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Salim F Idriss

Publications and source records attributed to Salim F Idriss.

16 recordsLinked to original sources
PubMed2006

Spatial heterogeneity of the restitution portrait in rabbit epicardium.

Spatial heterogeneity of repolarization can provide a substrate for reentry to occur in myocardium. This heterogeneity may result from spatial differences in action potential duration (APD) restitution. The restitution portrait (RP) measures many aspects of rate-dependent restitution: the dynamic restitution curve (RC), S1-S2 RC, and short-term memory response. We used the RP to characterize epicardial patterns of spatial heterogeneity of restitution that were repeatable across animals. New Zealand White rabbit ventricles were paced from the epicardial apex, midventricle, or base, and optical action potentials were recorded from the same three regions. A perturbed downsweep pacing protocol was applied that measured the RP over a range of cycle lengths from 1,000 to 140 ms. The time constant of short-term memory measured close to the stimulus was dependent on location. In the midventricle the mean time constant was 19.1 +/- 1.1 s, but it was 39% longer at the apex (P < 0.01) and 23% longer at the base (P = 0.03). The S1-S2 RC slope was dependent on pacing site (P = 0.015), with steeper slope when pacing from the apex than from the base. There were no significant repeatable spatial patterns in steady-state APD at all cycle lengths or in dynamic RC slope. These results indicate that transient patterns of epicardial heterogeneity of APD may occur after a change in pacing rate. Thus it may affect cardiac electrical stability at the onset of a tachycardia or during a series of ectopic beats. Differences in restitution with respect to pacing site suggest that vulnerability may be affected by the location of reentry or ectopic foci.

Action Potentials↗
PubMed2006

Electrocardiographic response to enzyme replacement therapy for Pompe disease.

PURPOSE: Electrocardiogram (ECG) abnormalities are universal in infantile Pompe disease or glycogen storage disease type II, a fatal genetic muscle disorder caused by deficiency of acid alpha-glucosidase (GAA). Hallmarks of this disease include a shortened PR interval, an increased QT dispersion (QTd), and large left ventricular (LV) voltages. We evaluated the effect of recombinant human GAA (rhGAA) enzyme replacement therapy (ERT) on these ECG parameters in patients with infantile-onset Pompe disease. METHODS: A total of 134 ECGs were evaluated from 19 patients (5 females and 14 males) with a median age of 5.5 months at the time of enrollment in open-label clinical trials exploring the safety and efficacy of ERT at a single center from 1999 to 2004. rhGAA was purified from genetically engineered Chinese hamster ovary cells overproducing GAA and infused intravenously at doses ranging from 10 mg/kg per week to 20 to 40 mg/kg every 2 weeks in patients with infantile-onset Pompe disease. The PR interval, QTd (longest to shortest QT), and LV voltage (SV1 + RV6) were blindly determined by two independent observers. RESULTS: The median follow-up period was 6 months (range 2-30 months). The PR interval lengthened from 83 (42-110) ms to 107 (95-130) ms (P < .001), and the QTd decreased from 83 (40-125) ms to 53 (20-80) ms (P = .003). There were significant decreases in LV voltage (67 [17-83] mV vs. 48 [18-77] mV, P = .03), which correlated with decrease in LV mass on two-dimensional echocardiogram. There was no evident change in the QTc interval (429 [390-480] ms vs. 413 [370-450] ms, P = not significant). CONCLUSION: rhGAA ERT for infantile Pompe disease results in an increase in PR interval and a decrease in both the QTd and the LV voltage. These results suggest that these ECG parameters may be useful markers of the severity of cardiac disease and the response to ERT treatment in patients with infantile Pompe disease.

Cohort Studies↗
PubMed2006

Real-time, 3-D ultrasound with multiple transducer arrays.

Modifications were made to a commercial real-time, three-dimensional (3-D) ultrasound system for near simultaneous 3-D scanning with two matrix array transducers. As a first illustration, a transducer cable assembly was modified to incorporate two independent, 3-D intra-cardiac echo catheters, a 7 Fr (2.3 mm O.D.) side scanning catheter and a 14 Fr (4.7 mm O.D) forward viewing catheter with accessory port, each catheter using 85 channels operating at 5 MHz. For applications in treatment of atrial fibrillation, the goal is to place the sideviewing catheter within the coronary sinus to view the whole left atrium, including a pulmonary vein. Meanwhile, the forward-viewing catheter inserted within the left atrium is directed toward the ostium of a pulmonary vein for therapy using the integrated accessory port. Using preloaded, phasing data, the scanner switches between catheters automatically, at the push of a button, with a delay of about 1 second, so that the clinician can view the therapy catheter with the coronary sinus catheter and vice versa. Preliminary imaging studies in a tissue phantom and in vivo show that our system successfully guided the forward-viewing catheter toward a target while being imaged with the sideviewing catheter. The forward-viewing catheter then was activated to monitor the target while we mimicked therapy delivery. In the future, the system will switch between 3-D probes on a line-by-line basis and display both volumes simultaneously.

Algorithms↗
PubMed2005

Real-time 3D laparoscopic ultrasonography.

We have previously described 2D array ultrasound transducers operating up to 10 MHz for applications including real time 3D transthoracic imaging, real time volumetric intracardiac echocardiography (ICE), real time 3D intravascular ultrasound (IVUS) imaging, and real time 3D transesophageal echocardiography (TEE). We have recently built a pair of 2D array transducers for real time 3D laparoscopic ultrasonography (3D LUS). These transducers are intended to be placed down a trocar during minimally invasive surgery. The first is a forward viewing 5 MHz, 11 x 19 array with 198 operating elements. It was built on an 8 layer multilayer flex circuit. The interelement spacing is 0.20 mm yielding an aperture that is 2.2 mm x 3.8 mm. The O.D. of the completed transducer is 10.2 mm and includes a 2 mm tool port. The average measured center frequency is 4.5 MHz, and the -6 dB bandwidth ranges from 15% to 30%. The 50 omega insertion loss, including Gore MicroFlat cabling, is -81.2 dB. The second transducer is a 7 MHz, 36 x 36 array with 504 operating elements. It was built upon a 10 layer multilayer flex circuit. This transducer is in the forward viewing configuration and the interelement spacing is 0.18 mm. The total aperture size is 6.48 mm x 6.48 mm. The O.D. of the completed transducer is 11.4 mm. The average measured center frequency is 7.2 MHz, and the -6 dB bandwidth ranges from 18% to 33%. The 50 omega insertion loss is -79.5 dB, including Gore MicroFlat cable. Real-time in vivo 3D images of canine hearts have been made including an apical 4-chamber view from a substernal access with the first transducer to monitor cardiac function. In addition, we produced real time 3D rendered images of the right pulmonary veins from a right parastemal access with the second transducer, which would be valuable in the guidance of cardiac ablation catheters for treatment of atrial fibrillation.

Animals↗
PubMed2004

Feasibility study: real-time 3-D ultrasound imaging of the brain.

We tested the feasibility of real-time, 3-D ultrasound (US) imaging in the brain. The 3-D scanner uses a matrix phased-array transducer of 512 transmit channels and 256 receive channels operating at 2.5 MHz with a 15-mm diameter footprint. The real-time system scans a 65 degrees pyramid, producing up to 30 volumetric scans per second, and features up to five image planes as well as 3-D rendering, 3-D pulsed-wave and color Doppler. In a human subject, the real-time 3-D scans produced simultaneous transcranial horizontal (axial), coronal and sagittal image planes and real-time volume-rendered images of the gross anatomy of the brain. In a transcranial sheep model, we obtained real-time 3-D color flow Doppler scans and perfusion images using bolus injection of contrast agents into the internal carotid artery.

Animals↗
PubMed2004

Minimum energy single-shock internal atrial defibrillation in sheep.

Well-tolerated internal atrial defibrillation shocks must be below the pain threshold, which has been estimated to be less than 1 Joule. Defibrillation of the atria with low energy is made possible by delivering shocks at the low end of the defibrillation dose-response curve. We studied low-energy defibrillation in sheep to test the hypothesis that the energy that defibrillates the atria 10% of the time (ED10) is less than 1 Joule. The ED10 was estimated in seven sheep with rapid pacing induced chronic atrial fibrillation (AF). Low-energy defibrillation shocks were delivered from coronary sinus (CS) to superior vena cava (SVC) and the ED10 and ED50 (energy that defibrillates the atria 50% of the time) were then calculated using logistic regression. The mean ratio of ED10 to ED50 was 0.50, indicating that on average, the ED10 was equal to half of the ED50. ED10 shocks had energies ranging from 1.2 to 5.8 Joules. These results suggest that painless single-shock low-energy defibrillation may not be feasible.

Animals↗
PubMed2004

The restitution portrait: a new method for investigating rate-dependent restitution.

INTRODUCTION: Electrical restitution, relating action potential duration (APD) to diastolic interval (DI), was believed to determine the stability of heart rhythm. However, recent studies demonstrate that stability also depends on long-term APD changes caused by memory. This study presents a new method for investigation of rate- and memory-dependent aspects of restitution and for assessment of mapping models of APD. METHODS AND RESULTS: Bullfrog ventricular myocardium was paced with a "perturbed downsweep protocol." Starting from a basic cycle length (BCL) of 1,000 ms, the tissue was paced until steady state was achieved, followed by single beats of longer and shorter cycle lengths. BCL was decreased by 50 to 100 ms and the process repeated. All APDs were plotted as a function of the preceding DI, which allowed simultaneous observation of dynamic, S1-S2, and two constant-BCL restitution curves in a "restitution portrait." Responses were classified as 1:1 (stimulus:response), transient 2:2, or persistent 2:2 (alternans) and were related to the slopes of the restitution curves. None of these slopes approached unity for the persistent 2:2 response, demonstrating that the traditional restitution condition does not predict alternans. The restitution portrait was used to evaluate three mapping models of APD. The models with no memory and with one-beat memory did not produce restitution portraits similar to the experimental one. A model with two-beat memory produced a qualitatively similar portrait. CONCLUSION: The restitution portrait allows a more comprehensive assessment of cardiac dynamics than methods used to date. Further study of models with memory may result in a clinical criterion for electrical instability.

Action Potentials↗
PubMed2004

Transmural action potential repolarization heterogeneity develops postnatally in the rabbit.

INTRODUCTION: In the hereditary long QT syndrome, arrhythmia risk changes with age despite the presence of an ion channel mutation throughout development. Age-dependent changes in the transmural dispersion of repolarization may modulate this vulnerability. We recorded cardiac action potentials in infant, periadolescent, and adult rabbit myocardium to determine if transmural heterogeneities in repolarization are developmentally determined. METHODS AND RESULTS: Arterially perfused ventricular preparations were studied from 2-week (n = 7), 7-week (n = 7), and adult (n = 6) NZW rabbits. Action potentials were recorded with microelectrodes in five regions: epicardium (epi), subepicardium (subepi), midwall (mid), subendocardium (subendo), and endocardium (endo) during endocardial S1 pacing at cycle lengths of 2,000, 1,000, and 500 ms. At 2 weeks, the transmural APD90 profile was flat. With age, APD prolongation from subepi to endo created a transmural repolarization gradient. At 7 weeks, APD90 was significantly longer at subendo [204 +/- 2 ms (mean +/- SE) 2,000-ms cycle length, P < 0.05] vs both endo (193 +/- 2 ms) and epi (172 +/- 2 ms), causing a heterogeneous transmural APD90 gradient. In adults, the transmural gradient was a smooth continuum such that APD was shortest in epicardium and longest in endocardium. CONCLUSION: The transmural distribution of APD is developmentally determined. Tissue-specific age-dependent changes in APD can result in transmural repolarization heterogeneity. These age-related effects may modulate arrhythmia vulnerability during development.

Action Potentials↗
PubMed2004

A miniaturized catheter 2-D array for real-time, 3-D intracardiac echocardiography.

The design, fabrication, and characterization of a 112 channel, 5 MHz, two-dimensional (2-D) array transducer constructed on a six layer flexible polyimide interconnect circuit is described. The transducer was mounted in a 7 Fr (2.33 mm outside diameter) catheter for use in real-time intracardiac volumetric imaging. Two transducers were constructed: one with a single silver epoxy matching layer and the other without a matching layer. The center frequency and -6 dB fractional bandwidth of the transducer with a matching layer were 4.9 MHz and 31%, respectively. The 50 omega pitch-catch insertion loss was 80 dB, and the typical interelement crosstalk was -30 dB. The final element yield was greater than 97% for both transducers. The transducers were used to acquire real-time, 3-D images in an in vivo sheep model. We present in vivo images of cardiac anatomy obtained from within the coronary sinus, including the left and right atria, aorta, coronary arteries, and pulmonary veins. We also present images showing the manipulation of a separate electrophysiological catheter into the coronary sinus.

Animals↗
PubMed2004

Real-time 3D color flow Doppler for guidance of vibrating interventional devices.

The goal of this investigation was to examine the feasibility of guiding interventional devices using piezoelectric buzzers to create velocity sources, which were imaged and tracked with real-time 3D color flow Doppler. The interventional devices examined in this study included a pacemaker lead, Brockenbrough needle for cardiac septal puncture, cardiac guidewire and radiofrequency ablation needles for cancer therapy. Each was mechanically coupled to a piezoelectric buzzer and was imaged using a commercial real-time 3D ultrasound system with either a 2.5 MHz matrix array transducer or a 5 MHz, 22 F catheter transducer equipped with a tool port. In vitro images acquired in tissue phantoms, excised liver with a 'tumor' target and an excised sheep heart show strong vibration signals in 3D color flow Doppler, enabling real-time tracking and guidance of all the devices in three dimensions. In a sheep model, in vivo tracking of the pacing lead was performed in the superior vena cava as well as the right atrium using RT3D color flow Doppler images. The vibrating rf ablation needles were guided through the liver toward "tumor" targets in vivo with real-time 3D color flow Doppler images.

Animals↗
PubMed2004

Real-time 3D transesophageal echocardiography.

Transesophageal echocardiography (TEE) is an essential diagnostic tool in patients with poor transthoracic echocardiographic windows or when detailed imaging of structures distant from the chest wall is necessary. A real-time 3D TEE probe has been fabricated in our laboratory in order to increase the amount of information available during a transesophageal procedure. The 1 cm diameter esophageal probe utilizes a 2-dimensional, 5 MHz array at its tip with a 6.3 mm diameter aperture, including 504 active channels. The array has a periodic vernier geometry with an element pitch of 0.18 mm, built onto a multilayer flexible (MLF) interconnect circuit. In order to accommodate 504 channels within the device, a 1 m long Gore MicroFlat cable was utilized for wiring the MLF to the corresponding system connectors. Pulse-echo tests in a water tank have yielded a -6 dB bandwidth of 25.3%. Fully connected to the system through 3 m of cable, the probe shows an average 50 omega insertion loss of-85 dB with a standard deviation of 4 dB, as determined through pitch-catch measurements for a sampling of 10 elements. Using the completed 3D TEE probe with the Volumetrics Medical Imaging 3D scanner, real-time volumetric images of in vivo canine cardiac anatomy have been acquired, displaying atrial views, mitral valve function and interventional catheter guidance.

Animals↗
PubMed2003

Dual lumen transducer probes for real-time 3-D interventional cardiac ultrasound.

We have developed dual lumen probes incorporating a forward-viewing matrix array transducer with an integrated working lumen for delivery of tools in real-time 3-D (RT3-D) interventional echocardiography. The probes are of 14 Fr and 22 Fr sizes, with 112 channel 2-D arrays operating at 5 MHz. We obtained images of cardiac anatomy and simultaneous interventional device delivery with an in vivo sheep model, including: manipulation of a 0.36-mm diameter guidewire into the coronary sinus, guidance of a transseptal puncture using a 1.2-mm diameter Brockenbrough needle, and guidance of a right ventricular biopsy using 3 Fr biopsy forceps. We have also incorporated the 22 Fr probe within a 6-mm surgical trocar to obtain apical four-chamber ultrasound (US) scans from a subcostal position. Combining the imaging catheter with a working lumen in a single device may simplify cardiac interventional procedures by allowing clinicians to easily visualize cardiac structures and simultaneously direct interventional tools in a RT3-D image.

Animals↗
PubMed2002

Feasibility study of real-time three-dimensional intracardiac echocardiography for guidance of interventional electrophysiology.

The authors tested the feasibility of real-time three-dimensional intracardiac echocardiography for guidance of interventional electrophysiological studies. The three-dimensional scanner uses a matrix array ultrasound transducer of 64 channels operating at 5 MHz in a 12 Fr catheter. The system features real-time three-dimensional image rendering and produces up to 60 volumetric scans per second. Using an open-chest sheep model, real-time three-dimensional images of anatomic landmarks were obtained, including the pulmonary veins and coronary sinus, which are of value in electrophysiological procedures. In vivo radio frequency ablation procedures in the right ventricle were also monitored, which yielded lesions of high image contrast.

Animals↗
PubMed2002

Microvolt T wave alternans inducibility in normal newborn puppies: effects of development.

INTRODUCTION: The cause of sudden infant death syndrome is unknown, but increased cardiac vulnerability due to repolarization instability may be a contributing factor. The QT interval normally is long at birth and increases further during the first few postnatal months. Although excessive QT intervals indicate increased cardiac vulnerability in the long QT syndrome, the impact of less pronounced QT prolongation during this developmental period is unclear. In adults and older children, the ease of inducing microvolt-level T wave alternans (TWA) is used as a measure of repolarization instability and arrhythmia vulnerability. The aim of this study was to determine if TWA is inducible in normal newborn puppies. METHODS AND RESULTS: Atrial pacing was performed in 15 anesthetized beagle puppies 7 to 35 days old. The pacing drive cycle length was systematically decreased in 20-msec steps from baseline until AV conduction blocked. Pacing was performed for 8 minutes at each cycle length. Three-lead ECGs were recorded continuously during the last 5 minutes of pacing at each cycle length. The recordings were analyzed off-line for the presence of microvolt-level TWA using a sensitive spectral analysis technique. Microvolt-level TWA was present in all puppies. TWA was not present at baseline but developed and increased in amplitude as heart rate increased. The threshold heart rate for TWA did not correlate with age. However, due to age-dependent changes in baseline heart rate, the 7- to 14-day-old animals needed a 50% to 78% increase in heart rate to reach threshold heart rate, whereas the oldest animals needed only a 5% to 25% increase. CONCLUSION: These data suggest that developmentally dependent dynamic repolarization instability exists in puppies as manifest by the inducibility of TWA.

Age Factors↗
PubMed2002

Feasibility study for real time three dimensional Doppler intracardiac echocardiography.

Using catheter-mounted two-dimensional array transducers, we have obtained real-time three-dimensional color flow and spectral Doppler ultrasound images in phantoms. We have constructed several transducers operating at 5 MHz with up to 137 channels inside a 12 French catheter lumen. The transducer configuration may be side scanning or beveled with respect to the long axis of the catheter lumen. We have also included six electrodes to acquire simultaneous electrocardiograms. We have measured Doppler signals in two phantoms, a string phantom and a pulsatile flow phantom. Using an open chest sheep model, we inserted the catheter into the cardiac chambers to study the utility of in vivo 3D intracardiac Doppler echocardiography.

Animals↗