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Monaco C, Cheniti G, Benali K, Duchateau J, Vlachos K, Sacher F, Ploux S, Vigmond E, Bernus O, Haïssaguerre M. Electrophysiological Characteristics Associated With Spontaneous Termination of Ventricular Fibrillation. JACC Clin Electrophysiol 2024:S2405-500X(24)00753-9. [PMID: 39387740 DOI: 10.1016/j.jacep.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 10/15/2024]
Affiliation(s)
- Cinzia Monaco
- Cardiology Hospital Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (Cardiac Electrophysiology and Modeling), University of Bordeaux, Bordeaux, France; Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis, Brussels, Belgium.
| | - Ghassen Cheniti
- Cardiology Hospital Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (Cardiac Electrophysiology and Modeling), University of Bordeaux, Bordeaux, France
| | - Karim Benali
- Cardiology Hospital Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (Cardiac Electrophysiology and Modeling), University of Bordeaux, Bordeaux, France; Cardiac Arrhythmia Department, Saint-Etienne University Hospital, Jean Monnet University, Saint-Etienne, France
| | - Josselin Duchateau
- Cardiology Hospital Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (Cardiac Electrophysiology and Modeling), University of Bordeaux, Bordeaux, France
| | - Konsantinos Vlachos
- Cardiology Hospital Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (Cardiac Electrophysiology and Modeling), University of Bordeaux, Bordeaux, France
| | - Frederic Sacher
- Cardiology Hospital Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (Cardiac Electrophysiology and Modeling), University of Bordeaux, Bordeaux, France
| | - Sylvain Ploux
- Cardiology Hospital Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (Cardiac Electrophysiology and Modeling), University of Bordeaux, Bordeaux, France
| | - Edward Vigmond
- Cardiology Hospital Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (Cardiac Electrophysiology and Modeling), University of Bordeaux, Bordeaux, France
| | - Olivier Bernus
- Cardiology Hospital Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (Cardiac Electrophysiology and Modeling), University of Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Cardiology Hospital Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (Cardiac Electrophysiology and Modeling), University of Bordeaux, Bordeaux, France
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2
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Bai J, Zhang C, Liang Y, Tavares A, Wang L. Impact of Combined Modulation of Two Potassium Ion Currents on Spiral Waves and Turbulent States in the Heart. ENTROPY (BASEL, SWITZERLAND) 2024; 26:446. [PMID: 38920457 PMCID: PMC11202854 DOI: 10.3390/e26060446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/27/2024]
Abstract
In the realm of cardiac research, the control of spiral waves and turbulent states has been a persistent focus for scholars. Among various avenues of investigation, the modulation of ion currents represents a crucial direction. It has been proved that the methods involving combined control of currents are superior to singular approaches. While previous studies have proposed some combination strategies, further reinforcement and supplementation are required, particularly in the context of controlling arrhythmias through the combined regulation of two potassium ion currents. This study employs the Luo-Rudy phase I cardiac model, modulating the maximum conductance of the time-dependent potassium current and the time-independent potassium current, to investigate the effects of this combined modulation on spiral waves and turbulent states. Numerical simulation results indicate that, compared to modulating a single current, combining reductions in the conductance of two potassium ion currents can rapidly control spiral waves and turbulent states in a short duration. This implies that employing blockers for both potassium ion currents concurrently represents a more efficient control strategy. The control outcomes of this study represent a novel and effective combination for antiarrhythmic interventions, offering potential avenues for new antiarrhythmic drug targets.
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Affiliation(s)
- Jing Bai
- School of Statistics and Data Science, Zhuhai College of Science and Technology, Zhuhai 519041, China; (J.B.); (C.Z.)
- Department of Industrial Electronics, University of Minho, 4800-058 Guimaraes, Portugal
| | - Chunfu Zhang
- School of Statistics and Data Science, Zhuhai College of Science and Technology, Zhuhai 519041, China; (J.B.); (C.Z.)
- Department of Industrial Electronics, University of Minho, 4800-058 Guimaraes, Portugal
| | - Yanchun Liang
- School of Computer Science, Zhuhai College of Science and Technology, Zhuhai 519041, China
| | - Adriano Tavares
- Department of Industrial Electronics, University of Minho, 4800-058 Guimaraes, Portugal
| | - Lidong Wang
- School of Statistics and Data Science, Zhuhai College of Science and Technology, Zhuhai 519041, China; (J.B.); (C.Z.)
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3
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Baines O, Sha R, Kalla M, Holmes AP, Efimov IR, Pavlovic D, O’Shea C. Optical mapping and optogenetics in cardiac electrophysiology research and therapy: a state-of-the-art review. Europace 2024; 26:euae017. [PMID: 38227822 PMCID: PMC10847904 DOI: 10.1093/europace/euae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/07/2023] [Accepted: 01/12/2024] [Indexed: 01/18/2024] Open
Abstract
State-of-the-art innovations in optical cardiac electrophysiology are significantly enhancing cardiac research. A potential leap into patient care is now on the horizon. Optical mapping, using fluorescent probes and high-speed cameras, offers detailed insights into cardiac activity and arrhythmias by analysing electrical signals, calcium dynamics, and metabolism. Optogenetics utilizes light-sensitive ion channels and pumps to realize contactless, cell-selective cardiac actuation for modelling arrhythmia, restoring sinus rhythm, and probing complex cell-cell interactions. The merging of optogenetics and optical mapping techniques for 'all-optical' electrophysiology marks a significant step forward. This combination allows for the contactless actuation and sensing of cardiac electrophysiology, offering unprecedented spatial-temporal resolution and control. Recent studies have performed all-optical imaging ex vivo and achieved reliable optogenetic pacing in vivo, narrowing the gap for clinical use. Progress in optical electrophysiology continues at pace. Advances in motion tracking methods are removing the necessity of motion uncoupling, a key limitation of optical mapping. Innovations in optoelectronics, including miniaturized, biocompatible illumination and circuitry, are enabling the creation of implantable cardiac pacemakers and defibrillators with optoelectrical closed-loop systems. Computational modelling and machine learning are emerging as pivotal tools in enhancing optical techniques, offering new avenues for analysing complex data and optimizing therapeutic strategies. However, key challenges remain including opsin delivery, real-time data processing, longevity, and chronic effects of optoelectronic devices. This review provides a comprehensive overview of recent advances in optical mapping and optogenetics and outlines the promising future of optics in reshaping cardiac electrophysiology and therapeutic strategies.
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Affiliation(s)
- Olivia Baines
- Institute of Cardiovascular Sciences, College of Medical and Dental Science, University of Birmingham, Edgbastion, Wolfson Drive, Birmingham B15 2TT, UK
| | - Rina Sha
- Institute of Cardiovascular Sciences, College of Medical and Dental Science, University of Birmingham, Edgbastion, Wolfson Drive, Birmingham B15 2TT, UK
| | - Manish Kalla
- Institute of Cardiovascular Sciences, College of Medical and Dental Science, University of Birmingham, Edgbastion, Wolfson Drive, Birmingham B15 2TT, UK
| | - Andrew P Holmes
- Institute of Cardiovascular Sciences, College of Medical and Dental Science, University of Birmingham, Edgbastion, Wolfson Drive, Birmingham B15 2TT, UK
| | - Igor R Efimov
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
- Department of Medicine, Division of Cardiology, Northwestern University, Evanston, IL, USA
| | - Davor Pavlovic
- Institute of Cardiovascular Sciences, College of Medical and Dental Science, University of Birmingham, Edgbastion, Wolfson Drive, Birmingham B15 2TT, UK
| | - Christopher O’Shea
- Institute of Cardiovascular Sciences, College of Medical and Dental Science, University of Birmingham, Edgbastion, Wolfson Drive, Birmingham B15 2TT, UK
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4
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Wells SP, Raaijmakers AJ, Curl CL, O’Shea C, Hayes S, Mellor KM, Kalman JM, Kirchhof P, Pavlovic D, Delbridge LM, Bell JR. Localized cardiomyocyte lipid accumulation is associated with slowed epicardial conduction in rats. J Gen Physiol 2023; 155:e202213296. [PMID: 37787979 PMCID: PMC10547601 DOI: 10.1085/jgp.202213296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 05/20/2023] [Accepted: 08/29/2023] [Indexed: 10/04/2023] Open
Abstract
Transmural action potential duration differences and transmural conduction gradients aid the synchronization of left ventricular repolarization, reducing vulnerability to transmural reentry and arrhythmias. A high-fat diet and the associated accumulation of pericardial adipose tissue are linked with conduction slowing and greater arrhythmia vulnerability. It is predicted that cardiac adiposity may more readily influence epicardial conduction (versus endocardial) and disrupt normal transmural activation/repolarization gradients. The aim of this investigation was to determine whether transmural conduction gradients are modified in a rat model of pericardial adiposity. Adult Sprague-Dawley rats were fed control/high-fat diets for 15 wk. Left ventricular 300 µm tangential slices were generated from the endocardium to the epicardium, and conduction was mapped using microelectrode arrays. Slices were then histologically processed to assess fibrosis and cardiomyocyte lipid status. Conduction velocity was significantly greater in epicardial versus endocardial slices in control rats, supporting the concept of a transmural conduction gradient. High-fat diet feeding increased pericardial adiposity and abolished the transmural conduction gradient. Slowed epicardial conduction in epicardial slices strongly correlated with an increase in cardiomyocyte lipid content, but not fibrosis. The positive transmural conduction gradient reported here represents a physiological property of the ventricular activation sequence that likely protects against reentry. The absence of this gradient, secondary to conduction slowing and cardiomyocyte lipid accumulation, specifically in the epicardium, indicates a novel mechanism by which pericardial adiposity may exacerbate ventricular arrhythmias.
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Affiliation(s)
- Simon P. Wells
- Department of Anatomy and Physiology, University of Melbourne, Parkville, Australia
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | - Claire L. Curl
- Department of Anatomy and Physiology, University of Melbourne, Parkville, Australia
| | - Christopher O’Shea
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Sarah Hayes
- Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University, Bundoora, Australia
| | - Kimberley M. Mellor
- Department of Anatomy and Physiology, University of Melbourne, Parkville, Australia
- Department of Physiology, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Jonathan M. Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Sciences (DZHK), Partner Site Hamburg-Kiel-Lübeck, Hamburg, Germany
| | - Davor Pavlovic
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Lea M.D. Delbridge
- Department of Anatomy and Physiology, University of Melbourne, Parkville, Australia
| | - James R. Bell
- Department of Anatomy and Physiology, University of Melbourne, Parkville, Australia
- Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University, Bundoora, Australia
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Padilla JR, Anderson RD, Joens C, Masse S, Bhaskaran A, Niri A, Lai P, Azam MA, Lee G, Vigmond E, Nanthakumar K. Orientation of conduction velocity vectors on cardiac mapping surfaces. Europace 2023; 25:1172-1182. [PMID: 36609707 PMCID: PMC10062359 DOI: 10.1093/europace/euac259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/06/2022] [Indexed: 01/09/2023] Open
Abstract
AIMS Electroanatomical maps using automated conduction velocity (CV) algorithms are now being calculated using two-dimensional (2D) mapping tools. We studied the accuracy of mapping surface 2D CV, compared to the three-dimensional (3D) vectors, and the influence of mapping resolution in non-scarred animal and human heart models. METHODS AND RESULTS Two models were used: a healthy porcine Langendorff model with transmural needle electrodes and a computer stimulation model of the ventricles built from an MRI-segmented, excised human heart. Local activation times (LATs) within the 3D volume of the mesh were used to calculate true 3D CVs (direction and velocity) for different pixel resolutions ranging between 500 μm and 4 mm (3D CVs). CV was also calculated for endocardial surface-only LATs (2D CV). In the experimental model, surface (2D) CV was faster on the epicardium (0.509 m/s) compared to the endocardium (0.262 m/s). In stimulation models, 2D CV significantly exceeded 3D CVs across all mapping resolutions and increased as resolution decreased. Three-dimensional and 2D left ventricle CV at 500 μm resolution increased from 429.2 ± 189.3 to 527.7 ± 253.8 mm/s (P < 0.01), respectively, with modest correlation (R = 0.64). Decreasing the resolution to 4 mm significantly increased 2D CV and weakened the correlation (R = 0.46). The majority of CV vectors were not parallel (<30°) to the mapping surface providing a potential mechanistic explanation for erroneous LAT-based CV over-estimation. CONCLUSION Ventricular CV is overestimated when using 2D LAT-based CV calculation of the mapping surface and significantly compounded by mapping resolution. Three-dimensional electric field-based approaches are needed in mapping true CV on mapping surfaces.
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Affiliation(s)
| | - Robert D Anderson
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526, Toronto, Ontario M5G 2C4, Canada
| | - Christian Joens
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526, Toronto, Ontario M5G 2C4, Canada
| | - Stephane Masse
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526, Toronto, Ontario M5G 2C4, Canada
| | - Abhishek Bhaskaran
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526, Toronto, Ontario M5G 2C4, Canada
| | - Ahmed Niri
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526, Toronto, Ontario M5G 2C4, Canada
| | - Patrick Lai
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526, Toronto, Ontario M5G 2C4, Canada
| | - Mohammed Ali Azam
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526, Toronto, Ontario M5G 2C4, Canada
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | | | - Kumaraswamy Nanthakumar
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526, Toronto, Ontario M5G 2C4, Canada
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6
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Ezzeddine FM, Ward RC, Asirvatham SJ, DeSimone CV. Mapping and ablation of ventricular fibrillation substrate. J Interv Card Electrophysiol 2023:10.1007/s10840-022-01454-z. [PMID: 36598715 DOI: 10.1007/s10840-022-01454-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/09/2022] [Indexed: 01/05/2023]
Abstract
Ventricular fibrillation (VF) is a life-threatening arrhythmia and a common cause of sudden cardiac death (SCD). A basic understanding of its mechanistic underpinning is crucial for enhancing our knowledge to develop innovative mapping and ablation techniques for this lethal rhythm. Significant advances in our understanding of VF have been made especially in the basic science and pre-clinical experimental realms. However, these studies have not yet translated into a robust clinical approach to identify and successfully ablate both the structural and functional substrate of VF. In this review, we aim to (1) provide a conceptual framework of VF and an overview of the data supporting the spatiotemporal dynamics of VF, (2) review experimental approaches to mapping VF to elucidate drivers and substrate for maintenance with a focus on the His-Purkinje system, (3) discuss current approaches using catheter ablation to treat VF, and (4) highlight current unknowns and gaps in the field where future work is necessary to transform the clinical landscape.
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Affiliation(s)
- Fatima M Ezzeddine
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Robert Charles Ward
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Christopher V DeSimone
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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7
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Ezzeddine FM, Darlington AM, DeSimone CV, Asirvatham SJ. Catheter Ablation of Ventricular Fibrillation. Card Electrophysiol Clin 2022; 14:729-742. [PMID: 36396189 DOI: 10.1016/j.ccep.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Ventricular fibrillation (VF) is a common cause of sudden cardiac death (SCD) and is unfortunately without a cure. Current therapies focus on prevention of SCD, such as implantable cardioverter-defibrillator (ICD) implantation and anti-arrhythmic agents. Significant progress has been made in improving our understanding and ability to target the triggers of VF, via advanced mapping and ablation techniques, as well as with autonomic modulation. However, the critical substrate for VF maintenance remains incompletely defined. In this review, we discuss the evidence behind the basic mechanisms of VF and review the current role of catheter ablation in patients with VF.
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Affiliation(s)
- Fatima M Ezzeddine
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN, USA
| | - Ashley M Darlington
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN, USA
| | - Christopher V DeSimone
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN, USA.
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8
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Calvo D, Salinas L, Martínez-Camblor P, García-Iglesias D, Alzueta J, Rodríguez A, Romero R, Viñolas X, Fernández-Lozano I, Anguera I, Villacastín J, Bodegas A, Fontenla A, Jalife J, Berenfeld O. Distinct spectral dynamics of implanted cardiac defibrillator signals in spontaneous termination of polymorphic ventricular tachycardia and fibrillation in patients with electrical and structural diseases. Europace 2022; 24:1788-1799. [PMID: 35851611 PMCID: PMC10112842 DOI: 10.1093/europace/euac107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/09/2022] [Indexed: 01/16/2023] Open
Abstract
AIMS To determine the spectral dynamics of early spontaneous polymorphic ventricular tachycardia and ventricular fibrillation (PVT/VF) in humans. METHODS AND RESULTS Fifty-eight self-terminated and 173 shock-terminated episodes of spontaneously initiated PVT/VF recorded by Medtronic implanted cardiac defibrillators (ICDs) in 87 patients with various cardiac pathologies were analyzed by short fast Fourier transform of shifting segments to determine the dynamics of dominant frequency (DF) and regularity index (RI). The progression in the intensity of DF and RI accumulations further quantified the time course of spectral characteristics of the episodes. Episodes of self-terminated PVT/VF lasted 8.6 s [95% confidence interval (CI): 8.1-9.1] and shock-terminated lasted 13.9 s (13.6-14.3) (P < 0.001). Recordings from patients with primarily electrical pathologies displayed higher DF and RI values than those from patients with primarily structural pathologies (P < 0.05) independently of ventricular function or antiarrhythmic drug therapy. Regardless of the underlying pathology, the average DF and RI intensities were lower in self-terminated than shock-terminated episodes [DF: 3.67 (4.04-4.58) vs. 4.32 (3.46-3.93) Hz, P < 0.001; RI: 0.53 (0.48-0.56) vs. 0.63 (0.60-0.65), P < 0.001]. In a multivariate analysis controlled by the type of pathology and clinical variables, regularity remained an independent predictor of self-termination [hazard ratio: 0.954 (0.928-0.980)]. Receiver operating characteristic (ROC) curve analysis of DF and RI intensities demonstrated increased predictability for self-termination in time with 95% CI above the 0.5 cut-off limit at about t = 8.6 s and t = 6.95 s, respectively. CONCLUSION Consistent with the notion that fast organized sources maintain PVT/VF in humans, reduction of frequency and regularity correlates with early self-termination. Our findings might help generate ICD methods aiming to reduce inappropriate shock deliveries.
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Affiliation(s)
- David Calvo
- Arrhythmia Unit, Hospital Universitario Central de Asturias, Avd. Roma, s/n; 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Lucia Salinas
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, USA
| | | | - Daniel García-Iglesias
- Arrhythmia Unit, Hospital Universitario Central de Asturias, Avd. Roma, s/n; 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Javier Alzueta
- Arrhythmia Unit, Hospital Virgen de la Victoria, Málaga, Spain
| | - Anibal Rodríguez
- Arrhythmia Unit, Hospital Universitario de Canarias, Canarias, Spain
| | - Rafael Romero
- Arrhythmia Unit, Hospital Universitario Ntra Señora de la Candelaria, Canarias, Spain
| | | | | | | | | | | | | | - José Jalife
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, USA.,Cardiac Arrhythmia Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Omer Berenfeld
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, USA
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9
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Anderson RD, Rodriguez Padilla J, Joens C, Masse S, Bhaskaran A, Magtibay K, Niri A, Asta J, Lai P, Azam MA, Vigmond E, Nanthakumar K. On the Electrophysiology and Mapping of Intramural Arrhythmic Focus. Circ Arrhythm Electrophysiol 2022; 15:e010384. [PMID: 35323037 DOI: 10.1161/circep.121.010384] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Conventional mapping of focal ventricular arrhythmias relies on unipolar electrogram characteristics and early local activation times. Deep intramural foci are common and associated with high recurrence rates following catheter-based radiofrequency ablation. We assessed the accuracy of unipolar morphological patterns and mapping surface indices to predict the site and depth of ventricular arrhythmogenic focal sources. METHODS An experimental beating-heart model used Langendorff-perfused, healthy swine hearts. A custom 56-pole electrode array catheter was positioned on the left ventricle. A plunge needle was placed perpendicular in the center of the grid to simulate arrhythmic foci at variable depths. Unipolar electrograms and local activation times were generated. Simulation models from 2 human hearts were also included with grids positioned simultaneously on the endocardium-epicardium from multiple left ventricular, septal, and outflow tract sites. RESULTS A unipolar Q or QS complex lacks specificity for superficial arrhythmic foci, as this morphology pattern occupies a large surface area and is the predominant pattern as intramural depth increases without developing a R component. There is progressive displacement from the arrhythmic focus to the surface exit as intramural focus depth increases. A shorter total activation time over the overlying electrode array, larger surface area within initial 20 ms activation, and a dual surface breakout pattern all indicate a deep focus. CONCLUSIONS Displacement from the focal intramural origin to the exit site on the mapping surface could lead to erroneous lesion delivery strategies. Traditional unipolar electrogram features lack specificity to predict the intramural arrhythmic source; however, novel endocardial-epicardial mapping surface indices can be used to determine the depth of arrhythmic foci.
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Affiliation(s)
- Robert D Anderson
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | | | - Christian Joens
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Stephane Masse
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Abhishek Bhaskaran
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Karl Magtibay
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Ahmed Niri
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - John Asta
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Patrick Lai
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Mohammed Ali Azam
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Edward Vigmond
- IHU Liryc, Hôpital Xavier Arnozan, Pessac Cedex, France (J.R.P., E.V.)
| | - Kumaraswamy Nanthakumar
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
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10
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Downar E, Janse MJ, Bhaskaran A, Niri A, Velluppillai A, Massé S, Nanthakumar K. High density intramural mapping of post-infarct premature ventricular contractions and ventricular tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1781-1785. [PMID: 34314041 DOI: 10.1111/pace.14326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/07/2021] [Accepted: 07/25/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Spontaneous ventricular premature contractions (PVCs) and ventricular tachycardia (VT) in the acute post infarct milieu is assumed to be due to automaticity. However, the mechanism has not been studied with intramural mapping. OBJECTIVE To study the mechanism of spontaneous PVCs with high density intramural mapping in a canine model, and to test the hypothesis that post-infarct PVCs and VT are due to re-entry rather than automaticity. METHODS In 15 anesthetized dogs, using 768 intramural unipolar electrograms, simultaneous recordings were made. After 20 min of stabilization, recordings were made during the first 10 min of ischemia, and activation maps of individual beats were constructed. Acute ischemia was produced by clamping the left anterior descending coronary artery proximal to the first diagonal branch. RESULTS In all experiments ST-T alternans was present. Spontaneous ventricular beats occurred in five of 15 dogs where the earliest ectopic activity was manifested in the endocardium, well within the ischemic zone. From there, activity spread rapidly along the subendocardium, with endo-to epicardial spread along the non-ischemic myocardium. Epicardial breakthrough always occurred at the border of the ischemic myocardium. In three dogs, delayed potentials were observed, which were earliest at the ischemic epicardium and extended transmurally with increasing delay towards the endocardium, where they culminated in a premature beat. A similar sequence was observed in VT that followed. CONCLUSION Graded responses that occur with each sinus beat intramurally, when able to propagate from epicardium to endocardium are the mechanism of PVCs and VT in post-infarct myocardium.
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Affiliation(s)
- Eugene Downar
- Division of Cardiology. Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Michiel J Janse
- Experimental and Molecular Cardiology Group, Academic Medical Center, Amsterdam, Netherlands
| | - Abhishek Bhaskaran
- Division of Cardiology. Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ahmed Niri
- Division of Cardiology. Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Arulalan Velluppillai
- Division of Cardiology. Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Stéphane Massé
- Division of Cardiology. Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- Division of Cardiology. Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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11
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Handa BS, Li X, Baxan N, Roney CH, Shchendrygina A, Mansfield CA, Jabbour RJ, Pitcher DS, Chowdhury RA, Peters NS, Ng FS. Ventricular fibrillation mechanism and global fibrillatory organization are determined by gap junction coupling and fibrosis pattern. Cardiovasc Res 2021; 117:1078-1090. [PMID: 32402067 PMCID: PMC7983010 DOI: 10.1093/cvr/cvaa141] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/25/2020] [Accepted: 05/21/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Conflicting data exist supporting differing mechanisms for sustaining ventricular fibrillation (VF), ranging from disorganized multiple-wavelet activation to organized rotational activities (RAs). Abnormal gap junction (GJ) coupling and fibrosis are important in initiation and maintenance of VF. We investigated whether differing ventricular fibrosis patterns and the degree of GJ coupling affected the underlying VF mechanism. METHODS AND RESULTS Optical mapping of 65 Langendorff-perfused rat hearts was performed to study VF mechanisms in control hearts with acute GJ modulation, and separately in three differing chronic ventricular fibrosis models; compact fibrosis (CF), diffuse fibrosis (DiF), and patchy fibrosis (PF). VF dynamics were quantified with phase mapping and frequency dominance index (FDI) analysis, a power ratio of the highest amplitude dominant frequency in the cardiac frequency spectrum. Enhanced GJ coupling with rotigaptide (n = 10) progressively organized fibrillation in a concentration-dependent manner; increasing FDI (0 nM: 0.53 ± 0.04, 80 nM: 0.78 ± 0.03, P < 0.001), increasing RA-sustained VF time (0 nM: 44 ± 6%, 80 nM: 94 ± 2%, P < 0.001), and stabilized RAs (maximum rotations for an RA; 0 nM: 5.4 ± 0.5, 80 nM: 48.2 ± 12.3, P < 0.001). GJ uncoupling with carbenoxolone progressively disorganized VF; the FDI decreased (0 µM: 0.60 ± 0.05, 50 µM: 0.17 ± 0.03, P < 0.001) and RA-sustained VF time decreased (0 µM: 61 ± 9%, 50 µM: 3 ± 2%, P < 0.001). In CF, VF activity was disorganized and the RA-sustained VF time was the lowest (CF: 27 ± 7% vs. PF: 75 ± 5%, P < 0.001). Global fibrillatory organization measured by FDI was highest in PF (PF: 0.67 ± 0.05 vs. CF: 0.33 ± 0.03, P < 0.001). PF harboured the longest duration and most spatially stable RAs (patchy: 1411 ± 266 ms vs. compact: 354 ± 38 ms, P < 0.001). DiF (n = 11) exhibited an intermediately organized VF pattern, sustained by a combination of multiple-wavelets and short-lived RAs. CONCLUSION The degree of GJ coupling and pattern of fibrosis influences the mechanism sustaining VF. There is a continuous spectrum of organization in VF, ranging between globally organized fibrillation sustained by stable RAs and disorganized, possibly multiple-wavelet driven fibrillation with no RAs.
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Affiliation(s)
- Balvinder S Handa
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Xinyang Li
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Nicoleta Baxan
- Biological Imaging Centre, Department of Medicine, Imperial College London, London, UK
| | - Caroline H Roney
- Division of Imaging Sciences and Bioengineering, King’s College London, London, UK
| | - Anastasia Shchendrygina
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Catherine A Mansfield
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Richard J Jabbour
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - David S Pitcher
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Rasheda A Chowdhury
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Nicholas S Peters
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Fu Siong Ng
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
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12
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Krummen DE, Ho G, Hoffmayer KS, Schweis FN, Baykaner T, Rogers AJ, Han FT, Hsu JC, Viswanathan MN, Wang PJ, Rappel WJ, Narayan SM. Electrical Substrate Ablation for Refractory Ventricular Fibrillation: Results of the AVATAR Study. Circ Arrhythm Electrophysiol 2021; 14:e008868. [PMID: 33550811 DOI: 10.1161/circep.120.008868] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- David E Krummen
- University of California, San Diego (D.E.K., G.H., K.S.H., F.N.S., F.T.H., J.C.H., W.-J.R.).,Veterans Affairs San Diego Healthcare System, CA (D.E.K., G.H., K.S.H., F.T.H.)
| | - Gordon Ho
- University of California, San Diego (D.E.K., G.H., K.S.H., F.N.S., F.T.H., J.C.H., W.-J.R.).,Veterans Affairs San Diego Healthcare System, CA (D.E.K., G.H., K.S.H., F.T.H.)
| | - Kurt S Hoffmayer
- University of California, San Diego (D.E.K., G.H., K.S.H., F.N.S., F.T.H., J.C.H., W.-J.R.).,Veterans Affairs San Diego Healthcare System, CA (D.E.K., G.H., K.S.H., F.T.H.)
| | - Franz N Schweis
- University of California, San Diego (D.E.K., G.H., K.S.H., F.N.S., F.T.H., J.C.H., W.-J.R.)
| | - Tina Baykaner
- Stanford University, Palo Alto, CA (T.B., A.J.R., M.N.V., P.J.W., S.M.N.)
| | - A J Rogers
- Stanford University, Palo Alto, CA (T.B., A.J.R., M.N.V., P.J.W., S.M.N.)
| | - Frederick T Han
- University of California, San Diego (D.E.K., G.H., K.S.H., F.N.S., F.T.H., J.C.H., W.-J.R.).,Veterans Affairs San Diego Healthcare System, CA (D.E.K., G.H., K.S.H., F.T.H.)
| | - Jonathan C Hsu
- University of California, San Diego (D.E.K., G.H., K.S.H., F.N.S., F.T.H., J.C.H., W.-J.R.)
| | | | - Paul J Wang
- Stanford University, Palo Alto, CA (T.B., A.J.R., M.N.V., P.J.W., S.M.N.)
| | - Wouter-Jan Rappel
- University of California, San Diego (D.E.K., G.H., K.S.H., F.N.S., F.T.H., J.C.H., W.-J.R.)
| | - Sanjiv M Narayan
- Stanford University, Palo Alto, CA (T.B., A.J.R., M.N.V., P.J.W., S.M.N.)
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13
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Landaw J, Yuan X, Chen PS, Qu Z. The transient outward potassium current plays a key role in spiral wave breakup in ventricular tissue. Am J Physiol Heart Circ Physiol 2021; 320:H826-H837. [PMID: 33385322 PMCID: PMC8082802 DOI: 10.1152/ajpheart.00608.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 11/22/2022]
Abstract
Spiral wave reentry as a mechanism of lethal ventricular arrhythmias has been widely demonstrated in animal experiments and recordings from human hearts. It has been shown that in structurally normal hearts spiral waves are unstable, breaking up into multiple wavelets via dynamical instabilities. However, many of the second-generation action potential models give rise only to stable spiral waves, raising issues regarding the underlying mechanisms of spiral wave breakup. In this study, we carried out computer simulations of two-dimensional homogeneous tissues using five ventricular action potential models. We show that the transient outward potassium current (Ito), although it is not required, plays a key role in promoting spiral wave breakup in all five models. As the maximum conductance of Ito increases, it first promotes spiral wave breakup and then stabilizes the spiral waves. In the absence of Ito, speeding up the L-type calcium kinetics can prevent spiral wave breakup, however, with the same speedup kinetics, spiral wave breakup can be promoted by increasing Ito. Increasing Ito promotes single-cell dynamical instabilities, including action potential duration alternans and chaos, and increasing Ito further suppresses these action potential dynamics. These cellular properties agree with the observation that increasing Ito first promotes spiral wave breakup and then stabilizes spiral waves in tissue. Implications of our observations to spiral wave dynamics in the real hearts and action potential model improvements are discussed.NEW & NOTEWORTHY Spiral wave breakup manifesting as multiple wavelets is a mechanism of ventricular fibrillation. It has been known that spiral wave breakup in cardiac tissue can be caused by a steeply sloped action potential duration restitution curve, a property mainly determined by the recovery of L-type calcium current. Here, we show that the transient outward potassium current (Ito) is another current that plays a key role in spiral wave breakup, that is, spiral waves can be stable for low and high maximum Ito conductance but breakup occurs for intermediate maximum Ito conductance. Since Ito is present in normal hearts of many species and required for Brugada syndrome, it may play an important role in the spiral wave stability and arrhythmogenesis under both normal condition and Brugada syndrome.
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Affiliation(s)
- Julian Landaw
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
- Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Xiaoping Yuan
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
- Information Engineering School, Hangzhou Dianzi University, Hangzhou, People's Republic of China
| | | | - Zhilin Qu
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
- Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
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14
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Campbell T, Bennett RG, Kotake Y, Kumar S. Updates in Ventricular Tachycardia Ablation. Korean Circ J 2021; 51:15-42. [PMID: 33377327 PMCID: PMC7779814 DOI: 10.4070/kcj.2020.0436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023] Open
Abstract
Sudden cardiac death (SCD) due to recurrent ventricular tachycardia is an important clinical sequela in patients with structural heart disease. As a result, ventricular tachycardia (VT) has emerged as a major clinical and public health problem. The mechanism of VT is predominantly mediated by re-entry in the presence of arrhythmogenic substrate (scar), though focal mechanisms are also important. Catheter ablation for VT, when compared to standard medical therapy, has been shown to improve VT-free survival and burden of device therapies. Approaches to VT ablation are dependent on the underlying disease process, broadly classified into idiopathic (no structural heart disease) or structural heart disease (ischemic or non-ischemic heart disease). This update aims to review recent advances made for the treatment of VT ablation, with respect to current clinical trials, peri-procedure risk assessments, pre-procedural cardiac imaging, electro-anatomic mapping and advances in catheter and non-catheter based ablation techniques.
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Affiliation(s)
- Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Yasuhito Kotake
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, New South Wales, Australia.
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15
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Haïssaguerre M, Duchateau J, Dubois R, Hocini M, Cheniti G, Sacher F, Lavergne T, Probst V, Surget E, Vigmond E, Welte N, Chauvel R, Derval N, Pambrun T, Jais P, Nademanee W, Bernus O. Idiopathic Ventricular Fibrillation: Role of Purkinje System and Microstructural Myocardial Abnormalities. JACC Clin Electrophysiol 2020; 6:591-608. [PMID: 32553208 PMCID: PMC7308805 DOI: 10.1016/j.jacep.2020.03.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 12/18/2022]
Abstract
Idiopathic ventricular fibrillation is diagnosed in patients who survived a ventricular fibrillation episode without any identifiable structural or electrical cause after extensive investigations. It is a common cause of sudden death in young adults. The study reviews the diagnostic value of systematic investigations and the new insights provided by detailed electrophysiological mapping. Recent studies have shown the high incidence of microstructural cardiomyopathic areas, which act as the substrate of ventricular fibrillation re-entries. These subclinical alterations require high-density endo- and epicardial mapping to be identified using electrogram criteria. Small areas are involved and located individually in various sites (mostly epicardial). Their characteristics suggest a variety of genetic or acquired pathological processes affecting cellular connectivity or tissue structure, such as cardiomyopathies, myocarditis, or fatty infiltration. Purkinje abnormalities manifesting as triggering ectopy or providing a substrate for re-entry represent a second important cause. The documentation of ephemeral Purkinje ectopy requires continuous electrocardiography monitoring for diagnosis. A variety of diseases affecting Purkinje cell function or conduction are potentially at play in their pathogenesis. Comprehensive investigations can therefore allow the great majority of idiopathic ventricular fibrillation to ultimately receive diagnoses of a cardiac disease, likely underlain by a mosaic of pathologies. Precise phenotypic characterization has significant implications for interpretation of genetic variants, the risk assessment, and individual therapy. Future improvements in imaging or electrophysiological methods may hopefully allow the identification of the subjects at risk and the development of primary prevention strategies.
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Affiliation(s)
- Michel Haïssaguerre
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France.
| | - Josselin Duchateau
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Remi Dubois
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Frederic Sacher
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Thomas Lavergne
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | | | - Elodie Surget
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Ed Vigmond
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Nicolas Welte
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Remi Chauvel
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Pierre Jais
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Wee Nademanee
- Cardiology Department, Bumrungrad International Hospital, Bangkok, Thailand
| | - Olivier Bernus
- Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
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16
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Haïssaguerre M, Nademanee W, Hocini M, Duchateau J, André C, Lavergne T, Takigawa M, Sacher F, Derval N, Pambrun T, Jais P, Walton R, Potse M, Vigmond E, Dubois R, Bernus O. The Spectrum of Idiopathic Ventricular Fibrillation and J-Wave Syndromes: Novel Mapping Insights. Card Electrophysiol Clin 2019; 11:699-709. [PMID: 31706476 DOI: 10.1016/j.ccep.2019.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Idiopathic ventricular fibrillation and J-wave syndromes are causes of sudden cardiac death (SCD) without any identified structural cardiac disease after extensive investigations. Recent data show that high-density electrophysiological mapping may ultimately offer diagnoses of subclinical diseases in most patients including those termed "unexplained" SCD. Three major conditions can underlie the occurrence of SCD: (1) localized depolarization abnormalities (due to microstructural myocardial alteration), (2) Purkinje abnormalities manifesting as triggering ectopy and inducible reentry; or (3) repolarization heterogeneities. Each condition may result from a spectrum of pathophysiologic processes with implications for individual therapy.
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Affiliation(s)
- Michel Haïssaguerre
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France; Univ Bordeaux, CRCTB, U1045, Bordeaux, France.
| | | | - Mélèze Hocini
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France; Univ Bordeaux, CRCTB, U1045, Bordeaux, France
| | - Josselin Duchateau
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Clementine André
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Thomas Lavergne
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Masa Takigawa
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France
| | - Frederic Sacher
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Nicolas Derval
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Thomas Pambrun
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Pierre Jais
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Rick Walton
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Mark Potse
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Ed Vigmond
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Remi Dubois
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Olivier Bernus
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France; Univ Bordeaux, CRCTB, U1045, Bordeaux, France
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17
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High arrhythmic risk in antero-septal acute myocardial ischemia is explained by increased transmural reentry occurrence. Sci Rep 2019; 9:16803. [PMID: 31728039 PMCID: PMC6856379 DOI: 10.1038/s41598-019-53221-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/24/2019] [Indexed: 12/16/2022] Open
Abstract
Acute myocardial ischemia is a precursor of sudden arrhythmic death. Variability in its manifestation hampers understanding of arrhythmia mechanisms and challenges risk stratification. Our aim is to unravel the mechanisms underlying how size, transmural extent and location of ischemia determine arrhythmia vulnerability and ECG alterations. High performance computing simulations using a human torso/biventricular biophysically-detailed model were conducted to quantify the impact of varying ischemic region properties, including location (LAD/LCX occlusion), transmural/subendocardial ischemia, size, and normal/slow myocardial propagation. ECG biomarkers and vulnerability window for reentry were computed in over 400 simulations for 18 cases evaluated. Two distinct mechanisms explained larger vulnerability to reentry in transmural versus subendocardial ischemia. Macro-reentry around the ischemic region was the primary mechanism increasing arrhythmic risk in transmural versus subendocardial ischemia, for both LAD and LCX occlusion. Transmural micro-reentry at the ischemic border zone explained arrhythmic vulnerability in subendocardial ischemia, especially in LAD occlusion, as reentries were favoured by the ischemic region intersecting the septo-apical region. ST elevation reflected ischemic extent in transmural ischemia for LCX and LAD occlusion but not in subendocardial ischemia (associated with mild ST depression). The technology and results presented can inform safety and efficacy evaluation of anti-arrhythmic therapy in acute myocardial ischemia.
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Haïssaguerre M, Hocini M, Cheniti G, Duchateau J, Sacher F, Puyo S, Cochet H, Takigawa M, Denis A, Martin R, Derval N, Bordachar P, Ritter P, Ploux S, Pambrun T, Klotz N, Massoullié G, Pillois X, Dallet C, Schott JJ, Scouarnec S, Ackerman MJ, Tester D, Piot O, Pasquié JL, Leclerc C, Hermida JS, Gandjbakhch E, Maury P, Labrousse L, Coronel R, Jais P, Benoist D, Vigmond E, Potse M, Walton R, Nademanee K, Bernus O, Dubois R. Localized Structural Alterations Underlying a Subset of Unexplained Sudden Cardiac Death. Circ Arrhythm Electrophysiol 2019; 11:e006120. [PMID: 30002064 PMCID: PMC7661047 DOI: 10.1161/circep.117.006120] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 05/08/2018] [Indexed: 01/17/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Sudden cardiac death because of ventricular fibrillation (VF) is commonly unexplained in younger victims. Detailed electrophysiological mapping in such patients has not been reported. Methods: We evaluated 24 patients (29±13 years) who survived idiopathic VF. First, we used multielectrode body surface recordings to identify the drivers maintaining VF. Then, we analyzed electrograms in the driver regions using endocardial and epicardial catheter mapping during sinus rhythm. Established electrogram criteria were used to identify the presence of structural alterations. Results: VF occurred spontaneously in 3 patients and was induced in 16, whereas VF was noninducible in 5. VF mapping demonstrated reentrant and focal activities (87% versus 13%, respectively) in all. The activities were dominant in one ventricle in 9 patients, whereas they had biventricular distribution in others. During sinus rhythm areas of abnormal electrograms were identified in 15/24 patients (62.5%) revealing localized structural alterations: in the right ventricle in 11, the left ventricle in 1, and both in 3. They covered a limited surface (13±6 cm2) representing 5±3% of the total surface and were recorded predominantly on the epicardium. Seventy-six percent of these areas were colocated with VF drivers (P<0.001). In the 9 patients without structural alteration, we observed a high incidence of Purkinje triggers (7/9 versus 4/15, P=0.033). Catheter ablation resulted in arrhythmia-free outcome in 15/18 patients at 17±11 months follow-up. Conclusions: This study shows that localized structural alterations underlie a significant subset of previously unexplained sudden cardiac death. In the other subset, Purkinje electrical pathology seems as a dominant mechanism.
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Affiliation(s)
- Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.). .,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Mélèze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Ghassen Cheniti
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Frédéric Sacher
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Stéphane Puyo
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Masateru Takigawa
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Arnaud Denis
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Ruairidh Martin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.)
| | - Nicolas Derval
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Pierre Bordachar
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Philippe Ritter
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Sylvain Ploux
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Thomas Pambrun
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Nicolas Klotz
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Gregoire Massoullié
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Xavier Pillois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Corentin Dallet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.)
| | - Jean-Jacques Schott
- Inserm UMR 915 l'institut du thorax IRT, Nantes Cedex, France (J.-J.S., S.L.S.)
| | | | - Michael J Ackerman
- Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (M.J.A., D.T.)
| | - David Tester
- Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (M.J.A., D.T.)
| | | | | | | | | | | | | | - Louis Labrousse
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Ruben Coronel
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.)
| | - Pierre Jais
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - David Benoist
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.)
| | - Edward Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux, IMB UMR 5251, CNRS (E.V.).,CNRS, IMB, UMR5251, Talence (E.V.)
| | - Mark Potse
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.)
| | - Richard Walton
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.)
| | - Koonlawee Nademanee
- Pacific Rim Electrophysiology Research Institute, White Memorial Medical Center, Los Angeles, CA (K.N.)
| | - Olivier Bernus
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.)
| | - Remi Dubois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.)
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19
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Cheniti G, Puyo S, Martin CA, Frontera A, Vlachos K, Takigawa M, Bourier F, Kitamura T, Lam A, Dumas-Pommier C, Pillois X, Pambrun T, Duchateau J, Klotz N, Denis A, Derval N, Cochet H, Sacher F, Dubois R, Jais P, Hocini M, Haissaguerre M. Noninvasive Mapping and Electrocardiographic Imaging in Atrial and Ventricular Arrhythmias (CardioInsight). Card Electrophysiol Clin 2019; 11:459-471. [PMID: 31400870 DOI: 10.1016/j.ccep.2019.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Electrocardiographic imaging is a mapping technique aiming to noninvasively characterize cardiac electrical activity using signals collected from the torso to reconstruct epicardial potentials. Its efficacy has been demonstrated clinically, from mapping premature ventricular complexes and accessory pathways to of complex arrhythmias. Electrocardiographic imaging uses a standardized workflow. Signals should be checked manually to avoid automatic processing errors. Reentry is confirmed in the presence of local activation covering the arrhythmia cycle length. Focal breakthroughs demonstrate a QS pattern associated with centrifugal activation. Electrocardiographic imaging offers a unique opportunity to better understand the mechanism of cardiac arrhythmias and guide ablation.
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Affiliation(s)
- Ghassen Cheniti
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France.
| | - Stephane Puyo
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Claire A Martin
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Antonio Frontera
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Konstantinos Vlachos
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Masateru Takigawa
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Felix Bourier
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Takeshi Kitamura
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Anna Lam
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Carole Dumas-Pommier
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France
| | - Xavier Pillois
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France
| | - Thomas Pambrun
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Josselin Duchateau
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Nicolas Klotz
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Arnaud Denis
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Nicolas Derval
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Hubert Cochet
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France; Department of Cardiovascular Imaging, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France
| | - Frederic Sacher
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Remi Dubois
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Pierre Jais
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Meleze Hocini
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Michel Haissaguerre
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
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20
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Anderson RD, Kumar S, Kalman JM, Sanders P, Sacher F, Hocini M, Jais P, Haïsaguerre M, Lee G. Catheter Ablation of Ventricular Fibrillation. Heart Lung Circ 2019; 28:110-122. [DOI: 10.1016/j.hlc.2018.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/29/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
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21
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Vandersickel N, Watanabe M, Tao Q, Fostier J, Zeppenfeld K, Panfilov AV. Dynamical anchoring of distant arrhythmia sources by fibrotic regions via restructuring of the activation pattern. PLoS Comput Biol 2018; 14:e1006637. [PMID: 30571689 PMCID: PMC6319787 DOI: 10.1371/journal.pcbi.1006637] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 01/04/2019] [Accepted: 11/09/2018] [Indexed: 11/27/2022] Open
Abstract
Rotors are functional reentry sources identified in clinically relevant cardiac arrhythmias, such as ventricular and atrial fibrillation. Ablation targeting rotor sites has resulted in arrhythmia termination. Recent clinical, experimental and modelling studies demonstrate that rotors are often anchored around fibrotic scars or regions with increased fibrosis. However, the mechanisms leading to abundance of rotors at these locations are not clear. The current study explores the hypothesis whether fibrotic scars just serve as anchoring sites for the rotors or whether there are other active processes which drive the rotors to these fibrotic regions. Rotors were induced at different distances from fibrotic scars of various sizes and degree of fibrosis. Simulations were performed in a 2D model of human ventricular tissue and in a patient-specific model of the left ventricle of a patient with remote myocardial infarction. In both the 2D and the patient-specific model we found that without fibrotic scars, the rotors were stable at the site of their initiation. However, in the presence of a scar, rotors were eventually dynamically anchored from large distances by the fibrotic scar via a process of dynamical reorganization of the excitation pattern. This process coalesces with a change from polymorphic to monomorphic ventricular tachycardia. Rotors are waves of cardiac excitation like a tornado causing cardiac arrhythmia. Recent research shows that they are found in ventricular and atrial fibrillation. Burning (via ablation) the site of a rotor can result in the termination of the arrhythmia. Recent studies showed that rotors are often anchored to regions surrounding scar tissue, where part of the tissue still survived called fibrotic tissue. However, it is unclear why these rotors anchor to these locations. Therefore, in this work, we investigated why rotors are so abundant in fibrotic tissue with the help of computer simulations. We performed simulations in a 2D model of human ventricular tissue and in a patient-specific model of a patient with an infarction. We found that even when rotors are initially at large distances from the fibrotic region, they are attracted by this region, to finally end up at the fibrotic tissue. We called this process dynamical anchoring and explained how the process works.
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Affiliation(s)
- Nele Vandersickel
- Department of Physics and Astronomy, Ghent University, Belgium
- * E-mail: (NV); (AVP)
| | - Masaya Watanabe
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Qian Tao
- Department of Radiology, Division of Image Processing, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jan Fostier
- Department of Information Technology (INTEC), IDLab, Ghent University — imec, Ghent, Belgium
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexander V. Panfilov
- Department of Physics and Astronomy, Ghent University, Belgium
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- Laboratory of Computational Biology and Medicine, Ural Federal University, Ekaterinburg, Russia
- * E-mail: (NV); (AVP)
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22
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Handa BS, Roney CH, Houston C, Qureshi NA, Li X, Pitcher DS, Chowdhury RA, Lim PB, Dupont E, Niederer SA, Cantwell CD, Peters NS, Ng FS. Analytical approaches for myocardial fibrillation signals. Comput Biol Med 2018; 102:315-326. [PMID: 30025847 PMCID: PMC6215772 DOI: 10.1016/j.compbiomed.2018.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 12/11/2022]
Abstract
Atrial and ventricular fibrillation are complex arrhythmias, and their underlying mechanisms remain widely debated and incompletely understood. This is partly because the electrical signals recorded during myocardial fibrillation are themselves complex and difficult to interpret with simple analytical tools. There are currently a number of analytical approaches to handle fibrillation data. Some of these techniques focus on mapping putative drivers of myocardial fibrillation, such as dominant frequency, organizational index, Shannon entropy and phase mapping. Other techniques focus on mapping the underlying myocardial substrate sustaining fibrillation, such as voltage mapping and complex fractionated electrogram mapping. In this review, we discuss these techniques, their application and their limitations, with reference to our experimental and clinical data. We also describe novel tools including a new algorithm to map microreentrant circuits sustaining fibrillation.
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Affiliation(s)
- Balvinder S Handa
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Caroline H Roney
- Division of Imaging Sciences and Bioengineering, King's College London, United Kingdom
| | - Charles Houston
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Norman A Qureshi
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Xinyang Li
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - David S Pitcher
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Rasheda A Chowdhury
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Phang Boon Lim
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Emmanuel Dupont
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Steven A Niederer
- Division of Imaging Sciences and Bioengineering, King's College London, United Kingdom
| | - Chris D Cantwell
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom; Department of Aeronautics, Imperial College London, United Kingdom
| | - Nicholas S Peters
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Fu Siong Ng
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom.
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23
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Cheniti G, Vlachos K, Meo M, Puyo S, Thompson N, Denis A, Duchateau J, Takigawa M, Martin C, Frontera A, Kitamura T, Lam A, Bourier F, Klotz N, Derval N, Sacher F, Jais P, Dubois R, Hocini M, Haissaguerre M. Mapping and Ablation of Idiopathic Ventricular Fibrillation. Front Cardiovasc Med 2018; 5:123. [PMID: 30280100 PMCID: PMC6153961 DOI: 10.3389/fcvm.2018.00123] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/20/2018] [Indexed: 01/30/2023] Open
Abstract
Idiopathic ventricular fibrillation (IVF) is the main cause of unexplained sudden cardiac death, particularly in young patients under the age of 35. IVF is a diagnosis of exclusion in patients who have survived a VF episode without any identifiable structural or metabolic causes despite extensive diagnostic testing. Genetic testing allows identification of a likely causative mutation in up to 27% of unexplained sudden deaths in children and young adults. In the majority of cases, VF is triggered by PVCs that originate from the Purkinje network. Ablation of VF triggers in this setting is associated with high rates of acute success and long-term freedom from VF recurrence. Recent studies demonstrate that a significant subset of IVF defined by negative comprehensive investigations, demonstrate in fact subclinical structural alterations. These localized myocardial alterations are identified by high density electrogram mapping, are of small size and are mainly located in the epicardium. As reentrant VF drivers are often colocated with regions of abnormal electrograms, this localized substrate can be shown to be mechanistically linked with VF. Such areas may represent an important target for ablation.
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Affiliation(s)
- Ghassen Cheniti
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France.,Department of Cardiology, Sahloul Hospital, Universite de Sousse, Sousse, Tunisia
| | - Konstantinos Vlachos
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Marianna Meo
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Stephane Puyo
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Nathaniel Thompson
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Arnaud Denis
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Josselin Duchateau
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Masateru Takigawa
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Claire Martin
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France.,Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Antonio Frontera
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Takeshi Kitamura
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Anna Lam
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Felix Bourier
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Nicolas Klotz
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Nicolas Derval
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Frederic Sacher
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Pierre Jais
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Remi Dubois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Meleze Hocini
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Michel Haissaguerre
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
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Fast nonclinical ventricular tachycardia inducible after ablation in patients with structural heart disease: Definition and clinical implications. Heart Rhythm 2018; 15:668-676. [DOI: 10.1016/j.hrthm.2018.01.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Indexed: 11/23/2022]
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25
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Nayyar S, Porta-Sánchez A, Nanthakumar K. Twisting and Turning to Find an Explanation for Torsades de Pointes. JACC Clin Electrophysiol 2017; 3:1577-1579. [PMID: 29759840 DOI: 10.1016/j.jacep.2017.09.174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/07/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Sachin Nayyar
- Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andreu Porta-Sánchez
- Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
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Ho G, Villongco CT, Yousefian O, Bradshaw A, Nguyen A, Faiwiszewski Y, Hayase J, Rappel WJ, McCulloch AD, Krummen DE. Rotors exhibit greater surface ECG variation during ventricular fibrillation than focal sources due to wavebreak, secondary rotors, and meander. J Cardiovasc Electrophysiol 2017; 28:1158-1166. [PMID: 28670858 DOI: 10.1111/jce.13283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 05/21/2017] [Accepted: 06/06/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Ventricular fibrillation is a common life-threatening arrhythmia. The ECG of VF appears chaotic but may allow identification of sustaining mechanisms to guide therapy. HYPOTHESIS We hypothesized that rotors and focal sources manifest distinct features on the ECG, and computational modeling may identify mechanisms of such features. METHODS VF induction was attempted in 31 patients referred for ventricular arrhythmia ablation. Simultaneous surface ECG and intracardiac electrograms were recorded using biventricular basket catheters. Endocardial phase maps were used to mechanistically classify each VF cycle as rotor or focally driven. ECGs were analyzed from patients demonstrating both mechanisms in the primary analysis and from all patients with induced VF in the secondary analysis. The ECG voltage variation during each mechanism was compared. Biventricular computer simulations of VF driven by focal sources or rotors were created and resulting ECGs of each VF mechanism were compared. RESULTS Rotor-based VF exhibited greater voltage variation than focal source-based VF in both the primary analysis (n = 8, 110 ± 24% vs. 55 ± 32%, P = 0.02) and the secondary analysis (n = 18, 103 ± 30% vs. 67 ± 34%, P = 0.009). Computational VF simulations also revealed greater voltage variation in rotors compared to focal sources (110 ± 19% vs. 33 ± 16%, P = 0.001), and demonstrated that this variation was due to wavebreak, secondary rotor initiation, and rotor meander. CONCLUSION Clinical and computational studies reveal that quantitative criteria of ECG voltage variation differ significantly between VF-sustaining rotors and focal sources, and provide insight into the mechanisms of such variation. Future studies should prospectively evaluate if these criteria can separate clinical VF mechanisms and guide therapy.
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Affiliation(s)
- Gordon Ho
- Department of Medicine, University of California, San Diego, CA, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | | | - Omid Yousefian
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Andrew Nguyen
- Department of Medicine, University of California, San Diego, CA, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Yonatan Faiwiszewski
- Department of Medicine, University of California, San Diego, CA, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Justin Hayase
- Department of Medicine, University of California, San Diego, CA, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | | | - Andrew D McCulloch
- Department of Medicine, University of California, San Diego, CA, USA.,Department of Bioengineering, University of California, San Diego, CA, USA
| | - David E Krummen
- Department of Medicine, University of California, San Diego, CA, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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Abstract
Objectives The objective of this study was to evaluate the spatio-temporal organization and progression of human ventricular fibrillation (VF) in the left (LV) and right (RV) ventricles. Background Studies suggest that localized sources contribute to VF maintenance, but the evolution of VF episodes has not been quantified. Methods Synchrony between electrograms recorded from 25 patients with induced VF is computed and used to define the Asynchronous Index (ASI), indicating regions which are out-of-step with surrounding tissue. Computer simulations show that ASI can identify the location of VF-maintaining sources, where larger values of ASImax correlate with more stable sources. Results Automated synchrony analysis shows elevated values of ASI in a majority of self-terminating episodes (LV: 8/9, RV: 7/8) and sustained episodes (LV: 11/11, RV: 12/12). The locations of ASImax in sustained episodes co-localize with rotor cores when rotational activity is simultaneously present in phase maps (LV: 8/8, RV: 5/7, p<.05). The distribution of ASImax differentiates self-terminating from sustained episodes (mean ASImax = 0.60±0.14 and 0.70±0.16, respectively; p=0.01). Across sustained episodes the LV exhibits an increase in ASImax with time. Conclusions Quantitative analysis identifies localized asynchronous regions that correlate with sources in VF, with sustained episodes evolving to exhibit more stable activation in the LV. This successive increase in stability indicates a stabilizing agent may be responsible for perpetuating fibrillation in a "migrate-and-capture" mechanism in the LV.
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Transmural electrophysiological heterogeneity, the T-wave and ventricular arrhythmias. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2016; 122:202-214. [DOI: 10.1016/j.pbiomolbio.2016.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/21/2016] [Accepted: 05/03/2016] [Indexed: 01/05/2023]
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Krummen DE, Ho G, Villongco CT, Hayase J, Schricker AA. Ventricular fibrillation: triggers, mechanisms and therapies. Future Cardiol 2016; 12:373-90. [PMID: 27120223 DOI: 10.2217/fca-2016-0001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Ventricular fibrillation (VF) is a common, life-threatening arrhythmia responsible for significant morbidity and mortality. Due to challenges in safely mapping VF, a comprehensive understanding of its mechanisms remains elusive. Recent findings have provided new insights into mechanisms that sustain early VF. Notably, the central role of electrical rotors and catheter-based ablation of VF rotor substrate have been recently reported. In this article, we will review data regarding four stages of VF: initiation, transition, maintenance and evolution. We will discuss the particular mechanisms for each stage and therapies targeting these mechanisms. We also examine inherited arrhythmia syndromes, including the mechanisms and therapies specific to each. We hope that the overview of VF outlined in this work will assist other investigators in designing future therapies to interrupt this life-threatening arrhythmia.
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Affiliation(s)
- David E Krummen
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.,Department of Medicine, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
| | - Gordon Ho
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.,Department of Medicine, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
| | - Christopher T Villongco
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Justin Hayase
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.,Department of Medicine, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
| | - Amir A Schricker
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.,Department of Medicine, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
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Filgueiras-Rama D, Jalife J. STRUCTURAL AND FUNCTIONAL BASES OF CARDIAC FIBRILLATION. DIFFERENCES AND SIMILARITIES BETWEEN ATRIA AND VENTRICLES. JACC Clin Electrophysiol 2016; 2:1-3. [PMID: 27042693 DOI: 10.1016/j.jacep.2015.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Evidence accumulated over the last 25 years suggests that, whether in the atria or ventricles, fibrillation may be explained by the self-organization of the cardiac electrical activity into rapidly spinning rotors giving way to spiral waves that break intermittently and result in fibrillatory conduction. The dynamics and frequency of such rotors depend on the ion channel composition, excitability and refractory properties of the tissues involved, as well as on the thickness and respective three-dimensional fiber structure of the atrial and ventricular chambers. Therefore, improving the understanding of fibrillation has required the use of multidisciplinary research approaches, including optical mapping, patch clamping and molecular biology, and the application of concepts derived from the theory of wave propagation in excitable media. Moreover, translation of such concepts to the clinic has recently opened new opportunities to apply novel mechanistic approaches to therapy, particularly during atrial fibrillation ablation. Here we review the current understanding of the manner in which the underlying myocardial structure and function influence rotor initiation and maintenance during cardiac fibrillation. We also examine relevant underlying differences and similarities between atrial fibrillation and ventricular fibrillation and evaluate the latest clinical mapping technologies used to identify rotors in either arrhythmia. Altogether, the data being discussed have significantly improved our understanding of the cellular and structural bases of cardiac fibrillation and pointed toward potentially exciting new avenues for more efficient and effective identification and therapy of the most complex cardiac arrhythmias.
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Affiliation(s)
- David Filgueiras-Rama
- Fundación Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC)., Myocardial Pathophysiology Area, Madrid, Spain; Hospital Clínico San Carlos, Cardiology department, Madrid, Spain
| | - José Jalife
- Fundación Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC)., Myocardial Pathophysiology Area, Madrid, Spain; Center for Arrhythmia Research, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, EEUU
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Narayan SM, Zaman JAB. Mechanistically based mapping of human cardiac fibrillation. J Physiol 2016; 594:2399-415. [PMID: 26607671 PMCID: PMC4850202 DOI: 10.1113/jp270513] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/20/2015] [Indexed: 12/02/2022] Open
Abstract
The mechanisms underpinning human cardiac fibrillation remain elusive. In his 1913 paper ‘On dynamic equilibrium in the heart’, Mines proposed that an activation wave front could propagate repeatedly in a circle, initiated by a stimulus in the vulnerable period. While the dynamics of activation and recovery are central to cardiac fibrillation, these physiological data are rarely used in clinical mapping. Fibrillation is a rapid irregular rhythm with spatiotemporal disorder resulting from two fundamental mechanisms – sources in preferred cardiac regions or spatially diffuse self‐sustaining activity, i.e. with no preferred source. On close inspection, however, this debate may also reflect mapping technique. Fibrillation is initiated from triggers by regional dispersion in repolarization, slow conduction and wavebreak, then sustained by non‐uniform interactions of these mechanisms. Notably, optical mapping of action potentials in atrial fibrillation (AF) show spiral wave sources (rotors) in nearly all studies including humans, while most traditional electrogram analyses of AF do not. Techniques may diverge in fibrillation because electrograms summate non‐coherent waves within an undefined field whereas optical maps define waves with a visually defined field. Also fibrillation operates at the limits of activation and recovery, which are well represented by action potentials while fibrillatory electrograms poorly represent repolarization. We conclude by suggesting areas for study that may be used, until such time as optical mapping is clinically feasible, to improve mechanistic understanding and therapy of human cardiac fibrillation.
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Affiliation(s)
| | - Junaid A B Zaman
- Stanford University, Palo Alto, CA, USA.,Imperial College London, London, UK
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Filament Dynamics during Simulated Ventricular Fibrillation in a High-Resolution Rabbit Heart. BIOMED RESEARCH INTERNATIONAL 2015; 2015:720575. [PMID: 26587544 PMCID: PMC4637469 DOI: 10.1155/2015/720575] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 02/06/2015] [Indexed: 11/30/2022]
Abstract
The mechanisms underlying ventricular fibrillation (VF) are not well understood. The electrical activity on the heart surface during VF has been recorded extensively in the experimental setting and in some cases clinically; however, corresponding transmural activation patterns are prohibitively difficult to measure. In this paper, we use a high-resolution biventricular heart model to study three-dimensional electrical activity during fibrillation, focusing on the driving sources of VF: “filaments,” the organising centres of unstable reentrant scroll waves. We show, for the first time, specific 3D filament dynamics during simulated VF in a whole heart geometry that includes fine-scale anatomical structures. Our results suggest that transmural activity is much more complex than what would be expected from surface observations alone. We present examples of complex intramural activity, including filament breakup and reattachment, anchoring to the thin right ventricular apex; rapid transitions among various filament shapes; and filament lengths much greater than wall thickness. We also present evidence for anatomy playing a major role in VF development and coronary vessels and trabeculae influencing filament dynamics. Overall, our results indicate that intramural activity during simulated VF is extraordinarily complex and suggest that further investigation of 3D filaments is necessary to fully comprehend recorded surface patterns.
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Krummen DE, Hayase J, Vampola SP, Ho G, Schricker AA, Lalani GG, Baykaner T, Coe TM, Clopton P, Rappel WJ, Omens JH, Narayan SM. Modifying Ventricular Fibrillation by Targeted Rotor Substrate Ablation: Proof-of-Concept from Experimental Studies to Clinical VF. J Cardiovasc Electrophysiol 2015; 26:1117-26. [PMID: 26179310 PMCID: PMC4826737 DOI: 10.1111/jce.12753] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 05/30/2015] [Accepted: 06/19/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Recent work has suggested a role for organized sources in sustaining ventricular fibrillation (VF). We assessed whether ablation of rotor substrate could modulate VF inducibility in canines, and used this proof-of-concept as a foundation to suppress antiarrhythmic drug-refractory clinical VF in a patient with structural heart disease. METHODS AND RESULTS In 9 dogs, we introduced 64-electrode basket catheters into one or both ventricles, used rapid pacing at a recorded induction threshold to initiate VF, and then defibrillated after 18±8 seconds. Endocardial rotor sites were identified from basket recordings using phase mapping, and ablation was performed at nonrotor (sham) locations (7 ± 2 minutes) and then at rotor sites (8 ± 2 minutes, P = 0.10 vs. sham); the induction threshold was remeasured after each. Sham ablation did not alter canine VF induction threshold (preablation 150 ± 16 milliseconds, postablation 144 ± 16 milliseconds, P = 0.54). However, rotor site ablation rendered VF noninducible in 6/9 animals (P = 0.041), and increased VF induction threshold in the remaining 3. Clinical proof-of-concept was performed in a patient with repetitive ICD shocks due to VF refractory to antiarrhythmic drugs. Following biventricular basket insertion, VF was induced and then defibrillated. Mapping identified 4 rotors localized at borderzone tissue, and rotor site ablation (6.3 ± 1.5 minutes/site) rendered VF noninducible. The VF burden fell from 7 ICD shocks in 8 months preablation to zero ICD therapies at 1 year, without antiarrhythmic medications. CONCLUSIONS Targeted rotor substrate ablation suppressed VF in an experimental model and a patient with refractory VF. Further studies are warranted on the efficacy of VF source modulation.
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Affiliation(s)
- David E Krummen
- Department of Medicine, University of California, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Justin Hayase
- Department of Medicine, University of California, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Stephen P Vampola
- Department of Medicine, University of California, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Gordon Ho
- Department of Medicine, University of California, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Amir A Schricker
- Department of Medicine, University of California, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Gautam G Lalani
- Department of Medicine, University of California, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Tina Baykaner
- Department of Medicine, University of California, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Taylor M Coe
- Department of Bioengineering, University of California, San Diego, California, USA
| | - Paul Clopton
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Wouter-Jan Rappel
- Department of Physics, University of California, San Diego, California, USA
| | - Jeffrey H Omens
- Department of Bioengineering, University of California, San Diego, California, USA
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Magtibay K, Beheshti M, Foomany FH, Balasundaram K, Masse S, Lai P, Asta J, Zamiri N, Jaffray DA, Nanthakumar K, Krishnan S, Umapathy K. Fusion of structural and functional cardiac magnetic resonance imaging data for studying ventricular fibrillation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:5579-82. [PMID: 25571259 DOI: 10.1109/embc.2014.6944891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Magnetic Resonance Imaging (MRI) techniques such as Current Density Imaging (CDI) and Diffusion Tensor Imaging (DTI) provide a complementing set of imaging data that can describe both the functional and structural states of biological tissues. This paper presents a Joint Independent Component Analysis (jICA) based fusion approach which can be utilized to fuse CDI and DTI data to quantify the differences between two cardiac states: Ventricular Fibrillation (VF) and Asystolic/Normal (AS/NM). Such an approach could lead to a better insight on the mechanism of VF. Fusing CDI and DTI data from 8 data sets from 6 beating porcine hearts, in effect, detects the differences between two cardiac states, qualitatively and quantitatively. This initial study demonstrates the applicability of MRI-based imaging techniques and jICA-based fusion approach in studying cardiac arrhythmias.
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Calvo D, Atienza F, Saiz J, Martínez L, Ávila P, Rubín J, Herreros B, Arenal Á, García-Fernández J, Ferrer A, Sebastián R, Martínez-Camblor P, Jalife J, Berenfeld O. Ventricular Tachycardia and Early Fibrillation in Patients With Brugada Syndrome and Ischemic Cardiomyopathy Show Predictable Frequency-Phase Properties on the Precordial ECG Consistent With the Respective Arrhythmogenic Substrate. Circ Arrhythm Electrophysiol 2015; 8:1133-43. [PMID: 26253505 PMCID: PMC4608487 DOI: 10.1161/circep.114.002717] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 07/23/2015] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Ventricular fibrillation (VF) has been proposed to be maintained by localized high-frequency sources. We tested whether spectral-phase analysis of the precordial ECG enabled identification of periodic activation patterns generated by such sources.
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Affiliation(s)
- David Calvo
- From the Arrhythmia Unit, Hospital Universitario Central de Asturias, Oviedo, Spain (D.C., J.R.); Center for Arrhythmia Research, University of Michigan, Ann Arbor (J.J., O.B.); Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A., P.Á., Á.A.); Centro de Investigación e Innovación en Bioingeniería, Ci2B, Universitat Politècnica de Valencia, Valencia, Spain (J.S., L.M., A.F.); Arrhythmia Unit, Hospital Río Hortega de Valladolid and Universitario de Burgos, Valladolid-Burgos, Spain (B.H., J.G.-F.); Universitat de Valencia, Valencia, Spain (R.S.); and Department of Statistics, Hospital Universitario Central de Asturias, Oviedo, Spain (P.M.-C.)
| | - Felipe Atienza
- From the Arrhythmia Unit, Hospital Universitario Central de Asturias, Oviedo, Spain (D.C., J.R.); Center for Arrhythmia Research, University of Michigan, Ann Arbor (J.J., O.B.); Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A., P.Á., Á.A.); Centro de Investigación e Innovación en Bioingeniería, Ci2B, Universitat Politècnica de Valencia, Valencia, Spain (J.S., L.M., A.F.); Arrhythmia Unit, Hospital Río Hortega de Valladolid and Universitario de Burgos, Valladolid-Burgos, Spain (B.H., J.G.-F.); Universitat de Valencia, Valencia, Spain (R.S.); and Department of Statistics, Hospital Universitario Central de Asturias, Oviedo, Spain (P.M.-C.)
| | - Javier Saiz
- From the Arrhythmia Unit, Hospital Universitario Central de Asturias, Oviedo, Spain (D.C., J.R.); Center for Arrhythmia Research, University of Michigan, Ann Arbor (J.J., O.B.); Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A., P.Á., Á.A.); Centro de Investigación e Innovación en Bioingeniería, Ci2B, Universitat Politècnica de Valencia, Valencia, Spain (J.S., L.M., A.F.); Arrhythmia Unit, Hospital Río Hortega de Valladolid and Universitario de Burgos, Valladolid-Burgos, Spain (B.H., J.G.-F.); Universitat de Valencia, Valencia, Spain (R.S.); and Department of Statistics, Hospital Universitario Central de Asturias, Oviedo, Spain (P.M.-C.)
| | - Laura Martínez
- From the Arrhythmia Unit, Hospital Universitario Central de Asturias, Oviedo, Spain (D.C., J.R.); Center for Arrhythmia Research, University of Michigan, Ann Arbor (J.J., O.B.); Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A., P.Á., Á.A.); Centro de Investigación e Innovación en Bioingeniería, Ci2B, Universitat Politècnica de Valencia, Valencia, Spain (J.S., L.M., A.F.); Arrhythmia Unit, Hospital Río Hortega de Valladolid and Universitario de Burgos, Valladolid-Burgos, Spain (B.H., J.G.-F.); Universitat de Valencia, Valencia, Spain (R.S.); and Department of Statistics, Hospital Universitario Central de Asturias, Oviedo, Spain (P.M.-C.)
| | - Pablo Ávila
- From the Arrhythmia Unit, Hospital Universitario Central de Asturias, Oviedo, Spain (D.C., J.R.); Center for Arrhythmia Research, University of Michigan, Ann Arbor (J.J., O.B.); Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A., P.Á., Á.A.); Centro de Investigación e Innovación en Bioingeniería, Ci2B, Universitat Politècnica de Valencia, Valencia, Spain (J.S., L.M., A.F.); Arrhythmia Unit, Hospital Río Hortega de Valladolid and Universitario de Burgos, Valladolid-Burgos, Spain (B.H., J.G.-F.); Universitat de Valencia, Valencia, Spain (R.S.); and Department of Statistics, Hospital Universitario Central de Asturias, Oviedo, Spain (P.M.-C.)
| | - José Rubín
- From the Arrhythmia Unit, Hospital Universitario Central de Asturias, Oviedo, Spain (D.C., J.R.); Center for Arrhythmia Research, University of Michigan, Ann Arbor (J.J., O.B.); Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A., P.Á., Á.A.); Centro de Investigación e Innovación en Bioingeniería, Ci2B, Universitat Politècnica de Valencia, Valencia, Spain (J.S., L.M., A.F.); Arrhythmia Unit, Hospital Río Hortega de Valladolid and Universitario de Burgos, Valladolid-Burgos, Spain (B.H., J.G.-F.); Universitat de Valencia, Valencia, Spain (R.S.); and Department of Statistics, Hospital Universitario Central de Asturias, Oviedo, Spain (P.M.-C.)
| | - Benito Herreros
- From the Arrhythmia Unit, Hospital Universitario Central de Asturias, Oviedo, Spain (D.C., J.R.); Center for Arrhythmia Research, University of Michigan, Ann Arbor (J.J., O.B.); Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A., P.Á., Á.A.); Centro de Investigación e Innovación en Bioingeniería, Ci2B, Universitat Politècnica de Valencia, Valencia, Spain (J.S., L.M., A.F.); Arrhythmia Unit, Hospital Río Hortega de Valladolid and Universitario de Burgos, Valladolid-Burgos, Spain (B.H., J.G.-F.); Universitat de Valencia, Valencia, Spain (R.S.); and Department of Statistics, Hospital Universitario Central de Asturias, Oviedo, Spain (P.M.-C.)
| | - Ángel Arenal
- From the Arrhythmia Unit, Hospital Universitario Central de Asturias, Oviedo, Spain (D.C., J.R.); Center for Arrhythmia Research, University of Michigan, Ann Arbor (J.J., O.B.); Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A., P.Á., Á.A.); Centro de Investigación e Innovación en Bioingeniería, Ci2B, Universitat Politècnica de Valencia, Valencia, Spain (J.S., L.M., A.F.); Arrhythmia Unit, Hospital Río Hortega de Valladolid and Universitario de Burgos, Valladolid-Burgos, Spain (B.H., J.G.-F.); Universitat de Valencia, Valencia, Spain (R.S.); and Department of Statistics, Hospital Universitario Central de Asturias, Oviedo, Spain (P.M.-C.)
| | - Javier García-Fernández
- From the Arrhythmia Unit, Hospital Universitario Central de Asturias, Oviedo, Spain (D.C., J.R.); Center for Arrhythmia Research, University of Michigan, Ann Arbor (J.J., O.B.); Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A., P.Á., Á.A.); Centro de Investigación e Innovación en Bioingeniería, Ci2B, Universitat Politècnica de Valencia, Valencia, Spain (J.S., L.M., A.F.); Arrhythmia Unit, Hospital Río Hortega de Valladolid and Universitario de Burgos, Valladolid-Burgos, Spain (B.H., J.G.-F.); Universitat de Valencia, Valencia, Spain (R.S.); and Department of Statistics, Hospital Universitario Central de Asturias, Oviedo, Spain (P.M.-C.)
| | - Ana Ferrer
- From the Arrhythmia Unit, Hospital Universitario Central de Asturias, Oviedo, Spain (D.C., J.R.); Center for Arrhythmia Research, University of Michigan, Ann Arbor (J.J., O.B.); Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A., P.Á., Á.A.); Centro de Investigación e Innovación en Bioingeniería, Ci2B, Universitat Politècnica de Valencia, Valencia, Spain (J.S., L.M., A.F.); Arrhythmia Unit, Hospital Río Hortega de Valladolid and Universitario de Burgos, Valladolid-Burgos, Spain (B.H., J.G.-F.); Universitat de Valencia, Valencia, Spain (R.S.); and Department of Statistics, Hospital Universitario Central de Asturias, Oviedo, Spain (P.M.-C.)
| | - Rafael Sebastián
- From the Arrhythmia Unit, Hospital Universitario Central de Asturias, Oviedo, Spain (D.C., J.R.); Center for Arrhythmia Research, University of Michigan, Ann Arbor (J.J., O.B.); Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A., P.Á., Á.A.); Centro de Investigación e Innovación en Bioingeniería, Ci2B, Universitat Politècnica de Valencia, Valencia, Spain (J.S., L.M., A.F.); Arrhythmia Unit, Hospital Río Hortega de Valladolid and Universitario de Burgos, Valladolid-Burgos, Spain (B.H., J.G.-F.); Universitat de Valencia, Valencia, Spain (R.S.); and Department of Statistics, Hospital Universitario Central de Asturias, Oviedo, Spain (P.M.-C.)
| | - Pablo Martínez-Camblor
- From the Arrhythmia Unit, Hospital Universitario Central de Asturias, Oviedo, Spain (D.C., J.R.); Center for Arrhythmia Research, University of Michigan, Ann Arbor (J.J., O.B.); Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A., P.Á., Á.A.); Centro de Investigación e Innovación en Bioingeniería, Ci2B, Universitat Politècnica de Valencia, Valencia, Spain (J.S., L.M., A.F.); Arrhythmia Unit, Hospital Río Hortega de Valladolid and Universitario de Burgos, Valladolid-Burgos, Spain (B.H., J.G.-F.); Universitat de Valencia, Valencia, Spain (R.S.); and Department of Statistics, Hospital Universitario Central de Asturias, Oviedo, Spain (P.M.-C.)
| | - José Jalife
- From the Arrhythmia Unit, Hospital Universitario Central de Asturias, Oviedo, Spain (D.C., J.R.); Center for Arrhythmia Research, University of Michigan, Ann Arbor (J.J., O.B.); Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A., P.Á., Á.A.); Centro de Investigación e Innovación en Bioingeniería, Ci2B, Universitat Politècnica de Valencia, Valencia, Spain (J.S., L.M., A.F.); Arrhythmia Unit, Hospital Río Hortega de Valladolid and Universitario de Burgos, Valladolid-Burgos, Spain (B.H., J.G.-F.); Universitat de Valencia, Valencia, Spain (R.S.); and Department of Statistics, Hospital Universitario Central de Asturias, Oviedo, Spain (P.M.-C.)
| | - Omer Berenfeld
- From the Arrhythmia Unit, Hospital Universitario Central de Asturias, Oviedo, Spain (D.C., J.R.); Center for Arrhythmia Research, University of Michigan, Ann Arbor (J.J., O.B.); Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A., P.Á., Á.A.); Centro de Investigación e Innovación en Bioingeniería, Ci2B, Universitat Politècnica de Valencia, Valencia, Spain (J.S., L.M., A.F.); Arrhythmia Unit, Hospital Río Hortega de Valladolid and Universitario de Burgos, Valladolid-Burgos, Spain (B.H., J.G.-F.); Universitat de Valencia, Valencia, Spain (R.S.); and Department of Statistics, Hospital Universitario Central de Asturias, Oviedo, Spain (P.M.-C.).
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Killu AM, Mulpuru SK. Mapping and Ablation of Rotors: Exploring New Frontiers in Treatment of Ventricular Fibrillation. J Cardiovasc Electrophysiol 2015. [PMID: 26202001 DOI: 10.1111/jce.12760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Ammar M Killu
- Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Siva K Mulpuru
- Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Mechanisms of Long-Duration Ventricular Fibrillation in Human Hearts and Experimental Validation in Canine Purkinje Fibers. JACC Clin Electrophysiol 2015; 1:187-197. [DOI: 10.1016/j.jacep.2015.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/03/2015] [Accepted: 04/09/2015] [Indexed: 11/20/2022]
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Krummen DE, Hebsur S, Salcedo J, Narayan SM, Lalani GG, Schricker AA. Mechanisms Underlying AF: Triggers, Rotors, Other? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:371. [PMID: 25778423 DOI: 10.1007/s11936-015-0371-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OPINION STATEMENT There is ongoing debate regarding the precise mechanisms underlying atrial fibrillation (AF). An improved understanding of these mechanisms is urgently needed to improve interventional strategies to suppress and eliminate AF, since the success of current strategies is suboptimal. At present, guidelines for AF ablation focus on pulmonary vein (PV) isolation for the prevention of arrhythmia. Additional targets are presently unclear, and include additional linear ablation and electrogram-guided substrate modification, without clear mechanistic relevance. PV and non-PV triggers are likely central in the first few seconds of AF initiation. Rapid activation from such triggers interacts with transitional mechanisms including conduction velocity slowing, action potential duration (APD) alternans, and steep APD restitution to cause conduction block and initiate functional reentry. However, complete suppression of potential triggers has proven elusive, and the intra-procedural mapping and targeting of transitional mechanisms has not been reported. A growing body of research implicates electrical rotors and focal sources as central mechanisms for the maintenance of AF. In several recent series, they were observed in nearly all patients with sustained arrhythmia. Ablation of rotor and focal source sites, prior to pulmonary vein isolation, substantially modulated atrial fibrillation in a high proportion of patients, and improved ablation outcomes versus pulmonary vein isolation alone. These results have subsequently been confirmed in multicenter series, and the improved outcomes have been found to persist to a mean follow-up of 3 years. Recently, rotors have been observed by multiple groups using diverse technologies. These findings represent a paradigm shift in AF, focusing on sustaining mechanisms, as is currently done with other arrhythmias such as atrioventricular node reentrant tachycardia. Studies are currently underway to assess the optimal strategy for the application of rotor-based ablation in AF management, including clinical trials on the relative efficacy of rotor-only ablation versus PVI-only ablation, which will inform future practice guidelines.
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Affiliation(s)
- David E Krummen
- University of California San Diego and VA San Diego Healthcare System, 3350 La Jolla Village Drive, Cardiology Section 111A, San Diego, CA, 92161, USA,
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Krummen DE, Swarup V, Narayan SM. The role of rotors in atrial fibrillation. J Thorac Dis 2015; 7:142-51. [PMID: 25713729 DOI: 10.3978/j.issn.2072-1439.2014.11.15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/23/2014] [Indexed: 11/14/2022]
Abstract
Despite significant advances in our understanding of atrial fibrillation (AF) mechanisms in the last 15 years, ablation outcomes remain suboptimal. A potential reason is that many ablation techniques focus on anatomic, rather than patient-specific functional targets for ablation. Panoramic contact mapping, incorporating phase analysis, repolarization and conduction dynamics, and oscillations in AF rate, overcomes many prior difficulties with mapping AF. This approach provides evidence that the mechanisms sustaining human AF are deterministic, largely due to stable electrical rotors and focal sources in either atrium. Ablation of such sources (Focal Impulse and Rotor Modulation: FIRM ablation) has been shown to improve ablation outcome compared with conventional ablation alone; independent laboratories directly targeting stable rotors have shown similar results. Clinical trials examining the role of stand-alone FIRM ablation are in progress. Looking forward, translating insights from patient-specific mapping to evidence-based guidelines and clinical practice is the next challenge in improving patient outcomes in AF management.
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Affiliation(s)
- David E Krummen
- 1 Department of Medicine/Cardiology, University of California San Diego Medical Center, San Diego, CA and VA San Diego Healthcare System, San Diego, CA 92161, USA ; 2 Arizona Heart Hospital, Phoenix, AZ, USA ; 3 Stanford University, Palo Alto, CA, USA
| | - Vijay Swarup
- 1 Department of Medicine/Cardiology, University of California San Diego Medical Center, San Diego, CA and VA San Diego Healthcare System, San Diego, CA 92161, USA ; 2 Arizona Heart Hospital, Phoenix, AZ, USA ; 3 Stanford University, Palo Alto, CA, USA
| | - Sanjiv M Narayan
- 1 Department of Medicine/Cardiology, University of California San Diego Medical Center, San Diego, CA and VA San Diego Healthcare System, San Diego, CA 92161, USA ; 2 Arizona Heart Hospital, Phoenix, AZ, USA ; 3 Stanford University, Palo Alto, CA, USA
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Park SA, Gray RA. Optical Mapping of Ventricular Fibrillation Dynamics. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 859:313-42. [PMID: 26238059 DOI: 10.1007/978-3-319-17641-3_13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
There is very limited information regarding the dynamic patterns of the electrical activity during ventricular fibrillation (VF) in humans. Most of the data used to generate and test hypotheses regarding the mechanisms of VF come from animal models and computer simulations and the quantification of VF patterns is non-trivial. Many of the experimental recordings of the dynamic spatial patterns of VF have been obtained from mammals using "optical mapping" or "video imaging" technology in which "phase maps" are derived from high-resolution transmembrane recordings from the heart surface. The surface manifestation of the unstable reentrant waves sustaining VF can be identified as "phase singularities" and their number and location provide one measure of VF complexity. After providing a brief history of optical mapping of VF, we compare and contrast a quantitative analysis of VF patterns from the heart surface for four different animal models, hence providing physiological insight into the variety of VF dynamics among species. We found that in all four animal models the action potential duration restitution slope was actually negative during VF and that the spatial dispersion of electrophysiological parameters were not different during the first second of VF compared to pacing immediately before VF initiation. Surprisingly, our results suggest that APD restitution and spatial dispersion may not be essential causes of VF dynamics. Analyses of electrophysiological quantities in the four animal models are consistent with the idea that VF is essentially a two-dimensional phenomenon in small rabbit hearts whose size are near the boundary of the "critical mass" required to sustain VF, while VF in large pig hearts is three-dimensional and exhibits the maximal theoretical phase singularity density, and thus will not terminate spontaneously.
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Affiliation(s)
- Sarah A Park
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
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Krummen DE, Hayase J, Morris DJ, Ho J, Smetak MR, Clopton P, Rappel WJ, Narayan SM. Rotor stability separates sustained ventricular fibrillation from self-terminating episodes in humans. J Am Coll Cardiol 2014; 63:2712-21. [PMID: 24794115 DOI: 10.1016/j.jacc.2014.03.037] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/23/2014] [Accepted: 03/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study mapped human ventricular fibrillation (VF) to define mechanistic differences between episodes requiring defibrillation versus those that spontaneously terminate. BACKGROUND VF is a leading cause of mortality; yet, episodes may also self-terminate. We hypothesized that the initial maintenance of human VF is dependent upon the formation and stability of VF rotors. METHODS We enrolled 26 consecutive patients (age 64 ± 10 years, n = 13 with left ventricular dysfunction) during ablation procedures for ventricular arrhythmias, using 64-electrode basket catheters in both ventricles to map VF prior to prompt defibrillation per the institutional review board-approved protocol. A total of 52 inductions were attempted, and 36 VF episodes were observed. Phase analysis was applied to identify biventricular rotors in the first 10 s or until VF terminated, whichever came first (11.4 ± 2.9 s to defibrillator charging). RESULTS Rotors were present in 16 of 19 patients with VF and in all patients with sustained VF. Sustained, but not self-limiting VF, was characterized by greater rotor stability: 1) rotors were present in 68 ± 17% of cycles in sustained VF versus 11 ± 18% of cycles in self-limiting VF (p < 0.001); and 2) maximum continuous rotations were greater in sustained (17 ± 11, range 7 to 48) versus self-limiting VF (1.1 ± 1.4, range 0 to 4, p < 0.001). Additionally, biventricular rotor locations in sustained VF were conserved across multiple inductions (7 of 7 patients, p = 0.025). CONCLUSIONS In patients with and without structural heart disease, the formation of stable rotors identifies individuals whose VF requires defibrillation from those in whom VF spontaneously self-terminates. Future work should define the mechanisms that stabilize rotors and evaluate whether rotor modulation may reduce subsequent VF risk.
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Affiliation(s)
- David E Krummen
- University of California San Diego, San Diego, California; Veterans Affairs San Diego Healthcare System, San Diego, California.
| | - Justin Hayase
- University of California San Diego, San Diego, California; Veterans Affairs San Diego Healthcare System, San Diego, California
| | - David J Morris
- University of California San Diego, San Diego, California; Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Jeffrey Ho
- University of California San Diego, San Diego, California; Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Miriam R Smetak
- Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Paul Clopton
- Veterans Affairs San Diego Healthcare System, San Diego, California
| | | | - Sanjiv M Narayan
- University of California San Diego, San Diego, California; Veterans Affairs San Diego Healthcare System, San Diego, California
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Bishop MJ, Burton RAB, Kalla M, Nanthakumar K, Plank G, Bub G, Vigmond EJ. Mechanism of reentry induction by a 9-V battery in rabbit ventricles. Am J Physiol Heart Circ Physiol 2014; 306:H1041-53. [PMID: 24464758 DOI: 10.1152/ajpheart.00591.2013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although the application of a 9-V battery to the epicardial surface is a simple method of ventricular fibrillation induction, the fundamental mechanisms underlying this process remain unstudied. We used a combined experimental and modelling approach to understand how the interaction of direct current (DC) from a battery may induce reentrant activity within rabbit ventricles and its dependence on battery application timing and duration. A rabbit ventricular computational model was used to simulate 9-V battery stimulation for different durations at varying onset times during sinus rhythm. Corresponding high-resolution optical mapping measurements were conducted on rabbit hearts with DC stimuli applied via a relay system. DC application to diastolic tissue induced anodal and cathodal make excitations in both simulations and experiments. Subsequently, similar static epicardial virtual electrode patterns were formed that interacted with sinus beats but did not induce reentry. Upon battery release during diastole, break excitations caused single ectopics, similar to application, before sinus rhythm resumed. Reentry induction was possible for short battery applications when break excitations were slowed and forced to take convoluted pathways upon interaction with refractory tissue from prior make excitations or sinus beats. Short-lived reentrant activity could be induced for battery release shortly after a sinus beat for longer battery applications. In conclusion, the application of a 9-V battery to the epicardial surface induces reentry through a complex interaction of break excitations after battery release with prior induced make excitations or sinus beats.
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Affiliation(s)
- Martin J Bishop
- Department of Biomedical Engineering, King's College London, London, United Kingdom
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Hayase J, Tung R, Narayan SM, Krummen DE. A case of a human ventricular fibrillation rotor localized to ablation sites for scar-mediated monomorphic ventricular tachycardia. Heart Rhythm 2013; 10:1913-6. [PMID: 23911894 DOI: 10.1016/j.hrthm.2013.07.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Indexed: 11/20/2022]
Affiliation(s)
- Justin Hayase
- University of California San Diego, San Diego, California; Veterans Affairs San Diego Healthcare System, San Diego, California
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Abstract
The objective of this article is to present a broad review of the role of cardiac electric rotors and their accompanying spiral waves in the mechanism of cardiac fibrillation. At the outset, we present a brief historical overview regarding reentry and then discuss the basic concepts and terminologies pertaining to rotors and their initiation. Thereafter, the intrinsic properties of rotors and spiral waves, including phase singularities, wavefront curvature, and dominant frequency maps, are discussed. The implications of rotor dynamics for the spatiotemporal organization of fibrillation, independent of the species being studied, are described next. The knowledge gained regarding the role of cardiac structure in the initiation or maintenance of rotors and the ionic bases of spiral waves in the past 2 decades, as well as the significance for drug therapy, is reviewed subsequently. We conclude by examining recent evidence suggesting that rotors are critical in sustaining both atrial and ventricular fibrillation in the human heart and its implications for treatment with radiofrequency ablation.
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Affiliation(s)
- Sandeep V Pandit
- Center for Arrhythmia Research, University of Michigan, NCRC, 2800 Plymouth Rd, Ann Arbor, MI 48109, USA
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Quintanilla JG, Moreno J, Archondo T, Chin A, Pérez-Castellano N, Usandizaga E, García-Torrent MJ, Molina-Morúa R, González P, Rodríguez-Bobada C, Macaya C, Pérez-Villacastín J. KATP channel opening accelerates and stabilizes rotors in a swine heart model of ventricular fibrillation. Cardiovasc Res 2013; 99:576-85. [PMID: 23612586 DOI: 10.1093/cvr/cvt093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The mechanisms underlying ventricular fibrillation (VF) are still disputed. Recent studies have highlighted the role of KATP-channels. We hypothesized that, under certain conditions, VF can be driven by stable and epicardially detectable rotors in large hearts. To test our hypothesis, we used a swine model of accelerated VF by opening KATP-channels with cromakalim. METHODS AND RESULTS Optical mapping, spectral analysis, and phase singularity tracking were performed in eight perfused swine hearts during VF. Pseudo-bipolar electrograms were computed. KATP-channel opening almost doubled the maximum dominant frequency (14.3 ± 2.2 vs. 26.5 ± 2.8 Hz, P < 0.001) and increased the maximum regularity index (0.82 ± 0.05 vs. 0.94 ± 0.04, P < 0.001), the density of rotors (2.0 ± 1.4 vs. 16.0 ± 7.0 rotors/cm²×s, P < 0.001), and their maximum lifespans (medians: 368 vs. ≥3410 ms, P < 0.001). Persistent rotors (≥1 movie = 3410 ms) were found in all hearts after cromakalim (mostly coinciding with the fastest and highest organized areas), but they were not epicardially visible at baseline VF. A 'beat phenomenon' ruled by inter-domain frequency gradients was observed in all hearts after cromakalim. Acceleration of VF did not reveal any significant regional preponderance. Complex fractionated electrograms were not found in areas near persistent rotors. CONCLUSION Upon KATP-channel opening, VF consisted of rapid and highly organized domains mainly due to stationary rotors, surrounded by poorly organized areas. A 'beat phenomenon' due to the quasi-periodic onset of drifting rotors was observed. These findings demonstrate the feasibility of a VF driven by stable rotors in hearts whose size is similar to the human heart. Our model also showed that complex fractionation does not seem to localize stationary rotors.
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Affiliation(s)
- Jorge G Quintanilla
- Optical Mapping Laboratory, Arrhythmia Unit, Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CP 28040, Madrid, Spain.
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Is defibrillation testing of ICDs necessary? Nat Rev Cardiol 2012; 9:618-9. [PMID: 23026864 DOI: 10.1038/nrcardio.2012.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Defibrillation testing during implantation of cardioverter–defibrillators is controversial because of potential safety concerns and a lack of evidence for the effectiveness of the procedure. New data from the SAFE-ICD study is helpful, but does not completely resolve the issue.
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Abstract
Cardiac optical mapping has proven to be a powerful technology for studying cardiovascular function and disease. The development and scientific impact of this methodology are well-documented. Because of its relevance in cardiac research, this imaging technology advances at a rapid pace. Here, we review technological and scientific developments during the past several years and look toward the future. First, we explore key components of a modern optical mapping set-up, focusing on: (1) new camera technologies; (2) powerful light-emitting-diodes (from ultraviolet to red) for illumination; (3) improved optical filter technology; (4) new synthetic and optogenetic fluorescent probes; (5) optical mapping with motion and contraction; (6) new multiparametric optical mapping techniques; and (7) photon scattering effects in thick tissue preparations. We then look at recent optical mapping studies in single cells, cardiomyocyte monolayers, atria, and whole hearts. Finally, we briefly look into the possible future roles of optical mapping in the development of regenerative cardiac research, cardiac cell therapies, and molecular genetic advances.
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Affiliation(s)
- Todd J Herron
- Department of Internal Medicine, Cardiovascular Research Center, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, USA
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Sturdivant JL, Gold MR. Pre-discharge defibrillation testing: clinically important or obsolete? Europace 2011; 14:155-6. [PMID: 22080474 DOI: 10.1093/europace/eur349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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