National projects

SIMRIC

Mechanically realistic pedagogical simulator for cardiac interventions

 

Over the last few years, procedures consisting of introducing catheters into the heart, improve the prognosis of patients in arrhythmia applying therapy on focused pathogenic areas. For patients suffering from heart failure, a possible therapy consists of introducing stimulation leads to resynchronize the ventricles.

Despite the ability to simulate all aspects of this type of intervention (introduction of the catheter, electrical signals, imaging, ...), there is not yet a simulator integrating all these characteristics.

The objective of this project was to develop a simulator for manipulating electrophysiological catheters on a mechanically realistic model and to propose to the operator different realistic scenarios of arrhythmias with electrical signals.

 

The SIMRIC project received funding from the Bordeaux IDEX as part of the Future Investment Program.
 

PURKINJE CRA

Characterization of the Purkinje Network from cell to organ, based on cell tissue imaging and clinical data

 

This project aims to characterize the behavior and structure of the Purkinje Network (RP) in order to better understand its role in the genesis of arrhythmias and to develop new interventional therapies. This involves developing new imaging techniques, performing experiments at cellular and tissue levels, acquiring clinical records of the electrical activity of the RP, and integrating all of these data into a computer model. This model will help to better understand how the observed dysfunctions at cellular or tissue level degenerate into organ-level arrhythmias allowing a better stratification of patients at risk.
 

This project received financial support from "Région Aquitaine Limousin Poitou-Charentes" in the framework of call for projects Research 2016 (Agreement  n°2016-1R30113)

Equipex MUSIC

Multi-modality platform for specific imaging in cardiology

 

Through this MUSIC project, a multi-modal exploration platform has been created, combining different existing technologies so as to enable multi-parametric assessment of cardiac electrical diseases and guide therapy. The equipment includes MRI, Fluoroscopy, 3D localization and invasive / non-invasive electrophysiological mapping systems - each of which are currently being used separately due to the unavailability / non-existence of the platform that we are proposing propose through this project/this project proposes. With such a platform, developed by academics, different sets of data from multiple vendors and technologies are interconnected and registered under the same spatio-temporal coordinates. MUSIC allows a unique piece of equipment to be installed in the hospital to treat patients. The equipment is located in the heart of the hospital, and intended for the care of patients.

MUSIC is used in an international consortium, for therapeutic purposes, in more than 20 international hospitals in 2017.

Further details

FFC ROTOR

Mechanisms of sudden cardiac death

 

The main goal of this project is to assess fibrosis and electrophysiological remodeling of the atria, to characterize the re-entrant "drivers" ("rotors") or focal "drivers", perpetuating atrial fibrillation and to analyze their relationship with the atrial structure changes. Specifically, we aim to establish a relationship between reentry and structural remodeling. This project will help to clarify how the structural remodeling has a role in the perpetuation of AF and rotors which would pave the way for new diagnostic (signal processing) and therapeutic (optimal site for thermoablation procedure) algorithm prospects.

 
HR-CEM

High resolution numerical models for cardiac electrophysiology

 

The objectives of the HR-CEM project are:

  • to build high-resolution models of the whole heart and torso including the 4 chambers and the specialized conduction network.
  • to propose high-order and verified numerical techniques, load-balancing strategies and high-performance numerical software in order to implement the models defined above numerically.
  • to construct numerical heart models and assess their performance validation against experimental data provided by LIRYC. Both animal and human data will be considered. The interaction with experimental data will be twofold: First, the data will directly contribute to objective 1 on modelling. Second, the numerical implementation of these models will be compared to in-vivo and ex-vivo electrical recordings for validation. Ultimately, the numerical models will become predictive.

 

This study received financial support from the ‘Agence Nationale de la Recherche (ANR)’ in the framework of the MONU Programme 2013 (Agreement n°ANR-13-MONU-0004-04)

MIGAT

Multimodal Image processing software to Guide Cardiac Ablation Therapy

 

Cardiac electrical disorders are a major cause of human mortality and morbidity worldwide. Catheter ablation therapy has become part of international recommendations for the management of both atrial and ventricular arrhythmia. Advanced catheter localization systems now enable 3-dimensional mapping of cardiac electrical activity. The integration of 3-dimensional imaging data acquired prior to the procedure and its merging with the mapping geometry has been shown as feasible.

 

MIGAT objectives are to develop within 3 years software with subsequent CE/FDA marking able to process and fuse multi-modal non-invasive 3-dimensional data and to clinically validate multi- modal data integration for the guidance of cardiac ablation.

 

This work received funding from the ANR (ANR-13-PRTS-0014-01).

NOVELECGi

NOn-invasiVE three-dimensionaL ElectroCardioGraphic imaging of trigger and substrate

 

Non-invasive electrocardiographic imaging is a promising new tool to provide high resolution panoramic imaging of cardiac electricity from chest electrodes. We have recently successfully applied this tool to the study and treatment of atrial fibrillation and the current project will extend our previous work to the study of ventricular fibrillation. However, this will require validation of novel signal analysis tools and improvements to the solution of the inverse problem. The main objectives of NOVELECGi are therefore (i) to apply and further develop non-invasive threedimensional electrocardiographic imaging of ventricular fibrillation, (ii) to advance our fundamental understanding in the trigger and substrate mechanisms underlying sudden cardiac death, and (iii) to improve current preventive, diagnostic and treatment methods for these life-threatening cardiac electrical disorders.


NOVELECGi is a fundamental and clinical research project that will lead to significant progress in the understanding, prevention and treatment of sudden cardiac death.

TACIT

MR guided cardiac RF ablation

 

The objectives of this research project are to develop fast and reliable cardiac MR thermometry in order to improve the efficiency and safety of Radio-frequency ablation (RFA) for patients. RFA using a dedicated catheter has proved effective in treating cardiac arrhythmia. However, the lack of real time visualization of thermal lesion formation in current clinical practice prevents the physician from evaluating the size of the lesion during the procedure.

 

In this “TACIT” project, MR acquisition methods, real-time image processing and dedicated MR compatible instrumentation will be developed to allow online visualization of thermal lesion formation during the RF ablation procedure.

 

This work received funding from the 'ANR (ANR-11-TecSan-003-01).

TEMPO

Trigger and substratE Mechanisms of Pulmonary vein ectOpy

 

The main objective of the TEMPO research project is to gain a better understanding of the trigger and substrate mechanisms underlying PV ectopy and the onset of paroxysmal AF. Specifically, this project will consist of 4 workpackages that will aim at: (i) a comprehensive molecular, cellular and clinical characterization of PV electrophysiology, with a special emphasis on afterdepolarizations as a mechanism of ectopy; (ii) determining the effects of stretch on PV ectopy from the molecular level to the clinical situation; (iii) investigating the effects of increased adrenergic and vagal stimulation upon PVs from the single cell to the patient; and (iv) reconstructing the complex myofiber architecture of the PVs, before and after ablation, and investigating its role on AF initiation.

 

This work received funding from the ANR (ANR-12-BSV1-0029-02).

WAYLESS

A novel therapy for terminating ventricular fibrillation with WAYLESS: Wide Area Yielding Low Energy Surface Stimulation

 

The basic strategy of WAYLESS is to minimize the energy requirements for terminating Ventricular Fibrillation (VF) by utilizing low-energy DC surface stimulation administered via electrodes strategically placed over wide-areas of the heart. This entails combining advanced computational and experimental approaches to determine WAYLESS stimulation protocols and electrode configurations capable of reducing defibrillation energy requirements below tissue damage and pain thresholds. Accordingly, WAYLESS will first be developed in silico using a fast, cost-effective, and ethical computational approach for simulating and studying VF in a virtual human heart. After the optimal electrode configurations and stimulation protocols are determined in silico, WAYLESS will be subsequently tested and validated experimentally using a robust optical imaging approach for studying VF in perfused mammalian tissue preparations and intact hearts ex vivo.

ANR JCJC

CARTLOVE

MR thermometry for radiofrequency ablation in atria and ventricles, a key point for efficacy and safety

 

Catheter ablation is the cornerstone of curative treatment for arrhythmia but the success rate of this procedure for complex arrhythmia like ventricular tachycardia and atrial fibrillation, requiring a complete electrical isolation, is currently limited by a lack of visualization of lesion formation during the procedure. The project CARTLOVE aims to overcome the limit of radiofrequency ablation for the treatment of cardiac arrhythmias, by demonstrating that immediate visualization in response to catheter ablation is possible through MR (Magnetic resonance)-thermometry. The adoption of MR-guided electrophysiology includes the possibility of real-time adjustment of the optimal Radio Frequency energy that must be delivered to the tissue to ensure complete destruction of the arrhythmogenic substrate and could considerably reduce redo-procedures. MR thermometry (at 1°C uncertainty) for ablation monitoring in the atrium requires improvement in image spatial resolution since the atrial wall ranges between 2 to 5 mm. 

ANR JCJC

Improving Noninvasive Cardiac Imaging by Characterizing Scar

Improving Noninvasive Cardiac Imaging by Characterizing Scar

Noninvasive electrocardiographic imaging (ECGi) is a promising technology coming into greater clinical play. It visualizes the propagation of electrical activity over the surface of the heart, allowing identification of re-entrant drivers for diagnosis and to aid in ablation therapy. ECGi records electrical potentials on the body and then solves an inverse mathematical problem using personalized geometry of the heart and torso. However, the presence of scars in the heart causes artefacts in results since the electric potentials in these regions are attenuated and complex. This is problematic since it is around scars that conducting channels sustaining re-entries are located. Better inverse solutions could be obtained if the structural information available from MRI was incorporated into the process.  We hypothesize that ECGi can be significantly improved through better incorporation of MRI data in a novel inverse methodology based on source parameterization. Computer modelling will assess the contribution of specific structures to body surface potentials, characterize sources as functions of scar geometry, and generate synthetic data for method validation.

UNMASC

Understanding the remodelling processes during atrial fibrillation stabilization for improved therapeutics

 

 

Atrial fibrillation (AF) is the most common heart rhythm disturbance associated with adverse prognosis. AF progression is characterized by a transition phase during which arrhythmic episodes frequency and duration increase until stabilization. The biological nature and chronology of the underlying processes participating to the arrhythmogenic substrate development are still unclear. Thus, our main goal is to characterize the molecular, cellular and tissular remodelling responsible for AF progression during the transition phase. Investigations will be performed in a clinically relevant animal model of AF (sheep) at different levels of integration. We will use physiological, clinical and biochemical approaches that integrate whole animal biology, high resolution imaging techniques and electrophysiology on single cardiomyocytes and whole hearts. The output shall be to improve the success rate of anti-arrhythmic therapies by suppressing the evolution of the arrhythmogenic substrate.

ANR PRC

Relationships between endothelial dysfunction, obstruction and sudden death in hypertrophic cardiomyopathy

Relationships between endothelial dysfunction, obstruction and sudden death in hypertrophic cardiomyopathy

 


Hypertrophic cardiomyopathy (HCM) is a chronic and debilitating hereditary cardiac condition that affects 1/500 people. It can be complicated (65% of patients) of left intraventricular (LV) obstruction responsible for exercise symptoms (dyspnea, chest pain, lipothymia) limiting daily physical activity, heart failure or sudden death (1%/ year). Intra-VG obstruction is a complex multifactorial dynamic phenomenon, partly influenced by load variations (including peripheral venous return). The translational research team (clinical and experimental) of Pr Lafitte and Dr. Réant has already recently shown that the provocable intra-VG obstruction in the CMH could be influenced by the position and the modalities of realization of a test of effort and therefore venous return. In parallel with this, it has also been shown by other teams that MHC may be associated with endothelial and peripheral microvascular dysfunction. The main scientific objective of this project will be to study the relationship between, on the one hand, the degree of endothelial dysfunction and abnormality of the venous network of the lower limbs in patients with symptomatic MCH (dyspnea or chest pain of effort) and on the other hand the degree of intra-VG obstruction of rest and / or provocative obstruction (= latent) to orthostatism and stress on treadmill. The seconda objective will be to study the relationship between this endothelial and venous dysfunction on the one hand and the known markers of ventricular rhythmic risk in the MHC on the other hand.

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