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David J Christini

Publications and source records attributed to David J Christini.

17 recordsLinked to original sources
PubMed2006

Action potential duration dispersion and alternans in simulated heterogeneous cardiac tissue with a structural barrier.

Structural barriers to wave propagation in cardiac tissue are associated with a decreased threshold for repolarization alternans both experimentally and clinically. Using computer simulations, we investigated the effects of a structural barrier on the onset of spatially concordant and discordant alternans. We used two-dimensional tissue geometry with heterogeneity in selected potassium conductances to mimic known apex-base gradients. Although we found that the actual onset of alternans was similar with and without the structural barrier, the increase in alternans magnitude with faster pacing was steeper with the barrier--giving the appearance of an earlier alternans onset in its presence. This is consistent with both experimental structural barrier findings and the clinical observation of T-wave alternans occurring at slower pacing rates in patients with structural heart disease. In ionically homogeneous tissue, discordant alternans induced by the presence of the structural barrier arose at intermediate pacing rates due to a source-sink mismatch behind the barrier. In heterogeneous tissue, discordant alternans occurred during fast pacing due to a barrier-induced decoupling of tissue with different restitution properties. Our results demonstrate a causal relationship between the presence of a structural barrier and increased alternans magnitude and action potential duration dispersion, which may contribute to why patients with structural heart disease are at higher risk for ventricular tachyarrhythmias.

Action Potentials↗
PubMed2006

Control of electrical alternans in canine cardiac purkinje fibers.

Alternation in the duration of consecutive cardiac action potentials (electrical alternans) may precipitate conduction block and the onset of arrhythmias. Consequently, suppression of alternans using properly timed premature stimuli may be antiarrhythmic. To determine the extent to which alternans control can be achieved in cardiac tissue, isolated canine Purkinje fibers were paced from one end using a feedback control method. Spatially uniform control of alternans was possible when alternans amplitude was small. However, control became attenuated spatially as alternans amplitude increased. The amplitude variation along the cable was well described by a theoretically expected standing wave profile that corresponds to the first quantized mode of the one-dimensional Helmholtz equation. These results confirm the wavelike nature of alternans and may have important implications for their control using electrical stimuli.

Action Potentials↗
PubMed2005

Action potential morphology influences intracellular calcium handling stability and the occurrence of alternans.

Instability in the intracellular Ca2+ handling system leading to Ca2+ alternans is hypothesized to be an underlying cause of electrical alternans. The highly coupled nature of membrane voltage and Ca2+ regulation suggests that there should be reciprocal effects of membrane voltage on the stability of the Ca2+ handling system. We investigated such effects using a mathematical model of the cardiac intracellular Ca2+ handling system. We found that the morphology of the action potential has a significant effect on the stability of the Ca2+ handling system at any given pacing rate, with small changes in action potential morphology resulting in a transition from stable nonalternating Ca2+ transients to stable alternating Ca2+ transients. This bifurcation occurs as the alternans eigen value of the system changes from absolute value <1 to absolute value >1. These results suggest that the stability of the intracellular Ca2+ handling system and the occurrence of Ca2+ alternans are not dictated solely by the Ca2+ handling system itself, but are also modulated to a significant degree by membrane voltage (through its influence on sarcolemmal Ca2+ currents) and, therefore, by all ionic currents that affect membrane voltage.

Action Potentials↗
PubMed2005

Detection of repolarization alternans with an implantable cardioverter defibrillator lead in a porcine model.

Mechanistic links have been suggested between repolarization alternans (RPA) and the onset of ventricular tachycardia (VT) and/or fibrillation. Endocardial detection of RPA may, therefore, be an important step in future device-based treatments of arrhythmias. Here, we investigate if RPA could be detected during acute ischemia using an implantable cardioverter defibrillator (ICD) lead (tip to distal coil) located in the right ventricular apex. In 18 pigs, the right coronary (n = 10) or left anterior descending coronary (n = 8) artery was occluded for 10 min using a balloon catheter, followed by reperfusion for 30 min, and re-occlusion for 30 min. RPA magnitude, computed using the modified moving average (MMA) method, showed a sharp increase in all 18 animals, from a mean baseline level of 1.9 +/- 1.3 mV to 3.0 +/- 1.3 mV during first occlusion (p < 0.001). RPA magnitude showed a prominent increase in 10 animals during re-occlusion, from a mean baseline level of 1.7 +/- 1.0 mV to 3.3 +/- 1.5 mV (p < 0.001). The protocol was terminated during the first two stages of occlusion and reperfusion for the remaining 8 animals due to the occurrence of ventricular fibrillation (VF). These results confirm that RPA increases under ischemic conditions and that it is possible to detect and track RPA dynamics with an ICD lead that is positioned in a clinically realistic location. Such an approach may be useful in formulating improved arrhythmia detection and control algorithms.

Algorithms↗
PubMed2005

Therapies for ventricular cardiac arrhythmias.

During recent years, engineers and physicists have become increasingly interested in studying the electrical activity of the heart. Despite the fact that the heart is a complex and highly nonlinear system, its electrical behavior can be studied using a variety of experimental and clinical techniques, and can be modeled mathematically using relatively simple systems of differential equations, allowing scientists to perform both real and virtual (in silico) experiments to gain insights into its physiology and pathophysiology. Although these approaches have in recent years allowed great headway to be made into understanding the dynamic behavior of the heart, cardiac arrhythmias such as ventricular fibrillation still claim the lives of hundreds of thousands of people each year in the United States alone. Bridging the gap between understanding the mechanistic bases of arrhythmias and applying such knowledge to improving therapy presents one of the greatest challenges in the field of cardiac electrophysiology. In this review, we describe the basic electrical properties and dynamic behavior of the heart and review the current state of the art in ventricular arrhythmia therapy. We also discuss some possibilities for future therapies, with the hope that such informed speculation will promote new investigations in these areas.

Animals↗
PubMed2004

Effect of beta-adrenergic blockade on dynamic electrical restitution in vivo.

The slope of the action potential duration (APD) restitution curve may be a significant determinant of the propensity to develop ventricular fibrillation, with steeper slopes associated with a more arrhythmogenic substrate. We hypothesized that one mechanism by which beta-blockers reduce sudden cardiac death is by flattening the APD restitution curve. Therefore, we investigated whether infusion of esmolol modulates the APD restitution curve in vivo. In 10 Yorkshire pigs, dynamic APD restitution curves were determined from measurements of APD at 90% repolarization with a monophasic action potential catheter positioned against the right ventricular septum during right ventricular apical pacing in the basal state and during infusion of esmolol. APD restitution curves were fitted to the three-parameter (a, b, c) exponential equation, APD = a.[1 - e((-b.DI))] + c, where DI is the diastolic interval. Esmolol decreased the maximal APD slope, 0.68 +/- 0.14 vs. 0.94 +/- 0.24 (baseline), P = 0.002, and flattened the APD restitution curve at shorter DIs, 75 and 100 ms (P < 0.05). To compare the slopes of the APD restitution curves at similar steady states, slopes were also computed at points of intersection between the restitution curve and the lines representing pacing at a fixed cycle length (CL) of 200, 225, 250, 275, and 300 ms using the relationship CL = APD + DI. Esmolol decreased APD restitution slopes at CLs 200-275 ms (P < 0.05). Esmolol flattens the cardiac APD restitution curve in vivo, particularly at shorter CLs and DIs. This may represent a novel mechanism by which beta-blockers prevent sudden cardiac death.

Action Potentials↗
PubMed2004

Adaptive diastolic interval control of cardiac action potential duration alternans.

INTRODUCTION: Recent experimental and computational studies have shown that beat-to-beat alternation in action potential duration can trigger cardiac reentry, suggesting that such "alternans" is a mechanistic precursor to arrhythmias. Given such a link, termination of alternans may help prevent the onset of arrhythmias. To this end, recent efforts have shown that chaos control methods can modulate the timing of electrical stimulation to eliminate alternans. METHODS AND RESULTS: We have developed an alternative control method founded entirely in cardiac electrophysiology (rather than borrowing techniques from the control of physical systems as with existing control techniques). Using computer simulations, we show that this method, which exploits the rate-dependent behavior of cardiac tissue, can be used to control alternans (and higher-order) rhythms, and is robust to drift and noise. When applied to individual model cells exhibiting alternans, the algorithm converges to the period-1 rhythm over as wide, and in some cases a wider, range of feedback proportionality constant values relative to existing methods. Control success comparable to existing methods is achieved when the algorithm is applied to a simulated one-dimensional Purkinje fiber exhibiting alternans. CONCLUSION: We have developed a method that adaptively controls the timing of electrical stimulation to rapidly eliminate action potential duration alternans in cardiac tissue. This control method may prove valuable in future arrhythmia prevention therapies.

Action Potentials↗
PubMed2004

Determining the effects of memory and action potential duration alternans on cardiac restitution using a constant-memory restitution protocol.

Restitution, the dependence of action potential duration (APD) on diastolic interval, may be causally linked to the vulnerability of cardiac tissue to certain types of arrhythmias. While a number of pacing protocols are commonly used to quantify the restitution relation, one of these, the dynamic protocol, may result in the occurrence of APD alternans. However, the effects of APD alternans, and the concomitant alternation in cardiac memory, on the restitution curve are currently not well understood. Alternans preceding a given action potential may cause that action potential to have a different duration from one preceded by action potentials of identical duration. This interaction of alternans and memory can result in a dynamic restitution curve that is not unique. To address this, we have developed a constant-memory restitution protocol that enables the experimenter or modeller to obtain unique, constant-memory restitution curves at all diastolic intervals. Using this protocol, we obtained unique restitution curves for two ionic models of the cardiac action potential in the absence of alternans at all diastolic intervals. A comparison of the unique constant-memory and non-unique dynamic restitution curves for the two models shows that the presence of alternans can significantly alter the shape of the restitution curve compared to when alternans is absent.

Action Potentials↗
PubMed2004

Time course and predictors of autonomic dysfunction after ablation of the slow atrioventricular nodal pathway.

Withdrawal of parasympathetic tone has been reported after ablation in the posteroseptal right atrium and has been attributed to injury of vagal efferent fibers. The purpose of this study was to assess the time course and predictors of autonomic dysfunction after slow pathway ablation. In 30 patients with AV nodal reentrant tachycardia, time- and frequency-domain measures of heart rate variability (HRV) were measured before, 30 minutes after, and 1 day after slow pathway ablation. There were significant reductions in mean RR interval (724 +/- 163 vs 836 +/- 164 ms, P < 0.05), SD of RR intervals (29 +/- 17 vs 40 +/- 18 ms, P < 0.05), root mean squared difference (15 +/- 8 vs 29 +/- 17 ms, P < 0.05), and high frequency power (4.1 +/- 0.4 vs 4.5 +/- 0.6 log10ms2, P < 0.05) 30 minutes after ablation. However, these parameters returned to baseline 1 day after ablation. Multivariate regression identified isoproterenol dose during the diagnostic study (P = 0.02) and radiofrequency duration (P = 0.02) as statistically significant predictors of heart rate change (R2= 0.45). These findings suggest that changes in autonomic tone after ablation in the posteroseptal right atrium are transitory and resolve within 1 day of the procedure. These short-term changes may be related to procedural variables rather than direct injury to vagal efferent fibers.

Adult↗
PubMed2003

MinK-related peptide 2 modulates Kv2.1 and Kv3.1 potassium channels in mammalian brain.

Delayed rectifier potassium current diversity and regulation are essential for signal processing and integration in neuronal circuits. Here, we investigated a neuronal role for MinK-related peptides (MiRPs), membrane-spanning modulatory subunits that generate phenotypic diversity in cardiac potassium channels. Native coimmunoprecipitation from rat brain membranes identified two novel potassium channel complexes, MiRP2-Kv2.1 and MiRP2-Kv3.1b. MiRP2 reduces the current density of both channels, slows Kv3.1b activation, and slows both activation and deactivation of Kv2.1. Altering native MiRP2 expression levels by RNAi gene silencing or cDNA transfection toggles the magnitude and kinetics of endogenous delayed rectifier currents in PC12 cells and hippocampal neurons. Computer simulations predict that the slower gating of Kv3.1b in complexes with MiRP2 will broaden action potentials and lower sustainable firing frequency. Thus, MiRP2, unlike other known neuronal beta subunits, provides a mechanism for influence over multiple delayed rectifier potassium currents in mammalian CNS via modulation of alpha subunits from structurally and kinetically distinct subfamilies.

Action Potentials↗
PubMed2003

Antispiral waves in reaction-diffusion systems.

We report spontaneous antispiral wave formation in typical reaction-diffusion systems. Our findings qualitatively reproduce a series of phenomena recently observed in a Belousov-Zhabotinsky-type chemical reaction. We found that antispiral waves can occur only near the Hopf bifurcation, when the system is characterized by small amplitude oscillatory (as opposed to excitable) dynamics. For reaction-diffusion systems in the vicinity of the Hopf bifurcation, the specific conditions required for antispiral formation are established here through theoretical analyses and numerical simulations. Thus, this work provides a comprehensive description of the mechanisms underlying antispiral waves in reaction-diffusion systems.

Journal Article↗
PubMed2003

Endocardial detection of repolarization alternans.

Repolarization alternans (RPA) is prognostic of sudden cardiac death and is thought to be mechanistically linked to the initiation of ventricular tachyarrhythmias. Thus, implantable cardiac device detection of RPA may be therapeutically valuable. Because alternans detection is currently limited to surface electrocardiograms, we investigated whether RPA could be measured using a single right-ventricular endocardial lead in humans. Such a location was chosen because it is consistent with the requirements for long-term implantable-device implementation. During diagnostic electrophysiological testing, 28 patients (23 male, 5 female; 61 +/- 15 years) were evaluated for surface T-wave alternans (TWA; the current "gold standard" for RPA detection) and endocardial RPA during 5 min of 550-ms right-atrial pacing. Power spectral analysis indicated that 11/28 patients had both surface TWA and endocardial RPA, 9/28 patients had neither, and 8/28 patients had discordant results (71% concordance; p = 0.02). Importantly, unlike surface TWA, endocardial RPA was detectable on a beat-to-beat basis. Given the putative mechanistic link between RPA and ventricular arrhythmias, beat-to-beat endocardial RPA detection might be of diagnostic or therapeutic utility.

Algorithms↗
PubMed2003

Genetically engineered biologically based hemostatic bioassay.

Real-time direct measures of hemostatic parameters in vivo are required for optimizing the dynamic delivery of coagulation modifying pharmacotherapies. Typical sensors of physiologic functions in vivo, however, have only a restricted array of sensory inputs, and thus limited capacity to monitor thrombotic and hemostatic activity. To overcome this limitation we have developed a genetically engineered excitable cell line that can be potentially used for an implantable thrombin biosensor. Specifically, we have generated stem cell-derived cardiac myocyte aggregates overexpressing the human thrombin receptor, protease activated receptor-1 (PAR-1), which exploit the inherent electropotential input-output relationship of the cells to detect local changes in thrombin activity. In vitro, the signaling activity of PAR-1 cardiac myocytes was highly responsive to thrombin, inducing a sixfold increase in intracellular cAMP as compared with a twofold increase in control cells. In vivo, the engineered myocytes also detected alterations in local coagulation potential. Specifically, PAR-1 engineered cells implanted in vivo detected local increases in thrombin with a doubling in chronotropic activity compared with a 50% increase in control aggregates. Overall these studies demonstrate the potential of genetic engineering to expand the physiologic signals recognized by excitable cells, and may facilitate the translation of this approach for the real-time monitoring of hemostatic function in vivo.

Animals↗
PubMed2002

Termination of reentry in an inhomogeneous ring of model cardiac cells.

Reentrant waves propagating in a ring or annulus of excitable media are a model of the basic mechanism underlying a major class of irregular cardiac rhythms known as anatomical reentry. Such reentrant waves are terminated by rapid electrical stimulation (pacing) from an implantable device. Because the mechanisms of such termination are poorly understood, we study pacing of anatomical reentry in a one-dimensional ring of model cardiac cells. For realistic off-circuit pacing, our model-independent results suggest that circuit inhomogeneities, and the electrophysiological dynamical changes they introduce, may be essential for terminating reentry in some cases.

Action Potentials↗
PubMed2002

Enhanced myocyte-based biosensing of the blood-borne signals regulating chronotropy.

Biosensors play a critical role in the real-time determination of relevant functional physiological needs. However, typical in vivo biosensors only approximate endogenous function via the measurement of surrogate signals and, therefore, may often lack a high degree of dynamic fidelity with physiological requirements. To overcome this limitation, we have developed an excitable tissue-based implantable biosensor approach, which exploits the inherent electropotential input-output relationship of cardiac myocytes to measure the physiological regulatory inputs of chronotropic demand via the detection of blood-borne signals. In this study, we report the improvement of this application through the modulation of host-biosensor communication via the enhancement of vascularization of chronotropic complexes in mice. Moreover, in an effort to further improve translational applicability as well as molecular plasticity, we have advanced this approach by employing stem cell-derived cardiac myocyte aggregates in place of whole cardiac tissue. Overall, these studies demonstrate the potential of biologically based biosensors to predict endogenous physiological dynamics and may facilitate the translation of this approach for in vivo monitoring.

Animals↗