Ventricular catheter ablation has been established as the most desirable from cost and patient safety point of view approach in treating cardiac arrhythmias, yet its success rate has not broad acceptance. This is primarily because this treatment modality relies almost entirely on the experience and abilities of the physician in charge to identify the ablative site through endocardial mapping. In this grant application we aim to investigate the ability of a new method to rapidly, reliably and safely identify the site of origin of the arrhythmia. Our method relies on assigning properties of an equivalent moving dipole to each phase of the cardiac cycle and then inversely resolving the properties (location and strength) of the dipole. Our hypothesis is that the inverse dipole solution will accurately locate the arrhythmogenic focus at the point in the cardiac cycle when electrical activity is still focal, as the depolarization wave emerges from the focus. We will build a state-of-art system aimed to provide the cardiac electrophysiologist with a tool that will facilitate the identification of the site of the arrhythmia in the heart and will enable the accurate guiding of the ablation catheter to the site of origin of that arrhythmia. We will evaluate its performance by means of saline tank and animal studies. In the latter study, we will ultimately compare the location of the site identified by means of the equivalent dipole solution with the site initially identified by the operator as well as the site which ultimately results in the abolition of inducibility of ventricular tachycardia. The ability to perform three dimensional mapping and view the arrhythmia in real-time represents a step ahead from the standard fluoroscopic two-dimensional imaging or activation mapping. Furthermore our methodology promises to reduce the time required to perform the mapping and make it well tolerated from the patient. The impact of successful catheter ablation of ventricular tachycardia may be to (i) reduce the incidence of sudden cardiac death, (ii) reduce the frequency of implantable cardioverter shocks, and (iii) decrease the need of anti-arrhythmic medications with their potentially pro-arrhythmic and/or other side effects.

Public Health Relevance

Ventricular catheter ablation has been established as the most desirable from cost and patient safety point of view approach in treating cardiac arrhythmias, yet its success rate has not broad acceptance. This is primarily because this treatment modality relies almost entirely on the experience and abilities of the physician in charge to identify the ablative site through endocardial mapping. This proposal investigates the ability of a new method to rapidly, reliably and safely identify the site of origin of the arrhythmia and help guide the ablation catheter to that site.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL103961-04
Application #
8470224
Study Section
Clinical and Integrative Cardiovascular Sciences Study Section (CICS)
Program Officer
Boineau, Robin
Project Start
2010-08-15
Project End
2014-05-31
Budget Start
2013-06-01
Budget End
2014-05-31
Support Year
4
Fiscal Year
2013
Total Cost
$406,197
Indirect Cost
$170,577
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
Sohn, Kwanghyun; Armoundas, Antonis A (2016) On the efficiency and accuracy of the single equivalent moving dipole method to identify sites of cardiac electrical activation. Med Biol Eng Comput 54:1611-9
Sohn, Kwanghyun; Lv, Wener; Lee, Kichang et al. (2014) The single equivalent moving dipole model does not require spatial anatomical information to determine cardiac sources of activation. IEEE J Biomed Health Inform 18:222-30
Sohn, Kwanghyun; Lv, Wener; Lee, Kichang et al. (2014) A method to noninvasively identify cardiac bioelectrical sources. Pacing Clin Electrophysiol 37:1038-50
Lee, Kichang; Lv, Wener; Ter-Ovanesyan, Evgeny et al. (2013) Cardiac ablation catheter guidance by means of a single equivalent moving dipole inverse algorithm. Pacing Clin Electrophysiol 36:811-22
Armoundas, Antonis A; Mela, Theofanie; Merchant, Faisal M (2012) On the estimation of T-wave alternans using the spectral fast fourier transform method. Heart Rhythm 9:449-56
Merchant, Faisal M; Ikeda, Takanori; Pedretti, Roberto F E et al. (2012) Clinical utility of microvolt T-wave alternans testing in identifying patients at high or low risk of sudden cardiac death. Heart Rhythm 9:1256-64.e2
Merchant, Faisal M; Armoundas, Antonis A (2012) Role of substrate and triggers in the genesis of cardiac alternans, from the myocyte to the whole heart: implications for therapy. Circulation 125:539-49
Weiss, Eric H; Merchant, Faisal M; d'Avila, Andre et al. (2011) A novel lead configuration for optimal spatio-temporal detection of intracardiac repolarization alternans. Circ Arrhythm Electrophysiol 4:407-17
Guo, Lei-Sheng; Zhou, Xu; Li, Yan-Hui et al. (2010) Alcohol ablation at the posterior papillary muscle prevents ventricular fibrillation in swine without affecting mitral valve function. Europace 12:1781-6
Kurz, Felix T; Aon, Miguel A; O'Rourke, Brian et al. (2010) Wavelet analysis reveals heterogeneous time-dependent oscillations of individual mitochondria. Am J Physiol Heart Circ Physiol 299:H1736-40