1. Dr. Knisley Frank Giammo Amanda Schaeffer John Spain

2. Assist Dr. Knisley in pilot experiment for Boston Scientific. * Focus: Cardiac Resynchronization Therapy(CRT) methods

3. * Heart Failure: the inablity of the heart to supply the body with sufficient blood flow. * Common Causes: * Myocardial infarction: Heart attack * Heart Disease: * Ischemic: Reduced blood supply to myocardium * Valvular: Any disease process which involves the valves * Cardiomyopathy: Deterioration of the myocardium's functionality. * Hypertension: High blood pressure Affects ~2% of adults in developed countries, and 6-10% ages 65+ Leading cause of death in United states (25% of total deaths)

4. * Transplant: Most severe method; reserved for mainly end- stage heart failure or severe coronary artery disease patients. * Pharmaceutical: Use of drugs to treat specific types of heart disease. Common medications: Aspirin, Beta-Blockers, ACE inhibitor, Blood Cholesterol-lowering Agents. * Cardiac Resynchronization Therapy(CRT): Electrical pacing of the heart by electrodes in order to regulate the heart’s rhythm e.g. pacemaker.

5. * Can be programmed per patient, and controlled externally. * Allows for continuous real-time monitoring of heart. * Can be implanted in body and also coupled with a defibrillator, which allows for immediate response to heart failure. * Three types of CRT: * Unipolar * Bipolar * OverLapping Biphasic(OLBI)

6. note: All circuit models are derived from Lazarus’ models OLBIBipolarUnipolar + _ + _ _ + Note: Both OLBI and bipolar use two wires

7. * Main Goal: Determine whether OLBI pacing affects the heart differently than bipolar methods. * Minor Goals: Locate His bundle, refine protocol for optical mapping, and verify OLBI model defined by Lazarus.

8. * Eleven experiments were conducted in groups of two in between May and August * Each experiment’s objective was unique : * Pacing thresholds * Optical recording of different modes of pacing with use of fluorescent dye(DYE-4 ANEPPS) * Stimulation Duration * Locating His bundle * Intermediate results from previous experiments guided future interests * Road blocks encountered: High background noise in both Powerlab and optical data, His bundle stimulation, application of data, synchronization of equipment for optical data

14. * Problem: Cyclical noise interfering with His signal detection in Powerlab data. * Solution: Apply a learning filter which would remove noise without skewing real values due to interpolation.

16. Primary Goal: Verify OLBI model. * Create ammeter to measure current with respect to position of electrodes * Test experimental procedure with saline model * Decide whether to proceed to live experiment * Analyze summer data and submit conclusions _ +

18. * Lazarus, A. “Reduction in Energy Pacing Thresholds by Overlapping Biphasic Stimulation Versus Conventional Bipolar Pacing.” Saint Cloud, France. 2006 * Common Heart Disease Medications. http://www.caregiverslibrary.org/Default.aspx?tabid=473 * Heart Disease. http://en.wikipedia.org/wiki/Heart_disease.http://en.wikipedia.org/wiki/Heart_disease * http://en.wikipedia.org/wiki/File:Idiopathic_cardiomyopathy,_g ross_pathology_20G0018_lores.jpg (ref figure on slide Heart Disease Therapies) http://en.wikipedia.org/wiki/File:Idiopathic_cardiomyopathy,_g * Drawings by Frank Giammo * Photos, lab figures c/o Dr. Knisley