Bryan J. Caldwell

Laminar arrangement of ventricular myocytes influences electrical behavior of the heart.

The response of the heart to electrical shock, electrical propagation in sinus rhythm, and the spatiotemporal dynamics of ventricular fibrillation all depend critically on the electrical anisotropy of cardiac tissue. A long-held view of cardiac electrical anisotropy is that electrical conductivity is greatest along the myocyte axis allowing most rapid propagation of electrical activation in this direction, and that conductivity is isotropic transverse to the myocyte axis supporting a slower uniform spread of activation in this plane. In this context, knowledge of conductivity in two directions, parallel and transverse to the myofiber axis, is sufficient to characterize the electrical action of the heart. Here we present new experimental data that challenge this view. We have used a novel combination of intramural electrical mapping, and experiment-specific computer modeling, to demonstrate that left ventricular myocardium has unique bulk conductivities associated with three microstructurally-defined axes. We show that voltage fields induced by intramural current injection are influenced by not only myofiber direction, but also the transmural arrangement of muscle layers or myolaminae. Computer models of these experiments, in which measured 3D tissue structure was reconstructed in-silico, best matched recorded voltages with conductivities in the myofiber direction, and parallel and normal to myolaminae, set in the ratio 4:2:1, respectively. These findings redefine cardiac tissue as an electrically orthotropic substrate and enhance our understanding of how external shocks may act to successfully reset the fibrillating heart into a uniform electrical state. More generally, the mechanisms governing the destabilization of coordinated electrical propagation into ventricular arrhythmia need to be evaluated in the light of this discovery.

Three Distinct Directions of Intramural Activation Reveal Nonuniform Side-to-Side Electrical Coupling of Ventricular Myocytes

Background—The anisotropy of cardiac tissue is a key determinant of 3D electric propagation and the stability of activation wave fronts in the heart. The electric properties of ventricular myocardium are widely assumed to be axially anisotropic, with activation propagating most rapidly in the myofiber direction and at uniform velocity transverse to this. We present new experimental evidence that contradicts this view. Methods and Results—For the first time, high-density intramural electric mapping (325 electrodes at ≈4×4×1-mm spacing) from pig left ventricular tissue was used to reconstruct 3D paced activation surfaces projected directly onto 3D tissue structure imaged throughout the same left ventricular volume. These data from 5 hearts demonstrate that ventricular tissue is electrically orthotropic with 3 distinct propagation directions that coincide with local microstructural axes defined by the laminar arrangement of ventricular myocytes. The maximum conduction velocity of 0.67±0.019 ms−1 was aligned with the myofiber axis. However, transverse to this, the maximum conduction velocity was 0.30±0.010 ms−1, parallel to the myocyte layers and 0.17±0.004 ms−1 normal to them. These orthotropic conduction velocities give rise to preferential activation pathways across the left ventricular free wall that are not captured by structurally detailed computer models, which incorporate axially anisotropic electric properties. Conclusions—Our findings suggest that current views on uniform side-to-side electric coupling in the heart need to be revised. In particular, nonuniform laminar myocardial architecture and associated electric orthotropy should be included in future models of initiation and maintenance of ventricular arrhythmia.

Intramural Measurement of Transmembrane Potential in the Isolated Pig Heart: Validation of a Novel Technique

Introduction: Transmembrane potentials can be recorded at multiple intramural sites in the intact heart using fiber optic probes or optrodes. The technique has considerable potential utility for studies of arrhythmia and defibrillation, but has not been validated in large mammalian hearts.

Cardiac structure and electrical activation: Models and measurement

1. Our group has developed finite element models of ventricular anatomy that incorporate detailed structural information. These have been used to study normal electrical activation and re‐entrant arrhythmia.

Experiment-specific models of ventricular electrical activation: Construction and application

Experimental intramural recordings of electrical activity at high resolution have been made in the in-vivo pig LV free wall. To analyze features of these recordings experiment-specific 3D computer models of tissue structures and electrical behavior around the recording sites were constructed. The construction of the models used novel tissue image registration, correction and feature extraction methods. Appropriate model conductivity parameters were deduced from measurements and used to replicate features of experimental recordings.

Modeling Cardiac Activation and the Impact of a Discontinuous Myocardium

Methods have been developed for modeling cardiac activation which accounts for detailed myocardial geometric structures derived from specific tissue samples. This modeling allows both study and analysis of the effects of cleavage planes and other structural barriers to myocardial current flow. Specialized numerical and computational procedures have been developed to enable this modeling. The results that have been obtained clearly show the impact that discontinuities have in the formation of transmural virtual sources and also assist in better understanding experimental recordings. We are continuing to increase our capacity for modeling larger tissue samples, particularly those capable of sustaining reentry

Development of 3-D Intramural and Surface Potentials in the LV: Microstructural Basis of Preferential Transmural Conduction

Extracellular potentials measured on the heart surfaces are used to infer events that originate deep within the heart wall. We have reconstructed intramural potentials in three dimensions for the first time, and compare these with epicardial and endocardial surface potentials and cardiac microstructure.

A modular fiber optic system for intramural functional fluorescence measurement

Fluorescence imaging techniques have been central to much biomedical science research over the past two decades. In particular, functional imaging has provided important new information about processes that occur at cellular and sub-cellular levels. With this approach, living tissues are stained with dyes whose emission is modulated by changes in the environment to which the dye is exposed. The fluorescence imaging systems used within this context typically incorporate relatively complex free space optical assemblies and a stable platform is necessary to maintain appropriate alignment of their components. Because of the poor efficiency of these systems, it is necessary to use powerful light sources and sensitive photo-detectors. We have developed a novel fluorescence imaging system in which free-space optics are replaced by optical fibers, passive optical splitters and associated components. Solid state lasers are used as the excitation light source. A variety of detection systems have been utilized including a spectrometer. The feasibility of the approach has been established using a rat heart preparation stained with the membrane potential-sensitive dye, di-4-ANEPPS. Detailed emission spectra for this dye, at different levels of resting membrane potential, are presented here for 532 nm and 488 nm excitation. Cardiac action potentials obtained with the modular fiber optic system correspond closely to intracellular potentials acquired at adjacent sites in the isolated rat heart preparation. Our modular fiber optic system is cheaper, more efficient, more flexible and more robust than conventional fluorescence imaging systems. Using a high-speed spectrometer for photodetection, it is possible to implement the signal processing required for multi-line or ratiometric imaging in software, which further enhances the efficiency and flexibility of the system. We believe that this approach has wide potential applications for biomedical fluorescence imaging.

Shock induced electrical activation in structurally detailed models of pig left-ventricular tissue

Detailed models of sample specific structures in pig left-ventricular tissue have been constructed. These models include epicardial and endocardial surfaces, fiber and sheet orientations, vessels and cleavage planes with significant dimensions. This work shows that it is possible to extract from 3D tissue images reduced dimension descriptions of cleavage planes in the heart wall. These descriptions are used to analyze the response of tissue to electrical shocks of varying strengths. The presence of explicit discontinuities in the heart significantly reduces the time required for transmural activation and provides a basis for understanding successful defibrillation.