Abstract 14985: Presence of Repolarization Gradients Reverses Post-infarct Ventricular Tachycardia Exit and Entrance Sites in Personalized Digital Hearts

Introduction: Post-infarct ventricular tachycardias (VT) arise due to structural remodeling (scarring). Physiological repolarization gradients (apicobasal and transmural) exist in the human heart, but the effects on post-infarct VT dynamics are unknown. Hypothesis: We hypothesized that incorporation of repolarization gradients in personalized digital hearts of post-infarct patients impacts VT exit sites without altering the location of the VTs. Methods: 3D late-gadolinium enhanced CMR images were acquired from 7 post-infarct patients. Personalized image-based computational heart models (digital hearts) representing scar and infarct border zone distributions were constructed. Apicobasal (AB) and transmural (TM) repolarization gradients were incorporated using a validated method (Fig A). VTs were induced at baseline (no repolarization gradient) via rapid pacing in the right ventricular apex, using two pacing cycle lengths, mimicking non-invasive programmed stimulation. Pacing protocols that induced baseline VTs were repeated under AB and TM conditions. Results: Ten VTs were induced in baseline digital hearts. 8 AB VTs and 8 TM VTs were induced; the remaining 2 VTs for both AB and TM digital hearts could not be induced. 5/8 induced AB VTs had VT exit sites matching baseline VT exit sites; the remaining 3/8 AB VTs had reversed VT exit and entrance sites from the corresponding baseline VTs (Fig B, VT 1 & 2). 4/8 induced TM VTs had exit sites that matched those at baseline; the remaining TM VTs had exit and entrance sites reversed from those of baseline VTs (Fig B, VT 1, 2 & 3). All 8 AB VTs and 8 TM VTs had the same location as corresponding baseline VTs. Conclusion: AB and TM repolarization gradients can act to reverse VT entrance and exit sites without changing VT location. Thus, incorporation of physiological repolarization gradients into personalized digital hearts may not impact VT ablation targeting but may affect accurate prediction of VT exit or entrance sites.

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Abstract 14725: Image-based Virtual-heart Predictions Co-localize With ECG-based Automated Localization of Scar-related Ventricular Tachycardias

Circulation ◽

10.1161/circ.142.suppl_3.14725 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Shijie Zhou ◽

Eric Sung ◽

Adityo Prakosa ◽

Jonathan Chrispin ◽

Amir AbdelWahab ◽

...

Keyword(s):

Border Zone ◽

Patient Specific ◽

Heart Arrhythmia ◽

Surface Ecg ◽

Improve Accuracy ◽

Endocardial Surface ◽

Ventricular Tachycardias ◽

Ecg Leads ◽

Infarct Border Zone ◽

Infarct Border

Introduction: We previously developed an LGE-MRI-based virtual-heart arrhythmia ablation targeting (VAAT) methodology to non-invasively determine potential ablation targets for infarct-related VT. However, it is unknown whether VAAT’s predictions correspond with surface ECG predictions. Hypothesis: We hypothesized that the VAAT predicted VT circuits and potential ablation lesions would co-localize with ECG-based VT-exit predictions from a previously validated population-derived automated VT exit localization (PAVEL) system. Methods: We retrospectively enrolled 5 post-infarct patients who underwent LV endocardial VT ablation and had pre-procedural 2D LGE-MRIs. The PAVEL system based on a population-derived statistical method was used to localize VT-exit sites onto one of 238 triangles on the patient-specific virtual-heart LV endocardial surface using 8 independent ECG leads (I, II, V1-V6). The VAAT methodology incorporating patient-specific scar and infarct border zone distributions was used to identify potential VT circuits and find ablation lesions. Results: Eleven induced VTs were analyzed. Ten VT-exit sites were localized onto the patient-specific virtual-heart LV endocardial surface by the PAVEL system, and were used for the comparisons. One VT-exit site was too basal to be localized onto the virtual-heart geometry. The spatial resolution of the 10 predicted VT-exit sites was 13.8 ± 1.8 mm. VAAT-predicted VT circuits and ablation lesions correlated well with all 10 predicted VT-exit sites. Lastly, VAAT ablation lesions fell within the regions ablated clinically. Conclusions: The VAAT-predicted VT circuits and ablation lesions matched VT-exit sites predicted by the surface ECG-based PAVEL system. Combining these two complementary technologies may improve accuracy for non-invasively identifying optimal ablation targets to increase ablation efficacy.

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Analyzing the Role of Repolarization Gradients in Post-infarct Ventricular Tachycardia Dynamics Using Patient-Specific Computational Heart Models

Frontiers in Physiology ◽

10.3389/fphys.2021.740389 ◽

2021 ◽

Vol 12 ◽

Author(s):

Eric Sung ◽

Adityo Prakosa ◽

Natalia A. Trayanova

Keyword(s):

Ventricular Tachycardia ◽

Cardiac Magnetic Resonance ◽

Conduction Block ◽

Magnetic Resonance Images ◽

Border Zone ◽

Patient Specific ◽

Rapid Pacing ◽

Infarct Border Zone ◽

Infarct Border

Aims: Disease-induced repolarization heterogeneity in infarcted myocardium contributes to VT arrhythmogenesis but how apicobasal and transmural (AB-TM) repolarization gradients additionally affect post-infarct VT dynamics is unknown. The goal of this study is to assess how AB-TM repolarization gradients impact post-infarct VT dynamics using patient-specific heart models.Method: 3D late gadolinium-enhanced cardiac magnetic resonance images were acquired from seven post-infarct patients. Models representing the patient-specific scar and infarct border zone distributions were reconstructed without (baseline) and with repolarization gradients along both the AB-TM axes. AB only and TM only models were created to assess the effects of each ventricular gradient on VT dynamics. VTs were induced in all models via rapid pacing.Results: Ten baseline VTs were induced. VT inducibility in AB-TM models was not significantly different from baseline (p>0.05). Reentry pathways in AB-TM models were different than baseline pathways due to alterations in the location of conduction block (p<0.05). VT exit sites in AB-TM models were different than baseline VT exit sites (p<0.05). VT inducibility of AB only and TM only models were not significantly different than that of baseline (p>0.05) or AB-TM models (p>0.05). Reentry pathways and VT exit sites in AB only and TM only models were different than in baseline (p<0.05). Lastly, repolarization gradients uncovered multiple VT morphologies with different reentrant pathways and exit sites within the same structural, conducting channels.Conclusion: VT inducibility was not impacted by the addition of AB-TM repolarization gradients, but the VT reentrant pathway and exit sites were greatly affected due to modulation of conduction block. Thus, during ablation procedures, physiological and pharmacological factors that impact the ventricular repolarization gradient might need to be considered when targeting the VTs.

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Impaired Cross Bridge Formation Contributes to Reduced Cardiac Contraction in the Infarct Border Zone

Biophysical Journal ◽

10.1016/j.bpj.2012.11.867 ◽

2013 ◽

Vol 104 (2) ◽

pp. 153a

Author(s):

Rafael Shimkunas ◽

Om Makwana ◽

Mona Bazagan ◽

Paul C. Simpson ◽

Mark B. Ratcliffe ◽

...

Keyword(s):

Cardiac Contraction ◽

Border Zone ◽

Bridge Formation ◽

Cross Bridge ◽

Infarct Border Zone ◽

Infarct Border

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Abstract 14412: Activation of Autophagic Flux Maintains Mitochondrial Homeostasis During Cardiac Ischemia/reperfusion Injury

Circulation ◽

10.1161/circ.142.suppl_3.14412 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jing Yang ◽

Geoffrey W CHO ◽

Lihao He ◽

Yuxin Chu ◽

Jin He ◽

...

Keyword(s):

Infarct Size ◽

Reperfusion Injury ◽

Mitochondrial Dynamics ◽

Systolic Function ◽

Ischemia Reperfusion ◽

Border Zone ◽

Autophagic Flux ◽

Hdac Inhibition ◽

Infarct Border Zone ◽

Infarct Border

Background and Hypothesis: Reperfusion injury accounts for ~50% of myocardial infarct size, and clinically efficacious therapies are lacking. Histone deacetylase (HDAC) inhibition enhances cardiomyocyte autophagic activity, mitochondria biogenesis, and blunts ischemia/reperfusion (I/R) injury when given at the time of reperfusion. However, as HDAC inhibition has pleiotropic effects, we will test whether augmentation of autophagic flux using a specific autophagy-inducing peptide, Tat-Beclin (TB), is cardioprotective. Methods: 8-12-week-old, wild-type, C57BL6 mice were randomized into three groups: vehicle control, Tat-Scrambled (TS) peptide, or Tat-Beclin (TB) peptide. Each group was subjected to I/R surgery (45min ischemia, 24h reperfusion). Infarct size, systolic function, and mitochondrial dynamics were assayed. Cultured neonatal rat ventricular myocytes (NRVMs) were used to test for cardiomyocyte specificity. Conditional cardiomyocyte ATG7 knockout (ATG7 KO) mice and ATG7 knockdown by siRNA in NRVMs were used to evaluate the role of autophagy. Results: TB treatment at reperfusion reduced infarct size by 20.1±6.3% (n=23, p<0.02) and improved systolic function. Increased autophagic flux and reduced reactive oxygen species (ROS) were observed in the infarct border zone. The cardioprotective effects of TB were abolished in ATG7 KO mice. TB increased mtDNA content in the border zone significantly. In NRVMs subjected to I/R, TB reduced cell death by 41±6% (n=12, p<0.001), decreased ROS, and increased mtDNA content significantly by ~50%. Moreover, TB promoted expression of PGC1α (a major driver of mitochondrial biogenesis) both in the infarct border zone and NRVMs subjected to I/R by ~40%, and increased levels of mitochondrial dynamics gene transcripts Drp1, Fis1, and MFN1 / 2. Conversely, ATG7 knockdown in NRVMs and cardiac ATG7 KO abolished the beneficial effects of TB on mitochondria DNA content. Conclusions: Autophagic flux is an essential process to mitigate myocardial reperfusion injury acting, at least in part, by inducing PGC1α-mediated mitochondrial biogenesis. Augmentation of autophagic flux may emerge as a viable clinical therapy to reduce reperfusion injury in myocardial infarction.

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Abstract 342: Cortical Bone Stem Cell Therapy Alters Macrophage Phenotype and Reduces Cardiac Cell Death After Myocardial Infarction

Circulation Research ◽

10.1161/res.127.suppl_1.342 ◽

2020 ◽

Vol 127 (Suppl_1) ◽

Author(s):

Alexander R Hoachlandr-Hobby ◽

Remus M Berretta ◽

Yijun Yang ◽

Eric Feldsott ◽

Hajime Kubo ◽

...

Keyword(s):

Myocardial Infarction ◽

Immune Response ◽

Infarct Size ◽

Reperfusion Injury ◽

Cortical Bone ◽

Myocardial Injury ◽

Border Zone ◽

Paracrine Factors ◽

Infarct Border Zone ◽

Infarct Border

Acute injuries to the heart, like myocardial infarction (MI), contribute to the development and pathology of heart failure (HF). Reperfusion of the ischemic heart greatly increases survival but results in reperfusion injury that can account for up to 50% of the final infarct size. The inflammatory response to MI-induced myocardial injury is thought to be responsible for the propagation of reperfusion injury into the infarct border zone, expanding myocardial damage. We have previously shown in a swine model of MI that intramyocardial injections of cortical bone-derived stem cells (CBSCs) into the infarct border zone has no acute cardioprotective effect but reduces scar size by half and prevents the decline of ejection fraction and LV dilation 3 months after MI. Our new preliminary data show that CBSCs have potent immunoregulatory capabilities. Therefore, we hypothesize that CBSC treatment has an effect on the immune response to MI that improves the wound healing response to myocardial injury and mitigates LV remodeling and infarct size 3 months later. To test this hypothesis, we characterized the effects of CBSC paracrine factors on macrophages in vitro and found that CBSC-treated macrophages express higher levels of CD206, produce more IL-1RA and IL-10, and phagocytose apoptotic myocytes more efficiently. In addition, macrophages were increased in CBSC-treated swine hearts 7 days after MI compared to controls with a corresponding increase in IL-1RA and TIMP-2. Apoptosis was decreased overall and in macrophages specifically in CBSC-treated animals. From these data we conclude CBSCs may exert an acute pro-reparative effect on the immune response after MI, reducing reperfusion injury and adverse remodeling resulting in improved functional outcomes at later time points.

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Recurrent appearance of protective zones after an unsuccessful defibrillation shock

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1996.271.4.h1491 ◽

1996 ◽

Vol 271 (4) ◽

pp. H1491-H1497 ◽

Cited By ~ 1

Author(s):

C. Hwang ◽

W. Fan ◽

P. S. Chen

Keyword(s):

Right Ventricular ◽

Energy Requirement ◽

Right Ventricular Outflow Tract ◽

Posterior Wall ◽

Ventricular Outflow Tract ◽

Specific Time ◽

Time Intervals ◽

Cycle Lengths ◽

Right Ventricular Apex ◽

The Right

This study was designed to test the hypothesis that protective zones appear recurrently at the initiation of ventricular fibrillation (VF) and that when shocks are delivered during protective zones, there can be a decrease in the defibrillation energy requirement. A total of 12 open-chest dogs were studied. Six dogs were included in protocol 1. After eight baseline pacing stimuli (S1) with cycle lengths of 300 ms, a strong premature stimulus (S2) (73 +/- 10 mA) was given to induce VF. In subsequent episodes, a second strong premature stimulus (S3) was given at progressively longer S2-S3 intervals in 20-ms increments. In protocol 2, we delivered unsuccessful defibrillation shocks via a transvenous defibrillation electrode placed in the right ventricular apex of six dogs. A second shock was then delivered to patch electrodes on the right ventricular outflow tract and the posterior wall of the left ventricle. The results of protocol 1 showed that the S3 terminated reentry and prevented VF only when it occurred at specific time intervals after the S2 (the protective zones). These protective zones appear recurrently up to 375 ms after the onset of VF. The results of protocol 2 showed that the total energy required for successful defibrillation was dependent on the interval between the first and second shocks. Intervals favoring effective defibrillation (protective zones) appeared recurrently for up to 280 ms after the first shock. When the second shock was delivered during a protective zone, the defibrillation energy requirement was decreased by up to 23% (from 13.1 +/- 2.0 to 10.1 +/- 1.8 J, P < 0.003). However, when the shock was delivered outside the protective zone, a significant increase in the defibrillation energy requirement was observed. We conclude that protective zones appear recurrently at the onset of VF and after unsuccessful defibrillation shocks.

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