1
|
Biasci V, Sacconi L, Cytrynbaum EN, Pijnappels DA, De Coster T, Shrier A, Glass L, Bub G. Universal mechanisms for self-termination of rapid cardiac rhythm. CHAOS (WOODBURY, N.Y.) 2020; 30:121107. [PMID: 33380016 DOI: 10.1063/5.0033813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/14/2020] [Indexed: 06/12/2023]
Abstract
Excitable media sustain circulating waves. In the heart, sustained circulating waves can lead to serious impairment or even death. To investigate factors affecting the stability of such waves, we have used optogenetic techniques to stimulate a region at the apex of a mouse heart at a fixed delay after the detection of excitation at the base of the heart. For long delays, rapid circulating rhythms can be sustained, whereas for shorter delays, there are paroxysmal bursts of activity that start and stop spontaneously. By considering the dependence of the action potential and conduction velocity on the preceding recovery time using restitution curves, as well as the reduced excitability (fatigue) due to the rapid excitation, we model prominent features of the dynamics including alternation of the duration of the excited phases and conduction times, as well as termination of the bursts for short delays. We propose that this illustrates universal mechanisms that exist in biological systems for the self-termination of such activities.
Collapse
Affiliation(s)
- Valentina Biasci
- Division of Physiology, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Leonardo Sacconi
- National Institute of Optics, National Research Council, 50125 Florence, Italy
| | - Eric N Cytrynbaum
- Department of Mathematics, UBC, Vancouver British Columbia V6T 1Z2, Canada
| | - Daniël A Pijnappels
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2333 ZA Leiden, The Netherlands
| | - Tim De Coster
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2333 ZA Leiden, The Netherlands
| | - Alvin Shrier
- Department of Physiology, McGill University, 3655 Promenade Sir William Osler, Montreal, Quebec H3G 1Y6, Canada
| | - Leon Glass
- Department of Physiology, McGill University, 3655 Promenade Sir William Osler, Montreal, Quebec H3G 1Y6, Canada
| | - Gil Bub
- Department of Physiology, McGill University, 3655 Promenade Sir William Osler, Montreal, Quebec H3G 1Y6, Canada
| |
Collapse
|
2
|
Duchateau J, Tixier R, Vlachos K, Nakatani Y, Ramirez FD, André C, Escande W, Chauvel R, Pambrun T, Derval N, Sacher F, Hocini M, Jaïs P, Haissaguerre M. Ventricular-triggered atrial pacing: A new maneuver for slow-fast atrioventricular nodal reentrant tachycardia. Heart Rhythm 2020; 17:955-964. [PMID: 31954857 DOI: 10.1016/j.hrthm.2020.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Atrioventricular (AV) node duality is suggested by several electrophysiological findings, none of which are strong predictors of AV nodal reentrant tachycardia (AVNRT). OBJECTIVE The purpose of this study was to propose a novel maneuver to study conduction over the AV node and attempt to induce slow-fast AVNRT. METHODS Ventricular-triggered atrial pacing (VTAP) with decremental VA delay was carried out in 36 consecutive patients with slow-fast AVNRT and in 21 controls after conventional electrophysiology study. Maneuvers were repeated after ablation in patients with AVNRT. RESULTS VTAP resulted in a hysteretic conduction curve in 21 of 36 patients (58%) in the AVNRT group but only 4 of 21 patients (19%) in the control group (sensitivity 58; specificity 81%). This finding demonstrates sustained conduction in a slow conducting pathway and concealed retrograde conduction over a fast pathway. VTAP resulted in AVNRT induction in 15 of 25 inducible patients at baseline (60%), 4 of which were not inducible with incremental pacing or programmed atrial stimulation. VTAP resulting in a suspended p wave had 51% (39%-64%) sensitivity and 100% (89%-100%) specificity for predicting noninducibility in a given autonomic state. CONCLUSION VTAP is useful in patients with suspected slow-fast AVNRT. A hysteretic conduction curve demonstrates sustained conduction over a slow pathway and concealed retrograde conduction through the fast pathway, a finding in favor of slow-fast AVNRT. VTAP may facilitate AVNRT induction and proves to be an interesting complement to classic maneuvers. A suspended p-wave response specifically predicts noninducibility of slow-fast AVNRT in a given autonomic state, providing an interesting surrogate to noninducibility as a procedural end point.
Collapse
Affiliation(s)
- Josselin Duchateau
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France.
| | - Romain Tixier
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Konstantinos Vlachos
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Yosuke Nakatani
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - F Daniel Ramirez
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Clémentine André
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - William Escande
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Rémi Chauvel
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Thomas Pambrun
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Michel Haissaguerre
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| |
Collapse
|
3
|
Podziemski P, Żebrowski JJ. A simple model of the right atrium of the human heart with the sinoatrial and atrioventricular nodes included. J Clin Monit Comput 2013; 27:481-98. [PMID: 23430363 PMCID: PMC3689917 DOI: 10.1007/s10877-013-9429-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 01/09/2013] [Indexed: 11/29/2022]
Abstract
Existing atrial models with detailed anatomical structure and multi-variable cardiac transmembrane current models are too complex to allow to combine an investigation of long time dycal properties of the heart rhythm with the ability to effectively simulate cardiac electrical activity during arrhythmia. Other ways of modeling need to be investigated. Moreover, many state-of-the-art models of the right atrium do not include an atrioventricular node (AVN) and only rarely--the sinoatrial node (SAN). A model of the heart tissue within the right atrium including the SAN and AVN nodes was developed. Looking for a minimal model, currently we are testing our approach on chosen well-known arrhythmias, which were until now obtained only using much more complicated models, or were only observed in a clinical setting. Ultimately, the goal is to obtain a model able to generate sequences of RR intervals specific for the arrhythmias involving the AV junction as well as for other phenomena occurring within the atrium. The model should be fast enough to allow the study of heart rate variability and arrhythmias at a time scale of thousands of heart beats in real-time. In the model of the right atrium proposed here, different kinds of cardiac tissues are described by sets of different equations, with most of them belonging to the class of Liénard nonlinear dynamical systems. We have developed a series of models of the right atrium with differing anatomical simplifications, in the form of a 2D mapping of the atrium or of an idealized cylindrical geometry, including only those anatomical details required to reproduce a given physiological phenomenon. The simulations allowed to reconstruct the phase relations between the sinus rhythm and the location and properties of a parasystolic source together with the effect of this source on the resultant heart rhythm. We model the action potential conduction time alternans through the atrioventricular AVN junction observed in cardiac tissue in electrophysiological studies during the ventricular-triggered atrial tachycardia. A simulation of the atrio-ventricular nodal reentry tachycardia was performed together with an entrainment procedure in which the arrhythmia circuit was located by measuring the post-pacing interval (PPI) at simulated mapping catheters. The generation and interpretation of RR times series is the ultimate goal of our research. However, to reach that goal we need first to (1) somehow verify the validity of the model of the atrium with the nodes included and (2) include in the model the effect of the sympathetic and vagal ANS. The current paper serves as a partial solution of the 1). In particular we show, that measuring the PPI-TCL entrainment response in proximal (possibly-the slow-conducting pathway), the distal and at a mid-distance from CS could help in rapid distinction of AVNRT from other atrial tachycardias. Our simulations support the hypothesis that the alternans of the conduction time between the atria and the ventricles in the AV orthodromic reciprocating tachycardia can occur within a single pathway. In the atrial parasystole simulation, we found a mathematical condition which allows for a rough estimation of the location of the parasystolic source within the atrium, both for simplified (planar) and the cylindrical geometry of the atrium. The planar and the cylindrical geometry yielded practically the same results of simulations.
Collapse
Affiliation(s)
- Piotr Podziemski
- Faculty of Physics, Warsaw University of Technology, Koszykowa 75, 00-662 Warsaw, Poland
| | - Jan J. Żebrowski
- Faculty of Physics, Warsaw University of Technology, Koszykowa 75, 00-662 Warsaw, Poland
| |
Collapse
|
4
|
Masè M, Glass L, Disertori M, Ravelli F. Nodal recovery, dual pathway physiology, and concealed conduction determine complex AV dynamics in human atrial tachyarrhythmias. Am J Physiol Heart Circ Physiol 2012; 303:H1219-28. [DOI: 10.1152/ajpheart.00228.2012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The genesis of complex ventricular rhythms during atrial tachyarrhythmias in humans is not fully understood. To clarify the dynamics of atrioventricular (AV) conduction in response to a regular high-rate atrial activation, 29 episodes of spontaneous or pacing-induced atrial flutter (AFL), covering a wide range of atrial rates (cycle lengths from 145 to 270 ms), were analyzed in 10 patients. AV patterns were identified by applying firing sequence and surrogate data analysis to atrial and ventricular activation series, whereas modular simulation with a difference-equation AV node model was used to correlate the patterns with specific nodal properties. AV node response at high atrial rate was characterized by 1) AV patterns of decreasing conduction ratios at the shortening of atrial cycle length (from 236.3 ± 32.4 to 172.6 ± 17.8 ms) according to a Farey sequence ordering (conduction ratio from 0.34 ± 0.12 to 0.23 ± 0.06; P < 0.01); 2) the appearance of high-order alternating Wenckebach rhythms, such as 6:2, 10:2, and 12:2, associated with ventricular interval oscillations of large amplitude (407.7 ± 150.4 ms); and 3) the deterioration of pattern stability at advanced levels of block, with the percentage of stable patterns decreasing from 64.3 ± 35.2% to 28.3 ± 34.5% ( P < 0.01). Simulations suggested these patterns to originate from the combined effect of nodal recovery, dual pathway physiology, and concealed conduction. These results indicate that intrinsic nodal properties may account for the wide spectrum of AV block patterns occurring during regular atrial tachyarrhythmias. The characterization of AV nodal function during different AFL forms constitutes an intermediate step toward the understanding of complex ventricular rhythms during atrial fibrillation.
Collapse
Affiliation(s)
- Michela Masè
- Department of Physics and BioTech, University of Trento, Povo-Trento, Italy
| | - Leon Glass
- Department of Physiology, McGill University, Montreal, Québec, Canada; and
| | | | - Flavia Ravelli
- Department of Physics and BioTech, University of Trento, Povo-Trento, Italy
| |
Collapse
|
5
|
Lian J, Müssig D, Lang V. Computer modeling of ventricular rhythm during atrial fibrillation and ventricular pacing. IEEE Trans Biomed Eng 2006; 53:1512-20. [PMID: 16916085 DOI: 10.1109/tbme.2006.876627] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We propose a unified atrial fibrillation (AF)-ventricular pacing (VP) (AF-VP) model to demonstrate the effects of VP on the ventricular rhythm during atrial fibrillation AF. In this model, the AV junction (AVJ) is treated as a lumped structure characterized by refractoriness and automaticity. Bombarded by random AF impulses, the AVJ can also be invaded by the VP-induced retrograde wave. The model includes bidirectional conduction delays in the AVJ and ventricle. Both refractory period and conduction delay of the AVJ are dependent upon its recovery time. The electrotonic modulation by blocked impulses is also considered in the model. Our simulations show that, with proper parameter settings, the present model can account for most principal statistical properties of the RR intervals during AF. We further demonstrate that the AV conduction property and the ventricular rate in AF depend on both AF rate and the degree of electrotonic modulation in the AVJ. Finally, we show that multilevel interactions between AF and VP can generate various patterns of ventricular rhythm that are consistent with previous experimental observations.
Collapse
Affiliation(s)
- Jie Lian
- Micro Systems Engineering Inc, Lake Oswego, OR 97035, USA.
| | | | | |
Collapse
|
6
|
Christini DJ, Stein KM, Markowitz SM, Mittal S, Slotwiner DJ, Scheiner MA, Iwai S, Lerman BB. Nonlinear-dynamical arrhythmia control in humans. Proc Natl Acad Sci U S A 2001; 98:5827-32. [PMID: 11320216 PMCID: PMC33298 DOI: 10.1073/pnas.091553398] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2000] [Indexed: 01/17/2023] Open
Abstract
Nonlinear-dynamical control techniques, also known as chaos control, have been used with great success to control a wide range of physical systems. Such techniques have been used to control the behavior of in vitro excitable biological tissue, suggesting their potential for clinical utility. However, the feasibility of using such techniques to control physiological processes has not been demonstrated in humans. Here we show that nonlinear-dynamical control can modulate human cardiac electrophysiological dynamics by rapidly stabilizing an unstable target rhythm. Specifically, in 52/54 control attempts in five patients, we successfully terminated pacing-induced period-2 atrioventricular-nodal conduction alternans by stabilizing the underlying unstable steady-state conduction. This proof-of-concept demonstration shows that nonlinear-dynamical control techniques are clinically feasible and provides a foundation for developing such techniques for more complex forms of clinical arrhythmia.
Collapse
Affiliation(s)
- D J Christini
- Department of Medicine, Division of Cardiology, Cornell University Medical College, New York, NY 10021, USA.
| | | | | | | | | | | | | | | |
Collapse
|