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Odening KE, Gomez AM, Dobrev D, Fabritz L, Heinzel FR, Mangoni ME, Molina CE, Sacconi L, Smith G, Stengl M, Thomas D, Zaza A, Remme CA, Heijman J. ESC working group on cardiac cellular electrophysiology position paper: relevance, opportunities, and limitations of experimental models for cardiac electrophysiology research. Europace 2021; 23:1795-1814. [PMID: 34313298 DOI: 10.1093/europace/euab142] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/19/2021] [Indexed: 12/19/2022] Open
Abstract
Cardiac arrhythmias are a major cause of death and disability. A large number of experimental cell and animal models have been developed to study arrhythmogenic diseases. These models have provided important insights into the underlying arrhythmia mechanisms and translational options for their therapeutic management. This position paper from the ESC Working Group on Cardiac Cellular Electrophysiology provides an overview of (i) currently available in vitro, ex vivo, and in vivo electrophysiological research methodologies, (ii) the most commonly used experimental (cellular and animal) models for cardiac arrhythmias including relevant species differences, (iii) the use of human cardiac tissue, induced pluripotent stem cell (hiPSC)-derived and in silico models to study cardiac arrhythmias, and (iv) the availability, relevance, limitations, and opportunities of these cellular and animal models to recapitulate specific acquired and inherited arrhythmogenic diseases, including atrial fibrillation, heart failure, cardiomyopathy, myocarditis, sinus node, and conduction disorders and channelopathies. By promoting a better understanding of these models and their limitations, this position paper aims to improve the quality of basic research in cardiac electrophysiology, with the ultimate goal to facilitate the clinical translation and application of basic electrophysiological research findings on arrhythmia mechanisms and therapies.
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Affiliation(s)
- Katja E Odening
- Translational Cardiology, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland.,Institute of Physiology, University of Bern, Bern, Switzerland
| | - Ana-Maria Gomez
- Signaling and cardiovascular pathophysiology-UMR-S 1180, Inserm, Université Paris-Saclay, 92296 Châtenay-Malabry, France
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Department of Cardiology, University Hospital Birmingham NHS Trust, Birmingham, UK
| | - Frank R Heinzel
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Matteo E Mangoni
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Cristina E Molina
- Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site, Hamburg/Kiel/Lübeck, Germany
| | - Leonardo Sacconi
- National Institute of Optics and European Laboratory for Non Linear Spectroscopy, Italy.,Institute for Experimental Cardiovascular Medicine, University Freiburg, Germany
| | - Godfrey Smith
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Milan Stengl
- Department of Physiology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Dierk Thomas
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site, Heidelberg/Mannheim, Germany
| | - Antonio Zaza
- Department of Biotechnology and Bioscience, University of Milano-Bicocca, Milano, Italy
| | - Carol Ann Remme
- Department of Experimental Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Jordi Heijman
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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Caluori G, Odehnalova E, Jadczyk T, Pesl M, Pavlova I, Valikova L, Holzinger S, Novotna V, Rotrekl V, Hampl A, Crha M, Cervinka D, Starek Z. AC Pulsed Field Ablation Is Feasible and Safe in Atrial and Ventricular Settings: A Proof-of-Concept Chronic Animal Study. Front Bioeng Biotechnol 2020; 8:552357. [PMID: 33344428 PMCID: PMC7744788 DOI: 10.3389/fbioe.2020.552357] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 11/09/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction Pulsed field ablation (PFA) exploits the delivery of short high-voltage shocks to induce cells death via irreversible electroporation. The therapy offers a potential paradigm shift for catheter ablation of cardiac arrhythmia. We designed an AC-burst generator and therapeutic strategy, based on the existing knowledge between efficacy and safety among different pulses. We performed a proof-of-concept chronic animal trial to test the feasibility and safety of our method and technology. Methods We employed 6 female swine - weight 53.75 ± 4.77 kg - in this study. With fluoroscopic and electroanatomical mapping assistance, we performed ECG-gated AC-PFA in the following settings: in the left atrium with a decapolar loop catheter with electrodes connected in bipolar fashion; across the interventricular septum applying energy between the distal electrodes of two tip catheters. After procedure and 4-week follow-up, the animals were euthanized, and the hearts were inspected for tissue changes and characterized. We perform finite element method simulation of our AC-PFA scenarios to corroborate our method and better interpret our findings. Results We applied square, 50% duty cycle, AC bursts of 100 μs duration, 100 kHz internal frequency, 900 V for 60 pulses in the atrium and 1500 V for 120 pulses in the septum. The inter-burst interval was determined by the native heart rhythm - 69 ± 9 bpm. Acute changes in the atrial and ventricular electrograms were immediately visible at the sites of AC-PFA - signals were elongated and reduced in amplitude (p < 0.0001) and tissue impedance dropped (p = 0.011). No adverse event (e.g., esophageal temperature rises or gas bubble streams) was observed - while twitching was avoided by addition of electrosurgical return electrodes. The implemented numerical simulations confirmed the non-thermal nature of our AC-PFA and provided specific information on the estimated treated area and need of pulse trains. The postmortem chest inspection showed no peripheral damage, but epicardial and endocardial discolorations at sites of ablation. T1-weighted scans revealed specific tissue changes in atria and ventricles, confirmed to be fibrotic scars via trichrome staining. We found isolated, transmural and continuous scars. A surviving cardiomyocyte core was visible in basal ventricular lesions. Conclusion We proved that our method and technology of AC-PFA is feasible and safe for atrial and ventricular myocardial ablation, supporting their systematic investigation into effectiveness evaluation for the treatment of cardiac arrhythmia. Further optimization, with energy titration or longer follow-up, is required for a robust atrial and ventricular AC-PFA.
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Affiliation(s)
- Guido Caluori
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia.,IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, France.,Univ. Bordeaux, INSERM, UMR 1045, Cardiothoracic Research Center of Bordeaux, Pessac, France
| | - Eva Odehnalova
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia
| | - Tomasz Jadczyk
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia.,Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Martin Pesl
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia.,Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia.,First Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital, Masaryk University, Brno, Czechia
| | - Iveta Pavlova
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czechia
| | - Lucia Valikova
- Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences, Brno, Czechia
| | | | - Veronika Novotna
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia.,Department of Power Electrical and Electronic Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Brno, Czechia
| | - Vladimir Rotrekl
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia.,Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Ales Hampl
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia.,Department of Histology and Embryology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Michal Crha
- Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences, Brno, Czechia
| | - Dalibor Cervinka
- Department of Power Electrical and Electronic Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Brno, Czechia
| | - Zdenek Starek
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia.,First Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital, Masaryk University, Brno, Czechia
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Soucek F, Caluori G, Lehar F, Jez J, Pesl M, Wolf J, Wojtaszczyk A, Belaskova S, Starek Z. Bipolar ablation with contact force-sensing of swine ventricles shows improved acute lesion features compared to sequential unipolar ablation. J Cardiovasc Electrophysiol 2020; 31:1128-1136. [PMID: 32083360 DOI: 10.1111/jce.14407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 01/31/2020] [Accepted: 02/19/2020] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Despite technical progress, ventricular tachycardia (VT) recurrence after unipolar ablation remains relatively high (12%-47%). Bipolar ablation has been proposed as an appealing solution that may overcome limitations associated with unipolar ablation settings. We designed an animal study to compare bipolar (BPA) vs sequential unipolar ablation (UPA) using contact force-sensing technology on both ablation catheters. METHODS Twenty large white female pigs (6-months-old, 50-60 kg) underwent multiple RF ablations (30 W, 60 seconds, 30 mL/min irrigation) on the ventricular myocardium from the epicardial and endocardial sides. The hearts were fixed and scanned with high-resolution cardiac magnetic resonance imaging. Thermal lesions were located and characterized in volume, depth, width, and transmurality. RESULTS Lesion volume was calculated as the sum of epicardial or endocardial conjoined/isolated lesions at one location. Linear dimensions (width and depth) were measured twice for each location, on the endocardial and epicardial side. We evaluated 35 lesions across the intraventricular septum (UPA, N = 17 vs BPA, N = 18). No difference in volume, linear dimensions or impedance drop was observed in this area between UPA and BPA. However, BPA required half RF time and showed an increased transmurality trend. We then analyzed 73 lesions from the endocardial side (UPA, N = 35 vs BPA, N = 38) and 50 from the epicardial side (UPA, N = 11 vs BPA N = 39) of the ventricular free walls. Lesion transmurality was markedly improved by BPA (P = .030, odds ratio, 23.73 [4.71,31.96]). Ventricular BPA lesions were significantly deeper on the epicardial side (P < .0001) and endocardial side (P = .015). CONCLUSION Bipolar ablation is more likely to create transmural and epicardial lesions in the ventricle wall. Half the time is needed for the creation of comparably deep and large lesions.
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Affiliation(s)
- Filip Soucek
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic
| | - Guido Caluori
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,Nanobiotechnology, CEITEC, Masaryk University, Brno, Czech Republic
| | - Frantisek Lehar
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic
| | - Jiri Jez
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic
| | - Martin Pesl
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic.,Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Wolf
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic
| | - Adam Wojtaszczyk
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Silvie Belaskova
- Biostatistics, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Zdenek Starek
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic
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Jež J, Caluori G, Jadczyk T, Lehar F, Pešl M, Kulík T, Bělašková S, Kubeš V, Stárek Z. Remotely Navigated Ablations in Ventricle Myocardium Result in Acute Lesion Size Comparable to Force-Sensing Manual Navigation. Circ Arrhythm Electrophysiol 2019; 12:e007644. [DOI: 10.1161/circep.119.007644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jiří Jež
- Interventional Cardiac Electrophysiology (J.J., G.C., T.J., F.L., M.P., T.K., Z.S.), International Clinical Research Center of St Anne’s University Hospital, Brno, Czech Republic
- First Department of Internal Medicine – Cardioangiology (J.J., F.L., M.P., Z.S.), Masaryk University, Brno, Czech Republic
| | - Guido Caluori
- Interventional Cardiac Electrophysiology (J.J., G.C., T.J., F.L., M.P., T.K., Z.S.), International Clinical Research Center of St Anne’s University Hospital, Brno, Czech Republic
- Faculty of Medicine, and CEITEC MU (G.C.), Masaryk University, Brno, Czech Republic
| | - Tomasz Jadczyk
- Interventional Cardiac Electrophysiology (J.J., G.C., T.J., F.L., M.P., T.K., Z.S.), International Clinical Research Center of St Anne’s University Hospital, Brno, Czech Republic
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland (T.J.)
| | - František Lehar
- Interventional Cardiac Electrophysiology (J.J., G.C., T.J., F.L., M.P., T.K., Z.S.), International Clinical Research Center of St Anne’s University Hospital, Brno, Czech Republic
- First Department of Internal Medicine – Cardioangiology (J.J., F.L., M.P., Z.S.), Masaryk University, Brno, Czech Republic
| | - Martin Pešl
- Interventional Cardiac Electrophysiology (J.J., G.C., T.J., F.L., M.P., T.K., Z.S.), International Clinical Research Center of St Anne’s University Hospital, Brno, Czech Republic
- Department of Biology (M.P.), Masaryk University, Brno, Czech Republic
- First Department of Internal Medicine – Cardioangiology (J.J., F.L., M.P., Z.S.), Masaryk University, Brno, Czech Republic
| | - Tomáš Kulík
- Interventional Cardiac Electrophysiology (J.J., G.C., T.J., F.L., M.P., T.K., Z.S.), International Clinical Research Center of St Anne’s University Hospital, Brno, Czech Republic
| | - Silvie Bělašková
- Biostatistics (S.B.), International Clinical Research Center of St Anne’s University Hospital, Brno, Czech Republic
| | - Václav Kubeš
- Department of Pathology (V.K.), Masaryk University, Brno, Czech Republic
| | - Zdeněk Stárek
- Interventional Cardiac Electrophysiology (J.J., G.C., T.J., F.L., M.P., T.K., Z.S.), International Clinical Research Center of St Anne’s University Hospital, Brno, Czech Republic
- First Department of Internal Medicine – Cardioangiology (J.J., F.L., M.P., Z.S.), Masaryk University, Brno, Czech Republic
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