Multi-system Monitoring for Identification of Seizures, Arrhythmias and Apnea in Conscious Restrained Rabbits
Summary
Using simultaneous video-EEG-ECG-oximetry-capnography, we developed a methodology to evaluate the susceptibility of rabbit models to develop provoked arrhythmias and seizures. This novel recording system establishes a platform to test the efficacy and safety of therapeutics and can capture the complex cascade of multi-system events that culminate in sudden death.
Abstract
Patients with ion channelopathies are at a high risk of developing seizures and fatal cardiac arrhythmias. There is a higher prevalence of heart disease and arrhythmias in people with epilepsy (i.e., epileptic heart.) Additionally, cardiac and autonomic disturbances have been reported surrounding seizures. 1:1,000 epilepsy patients/year die of sudden unexpected death in epilepsy (SUDEP). The mechanisms for SUDEP remain incompletely understood. Electroencephalograms (EEG) and electrocardiograms (ECG) are two techniques routinely used in the clinical setting to detect and study the substrates/triggers for seizures and arrhythmias. While many studies and descriptions of this methodology are in rodents, their cardiac electrical activity differs significantly from humans. This article provides a description of a non-invasive method for recording simultaneous video-EEG-ECG-oximetry-capnography in conscious rabbits. As cardiac electrical function is similar in rabbits and humans, rabbits provide an excellent model of translational diagnostic and therapeutic studies. In addition to outlining the methodology for data acquisition, we discuss the analytical approaches for examining neuro-cardiac electrical function and pathology in rabbits. This includes arrhythmia detection, spectral analysis of EEG and a seizure scale developed for restrained rabbits.
Introduction
Electrocardiography (ECG) is routinely used in the clinical setting to assess the dynamics of cardiac electrical conduction and the electrical activation-recovery process. ECG is important for detecting, localizing, and assessing the risk of arrhythmias, ischemia, and infarctions. Typically, electrodes are affixed to the patient's chest, arms, and legs in order to provide a three-dimensional view of the heart. A positive deflection is produced when the direction of myocardial depolarization is toward the electrode and a negative deflection is produced when the direction of myocardial depolarization is away from the electrode. Electrographic components of the cardiac cycle include atrial depolarization (P wave), atrial-ventricular conduction (P-R interval), ventricular excitation (QRS complex), and ventricular repolarization (T wave). There are great similarities in ECG and action potential measures across many mammals including humans, rabbits, dogs, guinea pigs, pigs, goats, and horses1,2,3.
Rabbits are an ideal model for cardiac translational research. The rabbit heart is similar to the human heart in terms of ion channel composition, and action potential properties2,4,5. Rabbits have been used for the generation of genetic, acquired, and drug-induced models of heart disease2,4,6,7,8. There are great similarities in the cardiac ECG and action potential response to drugs in humans and rabbits7,10,11.
The heart rate and cardiac electrical activation-recovery process is very different in rodents, as compared to rabbits, humans, and other larger mammals12,13,14. The rodent heart beats ~10 times as fast as humans. In contrast, to the iso-electric ST segment in human and rabbit ECGs, there is no ST segment in rodents14,15,16. Also, rodents have a QRS-r' waveform with an inverted T wave14,15,16. Measurements of the QT interval are very different in rodents vs. humans and rabbits14,15,16. Furthermore, normal ECG values are very different in humans vs. rodents12,15,16. These differences in the ECG waveforms can be attributed to differences in the action potential morphology and the ion channels that drive cardiac repolarization9,14. While the transient outward potassium current is the major repolarizing current in the short (non-dome) cardiac action potential morphology in rodents, in humans and rabbits there is a large phase-2 dome on the action potential, and the delayed rectifier potassium currents (IKr and IKs) are the major repolarizing currents in humans and rabbits4,9,13,17. Importantly, the expression of IKr and IKs is absent/minimal in rodents, and due to the temporal activation kinetics of IKr and IKs it does not have a role in the cardiac action potential morphology9,13. Thus, rabbits provide a more translational model for assessing the mechanisms for drug-induced, acquired, and inherited ECG abnormalities and arrhythmias4,7,13. Next, as numerous studies have shown the presence of both neuronal and cardiac electrical abnormalities in primary cardiac (Long QT Syndrome18,19,20) or neuronal diseases (epilepsy21,22,23,24), it is important to study the underlying mechanisms in an animal model that closely reproduces human physiology. While rodents may be sufficient to model the human brain, rodents are not an ideal model of human cardiac physiology7.
Electroencephalography (EEG) uses electrodes, usually placed on the scalp or intracranially, to record cortical electrical function. These electrodes can detect changes in the firing rate and synchronicity of groups of nearby pyramidal neurons in the cerebral cortex25. This information can be used to assess cerebral function and awake/sleep state. Also, EEGs are useful to localize epileptiform activity, and distinguish epileptic seizures from non-epileptic events (e.g., psychogenic non-epileptiform activity and cardiogenic events). In order to diagnose epilepsy type, provoking factors, and origin of the seizure, epilepsy patients are subjected to various maneuvers which may bring on a seizure. Various methods include hyperventilation, photic stimulation, and sleep deprivation. This protocol demonstrates the use of photic stimulation to induce EEG aberrations and seizures in rabbits26,27,28,29.
Simultaneous video-EEG-ECG recordings have been extensively used in humans and rodents to assess behavioral, neuronal, and cardiac activity during the pre-ictal, ictal, and post-ictal states30. While several studies have conducted EEG and ECG recordings separately in rabbits4,31,32,33, a system for acquiring and analyzing simultaneous video-EEG-ECG in the conscious restrained rabbit is not well established34. This paper describes the design and implementation of a protocol that can record simultaneous video-EEG-ECG -capnography-oximetry data in conscious rabbits in order to assess neuro-cardiac electrical and respiratory function. Results gathered from this method can indicate the susceptibility, triggers, dynamics and concordance between arrhythmias, seizures, respiratory disturbances, and physical manifestations. An advantage of our experimental system is that we acquire conscious recordings without the need of a sedative. The rabbits remain in the restrainers for ≥5 h, with minimal movement. As anesthetics perturb neuronal, cardiac, respiratory, and autonomic function, recordings during the conscious state provide the most physiological data.
This recording system may ultimately provide detailed insights to advance the understanding of the neurologic, cardiac and respiratory mechanisms for sudden unexpected death in epilepsy (SUDEP). In addition to neurologic and cardiac monitoring above, recent evidence has also supported the role of respiratory failure as a potential contribution to sudden death after a seizure35,36. To monitor the respiratory status of the rabbits, oximetry and capnography were implemented to evaluate the status of the respiratory system before, during and after a seizure. The protocol presented here was designed with the purpose of assessing the threshold for pharmacologically and photic-stimuli induced rabbit seizures. This protocol can detect subtle EEG and ECG abnormalities that may not result in physical manifestations. In addition, this method can be used for cardiac safety and anti-arrhythmic efficacy testing of novel drugs and devices.
Protocol
Representative Results
Discussion
This experimental setup facilitates detailed simultaneous video-EEG-ECG-oximetry-capnography recordings and analyses in rabbits, particularly in models of cardiac and/or neuronal diseases. The results of this article show that this method is capable of detecting seizures and arrhythmias and differentiating them from electrographic artifacts. Expected results were obtained when giving rabbits a proconvulsant, which induced seizures. The data obtained from the video-EEG recordings were able to be further analyzed to differ…
Divulgazioni
The authors have nothing to disclose.
Acknowledgements
Authors acknowledge this study was supported by grants from the American Heart Association, American Epilepsy Society, and SUNY Upstate Department of Pharmacology.
Materials
| 0.9% Sodium Chloride Irrigation, USP – Flexible Container | PFIZER (HOSPIRA) | 7983-09 | Dilutant |
| 10cc Luer Lock syringe with 20G x 1" Needle | Sur-Vet | SS-10L2025 | Used as a flush after drug injection |
| 4×4 gauze sponges | Fisher Scientific | 22-415-469 | Rolled in a tube to splint ear with angiocatheter |
| Apple Sauce | Kirkland | 897971 | Vehicle for oral medications |
| Computer | Dell | Optiplex 5040 | Acquisition computer |
| E-4031 | Tocris | 1808 | Agent known to prolong the QT interval |
| ECG Electrode | RhythmLink | RLSND116-2.5 | 13mm 35-degree bent (0.4 mm diameter) subdermal pin electrodes |
| EEG Electrode | RhythmLink | RLSP513 | 5-twist 13mm straight (0.4mm diameter) subdermal pin electrodes |
| EEGLAB (2020) | Swartz Center for Computational Neuroscience | Open Access | Can perform spectral analysis of EEG |
| Ethernet-to-ethernet adapter | Linksys | USB3G16 | Adapter for connecting the camera to the computer |
| Euthanasia-III Solution | Med-Pharmex | ANADA 200-280 | Contains pentobarbital sodium and phenytoin sodium, controlled substance |
| Foam padding | Generic | N/A | Reduces pressure applied to the neck of small rabbits by the restrainer in order to prevent the adverse cardiorespiratory effects of neck compression |
| Heparin Lock Flush | Medline | EMZ50051240 | To maintain patency of angiocatheter |
| IR Light | Bosch | EX12LED-3BD-8W | Facilitates recordings in the dark |
| LabChart Pro (2019, Version 8.1.16) | ADInstruments | N/A | ECG Analysis |
| JELCO PROTECTIV Safety I.V. Catheters, 25 gauge | Smiths Medical | 3060 | Used to catherize marginal ear vein |
| MATLAB (R2019b, Update 5) | MathWorks | N/A | Required to run EEGLAB |
| Microphone | Sony Stereo | ECM-D570P | Recording of audible manifestions of seizures |
| Micropore Medical Tape, Paper, White | 3M | 1530-1 | Used to secure wires and create ear splint |
| Natus NeuroWorks | Natus | LC101-8 | Acquisition and review software |
| Pentylenetetrazol (1 – 10 mg/kg always in 1mL volume) | Sigma-Aldrich | 88580 | Dilutions prepared in saline |
| Photic Stimulator | Grass | PS22 | Stimulator to control frequency, delay, duration, intensity of the light pulses |
| Plastic wire organizer / bundler | 12Vwire.com | LM-12-100-BLK | Bundle wires to cut down on noise |
| PS 22 Photic Stimulator | Grass Instruments | BZA641035 | Strobe light with adjustable flash frequency, delay, and intensity |
| PVC pipe | Generic | N/A | Prevents small rabbits from kicking their hind legs and causing spinal injury |
| Quantum Amplifier | Natus | 13926 | Amplifier / digitizer |
| Quantum HeadBox Amplifier | Natus | 22134 | 64-pin breakout box |
| Rabbit Restrainer | Plas-Labs | 501-TC | Various size rabbit restrainers are available. 6" x 18" x 6" in this study. |
| Rubber pad (booster) | Generic | N/A | Raises small rabbits up in the restrainer to prevent neck compression |
| SpO2 ear clip | NONIN | 61000 | PureSAT/SpO2 |
| SpO2 sensor adapter | NONIN | 13931 | XPOD PureSAT/SpO2 |
| SRG-X120 1080p PTZ Camera with HDMI, IP & 3G-SDI Output | Sony | SRG-X120 | Impela Camera |
| Terumo Sur-Vet Tuberculin Syringe 1cc 25G X 5/8" Regular Luer | Sur-Vet | 13882 | Used to inject intravenous medications |
| Veterinary Injection Plug Luer Lock | Sur-Vet | SRIP2V | Injection plug for inserting the needle for intravenous medication |
| Webcol Alcohol Prep, Sterile, Large, 2-ply | Covidien | 5110 | To prepare ear vein before catheterization |
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