Cardiac arrhythmia is the cardiovascular epidemic of the 21st century. The number of patients diagnosed with cardiac arrhythmia is rapidly increasing due to ageing, obesity, diabetes and elevated blood pressure.
Atrium fibrillation is the most common arrhythmia. It is a progressive disease, which means that episodes of arrhythmia progress from short-lasting episodes to episodes which are continuously present and no longer terminate spontaneously. Atrium fibrillation may cause stroke and heart failure and is even associated with death.
Treatments are often not successful, but a new patient-specific therapy can improve existing treatments. This can be achieved by measuring the degree of electropathology (‘staging the arrhythmia’). However, this is still not yet possible because there are no diagnostic tools to measure electropathology. It is therefore also not possible to recognize patients at risk of arrhythmia early. In addition, there are no therapies specifically targeting electropathology.
Treatment of Arrhythmia
Electrical signals recorded from young hearts usually have a simple morphology, as electrical waves propagate smoothly through cardiac tissue. Over the years, these electrical signals may become more complex (electropathology) due to damaged cardiac tissue. When the degree of electropathology exceeds a certain threshold, cardiac arrhythmia may occur.
Treatment of cardiac arrhythmia is still often not successful, says Natasja de Groot, professor and cardiologist-electrophysiologist at Erasmus MC. Current treatment consists of either an ‘electrical shock’ to restore the normal heart rhythm, drugs or ablative therapy (eliminating the cardiac tissue that is causing arrhythmia). Unfortunately, these therapies have side-effects and are only moderately effective.
The aim of the Medical Delta Cardiac Arrhythmia Lab is to reduce the cardiac arrhythmia burden by unravelling arrhythmia-related electropathology and designing and testing novel bio-electrical diagnostic tools and therapies targeting electropathology. This enables staging of the cardiac arrhythmia and selection of the appropriate treatment in the individual patient, thereby improving therapy outcome.
A first step is to unravel electropathology by quantifying electrical parameters. For this purpose, a 192 electrode-array has been designed to record electrical signals directly from the surface of the heart during open heart surgery. Advance signal processing techniques are then used to comprehend electrical activation patterns during arrhythmia. Linking electrical signals with the structure of cardiac tissue is essential to unravel the mechanisms of arrhythmia. The future goal is to assess the degree of electropathology using non-invasive mapping techniques.
To further unravel the mechanisms of arrhythmia, this consortium aims to design an arrhythmia-on-a-chip platform enabling the investigation of electrical conduction in relation to e.g. genetic defects.
Lowlands center for Bioelectric Medicine
The Lowlands center for Bioelectric Medicine, established by prof. Natasja de Groot and Dr. Yanick Taverne aims to restore a healthy, bio-electrical function of the heart by capturing, analyzing and modulation of an individual’s bioelectronic signals. The goals are to:
- create organ specific bioelectrical atlas by analyzing bio-electrical signaling governing organ (dys)function in a subset of diseases
- develop and test interface (diagnostic) technologies, including electrode-based interfaces for remotely monitoring bio-electrical function, implantable, shape adaptable electrode-based interfaces for monitoring of bioelectricity function of organs, and miniaturized electrode-based interfaces for integrated bioelectronic therapies
- establish therapeutic feasibility.
The scope of the Lowlands Center for Bioelectric Medicine is not confined to one organ but currently also extends to other organs, e.g. the brain, skin, intestines and bladder. Research facilities available in this lab include ex-vivo-heart-perfusion set up and biomimetic systems.
In collaboration with Dr. Maryam Kavousi, epidemiological aspects of cardiac arrhythmias in a population-based study, the Rotterdam Study, are being investigated.
This program is a collaboration between biologists, engineers and medical doctors from Erasmus MC, LUMC and TU Delft. They combine their unique expertise on advanced signal recording and processing techniques, cardiac mapping tools and arrhythmia related molecular mechanics.
(Photo: Esther Morren)