- Division of Cardiovascular SciencesUniversity of ManchesterUnited Kingdom
| | - Alexandra D. Ivanova
- Department of Human and Animal PhysiologyLomonosov Moscow State UniversityMoscowRussia
| | - Ksenia B. Pustovit
- Department of Human and Animal PhysiologyLomonosov Moscow State UniversityMoscowRussia
| | - Connor Geragthy
- Division of Cardiovascular SciencesUniversity of ManchesterUnited Kingdom
| | - Amy Feather
- Division of Cardiovascular SciencesUniversity of ManchesterUnited Kingdom
| | - Ning Li
- Physiology and Cell Biology DepartmentThe Bob and Corrine Frick Center for Heart Failure and ArrhythmiaThe Ohio State University Wexner Medical CenterColumbusOH
| | - Yu Zhang
- Division of Cardiovascular SciencesUniversity of ManchesterUnited Kingdom
| | - Delvac Oceandy
- Division of Cardiovascular SciencesUniversity of ManchesterUnited Kingdom
| | - Filip Perde
- National Institute of Legal MedicineBucharestRomania
| | - Peter Molenaar
- School of Biomedical SciencesQueensland University of TechnologyBrisbaneAustralia
- Cardiovascular Molecular & Therapeutics Translational Research GroupThe Prince Charles HospitalBrisbaneAustralia
| | - Alicia D’Souza
- Division of Cardiovascular SciencesUniversity of ManchesterUnited Kingdom
| | - Vadim V. Fedorov
- Physiology and Cell Biology DepartmentThe Bob and Corrine Frick Center for Heart Failure and ArrhythmiaThe Ohio State University Wexner Medical CenterColumbusOH
| | - Halina Dobrzynski
- Division of Cardiovascular SciencesUniversity of ManchesterUnited Kingdom
- Department of AnatomyJagiellonian University Medical CollegeKrakowPoland
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48
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Dejea H, Bonnin A, Cook AC, Garcia-Canadilla P. Cardiac multi-scale investigation of the right and left ventricle ex vivo: a review. Cardiovasc Diagn Ther 2020; 10:1701-1717. [PMID: 33224784 DOI: 10.21037/cdt-20-269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The heart is a complex multi-scale system composed of components integrated at the subcellular, cellular, tissue and organ levels. The myocytes, the contractile elements of the heart, form a complex three-dimensional (3D) network which enables propagation of the electrical signal that triggers the contraction to efficiently pump blood towards the whole body. Cardiovascular diseases (CVDs), a major cause of mortality in developed countries, often lead to cardiovascular remodeling affecting cardiac structure and function at all scales, from myocytes and their surrounding collagen matrix to the 3D organization of the whole heart. As yet, there is no consensus as to how the myocytes are arranged and packed within their connective tissue matrix, nor how best to image them at multiple scales. Cardiovascular imaging is routinely used to investigate cardiac structure and function as well as for the evaluation of cardiac remodeling in CVDs. For a complete understanding of the relationship between structural remodeling and cardiac dysfunction in CVDs, multi-scale imaging approaches are necessary to achieve a detailed description of ventricular architecture along with cardiac function. In this context, ventricular architecture has been extensively studied using a wide variety of imaging techniques: ultrasound (US), optical coherence tomography (OCT), microscopy (confocal, episcopic, light sheet, polarized light), magnetic resonance imaging (MRI), micro-computed tomography (micro-CT) and, more recently, synchrotron X-ray phase contrast imaging (SR X-PCI). Each of these techniques have their own set of strengths and weaknesses, relating to sample size, preparation, resolution, 2D/3D capabilities, use of contrast agents and possibility of performing together with in vivo studies. Therefore, the combination of different imaging techniques to investigate the same sample, thus taking advantage of the strengths of each method, could help us to extract the maximum information about ventricular architecture and function. In this review, we provide an overview of available and emerging cardiovascular imaging techniques for assessing myocardial architecture ex vivo and discuss their utility in being able to quantify cardiac remodeling, in CVDs, from myocyte to whole organ.
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Affiliation(s)
- Hector Dejea
- Paul Scherrer Institut, Villigen PSI, Villigen, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Anne Bonnin
- Paul Scherrer Institut, Villigen PSI, Villigen, Switzerland
| | - Andrew C Cook
- Institute of Cardiovascular Science, University College London, London, UK
| | - Patricia Garcia-Canadilla
- Institute of Cardiovascular Science, University College London, London, UK.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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49
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Tretter JT, Gupta SK, Izawa Y, Nishii T, Mori S. Virtual Dissection: Emerging as the Gold Standard of Analyzing Living Heart Anatomy. J Cardiovasc Dev Dis 2020; 7:E30. [PMID: 32806725 PMCID: PMC7570024 DOI: 10.3390/jcdd7030030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022] Open
Abstract
Traditionally, gross cardiac anatomy has been described mainly based on the findings in the dissection suite. Analyses of heart specimens have contributed immensely towards building a fundamental knowledge of cardiac anatomy. However, there are limitations in analyzing the autopsied heart removed from the thorax. Three-dimensional imaging allows visualization of the blood-filled heart in vivo in attitudinally appropriate fashion. This is of paramount importance for not only demonstration of cardiac anatomy for educational purposes, but also for the detailed anatomical evaluation in patients with acquired and congenital heart disease. In this review, we discuss the advantages of three-dimensional imaging, specifically focusing on virtual dissection, a volume rendering-based reconstruction technique using computed tomographic data. We highlight examples of three-dimensional imaging in both education and guiding patient management.
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Affiliation(s)
- Justin T. Tretter
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India;
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan;
| | - Tatsuya Nishii
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka 564-8565, Japan;
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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Kaza AK, Mondal A, Piekarski B, Sachse FB, Hitchcock R. Intraoperative localization of cardiac conduction tissue regions using real-time fibre-optic confocal microscopy: first in human trial. Eur J Cardiothorac Surg 2020; 58:261-268. [PMID: 32083653 DOI: 10.1093/ejcts/ezaa040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/11/2020] [Accepted: 01/17/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the feasibility and safety of fibre-optic confocal microscopy (FCM) using fluorescein sodium dye for the intraoperative location of conduction tissue regions during paediatric heart surgery. METHODS The pilot study included 6 patients undergoing elective surgery for the closure of isolated secundum atrial septal defect aged 30 days to 21 years. FCM imaging was integrated within the normal intraoperative protocol for atrial septal defect repair. Fluorescein sodium dye was applied on the arrested heart. FCM images were acquired at the atrioventricular node region, sinus node region and right ventricle (RV). Total imaging time was limited to 3 min. Any adverse events related to the study were recorded and analysed. Subjects received standard postoperative care. Trained reviewers (n = 9) classified, de-identified and randomized FCM images (n = 60) recorded from the patients as presenting striated, reticulated or indistinguishable microstructures. The reliability of reviewer agreement was assessed using Fleiss' kappa. RESULTS The FCM imaging instruments were integrated effectively into the cardiac surgery operating room. All adverse events found in the study were deemed expected and not related to FCM imaging. Reticulated myocardial microstructures were found during FCM imaging at atrioventricular node and sinus node regions, while striated microstructures were observed in RV. Reliability of agreement of reviewers classifying the FCM images was high (Fleiss' kappa: 0.822). CONCLUSIONS FCM using fluorescein sodium dye was found to be safe for use during paediatric heart surgery. The study demonstrates the potential for FCM to be effective in identifying conduction tissue regions during congenital heart surgery. CLINICAL TRIAL REGISTRATION NUMBER NCT03189134.
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Affiliation(s)
- Aditya K Kaza
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Abhijit Mondal
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Breanna Piekarski
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Frank B Sachse
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.,Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
| | - Robert Hitchcock
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
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