Cardiac Arrhythmia Mapping - Scientific Computing and...

SCHOOL OF MEDICINE COMPREHENSIVE ARRHYTHMIA RESEARCH & MANAGEMENT CENTER

Cardiac Arrhythmia Mapping!Challenges and Opportunities"

Derek J. Dosdall, Ph.D. 22 October, 2010

OUTLINE!•! Historical perspective

•! Current mapping techniques –!Optical mapping –!Electrical mapping (Purkinje example)

•! Future directions and opportunities

Noninvasive Electrical Mapping!•!Surface ECG was developed by William Einthoven in the early 1900s •!Lead I, II, III

Noninvasive Electrical Mapping!

If 3 leads were good, then 12 leads must be better!

And dozens to hundreds of body surface potentials even more useful!

Epicardial Mapping!•! Initially performed with a limited number of

channels on the epicardial surface. •! Advances in computing power and

storage have allowed for thousands of channels of data to be collected simultaneously.

Electrical Epicardial Mapping!•! Direct contact with plaques and socks

Epicardial & transmural arrays"!

Epicardial array

Plunge electrodes

Electrical Endocardial Mapping!

Endocardial baskets Open heart models Plunge needles Endocardial catheter

mapping

Clinical Endocardial Mapping!•! Endovascular catheter mapping reduces

invasiveness of mapping techniques •! Many clinically available mapping systems

with mapping catheters –!Carto (Biosense-Webster) –!EnSite NavX (St. Jude Medical) –!Others

Invasive Electrical Mapping!

Historical Optical Mapping!•! Carl Wiggers performed high speed

cinematography of VF in the 1930s and 40s

•! He visualized motion and defined 4 distinct periods of activity during VF

Current Optical Mapping!•! Voltage sensitive dye binds to cell

membrane and fluoresces at a different wavelength when the transmembrane potential (Vm) changes

•! Other dyes may be used to display intracellular calcium (Cai

++) levels

Optical Mapping!•! Advantages

–!Simultaneous Vm and Cai++ possible

–!Large numbers of pixels and high resolution •! Disadvantages

–!Motion artifact problematic –!Direct line of site required

Panoramic Optical Mapping of Vm!

Optrode Recordings!•! Fiberoptic bundles arranged in an

optical plunge needle configuration

From Omichi et al.,!Am J Physiol Heart Circ Physiol 286:!

H1836-1844, 2004.!

Simultaneous Vm and Cai++ measurements

Example of Multiple Mapping Techniques in Research!

Role of Purkinje Fibers in Long Duration Ventricular Fibrillation

Purkinje Fibers in Sinus Rhythm!

Wandering Wavelets Mother Rotor Reentry

Traditional Mechanisms of VF Maintenance!

Development of Activation Rate!•! Several groups have observed an

activation rate gradient in LDVF •! Present in dogs but not pigs

Endocardium"

Epicardium"

Purkinje Fiber Distribution!In humans, dogs, primates, and rabbits: In pigs, sheep, cows, ungulates, whales:

Purkinje Potential During VF!

V to PF Activation!

PF to V Pattern!

Focal PF Activation Pattern!

Lugol’s Ablation!Caused VF to terminate after 4.9 min in treated

hearts vs 9.2 min in control hearts

Eliminated the activation rate gradient

3-D Plunge Needle Mapping!

Intact Endocardial Mapping!

Purkinje in Defibrillation!Sinus

SDVF Success

LDVF Success

SDVF Failure

LDVF Failure

Purkinje System in LDVF:!

1.! Is a source of rapid activation in VF lasting more than 2-3 minutes

2.! Is the source of first postshock activation following long but not short duration VF

What next?!•! Optical mapping of the Purkinje system and

endocardium during LDVF •! Mapping with pharmacological interventions •! Pacing of Purkinje system •! Mapping of human hearts •! Improved modeling

Future of Cardiac Mapping!•! Electrophysiological mapping combined with

anatomical (CT, MRI) or functional imaging (DTI, SPECT or PET)

•! Electrical and optical mapping of arrythmogenic models (AF, HF, ischemia/reperfusion, pathologic ion channel conditions, genetic conditions, etc.)

Cardiac Arrhythmia Mapping - Scientific Computing and...

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