Heart Rhythm Disease Program

The Heart Rhythm Disease Program in the Cardiovascular Research Center focuses on several areas related to cardiac arrhythmias.

Atrial fibrillation

Atrial fibrillation is a major focus of the Heart Rhythm Disease Program. Mayo Clinic led the Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial. This is a National Institutes of Health-funded study involving 131 international medical centers. Results from the CABANA study continue to provide novel insights into catheter ablation for atrial fibrillation and improving quality of life.

Our work includes:

  • Designing and testing novel catheter ablation methods for pulsed electric field ablation for paroxysmal atrial fibrillation.
  • Developing novel approaches to map and ablate persistent atrial fibrillation, combining novel prototype catheters, recurrent mapping and advanced data analysis techniques for a personalized approach.

Sudden cardiac death

Mayo Clinic is one of the major referral centers for the evaluation and treatment of people with genetic causes of sudden arrhythmia death. Research in the Heart Rhythm Disease Program focuses on the role of autonomic modulation in cardiac arrhythmias, including sudden cardiac death.

Sympathetic denervation has been successfully used to treat people at risk of sudden cardiac death, including those with long QT syndrome and catecholaminergic polymorphic ventricular tachycardia. Our researchers also are extending the use of this approach to treat ventricular tachycardia and ventricular fibrillation in people with ischemic and nonischemic cardiomyopathies.

Innovation in ventricular fibrillation

We have developed a large animal in vivo model to study ventricular fibrillation. These studies have provided novel insights into the natural history of ventricular fibrillation in large-scale models. This includes developing novel mapping and ablation catheters and studies of a novel means to characterize ventricular fibrillation activity and substrate to better understand and treat ventricular fibrillation.

Current investigations include mapping ventricular fibrillation while using hemodynamic support, such as cardiopulmonary bypass and extracorporeal membrane oxygenation (ECMO). Such studies are paving the way for innovative catheter development, advanced signal analysis mapping and novel means for catheter ablation using electroporation.

Artificial intelligence and augmented intelligence

Researchers in this program have achieved major breakthroughs in unleashing the power of the electrocardiogram (ECG). We're continuing efforts to expand ECG for early detection, disease monitoring and diagnosis.

Several avenues that have been pursued include the application of artificial intelligence (AI) approaches to the ECG for both interpretation and identification of patterns that can be used to screen for unrecognized conditions. This includes identifying people with atrial fibrillation from predictions based on sinus rhythm, identification of reduced left ventricular function or systolic heart failure, and detection of hypertrophic cardiomyopathy.

Our team has designed and executed several prospective, pragmatic and digitally enabled clinical trials to evaluate the use of AI-ECG in clinical practice. This effort has led to large-scale, real-world analysis of the comparative effectiveness of various cardiac interventions. This included assessment of information gathered from clinical trials such as CABANA into generalizable real-world practice.

Proton and photon beam for refractory ventricular tachycardia

The cardiac radioablation team at Mayo Clinic is a world leader in developing cutting-edge methods for the noninvasive, radiation-based treatment of refractory ventricular arrhythmias. This group is the product of fruitful multidisciplinary collaboration between the Division of Heart Rhythm Services and the Department of Radiation Oncology.

Our investigators conduct basic, translational and clinical research to study noninvasive ablation of ventricular tachycardia using photon-based and particle-based radiation.

Our group has extensive translational experience in cardiac radioablation. We demonstrated the feasibility of photon and particle radiation therapy to treat myocardial targets in large-scale models. Insights into the principles of cardiac radioablation, mechanisms of action at the cellular and tissue levels, and treatment planning and safety have led to the largest preclinical dataset of cardiac radioablation. Our research has been funded continuously through intramural and extramural grants. Results have been published in high-impact peer-reviewed journals.

Our group is continuing this innovative preclinical work with active projects in various domains of cardiac radioablation, including gated beam delivery to correct for cardiac and respiratory motion, AI-guided treatment planning and cardiac structure contouring, and methods to minimize nontarget tissue toxicity, among other work.

We also have launched the first-in-human phase 1 clinical trial of particle therapy of refractory ventricular tachycardia through an investigational device exception granted by the U.S. Food and Drug Administration (FDA).

Mayo Clinic also is participating in a large, pivotal, multicenter randomized trial to compare photon-based cardiac radioablation to repeat catheter ablation for refractory ventricular tachycardia after previous ablation.

Cardiac devices

Another major focus of the Heart Rhythm Disease Program is in the area of cardiac devices. These include pacemakers, implantable cardioverter-defibrillators and cardiac resynchronization therapy.