MEDICAL EARLY RESPONSE INTERVENTION AND THERAPY (MERIT): A RANDOMISED CLINICAL TRIAL
Funder
National Health and Medical Research Council
Funding Amount
$530,500.00
Summary
Every year, between 12,000 and 23,000 deaths are associated with in-hospital adverse events, making them one of the leading causes of death in the general population. These adverse events lost Australia over three million bed-days per year, and cost the country up to $4.7 billion every year. Among the adverse events, death, cardiac arrest and unplanned admissions to intensive care unit (ICU) are the most serious occurrences. The majority of the events were preceded by serious clinical deteriorat ....Every year, between 12,000 and 23,000 deaths are associated with in-hospital adverse events, making them one of the leading causes of death in the general population. These adverse events lost Australia over three million bed-days per year, and cost the country up to $4.7 billion every year. Among the adverse events, death, cardiac arrest and unplanned admissions to intensive care unit (ICU) are the most serious occurrences. The majority of the events were preceded by serious clinical deterioration, which can be easily identified. Recognising these problems, a hospital-wide intervention system called the Medical Emergency Team (MET) has been developed in Australia over the last 10 years. Under this system, when a patient's clinical condition is unstable, a call is immediately placed to the MET for intervention. Preliminary data have shown that the MET can reduce in-hospital deaths, cardiac arrests and unplanned ICU admissions. However, past studies have been based on observational design and their results lack scientific credence due to uncontrolled confounders and biases. It is proposed to conduct a multi-centre randomised clinical trial to test the hypothesis that the implementation of the hospital-wide MET system will reduce the aggregate incidence of the following three adverse events: unplanned admissions to intensive care units, cardiopulmonary arrest, and in-hospital death. The study will involve 20 Australian and New Zealand hospitals, each with at least 20,000 admissions per year. This study will provide crucial scientific evidence for health managers and governments to make decision on the implementation of MET in Australian and New Zealand hospitals. If the MET system is shown to reduce adverse events as observed in preliminary studies, then the introduction of MET could save approximately 4000 lives, avoid 1500 cardiac arrests, and prevent 2500 unplanned ICU admissions every year.Read moreRead less
Substrate Mapping And Ablation Of Ventricular Tachycardia
Funder
National Health and Medical Research Council
Funding Amount
$444,129.00
Summary
Sudden death is a tragic occurrence and can afflict Australians of all ages, racial and ethnic backgrounds. This research will aim to understand abnormalities in the heart muscle that cause dangerous heart rhythm abnormalities, which is the most common cause of sudden death. We will study ways to improve the technology of keyhole cardiac procedures so that it can be used to prevent these arrhythmias from occurring in the first place, and in improving the chance of long-term successful cure.
Heartbeats are considered to arise through specialised pacemaker cells establishing rhythmically generated (i.e. pacemaker) action potentials, which then trigger propagating action potentials in heart muscle causing contraction and pumping of blood. This research proposal aims to challenge the physical model that is used to describe this pacemaker process and resultant heart conduction. Our reasons for doing this derive from our discovery of an alternative pacemaker-conduction mechanism, which w ....Heartbeats are considered to arise through specialised pacemaker cells establishing rhythmically generated (i.e. pacemaker) action potentials, which then trigger propagating action potentials in heart muscle causing contraction and pumping of blood. This research proposal aims to challenge the physical model that is used to describe this pacemaker process and resultant heart conduction. Our reasons for doing this derive from our discovery of an alternative pacemaker-conduction mechanism, which we have shown to operate in various smooth muscles. This mechanism, termed store-based pacemaking, is entirely different to the currently held cardiac model but could readily achieve the same outcome. We will investigate the hypotheses that this pacemaker mechanism is also fundamental to mammalian heart pacemaking and conduction. Positive support for our hypotheses, as indicated by our findings on amphibian hearts and from pilot findings, may severely challenge the present model for cardiac pacemaking. Such an outcome will have major ramifications on present interpretation of cardiac function in health and disease and will be particularly important to interpretation of disorders associated with cardiac arrhythmias and heart conduction.Read moreRead less
Atrial fibrillation (AF) is the most common cause for an irregular heart beat. Catheter ablation is the only potential cure and involves passing wires via veins in the leg into the heart to deliver discrete small burns(ablation) around the pulmonary veins (PV), the major source for AF. Unfortunately 30-50% of patients have recurrent arrhythmia due to reestablishment of electrical connections. This multicentre internation trial examines whether more (maximal) ablation will improve the outcomes of ....Atrial fibrillation (AF) is the most common cause for an irregular heart beat. Catheter ablation is the only potential cure and involves passing wires via veins in the leg into the heart to deliver discrete small burns(ablation) around the pulmonary veins (PV), the major source for AF. Unfortunately 30-50% of patients have recurrent arrhythmia due to reestablishment of electrical connections. This multicentre internation trial examines whether more (maximal) ablation will improve the outcomes of the procedure.Read moreRead less
Regulation Of RyR2 Channels By Calmodulin In Healthy And Diseased Hearts
Funder
National Health and Medical Research Council
Funding Amount
$614,421.00
Summary
In the heart, RyR2 is responsible for intracellular Ca2+ release. The RyR2 is comprised of a Ca2+ channel and accessory proteins such as CaM that regulate channel activity. Evidence suggests that RyR2 regulation by CaM is altered in heart failure and human arrhythmia syndromes, but there has been no direct evidence for this. We will provide this direct evidence plus determine how CaM regulates RyR2 channels and intracellular Ca2+ release and how this leads to cardiac arrhythmias.
Ryanodine Receptor Inhibitors As Therapy For Ca2+ Store Overload Induced Arrhythmias
Funder
National Health and Medical Research Council
Funding Amount
$555,892.00
Summary
This study investigates a new therapeutic action recently discovered for flecainide, an antiarrhythmic agent that we find to completely prevent and inherited form of stress-induced arrhythmias called CPVT. The findings will provide the first detailed mechanistic understanding of an antiarrhythmic drug, findings that will also give a new direction for drug design to control common arrhythmias such as occur in diseases such as coronary artery disease.
Type 2 diabetes is the most common endocrine disease in the world and up to 60% of diabetic patients have heart disease. Heart disease is the most expensive heath condition and biggest cause of death in Australia. Diabetic patients often accumulate fat (triglyceride) within their heart cells, leading to diabetic heart disease. The present study sought to determine if diabetic patients with increased fat within their heart cells have more scarring which eventually results heart muscle dysfunction ....Type 2 diabetes is the most common endocrine disease in the world and up to 60% of diabetic patients have heart disease. Heart disease is the most expensive heath condition and biggest cause of death in Australia. Diabetic patients often accumulate fat (triglyceride) within their heart cells, leading to diabetic heart disease. The present study sought to determine if diabetic patients with increased fat within their heart cells have more scarring which eventually results heart muscle dysfunction.Read moreRead less
Atrial Fibrillation And Hypertension: Reverse Cardiac Remodelling Post Renal Denervation
Funder
National Health and Medical Research Council
Funding Amount
$90,144.00
Summary
Patients with hypertension are at increased risk of heart rhythm disorders, yet little is known if treatment of high blood pressure will improve abnormal rhythm. Renal denervation is a new and effective treatment for severe hypertension; this study will assess the adverse changes in heart structure and function due to severe hypertension, and investigate whether renal denervation can ameliorate these changes on a structural and electrical level.
Genetic Predisposition To Abnormal Atrial Substrate In Atrial Fibrillation (GENE-AF Study)
Funder
National Health and Medical Research Council
Funding Amount
$100,531.00
Summary
Atrial fibrillation (AF) is the most common heart rhythm disorder worldwide and its incidence is growing. Our world-first research aims to demonstrate that individuals who carry specific genetic variants are more likely to develop abnormal electrical and structural changes in the heart, which predispose to AF. In doing so, we intend to find the link between genetics and AF, paving the way for research into novel targeted therapies to better manage this complex and difficult to treat disease.
Noncontact Biventricular Mapping And Intramural Ablation In A Chronic Ovine Model Of Septal Ventricular Tachycardia
Funder
National Health and Medical Research Council
Funding Amount
$519,279.00
Summary
Ventricular tachycardia (VT), an abnormal rhythm originating from the bottom portion of the heart is the major cause of sudden death in the community. Medications are not reliably effective. Expensive (costing about $40,000 every 5 years) implanted defibrillators are very effective in terminating VT, but frequently require painful shocks. Patients who require frequent treatment from their defibrillators are considered for mapping and ablation. About half of the patients with VT have the arrhythm ....Ventricular tachycardia (VT), an abnormal rhythm originating from the bottom portion of the heart is the major cause of sudden death in the community. Medications are not reliably effective. Expensive (costing about $40,000 every 5 years) implanted defibrillators are very effective in terminating VT, but frequently require painful shocks. Patients who require frequent treatment from their defibrillators are considered for mapping and ablation. About half of the patients with VT have the arrhythmia originating from the septum (heart muscle separating the two bottom portions of the heart). This area of the heart is difficult to map from an electrical point of view. A new type of mapping system called the Ensite 3000 system enables acquisition of 3,300 virtual electrical signals from within a heart chamber using an electrode array that does not have to be in direct contact with the heart muscle surface. Our evaluation of the Ensite system in one chamber of the heart has found it to be very good in identifying areas of abnormal electrical activity. It is possible that simultaneous mapping from both sides of the septum using Ensite might be useful in mapping VT originating from the septum. Destruction of the abnormal area, once identified, is generally done using a catheter, but is limited by its ability to destroy targets deep in the heart tissue. We have designed and developed a catheter that is equipped with a needle at its tip that can create deeper lesions. In this study we will be evaluating mapping using the Ensite electrodes in both ventricles in a chronic sheep model with VT originating from the septum. The Ensite mapping will be validated with detailed contact (conventional) mapping. The prototype catheter will be used to destroy the site of origin of VT, once identified. This study should enable more effective treatment of patients with VT and improve their quality of life.Read moreRead less