Systems and methods for assessing data collected from an electrically active cell culture
10969382 · 2021-04-06
Assignee
Inventors
- Stacie Ann Chvatal (Lawrenceville, GA, US)
- Daniel Christopher MILLARD (Atlanta, GA, US)
- James David Ross (Decatur, GA)
Cpc classification
A61B5/24
HUMAN NECESSITIES
H04L67/12
ELECTRICITY
International classification
Abstract
Disclosed herein are systems and methods for assessing electrically active cell cultures. Optionally, the data can be collected using a microelectrode array (MEA). For example, electrically active cells, such as cardiomyocytes, are cultured such that they are in electrical communication with at least a portion of the electrodes of a well of the MEA. The assessments derived from the disclosed methods may be used to reduce the effects of confounding variables in data obtained from an electrically active cell culture. The methods may also be used to determine a quantitative measure of arrhythmia burden. The methods may also be used to decide if a particular culture or set of data is suitable for inclusion in scientific and characterization studies. Also disclosed is a method of finding the global conduction velocity of an electrically active cell culture.
Claims
1. An electrophysiology culture system, comprising: a sensor configured to record a physiological signal from an electrically active cell culture; and an analyzer having a processor and a memory, the memory having computer-readable instructions stored thereon, wherein the processor is communicatively coupled with the sensor, the processor being configured to execute the computer-readable instructions that cause the processor to: receive the physiological signal recorded by the sensor, for each of at least two collections of beats, analyze the physiological signal to determine a respective beat period associated with the electrically active cell culture and identify one or more beats exhibiting a pro-arrhythmic indicator, wherein each of the at least two collections of beats has a distinct beat period, and wherein each of the at least two collections of beats is recorded from the electrically active cell culture under a same treatment condition, the same treatment condition being defined by at least a type and concentration of a pharmaceutical compound and an exposure time to the pharmaceutical compound, and determine a quantitative measure of arrhythmia burden using the respective beat period associated with the electrically active cell culture and the one or more beats exhibiting the pro-arrhythmic indicator for each of the at least two collections of beats.
2. The electrophysiology culture system of claim 1, wherein determining a quantitative measure of arrhythmia burden comprises determining a respective percentage of beats exhibiting the pro-arrhythmic indicator for each of the at least two collections of beats.
3. The electrophysiology culture system of claim 2, wherein the quantitative measure of arrhythmia burden comprises a specific beat period associated with the electrically active cell culture at which a predetermined percentage of beats exhibit the pro-arrhythmic indicator.
4. The electrophysiology culture system of claim 1, wherein the sensor comprises at least one electrode configured to deliver electrical stimulation to the electrically active cell culture, and wherein the processor is configured to execute further computer-readable instructions that cause the processor to control the respective beat period associated with the electrically active cell culture using electrical stimulation.
5. The electrophysiology culture system of claim 4, wherein the processor is configured to execute further computer-readable instructions that cause the processor to generate a curve that defines a relationship between the respective best period associated with the electrically active cell culture and a respective percentage of beats exhibiting the pro-arrhythmic indicator for each of the at least two collection of beats.
6. The electrophysiology culture system of claim 5, wherein the quantitative measure of arrhythmia burden comprises a characteristic of the curve.
7. The electrophysiology culture system of claim 1, further comprising at least one light-emitting element configured to deliver optogenetic stimulation to the electrically active cell culture, and wherein the processor is configured to execute further computer-readable instructions that cause the processor to control the respective beat period associated with the electrically active cell culture using optogenetic stimulation.
8. The electrophysiology culture system of claim 7, wherein the memory has further computer-readable instructions that, when executed by the processor, cause the processor to generate a curve that defines a relationship between the respective beat period associated with the electrically active cell culture and a respective percentage of beats exhibiting the pro-arrhythmic indicator for each of the at least two collection of beats.
9. The electrophysiology culture system of claim 8, wherein the quantitative measure of arrhythmia burden comprises a characteristic of the curve.
10. The electrophysiology culture system of claim 1, wherein the memory has further computer-readable instructions that, when executed by the processor, cause the processor to control the respective beat period associated with the electrically active cell culture to obtain the at least two collections of beats.
11. The electrophysiology culture system of claim 10, wherein receiving the physiological signal recorded by the sensor comprises receiving a first collection of beats having a first distinct beat period and receiving a second collection of beats having a second distinct beat period.
12. The electrophysiology culture system of claim 1, wherein the quantitative measure of arrhythmia burden is used to assess the safety of the pharmaceutical compound in contact with the electrically active cell culture.
13. The electrophysiology culture system of claim 1, wherein the physiological signal comprises at least one of a field potential signal, an impedance signal, an action potential signal, a calcium signal, or an optical signal.
14. The electrophysiology culture system of claim 1, wherein the pro-arrhythmic indicator comprises an early after depolarization (EAD) event.
15. The electrophysiology culture system of claim 1, wherein the electrically active cell culture is an in vitro cell culture.
16. A method for quantifying an arrhythmia burden, comprising: recording, using a sensor, a physiological signal from an electrically active cell culture; for each of at least two collections of beats, analyzing, using an analyzer, the physiological signal to determine a respective beat period associated with the electrically active cell culture and identify one or mom beats exhibiting a pro-arrhythmic indicator, wherein each of the at least two collections of beats has a distinct beat period, wherein each of the at least two collections of beats is recorded from the electrically active cell culture under a same treatment condition, the same treatment condition being defined by at least a type and concentration of a pharmaceutical compound and an exposure time to the pharmaceutical compound; and determining, using the analyzer, a quantitative measure of arrhythmia burden using the respective beat period associated with the electrically active cell culture and the one or more beats exhibiting the pro-arrhythmic indicator for each of the at least two collections of beats, wherein the analyzer has a processor and a memory, the memory having computer-readable instructions stored thereon, and wherein the processor is communicatively coupled with the sensor.
17. The method of claim 16, wherein determining a quantitative measure of arrhythmia burden comprises determining a respective percentage of beats exhibiting the pro-arrhythmic indicator for each of the at least two collections of beats.
18. The method of claim 17, wherein the quantitative measure of arrhythmia burden comprises a specific beat period associated with the electrically active cell culture at which a predetermined percentage of beats exhibit the pro-arrhythmic indicator.
19. The method of claim 16, further comprising controlling the respective beat period associated with the electrically active cell culture using at least one of electrical stimulation, optogenetic stimulation, or temperature.
20. The method of claim 19, further comprising generating a curve that defines a relationship between the respective beat period associated with the electrically active cell culture and a respective percentage of beats exhibiting the pro-arrhythmic indicator.
21. The method of claim 20, wherein the quantitative measure of arrhythmia burden comprises a characteristic of the curve.
22. The method of claim 19, further comprising: maintaining the respective beat period associated with the electrically active cell culture at a fixed beat period; and contacting the pharmaceutical compound with the electrically active cell culture, wherein the quantitative measure of arrhythmia burden further comprises a concentration of the pharmaceutical compound that induces a predetermined percentage of beats exhibiting the pro-arrhythmic indicator.
23. The method of claim 16, further comprising contacting the pharmaceutical compound with the electrically active cell culture.
24. The method of claim 23, further comprising assessing the safety of the pharmaceutical compound based on the quantitative measure of arrhythmia burden.
25. The method of claim 16, wherein the physiological signal comprises at least one of a field potential signal, an impedance signal, an action potential signal, a calcium signal, or an optical signal.
26. The method of claim 16, wherein the pro-arrhythmic indicator comprises an early after depolarization (EAD) event.
27. The method of claim 16, wherein the electrically active cell culture is an in vitro cell culture.
Description
DESCRIPTION OF DRAWINGS
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DETAILED DESCRIPTION
(32) The following description of certain examples of the inventive concepts should not be used to limit the scope of the claims. Other examples, features, aspects, embodiments, and advantages will become apparent to those skilled in the art from the following description, which is by way of illustration, one of the best modes contemplated for carrying out the inventive concepts. As will be realized, the device and/or methods are capable of other different and obvious aspects, all without departing from the spirit of the inventive concepts. For example, the disclosed methods can be applied to other technologies used to monitor electrically active cell cultures without departing from the spirit of the inventive concepts. Accordingly, the drawings and descriptions should be regarded as illustrative in nature and not restrictive.
(33) As used in the specification and the appended claims, the singular forms “a,” “an” and “the” include plural referents unless the context clearly dictates otherwise. Ranges may be expressed herein as from “about” one particular value, and/or to “about” another particular value. When such a range is expressed, another aspect includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent “about,” it will be understood that the particular value forms another aspect. It will be further understood that the endpoints of each of the ranges are significant both in relation to the other endpoint, and independently of the other endpoint.
(34) “Optional” or “optionally” means that the subsequently described event or circumstance may or may not occur, and that the description includes instances where said event or circumstance occurs and instances where it does not.
(35) Throughout the description and claims of this specification, the word “comprise” and variations of the word, such as “comprising” and “comprises,” means “including but not limited to,” and is not intended to exclude, for example, other additives, components, integers or steps. “Exemplary” means “an example of” and is not intended to convey an indication of a preferred or ideal aspect. “Such as” is not used in a restrictive sense, but for explanatory purposes.
(36) Disclosed herein are methods of collecting data from an electrically active cell culture using a microelectrode array (MEA). Generally, an MEA is comprised of one or more wells, each well further comprising a plurality of electrodes.
(37) The data from the electrically active cell culture obtained using a microelectrode array (MEA) can be used to determine parameters that assist in making assessments of the electrically active cell culture. Electrically active cells, such as cardiomyocytes, are cultured such that they are in electrical communication with at least a portion of the electrodes in a well of the MEA. The assessments derived from the disclosed methods can be used to reduce the effects of confounding variables in data obtained from an electrically active cell culture. The methods can also be used to decide if a particular culture is suitable for inclusion in scientific and characterization studies. Also disclosed is a method of finding the global conduction velocity of an electrically active cell culture.
(38) Cardiomyocytes or cardiomyocyte-like cells can be derived from primary tissue harvests, from cell lines, from stem cells, or from cellular reprogramming protocols. The term “cardiomyocyte-like” is used to describe cells that have certain aspects in common with cardiomyocytes present in actual heart tissue. For example, like cardiomyocytes, cardiomyocyte-like cells can beat and transmit electrical signals to neighboring cells via gap junctions. The methods described herein use the term cardiomyocyte. However, the methods can be also performed using cardiomyocyte-like cell cultures or other electrically active cell cultures.
(39)
(40) Referring back to
(41) The beat timestamp is measured for each beat on each electrode in the array 20. Beats detected on individual electrodes 22 can be grouped into well-wide beats, based on the timestamp registered by each electrode. A single well-wide beat is expected to manifest as a single depolarization spike occurring on each electrode in very close proximity in time (for
(42) TABLE-US-00001 TABLE 1 Column Row 1 2 3 4 5 6 7 8 8 3.6327 3.6964 3.78702 4.18841 4.37583 4.67548 5.17479 5.66754 7 NaN 2.9467 3.11522 3.30799 3.64539 NaN 4.53261 5.05423 6 2.35768 2.20678 2.42413 2.54364 2.94875 3.33247 NaN 4.55266 5 1.62226 1.53979 1.66882 2.00895 2.2531 2.79953 3.24352 4.08216 4 0.85232 0.83772 1.08154 1.32714 1.92559 2.50316 2.99534 3.72355 3 0.32801 0.33066 0.56054 1.00057 1.56233 2.37925 2.75342 3.37616 2 0 0.32583 0.39601 0.89373 1.34638 2.02139 2.58265 3.32552 1 0.32329 0.36746 0.43794 0.70659 1.19332 1.93906 2.52624 3.24036
example, within 30 ms).
t.sub.di=t.sub.i−t.sub.0
(43) The velocity at which a beat propagates through the cellular network, or the conduction velocity, is a useful parameter for assessing a cardiomyocyte culture. However, the conduction velocity can vary depending upon the location within the cell culture, and thus it is another example of a parameter that is subject to spatial variability. A data array of delay times, such as the one shown in Table 1, can be used to calculate a global conduction velocity (GCV) that is representative for the entire cell culture. The data array can be presented, for example, as a scatter plot, as shown in
(44)
The reciprocal of the slope of this line is the global conduction velocity, reported in distance/time.
(45) As shown in
(46) The GCV method can be useful for detecting changes induced by adding compounds to a cardiomyocyte culture. For example, flecainide is an exemplary compound known to slow beat conduction velocity by blocking sodium channels within the cardiomyocyte network.
(47) Cardiomyocyte cultures can be used to evaluate the safety risk of a candidate compound before the compound is advanced to human clinical trials. Growing cells on an MEA 20 allows baseline measurements of the field potential 7 to be made. These measurements can be used to assess parameters relating to the cellular health, function, and quality level of the culture. The parameters can include, for example, the amplitude 18 or maximum slope 8 of the depolarization spike, the beat period, the field potential duration 12, the global conduction velocity, or others. The measurements can then be repeated after the candidate compound has been exposed to the cellular network for a pre-determined amount of time. The degree to which any of the measurements changes upon addition of the candidate compound can inform the safety risk of the compound. These measurements can also be used to develop and characterize new stem cell lines, to compare the electrophysiology of cultured cardiomyocytes to in vivo cardiomyocytes, and/or to evaluate in vitro models of disease.
(48) Disclosed herein are methods of filtering data obtained from electrically active cell cultures, such as cardiomyocyte cultures. The methods of filtering data can include gauging a quality level of the cell culture based on one or more parameters. The assessment of a cardiac cell culture may be more accurate if it is made using only cultures that are high quality, reliable, and healthy at baseline. Accuracy can be further improved by taking measurements across many individual beats. A threshold requirement can be defined that states 1) if a particular cardiomyocyte network should be included in an evaluation of the compound, and 2) which collection of individual beats should be used to make the measurements from that particular cardiomyocyte culture. Data and parameters determined from the data can be compared to the threshold requirement to determine if the data should be included in further analyses and/or scientific and characterization studies.
(49) Parameters that can be used in the methods of filtering data and assessing a quality level of a culture can include but are not limited to: cell density, an ion channel distribution, arrhythmogenic behaviors, early after depolarization events, cell viability, number of pacemaker regions, distribution of pacemaker regions, pacemaker region activation frequency and timing, areas of conduction block, quality of attachment to a cell culture substrate, quality of contact with the electrodes, conduction velocity, global conduction velocity, field potential duration, repolarization morphology, amplitude of the field potential signal, slope of the field potential signal, beat period, variability in beat period, and beat propagation patterns of the electrically active cell culture based on the data collected.
(50) In one example of the method of filtering data, determining which wells and/or beats will be included in further scientific and characterization studies is a four-step process. A flow chart of the exemplary, four-step method of filtering data and assessing a quality level of a culture is shown in
(51) Methods of filtering data from inclusion in scientific and characterization studies can consider the spatial stability of one or more parameters. As described above, the timestamp of the beat detected by each electrode 22 can be used to generate a delay map illustrating the spatial pattern of beat propagation across a culture in a well of the MEA 20. In healthy cultures, the beat begins in one portion of the culture and propagates uniformly through the rest of the culture. This manifests in a delay map that indicates a single beat origin location and a smooth gradient of time delays through the rest of the array, as seen in
(52) Irregular propagation patterns, such as those seen in
(53) A culture can also have multiple pacemaker regions, resulting in action potentials propagating through the culture in two different directions simultaneously. This can result in a collision of the beats at particular regions of the culture, which manifests in the propagation delay maps as non-uniform beat propagation as seen in
(54) A single cardiomyocyte culture can present different propagation patterns at different times. This can be the result of, for example, changes in the syncytium as the culture develops over time, the existence of multiple pacemaking sites, or the addition of a compound affecting propagation. These varying propagation patterns can have different conduction velocities. An example of this phenomenon is shown in
(55) Temporal stability of various parameters can also be considered when performing the methods of filtering data and gauging the quality level of an electrically active cell culture. For example, the beat period is the time difference between two consecutive beats. A healthy culture will exhibit low variability in beat period from beat to beat. However, spontaneous changes in beat period can occur. An example of this is shown in
(56) In some implementations of the methods, a measure of stability, S, can be defined as the standard deviation of a parameter (for example, the beat period) over a collection of N beats ψ. A lower value of S indicates greater stability, given by the following equation:
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The most stable set of N beats, ω.sub.stable, is chosen by minimizing the stability metric S:
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If the beat periods are unstable throughout the entire measurement period for a baseline condition, the well can be excluded from further participation in the study.
(59) An unhealthy, low quality culture, or a culture that has been exposed to a dangerous compound, may exhibit irregular beating. Irregular beat periods induced by addition of a compound may be an indication of the compound being pro-arrhythmic, which is an important determination in cardiac drug safety testing. Arrhythmias can present in different forms within the culture, but in all cases a measurement of the temporal stability over a collection of beats, as described above, can be used to detect the arrhythmic activity.
(60) A specific arrhythmic pattern can further indicate the presence of an early afterdepolarization (EAD) event, which is another important pro-arrhythmic indicator. Other pro-arrhythmic indicators can include ectopic beats, triggered activity, “rolling” EADs, or repolarization instability. For example, as shown in
(61) Detection of EADs can be automated by detecting regions of beat period “bi-stability” within the time frame of measurement. A period of “bi-stability” is characterized by a rapid switching of the beat period between two different values, as is illustrated in
(62) Temporal and spatial stability can be altered, and in some cases improved, by electrically pacing or electrically stimulating the culture. To pace a cardiomyocyte culture plated on an MEA 20, electrical current is applied to the culture via one or more of the microelectrodes 22. This current triggers a well-wide beat in the culture. Electrical stimulation can be applied at 1 Hz, for example, so that the culture beats reliably at 1 Hz. As seen in
(63) As will be appreciated by one skilled in the art, at least portions of the methods and systems can take the form of a computer program product on a computer-readable storage medium having computer-readable program instructions (e.g., computer software) embodied in the storage medium. Any suitable computer-readable storage medium can be utilized including hard disks, CD-ROMs, optical storage devices, or magnetic storage devices.
(64) These computer program instructions can also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including computer-readable instructions for implementing the function specified in the flowchart block or blocks. The computer program instructions can also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational steps to be performed on the computer or other programmable apparatus to produce a computer-implemented process such that the instructions that execute on the computer or other programmable apparatus provide steps for implementing the functions specified in the flowchart block or blocks.
(65) Accordingly, blocks of the block diagrams and flowchart illustrations support combinations of means for performing the specified functions, combinations of steps for performing the specified functions and program instruction means for performing the specified functions. It will also be understood that each block of the block diagrams and flowchart illustrations, and combinations of blocks in the block diagrams and flowchart illustrations, can be implemented by special purpose hardware-based computer systems that perform the specified functions or steps, or combinations of special purpose hardware and computer instructions.
(66)
(67) As described above, arrhythmia analysis according to conventional techniques consists of identifying, in a binary sense, whether an arrhythmic event has or has not occurred during a defined analysis time window. Additionally, recent studies (e.g., Guo, L. et al. and Gilchrist, K. H. et al.) have aimed to provide an analog, or graded, quantification of the arrhythmia burden induced by a test compound. However, these recent studies have not involved assigning quantitative arrhythmic risk scores based on a relationship between beat period (or beat rate) associated with an electroactive cell culture and arrhythmic indicators or events. As described below, beat period (or beat rate, which is the inverse of beat period) can be adjusted or controlled by pacing the electroactive cell culture, and pro-arrhythmic indicators can be automatically identified and counted at each of a plurality of beat periods. Additionally, a quantitative measure of arrhythmia burden can be assigned based on the relationship between beat period and pro-arrhythmic indicators.
(68) Referring now to
(69) According to implementations described herein, the relationship between beating rate and arrhythmia burden can be measured and analyzed. Additionally, by pacing the activity of the electrically active cell culture at a plurality of frequencies following drug or compound addition, the arrhythmia burden can be determined at each of the plurality of frequencies. The relationship between beat period and arrhythmic burden can then be plotted as shown in
(70) Alternatively or additionally, the quantitative measure of arrhythmia burden can be obtained from the curve defining the relationship between beat period and arrhythmic burden (e.g.,
(71) According to one embodiment, electronics 108 can include one or more hardware components such as a central processing unit (CPU) or microprocessor 811, a random access memory (RAM) module 812, a read-only memory (ROM) module 813, a memory or data storage module 814, a database 815, one or more input/output (I/O) devices 816, and an interface 817. Alternatively and/or additionally, electronics 108 can include one or more software media components such as a computer-readable medium including computer-executable instructions for performing methods consistent with certain disclosed embodiments. It is contemplated that one or more of the hardware components listed above can be implemented using software. For example, storage 814 can include a software partition associated with one or more other hardware components of control and monitoring system 800. Electronics 108 can include additional, fewer, and/or different components than those listed above. It is understood that the components listed above are exemplary only and not intended to be limiting.
(72) CPU 811 can include one or more processors, each configured to execute instructions and process data to perform one or more functions associated with electronics 108. As illustrated in
(73) RAM 812 and ROM 813 can each include one or more devices for storing information associated with an operation of electronics 108 and/or CPU 811. For example, ROM 813 can include a memory device configured to access and store information associated with control and monitoring system 800, including, for example, stimulation schemes for different types of experiments. RAM 812 can include a memory device for storing data associated with one or more operations of CPU 811. For example, ROM 303 can load instructions into RAM 302 for execution by CPU 811.
(74) Storage 814 can include any type of mass storage device configured to store information that CPU 811 can need to perform processes consistent with the disclosed embodiments. For example, storage 814 can include one or more magnetic and/or optical disk devices, such as hard drives, CD-ROMs, DVD-ROMs, or any other type of mass media device. Alternatively or additionally, storage 814 can include flash memory mass media storage or other semiconductor-based storage medium. Database 815 can include one or more software and/or hardware components that cooperate to store, organize, sort, filter, and/or arrange data used by electronics 108 and/or CPU 811.
(75) I/O devices 816 can include one or more components configured to communicate information with a component or user associated with electronics 108. For example, I/O devices 816 can include a console with an integrated keyboard and mouse to allow a user to input parameters associated with electronics 108. I/O devices 816 can also include a display including a graphical user interface (GUI) for providing a network management console for network administrators to configure electronics 108. I/O devices 816 can also include peripheral devices such as a printer for printing information associated with electronics 108, a user-accessible disk drive (e.g., a USB port, a floppy, CD-ROM, or DVD-ROM drive, etc.) to allow a user to input data stored on a portable media device, a microphone, a speaker system, or any other suitable type of interface device. I/O devices can be configured to output network analysis results and traffic characteristics.
(76) Interface 817 can include one or more components configured to transmit and receive data via a communication network, such as the Internet, a local area network, a workstation peer-to-peer network, a direct link network, a wireless network, MEA 20, or any other suitable communication platform. For example, interface 817 can include one or more modulators, demodulators, multiplexers, demultiplexers, network communication devices, wireless devices, antennas, modems, and any other type of device configured to enable data communication via a communication network. According to one embodiment, interface 817 can be coupled to or include wireless communication devices, such as a module or modules configured to transmit information wirelessly using Wi-Fi or Bluetooth wireless protocols.
(77) Unless otherwise expressly stated, it is in no way intended that any method set forth herein be construed as requiring that its steps be performed in a specific order. Accordingly, where a method claim does not actually recite an order to be followed by its steps or it is not otherwise specifically stated in the claims or descriptions that the steps are to be limited to a specific order, it is no way intended that an order be inferred, in any respect. This holds for any possible non-express basis for interpretation, including: matters of logic with respect to arrangement of steps or operational flow; plain meaning derived from grammatical organization or punctuation; the number or type of embodiments described in the specification.
(78) It should be appreciated that the logical operations described herein with respect to the various figures may be implemented (1) as a sequence of computer implemented acts or program modules (i.e., software) running on a computing device (e.g., the computing device described in
(79) Referring now to
(80) As described herein, the quantitative measure of arrhythmia burden can be a relationship between the beat period associated with the electrically active cell culture and the pro-arrhythmic indicator. For example, the quantitative measure of arrhythmia burden can be a measure of beats exhibiting a pro-arrhythmic indicator (or other arrhythmic indicator). For example, the quantitative measure of arrhythmia burden can be a specific beat period (or beat rate) associated with the electrically active cell culture at which a predetermined percentage of beats exhibit the pro-arrhythmic indicator such as EAD 50 or EAD 20. Alternatively or additionally, the quantitative measure of arrhythmia burden can be based on a curve that defines the relationship between the beat period associated with the electrically active cell culture and the percentage of beats exhibiting the pro-arrhythmic indicator (e.g.,
(81) Referring now to
(82) Referring now to
(83) Referring now to
(84) Throughout this application, various publications are referenced. The disclosures of these publications in their entireties are hereby incorporated by reference into this application in order to more fully describe the state of the art to which the methods and systems pertain.
(85) It will be apparent to those skilled in the art that various modifications and variations can be made without departing from the scope or spirit. Other embodiments will be apparent to those skilled in the art from consideration of the specification and practice disclosed herein. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit being indicated by the following claims.