Development of optical mapping system with real-time feedback stimulation in the heart

Real-time feedback based control of cardiac restitution using optical mapping

Cardiac restitution is the shortening of the action potential duration with an increase in the heart rate. A shorter action potential duration enables a longer diastolic interval which ensures that the heart gets adequate time to refill with blood. At higher rates however, restitution becomes steep and thus, can lead to unstable electrical activity (alternans) in the heart, leading to fatal cardiac rhythms. It has been proposed that maintaining a shallow slope of cardiac restitution could have potentially anti-arrhythmic effects. Previous studies involved the control of action potential duration (APD) or diastolic interval (DI) in isolated tissue samples based on the feedback from single microelectrode recordings. This limited the spatial resolution of the feedback system. Here, we aimed to develop a real time feedback control system that enabled the detection of APDs from various single pixels based on optical mapping recordings. Stimuli were applied after a predefined fixed DI after detection of an APD. We validated our algorithm using optical mapping movies from an ex-vivo rabbit heart. Thus, we provide an optical mapping based approach for the control of cardiac restitution and a potential means to validate its anti-arrhythmic effects.

Optical mapping system with real-time control capability

Real-time, closed-loop intervention is an emerging experiment-control method that promises to provide invaluable new insight into cardiac electrophysiology. One example is the investigation of closed-loop feedback control of cardiac activity (e.g., alternans) as a possible method of preventing arrhythmia onset. To date, such methods have been investigated only in vitro using microelectrode systems, which are hindered by poor spatial resolution and are not well suited for atrial or ventricular tissue preparations. We have developed a system that uses optical mapping techniques and an electrical stimulator as the sensory and effector arms, respectively, of a closed-loop, real-time control system. The system consists of a 2,048 x 1 pixel line-scan charge-coupled device camera that records optical signals from the tissue. Custom-image processing and control software, which is implemented on top of a hard real-time operation system (RTAI Linux), process the data and make control decisions with a deterministic delay of <1 ms. The system is tested in two ways: 1) it is used to control, in real time, simulated optical signals of electrical alternans; and 2) it uses precisely timed, feedback-controlled initiation of antitachycardia pacing to terminate reentrant arrhythmias in an arterially perfused swine right ventricle stained with voltage-sensitive fluorescent dye 4{beta-[2-(di-n-butylamino)-6-napathy]vinyl}pyridinium (di-4-ANEPPS). Thus real-time control of cardiac activity using optical mapping techniques is feasible. Such a system is attractive because it offers greater measurement resolution than the electrode-based systems with which real-time control has been used previously.