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Kappadan V, Sohi A, Parlitz U, Luther S, Uzelac I, Fenton F, Peters NS, Christoph J, Ng FS. Optical mapping of contracting hearts. J Physiol 2023; 601:1353-1370. [PMID: 36866700 PMCID: PMC10952556 DOI: 10.1113/jp283683] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/27/2023] [Indexed: 03/04/2023] Open
Abstract
Optical mapping is a widely used tool to record and visualize the electrophysiological properties in a variety of myocardial preparations such as Langendorff-perfused isolated hearts, coronary-perfused wedge preparations, and cell culture monolayers. Motion artifact originating from the mechanical contraction of the myocardium creates a significant challenge to performing optical mapping of contracting hearts. Hence, to minimize the motion artifact, cardiac optical mapping studies are mostly performed on non-contracting hearts, where the mechanical contraction is removed using pharmacological excitation-contraction uncouplers. However, such experimental preparations eliminate the possibility of electromechanical interaction, and effects such as mechano-electric feedback cannot be studied. Recent developments in computer vision algorithms and ratiometric techniques have opened the possibility of performing optical mapping studies on isolated contracting hearts. In this review, we discuss the existing techniques and challenges of optical mapping of contracting hearts.
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Affiliation(s)
- Vineesh Kappadan
- National Heart and Lung Institute (NHLI)Imperial College LondonLondonUK
| | - Anies Sohi
- National Heart and Lung Institute (NHLI)Imperial College LondonLondonUK
| | - Ulrich Parlitz
- Biomedical Physcis GroupMax Planck Institute for Dynamics and Self‐OrganizationGöttingenGermany
| | - Stefan Luther
- Biomedical Physcis GroupMax Planck Institute for Dynamics and Self‐OrganizationGöttingenGermany
| | - Ilija Uzelac
- School of PhysicsGeorgia Institute of TechnologyAtlantaGAUSA
| | - Flavio Fenton
- School of PhysicsGeorgia Institute of TechnologyAtlantaGAUSA
| | - Nicholas S Peters
- National Heart and Lung Institute (NHLI)Imperial College LondonLondonUK
| | - Jan Christoph
- Cardiovascular Research InstituteUniversity of CaliforniaSan FranciscoCAUSA
| | - Fu Siong Ng
- National Heart and Lung Institute (NHLI)Imperial College LondonLondonUK
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Cumberland MJ, Riebel LL, Roy A, O’Shea C, Holmes AP, Denning C, Kirchhof P, Rodriguez B, Gehmlich K. Basic Research Approaches to Evaluate Cardiac Arrhythmia in Heart Failure and Beyond. Front Physiol 2022; 13:806366. [PMID: 35197863 PMCID: PMC8859441 DOI: 10.3389/fphys.2022.806366] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/10/2022] [Indexed: 12/20/2022] Open
Abstract
Patients with heart failure often develop cardiac arrhythmias. The mechanisms and interrelations linking heart failure and arrhythmias are not fully understood. Historically, research into arrhythmias has been performed on affected individuals or in vivo (animal) models. The latter however is constrained by interspecies variation, demands to reduce animal experiments and cost. Recent developments in in vitro induced pluripotent stem cell technology and in silico modelling have expanded the number of models available for the evaluation of heart failure and arrhythmia. An agnostic approach, combining the modalities discussed here, has the potential to improve our understanding for appraising the pathology and interactions between heart failure and arrhythmia and can provide robust and validated outcomes in a variety of research settings. This review discusses the state of the art models, methodologies and techniques used in the evaluation of heart failure and arrhythmia and will highlight the benefits of using them in combination. Special consideration is paid to assessing the pivotal role calcium handling has in the development of heart failure and arrhythmia.
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Affiliation(s)
- Max J. Cumberland
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Leto L. Riebel
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Ashwin Roy
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Christopher O’Shea
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Andrew P. Holmes
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Chris Denning
- Stem Cell Biology Unit, Biodiscovery Institute, British Heart Foundation Centre for Regenerative Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Blanca Rodriguez
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Katja Gehmlich
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford and British Heart Foundation Centre of Research Excellence Oxford, Oxford, United Kingdom
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Iijima K, Zhang H, Strachan MT, Huang J, Walcott GP, Rogers JM. Right ventricular insertion promotes reinitiation of ventricular fibrillation in defibrillation failure. Heart Rhythm 2021; 18:995-1003. [PMID: 33508518 PMCID: PMC8169561 DOI: 10.1016/j.hrthm.2021.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/04/2021] [Accepted: 01/18/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Shocks near defibrillation threshold (nDFT) strength commonly extinguish all ventricular fibrillation (VF) wavefronts, but a train of rapid, well-organized postshock activations (PAs) typically appears before sinus rhythm ensues. If one of the PA waves undergoes partial propagation block (wavebreak), reentry may be induced, causing VF to reinitiate and the shock to fail. OBJECTIVE The purpose of this study was to determine whether wavebreak leading to VF reinititation following nDFT shocks occurs preferentially at the right ventricular insertion (RVI), which previous studies have identified as a key site for wavebreak. METHODS We used panoramic optical mapping to image the ventricular epicardium of 6 isolated swine hearts during nDFT defibrillation episodes. After each experiment, the hearts were fixed and their geometry scanned with magnetic resonance imaging (MRI). The MRI and mapping datasets were spatially coregistered. For failed shocks, we identified the site of the first wavebreak of a PA wave during VF reinitiation. RESULTS We recorded 59 nDFT failures. In 31 of these, the first wavebreak event occurred within 1 cm of the RVI centerline, most commonly on the anterior side of the right ventricular insertion (aRVI) (23/31). The aRVI region occupies 16.8% ± 2.5% of the epicardial surface and would be expected to account for only 10 wavebreaks if they were uniformly distributed. By χ2 analysis, aRVI wavebreaks were significantly overrepresented. CONCLUSION The anterior RVI is a key site in promoting nDFT failure. Targeting this site to prevent wavebreak could convert defibrillation failure to success and improve defibrillation efficacy.
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Affiliation(s)
- Kenichi Iijima
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hanyu Zhang
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew T Strachan
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jian Huang
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gregory P Walcott
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jack M Rogers
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama.
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Shibata N, Inada S, Nakazawa K, Tomii N, Yamazaki M, Seno H, Honjo H, Sakuma I. Mechanism of Electrical Defibrillation: Current Status and Future Perspective. ADVANCED BIOMEDICAL ENGINEERING 2020. [DOI: 10.14326/abe.9.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Nitaro Shibata
- Department of Cardiology, Shinjuku Mitsui Building Clinic
| | - Shin Inada
- Faculty of Health Sciences, Morinomiya University of Medical Sciences
| | - Kazuo Nakazawa
- Faculty of Health Sciences, Morinomiya University of Medical Sciences
| | - Naoki Tomii
- Department of Bioengineering, The University of Tokyo
| | | | - Hiroshi Seno
- Department of Bioengineering, The University of Tokyo
| | - Haruo Honjo
- Research Institute of Environmental Medicine, Nagoya University
| | - Ichiro Sakuma
- Department of Bioengineering, The University of Tokyo
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Karathanos TV, Bayer JD, Wang D, Boyle PM, Trayanova NA. Opsin spectral sensitivity determines the effectiveness of optogenetic termination of ventricular fibrillation in the human heart: a simulation study. J Physiol 2016; 594:6879-6891. [PMID: 26941055 PMCID: PMC5134403 DOI: 10.1113/jp271739] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/01/2016] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Optogenetics-based defibrillation, a theoretical alternative to electrotherapy, involves expression of light-sensitive ion channels in the heart (via gene or cell therapy) and illumination of the cardiac surfaces (via implanted LED arrays) to elicit light-induced activations. We used a biophysically detailed human ventricular model to determine whether such a therapy could terminate fibrillation (VF) and identify which combinations of light-sensitive ion channel properties and illumination configurations would be effective. Defibrillation was successful when a large proportion (> 16.6%) of ventricular tissue was directly stimulated by light that was bright enough to induce an action potential in an uncoupled cell. While illumination with blue light never successfully terminated VF, illumination of red light-sensitive ion channels with dense arrays of implanted red light sources resulted in successful defibrillation. Our results suggest that cardiac expression of red light-sensitive ion channels is necessary for the development of effective optogenetics-based defibrillation therapy using LED arrays. ABSTRACT Optogenetics-based defibrillation has been proposed as a novel and potentially pain-free approach to enable cardiomyocyte-selective defibrillation in humans, but the feasibility of such a therapy remains unknown. This study aimed to (1) assess the feasibility of terminating sustained ventricular fibrillation (VF) via light-induced excitation of opsins expressed throughout the myocardium and (2) identify the ideal (theoretically possible) opsin properties and light source configurations that would maximise therapeutic efficacy. We conducted electrophysiological simulations in an MRI-based human ventricular model with VF induced by rapid pacing; light sensitisation via systemic, cardiac-specific gene transfer of channelrhodopsin-2 (ChR2) was simulated. In addition to the widely used blue light-sensitive ChR2-H134R, we also modelled theoretical ChR2 variants with augmented light sensitivity (ChR2+), red-shifted spectral sensitivity (ChR2-RED) or both (ChR2-RED+). Light sources were modelled as synchronously activating LED arrays (LED radius: 1 mm; optical power: 10 mW mm-2 ; array density: 1.15-4.61 cm-2 ). For each unique optogenetic configuration, defibrillation was attempted with two different optical pulse durations (25 and 500 ms). VF termination was only successful for configurations involving ChR2-RED and ChR2-RED+ (for LED arrays with density ≥ 2.30 cm-2 ), suggesting that opsin spectral sensitivity was the most important determinant of optogenetic defibrillation efficacy. This was due to the deeper penetration of red light in cardiac tissue compared with blue light, which resulted in more widespread light-induced propagating wavefronts. Longer pulse duration and higher LED array density were associated with increased optogenetic defibrillation efficacy. In all cases observed, the defibrillation mechanism was light-induced depolarisation of the excitable gap, which led to block of reentrant wavefronts.
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Affiliation(s)
- Thomas V. Karathanos
- Institute for Computational MedicineDepartment of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMDUSA
| | - Jason D. Bayer
- LIRYC Electrophysiology and Heart Modelling InstituteUniversity of BordeauxBordeauxFrance
| | - Dafang Wang
- Institute for Computational MedicineDepartment of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMDUSA
| | - Patrick M. Boyle
- Institute for Computational MedicineDepartment of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMDUSA
| | - Natalia A. Trayanova
- Institute for Computational MedicineDepartment of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMDUSA
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
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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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Thunsiri K, Shinlapawittayatorn K, Chinda K, Palee S, Surinkaew S, Chattipakorn SC, KenKnight BH, Chattipakorn N. Application of vagus nerve stimulation from the onset of ventricular fibrillation to post-shock period improves defibrillation efficacy. Int J Cardiol 2014; 176:1030-2. [DOI: 10.1016/j.ijcard.2014.07.302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 07/26/2014] [Indexed: 10/24/2022]
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Dura M, Schröder-Schetelig J, Luther S, Lehnart SE. Toward panoramic in situ mapping of action potential propagation in transgenic hearts to investigate initiation and therapeutic control of arrhythmias. Front Physiol 2014; 5:337. [PMID: 25249982 PMCID: PMC4157545 DOI: 10.3389/fphys.2014.00337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/19/2014] [Indexed: 11/23/2022] Open
Abstract
To investigate the dynamics and propensity for arrhythmias in intact transgenic hearts comprehensively, optical strategies for panoramic fluorescence imaging of action potential (AP) propagation are essential. In particular, mechanism-oriented molecular studies usually depend on transgenic mouse hearts of only a few millimeters in size. Furthermore, the temporal scales of the mouse heart remain a challenge for panoramic fluorescence imaging with heart rates ranging from 200 min−1 (e.g., depressed sinus node function) to over 1200 min−1 during fast arrhythmias. To meet these challenging demands, we and others developed physiologically relevant mouse models and characterized their hearts with planar AP mapping. Here, we summarize the progress toward panoramic fluorescence imaging and its prospects for the mouse heart. In general, several high-resolution cameras are synchronized and geometrically arranged for panoramic voltage mapping and the surface and blood vessel anatomy documented through image segmentation and heart surface reconstruction. We expect that panoramic voltage imaging will lead to novel insights about molecular arrhythmia mechanisms through quantitative strategies and organ-representative analysis of intact mouse hearts.
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Affiliation(s)
- Miroslav Dura
- Heart Research Center Göttingen Göttingen, Germany ; Department of Cardiology and Pulmonology, University Medical Center Göttingen Göttingen, Germany
| | - Johannes Schröder-Schetelig
- Heart Research Center Göttingen Göttingen, Germany ; Biomedical Physics, Max Planck Institute for Dynamics and Self-Organization Göttingen, Germany ; Institute for Nonlinear Dynamics, Georg-August-Universität Göttingen Göttingen, Germany
| | - Stefan Luther
- Heart Research Center Göttingen Göttingen, Germany ; Biomedical Physics, Max Planck Institute for Dynamics and Self-Organization Göttingen, Germany ; Institute for Nonlinear Dynamics, Georg-August-Universität Göttingen Göttingen, Germany ; German Centre for Cardiovascular Research (DZHK), partner site Göttingen (DZHK-GOE) Göttingen, Germany
| | - Stephan E Lehnart
- Heart Research Center Göttingen Göttingen, Germany ; Department of Cardiology and Pulmonology, University Medical Center Göttingen Göttingen, Germany ; German Centre for Cardiovascular Research (DZHK), partner site Göttingen (DZHK-GOE) Göttingen, Germany
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9
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Trayanova NA, Rantner LJ. New insights into defibrillation of the heart from realistic simulation studies. Europace 2014; 16:705-13. [PMID: 24798960 PMCID: PMC4010179 DOI: 10.1093/europace/eut330] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/17/2013] [Indexed: 11/12/2022] Open
Abstract
Cardiac defibrillation, as accomplished nowadays by automatic, implantable devices, constitutes the most important means of combating sudden cardiac death. Advancing our understanding towards a full appreciation of the mechanisms by which a shock interacts with the heart, particularly under diseased conditions, is a promising approach to achieve an optimal therapy. The aim of this article is to assess the current state-of-the-art in whole-heart defibrillation modelling, focusing on major insights that have been obtained using defibrillation models, primarily those of realistic heart geometry and disease remodelling. The article showcases the contributions that modelling and simulation have made to our understanding of the defibrillation process. The review thus provides an example of biophysically based computational modelling of the heart (i.e. cardiac defibrillation) that has advanced the understanding of cardiac electrophysiological interaction at the organ level, and has the potential to contribute to the betterment of the clinical practice of defibrillation.
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Affiliation(s)
- Natalia A. Trayanova
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 3400 N Charles Street, 216 Hackerman Hall, Baltimore, MD 21218, USA
- Institute for Computational Medicine, Johns Hopkins University, 3400 N Charles Street, Baltimore, MD 21218, USA
| | - Lukas J. Rantner
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 3400 N Charles Street, 216 Hackerman Hall, Baltimore, MD 21218, USA
- Institute for Computational Medicine, Johns Hopkins University, 3400 N Charles Street, Baltimore, MD 21218, USA
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Jin Q, Zhang N, Zhou J, Lin CJ, Pang Y, Gu G, Shen WF, Wu LQ. The effect of pinacidil on postshock activation and ventricular defibrillation threshold in canine hearts. Acta Pharmacol Sin 2012; 33:1488-94. [PMID: 23064720 DOI: 10.1038/aps.2012.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIM To determine the postshock activation patterns with both successful and failed shocks in a canine model of ventricular fibrillation, and whether piniacidil, an early after-depolarization (EAD) inhibitor, altered the defibrillation threshold (DFT) and postshock activation patterns. METHODS In 6 beagles, a basket catheter with 64 unipolar electrodes was placed in the LV for global endocardial mapping, a monophasic action potential catheter was inserted into the LV apex, and a catheter with the negative electrode in the right ventricle and the positive electrode in the superior vena cava was inserted for defibrillation. The DFT, 90% action potential duration (APD(90)) and activation recovery interval (ARI) were evaluated before and after pinacidil administration (loading dosage 0.5 mg/kg and maintenance dosage 0.5 mg·kg(-1)·h(-1), iv). Electrical heterogeneities were defined with the dispersion of ARI. After successful and failed shocks with near-DFT strength, the earliest postshock activation patterns (focal or nonfocal endocardial activation), interval and location were detected. RESULTS Pinacidil significantly decreased APD(90) (from 178±16 ms to 168±18 ms) and ARI from (152±10 ms to 143±10 ms) at pacing cycle length of 300 ms. The drug significantly increased VF activation rate (from 10.0±1.9 Hz to 10.8±2.0 Hz). The drug did not affect the dispersion of ARI, neither it changed DFT (baseline: 480±110 V; pinacidil: 425±55 V, P>0.05). The earliest postshock activation arose locally on the LV apical endocardium before and after the drug treatment. Pinacidil significantly prolonged the postshock cycle length of cycles 2 to 5 for the successful episodes but not for the failed episodes. CONCLUSION Pinacidil increases the postshock cycle length suggesting that EAD may play a role in postshock activation, while it fails to alter DFT suggesting that EAD produced by shock does not determine a defibrillation success or failure.
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Trayanova N, Constantino J, Ashihara T, Plank G. Modeling defibrillation of the heart: approaches and insights. IEEE Rev Biomed Eng 2012; 4:89-102. [PMID: 22273793 DOI: 10.1109/rbme.2011.2173761] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiac defibrillation, as accomplished nowadays by automatic, implantable devices (ICDs), constitutes the most important means of combating sudden cardiac death. While ICD therapy has proved to be efficient and reliable, defibrillation is a traumatic experience. Thus, research on defibrillation mechanisms, particularly aimed at lowering defibrillation voltage, remains an important topic. Advancing our understanding towards a full appreciation of the mechanisms by which a shock interacts with the heart is the most promising approach to achieve this goal. The aim of this paper is to assess the current state-of-the-art in ventricular defibrillation modeling, focusing on both numerical modeling approaches and major insights that have been obtained using defibrillation models, primarily those of realistic ventricular geometry. The paper showcases the contributions that modeling and simulation have made to our understanding of the defibrillation process. The review thus provides an example of biophysically based computational modeling of the heart (i.e., cardiac defibrillation) that has advanced the understanding of cardiac electrophysiological interaction at the organ level and has the potential to contribute to the betterment of the clinical practice of defibrillation.
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Affiliation(s)
- Natalia Trayanova
- Department of Biomedical Engineering and Institute for Computational Medicine, The Johns Hopkins University, Baltimore, MD 20218, USA.
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Abstract
Electrical shock has been the one effective treatment for ventricular fibrillation for several decades. With the advancement of electrical and optical mapping techniques, histology, and computer modeling, the mechanisms responsible for defibrillation are now coming to light. In this review, we discuss recent work that demonstrates the various mechanisms responsible for defibrillation. On the cellular level, membrane depolarization and electroporation affect defibrillation outcome. Cell bundles and collagenous septae are secondary sources and cause virtual electrodes at sites far from shocking electrodes. On the whole-heart level, shock field gradient and critical points determine whether a shock is successful or whether reentry causes initiation and continuation of fibrillation.
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Affiliation(s)
- Derek J Dosdall
- Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
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13
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Constantino J, Long Y, Ashihara T, Trayanova NA. Tunnel propagation following defibrillation with ICD shocks: hidden postshock activations in the left ventricular wall underlie isoelectric window. Heart Rhythm 2010; 7:953-61. [PMID: 20348028 DOI: 10.1016/j.hrthm.2010.03.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 03/20/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND After near-defibrillation threshold (DFT) shocks from an implantable cardioverter-defibrillator (ICD), the first postshock activation that leads to defibrillation failure arises focally after an isoelectric window (IW). The mechanisms underlying the IW remain incompletely understood. OBJECTIVE The goal of this study was to provide mechanistic insight into the origins of postshock activations and IW after ICD shocks, and to link shock outcome to the preshock state of the ventricles. We hypothesized that the nonuniform ICD field results in the formation of an intramural excitable area (tunnel) only in the left ventricular (LV) free wall, through which both pre-existing and new shock-induced wavefronts propagate during the IW. METHODS Simulations were conducted using a realistic three dimensional (3D) model of defibrillation in the rabbit ventricles. Biphasic ICD shocks of varying strengths were delivered to 27 different fibrillatory states. RESULTS After near-DFT shocks, regardless of preshock state, the main postshock excitable area was always located within LV free wall, creating an intramural tunnel. Either pre-existing fibrillatory or shock-induced wavefronts propagated during the IW (duration of up to 74 ms) in this tunnel and emerged as breakthroughs on LV epicardium. Preshock activity within the LV played a significant role in shock outcome: a large number of preshock filaments resulted in an IW associated with tunnel propagation of pre-existing rather than shock-induced wavefronts. Furthermore, shocks were more likely to succeed if the LV excitable area was smaller. CONCLUSION The LV intramural excitable area is the primary reason for near-DFT failure. Any intervention that decreases the extent of this area will improve the likelihood of defibrillation success.
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Affiliation(s)
- Jason Constantino
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
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Daubert JP, Sheu SS. Mystery of biphasic defibrillation waveform efficacy is it calcium? J Am Coll Cardiol 2008; 52:836-8. [PMID: 18755346 DOI: 10.1016/j.jacc.2008.05.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Accepted: 05/20/2008] [Indexed: 11/28/2022]
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Dosdall DJ, Sweeney JD. Extended charge banking model of dual path shocks for implantable cardioverter defibrillators. Biomed Eng Online 2008; 7:22. [PMID: 18673561 PMCID: PMC2527568 DOI: 10.1186/1475-925x-7-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Accepted: 08/01/2008] [Indexed: 11/15/2022] Open
Abstract
Background Single path defibrillation shock methods have been improved through the use of the Charge Banking Model of defibrillation, which predicts the response of the heart to shocks as a simple resistor-capacitor (RC) circuit. While dual path defibrillation configurations have significantly reduced defibrillation thresholds, improvements to dual path defibrillation techniques have been limited to experimental observations without a practical model to aid in improving dual path defibrillation techniques. Methods The Charge Banking Model has been extended into a new Extended Charge Banking Model of defibrillation that represents small sections of the heart as separate RC circuits, uses a weighting factor based on published defibrillation shock field gradient measures, and implements a critical mass criteria to predict the relative efficacy of single and dual path defibrillation shocks. Results The new model reproduced the results from several published experimental protocols that demonstrated the relative efficacy of dual path defibrillation shocks. The model predicts that time between phases or pulses of dual path defibrillation shock configurations should be minimized to maximize shock efficacy. Discussion Through this approach the Extended Charge Banking Model predictions may be used to improve dual path and multi-pulse defibrillation techniques, which have been shown experimentally to lower defibrillation thresholds substantially. The new model may be a useful tool to help in further improving dual path and multiple pulse defibrillation techniques by predicting optimal pulse durations and shock timing parameters.
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Affiliation(s)
- Derek J Dosdall
- Department of Biomedical Engineering at the University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Gray RA, Huelsing DJ. Excito-oscillatory dynamics as a mechanism of ventricular fibrillation. Heart Rhythm 2008; 5:575-84. [PMID: 18362026 DOI: 10.1016/j.hrthm.2008.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Accepted: 01/08/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND The instabilities associated with reentrant spiral waves are of paramount importance to the initiation and maintenance of tachyarrhythmias, especially ventricular fibrillation (VF). In addition to tissue heterogeneities, there are only a few basic purported mechanisms of spiral wave breakup, most notably restitution. OBJECTIVE We test the hypothesis that oscillatory membrane properties act to destabilize spiral waves. METHODS We recorded transmembrane potential (V(m)) from isolated rabbit myocytes using a constant current stimulation protocol. We developed a mathematical model that included both the stable excitable equilibrium point at resting V(m) (-80 mV) and the unstable oscillatory equilibrium point at elevated V(m) (-10 mV). Spiral wave dynamics were studied in 2-dimensional grids using variants of the model. RESULTS All models showed restitution and reproduced the experimental values of transmembrane resistance at rest and during the action potential plateau. Stable spiral waves were observed when the model showed only 1 equilibrium point. However, spatio-temporal complexity was observed if the model showed both excitable and oscillatory equilibrium points (i.e., excito-oscillatory models). The initial wave breaks resulted from oscillatory waves expanding in all directions; after a few beats, the patterns were characterized by a combination of unstable spiral waves and target patterns consistent with the patterns observed on the heart surface during VF. In our model, this VF-like activity only occurred when the single cell period of V(m) oscillations was within a specific range. CONCLUSION The VF-like patterns observed in our excito-oscillatory models could not be explained by the existing proposed instability mechanisms. Our results introduce the important suggestion that membrane dynamics responsible for V(m) oscillations at elevated V(m) levels can destabilize spiral waves and thus may be a novel therapeutic target for preventing VF.
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Affiliation(s)
- Richard A Gray
- Department of Biomedical Engineering at the University of Alabama at Birmingham, Birmingham, Alabama 35294-0019, USA.
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Chattipakorn N, Shinlapawiittayatorn K, Sungnoon R, Chattipakorn S. Fish oil does not improve defibrillation efficacy. Int J Cardiol 2007; 122:85-6. [PMID: 17187881 DOI: 10.1016/j.ijcard.2006.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 11/02/2006] [Indexed: 11/20/2022]
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Chattipakorn N. Preshock phase singularity and defibrillation outcome: Another piece to solve the jigsaw puzzle? Heart Rhythm 2007; 4:935-7. [PMID: 17599681 DOI: 10.1016/j.hrthm.2007.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Indexed: 11/16/2022]
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Hayashi H, Lin SF, Chen PS. Preshock phase singularity and the outcome of ventricular defibrillation. Heart Rhythm 2007; 4:927-34. [PMID: 17599680 DOI: 10.1016/j.hrthm.2007.02.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Accepted: 02/28/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Phase singularity (PS) is a topological defect that serves as a source of ventricular fibrillation (VF). Whether or not the quantity of preshock PS determines defibrillation outcome is unclear. OBJECTIVE The purpose of this study was to test the hypothesis that the number of PSs at the time of shock is an important factor that determines the shock outcome. METHODS Isolated, perfused rabbit hearts (n = 7) were optically mapped with a potentiometric dye (di-4-ANNEPS). Shocks were delivered during short (10 seconds) and long (1 minute) VF, and the outcome was classified as successful type A (immediate termination), type B (postshock repetitive responses before termination), and unsuccessful. RESULTS When shock strengths of 50% probability of successful defibrillation (DFT50) +/- 50 V were given in short VF, the types A and B and unsuccessful shocks were associated with a preshock PS number of 0.3 +/- 0.4, 1.4 +/- 0.3, and 1.5 +/- 0.4 (P <.01 by analysis of variance) and shock strengths of 205 +/- 77, 207 +/- 65, and 173 +/- 74 V (P <.01), respectively. When the same shocks were applied during long VF, the PS numbers were 1.7 +/- 0.5, 3.0 +/- 0.5, and 3.5 +/- 0.6, respectively (P <.01), and the shock strengths were 282 +/- 100, 283 +/- 135, and 256 +/- 126 V, respectively (P <.01). If we only analyze shocks with strength at DFT(50), the preshock PS number was still significantly different for short VF (0.6 +/- 0.5, 1.6 +/- 0.9, and 1.5 +/- 0.8; P <.05) and for long VF (1.4 +/- 0.5, 2.7 +/- 0.6, and 2.7+/-1.3; P <.05), respectively. All preshock PSs were eliminated by shocks. However, rapid repetitive activity was then reinitiated in unsuccessful and type B successful shocks but not in type A successful shocks. CONCLUSIONS A low number or an absence of preshock PS was associated with type A successful defibrillation. There was no difference in preshock PS numbers between unsuccessful and type B successful defibrillation.
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Affiliation(s)
- Hideki Hayashi
- Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, CA 90048, USA.
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20
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Meunier JM, Ramalingam S, Lin SF, Patwardhan AR. Capture of activation during ventricular arrhythmia using distributed stimulation. J Interv Card Electrophysiol 2007; 18:207-15. [PMID: 17520359 DOI: 10.1007/s10840-007-9094-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Accepted: 02/25/2007] [Indexed: 11/29/2022]
Abstract
UNLABELLED Results of previous studies suggest that pacing strength stimuli can capture activation during ventricular arrhythmia locally near pacing sites. The existence of spatio-temporal distribution of excitable gap during arrhythmia suggests that multiple and timed stimuli delivered over a region may permit capture over larger areas. OBJECTIVE OF THE STUDY Our objective in this study was to evaluate the efficacy of using spatially distributed pacing (DP) to capture activation during ventricular arrhythmia. METHODS Data were obtained from rabbit hearts which were placed against a lattice of parallel wires through which biphasic pacing stimuli were delivered. Electrical activity was recorded optically. Pacing stimuli were delivered in sequence through the parallel wires starting with the wire closest to the apex and ending with one closest to the base. Inter-stimulus delay was based on conduction velocity. Time-frequency analysis of optical signals was used to determine variability in activation. A decrease in standard deviation of dominant frequencies of activation from a grid of locations that spanned the captured area and a concurrence with paced frequency were used as an index of capture. RESULTS Results from five animals showed that the average standard deviation decreased from 0.81 Hz during arrhythmia to 0.66 Hz during DP at pacing cycle length of 125 ms (p = 0.03) reflecting decreased spatio-temporal variability in activation during DP. Results of time-frequency analysis during these pacing trials showed agreement between activation and paced frequencies. CONCLUSIONS These results show that spatially distributed and timed stimulation can be used to modify and capture activation during ventricular arrhythmia.
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Affiliation(s)
- Jason M Meunier
- 2 Wenner-Gren Research Laboratory, The Center for Biomedical Engineering, The University of Kentucky, Lexington, KY 40506-0070, USA
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21
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22
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Dosdall DJ, Cheng KA, Huang J, Allison JS, Allred JD, Smith WM, Ideker RE. Transmural and endocardial Purkinje activation in pigs before local myocardial activation after defibrillation shocks. Heart Rhythm 2007; 4:758-65. [PMID: 17556199 PMCID: PMC2077846 DOI: 10.1016/j.hrthm.2007.02.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Accepted: 02/13/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Earliest recorded postshock myocardial activations in pigs originate in the subepicardium of the apex and lateral free wall of the left ventricle (LV) 30-90 ms after the shock. OBJECTIVE The purpose of this study was to determine whether the Purkinje system is a candidate for the source of postshock activations by performing endocardial and transmural postshock activation mapping. METHODS In five pigs, 32 plunge needles with 12 electrodes (1-mm spacing) were inserted into the LV apex and lateral free wall. Up to 70 plunge needles with six electrodes (2-mm spacing) were spread throughout the remainder of the LV, while 9-12 plunge needles with four electrodes (2-mm spacing) were inserted into the right ventricle. A basket catheter with 32 bipolar recording sites was inserted into the LV. Defibrillation-threshold (DFT)-level shocks were delivered during 10 episodes of electrically induced ventricular fibrillation. Electrograms of postshock activation cycles were analyzed for Purkinje and myocardial activations. RESULTS Purkinje activations were recorded before local myocardial activation in 9% of basket electrograms and in 15% of plunge needles during the first postshock activation cycle. Purkinje activations were identified during the first and subsequent several postshock activation cycles in at least one basket and one needle electrogram in 96% and 98% of defibrillation episodes, respectively. CONCLUSIONS The Purkinje system is active during the early postshock activation cycles after DFT-level shocks. Further studies are required to determine whether activation initiates in the Purkinje system or whether it is activated by the myocardium or by Purkinje-myocardial junctional cells.
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Affiliation(s)
- Derek J. Dosdall
- University of Alabama at Birmingham, Department of Biomedical Engineering Birmingham, Alabama, USA
| | - Kang-An Cheng
- University of Alabama at Birmingham, Department of Medicine Birmingham, Alabama, USA
| | - Jian Huang
- University of Alabama at Birmingham, Department of Medicine Birmingham, Alabama, USA
| | - J. Scott Allison
- University of Alabama at Birmingham, Department of Medicine Birmingham, Alabama, USA
| | - James D. Allred
- University of Alabama at Birmingham, Department of Medicine Birmingham, Alabama, USA
| | - William M. Smith
- University of Alabama at Birmingham, Department of Biomedical Engineering Birmingham, Alabama, USA
- University of Alabama at Birmingham, Department of Medicine Birmingham, Alabama, USA
| | - Raymond E. Ideker
- University of Alabama at Birmingham, Department of Biomedical Engineering Birmingham, Alabama, USA
- University of Alabama at Birmingham, Department of Medicine Birmingham, Alabama, USA
- University of Alabama at Birmingham, Department of Physiology Birmingham, Alabama, USA
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Abstract
I am deeply grateful and honored to receive the 2006 Distinguished Scientist Award from the Heart Rhythm Society. Many outstanding individuals have received this award since it was established in 1982, and it is humbling to realize that my small feet are walking in the footsteps of these giants. I would be remiss if I did not thank the numerous colleagues, fellows, and students who performed most of the work leading to the papers of which I am a coauthor.
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Affiliation(s)
- Raymond E Ideker
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama, Birmingham, Alabama 35294-0019, USA.
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Swerdlow CD, Shehata M, Chen PS. Using the Upper Limit of Vulnerability to Assess Defibrillation Efficacy at Implantation of ICDs. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:258-70. [PMID: 17338725 DOI: 10.1111/j.1540-8159.2007.00659.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The upper limit of vulnerability (ULV) is the weakest shock strength at or above which ventricular fibrillation (VF) is not induced when the shock is delivered during the vulnerable period. The ULV, a measurement made in regular rhythm, provides an estimate of the minimum shock strength required for reliable defibrillation that is as accurate or more accurate than the defibrillation threshold (DFT). The ULV hypothesis of defibrillation postulates a mechanistic relationship between the ULV-measured during regular rhythm-and the minimum shock strength that defibrillates reliably. Vulnerability testing can be applied at implantable cardioverter defibrillator (ICD) implant to confirm a clinically adequate defibrillation safety margin without inducing VF in 75%-95% of ICD recipients. Alternatively, the ULV provides an accurate patient-specific safety margin with a single fibrillation-defibrillation episode. Programming first ICD shocks based on patient-specific measurements of ULV rather than programming routinely to maximum output shortens charge time and may reduce the probability of syncope as ICDs age and charge times increase. Because the ULV is more reproducible than the DFT, it provides greater statistical power for clinical research with fewer episodes of VF. Limited evidence suggests that vulnerability testing is safer than conventional defibrillation testing.
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Affiliation(s)
- Charles D Swerdlow
- Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, David Geffen School of Medicine, UCLA, Los Angeles, California, USA.
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25
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Bourn DW, Maleckar MM, Rodriguez B, Trayanova NA. Mechanistic enquiry into the effect of increased pacing rate on the upper limit of vulnerability. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2006; 364:1333-48. [PMID: 16766348 DOI: 10.1098/rsta.2006.1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The goal of this study is to investigate the mechanisms responsible for the increase in the upper limit of vulnerability (ULV; highest shock strength that induces arrhythmia) following the increase in pacing rate. To accomplish this goal, the study employs a three-dimensional bidomain finite element model of a slice through the canine ventricles. The preparation was paced eight times at a basic cycle length (BCL) of either 80 or 150ms followed by delivery of shocks of various strengths and timings. Our results demonstrate that the shock strength, which induced an arrhythmia 50% of the time, increased 20% for the faster pacing compared to the slower pacing. Analysis of the mechanisms underlying the increased vulnerability revealed that delayed post-shock activations originating in the tissue depths appear as breakthrough activations on the surfaces of the preparation following an isoelectric window (IW). However, the IW duration was consistently shorter in the faster-paced preparation. Consequently, breakthrough activations appeared on the surfaces of this preparation earlier, when the tissue was less recovered, resulting in higher probability of unidirectional block and reentry. This explains why shocks of the same strength were more likely to result in arrhythmia induction when delivered to a preparation that was rapidly paced.
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Affiliation(s)
- David W Bourn
- Tulane University, Department of Biomedical Engineering 7001 Freret Street, New Orleans, LA 70118, USA.
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26
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Shinlapawittayatorn K, Sungnoon R, Chattipakorn S, Chattipakorn N. Effects of Sildenafil Citrate on Defibrillation Efficacy. J Cardiovasc Electrophysiol 2006; 17:292-5. [PMID: 16643403 DOI: 10.1111/j.1540-8167.2006.00348.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although fatal arrhythmia and sudden death have been reported in patients taking sildenafil citrate, its effect on defibrillation efficacy has not been investigated. The aim of this study was to test the hypothesis that sildenafil citrate increases the shock strength required to successfully defibrillate during ventricular fibrillation (VF). METHODS AND RESULTS A total of 26 pigs (20-25 kg) were randomly assigned into three groups. In each group, the defibrillation threshold (DFT) was determined at the beginning of the study using a three-reversal up/down protocol. Each shock (RV-SVC, biphasic) was delivered after 10 seconds of VF. Group 1 (n = 10) received 50 mg and group 2 (n = 10) received 100 mg of sildenafil citrate intravenously at a rate of 2 mL/minute for 50 minutes. Group 3 (n = 6) received 100 mL of saline intravenously at the same rate as in group 1. The DFT was determined again after the drug (drug-DFT) and saline (saline-DFT) administration. For 100-mg sildenafil citrate infusion, the DFT (483 +/- 39 V, 18 +/- 3 J) was significantly (P < 0.003 and P < 0.01, respectively) higher than the control-DFT (407 +/- 123 V, 13 +/- 7 J). This sildenafil citrate infusion increased the DFT approximately 19% by voltage, and approximately 38% by total energy. After 50-mg sildenafil citrate infusion, the DFT (454 +/- 28 V, 15 +/- 2 J) was not different than the control DFT (449 +/- 28 V, 15 +/- 2 J). Saline infusion (391 +/- 18 V, 12 +/- 1 J) did not alter the control DFT (399 +/- 22 V, 12 +/- 1 J). CONCLUSION The 100-mg sildenafil citrate infusion, representing a supra-therapeutic plasma level, significantly increased the DFT. This finding indicates that VF occurring during supra-therapeutic sildenafil citrate treatment would require a stronger shock to successfully defibrillate.
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Affiliation(s)
- Krekwit Shinlapawittayatorn
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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27
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Bishop MJ, Rodriguez B, Eason J, Whiteley JP, Trayanova N, Gavaghan DJ. Synthesis of voltage-sensitive optical signals: application to panoramic optical mapping. Biophys J 2006; 90:2938-45. [PMID: 16443665 PMCID: PMC1414570 DOI: 10.1529/biophysj.105.076505] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Fluorescent photon scattering is known to distort optical recordings of cardiac transmembrane potentials; however, this process is not well quantified, hampering interpretation of experimental data. This study presents a novel model, which accurately synthesizes fluorescent recordings over the irregular geometry of the rabbit ventricles. Using the model, the study aims to provide quantification of fluorescent signal distortion for different optical characteristics of the preparation and of the surrounding medium. A bi-domain representation of electrical activity is combined with finite element solutions to the photon diffusion equation simulating both the excitation and emission processes, along with physically realistic boundary conditions at the epicardium, which allow simulation of different experimental setups. We demonstrate that distortion in the optical signal as a result of fluorescent photon scattering is truly a three-dimensional phenomenon and depends critically upon the geometry of the preparation, the scattering properties of the tissue, the direction of wavefront propagation, and the specifics of the experimental setup. Importantly, we show that in an anatomically accurate model of ventricular geometry and fiber orientation, the morphology of the optical signal does not provide reliable information regarding the intramural direction of wavefront propagation. These findings underscore the potential of the new model in interpreting experimental data.
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Affiliation(s)
- Martin J Bishop
- Oxford University Computing Laboratory, Oxford, United Kingdom
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28
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Mironov SF, Vetter FJ, Pertsov AM. Fluorescence imaging of cardiac propagation: spectral properties and filtering of optical action potentials. Am J Physiol Heart Circ Physiol 2006; 291:H327-35. [PMID: 16428336 DOI: 10.1152/ajpheart.01003.2005] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Fluorescence imaging using voltage-sensitive dyes is an important tool for studying electrical propagation in the heart. Yet, the low amplitude of the voltage-sensitive component in the fluorescence signal and high acquisition rates dictated by the rapid propagation of the excitation wave front make it difficult to achieve recordings with high signal-to-noise ratios. Although spatially and temporally filtering the acquired signals has become de facto one of the key elements of optical mapping, there is no consensus regarding their use. Here we characterize the spatiotemporal spectra of optically recorded action potentials and determine the distortion produced by conical filters of different sizes. On the basis of these findings, we formulate the criteria for rational selection of filter characteristics. We studied the evolution of the spatial spectra of the propagating wave front after epicardial point stimulation of the isolated, perfused right ventricular free wall of the pig heart stained with di-4-ANEPPS. We found that short-wavelength (<3 mm) spectral components represent primarily noise and surface features of the preparation (coronary vessels, fat, and connective tissue). The time domain of the optical action potential spectrum also lacks high-frequency components (>100 Hz). Both findings are consistent with the reported effect of intrinsic blurring caused by light scattering inside the myocardial wall. The absence of high-frequency spectral components allows the use of aggressive low-pass spatial and temporal filters without affecting the optical action potential morphology. We show examples where the signal-to-noise ratio increased up to 150 with <3% distortion. A generalization of our approach to the rational filter selection in various applications is discussed.
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Affiliation(s)
- Sergey F Mironov
- Department of Pharmacology, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA
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29
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Zheng X, Walcott GP, Smith WM, Ideker RE. Evidence that activation following failed defibrillation is not caused by triggered activity. J Cardiovasc Electrophysiol 2006; 16:1200-5. [PMID: 16302904 DOI: 10.1111/j.1540-8167.2005.50045.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Earliest postshock activation following failed defibrillation shocks slightly lower than the defibrillation threshold (DFT) in large animals appears to arise from a focus. We tested the hypothesis that these foci are caused by early or delayed afterdepolarizations (EADs or DADs) by performing epicardial electrical mapping and giving the EAD inhibitor pinacidil or the DAD inhibitor flunarizine to see if the foci were extinguished or altered in timing or location. METHODS AND RESULTS A sock containing 504 electrodes was placed over the entire ventricular epicardium of 12 open-chested pigs. After the DFT was determined and additional shocks given, pinacidil was administered to 6 pigs and flunarizine to 6 pigs. Then, the DFT was again determined and additional shocks were given. Pinacidil significantly shortened the effective refractory period (ERP) (162 +/- 16 vs 130 +/- 28 msec) and action potential duration (APD(90)) (179 +/- 6 vs 149 +/- 19 msec) and significantly increased the peak frequency of the power spectrum of a left ventricle (LV) electrode during ventricular fibrillation (VF) (9.3 +/- 0.6 vs 10.5 +/- 1.0 Hz), while flunarizine did not significantly alter the ERP (162 +/- 8 vs 167 +/- 18 msec) or APD(90) (187 +/- 12 vs 191 +/- 20) but significantly reduced the peak frequency (9.2 +/- 0.5 vs 7.5 +/- 1.0 Hz). These findings suggest the drugs had their expected electrophysiological effects. However, the DFT was not significantly changed by either drug. Following the same strength shock 10% below the predrug DFT, earliest postshock activation arose in a focal epicardial pattern from the anterior-apical LV both before and after the drugs. The time from the shock until the appearance of this activation was not significantly different before and after either drug. CONCLUSION The lack of change in DFT as well as the lack of change in the incidence, location, and timing of the postshock focus with sub-DFT strength shocks before and after pinacidil and flunarizine provide evidence that these foci are not caused by triggered activity.
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Affiliation(s)
- Xiangsheng Zheng
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
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Caldwell BJ, Legrice IJ, Hooks DA, Tai DCS, Pullan AJ, Smaill BH. Intramural measurement of transmembrane potential in the isolated pig heart: validation of a novel technique. J Cardiovasc Electrophysiol 2005; 16:1001-10. [PMID: 16174023 DOI: 10.1111/j.1540-8167.2005.40558.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Transmembrane potentials can be recorded at multiple intramural sites in the intact heart using fiber optic probes or optrodes. The technique has considerable potential utility for studies of arrhythmia and defibrillation, but has not been validated in large mammalian hearts. METHODS AND RESULTS An optrode was used to acquire intramural transmembrane potentials in six isolated Langendorff-perfused pig hearts. Mechanical activity was suppressed with 2,3-butanedione monoxime (BDM). Excitation light (488 nm) was delivered to and fluorescence collected from six sites, each spaced 1.4 mm apart across the left ventricle (LV) free wall that was stained with di-4 ANEPPS. Intramural membrane potentials were compared with extracellular potentials recorded at adjacent locations in sinus rhythm, and during atrial and subepicardial ventricular pacing (1-3 Hz). In three hearts, epicardial intracellular potentials were also measured close to the optrode. Optical action potentials were reproducible, with no significant transmural variation in morphology. There was close correspondence between subepicardial optical and intracellular potentials (R2 = 0.948, n = 23). The onset of activation at and its progression across adjacent optical and extracellular recording sites were consistent, as was the variation of action potential duration (APD) with cycle length. However, there was greater variability in absolute APD estimated from optical and extracellular records (R2 = 0.773, n = 258). Comparison of extracellular potentials at the same intramural sites in vivo confirms that heart isolation and BDM slow electrical propagation and depress restitution relationships, but otherwise preserve intramural patterns of electrical activation. CONCLUSIONS We have demonstrated that our optrode provides reliable intramural transmembrane potential recordings in the isolated pig heart preparation.
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Affiliation(s)
- Bryan J Caldwell
- Bioengineering Institute and Physiology Department, University of Auckland, Auckland, New Zealand
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Shinlapawittayatorn K, Chattipakorn S, Chattipakorn N. Effect of sildenafil citrate on the cardiovascular system. Braz J Med Biol Res 2005; 38:1303-11. [PMID: 16138212 DOI: 10.1590/s0100-879x2005000900003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Sildenafil citrate is a drug commonly used to manage erectile dysfunction. It is designated chemically as 1-[[3-(6,7-dihydro-1-methyl-7-oxo-3-propyl-1H -pyrazolo[4,3-d]pyrimidin-5-yl)-4 ethoxyphenyl] sulfonyl]-4-methylpiperazine citrate (C22H30N6(O4)S). It is a highly selective inhibitor of cyclic guanine monophosphate-specific phosphodiesterase type 5. In late March through mid-November 1998, the US Food and Drug Administration (FDA) published a report on 130 confirmed deaths among men (mean age, 64 years) who received prescriptions for sildenafil citrate, a period during which >6 million outpatient prescriptions (representing about 50 million tablets) were dispensed. The US FDA recently reported that significant cardiovascular events, including sudden cardiac death, have occurred in men with erectile dysfunction who were taking sildenafil citrate. These reports have raised concerns that sildenafil citrate may increase the risk of cardiovascular events, particularly fatal arrhythmias, in patients with cardiovascular disease. In the past few years, the cardiac electrophysiological effects of sildenafil citrate have been investigated extensively in both animal and clinical studies. According to extensive data available to date, sildenafil citrate has been shown to pose minimal cardiovascular risks to healthy people taking this drug. Some precautions are needed for patients with cardiovascular diseases. However, the only absolute contraindication for sildenafil citrate is the concurrent use of nitrates. This article is intended to review sildenafil citrate's cardiovascular effects, as well as current debates about its arrhythmogenic effects.
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Aizawa Y. Idiopathic ventricular fibrillation refractory to ICD therapy. Intern Med 2005; 44:777-8. [PMID: 16157969 DOI: 10.2169/internalmedicine.44.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Smaill BH, LeGrice IJ, Hooks DA, Pullan AJ, Caldwell BJ, Hunter PJ. Cardiac structure and electrical activation: models and measurement. Clin Exp Pharmacol Physiol 2005; 31:913-9. [PMID: 15659059 DOI: 10.1111/j.1440-1681.2004.04131.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
1. Our group has developed finite element models of ventricular anatomy that incorporate detailed structural information. These have been used to study normal electrical activation and re-entrant arrhythmia. 2. A model based on the actual three-dimensional microstructure of a transmural left ventricular (LV) segment predicts that cleavage planes between muscle layers may give rise to non-uniform, anisotropic electrical propagation and also provide a substrate for bulk resetting of the myocardium during defibrillation. 3. The model predictions are consistent with the results of preliminary experiments in which a novel fibre-optic probe is used to record transmembrane potentials at multiple intramural sites in the intact heart. Extracellular potentials are recorded at adjacent LV sites in these studies. 4. We conclude that structural discontinuities in ventricular myocardium may play a role in the initiation of re-entrant arrhythmia and discuss future studies that address this hypothesis.
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Affiliation(s)
- Bruce H Smaill
- Bioengineering Institute and Department of Physiology, University of Auckland, Auckland, New Zealand.
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Gray RA, Chattipakorn N. Termination of spiral waves during cardiac fibrillation via shock-induced phase resetting. Proc Natl Acad Sci U S A 2005; 102:4672-7. [PMID: 15769861 PMCID: PMC555701 DOI: 10.1073/pnas.0407860102] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Multiple unstable spiral waves rotating around phase singularities (PSs) in the heart, i.e., ventricular fibrillation (VF), is the leading cause of death in the industrialized world. Spiral waves are ubiquitous in nature and have been extensively studied by physiologists, mathematicians, chemists, and biologists, with particular emphasis on their movement and stability. Spiral waves are not easy to terminate because of the difficulty of "breaking" the continuous spatial progression of phase around the PSs. The only means to stop VF (i.e., cardiac defibrillation) is to deliver a strong electric shock to the heart. Here, we use the similarities between spiral wave dynamics and limit cycle oscillators to characterize the spatio-temporal dynamics of VF and defibrillation via phase-resetting curves. During VF, only PSs, including their formation and termination, were associated with large phase changes. At low shock strengths, phase-resetting curves exhibited characteristics of weak (type 1) resetting. As shock strength increased, the number of postshock PSs decreased to zero coincident with a transition to strong (type 0) resetting. Our results indicate that shock-induced spiral wave termination in the heart is caused by altering the phase around the PSs, such that, depending on the preshock phase, sites are either excited by membrane depolarization (phase advanced) or exhibit slowed membrane repolarization (phase delay). Strong shocks that defibrillate break the continuity of phase around PSs by forcing the state of all sites to the fast portion of state space, thus quickly leading to a "homogeneity of state," subsequent global repolarization and spiral wave termination.
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Affiliation(s)
- Richard A Gray
- Department of Biomedical Engineering, University of Alabama at Birmingham, AL 35294, USA.
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Kay MW, Amison PM, Rogers JM. Three-Dimensional Surface Reconstruction and Panoramic Optical Mapping of Large Hearts. IEEE Trans Biomed Eng 2004; 51:1219-29. [PMID: 15248538 DOI: 10.1109/tbme.2004.827261] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Optical mapping of electrical activity from the surface of the heart is a powerful tool for studying complex arrhythmias. However, a limitation of traditional optical mapping is that the mapped region is restricted to the field of view of the sensor, which makes it difficult to track electrical waves as they drift in and out of view. To address this, we developed an optical system that panoramically maps epicardial electrical activity in three dimensions. The system was engineered to accomodate hearts comparable in size to human hearts. It is comprised of a surface scanner that measures epicardial geometry and a panoramic fluorescence imaging system that records electrical activity. Custom software texture maps the electrical data onto a reconstructed epicardial surface. The result is a high resolution, spatially contiguous, mapping dataset. In addition, the three-dimensional positions of the recording sites are known, making it possible to accurately measure parameters that require geometric information, such as propagation velocity. In this paper, we describe the system and demonstrate it by mapping a swine heart.
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Affiliation(s)
- Matthew W Kay
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL 35294-0019, USA.
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Tai DCS, Caldwell BJ, LeGrice IJ, Hooks DA, Pullan AJ, Smaill BH. Correction of motion artifact in transmembrane voltage-sensitive fluorescent dye emission in hearts. Am J Physiol Heart Circ Physiol 2004; 287:H985-93. [PMID: 15130885 DOI: 10.1152/ajpheart.00574.2003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Fast voltage-sensitive dyes are widely used to image cardiac electrical activity. Typically, the emission spectrum of these fluorochromes is wavelength shifted with altered membrane potential, but the optical signals obtained also decay with time and are affected by contraction. Ratiometry reduces, but may not fully remove, these artifacts. An alternate approach has been developed in which the time decay in simultaneously acquired short- and long-wavelength signals is characterized nonparametrically and removed. Motion artifact is then identified as the time-varying signal component common to both decay-corrected signals and subtracted. Performance of this subtraction technique was compared with ratiometry for intramural optical signals acquired with a fiber-optic probe in an isolated, Langendorff-perfused pig heart preparation (n = 4) stained with di-4-ANEPPS. Perfusate concentration of 2,3-butanedione monoxime was adjusted (7.5-12.5 mM) to alter contractile activity. Short-wavelength (520-600 nm) and long-wavelength (>600 nm) signals were recorded over 8-16 cardiac cycles at 6 sites across the left ventricular free wall in sinus rhythm and during pacing. A total of 451 such data sets were acquired. Appreciable wall motion was observed in 225 cases, with motion artifact classed as moderate (less than modulation due to action potential) in 187 and substantial (more than modulation due to action potential) in 38. In all cases, subtraction performed as well as, or better than, ratiometry in removing motion artifact and decay. Action potential morphology was recovered more faithfully by subtraction than by ratiometry in 58 of 187 and 31 of 38 cases with moderate and substantial motion artifact, respectively. This novel subtraction approach may therefore provide a means of reducing the concentration of uncoupling agents used in cardiac optical mapping studies.
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Affiliation(s)
- Dean C-S Tai
- Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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Banville I, Chattipakorn N, Gray RA. Restitution Dynamics During Pacing and Arrhythmias in Isolated Pig Hearts. J Cardiovasc Electrophysiol 2004; 15:455-63. [PMID: 15089996 DOI: 10.1046/j.1540-8167.2004.03330.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The dependence of action potential duration (APD) on the preceding diastolic interval (DI), i.e., restitution, has been purported to predict the development of alternans and reentrant arrhythmias. However, restitution depends on the history of activation (i.e., memory), and its relevance to arrhythmia induction and maintenance is unknown. METHODS AND RESULTS Using a dual-camera video imaging system, we recorded action potentials from thousands of sites on the surface of the isolated pig heart. A steady-state pacing (SSP) protocol was performed to generate the SSP APD restitution curve. During SSP, the minimum DI and APD were 57 +/- 6 ms and 107 +/- 6 ms, respectively. The restitution slope was >1 for DIs <85 +/- 5 ms; however, alternans were not observed. Abrupt decreases in cycle length (CL) resulted in a rapid (<5 beats) decrease in APD followed by a slower decrease to "steady state." DI, APD pairs for the initial beats following these rate changes were significantly above the SSP restitution curve. DI, APD pairs measured during sustained ventricular fibrillation clustered significantly below the SSP restitution curve, at significantly shorter APDs (57 +/- 4 ms) and DIs (49 +/- 6 ms) than could be achieved during SSP. In addition, abrupt increases in CL following SSP resulted in APDs significantly shorter than those predicted from the SSP restitution curve. CONCLUSION Our results indicate that the responses of APD and DI to sudden rate changes and during arrhythmias are not predicted by the SSP restitution relationship. Acute dynamics act to damp out the proarrhythmic oscillations predicted from the SSP restitution curve.
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Affiliation(s)
- Isabelle Banville
- Department of Biomedical Engineering, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL 35294, USA
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Rogers JM. Combined phase singularity and wavefront analysis for optical maps of ventricular fibrillation. IEEE Trans Biomed Eng 2004; 51:56-65. [PMID: 14723494 DOI: 10.1109/tbme.2003.820341] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Much of the research into the mechanisms of ventricular fibrillation (VF) employs high-resolution mapping of electrical activation and recovery patterns. We previously developed a method for analyzing electrically mapped VF patterns that was based on identifying individual VF wavefronts. We now introduce a related method designed to take into account the information on repolarization that is present in optically mapped VF data. The new method first converts raw fluorescence data to an angular variable that tracks the phase of the mapped tissue through the depolarization-repolarization cycle. We define wavefronts in this context as isolines of phase that terminate either at boundaries or at singular points within the phase field. These singularities are the pivots of functional reentry and are important determinants of VF patterns. We parameterize VF by constructing data structures that describe wavefronts and singularities and also maintain wavefront-wavefront, wavefront-singularity, and singularity-singularity relationships. We describe one important application of this parameterization, which is to identify, localize, and characterize the importance of occurrences of propagation block during VF.
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Affiliation(s)
- Jack M Rogers
- Department of Biomedical Engineering, University of Alabama at Birmingham, 1670 University Blvd., Volker Hall B140, Birmingham, AL 35294, USA.
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Abstract
INTRODUCTION Lidocaine is known to increase the defibrillation threshold (DFT) of monophasic shocks (MS) and have no effect on DFT of biphasic shocks (BS). The aim of this study was to enhance our understanding of the mechanisms of vulnerability and defibrillation through the investigation of this difference. METHODS AND RESULTS We studied the effect of 15 microM lidocaine on shock-induced vulnerability using fluorescent imaging of Langendorff-perfused rabbit hearts. Vulnerability was assessed as vulnerable window with shock strengths of 15 to 150 V and vulnerable period (VP) with shock delivery phase of 0% to 100% of action potential duration (% APD). With MS, lidocaine caused a significant increase in both the upper limit of vulnerability (ULV, 71 +/- 17 V vs 120 +/- 1.5 V, P < 0.01) and upper limit of VP (91 +/- 8.0% APD vs 110 +/- 4.2% APD, P < 0.01). With BS, lidocaine had no effect on ULV (40 +/- 3.4 V vs 45 +/- 4.5 V) and did not increase the upper limit of VP (78 +/- 8.9% APD vs 96 +/- 12% APD, P < 0.01). Lidocaine caused reduction of the conduction velocity during pacing (0.58 +/- 0.08 m/s vs 0.44 +/- 0.05 m/s, P < 0.01), shock-induced break excitation (0.82 +/- 0.17 m/s vs 0.30 +/- 0.07 m/s, P < 0.01), and postshock reentry (0.34 +/- 0.07 m/s vs 0.19 +/- 0.08 m/s, P < 0.01). Lidocaine had no effect on shock-induced virtual electrode polarization. CONCLUSION Lidocaine increased MS ULV due to slowing of shock-induced break-excitation wavefronts, which resulted in enhanced probability of survival of virtual electrode induced phase singularity. Lidocaine had no effect on BS ULV because no break excitation was induced by BS. Reduction of conduction velocity by lidocaine resulted in increased dispersion of repolarization and led to upper limit of VP increase for both MS and BS.
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Affiliation(s)
- Li Li
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106-7207, USA
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Evans FG, Gray RA. Shock-Induced Epicardial and Endocardial Virtual Electrodes Leading to Ventricular Fibrillation via Reentry, Graded Responses, and Transmural Activation. J Cardiovasc Electrophysiol 2004; 15:79-87. [PMID: 15028078 DOI: 10.1046/j.1540-8167.2004.03312.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The mechanism of ventricular fibrillation (VF) induction by T wave shocks has been attributed to reentry, propagated graded responses (PGR), and triggered activity. The limitation of recording transmembrane potential (V(m)) from only a single surface has hampered efforts to elucidate the relative role of these phenomena and their relationship to shock-induced virtual electrodes. METHODS AND RESULTS V(m) patterns from epicardial and endocardial surfaces of isolated sheep right ventricles were recorded with two CCD cameras for monophasic (M) and biphasic (B) shocks delivered at various coupling intervals (CI) from a unipolar mesh electrode on the epicardium. VF was induced via (1) the formation of reentry following make or break excitation; (2) propagated graded responses during apparent isoelectric window; and (3) breakthrough activation patterns coincident with endocardial-to-epicardial gradients in V(m). M shocks depolarized both surfaces at long CIs and polarized epicardial and endocardial surfaces oppositely at short CIs. At intermediate CIs, postshock V(m) patterns could lead to reentry on one surface or endocardial-to-epicardial gradients resulting in breakthrough. B induced VF less than M for short and intermediate CIs due to more homogeneous end-shock V(m) patterns. However, at long CIs these homogeneous patterns resulted in more VF induction because B left the tissue closer to the V(m) threshold for propagation. CONCLUSION Postshock activity occurred either immediately via epicardial or endocardial reentry, or after a delay caused by transmural propagation or propagated graded responses. These findings could explain the isoelectric window and focal activation patterns observed on the epicardium following VF induction shocks.
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Affiliation(s)
- Frederick G Evans
- Cardiac Rhythm Management Laboratory, Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA
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Hillebrenner MG, Eason JC, Trayanova NA. Mechanistic inquiry into decrease in probability of defibrillation success with increase in complexity of preshock reentrant activity. Am J Physiol Heart Circ Physiol 2003; 286:H909-17. [PMID: 14604852 DOI: 10.1152/ajpheart.00492.2003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Energy requirements for successful antiarrhythmia shocks are arrhythmia specific. However, it remains unclear why the probability of shock success decreases with increasing arrhythmia complexity. The goal of this research was to determine whether a diminished probability of shock success results from an increased number of functional reentrant circuits in the myocardium, and if so, to identify the responsible mechanisms. To achieve this goal, we assessed shock efficacy in a bidomain defibrillation model of a 4-mm-thick slice of canine ventricles. Shocks were applied between a right ventricular cathode and a distant anode to terminate either a single scroll wave (SSW) or multiple scroll waves (MSWs). From the 160 simulations conducted, dose-response curves were constructed for shocks given to SSWs and MSWs. The shock strength that yielded a 50% probability of success (ED(50)) for SSWs was found to be 13% less than that for MSWs, which indicates that a larger number of functional reentries results in an increased defibrillation threshold. The results also demonstrate that an isoelectric window exists after both failed and successful shocks; however, shocks of strength near the ED(50) value that were given to SSWs resulted in 16.3% longer isoelectric window durations than the same shocks delivered to MSWs. Mechanistic inquiry into these findings reveals that the two main factors underlying the observed relationships are 1) smaller virtual electrode polarizations in the tissue depth, and 2) differences in preshock tissue state. As a result of these factors, intramural excitable pathways leading to delayed breakthrough on the surface were formed earlier after shocks given to MSWs compared with SSWs and thus resulted in a lower defibrillation threshold for shocks given to SSWs.
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Affiliation(s)
- Matthew G Hillebrenner
- Dept. of Biomedical Engineering, 500 Lindy Boggs Center, Suite 500, Tulane Univ., New Orleans, LA 70118, USA
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Abstract
INTRODUCTION Defibrillation shocks slightly stronger than cardioversion threshold may defibrillate not immediately but after a transient period of postshock activity (delayed success). The effect of a defibrillation shock is that it polarizes the tissue, primarily at the surfaces; therefore, surface polarization may play an important role at near-threshold shock intensities. METHODS AND RESULTS We numerically investigate the effect of a monophasic transmural electrical shock on a three-dimensional (3D) reentrant wave (scroll wave). For simplicity, we assume uniform polarization of the epicardial and endocardial surfaces. We demonstrate that the effect of surface polarization alone is sufficient to induce delayed termination of self-sustained activity (3-4 beats after the shock). In agreement with experimental observations, both successful and failed shocks cause prolongation of the action potentials on the depolarized side and shortening on the hyperpolarized side, while at the same time inducing a shift from a reentrant to a focal activation pattern. Our simulations suggest that the outcome of the shock is determined by its effect on the shape of the scroll wave's center of rotation (filament). We propose a simple rule to predict the postshock filament shape that allows us to make accurate predictions of success and failure of a termination attempt. CONCLUSION Surface polarization due to an electrical shock can terminate a reentrant scroll wave. This mechanism may explain the phenomenon of delayed success in defibrillation.
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Affiliation(s)
- Christian Zemlin
- Department of Pharmacology, SUNY Upstate Medical Center, Syracuse, New York 13210, USA.
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Trayanova NA, Gray RA, Bourn DW, Eason JC. Virtual electrode-induced positive and negative graded responses: new insights into fibrillation induction and defibrillation. J Cardiovasc Electrophysiol 2003; 14:756-63. [PMID: 12930258 DOI: 10.1046/j.1540-8167.2003.03042.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Natalia A Trayanova
- Department of Biomedical Engineering, Tulane University, Boggs Center, Suite 500, New Orleans, LA 70118, USA.
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Qin H, Kay MW, Chattipakorn N, Redden DT, Ideker RE, Rogers JM. Effects of heart isolation, voltage-sensitive dye, and electromechanical uncoupling agents on ventricular fibrillation. Am J Physiol Heart Circ Physiol 2003; 284:H1818-26. [PMID: 12679330 DOI: 10.1152/ajpheart.00923.2002] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We tested whether the interventions typically required for optical mapping affect activation patterns during ventricular fibrillation (VF). A 21 x 24 unipolar electrode array (1.5 mm spacing) was sutured to the left ventricular epicardium of 16 anesthetized pigs, and four episodes of electrically induced VF (30-s duration) were recorded. The hearts were then rapidly excised and connected to a Langendorff perfusion apparatus. Four of the hearts were controls, in which 24 additional VF episodes were then mapped. In the remaining 12 hearts, four VF episodes were mapped after isolation, four more episodes were mapped after exposure to the voltage-sensitive dye di-4-ANEPPS, and six more episodes were mapped after exposure to the electromechanical uncoupling agents diacetyl monoxime (DAM; 20 mmol/l, n = 6) or cytochalasin D (CytoD; 10 micromol/l, n = 6). VF episodes were separated by 4 min. VF activation patterns were quantified using custom pattern analysis algorithms. From comparisons with time-corrected control data, all interventions significantly changed VF patterns. Most changes were broadly consistent with slowing and regularization due to loss of excitability. Heart isolation had the largest effect on VF patterns, followed by CytoD, DAM, and dye.
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Affiliation(s)
- Hao Qin
- Department of Physiology and Biophysics, University of Alabama, 1670 University Boulevard, Birmingham, AL 35294, USA
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Ashihara T, Namba T, Yao T, Ozawa T, Kawase A, Ikeda T, Nakazawa K, Ito M. Vortex cordis as a mechanism of postshock activation: arrhythmia induction study using a bidomain model. J Cardiovasc Electrophysiol 2003; 14:295-302. [PMID: 12716113 DOI: 10.1046/j.1540-8167.2003.02408.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The ventricular apex has a helical arrangement of myocardial fibers called the "vortex cordis." Experimental studies have demonstrated that the first postshock activation originates from the ventricular apex, regardless of the electrical shock outcome; however, the related underlying mechanism is unclear. We hypothesized that the vortex cordis contributes to the initiation of postshock activation. To clarify this issue, we numerically studied the transmembrane potential distribution produced by various electrical shocks. METHODS AND RESULTS Using an active membrane model, we simulated a two-dimensional bidomain myocardial tissue incorporating a typical fiber orientation of the vortex cordis. Monophasic or biphasic shock was delivered via two line electrodes located at opposite tissue borders. Transmembrane potential distribution during the monophasic shock at the center of the vortex cordis showed a gradient high enough to initiate postshock activation. The postshock activation from the center of the vortex cordis was not suppressed, regardless of the initiation of spiral wave reentry. Spiral wave reentry was induced by the monophasic shock when the center area of the vortex cordis was partially excited by the nonuniform virtual electrode polarization. Postshock activation following the biphasic shock also originated from the center of the vortex cordis, but it tended to be suppressed due to the narrower excitable gap around the center of the vortex cordis. The electroporation effect, which was maximal at the center of the vortex cordis, is another possible mechanism of postshock activation. CONCLUSION Our simulations suggest that the vortex cordis may cause postshock activation.
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Affiliation(s)
- Takashi Ashihara
- Division of Cardiology, Shiga University of Medical Science, Otsu, Japan.
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Chattipakorn N, Ideker RE. The vortex at the apex of the left ventricle: a new twist to the story of the electrical induction of rotors? J Cardiovasc Electrophysiol 2003; 14:303-5. [PMID: 12716114 DOI: 10.1046/j.1540-8167.2003.03048.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chattipakorn N, Ideker RE. Delayed afterdepolarization inhibitor: a potential pharmacologic intervention to improve defibrillation efficacy. J Cardiovasc Electrophysiol 2003; 14:72-5. [PMID: 12625614 DOI: 10.1046/j.1540-8167.2003.02396.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Electrical and optical mapping studies of defibrillation have demonstrated that following shocks of strength near the defibrillation threshold (DFT), the first several postshock cycles always arise focally. No immediate postshock reentry was observed. Delayed afterdepolarizations (DADs) have been suggested as a possible cause of this rapid repetitive postshock activity. The aim of this study was to test the hypothesis that DFT is decreased by application of a DAD inhibitor. METHODS AND RESULTS Six pigs (30-35 kg) were studied. First, control DFT was determined using a three-reversal up/down protocol. Each shock (RV-SVC, biphasic, 6/4 msec) was delivered after 10 seconds of ventricular fibrillation (VF). Then, flunarizine (a DAD inhibitor) was injected intravenously (2 mg/kg bolus and 4 mg/kg/hour maintenance) and the DFT was again determined. A third DFT was determined 50 minutes after drug infusion was terminated to allow the drug to wash out. DFT after flunarizine application (520 +/- 90 V, 14 +/- 3 J) was significantly lower than control DFT (663 +/- 133 V, 23 +/- 4 J). After the drug washed out, DFT (653 +/- 107 V, 22 +/- 4 J) returned to the control DFT value (P = 0.6). Flunarizine reduced the DFT approximately 22% by leading-edge voltage and approximately 40% by energy. CONCLUSION Flunarizine, a DAD inhibitor, significantly improved defibrillation efficacy. This finding suggests that DADs could be the source of the rapid repetitive focal activation cycles arising after failed near-DFT shocks before degeneration back into VF. Future studies are needed to investigate the cause of the earliest postshock activation and to determine if the DADs are responsible.
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Affiliation(s)
- Nipon Chattipakorn
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-0019, USA.
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Yashima M, Kim YH, Armin S, Wu TJ, Miyauchi Y, Mandel WJ, Chen PS, Karagueuzian HS. On the mechanism of the probabilistic nature of ventricular defibrillation threshold. Am J Physiol Heart Circ Physiol 2003; 284:H249-55. [PMID: 12388279 DOI: 10.1152/ajpheart.00742.2002] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The probabilistic nature of the ventricular defibrillation threshold (DFT) remains poorly understood. We hypothesized that shock outcome is a function of the amount of myocardium in its vulnerable period (VP). The endocardial surface of five isolated, perfused swine right ventricles was mapped with 477 bipolar electrodes during ventricular fibrillation (VF). Shock parameters and VF cycle length were not significantly different in the successful (S; n = 26) and failed (F; n = 26) trials. At the instant of the shock, the number of sites with 45- to 55-ms recovery was significantly smaller in the S trials than the F trials (P < 0.04). No significant difference in the number of sites with recovery intervals outside the 45- to 55-ms range was seen in S and F shocks. Endocardial action potential showed that a recovery time of 45-55 ms corresponded to the VP spanning -15 to -60 mV in 92% of the regenerative action potentials. We conclude that the probabilistic nature of the DFT is related to the amount of myocardium in its VP.
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Affiliation(s)
- Masaaki Yashima
- Division of Cardiology, Cedars-Sinai Medical Center, Department of Medicine, School of Medicine, University of California, Los Angeles 90048, USA
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