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Doshi SK, Flaherty MC, Laughner J, Quan M, Anic A. Catheter-tissue contact optimizes pulsed electric field ablation with a large area focal catheter. J Cardiovasc Electrophysiol 2024; 35:765-774. [PMID: 38357859 DOI: 10.1111/jce.16208] [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: 11/16/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Pulsed electric field (PEF) ablation relies on the intersection of a critical voltage gradient with tissue to cause cell death. Field-based lesion formation with PEF technologies may still depend on catheter-tissue contact (CTC). The purpose of this study was to assess the impact of CTC on PEF lesion formation with an investigational large area focal (LAF) catheter in a preclinical model. METHODS PEF ablation via a 10-spline LAF catheter was used to create discrete right ventricle (RV) lesions and atrial lesion sets in 10 swine (eight acute, two chronic). Local impedance (LI) was used to assess CTC. Lesions were assigned to three cohorts using LI above baseline: no tissue contact (NTC: ≤∆10 Ω, close proximity to tissue), low tissue contact (LTC: ∆11-29 Ω), and high tissue contact (HTC: ≥∆30 Ω). Acute animals were infused with triphenyl tetrazolium chloride (TTC) and killed ≥2 h post-treatment. Chronic animals were remapped 30 days post-index procedure and stained with infused TTC. RESULTS Mean (± SD) RV treatment sizes between LTC (n = 14) and HTC (n = 17) lesions were not significantly different (depth: 5.65 ± 1.96 vs. 5.68 ± 2.05 mm, p = .999; width: 15.68 ± 5.22 vs. 16.98 ± 4.45 mm, p = .737), while mean treatment size for NTC lesions (n = 6) was significantly smaller (1.67 ± 1.16 mm depth, 5.97 ± 4.48 mm width, p < .05). For atrial lesion sets, acute and chronic conduction block were achieved with both LTC (N = 7) and HTC (N = 6), and NTC resulted in gaps. CONCLUSIONS PEF ablation with a specialized LAF catheter in a swine model is dependent on CTC. LI as an indicator of CTC may aid in the creation of consistent transmural lesions in PEF ablation.
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Affiliation(s)
- Shephal K Doshi
- Cardiology Electrophysiology, Pacific Heart Institute, Santa Monica, California, USA
| | - Mary Clare Flaherty
- Electrophysiology, Galvanize Therapeutics, Redwood City, California, USA
- CardioFocus, Marlborough, Massachusetts, USA
| | - Jacob Laughner
- Electrophysiology, Galvanize Therapeutics, Redwood City, California, USA
- CardioFocus, Marlborough, Massachusetts, USA
| | - Melinda Quan
- Electrophysiology, Galvanize Therapeutics, Redwood City, California, USA
- CardioFocus, Marlborough, Massachusetts, USA
| | - Ante Anic
- Department for Cardiovascular Diseases, Klinički Bolnički Centar (KBC) Split, Split, Croatia
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2
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Wang HHS, Thaker H, Bigger-Allen A, Nagy JA, Rutkove SB. Novel phenotype characterization utilizing electrical impedance myography signatures in murine spinal cord injury neurogenic bladder models. Sci Rep 2023; 13:19520. [PMID: 37945675 PMCID: PMC10636012 DOI: 10.1038/s41598-023-46740-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023] Open
Abstract
Neurogenic bladder (NB) affects people of all ages. Electric impedance myography (EIM) assesses localized muscle abnormalities. Here, we sought to investigate whether unique detrusor EIM signatures are present in NB due to spinal cord injury (SCI). Twenty-eight, 8-10 weeks old, C57BL/6J female mice were studied. Twenty underwent spinal cord transection; 8 served as controls. Cohorts were euthanized at 4 and 6 weeks after spinal cord transection. Each bladder was measured in-situ with EIM with applied frequencies of 1 kHz to 10 MHz, and then processed for molecular and histologic study. SCI mice had greater bladder-to-body weight ratio (p < 0.0001), greater collagen deposition (p = 0.009), and greater smooth-muscle-myosin-heavy-chain isoform A/B ratio (p < 0.0001). Compared with the control group, the SCI group was associated with lower phase, reactance, and resistance values (p < 0.01). Significant correlations (p < 0.001) between bladder-to-body weight ratios and EIM measurements were observed across the entire frequency spectrum. A severely hypertrophied phenotype was characterized by even greater bladder-to-body weight ratios and more depressed EIM values. Our study demonstrated distinct EIM alterations in the detrusor muscle of mice with NB due to SCI. With further refinement, EIM may offer a potential point-of-care tool for the assessment of NB and its response to treatment.
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Affiliation(s)
- Hsin-Hsiao Scott Wang
- Department of Urology, Boston Children's Hospital, 300 Longwood Ave, HU390, Boston, MA, USA.
- Harvard Medical School, Boston, MA, 02215, USA.
| | - Hatim Thaker
- Department of Urology, Boston Children's Hospital, 300 Longwood Ave, HU390, Boston, MA, USA
- Harvard Medical School, Boston, MA, 02215, USA
| | - Alex Bigger-Allen
- Department of Urology, Boston Children's Hospital, 300 Longwood Ave, HU390, Boston, MA, USA
| | - Janice A Nagy
- Harvard Medical School, Boston, MA, 02215, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Seward B Rutkove
- Harvard Medical School, Boston, MA, 02215, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Amorós-Figueras G, Casabella-Ramon S, Company-Se G, Arzamendi D, Jorge E, Garcia-Osuna A, Macías Y, Sánchez-Quintana D, Rosell-Ferrer J, Guerra JM, Cinca J. Electrophysiological and histological characterization of atrial scarring in a model of isolated atrial myocardial infarction. Front Physiol 2023; 13:1104327. [PMID: 36714312 PMCID: PMC9877280 DOI: 10.3389/fphys.2022.1104327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
Background: Characterization of atrial myocardial infarction is hampered by the frequent concurrence of ventricular infarction. Theoretically, atrial infarct scarring could be recognized by multifrequency tissue impedance, like in ventricular infarction, but this remains to be proven. Objective: This study aimed at developing a model of atrial infarction to assess the potential of multifrequency impedance to recognize areas of atrial infarct scar. Methods: Seven anesthetized pigs were submitted to transcatheter occlusion of atrial coronary branches arising from the left coronary circumflex artery. Six weeks later the animals were anesthetized and underwent atrial voltage mapping and multifrequency impedance recordings. The hearts were thereafter extracted for anatomopathological study. Two additional pigs not submitted to atrial branch occlusion were used as controls. Results: Selective occlusion of the atrial branches induced areas of healed infarction in the left atrium in 6 of the 7 cases. Endocardial mapping of the left atrium showed reduced multi-frequency impedance (Phase angle at 307 kHz: from -17.1° ± 5.0° to -8.9° ± 2.6°, p < .01) and low-voltage of bipolar electrograms (.2 ± 0.1 mV vs. 1.9 ± 1.5 mV vs., p < .01) in areas affected by the infarction. Data variability of the impedance phase angle was lower than that of bipolar voltage (coefficient of variability of phase angle at307 kHz vs. bipolar voltage: .30 vs. .77). Histological analysis excluded the presence of ventricular infarction. Conclusion: Selective occlusion of atrial coronary branches permits to set up a model of selective atrial infarction. Atrial multifrequency impedance mapping allowed recognition of atrial infarct scarring with lesser data variability than local bipolar voltage mapping. Our model may have potential applicability on the study of atrial arrhythmia mechanisms.
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Affiliation(s)
- Gerard Amorós-Figueras
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, UAB, CIBERCV, Barcelona, Spain,*Correspondence: Gerard Amorós-Figueras,
| | - Sergi Casabella-Ramon
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, UAB, CIBERCV, Barcelona, Spain
| | - Georgina Company-Se
- Electronic and Biomedical Instrumentation Group, Department of Electronics Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Dabit Arzamendi
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, UAB, CIBERCV, Barcelona, Spain
| | - Esther Jorge
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, UAB, CIBERCV, Barcelona, Spain
| | - Alvaro Garcia-Osuna
- Biochemistry Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Yolanda Macías
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Damián Sánchez-Quintana
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Javier Rosell-Ferrer
- Electronic and Biomedical Instrumentation Group, Department of Electronics Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - José M. Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, UAB, CIBERCV, Barcelona, Spain
| | - Juan Cinca
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, UAB, CIBERCV, Barcelona, Spain
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Muñoz M, Eren Cimenci C, Goel K, Comtois-Bona M, Hossain M, McTiernan C, Zuñiga-Bustos M, Ross A, Truong B, Davis DR, Liang W, Rotstein B, Ruel M, Poblete H, Suuronen EJ, Alarcon EI. Nanoengineered Sprayable Therapy for Treating Myocardial Infarction. ACS NANO 2022; 16:3522-3537. [PMID: 35157804 DOI: 10.1021/acsnano.1c08890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We report the development, as well as the in vitro and in vivo testing, of a sprayable nanotherapeutic that uses surface engineered custom-designed multiarmed peptide grafted nanogold for on-the-spot coating of an infarcted myocardial surface. When applied to mouse hearts, 1 week after infarction, the spray-on treatment resulted in an increase in cardiac function (2.4-fold), muscle contractility, and myocardial electrical conductivity. The applied nanogold remained at the treatment site 28 days postapplication with no off-target organ infiltration. Further, the infarct size in the mice that received treatment was found to be <10% of the total left ventricle area, while the number of blood vessels, prohealing macrophages, and cardiomyocytes increased to levels comparable to that of a healthy animal. Our cumulative data suggest that the therapeutic action of our spray-on nanotherapeutic is highly effective, and in practice, its application is simpler than other regenerative approaches for treating an infarcted heart.
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Affiliation(s)
- Marcelo Muñoz
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Cagla Eren Cimenci
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
| | - Keshav Goel
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Maxime Comtois-Bona
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Mahir Hossain
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Christopher McTiernan
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Matias Zuñiga-Bustos
- Departamento de Bioinformática, Centro de Bioinformática, Simulación y Modelado (CBSM), Facultad de Ingeniería, Universidad de Talca, Campus Talca, 2 Norte 685, 3460000, Talca, Chile
| | - Alex Ross
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Brenda Truong
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Darryl R Davis
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, University of Ottawa, Ottawa, Ontario K1Y 4W7, Canada
- Cardiac Electrophysiology Lab, University of Ottawa, Ottawa, Ontario K1Y 4W7, Canada
| | - Wenbin Liang
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, University of Ottawa, Ottawa, Ontario K1Y 4W7, Canada
- Cardiac Electrophysiology Lab, University of Ottawa, Ottawa, Ontario K1Y 4W7, Canada
| | - Benjamin Rotstein
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
- Molecular Imaging Probes and Radiochemistry Laboratory, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Marc Ruel
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
| | - Horacio Poblete
- Departamento de Bioinformática, Centro de Bioinformática, Simulación y Modelado (CBSM), Facultad de Ingeniería, Universidad de Talca, Campus Talca, 2 Norte 685, 3460000, Talca, Chile
- Millennium Nucleus of Ion Channels-Associated Diseases (MiNICAD), Universidad de Talca, 2 Norte 685, 3460000 Talca, Chile
| | - Erik J Suuronen
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
| | - Emilio I Alarcon
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
- Molecular Imaging Probes and Radiochemistry Laboratory, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
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5
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Fu A, Yang Y, Wu J, Li S, Fan Y, Yau TM, Li R. Bio-Conductive Polymers for Treating Myocardial Conductive Defects: Long-Term Efficacy Study. Adv Healthc Mater 2022; 11:e2101838. [PMID: 34704404 DOI: 10.1002/adhm.202101838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/15/2021] [Indexed: 01/23/2023]
Abstract
Following myocardial infarction (MI), the resulting fibrotic scar is nonconductive and leads to ventricular dysfunction via electrical uncoupling of the remaining viable cardiomyocytes. The uneven conductive properties between normal myocardium and scar tissue result in arrhythmia, yielding sudden cardiac death/heart failure. A conductive biopolymer, poly-3-amino-4-methoxybenzoic acid-gelatin (PAMB-G), is able to resynchronize myocardial contractions in vivo. Intravenous PAMB-G injections into mice show that it does not cause any acute toxicity, up to the maximum tolerated dose (1.6 mL kg-1 ), which includes the determined therapeutic dose (0.4 mL kg-1 ). There is also no short- or long-term toxicity when PAMB-G is injected into the myocardium of MI rats, with no significant changes in body weight, organ-brain ratio, hematologic, and histological parameters for up to 12 months post-injection. At the therapeutic dose, PAMB-G restores electrical conduction in infarcted rat hearts, resulting in lowered arrhythmia susceptibility and improved cardiac function. PAMB-G is also durable, as mass spectrometry detected the biopolymer for up to 12 months post-injection. PAMB-G did not impact reproductive organ function or offspring characteristics when given intravenously into healthy adult rats. Thus, PAMB-G is a nontoxic, durable, and conductive biomaterial that is able to improve cardiac function for up to 1 year post-implantation.
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Affiliation(s)
- Anne Fu
- Toronto General Hospital Research Institute Division of Cardiovascular Surgery University Health Network TorontoM5G 1L7 Canada
- Department of Laboratory Medicine and Pathology University of Toronto TorontoM5G 1L7 Canada
| | - Yahan Yang
- Toronto General Hospital Research Institute Division of Cardiovascular Surgery University Health Network TorontoM5G 1L7 Canada
| | - Jun Wu
- Toronto General Hospital Research Institute Division of Cardiovascular Surgery University Health Network TorontoM5G 1L7 Canada
| | - Shu‐Hong Li
- Toronto General Hospital Research Institute Division of Cardiovascular Surgery University Health Network TorontoM5G 1L7 Canada
| | - Yunfei Fan
- Toronto General Hospital Research Institute Division of Cardiovascular Surgery University Health Network TorontoM5G 1L7 Canada
| | - Terrance M Yau
- Toronto General Hospital Research Institute Division of Cardiovascular Surgery University Health Network TorontoM5G 1L7 Canada
- Division of Cardiac Surgery Department of Surgery University of Toronto TorontoM5G 1L7 Canada
| | - Ren‐Ke Li
- Toronto General Hospital Research Institute Division of Cardiovascular Surgery University Health Network TorontoM5G 1L7 Canada
- Department of Laboratory Medicine and Pathology University of Toronto TorontoM5G 1L7 Canada
- Division of Cardiac Surgery Department of Surgery University of Toronto TorontoM5G 1L7 Canada
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6
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Chew DS, Manga S, Roberts A, Sumner GL, Kavanagh KM, Howarth AG, Lydell C, White JA, Cowan K, Rowlandson G, Xue J, Exner DV. A Novel High-Resolution Surface Electrocardiographic Method to Identify and Characterize Myocardial Scar: A Proof-of-Concept Study. CJC Open 2021; 3:1207-1213. [PMID: 34888504 PMCID: PMC8636230 DOI: 10.1016/j.cjco.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background The placement of the left ventricular (LV) lead in an area free of myocardial scar is an important determinant of cardiac resynchronization therapy response. We sought to develop and validate a simple, practical, and novel electrocardiographic (ECG)-based approach to intraoperatively identify the presence of LV scar. We hypothesized that there would be a reduction in the measured amplitude of the LV pacing stimulus on the skin surface using a high-resolution (HR) ECG when pacing from LV regions with scar compared with regions without scar. We term this the ECG Amplitude Signal Evaluation (EASE) method. Methods Consecutive patients with ischemic LV systolic dysfunction and standard criteria for de novo cardiac resynchronization therapy implantation were prospectively enrolled. All underwent a preimplant contrast-enhanced cardiac magnetic resonance study to assess for scar. The average amplitude of the LV pacing impulse was sampled on HR surface ECG intraprocedurally and then compared with the cardiac magnetic resonance results. Results A total of 38 LV pacing sites were assessed among 13 recipients. The median voltage measured on the surface HR ECG in regions with scar was reduced by 41% (interquartile range, 17% to 63%), whereas there was no measurable change in voltage (interquartile range, 0 to 0%) in regions without scar compared with the maximal amplitude (Wilcoxon P < 0.0001). Conclusion The EASE method appears to be of potential value as a novel intraoperative tool to guide LV lead placement to regions free of scar. Future work is required to validate the utility of this method in a larger patient cohort.
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Affiliation(s)
- Derek S Chew
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Sharita Manga
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Roberts
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Glen L Sumner
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Katherine M Kavanagh
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Andrew G Howarth
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Carmen Lydell
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - James A White
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Karen Cowan
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | | | - Joel Xue
- GE Healthcare, Milwaukee, Wisconsin, USA
| | - Derek V Exner
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Chegini F, Kopaničáková A, Krause R, Weiser M. Efficient identification of scars using heterogeneous model hierarchies. Europace 2021; 23:i113-i122. [PMID: 33751083 DOI: 10.1093/europace/euaa402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/09/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Detection and quantification of myocardial scars are helpful for diagnosis of heart diseases and for personalized simulation models. Scar tissue is generally characterized by a different conduction of excitation. We aim at estimating conductivity-related parameters from endocardial mapping data. Solving this inverse problem requires computationally expensive monodomain simulations on fine discretizations. We aim at accelerating the estimation by combining electrophysiology models of different complexity. METHODS AND RESULTS Distributed parameter estimation is performed by minimizing the misfit between simulated and measured electrical activity on the endocardial surface, subject to the monodomain model and regularization. We formulate this optimization problem, including the modelling of scar tissue and different regularizations, and design an efficient solver. We consider grid hierarchies and monodomain-eikonal model hierarchies in a recursive multilevel trust-region method. With numerical examples, efficiency and estimation quality, depending on the data, are investigated. The multilevel solver is significantly faster than a comparable single level solver. Endocardial mapping data of realistic density appears to be sufficient to provide quantitatively reasonable estimates of location, size, and shape of scars close to the endocardial surface. CONCLUSION In several situations, scar reconstruction based on eikonal and monodomain models differ significantly, suggesting the use of the more involved monodomain model for this purpose. Eikonal models can accelerate the computations considerably, enabling the use of complex electrophysiology models for estimating myocardial scars from endocardial mapping data.
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Affiliation(s)
- Fatemeh Chegini
- Institute of Computational Science, USI, Lugano, Switzerland.,Center for Computational Medicine in Cardiology, USI, Lugano, Switzerland
| | - Alena Kopaničáková
- Institute of Computational Science, USI, Lugano, Switzerland.,Center for Computational Medicine in Cardiology, USI, Lugano, Switzerland
| | - Rolf Krause
- Institute of Computational Science, USI, Lugano, Switzerland.,Center for Computational Medicine in Cardiology, USI, Lugano, Switzerland
| | - Martin Weiser
- Center for Computational Medicine in Cardiology, USI, Lugano, Switzerland.,Zuse Institute Berlin, Takustr 7, 14195 Berlin, Germany
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8
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Degache A, Poulletier de Gannes F, Garenne A, Renom R, Percherancier Y, Lagroye I, Bernus O, Lewis N. In vitrodifferentiation of human cardiac fibroblasts into myofibroblasts: characterization using electrical impedance. Biomed Phys Eng Express 2021; 8. [PMID: 34243179 DOI: 10.1088/2057-1976/ac12e1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/09/2021] [Indexed: 11/12/2022]
Abstract
Cardiac arrhythmias represent about 50% of the cardiovascular diseases which are the first cause of mortality in the world. Implantable medical devices play a major role for treating these arrhythmias. Nevertheless the leads induce an unwanted biological phenomenon called fibrosis. This phenomenon begins at a cellular level and is effective at a macroscopic scale causing tissue remodelling with a local modification of the active cardiac tissue. Fibrosis mechanism is complex but at the cellular level, it mainly consists in cardiac fibroblasts activation and differentiation into myofibroblasts. We developed a simplifiedin vitromodel of cardiac fibrosis, with human cardiac fibroblasts whom differentiation into myofibroblasts was promoted with TGF-β1. Our study addresses an unreported impedance-based method for real-time monitoring ofin vitrocardiac fibrosis. The objective was to study whether the differentiation of cardiac fibroblasts in myofibroblasts had a specific signature on the cell index, an impedance-based feature measured by the xCELLigence system. Primary human cardiac fibroblasts were cultured along 6 days, with or without laminin coating, to study the role of this adhesion protein in cultures long-term maintenance. The cultures were characterized in the presence or absence of TGF-β1 and we obtained a significant cell index signature specific to the human cardiac fibroblasts differentiation.
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Affiliation(s)
- Amelie Degache
- IMS Laboratory, CNRS UMR 5218, University of Bordeaux College of Science and Technology, 351 cours de la liberation, Talence, Aquitaine, 33400, FRANCE
| | - Florence Poulletier de Gannes
- IMS Laboratory, CNRS UMR 5218, University of Bordeaux College of Science and Technology, 351 cours de la liberation, Talence, Aquitaine, 33400, FRANCE
| | - André Garenne
- IMS Laboratory, CNRS UMR 5218, University of Bordeaux College of Science and Technology, 351 cours de la liberation, Talence, Aquitaine, 33400, FRANCE
| | - Rémy Renom
- IMS Laboratory, CNRS UMR 5218, University of Bordeaux College of Science and Technology, 351 cours de la liberation, Talence, Aquitaine, 33400, FRANCE
| | - Yann Percherancier
- IMS Laboratory, CNRS UMR 5218, University of Bordeaux College of Science and Technology, 351 cours de la liberation, Talence, Aquitaine, 33400, FRANCE
| | - Isabelle Lagroye
- IMS Laboratory, CNRS UMR 5218, University of Bordeaux College of Science and Technology, 351 cours de la liberation, Talence, Aquitaine, 33400, FRANCE
| | - Olivier Bernus
- IHU LIRYC, Electrophysiology and Heart Modelling Institute, U1045, University of Bordeaux, Avenue du haut leveque, Pessac, Aquitaine, 33600, FRANCE
| | - Noëlle Lewis
- IMS Laboratory, CNRS UMR 5218, University of Bordeaux College of Science and Technology, 351 cours de la liberation, Talence, Aquitaine, 33400, FRANCE
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9
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Masuda M, Kanda T, Kurata N, Asai M, Iida O, Okamoto S, Ishihara T, Nanto K, Tsujimura T, Matsuda Y, Hata Y, Uematsu H, Mano T. Clinical utility of local impedance monitoring during pulmonary vein isolation. J Cardiovasc Electrophysiol 2020; 31:2584-2591. [PMID: 32671932 DOI: 10.1111/jce.14678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Local impedance (LI) at the tip of ablation catheter can be measured using a recently available technology. We aimed to explore target LI measurements at each radiofrequency application (RFA) for creating sufficient ablation lesions during pulmonary vein (PV) isolation. METHODS This prospective study included 15 consecutive patients scheduled to undergo an initial ablation of paroxysmal atrial fibrillation (AF). Circumferential ablation around both ipsilateral PVs was performed using a 4-mm irrigated ablation catheter with an LI sensor. Point-by-point ablation was used with a 4-mm inter-ablation-point distance. Operators were blinded to LI measurements during the procedure. Creation of sufficient ablation lesions was assessed by the absence of a conduction gap. RESULTS After first-pass encircling PV antrum ablation, left atrium to PV conduction remained in 12 of 30 (40%) ipsilateral PVs. Mapping using the minibasket catheter identified 48 ablation points through which the propagation wave entered the PV. At ablation points with a gap, the LI drop during RFA was half that at points without a gap (12 ± 7 vs. 23 ± 12 Ω; p < .001). The generator impedance drop did not differ between ablation points with and without a gap (12 ± 7 vs. 14 ± 10 Ω; p = .10). An LI drop of 13.4 Ω predicted sufficient lesion formation without a gap with a sensitivity of 0.78, specificity of 0.75, and predictive accuracy of 0.75. CONCLUSION An LI drop of 13.4 Ω at each RFA under the conditions of a 4-mm inter-ablation-point distance and RFA duration ≥20 s may facilitate creation of sufficient lesions during PV isolation.
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Affiliation(s)
- Masaharu Masuda
- Department of Arrhythmia, Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Takashi Kanda
- Department of Arrhythmia, Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Naoya Kurata
- Department of Arrhythmia, Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Mitsutoshi Asai
- Department of Arrhythmia, Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Osamu Iida
- Department of Arrhythmia, Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Shin Okamoto
- Department of Arrhythmia, Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Takayuki Ishihara
- Department of Arrhythmia, Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Kiyonori Nanto
- Department of Arrhythmia, Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Takuya Tsujimura
- Department of Arrhythmia, Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Yasuhiro Matsuda
- Department of Arrhythmia, Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Yosuke Hata
- Department of Arrhythmia, Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Hiroyuki Uematsu
- Department of Arrhythmia, Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Toshiaki Mano
- Department of Arrhythmia, Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
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Amorós-Figueras G, Jorge E, Alonso-Martin C, Traver D, Ballesta M, Bragós R, Rosell-Ferrer J, Cinca J. Endocardial infarct scar recognition by myocardial electrical impedance is not influenced by changes in cardiac activation sequence. Heart Rhythm 2017; 15:589-596. [PMID: 29197656 DOI: 10.1016/j.hrthm.2017.11.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Measurement of myocardial electrical impedance can allow recognition of infarct scar and is theoretically not influenced by changes in cardiac activation sequence, but this is not known. OBJECTIVES The objectives of this study were to evaluate the ability of endocardial electrical impedance measurements to recognize areas of infarct scar and to assess the stability of the impedance data under changes in cardiac activation sequence. METHODS One-month-old myocardial infarction confirmed by cardiac magnetic resonance imaging was induced in 5 pigs submitted to coronary artery catheter balloon occlusion. Electroanatomic data and local electrical impedance (magnitude, phase angle, and amplitude of the systolic-diastolic impedance curve) were recorded at multiple endocardial sites in sinus rhythm and during right ventricular pacing. By merging the cardiac magnetic resonance and electroanatomic data, we classified each impedance measurement site either as healthy (bipolar amplitude ≥1.5 mV and maximum pixel intensity <40%) or scar (bipolar amplitude <1.5 mV and maximum pixel intensity ≥40%). RESULTS A total of 137 endocardial sites were studied. Compared to healthy tissue, areas of infarct scar showed 37.4% reduction in impedance magnitude (P < .001) and 21.5% decrease in phase angle (P < .001). The best predictive ability to detect infarct scar was achieved by the combination of the 4 impedance parameters (area under the receiver operating characteristic curve 0.96; 95% confidence interval 0.92-1.00). In contrast to voltage mapping, right ventricular pacing did not significantly modify the impedance data. CONCLUSION Endocardial catheter measurement of electrical impedance can identify infarct scar regions, and in contrast to voltage mapping, the impedance data are not affected by changes in cardiac activation sequence.
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Affiliation(s)
- Gerard Amorós-Figueras
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Esther Jorge
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBERCV, Barcelona, Spain.
| | - Concepción Alonso-Martin
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Maria Ballesta
- Electronic and Biomedical Instrumentation Group, Department of Electronic Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Ramon Bragós
- Electronic and Biomedical Instrumentation Group, Department of Electronic Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Javier Rosell-Ferrer
- CIBERCV, Barcelona, Spain; Electronic and Biomedical Instrumentation Group, Department of Electronic Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Juan Cinca
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBERCV, Barcelona, Spain
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