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Scardigli M, Müllenbroich C, Margoni E, Cannazzaro S, Crocini C, Ferrantini C, Coppini R, Yan P, Loew LM, Campione M, Bocchi L, Giulietti D, Cerbai E, Poggesi C, Bub G, Pavone FS, Sacconi L. Real-time optical manipulation of cardiac conduction in intact hearts. J Physiol 2018; 596:3841-3858. [PMID: 29989169 PMCID: PMC6117584 DOI: 10.1113/jp276283] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/05/2018] [Indexed: 11/28/2022] Open
Abstract
Key points Although optogenetics has clearly demonstrated the feasibility of cardiac manipulation, current optical stimulation strategies lack the capability to react acutely to ongoing cardiac wave dynamics. Here, we developed an all‐optical platform to monitor and control electrical activity in real‐time. The methodology was applied to restore normal electrical activity after atrioventricular block and to manipulate the intraventricular propagation of the electrical wavefront. The closed‐loop approach was also applied to simulate a re‐entrant circuit across the ventricle. The development of this innovative optical methodology provides the first proof‐of‐concept that a real‐time all‐optical stimulation can control cardiac rhythm in normal and abnormal conditions.
Abstract Optogenetics has provided new insights in cardiovascular research, leading to new methods for cardiac pacing, resynchronization therapy and cardioversion. Although these interventions have clearly demonstrated the feasibility of cardiac manipulation, current optical stimulation strategies do not take into account cardiac wave dynamics in real time. Here, we developed an all‐optical platform complemented by integrated, newly developed software to monitor and control electrical activity in intact mouse hearts. The system combined a wide‐field mesoscope with a digital projector for optogenetic activation. Cardiac functionality could be manipulated either in free‐run mode with submillisecond temporal resolution or in a closed‐loop fashion: a tailored hardware and software platform allowed real‐time intervention capable of reacting within 2 ms. The methodology was applied to restore normal electrical activity after atrioventricular block, by triggering the ventricle in response to optically mapped atrial activity with appropriate timing. Real‐time intraventricular manipulation of the propagating electrical wavefront was also demonstrated, opening the prospect for real‐time resynchronization therapy and cardiac defibrillation. Furthermore, the closed‐loop approach was applied to simulate a re‐entrant circuit across the ventricle demonstrating the capability of our system to manipulate heart conduction with high versatility even in arrhythmogenic conditions. The development of this innovative optical methodology provides the first proof‐of‐concept that a real‐time optically based stimulation can control cardiac rhythm in normal and abnormal conditions, promising a new approach for the investigation of the (patho)physiology of the heart. Although optogenetics has clearly demonstrated the feasibility of cardiac manipulation, current optical stimulation strategies lack the capability to react acutely to ongoing cardiac wave dynamics. Here, we developed an all‐optical platform to monitor and control electrical activity in real‐time. The methodology was applied to restore normal electrical activity after atrioventricular block and to manipulate the intraventricular propagation of the electrical wavefront. The closed‐loop approach was also applied to simulate a re‐entrant circuit across the ventricle. The development of this innovative optical methodology provides the first proof‐of‐concept that a real‐time all‐optical stimulation can control cardiac rhythm in normal and abnormal conditions.
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Affiliation(s)
- M Scardigli
- European Laboratory for Non-Linear Spectroscopy, Florence, 50019, Italy.,National Institute of Optics, National Research Council, Florence, 50125, Italy
| | - C Müllenbroich
- European Laboratory for Non-Linear Spectroscopy, Florence, 50019, Italy.,National Institute of Optics, National Research Council, Florence, 50125, Italy
| | - E Margoni
- European Laboratory for Non-Linear Spectroscopy, Florence, 50019, Italy.,Department of Physics, University of Pisa, Pisa, 56127, Italy
| | - S Cannazzaro
- European Laboratory for Non-Linear Spectroscopy, Florence, 50019, Italy.,National Institute of Optics, National Research Council, Florence, 50125, Italy
| | - C Crocini
- European Laboratory for Non-Linear Spectroscopy, Florence, 50019, Italy.,National Institute of Optics, National Research Council, Florence, 50125, Italy
| | - C Ferrantini
- Division of Physiology, Department of Experimental and Clinical Medicine, University of Florence, Florence, 50134, Italy
| | - R Coppini
- Division of Pharmacology, Department 'NeuroFarBa', University of Florence, Florence, 50139, Italy
| | - P Yan
- R. D. Berlin Center for Cell Analysis and Modeling, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
| | - L M Loew
- R. D. Berlin Center for Cell Analysis and Modeling, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
| | - M Campione
- Neuroscience Institute, National Research Council, Padova, 35121, Italy.,Department of Biomedical Sciences, Univercity ot Padua, Padua, 35121, Italy
| | - L Bocchi
- European Laboratory for Non-Linear Spectroscopy, Florence, 50019, Italy.,Department of Information Engineering, University of Florence, Via S. Marta 3, Florence, 50139, Italy
| | - D Giulietti
- National Institute of Optics, National Research Council, Florence, 50125, Italy.,Department of Physics, University of Pisa, Pisa, 56127, Italy
| | - E Cerbai
- Division of Pharmacology, Department 'NeuroFarBa', University of Florence, Florence, 50139, Italy
| | - C Poggesi
- Division of Physiology, Department of Experimental and Clinical Medicine, University of Florence, Florence, 50134, Italy
| | - G Bub
- Department of Physiology, McGill University, Montreal, Quebec, Canada
| | - F S Pavone
- European Laboratory for Non-Linear Spectroscopy, Florence, 50019, Italy.,National Institute of Optics, National Research Council, Florence, 50125, Italy.,Department of Physics and Astronomy, University of Florence, Sesto Fiorentino, 50019, Italy
| | - L Sacconi
- European Laboratory for Non-Linear Spectroscopy, Florence, 50019, Italy.,National Institute of Optics, National Research Council, Florence, 50125, Italy
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Kulkarni K, Lee SW, Tolkacheva EG. Pro-arrhythmic effect of heart rate variability during periodic pacing. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:149-152. [PMID: 28268301 DOI: 10.1109/embc.2016.7590662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Clinically, healthy hearts have been associated with a high ventricular heart rate variability (HRV) while diseased hearts have been known to exhibit low ventricular HRV. Hence, low HRV is suggested to be a marker of cardiac ventricular arrhythmias. Over the past few years, there has been considerable amount of interest in incorporating HRV in pacing to emulate healthy heart conditions and re-stabilize the electrical activity in diseased hearts. Recently, we used single cell numerical simulations to demonstrate that HRV incorporated into periodic pacing promotes alternans formation and thus, can be pro-arrhythmic. Here, we performed high-resolution optical mapping experiments on Langendorff perfused, healthy whole mice hearts to validate our numerical findings. Our results indeed demonstrate that HRV promoted the onset of cardiac alternans, which is believed to be a precursor of fatal cardiac rhythms. Hence, our present study suggests that incorporating HRV into periodic pacing while addressing several clinical needs may not be safe. There is a pressing need to better understand paced cardiac dynamics and develop anti-arrhythmic pacing techniques that would prevent cardiac arrhythmias.
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