Abstract

The long-term objective of this project is to identify the determinants of catheter ablation failure in AVnodal reentrant tachycardia (AVNNRT) and accessory pathways (AP). Recently, the NASPE CatheterAblation Registry showed that despite all the advances in mapping and ablation technology, the successrate of ablation has not improved between 1993 and 1998, suggesting that new strategies for selecting theablation target are needed.
The Specific Aim 1 of this project is to elucidate the causes of failed APablations. We hypothesize that the main cause of failure in AP ablation is inaccurate localization of the APwhen the AP has an oblique course. We will test this hypothesis by reversing the activation wavefront usingtwo different pacing sites to help identify an isolated AP potential, which will be targeted for ablation.
The Specific Aim 2 of this project is to elucidate the causes of failed AVNRT ablations. We postulate that themain cause of failed AVNRT ablation is that the reentrant circuit in AVNRT is not well understood. Ourworking hypothesis is that identification of the reentrant circuit and atrial connections in AVNRT will facilitateappropriate target selection and improve success in AVNRT ablation. We will systemically examine thereentrant circuit by (1) map the earliest retrograde atrial activation to help identify the retrograde limb of thecircuit in each variant of AVNRT. (2) establish the presence or absence of a lower common pathway in eachvariant of AVNRT to help localize the circuit. (3) deliver late atrial extrastimuli at different sites to identify theantegrade limb of the circuit. (4) ablate the reentrant circuit based on the mapping result to further confirmthe location of the circuit.My past research has focused on basic electrophysiology (ion channel related research). My immediatecareer goal is to utilize this project to successfully change my research direction from basic to clinicalelectrophysiology. My long-term goal is to be a 'linker' between basic and clinical electrophysiology andcontinue exploring the mechanism of cardiac arrhythmia.

  Funding Agency

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23HL069972-05
Application #
7153505
Study Section
Special Emphasis Panel (ZHL1-CSR-J (O1))
Program Officer
Scott, Jane
Project Start
2003-02-01
Project End
2007-11-30
Budget Start
2006-12-01
Budget End
2007-11-30
Support Year
5
Fiscal Year
2007
Total Cost
$152,193
Indirect Cost

  Institution

Name
University of Oklahoma Health Sciences Center
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
878648294
City
Oklahoma City
State
OK
Country
United States
Zip Code
73117

  Publications

Scherlag, Benjamin J; Nakagawa, Hiroshi; Jackman, Warren M et al. (2011) Non-pharmacological, non-ablative approaches for the treatment of atrial fibrillation: experimental evidence and potential clinical implications. J Cardiovasc Transl Res 4:35-41
Lu, Zhibing; Scherlag, Benjamin J; Lin, Jiaxiong et al. (2009) Autonomic mechanism for initiation of rapid firing from atria and pulmonary veins: evidence by ablation of ganglionated plexi. Cardiovasc Res 84:245-52
Zhang, Yuan; Scherlag, Benjamin J; Lu, Zhibing et al. (2009) Comparison of atrial fibrillation inducibility by electrical stimulation of either the extrinsic or the intrinsic autonomic nervous systems. J Interv Card Electrophysiol 24:5-10
Ghias, Muhammad; Scherlag, Benjamin J; Lu, Zhibing et al. (2009) The role of ganglionated plexi in apnea-related atrial fibrillation. J Am Coll Cardiol 54:2075-83
Niu, Guodong; Scherlag, Benjamin J; Lu, Zhibing et al. (2009) An acute experimental model demonstrating 2 different forms of sustained atrial tachyarrhythmias. Circ Arrhythm Electrophysiol 2:384-92
Lin, Jiaxiong; Scherlag, Benjamin J; Niu, Guodong et al. (2009) Autonomic elements within the ligament of Marshall and inferior left ganglionated plexus mediate functions of the atrial neural network. J Cardiovasc Electrophysiol 20:318-24
Lu, Zhibing; Scherlag, Benjamin J; Lin, Jiaxiong et al. (2008) Atrial fibrillation begets atrial fibrillation: autonomic mechanism for atrial electrical remodeling induced by short-term rapid atrial pacing. Circ Arrhythm Electrophysiol 1:184-92
Lin, Jiaxiong; Scherlag, Benjamin J; Lu, Zhibing et al. (2008) Inducibility of atrial and ventricular arrhythmias along the ligament of marshall: role of autonomic factors. J Cardiovasc Electrophysiol 19:955-62
Zhou, Jing; Scherlag, Benjamin J; Niu, Guodong et al. (2008) Anatomy and physiology of the right interganglionic nerve: implications for the pathophysiology of inappropriate sinus tachycardia. J Cardiovasc Electrophysiol 19:971-6
Lu, Zhibing; Scherlag, Benjamin J; Lin, Jiaxiong et al. (2008) Autonomic mechanism for complex fractionated atrial electrograms: evidence by fast fourier transform analysis. J Cardiovasc Electrophysiol 19:835-42

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