Cardiac Electrophysiology / Channel Biology Program
Director: Dr. Francis Marchlinski
Research
Molecular Cardiology Reseach Center / Patel Lab »
The research in our laboratory is focused on elucidated the molecular mechanisms of cardiac arrhythmogenesis and conduction disease.
We are using genetically engineered mouse models of human arrhythmogenic disorders to investigate arrhythmia mechanisms at the level of the
whole heart, cardiomyocyte and molecule. This integrative approach is accomplished by using the murine in vivo electrophysiology technique
in combination with the patch clamp technique and standard molecular and biochemical techniques.
To investigate arrhythmogenesis at the level of the whole heart, we insert a 2-french octapolar electrophysiology catheter into the
right internal jugular vein of an anesthetized mouse with the distal 4 poles in the right ventricle and the proximal 4 poles in the right atrium.
We can then stimulate and record electrograms from either cardiac chamber individually to perform programmed stimulation and assess
the presence of arrhythmia inducibility and conduction system disease, just as in humans.
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Clinical Research / Gerstenfeld Lab »
Applying signal processing techniques to better understand the mechanism of cardiac arrhythmias, particularly atrial fibrillation.
I am also interested in developing new energy sources and improving the success rates of catheter ablation.
Other interests include:
- Mechanisms of atrial fibrillation
- Developing new catheter based treatment modalities for atrial fibrillation
- Non-invasive risk stratification for atrial fibrillation
- Quantification of ECG waveform morphology in ventricular tachycardia
- Body surface potential mapping
- Signal averaged P waves
Physiology Core
The Physiology Core within the Penn Cardiovascular Institute (Penn CVI) allows appropriate Penn CVI investigators to perform in vivo physiologic cardiovascular analysis
of small animal models including rats and mice. Equipment and protocols developed within the core allow investigators to measure real time heart rate and rhythm using implantable telemetry devices.
Surface electrocardiograms and invasive electrophysiological testing is performed under the direction of Dr. Vic Patel. Invasive hemodynamic monitoring of both left and right heart allows for
direct measurements of cardiovascular pressures and function. Ischemia reperfusion models have been developed and validated using coronary ligation and fluorescent microsphere techniques to assess "myocardium at risk."
In combination with the Histology and Gene Expression Core Facility histologic analysis of infracted myocardium is performed.
Carotid injury models to examine vascular restenosis have also been developed.
Micro pump implantation to deliver constant infusion of substances including isoproteranol and angiotension II are also performed.
Equipment within the core includes intubation and anesthesia apparati, telemetry recording instruments,
electrophysiology recording devices and appropriate electrical and pressure recording catheters.
Core Director: Dr. Vic Patel, MD, PhD | patelv@mail.med.upenn.edu, (215) 898-5475
Clinical Program
Highest Performance Rates in the Region
The HUP EP program currently performs more than 500 Atrial Fibrilation (AF) ablation procedures per year, or more than 5 times the minimum
national standard. The program has performed more than 2300 AF ablation procedures and has more than 10 years of experience in the
field of AF ablation. The PENN Health system implants more than 1300 electrophysiology devices per year; including over 700 pacemakers and 750 Implantable defibrillators
making it the busiest arrhythmia program in the region for device implantation. The team performs more than 950 catheter ablation procedures per year -
more than the combined efforts of three of the next largest centers in the region.
HUP EP / Arrhythmia, Heart Failure and Echo teams have played a pivotal role in demonstrating the effectiveness of biventricular pacing
therapy for the improvement of heart failure. The Penn EP program works with our heart failure colleagues to implant over
250 biventricular pacing units every year, making them one of the most experienced programs in the country in using and programming these devices.
The Last Stop
Nearly a third of all patients undergoing ablation procedures with the Hospital of the University of Pennsylvania (HUP) Electrophysiology (EP) team
have failed their procedures elsewhere. For these patients, the HUP EP team is "the last stop." The team has a reknowned track record of success with the most difficult cases.
Leading Arrhythmia Program
The HUP EP / Arrhythmia program consists of 14 academic
electrophysiologists, making it the largest electrophysiology program on the east coast and one of the two largest single hospital programs in the country.
All faculty and staff are trained extensively and knowledgeable in all aspects of anti-arrhythmic drug, pacemaker, ICD device and ablation care.
In addition, the team has contributed more than 600 scientific publications to the field over the last decade.
Pioneering Therapies
The team has pioneered novel ablation therapies to cure
atrial and ventricular arrhythmias. Some novel therapies include surgical therapy for ventricular tachycardia (Pennsylvania Peel) and substrate base catheter ablation to treat unmappable ventricular
tachycardias. The HUP EP / Arrhythmia team pioneered the use of intracardiac echo to facilitate online imaging during electrophysiologic procedures and
catheter ablation of arrhythmias. The size and expertise of the team allows them to partner with other innovators in the field to offer patients the latest investigational tools and protocols.
History of Innovation
HUP electrophysiology team has consistently been first in the tristate region to make major scientific contributions to the
development of the field and evolution of techniques, including:
- 1st Catheter mapping of ventricular tachycardia (1976)
- 1st Surgical ablation for ventricular tachycardia (1977)
- 1st Surgical ablation for Wolfe Parkinson White Syndrome (1977)
- 1st ICD implant (1981)
- 1st Catheter ablation therapy (1984)
- 1st Implantation of totally intravascular (nonthoracotomy) ICD leads (1991)
- 1st Catheter ablation for atrial flutter (1992)
- 1st Use of electroanatomic computerized mapping to localize ventricular arrhythmias (1995)
- 1st Catheter ablation for atrial fibrillation (1997)
- 1st Substrate based catheter ablation for unmappable VT (1999)
- 1st Biventricular device implantation to treat heart failure by resynchronizing cardiac contractility (1999)
- 1st Percutaneous epicardial ablation of ventricular tachycardia (2002)
- 1st Balloon catheter technology to treat atrial fibrillation by isolating the pulmonary veins (2007)
- Contributed to the development of first LASER-energy catheter for ablation
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