Optogenetic Control of Cardiac Arrhythmias

The regular, coordinated contraction of the heart muscle is orchestrated by periodic waves generated by the heart’s natural pacemaker and transmitted through the heart’s electrical conduction system. Abnormalities occurring anywhere within the cardiac electrical conduction system can disrupt the propagation of these waves. Such dis- ruptions often lead to the development of high frequency spiral waves that override normal pacemaker activity and compromise cardiac function. The occurrence of high frequency spiral waves in the heart is associated with cardiac rhythm disorders such as tachycardia and fibrillation. While tachycardia may be terminated by rapid periodic stimulation known as anti-tachycardia pacing (ATP), life-threatening ventricular fibril- lation requires a single high-voltage electric shock that resets all the activity and restore the normal heart function. However, despite the high success rate of defibrillation, it is associated with significant side effects including tissue damage, intense pain and trauma. Thus, extensive research is conducted for developing low-energy alternatives to conventional defibrillation. An example of such an alternative is the low-energy anti-fibrillation pacing (LEAP). However, the clinical application of this technique, and other evolving techniques requires a detailed understanding of the dynamics of spiral waves that occur during arrhythmias. Optogenetics is a tool, that has recently gained popularity in the cardiac research, which serves as a probe to study biological processes. It involves genetically modifying cardiac muscle cells such that they become light sensitive, and then using light of specific wavelengths to control the electrical activity of these cells. Cardiac optogenetics opens up new ways of investigating the mechanisms underlying the onset, maintenance and control of cardiac arrhythmias. In this thesis, I employ optogenetics as a tool to control the dynamics of a spiral wave, in both computer simulations and in experiments.In the first study, I use optogenetics to investigate the mechanisms underlying de- fibrillation. Analogous to the conventional single electric-shock, I apply a single globally-illuminating light pulse to a two-dimensional cardiac tissue to study how wave termination occurs during defibrillation. My studies show a characteristic transient dynamics leading to the termination of the spiral wave at low light intensities, while at high intensities, the spiral waves terminate immediately. Next, I move on to explore the use of optogenetics to study spiral wave termina- tion via drift, theoretically well-known mechanism of arrhythmia termination in the context of electrical stimulation (e.g. ATP). I show that spiral wave drift can be induced by structured illumination patterns using lights of low intensity, that result in a spatial modulation of cardiac excitability. I observe that drift occurs in the positive direction of light intensity gradient, where the spiral also rotates with a longer period. I further show how modulation of the excitability in space can be used to control the dynamics of a spiral wave, resulting in the termination of the wave by collision with the domain boundary. Based on these observations, I propose a possible mechanism of optogenetic defibrillation. In the next chapter, I use optogenetics to demonstrate control over the dynamics of the spiral waves by periodic stimulation with light of different intensities and pacing frequencies resulting in a temporal modulation of cardiac excitability. I demonstrate how the temporal modulation of excitability leads to efficient termination of arrhythmia. In addition, I use computer simulations to identify mechanisms responsible for arrhyth- mia termination for sub- and supra-threshold light intensities. My numerical results are supported by experimental studies on intact hearts, extracted from transgenic mice. Finally, I demonstrate that cardiac optogenetics not only allows control of excita- tion waves, but also by generating new waves through the induction of wave breaks. We demonstrate the effects of high sub-threshold illumination on the morphology of the propagating wave, leading to the creation of new excitation windows in space that can serve as potential sites for re-entry initiation. In summary, this thesis investigates several approaches to control arrhythmia dy- namics using optogenetics. The experimental and numerical results demonstrate the potential of feedback-induced resonant pacing as a low-energy method to control arrhythmia.2022-01-1

Multiple mechanisms of spiral wave breakup in a model of cardiac electrical activity

It has become widely accepted that the most dangerous cardiac arrhythmias are due to re- entrant waves, i.e., electrical wave(s) that re-circulate repeatedly throughout the tissue at a higher frequency than the waves produced by the heart's natural pacemaker (sinoatrial node). However, the complicated structure of cardiac tissue, as well as the complex ionic currents in the cell, has made it extremely difficult to pinpoint the detailed mechanisms of these life-threatening reentrant arrhythmias. A simplified ionic model of the cardiac action potential (AP), which can be fitted to a wide variety of experimentally and numerically obtained mesoscopic characteristics of cardiac tissue such as AP shape and restitution of AP duration and conduction velocity, is used to explain many different mechanisms of spiral wave breakup which in principle can occur in cardiac tissue. Some, but not all, of these mechanisms have been observed before using other models; therefore, the purpose of this paper is to demonstrate them using just one framework model and to explain the different parameter regimes or physiological properties necessary for each mechanism (such as high or low excitability, corresponding to normal or ischemic tissue, spiral tip trajectory types, and tissue structures such as rotational anisotropy and periodic boundary conditions). Each mechanism is compared with data from other ionic models or experiments to illustrate that they are not model-specific phenomena. The fact that many different breakup mechanisms exist has important implications for antiarrhythmic drug design and for comparisons of fibrillation experiments using different species, electromechanical uncoupling drugs, and initiation protocols.Comment: 128 pages, 42 figures (29 color, 13 b&w

Development and application of novel processing tools and methods for cardiac optical mapping

Cardiac optical mapping provides unparalleled spatio-temporal resolution information of cardiac electrophysiology. It has hence emerged as an important technology in understanding cardiac electrical behaviour in physiological and pathophysiological states. There is a requirement for effective data analysis tools that are high-throughput, robustly characterised and flexible with regards to a growing array of experimental models. In this thesis a MATLAB based software, ElectroMap, was developed for analysis of diverse optical mapping datasets. ElectroMap incorporates existing and novel methods to allow quantification and mapping of action potential and calcium transient morphology and activation/repolarisation times. Automated pacing cycle length detection and segmentation were implemented, realising high-throughput analysis of beat-to-beat responses and transient behaviour. Standalone modules dedicated to calculation of conduction velocity and alternans were introduced, allowing thorough integration of key factors in arrhythmogenesis. Semi-automated analysis of temporal variations in wave morphology were developed from previous methodologies for electrogram analysis. Algorithms to use fractional rate of change of fluorescence as a measure of conduction were also introduced to the software. Algorithms were tested in silico datasets, mouse and guinea pig optical mapping datasets and preliminary experiments also showed use for in vivo human electrogram mapping of atrial fibrillation

Medical-Data-Models.org:A collection of freely available forms (September 2016)

MDM-Portal (Medical Data-Models) is a meta-data repository for creating, analysing, sharing and reusing medical forms, developed by the Institute of Medical Informatics, University of Muenster in Germany. Electronic forms for documentation of patient data are an integral part within the workflow of physicians. A huge amount of data is collected either through routine documentation forms (EHRs) for electronic health records or as case report forms (CRFs) for clinical trials. This raises major scientific challenges for health care, since different health information systems are not necessarily compatible with each other and thus information exchange of structured data is hampered. Software vendors provide a variety of individual documentation forms according to their standard contracts, which function as isolated applications. Furthermore, free availability of those forms is rarely the case. Currently less than 5 % of medical forms are freely accessible. Based on this lack of transparency harmonization of data models in health care is extremely cumbersome, thus work and know-how of completed clinical trials and routine documentation in hospitals are hard to be re-used. The MDM-Portal serves as an infrastructure for academic (non-commercial) medical research to contribute a solution to this problem. It already contains more than 4,000 system-independent forms (CDISC ODM Format, www.cdisc.org, Operational Data Model) with more than 380,000 dataelements. This enables researchers to view, discuss, download and export forms in most common technical formats such as PDF, CSV, Excel, SQL, SPSS, R, etc. A growing user community will lead to a growing database of medical forms. In this matter, we would like to encourage all medical researchers to register and add forms and discuss existing forms

Role of spiral wave pinning in inhomogeneous active media in the termination of atrial fibrillation by electrical cardioversion

Atrial fibrillation is the most common type of arrhythmia to affect humans. One of the treatment modalities for atrial fibrillation is an electrical cardioversion. Electrical cardioversion can result in one of three outcomes: an immediate termination of arrhythmic activity, a delayed termination or unsuccessful termination. The mechanism of delayed termination is unknown. Here we present a model of an atrial fibrillation as a coexistence of several spiral waves pinned to the inhomogeneities in active media. We show that in inhomogeneous system delayed termination can be explained as the unpinning of a spiral wave from inhomogeneities and its termination after collision with the edge of the system.Pawel Kuklik, Christopher X. Wong, Anthony G. Brooks, Jan Jacek Żebrowski, Prashanthan Sander