Endocardial Electrogram Analysis after Intramyocardial Injection of Mesenchymal Stem Cells in the Chronic Ischemic Myocardium |
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Authors: | KORFF KRAUSE,M.D.,CARSTEN SCHNEIDER,M.D.,CLAUDIA LANGE,Ph,.D.&dagger ,BULENT KOKTURK,M.D.,SIGRID BOCZOR,STEPHAN GEIDEL,M.D.,AHMED SALHI,M.D.,JUSUF ALASER,M.D.,AXEL R. ZANDER,M.D.,&dagger ,KARL-HEINZ KUCK,M.D., KAI JAQUET,M.D.,Ph,.D.&Dagger |
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Affiliation: | From the Department of Cardiology and Heart Surgery, Asklepios Hospital St. Georg, Hamburg, Germany;, and Department of Hematology/Oncology—Bone Marrow Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany;;and Arrhythmia Department and Electrophysiology Laboratory, State Research Institute of Circulation Pathology, Novosibirsk, Russia |
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Abstract: | Background: Cell injection therapies have been introduced for the treatment of patients with coronary heart disease. However, intramyocardial injection of bone marrow (BM)-derived cells may generate proarrhythmogenicity. Methods: Two weeks after the placement of a circumflex artery-ameroid constrictor, 21 pigs received mesenchymal stem cells (MSC, n = 9), mononuclear (BM)-derived stem cells (MNC, n = 6), and placebo (n = 6) using a electromechanical mapping (EMM)-guided percutaneous transendocardial injection catheter. At week 6, EMM was repeated and the injected areas were analyzed in detail to evaluate local bipolar electrogram fragmentation, duration, and amplitude. Myocardial fibrosis was evaluated by a quantitative histological analysis. Results: At week 6, the injection of MSC or MNC did not increase local electrogram fragmentation (MSC group: 1.4 ± 0.3 vs. 1.3 ± 0.2; MNC group: 1.4 ± 0.2 vs. 1.3 ± 0.2; P = NS), prolong electrogram duration (MSC group: 27.1 ± 7.8 ms vs. 23.7 ± 2.0 ms; MNC group: 27.8 ± 3.5 ms vs. 26.8 ± 5.6 ms; P = NS), or decrease bipolar voltages (MSC group 2.7 ± 0.9 mV vs. 2.8 ± 1.0 mV; MNC group 2.0 ± 1.0 mV vs. 1.7 ± 0.4 mV). From week 2 to week 6, mean left ventricular ejection fraction increased in the MSC group (37.9 ± 4.2% vs. 45.9 ± 2.2%; P = 0.039) only. Histological analysis of the ischemic regions revealed 17.6 ± 5% myocardial fibrosis in the MNC group vs. 13.6 ± 3.4% MSC vs. 28.7 ± 8.7% in the control group (P = 0.038 and P = 0.013). No death occurred in any animal after the injection procedure. Conclusion: Intramyocardial injection of MSC or MNC do not increase fragmentation and duration of endocardial electrograms in the injected ischemic myocardium but attenuate ischemic damage and therefore may not create an electrophysiological substrate for reentry tachycardias |
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Keywords: | stem cells chronic ischemic heart disease electromechanical mapping fragmentation arrhythmogenicity |
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