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Hussaini S, Mamyraiym Kyzy A, Schröder-Schetelig J, Lädke SL, Venkatesan V, Diaz-Maue L, Quiñonez Uribe RA, Richter C, Biktashev VN, Majumder R, Krinski V, Luther S. Efficient termination of cardiac arrhythmias using optogenetic resonant feedback pacing. CHAOS (WOODBURY, N.Y.) 2024; 34:031103. [PMID: 38526981 DOI: 10.1063/5.0191519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/03/2024] [Indexed: 03/27/2024]
Abstract
Malignant cardiac tachyarrhythmias are associated with complex spatiotemporal excitation of the heart. The termination of these life-threatening arrhythmias requires high-energy electrical shocks that have significant side effects, including tissue damage, excruciating pain, and worsening prognosis. This significant medical need has motivated the search for alternative approaches that mitigate the side effects, based on a comprehensive understanding of the nonlinear dynamics of the heart. Cardiac optogenetics enables the manipulation of cellular function using light, enhancing our understanding of nonlinear cardiac function and control. Here, we investigate the efficacy of optically resonant feedback pacing (ORFP) to terminate ventricular tachyarrhythmias using numerical simulations and experiments in transgenic Langendorff-perfused mouse hearts. We show that ORFP outperforms the termination efficacy of the optical single-pulse (OSP) approach. When using ORFP, the total energy required for arrhythmia termination, i.e., the energy summed over all pulses in the sequence, is 1 mJ. With a success rate of 50%, the energy per pulse is 40 times lower than with OSP with a pulse duration of 10 ms. We demonstrate that even at light intensities below the excitation threshold, ORFP enables the termination of arrhythmias by spatiotemporal modulation of excitability inducing spiral wave drift.
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Affiliation(s)
- S Hussaini
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Göttingen 37075, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony, Göttingen 37075, Germany
| | - A Mamyraiym Kyzy
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
| | - J Schröder-Schetelig
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Göttingen 37075, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony, Göttingen 37075, Germany
| | - S L Lädke
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
| | - V Venkatesan
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
| | - L Diaz-Maue
- DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony, Göttingen 37075, Germany
- Research Electronics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
| | - R A Quiñonez Uribe
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony, Göttingen 37075, Germany
| | - C Richter
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony, Göttingen 37075, Germany
- WG Cardiovascular Optogenetics, Lab Animal Science Unit, Leibniz Institute for Primate Research, Göttingen 37077, Germany
| | - V N Biktashev
- Department of Mathematics and Statistics, University of Exeter, Exeter EX4 4QF, United Kingdom
| | - R Majumder
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Göttingen 37075, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony, Göttingen 37075, Germany
| | - V Krinski
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
| | - S Luther
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Göttingen 37075, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony, Göttingen 37075, Germany
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Aron M, Lilienkamp T, Luther S, Parlitz U. Optimising low-energy defibrillation in 2D cardiac tissue with a genetic algorithm. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 3:1172454. [PMID: 37555132 PMCID: PMC10406519 DOI: 10.3389/fnetp.2023.1172454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/28/2023] [Indexed: 08/10/2023]
Abstract
Sequences of low-energy electrical pulses can effectively terminate ventricular fibrillation (VF) and avoid the side effects of conventional high-energy electrical defibrillation shocks, including tissue damage, traumatic pain, and worsening of prognosis. However, the systematic optimisation of sequences of low-energy pulses remains a major challenge. Using 2D simulations of homogeneous cardiac tissue and a genetic algorithm, we demonstrate the optimisation of sequences with non-uniform pulse energies and time intervals between consecutive pulses for efficient VF termination. We further identify model-dependent reductions of total pacing energy ranging from ∼4% to ∼80% compared to reference adaptive-deceleration pacing (ADP) protocols of equal success rate (100%).
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Affiliation(s)
- Marcel Aron
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Göttingen, Germany
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Institute for the Dynamics of Complex Systems, Georg-August-Universität Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Thomas Lilienkamp
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Computational Physics for Life Science, Nuremberg Institute of Technology Georg Simon Ohm, Nuremberg, Germany
| | - Stefan Luther
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Göttingen, Germany
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Institute for the Dynamics of Complex Systems, Georg-August-Universität Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ulrich Parlitz
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Institute for the Dynamics of Complex Systems, Georg-August-Universität Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
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Lilienkamp T, Parlitz U, Luther S. Taming cardiac arrhythmias: Terminating spiral wave chaos by adaptive deceleration pacing. CHAOS (WOODBURY, N.Y.) 2022; 32:121105. [PMID: 36587312 DOI: 10.1063/5.0126682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/26/2022] [Indexed: 06/17/2023]
Abstract
Sequences of weak electrical pulses are considered a promising alternative for terminating ventricular and atrial fibrillations while avoiding strong defibrillation shocks with adverse side effects. In this study, using numerical simulations of four different 2D excitable media, we show that pulse trains with increasing temporal intervals between successive pulses (deceleration pacing) provide high success rates at low energies. Furthermore, we propose a simple and robust approach to calculate inter-pulse spacing directly from the frequency spectrum of the dynamics (for instance, computed based on the electrocardiogram), which can be practically used in experiments and clinical applications.
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Affiliation(s)
- Thomas Lilienkamp
- Max Planck Institute for Dynamics and Self-Organization, Am Fassberg 17, 37077 Göttingen, Germany
| | - Ulrich Parlitz
- Max Planck Institute for Dynamics and Self-Organization, Am Fassberg 17, 37077 Göttingen, Germany
| | - Stefan Luther
- Max Planck Institute for Dynamics and Self-Organization, Am Fassberg 17, 37077 Göttingen, Germany
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Lilienkamp T, Parlitz U, Luther S. Non-monotonous dose response function of the termination of spiral wave chaos. Sci Rep 2022; 12:12043. [PMID: 35835979 PMCID: PMC9283470 DOI: 10.1038/s41598-022-16068-8] [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: 04/01/2022] [Accepted: 07/04/2022] [Indexed: 11/15/2022] Open
Abstract
The conventional termination technique of life threatening cardiac arrhythmia like ventricular fibrillation is the application of a high-energy electrical defibrillation shock, coming along with severe side-effects. In order to improve the current treatment reducing these side-effects, the application of pulse sequences of lower energy instead of a single high-energy pulse are promising candidates. In this study, we show that in numerical simulations the dose-response function of pulse sequences applied to two-dimensional spiral wave chaos is not necessarily monotonously increasing, but exhibits a non-trivial frequency dependence. This insight into crucial phenomena appearing during termination attempts provides a deeper understanding of the governing termination mechanisms in general, and therefore may open up the path towards an efficient termination of cardiac arrhythmia in the future.
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Affiliation(s)
- Thomas Lilienkamp
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, 37077, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, 37075, Germany.
| | - Ulrich Parlitz
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, 37077, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, 37075, Germany.,Institute for the Dynamics of Complex Systems, Georg-August-Universität Göttingen, 37077, Göttingen, Germany
| | - Stefan Luther
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, 37077, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, 37075, Germany. .,Institute for the Dynamics of Complex Systems, Georg-August-Universität Göttingen, 37077, Göttingen, Germany. .,University Medical Center Goettingen, Institute of Pharmacology and Toxicology, 37075, Göttingen, Germany.
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Overdrive pacing of spiral waves in a model of human ventricular tissue. Sci Rep 2020; 10:20632. [PMID: 33244010 PMCID: PMC7691998 DOI: 10.1038/s41598-020-77314-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 10/30/2020] [Indexed: 01/03/2023] Open
Abstract
High-voltage electrical defibrillation remains the only reliable method of quickly controlling life-threatening cardiac arrhythmias. This paper is devoted to studying an alternative approach, low-voltage cardioversion (LVC), which is based on ideas from non-linear dynamics and aims to remove sources of cardiac arrhythmias by applying high-frequency stimulation to cardiac tissue. We perform a detailed in-silico study of the elimination of arrhythmias caused by rotating spiral waves in a TP06 model of human cardiac tissue. We consider three parameter sets with slopes of the APD restitution curve of 0.7, 1.1 and 1.4, and we study LVC at the baseline and under the blocking of INa and ICaL and under the application of the drugs verapamil and amiodarone. We show that pacing can remove spiral waves; however, its efficiency can be substantially reduced by dynamic instabilities. We classify these instabilities and show that the blocking of INa and the application of amiodarone increase the efficiency of the method, while the blocking of ICaL and the application of verapamil decrease the efficiency. We discuss the mechanisms and the possible clinical applications resulting from our study.
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Holden AV, Begg GA, Bounford K, Stegemann B, Tayebjee MH. Phase Entrainment of Induced Ventricular Fibrillation: A Human Feasibility and Proof of Concept Study. J Atr Fibrillation 2019; 12:2217. [PMID: 32435345 DOI: 10.4022/jafib.2217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/19/2019] [Accepted: 09/21/2019] [Indexed: 11/10/2022]
Abstract
Cardioversion and defibrillation by a single high energy shock applied by myocardial or body surface electrodes is painful, causes long term tissue damage, and is associated with worsening long term outcomes, but is almost always required for treatment of ventricular fibrillation . As a initial step towards developing methods that can terminate ventricular arrhythmias painlessly, we aim to determine if pacing stimuli at a rate of 5/s applied via an implantable cardiac defibrillator (ICD) can modify human ventricular fibrillation. In 8 patients undergoing defibrillation testing of a new/exchanged intracardiac defibrillator, five seconds of pacing at five stimuli per second was applied during the 10-20 seconds of induced ventricular fibrillation before the defibrillation shock was automatically applied, and the cardiac electrograms recorded and analyzed. The high frequency pacing did not entrain the ventricular fibrillation, but altered the dominant frequency in all 8 patients, and modulated the phase computed via the Hilbert Transform, in four of the patients. In this pilot study we demonstrate that high frequency pacing applied via ICD electrodes during VF can alter the dominant frequency and modulate the probability density of the phase of the electrogram of the ventricular fibrillation.
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Affiliation(s)
- Arun V Holden
- School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT; UK
| | - Gordon A Begg
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Katrina Bounford
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Berthold Stegemann
- Medtronic Plc, Bakken Research Center, Endepolsdomein 5, 6229 GW Maastricht, The Netherlands
| | - Muzahir H Tayebjee
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
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Otani NF, Wheeler K, Krinsky V, Luther S. Termination of Scroll Waves by Surface Impacts. PHYSICAL REVIEW LETTERS 2019; 123:068102. [PMID: 31491191 PMCID: PMC7381943 DOI: 10.1103/physrevlett.123.068102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Indexed: 06/10/2023]
Abstract
Three-dimensional scroll waves direct cell movement and gene expression, and induce chaos in the brain and heart. We found an approach to terminate multiple three-dimensional scrolls. A pulse of a properly configured electric field detaches scroll filaments from the surface. They shrink due to filament tension and disappear. Since wave emission from small heterogeneities is not used, this approach requires a much lower electric field. It is not sensitive to the details of the excitable medium. It may affect future studies of low-energy chaos termination in the heart.
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Affiliation(s)
- Niels F. Otani
- School of Mathematical Sciences, Rochester Institute of Technology, Rochester, New York 14623, USA
| | - Kayleigh Wheeler
- School of Mathematical Sciences, Rochester Institute of Technology, Rochester, New York 14623, USA
| | - Valentin Krinsky
- CNRS, INPHYNI, 1361, route des Lucioles, 06560 Valbonne France
- Max Planck Institute for Dynamics and Self-Organization, Research Group of Biomedical Physics, Am Fassberg, 17, 37077, Göttingen, Germany
| | - Stefan Luther
- Max Planck Institute for Dynamics and Self-Organization, Research Group of Biomedical Physics, Am Fassberg, 17, 37077, Göttingen, Germany
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Tom Wörden H, Parlitz U, Luther S. Simultaneous unpinning of multiple vortices in two-dimensional excitable media. Phys Rev E 2019; 99:042216. [PMID: 31108599 DOI: 10.1103/physreve.99.042216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 06/09/2023]
Abstract
There are many examples of excitable media, such as the heart, that can show complex dynamics and where control is a challenging task. Heavy means like a strong electric shock are nowadays still necessary to control and terminate ventricular fibrillation (VF). It is known that heterogeneities in an excitable medium can stabilize the activity, e.g., spiral waves can pin to such obstacles. This might also be a reason for the persistence of VF and the difficulty to control it. Previous studies investigated systems with a single pinned spiral wave and demonstrated how the spiral can be unpinned. In this article, we extend this case and investigate a generic excitable system with multiple pinned spiral waves. We describe a control technique that allows the simultaneous unpinning of pinned spiral waves. Apart from theoretical considerations, we provide numerical evidence that the proposed technique is superior to the underdrive pacing method that has reportedly high success rates when applied to a single pinned spiral.
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Affiliation(s)
- Henrik Tom Wörden
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany; and Institute for the Dynamics of Complex Systems, University of Göttingen, Göttingen, Germany
| | - Ulrich Parlitz
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany; and Institute for the Dynamics of Complex Systems, University of Göttingen, Göttingen, Germany
| | - Stefan Luther
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany; Institute for the Dynamics of Complex Systems, University of Göttingen, Göttingen, Germany; Institute of Pharmacology, University Medical Center Göttingen, Göttingen, Germany
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Buran P, Bär M, Alonso S, Niedermayer T. Control of electrical turbulence by periodic excitation of cardiac tissue. CHAOS (WOODBURY, N.Y.) 2017; 27:113110. [PMID: 29195336 DOI: 10.1063/1.5010787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Electrical turbulence in cardiac tissue is associated with arrhythmias such as life-threatening ventricular fibrillation. Recent experimental studies have shown that a sequence of low-energy electrical far-field pulses is able to terminate fibrillation more gently than a single high-energy pulse which causes severe side effects. During this low-energy antifibrillation pacing (LEAP), only tissue near sufficiently large conduction heterogeneities, such as large coronary arteries, is activated. In order to optimize LEAP, we performed extensive simulations of cardiac tissue perforated by blood vessels, employing two alternative cellular models that exhibit electrical turbulence at a similar length scale. Moreover, the scale of blood vessels in our two-dimensional simulations was chosen such that the threshold for single pulse defibrillation matches experimental values. For each of the 100 initial conditions, we tested different electrical field strengths, pulse shapes, numbers of pulses, and periods between the pulses. LEAP is successful for both models, albeit with substantial differences. One model exhibits a spectrum of chaotic activity featuring a narrow peak around a dominant frequency. In this case, the optimal period between low-energy pulses matches this frequency and LEAP greatly reduces the required energy for successful defibrillation. For pulses with larger energies, the system is perturbed such that underdrive pacing becomes advantageous. The spectrum of the second model features a broader peak, resulting in a less pronounced optimal pacing period and a decreased energy reduction. In both cases, pacing with five or six pulses which are separated by the dominant period maximizes the energy reduction.
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Affiliation(s)
- Pavel Buran
- Physikalisch-Technische Bundesanstalt (PTB), Abbestr. 2-12, 10587 Berlin, Germany
| | - Markus Bär
- Physikalisch-Technische Bundesanstalt (PTB), Abbestr. 2-12, 10587 Berlin, Germany
| | - Sergio Alonso
- Department of Physics, Universitat Politècnica de Catalunya, Av. Dr. Marañón 44, 08028 Barcelona, Spain
| | - Thomas Niedermayer
- Physikalisch-Technische Bundesanstalt (PTB), Abbestr. 2-12, 10587 Berlin, Germany
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