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Groen MHA, van Driel VJHM, Neven K, van Wessel H, de Bakker JMT, Doevendans PAF, Wittkampf FHM, Loh P, van Es R. Multielectrode Contact Measurement Can Improve Long-Term Outcome of Pulmonary Vein Isolation Using Circular Single-Pulse Electroporation Ablation. Circ Arrhythm Electrophysiol 2022; 15:e010835. [PMID: 35917465 PMCID: PMC9384826 DOI: 10.1161/circep.121.010835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Irreversible electroporation (IRE) ablation is generally performed with multielectrode catheters. Electrode-tissue contact is an important predictor for the success of pulmonary vein (PV) isolation; however, contact force is difficult to measure with multielectrode ablation catheters. In a preclinical study, we assessed the feasibility of a multielectrode impedance system (MEIS) as a predictor of long-term success of PV isolation. In addition, we present the first-in-human clinical experience with MEIS. METHODS In 10 pigs, one PV was ablated based on impedance (MEIS group), and the other PV was solely based on local electrogram information (electrophysiological group). IRE ablations were performed at 200 J. After 3 months, recurrence of conduction was assessed. Subsequently, in 30 patients undergoing PV isolation with IRE, MEIS was evaluated and MEIS contact values were compared to local electrograms. RESULTS In the porcine study, 43 IRE applications were delivered in 19 PVs. Acutely, no reconnections were observed in either group. After 3 months, 0 versus 3 (P=0.21) PVs showed conduction recurrence in the MEIS and electrophysiological groups, respectively. Results from the clinical study showed a significant linear relation was found between mean MEIS value and bipolar dV/dt (r2=0.49, P<0.001), with a slope of 20.6 mV/s per Ohm. CONCLUSIONS Data from the animal study suggest that MEIS values predict effective IRE applications. For the long-term success of electrical PV isolation with circular IRE applications, no significant difference in efficacy was found between ablation based on the measurement of electrode interface impedance and ablation using the classical electrophysiological approach for determining electrode-tissue contact. Experiences of the first clinical use of MEIS were promising and serve as an important basis for future research.
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Affiliation(s)
- Marijn H A Groen
- Division Heart and Lungs, Department of Cardiology, University Medical Center (M.H.A.G., V.J.H.M.v.D., K.N., H.v.W., P.A.F.D., F.H.M.W., P.L., R.v.E.).,Netherlands Heart Institute, Utrecht (M.H.A.G., P.A.F.D.)
| | - Vincent J H M van Driel
- Division Heart and Lungs, Department of Cardiology, University Medical Center (M.H.A.G., V.J.H.M.v.D., K.N., H.v.W., P.A.F.D., F.H.M.W., P.L., R.v.E.).,Department of Cardiology, Haga Teaching Hospital, The Hague, the Netherlands (V.J.H.M.v.D.)
| | - Kars Neven
- Division Heart and Lungs, Department of Cardiology, University Medical Center (M.H.A.G., V.J.H.M.v.D., K.N., H.v.W., P.A.F.D., F.H.M.W., P.L., R.v.E.).,Department of Electrophysiology, Alfried Krupp Krankenhaus, Essen (K.N.).,Department of Medicine, Witten/Herdecke University, Witten, Germany (K.N.)
| | - Harry van Wessel
- Division Heart and Lungs, Department of Cardiology, University Medical Center (M.H.A.G., V.J.H.M.v.D., K.N., H.v.W., P.A.F.D., F.H.M.W., P.L., R.v.E.).,Abbott Medical Nederland B.V., Veenendaal (H.v.W.)
| | - J M T de Bakker
- Heart Center, Department of Experimental Cardiology, Academic Medical Center Amsterdam, the Netherlands (J.M.T.d.B.)
| | - Pieter A F Doevendans
- Division Heart and Lungs, Department of Cardiology, University Medical Center (M.H.A.G., V.J.H.M.v.D., K.N., H.v.W., P.A.F.D., F.H.M.W., P.L., R.v.E.).,Netherlands Heart Institute, Utrecht (M.H.A.G., P.A.F.D.)
| | - Fred H M Wittkampf
- Division Heart and Lungs, Department of Cardiology, University Medical Center (M.H.A.G., V.J.H.M.v.D., K.N., H.v.W., P.A.F.D., F.H.M.W., P.L., R.v.E.)
| | - Peter Loh
- Division Heart and Lungs, Department of Cardiology, University Medical Center (M.H.A.G., V.J.H.M.v.D., K.N., H.v.W., P.A.F.D., F.H.M.W., P.L., R.v.E.)
| | - René van Es
- Division Heart and Lungs, Department of Cardiology, University Medical Center (M.H.A.G., V.J.H.M.v.D., K.N., H.v.W., P.A.F.D., F.H.M.W., P.L., R.v.E.)
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Meijborg VMF, Belterman CNW, de Bakker JMT, Coronel R, Conrath CE. Mechano-electric coupling, heterogeneity in repolarization and the electrocardiographic T-wave. Prog Biophys Mol Biol 2017; 130:356-364. [PMID: 28527890 DOI: 10.1016/j.pbiomolbio.2017.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 11/28/2022]
Abstract
Stretch influences repolarization by mechano-electric coupling (MEC) and contributes to arrhythmogenesis. Although there is an abundance of research on electrophysiological effects of MEC, it is still unclear how MEC translates to the ECG. We aim to provide an overview of the MEC research focused on the ECG and the underlying changes in electrophysiology. In addition, we present new data on the effect of left ventricular pressure on the electrocardiographic T-wave. We show that an increase in left ventricular pressure leads to prolonged QT-intervals with increased amplitudes of the STT-segment. This corresponds to a prolongation in repolarization and an increased interventricular dispersion of repolarization. MEC is dependent on timing, intensity and modality of stretch and these three factors should be taken into account to analyse the effects of MEC on the heart and on the ECG. In addition, the deformation of the heart itself should be considered, since it influences the amplitude of the STT-segment. Because the electrocardiographic T-wave represents heterogeneity in repolarization, left ventricular pressure increases may have significant influence on the inducibility of (re-entrant) arrhythmias.
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Affiliation(s)
- V M F Meijborg
- Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Netherlands Heart Institute, Holland Heart House, Utrecht, The Netherlands.
| | - C N W Belterman
- Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Electrophysiology and Heart Modeling Institute LIRYC, Université Bordeaux, Bordeaux, France
| | - J M T de Bakker
- Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Netherlands Heart Institute, Holland Heart House, Utrecht, The Netherlands; Department of Medical Physiology, University of Utrecht, Utrecht, The Netherlands
| | - R Coronel
- Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Electrophysiology and Heart Modeling Institute LIRYC, Université Bordeaux, Bordeaux, France
| | - C E Conrath
- Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands
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Remme CA, Verkerk AO, Hoogaars WMH, Aanhaanen WTJ, Scicluna BP, Annink C, van den Hoff MJB, Wilde AAM, van Veen TAB, Veldkamp MW, de Bakker JMT, Christoffels VM, Bezzina CR. The cardiac sodium channel displays differential distribution in the conduction system and transmural heterogeneity in the murine ventricular myocardium. Basic Res Cardiol 2009; 104:511-22. [PMID: 19255801 PMCID: PMC2722719 DOI: 10.1007/s00395-009-0012-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Revised: 01/30/2009] [Accepted: 02/03/2009] [Indexed: 12/15/2022]
Abstract
Cardiac sodium channels are responsible for conduction in the normal and diseased heart. We aimed to investigate regional and transmural distribution of sodium channel expression and function in the myocardium. Sodium channel Scn5a mRNA and Na(v)1.5 protein distribution was investigated in adult and embryonic mouse heart through immunohistochemistry and in situ hybridization. Functional sodium channel availability in subepicardial and subendocardial myocytes was assessed using patch-clamp technique. Adult and embryonic (ED14.5) mouse heart sections showed low expression of Na(v)1.5 in the HCN4-positive sinoatrial and atrioventricular nodes. In contrast, high expression levels of Na(v)1.5 were observed in the HCN4-positive and Cx43-negative AV or His bundle, bundle branches and Purkinje fibers. In both ventricles, a transmural gradient was observed, with a low Na(v)1.5 labeling intensity in the subepicardium as compared to the subendocardium. Similar Scn5a mRNA expression patterns were observed on in situ hybridization of embryonic and adult tissue. Maximal action potential upstroke velocity was significantly lower in subepicardial myocytes (mean +/- SEM 309 +/- 32 V/s; n = 14) compared to subendocardial myocytes (394 +/- 32 V/s; n = 11; P < 0.05), indicating decreased sodium channel availability in subepicardium compared to subendocardium. Scn5a and Na(v)1.5 show heterogeneous distribution patterns within the cardiac conduction system and across the ventricular wall. This differential distribution of the cardiac sodium channel may have profound consequences for conduction disease phenotypes and arrhythmogenesis in the setting of sodium channel disease.
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Affiliation(s)
- C A Remme
- Heart Failure Research Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Eckardt D, Theis M, Degen J, Ott T, van Rijen HVM, Kirchhoff S, Kim JS, de Bakker JMT, Willecke K. Functional role of connexin43 gap junction channels in adult mouse heart assessed by inducible gene deletion. J Mol Cell Cardiol 2004; 36:101-10. [PMID: 14734052 DOI: 10.1016/j.yjmcc.2003.10.006] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The gap junction protein Connexin43 (Cx43) is expressed in various cell types during embryonic development and in adult mice. Cx43 null mice (Cx43-/-) die perinatally due to cardiac malformation. In order to define the major functional role of Cx43 gap junction channels in adult mice and to circumvent perinatal death as well as direct or indirect compensation of Cx43 deficiency during development, we established a novel conditional Cx43 mouse mutant. To ablate Cx43 in adult mice in all cells that express Cx43 at a certain time, we targeted the 4-hydroxytamoxifen inducible Cre recombinase, Cre-ER(T), into the endogenous Cx43 locus. This approach left only one Cx43 coding region to be deleted upon induction of Cre-ER(T) activity. Highly efficient inducible ablation of Cx43 was shown in an embryonic stem cell test system and in adult mice. Although Cx43 protein was decreased in different tissues after induction of Cre-ER(T)-mediated recombination, cardiac abnormalities most likely account for death of those mice. Surface and telemetric ECG recordings revealed significant delay of ventricular activation and death during periods of bradyarrhythmia preceded by tachycardias. This novel approach of inducible ablation of Cx43 highlights the functional importance of normal activation of ventricular cardiomyocytes mediated by Cx43 gap junction channels in adult mouse heart to prevent initiation of fatal arrhythmias. The new mouse model should be useful for further analyses of molecular changes initiated by acute loss of Cx43 expression in various cell types.
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Affiliation(s)
- D Eckardt
- Institut für Genetik, Abteilung Molekulargenetik, Universität Bonn, Römerstrasse 164, 53117 Bonn, Germany
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Jessurun ER, de Bakker JMT, van Hemel NM, Opthof T, Linnenbank AC, van Dessel PFHM, Defauw JJAMT, de la Rivière AB. Right atrial modification of maze surgery does not affect refractoriness and conduction patterns of human lone atrial fibrillation. Europace 2003; 5:39-46. [PMID: 12504639 DOI: 10.1053/eupc.2002.0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Tissue mass and structure are relevant for initiation and persistence of fibrillation. Modification of the right atrium during maze surgery may change the arrhythmogenic substrate of atrial fibrillation (AF). METHODS AND RESULTS Epicardial mapping was performed in 9 patients undergoing unmodified maze III surgery for lone paroxysmal AF. Simultaneous recording of AF on the right and left atrium was carried out with two spoon-electrodes each harbouring 64 terminals. Activation maps of AF were made to study AF wavelet organization. The recording position on right and left atria was outside the surgical field and remained unchanged before and after surgery. Before surgery, mean right and left fibrillatory intervals were 174+/-23 ms, and 175+/-26 ms, respectively, and did not differ. After completed right atrial surgery, these fibrillary intervals remained unchanged. Mean right and left atrial dispersion of refractoriness (expressed as the coefficient of variation) were 4.2+/-0.8 and 5.2+/-3.8 ms. Only right atrial dispersion of refractoriness increased significantly after right-sided surgery. Prior to surgery, activation patterns of the left atrium were more complex than that of the right atrium. The left activation patterns became less complex afterwards; the right atrial activation patterns did not change. CONCLUSION The right atrial modification of maze III surgery neither affects atrial refractoriness during human lone AF nor changes AF wavelet organization. Thus, right atrial surgery does not modify the arrhythmogenic substrate of AF. These findings may imply that maze surgery can be restricted to the left atrium.
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Affiliation(s)
- E R Jessurun
- Departments of Cardiology and Cardio-Thoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
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