Fédération Française de NHLBI Grants P01-HL039707 ve P01-HL087226 ve Leducq Vakfı (JJ ve OB), bir İspanyol Kardiyoloji Bursu Derneği tarafından, Fundación Pedro Barrie de la Maza ve Fundación Alfonso Martín Escudero (DFR) tarafından kısmen desteklenen Cardiologie (RPM), Kalp Ritmi Derneği dostluk Ödülü, Japonya Kalp Vakfı / Electrocardiology (MY) Japon Derneği Bursu.

1. Kalp kaldırılması ve Langendorff perfüzyon Koyun 35-40 Kg ağırlığında, 4-6 mg / kg propofol ve 60-100 mg / Kg pentobarbital sodyum ile anestezi. Kalpler torakotomi ile kaldırıldı ve (% 95 O2,% 5 CO2) 240-270 ml / dk, pH 7.4 ve 35,5-37,5 ° C sabit bir akış hızında Tyrode çözümü oksijenli dolaşan bir Langendorff-perfüzyon sistemine bağlı Tyrode kompozisyonu (mM): NaCl 130, KCl 4.0, MgCl2 1, CaCl2 1.8, NaHCO3 24, NaH2PO4 1.2, Glikoz 5.6 ve Albumin 0.04 g / L Blebbistatin 10 mcM (Enzo Yaşam Bilimleri Uluslararası, INC Plymouth Toplantı, PA, USA), kasılma gücü azaltmak için kullanılır. 2. Langendorff perfüze koyun kalbinde Streç bağlı atriyal fibrilasyon Izole perfüze koroner kalp kulakçıklar hem eşitledi intrakaviter basınç sağlamak için trans-bir atriyal septal ponksiyon uğrar. Ve açık uçlu bir çıkış kanül; Tüm ven orifisleri sonra kanüle bir dijital sensör (BIOPAC Systems, Inc, Santa Barbara, CA, USA BIOPAC Sistemleri transduser-TSD104A) bağlı inferior vena kava, dışında, mühürlenmiş. kulakçıklar üzerinde yüksekliği intra-atriyal basınç kontrol eder. Basınç, sonra 6 cm H 2 O hacmi atriyal volüm göreceli bir ~% 30 artış neden 12 cm H 2 O, yükselmiştir Basınç deney boyunca sabit tutulur. Damarlar sızdırmazlık önce tetrapolar elektrod kateterler (Torq, Medtronic Inc / Minneapolis / MN / ABD) BIOPAC Sistemleri amplifikatör kullanarak iki distal elektrotlar (örnekleme oranı, 1.0 kHz) bipolar sinyallerini kaydetmek için pulmoner venlerin her yerleştirilir (DA100C; BIOPAC Systems, Inc, Santa Barbara, CA, USA). Sol atriyal apendiks (SAA) ve sağ atriyal apendiks üst çatı İki ek custum yapılan bipolar elektrotlar yerleştirilir. 3. Optik haritalama <ol><li> Sol atriyal apendiks epikardiyal haritalama. 5 ila 10 ml Di-4-ANEPPS (10 mg / ml) (Sigma-Aldrich, St Louis, MO, ABD) ve 10 dakika yükleme süresi bir bolus enjeksiyon, lazer uyarım üzerine elde edilen voltaj duyarlı floresan ihtiyaç vardır (532 nm) epikardiyal yüzeyi. Yayılan floresan sonra (Bkz. şematik gösterimi 600 nm uzun geçiş filtresi yoluyla iletilir ve LittleJoe CCD video kamera (80x80 piksel, Analitik Systems, Inc Decatur, GA, ABD SciMeasure) yansıtılıyor ve saniyede 800 kare hızında elde edilen Şekil 1A). Beş saniyelik bir film AF sırasında 2 dakika aralıklarla elde edilir. Eşlenen epikardiyal yüzey alanı ~ 14 cm 2. </li><li> Bozulmamış kalp PLA Endokardial optik haritalama. Ikinci LittleJoe CCD kamera (80x80 piksel) epikardiyal kamera ile senkronize edilir. 90-derecelik bir görüş alanına sahip 10 mm çap çift kanallı sert borescope (Everest VIT, Inc. Flanders, NJ, ABD), mitral kapak genelinde, sol ventrikül ön duvarı boyunca ve endokardiyal yüzey üzerinde duruldu PLA. PLA optik eşlenen alan dört pulmoner venlerin ve atriyal septo-pulmoner paket (Şekil 1A, B) görselleştirmek sağlar ~ 4 cm 2,. Borescope c, ısmarlama bir mercek adaptör ile CCD kamera monte edilmiştir. Lazer 532 nm ışık, sonra da bir sıvı (çekirdek 0.2) ışık kılavuzu ile borescope ikaz kanala teslim edilir. </li></ol> 4. Atriyal fibrilasyon protokolü Sürekli atriyal gerilimin altında AF SAA üstünde bulunan bir pacing elektrod tarafından burst pacing (12 Hz, 5 ms bakliyat, 2x diyastolik eşiği) ile meydana gelir. AF, 50 dakika ve 5 saniye optik filmleri iki dakika aralıklarla satın devam etmek için izin verilir. Bipolar kayıtları sürekli olarak toplanır. Optik film Toplama bipolar kayıtları 5 sn segmentleri aynı anda satın alma tetikler. 5. Frekans analizi Frekans analizi, sol ve sağ atrium arasındaki frekans gradyanlar ile birlikte, AF sırasında aktivasyon oranı yüksek olan bölgelerin belirlenmesi sağlar. Hakim frekans (DF) haritaları, hızlı Fourier dönüşümü algoritması (FFT) her pikselin kaydedildi zaman serisi floresan sinyal uygulandıktan sonra her bir optik film elde edilir. 7 FFT de 5 saniye bipolar sinyaller (Yüksek geçişli filtrelenmiş uygulanır 3 Hz ve düşük geçmek optik filmleri ile senkronize) 35 Hz süzülmüş. 6. Atriyal fibrilasyon dinamikleri <ol><li> Faz haritaların üretilmesi. AF dinamikleri Analizi Hilbert dönüşümü ile üretilen faz film yararlanır 14 Kısaca her spektral bileşen ilgili çeyrek döngüsü tarafından kaydırılır, orijinal zaman serisi sinyallerine dönüştürerek, her piksel kaydedilen aksiyon potansiyeli anlık faz belirlenir. Afterwar. 15ds, sinyal anlık faz, orijinal sinyal dönüştürülmüş sinyal oranı ters teğet elde edilir. Ve π radyan π arasında değerler ile faz açısı, sürekli mekansal faz değişimi eksitasyon, repolarizasyon ve iyileşme sürecini yansıtan bir faz harita oluşturmak için sürekli bir renk düzeni olarak temsil edilmektedir. 14 </li><li> Aktivasyon paternlerinin Karakterizasyonu. Aktivasyon paternlerinin çeşitli sınıflar, aşağıdakiler de dahil olmak üzere faz filmleri (Şekil 2) kullanılarak tespit edilebilir: <ul><li> A rotor, birden fazla rotasyon (Şekil 2A) süren bir tekillik noktasında birleşen tüm aşamaları varlığı ile tanımlanır. </li><li> Bir atılım wavefront görüş alanı görünen ve bir hedef gibi desen dışa (Şekil 2B) propaganda olarak tanımlanır. </li><li> Spatiotemporally düzenlenen periyodik dalgalar, görüş alanı içinde aynı yerde, benzer yönde ve inter-dalga aralığı (Şekil 2C) ile ortaya çıkan dört sıralı periyodik dalgalar asgari olarak tanımlanır. </li></ul></li></ol> Daha fazla kantitasyonu, bu belirli bir bölgede elde edilen en yaygın aktivasyon deseni ile en yüksek frekans mekansal korelasyon sağlar. Yüksek frekans akut AF sırasında nerede yaygın bölgeyi temsil eden bu yana ikincisi, PLA endokardiyal yüzey haritalama önemli rol vurgulamaktadır. 7. Temsilcisi Sonuçlar: PLA SAA ve RAA Hakim frekans (DF) gradyanlar akut streç indüklenen AF sırasında mevcut. Yüksek DF bölge ya veya pulmoner venlerin veya yere PLA birinin yakınında lokalize 11 A temsilcisi AF bölüm (sağ inferior pulmoner ven) en yüksek DF PLA lokalize olduğu, Şekil 3&#39;te gösterildiği gibi. Sonuçları, paroksismal insan AF ablatif prosedürler sırasında gözlenen sağ DF gradyanlar sol tutarlı PLA sürüş AF yüksek frekans kaynaklarının varlığı destek 16 Aktivasyon aşaması harita film kullanarak desen Niceleme en yüksek sayıda rotor PLA ve PLA ve SAA arasında birleşme olduğunu gösterir. 8 Bazen rotasyon merkezi (Tekillik noktası) uzun ömürlü rotorlar tespit etmek mümkün. yüksek frekans alanı ile lokalize 10 atriyal doku, üç boyutlu yapısını temsil ettiğinden dolayı, PLA eşlenen endokardiyal yüzeyinde rotorlar tanımlayan bu rotorlar dönme merkezi (filament) sonunda haritalama alanının yüzeyine dik olduğunu göstermektedir . Şekil 4 PLA ve SAA (9 ve 6.4 Hz sırasıyla) arasında bir frekans farkı ile ilişkilidir SAA, doğru eş zamanlı fibrillatory iletimi ile PLA endokard kaydedilen böyle bir rotor gösterir. Rotor sayısı, bu model aritmi korumak için PLA reentry önemli bir rol anlaşılacağı SAA daha PLA sürekli yüksek. Genel olarak, sonuçlar, istikrarlı ve hızlı sol atrium rotorlar akut uzanan bağlı AF ve yayılan dalgalar sürebileceği teorisini desteklemek fibrillatory iletim olarak tezahür karmaşık, mekansal olarak dağınık iletim blok desen onlar başkanı olarak sağ atriyuma doğru geçmesi ve tedricen baskın azalan frekans. <img src="/files/ftp_upload/3103/3103fig1.jpg" alt="Şekil 1" /> Şekil 1 deneysel şematik gösterimi kurdu. A: Bir katı borescope, sol ventrikül ve mitral kapak orifis ön duvar ile tanıştırdı ve posterior sol atrium (PLA) endokardiyal yüzey üzerinde duruldu. Bir CCD kamera borescope akuple ve lazer aydınlatma borescope inferior kısmına bağlı bir lazer sıvı rehber aracılığıyla sağlanır. Epikardiyal haritalama SAA yapılır. Sağ atrium ve sol atrium çatı bipolar elektrotlar yerleştirilir. Pulmoner venlerin Ek bipolar sinyaller elde edilir. B: gösterim amaçlı lateral duvar açılış sonrası sol atriyum Yanal. Borescope ucu PLA endokardiyal yüzeyi aydınlatır. Bir bipolar elektrot sol atrium çatı yer alır. SAA: sol atriyal apendiks. LV: Sol ventrikül. RA: sağ atrium. RV: sağ ventrikül. <img src="/files/ftp_upload/3103/3103fig2.jpg" alt="Şekil 2" /> Şekil 2 faz film nesil sonra tanımlanan aktivasyon Farklı desen. A: Sol atriyal apendiks (SAA) Sıralı snap shot (Tekillik noktası) dönme merkezi etrafında bir rotor dönme göstermektedir. Soldan sağa, bir tam dönüş tamamlanmış olur. B: SAA örnek bir atılım aktivasyon paterni. Dalga yukarı görünürgörünüm ve dışa yayar alanının sağ köşesinde başına. C: SAA PLA doğru bölgeye gelen dört spatiotemporally düzenlenen periyodik dalgalar (sırasıyla% 0, 182, 352 ve 512 ms). İzokronlar 10 ms aralıklarla çizilir. Alt, aksiyon potansiyeli farklı aşamaları için temel renk kodlu. <img src="/files/ftp_upload/3103/3103fig3.jpg" alt="Şekil 3" /> Şekil 3 Langendorff izole perfüze koyun kalbinde akut streç indüklenen AF sırasında yüksek frekans aktivitesi ile bölgelerin belirlenmesi. A: sol atriyal apendiks (SAA), sağ atriyal apendiks (RAA) ve posterior sol atrium (PLA) anatomik görünümü. PLA görüntü dört pulmoner ven (PV) ile eşlenen bölge endoskopik görünümü. B: SAA ve PLA DF optik haritalama ile elde edilen haritalar. Bipolar electrograms RAA Frekans değeri elde edildi. Yüksek frekans bölge PLA yer almaktadır. C:, maksimum DF doğru sayfa gösterimi PLA bölgede 12.4 Hz tekabül eden Temsilcisi güç spektrumu,. LSPV: sol superior pulmoner ven. LIPV: sol inferior pulmoner ven. RSPV: sağ superior pulmoner ven. RIPV: sağ inferior pulmoner ven. Çoğaltılamaz referans 11 (David Filgueiras Rama &amp; José Jalife. Atriyal Fibrilasyon altında yatan mekanizmaları. Temel Bilimler Klinik elektrofizyolog, Cilt 3 (ed. Charles Antzelevitch) 141-156 (Saunders, 2011) . <img src="/files/ftp_upload/3103/3103fig4.jpg" alt="Şekil 4" /> Şekil 4 Simultaneousphase haritaları (A, B) ve posterior (PLA), sol atriyum ve sol atriyal apendiks (SAA) baskın frekans haritaları (C). A: bir rotor ve onun tekillik noktası sürüklenen gösteren PLA Sıralı snap shot. B: SAA Eşzamanlı faz snap shot. Aktivasyon paternleri fibrillatory iletim yayılma dalgaları ile uyumlu göstermektedir. Singularity noktaları da fibrillatory iletim bölgesi wavebreaks ile korelasyon mevcuttur. PLA ve SAA eş zamanlı baskın frekans haritaları: C (video 4 de bakınız). Hızlı bölge bir rotor faz harita analizi varlığı ile ilişkilidir PLA (9 Hz) yer almaktadır. SAA en yüksek frekans fibrillatory iletimi ile ilişkilidir 6 Hz. Panel C Sağ tarafta, tek bir pikselin optik aktivasyonlar PLA ve SAA gösterilmiştir.

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Çıkar çatışması ilan etti.

Izole koyun kalp streç indüklenen akut AF özellikleri insan paroksismal AF bazı özelliklerini andırır. Koyun kalbinde intra-atriyal basınç akut bir artış AF atriyal dilatasyon olan hastalarda gözlenen AF daha yüksek bir risk benzer uzun süre bakım sağlar. Soldan sağa DF degradelerin 1 varlığı koyun kulakçıklar insan elektrofizyolojik çalışmaların kayıt yaptırmış olanlar da benzer 16 Bu nedenle, bu akut modeli AF sürdürülmesi mekanizmasının anlaşılması, şu anda...

<table border="1"><tbody><tr><td> Malzeme Adı </td><td> Şirket </td><td> Katalog Numarası </td></tr><tr><td> Ötenazi </td><td></td><td></td></tr><tr><td> Heparin </td><td> Sigma </td><td> H3393 </td></tr><tr><td> Propofol </td><td> Abbott </td><td> 5206-04-03 </td></tr><tr><td> Pentobarbital </td><td> Lundbeck Inc. </td><td> NDC 67386-501-55 </td></tr><tr><td> Introducer 18 Gauge </td><td> Terumo </td><td> SS * FF1832 </td></tr><tr><td> Kelepçeli endotrakeal tüp (9 mm) </td><td> PRM Veteriner </td><td> # 9440 </td></tr><tr><td> Fiber Optik Laringoskop Çantası </td><td> PRM Veteriner </td><td> # 991 </td></tr><tr><td> Fiber Optik Blade </td><td> PRM Veteriner </td><td> # 984 </td></tr><tr><td> İşletim Makas </td><td> PRM Veteriner </td><td> # 9702 # 1944 </td></tr><tr><td> Neşter Kolu # 3 Solid 4 &quot; </td><td> Roboz Cerrahi Instrument Co, Inc. </td><td> RS-9843 </td></tr><tr><td> Steril bistüri Bıçaklar </td><td> Roboz Cerrahi Instrument Co, Inc. </td><td> RS-9801-10 </td></tr><tr><td> Havalandırma çanta </td><td> Westmed </td><td> 562013 </td></tr><tr><td> Künt / Sharp Sims Makas Eğri </td><td> Roboz Cerrahi Instrument Co, Inc. </td><td> RS-7035 </td></tr><tr><td> Doku Forseps (× 2) </td><td> PRM Veteriner </td><td> # 1895 </td></tr><tr><td> KANTROWITZ Göğüs Forseps, 11 &quot; </td><td> Biyomedikal Araştırma Instruments, Inc. </td><td> 34-1980 </td></tr><tr><td> Finochietto Büyük Göğüs Serpme </td><td> Kapp Cerrahi Enstrüman Inc. </td><td> KS-7301 </td></tr><tr><td> Torakotomi makaslar </td><td> Rostfrei Solingen </td><td></td></tr><tr><td> Plastik tepsisi </td><td> Nalgene </td><td> Fischer </td></tr><tr><td> Optik haritalama </td><td></td><td></td></tr><tr><td> Bonn Makas (× 2) </td><td> Roboz Cerrahi Instrument Co, Inc. </td><td> RS-5840SC </td></tr><tr><td> Cerrahi ipek </td><td> Fischer </td><td> 50-900-04214 </td></tr><tr><td> Mikro Diseksiyon Forseps </td><td> Roboz Cerrahi Instrument Co, Inc. </td><td> RS-5130 </td></tr><tr><td> Tetrapolar elektrod kateterler (Torq) (× 4) </td><td> Medtronic Inc. </td><td> 05580SP </td></tr><tr><td> Dijital sensör. BIOPAC Sistemleri transduser </td><td> BIOPAC Systems, Inc. </td><td> RX104A </td></tr><tr><td> BIOPAC Sistemleri amplifikatör </td><td> BIOPAC Systems, Inc. </td><td> DA-100C </td></tr><tr><td> Di-4-ANEPPS </td><td> Sigma-Aldrich, St. </td><td> D8604-5mg </td></tr><tr><td> Blebbistatin </td><td> Enzo Yaşam Bilimleri Uluslararası, INC. </td><td> BML-E1315-0025 </td></tr><tr><td> LittleJoe CCD video kamera (× 2) </td><td> Analitik Systems, Inc. SciMeasure </td><td></td></tr><tr><td> Çift kanal sert borescope </td><td> Everest VIT, Inc. </td><td> R10-25-0-90 </td></tr><tr><td> Perfüzyon pompaları (× 2) </td><td> Cole Parmer </td><td> GK-77.920-30 </td></tr><tr><td> Sıcaklık probu </td><td> Cole Parmer </td><td> R-08.491-02 </td></tr><tr><td> pH metre </td><td> Fischer </td><td> 01-913-806 </td></tr><tr><td> Dijital sıcaklık göstergesi </td><td> Cole Parmer </td><td> GK89000-10 </td></tr><tr><td> Oksijenatör filtreleri </td><td> Sorin </td><td> 05318 </td></tr><tr><td> Silikon perfüzyon tüpleri (L / S 15) </td><td> MASTERFLEX </td><td> 96410-15 </td></tr><tr><td> Lazer ışığı kılavuzları (× 6) </td><td> Oriel Corporation&#39;ın </td><td> 77536 </td></tr><tr><td> Sıvı ışık kılavuzu (çekirdek 0.2) </td><td> Newport Corporation&#39;ın </td><td> 77556 </td></tr><tr><td> Lazer jeneratör (1 watt) (x 1) </td><td> Şangay Rüya Lsaer Tecchnology </td><td> SDL-532-1000T </td></tr><tr><td> Lazer jeneratör (5 watt) (x 1) </td><td> Spectra Fizik Lazerler </td><td> DEĞİRMEN 5sJ </td></tr></tbody></table>

high-resolution endocardial and epicardial optical mapping in a sheep model of stretch-induced atrial fibrillation

Atriyal fibrilasyon (AF), yüksek morbidite ve mortalite ile karmaşık bir kardiyak aritmi. 1,2, klinik uygulamada görülen ve görülme sıklığı, önümüzdeki yıllarda artması beklenmektedir en sık kalıcı kalp ritmi bozukluğu. 3 Artan intra -atriyal basınç ve dilatasyonu AF, hayvan modelleri kullanarak önemi vurgular ve 1,4 AF dinamiklerini incelemek kadar uzanan uzun bir yol kabul edilmiştir. AF altında yatan mekanizmaların anlaşılması, yüksek mekansal ve zamansal çözünürlük ile kalp elektrik dalgalarının görselleştirme gerektirir. Yüksek temporal çözünürlük geleneksel insan elektrofizyolojik çalışmalarda kullanılan konvansiyonel elektrik haritalama ile elde edilebilir olsa da, aynı anda kullanılabilir intra-atriyal elektrot sayısının az uzaysal çözünürlüğü sınırlar ve aritmi esnasında elektrik dalgalarının detaylı bir izleme engellemektedir. Alt-hayvan modellerinde 5,6 milimetre mekansal çözünürlükte ve fibrillatory kaynağı olarak hızla elektriksel dalga şekilleri (rotor) iplik kimlik yol ile birlikte fibrillatory aktivitenin erken 90 etkin olduğu geniş alan karakterizasyonu optik haritalama giriş ventriküller ya da kulakçıklar oluşabilir aktivite 7-9 kombine zaman ve optik haritalama frekans alanı analizleri, sol ve sağ atrium arasındaki frekans gradyanlar ile birlikte AF ayrık siteleri sırasında yüksek frekanslı periyodik faaliyet göstermek mümkün . . Hızlı rotorlar ile bölgenin en yüksek frekansta aktive eder ve genel aritmi sürücüler gibi rotor kaynaklanan 10,11 dalgaları fibrillatory iletim fenomen, fonksiyonel veya anatomik olarak kendi yolunda engellerle etkileşim 12 Haritalama endokardiyal yüzey posterior sol atrium (PLA), en yüksek rotor frekansı ile dalga dinamiği bölge AF izleme sağlar. Önemlisi, PLA intrakaviter kateter bazlı ablatif prosedürler hasta, 13 AF sol atrium iç dinamikleri eğitim alaka altını en başarılı sonlandırma AF bölgedir. Burada, insan paroksismal AF bazı özellikleri benzer akut streç indüklenen AF, bir koyun modeli açıklanmaktadır. Sol atrium epikardiyal haritalama, sert borescope AF bakım için en uygun bölge aktivasyon desenleri görselleştirmek için en doğrudan bir yaklaşımı temsil eden bir CCD kamera, c monte bir dual-channel kullanarak PLA endokardiyal haritalama ile tamamlanmaktadır.

Watch this Scientific Journal Video about High-Resolution Endocardial and Epicardial Optical Mapping in a Sheep Model of Stretch-Induced Atrial Fibrillation at JoVE.com

High-Resolution Endocardial and Epicardial Optical Mapping in a Sheep Model of Stretch-Induced Atrial Fibrillation

Bu rapor, streç bağlı atriyal fibrilasyon sırasında Langendorff perfüze koyun kalp bozulmamış sol atrium elektriksel uyarım eşzamanlı endokardiyal ve epikardiyal optik haritalama metodolojisi ve sonuçları ayrıntılı bir açıklamasını sağlar.

Stretch Bağlı Atriyal Fibrilasyon Koyun Modelinde Yüksek Çözünürlüklü Endokardial ve Epikardiyal Optik Haritalama

 Atrial fibrillation (AF) is a complex cardiac arrhythmia with high morbidity and mortality.1,2 It is the most common sustained cardiac rhythm disturbance ...

high-resolution-endocardial-epicardial-optical-mapping-sheep-model

Research

JoVE Journal

Medicine

14.7K Görüntüleme.  University of Michigan. Bu rapor, streç bağlı atriyal fibrilasyon sırasında Langendorff perfüze koyun kalp bozulmamış sol atrium elektriksel uyarım eşzamanlı endokardiyal ve epikardiyal optik haritalama metodolojisi ve sonuçları ayrıntılı bir açıklamasını sağlar.

Video: High-Resolution Endocardial and Epicardial Optical Mapping in a Sheep Model of Stretch-Induced Atrial Fibrillation

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting an estimated 6 million people in the United States 1. Since AF affects primarily elderly people, its prevalence increases parallel with age. As such, it is expected that 15.9 million Americans will be affected by the year 2050 2. Ischemic stroke occurs in 5% of non-anticoagulated AF patients each year. Current treatments for AF include rate control, rhythm control and prevention of stroke 3.
The American College of Cardiology, American Heart Association, and European Society of Cardiology currently recommended rate control as the first course of therapy for AF 3. Rate control is achieved by administration of pharmacological agents, such as &beta;-blockers, that lower the heart rate until it reaches a less symptomatic state 3. Rhythm control aims to return the heart to its normal sinus rhythm and is typically achieved through administration of antiarrhythmic drugs such as amiodarone, electrical cardioversion or ablation therapy. Rhythm control methods, however, have not been demonstrated to be superior to rate-control methods 4-6. In fact, certain antiarrhythmic drugs have been shown to be associated with higher hospitalization rates, serious adverse effects 3, or even increases in mortality in patients with structural heart defects 7. Thus, treatment with antiarrhythmics is more often used when rate-control drugs are ineffective or contraindicated. Rate-control and antiarrhythmic agents relieve the symptoms of AF, including palpitations, shortness of breath, and fatigue 8, but don't reliably prevent thromboembolic events 6.
Treatment with the anticoagulant drug warfarin significantly reduces the rate of stroke or embolism 9,10. However, because of problems associated with its use, fewer than 50% of patients are treated with it. The therapeutic dose is affected by drug, dietary, and metabolic interactions, and thus requires detailed monitoring. In addition, warfarin has the potential to cause severe, sometimes lethal, bleeding 2. As an alternative, aspirin is commonly prescribed. While aspirin is typically well tolerated, it is far less effective at preventing stroke 10. Other alternatives to warfarin, such as dabigatran 11 or rivaroxaban 12 demonstrate non-inferiority to warfarin with respect to thromboembolic events (in fact, dabigatran given as a high dose of 150 mg twice a day has shown superiority). While these drugs have the advantage of eliminating dietary concerns and eliminating the need for regular blood monitoring, major bleeding and associated complications, while somewhat less so than with warfarin, remain an issue 13-15.
Since 90% of AF-associated strokes result from emboli that arise from the left atrial appendage (LAA) 2, one alternative approach to warfarin therapy has been to exclude the LAA using an implanted device to trap blood clots before they exit. Here, we demonstrate a procedure for implanting the WATCHMAN Left Atrial Appendage Closure Device. A transseptal cannula is inserted through the femoral vein, and under fluoroscopic guidance, inter-atrial septum is crossed. Once access to the left atrium has been achieved, a guidewire is placed in the upper pulmonary vein and the WATCHMAN Access Sheath and dilator are advanced over the wire into the left atrium. The guidewire is removed, and the access sheath is carefully advanced into the distal portion of the LAA over a pigtail catheter. The WATCHMAN Delivery System is prepped, inserted into the access sheath, and slowly advanced. The WATCHMAN device is then deployed into the LAA. The device release criteria are confirmed via fluoroscopy and transesophageal echocardiography (TEE) and the device is released.

The accompanying video describes a procedure for percutaneous placement of the WATCHMAN Left Atrial Appendage (LAA) Device. The WATCHMAN is a nitinol device designed to be permanently implanted at, or slightly distal to, the opening of the left atrial appendage (LAA) to trap blood clots before they exit the LAA, preventing thromboembolic stroke.

Bekçi Atriyal fibrilasyon için Atriyal Apendiks Kapatma Cihaz Sol

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting an estimated 6 million people in the United States 1. Since AF affects primarily ...

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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting millions of individuals worldwide 1-3. The rapid, irregular, and disordered electrical activity in the atria gives rise to palpitations, fatigue, dyspnea, chest pain and dizziness with or without syncope 4, 5. Patients with AF have a five-fold higher risk of stroke 6.
Oral anticoagulation (OAC) with warfarin is commonly used for stroke prevention in patients with AF and has been shown to reduce the risk of stroke by 64% 7. Warfarin therapy has several major disadvantages, however, including bleeding, non-tolerance, interactions with other medications and foods, non-compliance and a narrow therapeutic range 8-11. These issues, together with poor appreciation of the risk-benefit ratio, unawareness of guidelines, or absence of an OAC monitoring outpatient clinic may explain why only 30-60% of patients with AF are prescribed this drug 8.
The problems associated with warfarin, combined with the limited efficacy and/or serious side effects associated with other medications used for AF 12,13, highlight the need for effective non-pharmacological approaches to treatment. One such approach is catheter ablation (CA), a procedure in which a radiofrequency electrical current is applied to regions of the heart to create small ablation lesions that electrically isolate potential AF triggers 4. CA is a well-established treatment for AF symptoms 14, 15, that may also decrease the risk of stroke. Recent data showed a significant decrease in the relative risk of stroke and transient ischemic attack events among patients who underwent ablation compared with those undergoing antiarrhythmic drug therapy 16.
Since the left atrial appendage (LAA) is the source of thrombi in more than 90% of patients with non-valvular atrial fibrillation 17, another approach to stroke prevention is to physically block clots from exiting the LAA. One method for occluding the LAA is via percutaneous placement of the WATCHMAN LAA closure device. The WATCHMAN device resembles a small parachute. It consists of a nitinol frame covered by fabric polyethyl terephthalate that prevents emboli, but not blood, from exiting during the healing process. Fixation anchors around the perimeter secure the device in the LAA (Figure 1). To date, the WATCHMAN is the only implanted percutaneous device for which a randomized clinical trial has been reported. In this study, implantation of the WATCHMAN was found to be at least as effective as warfarin in preventing stroke (all-causes) and death (all-causes) 18. This device received the Conformit&eacute; Europ&eacute;enne (CE) mark for use in the European Union for warfarin eligible patients and in those who have a contraindication to anticoagulation therapy 19.
Given the proven effectiveness of CA to alleviate AF symptoms and the promising data with regard to reduction of thromboembolic events with both CA and WATCHMAN implantation, combining the two procedures is hoped to further reduce the incidence of stroke in high-risk patients while simultaneously relieving symptoms. The combined procedure may eventually enable patients to undergo implantation of the WATCHMAN device without subsequent warfarin treatment, since the CA procedure itself reduces thromboembolic events. This would present an avenue of treatment previously unavailable to patients ineligible for warfarin treatment because of recurrent bleeding 20 or other warfarin-associated problems.
The combined procedure is performed under general anesthesia with biplane fluoroscopy and TEE guidance. Catheter ablation is followed by implantation of the WATCHMAN LAA closure device. Data from a non-randomized trial with 10 patients demonstrates that this procedure can be safely performed in patients with a CHADS2 score of greater than 1 21. Further studies to examine the effectiveness of the combined procedure in reducing symptoms from AF and associated stroke are therefore warranted.

Catheter ablation is combined with placement of the WATCHMAN Left Atrial Appendage Closure Device to prevent ischemic stroke in a patient with non-valvular atrial fibrillation.

Atriyal fibrilasyon için Apendikse Kapatma ile kombinasyonu Kateter Ablasyon

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting millions of individuals worldwide 1-3. The rapid, irregular, and ...

A Rat Model of Ventricular Fibrillation and Resuscitation by Conventional Closed-chest Technique

A rat model of electrically-induced ventricular fibrillation followed by cardiac resuscitation using a closed chest technique that incorporates the basic components of cardiopulmonary resuscitation in humans is herein described. The model was developed in 1988 and has been used in approximately 70 peer-reviewed publications examining a myriad of resuscitation aspects including its physiology and pathophysiology, determinants of resuscitability, pharmacologic interventions, and even the effects of cell therapies. The model featured in this presentation includes: (1) vascular catheterization to measure aortic and right atrial pressures, to measure cardiac output by thermodilution, and to electrically induce ventricular fibrillation; and (2) tracheal intubation for positive pressure ventilation with oxygen enriched gas and assessment of the end-tidal CO2. A typical sequence of intervention entails: (1) electrical induction of ventricular fibrillation, (2) chest compression using a mechanical piston device concomitantly with positive pressure ventilation delivering oxygen-enriched gas, (3) electrical shocks to terminate ventricular fibrillation and reestablish cardiac activity, (4) assessment of post-resuscitation hemodynamic and metabolic function, and (5) assessment of survival and recovery of organ function. A robust inventory of measurements is available that includes &#8211; but is not limited to &#8211; hemodynamic, metabolic, and tissue measurements. The model has been highly effective in developing new resuscitation concepts and examining novel therapeutic interventions before their testing in larger and translationally more relevant animal models of cardiac arrest and resuscitation.

This article describes a rat model of electrically-induced ventricular fibrillation and resuscitation by chest compression, ventilation, and delivery of electrical shocks that simulates an episode of sudden cardiac arrest and conventional cardiopulmonary resuscitation. The model enables gathering insights on the pathophysiology of cardiac arrest and exploration of new resuscitation strategies.

Konvansiyonel Kapalı göğüs Tekniği ile Rat Ventriküler Fibrilasyon Modeli ve Resüsitasyon

A rat model of electrically-induced ventricular fibrillation followed by cardiac resuscitation using a closed chest technique that incorporates the basic ...

Robotic Ablation of Atrial Fibrillation

Background: Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). During PVI an electrical conduction block between pulmonary vein (PV) and left atrium (LA) is created. This conduction block prevents AF, which is triggered by irregular electric activity originating from the PV. However, transmural atrial lesions are required which can be challenging. Re-conduction and AF recurrence occur in 20 - 40% of the cases. Robotic catheter systems aim to improve catheter steerability. Here, a procedure with a new remote catheter system (RCS), is presented. Objective of this article is to show feasibility of robotic AF ablation with a novel system. Materials and Methods: After interatrial trans-septal puncture is performed using a long sheath and needle under fluoroscopic guidance. The needle is removed and a guide wire is placed in the left superior PV. Then an ablation catheter is positioned in the LA, using the sheath and wire as guide to the LA. LA angiography is performed over the sheath. A circular mapping catheter is positioned via the long sheath into the LA and a three-dimensional (3-D) anatomical reconstruction of the LA is performed. The handle of the ablation catheter is positioned in the robotic arm of the Amigo system and the ablation procedure begins. During the ablation procedure, the operator manipulates the ablation catheter via the robotic arm with the use of a remote control. The ablation is performed by creating point-by-point lesions around the left and right PV ostia. Contact force is measured at the catheter tip to provide feedback of catheter-tissue contact. Conduction block is confirmed by recording the PV potentials on the circular mapping catheter and by pacing maneuvers. The operator stays out of the radiationfield during ablation. Conclusion: The novel catheter system allows ablation with high stability on low operator fluoroscopy exposure.

Pulmonary vein isolation (PVI) with an ablation catheter is a curative treatment for atrial fibrillation (AF). Robotic catheter systems aim to improve catheter steerability. Here, a procedure with a new robotic catheter system is presented. The goal of the procedure is electrical block between pulmonary vein and left atrium.

Atriyal Fibrilasyon Robotik Ablasyon

Background: Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). During PVI an electrical conduction block between ...

Electrophysiological Assessment of Murine Atria with High-Resolution Optical Mapping

Recent genome-wide association studies targeting atrial fibrillation (AF) have indicated a strong association between the genotype and electrophysiological phenotype in the atria. That encourages us to utilize a genetically-engineered mouse model to elucidate the mechanism of AF. However, it is difficult to evaluate the electrophysiological properties in murine atria due to their small size. This protocol describes the electrophysiological evaluation of atria using an optical mapping system with a high temporal and spatial resolution in Langendorff perfused murine hearts. The optical mapping system is assembled with dual high-speed complementary metal oxide semiconductor cameras and high magnification objective lenses, to detect the fluorescence of a voltage-sensitive dye and Ca2+ indicator. To focus on the assessment of murine atria, optical mapping is performed with an area of 2 mm &#215; 2 mm or 10 mm x 10 mm, with a 100 &#215; 100 resolution (20 &#181;m/pixel or 100 &#181;m/pixel) and sampling rate of up to 10 kHz (0.1 ms) at maximum. A 1-French size quadripolar electrode pacing catheter is placed into the right atrium through the superior vena cava avoiding any mechanical damage to the atrium, and pacing stimulation is delivered through the catheter. An electrophysiological study is performed with programmed stimulation including constant pacing, burst pacing, and up to triple extrastimuli pacing. Under a spontaneous or pacing rhythm, the optical mapping recorded the action potential duration, activation map, conduction velocity, and Ca2+ transient individually in the right and left atria. In addition, the programmed stimulation also determines the inducibility of atrial tachyarrhythmias. Precise activation mapping is performed to identify the propagation of the excitation in the atrium during an induced atrial tachyarrhythmia. Optical mapping with a specialized setting enables a thorough electrophysiological evaluation of the atrium in murine pathological models.

This protocol describes the electrophysiological evaluation of murine atria utilizing an optical mapping system with a high temporal and spatial resolution, including dual recordings of the membrane voltage and Ca2+ transient under programmed stimulation through a specialized electrode catheter.

Yüksek çözünürlüklü optik eşleştirmenin fare Atria Elektrofizyolojik değerlendirme

Recent genome-wide association studies targeting atrial fibrillation (AF) have indicated a strong association between the genotype and ...

High-Throughput Analysis of Optical Mapping Data Using ElectroMap

Optical mapping is an established technique for high spatio-temporal resolution study of cardiac electrophysiology in multi-cellular preparations. Here we present, in a step-by-step guide, the use of ElectroMap for analysis, quantification, and mapping of high-resolution voltage and calcium datasets acquired by optical mapping. ElectroMap analysis options cover a wide variety of key electrophysiological parameters, and the graphical user interface allows straightforward modification of pre-processing and parameter definitions, making ElectroMap applicable to a wide range of experimental models. We show how built-in pacing frequency detection and signal segmentation allows high-throughput analysis of entire experimental recordings, acute responses, and single beat-to-beat variability. Additionally, ElectroMap incorporates automated multi-beat averaging to improve signal quality of noisy datasets, and here we demonstrate how this feature can help elucidate electrophysiological changes that might otherwise go undetected when using single beat analysis. Custom modules are included within the software for detailed investigation of conduction, single file analysis, and alternans, as demonstrated here. This software platform can be used to enable and accelerate the processing, analysis, and mapping of complex cardiac electrophysiology.

This protocol describes the setup and use of ElectroMap, a MATLAB-based open-source software platform for analysis of cardiac optical mapping data. ElectroMap provides a versatile high-throughput tool for analysis of optical mapping voltage and calcium datasets across a wide range of cardiac experimental models.

Elektromap kullanarak optik haritalama verilerinin yüksek verim Analizi

Optical mapping is an established technique for high spatio-temporal resolution study of cardiac electrophysiology in multi-cellular preparations. Here we ...

Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most frequent type of cardiac ablation procedure performed. Although generally safe, collateral injury to surrounding structures, particularly the esophagus, remains a concern. Cooling or warming the esophagus to counteract the heat from RF ablation, or the cold from cryoablation, is a method that is used to reduce thermal esophageal injury, and there are increasing data to support this approach. This protocol describes the use of a commercially available esophageal temperature management device to cool or warm the esophagus to reduce esophageal injury during left atrial ablation. The temperature management device is powered by standard water-blanket heat exchangers, and is shaped like a standard orogastric tube placed for gastric suctioning and decompression. Water circulates through the device in a closed-loop circuit, transferring heat across the silicone walls of the device, through the esophageal wall. Placement of the device is analogous to the placement of a typical orogastric tube, and temperature is adjusted via the external heat-exchanger console.

The goal of this protocol is to describe the use of esophageal temperature modulation to counteract esophageal thermal injury from left atrial ablation for the treatment of atrial fibrillation.

Atriyal Fibrilasyon Tedavisinde Sol Atriyal Ablasyon Sırasında Özofagusun Azaltılması veya Isınması

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most ...

Sterile Pericarditis in Aachener Minipigs As a Model for Atrial Myopathy and Atrial Fibrillation

Atrial fibrillation (AF) is the most common arrhythmia caused by structural remodeling of the atria, also called atrial myopathy. Current therapies only target the electrical abnormalities and not the underlying atrial myopathy. For the development of novel therapies, a reproducible large animal model of atrial myopathy is necessary. This paper presents a model of sterile pericarditis-induced atrial myopathy in Aachener minipigs. Sterile pericarditis was induced by spraying sterile talcum and leaving a layer of sterile gauze over the atrial epicardial surface. This led to inflammation and fibrosis, two crucial components of the pathophysiology of atrial myopathy, making the atria susceptible to the induction of AF. Two pacemaker electrodes were positioned epicardially on each atrium and connected to two pacemakers from different manufacturers. This strategy allowed for repeated non-invasive atrial programmed stimulation to determine the inducibility of AF at specified time points after surgery. Different protocols to test AF inducibility were used. The advantages of this model are its clinical relevance, with AF inducibility and the rapid induction of inflammation and fibrosis-both present in atrial myopathy-and its reproducibility. The model will be useful in the development of novel therapies targeting atrial myopathy and AF.

We describe a sterile pericarditis model in minipigs to study atrial myopathy and atrial fibrillation (AF). We present surgical and anesthetic techniques, strategies for vascular access, and a protocol to study the inducibility of AF.

Atriyal Miyopati ve Atriyal Fibrilasyon için Bir Model Olarak Aachener Minipiglerde Steril Perikardit

Atrial fibrillation (AF) is the most common arrhythmia caused by structural remodeling of the atria, also called atrial myopathy. Current therapies only ...

High-Resolution Three-Dimensional Imaging of the Footpad Vasculature in a Murine Hindlimb Gangrene Model

Peripheral arterial disease (PAD) is a significant cause of morbidity resulting from chronic exposure to atherosclerotic risk factors. Patients suffering from its most severe form, chronic limb-threatening ischemia (CLTI), face substantial impairments to daily living, including chronic pain, limited walking distance without pain, and nonhealing wounds. Preclinical models have been developed in various animals to study PAD, but mouse hindlimb ischemia remains the most widely used. There can be significant variation in response to ischemic insult in these models depending on the mouse strain used and the site, number, and means of arterial disruption. This protocol describes a unique method combining femoral artery and vein electrocoagulation with the administration of a nitric oxide synthase (NOS) inhibitor to reliably induce footpad gangrene in Friend Virus B (FVB) mice that resembles the tissue loss of CLTI. While traditional means of assessing reperfusion such as laser Doppler perfusion imaging (LDPI) are still recommended, intracardiac perfusion of the lipophilic dye 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI) is used to label the vasculature. Subsequent whole-mount confocal laser scanning microscopy allows for high-resolution, three-dimensional (3D) reconstruction of footpad vascular networks that complements traditional means of assessing reperfusion in hindlimb ischemia models.

The present protocol describes a unique, clinically relevant model of peripheral arterial disease that combines femoral artery and vein electrocoagulation with the administration of a nitric oxide synthase inhibitor to induce hindlimb gangrene in FVB mice. Intracardiac DiI perfusion is then used for high-resolution, three-dimensional imaging of the footpad vasculature.

Murin Arka Ekstremite Kangren Modelinde Footpad Vaskülatürünün Yüksek Çözünürlüklü Üç Boyutlu Görüntülenmesi

Peripheral arterial disease (PAD) is a significant cause of morbidity resulting from chronic exposure to atherosclerotic risk factors. Patients suffering ...

Transesophageal Atrial Burst Pacing for Atrial Fibrillation Induction in Rats

Animal studies have brought important insights into our understanding regarding atrial fibrillation (AF) pathophysiology and therapeutic management. Reentry, one of the main mechanisms involved in AF pathogenesis, requires a certain mass of myocardial tissue in order to occur. Due to the small size of the atria, rodents have long been considered 'resistant' to AF. Although spontaneous AF has been shown to occur in rats, long-term follow-up (up to 50 weeks) is required for the arrhythmia to occur in those models. The present work describes an experimental protocol of transesophageal atrial burst pacing for rapid and efficient induction of AF in rats. The protocol can be successfully used in rats with healthy or remodeled hearts, in the presence of a wide variety of risk factors, allowing the study of AF pathophysiology, identification of novel therapeutic targets, and evaluation of novel prophylactic and/or therapeutic strategies.

The present work describes an experimental protocol of transesophageal atrial burst pacing for efficient induction of atrial fibrillation (AF) in rats. The protocol can be used in rats with healthy or remodeled hearts, allowing the study of AF pathophysiology, identification of novel therapeutic targets, and evaluation of new therapeutic strategies.

Sıçanlarda Atriyal Fibrilasyon İndüksiyonu için Transözofageal Atriyal Patlama Pacing

Animal studies have brought important insights into our understanding regarding atrial fibrillation (AF) pathophysiology and therapeutic management. ...