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Decoding Heart-Brain Talk to Prevent Sudden Cardiac Deaths

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Deeptankar DeMazundar in a white doctor's coat
Credit: Colleen Kelley/UC Creative + Brand

As a cardiac electrophysiologist, Deeptankar DeMazumder has worked for years with people at risk for sudden cardiac arrest (SCA). Despite the latest medical advances, less than 10 percent of individuals stricken with an SCA will survive this highly dangerous condition in which irregular heart rhythms, or arrhythmias, cause the heart suddenly to stop beating.

In his role as a physician, DeMazumder keeps a tight focus on the electrical activity in their hearts, doing his best to prevent this potentially fatal event. In his other role, as a scientist at the University of Cincinnati College of Medicine, DeMazumder is also driven by a life-saving aspiration: finding ways to identify at-risk individuals with much greater accuracy than currently possible—and to develop better ways of protecting them from SCAs. He recently received a 2020 NIH Director’s New Innovator Award to pursue one of his promising ideas.

SCAs happen without warning and can cause death within minutes. Poor heart function and abnormal heart rhythms are important risk factors, but it’s not possible today to predict reliably who will have an SCA. However, doctors already routinely capture a wealth of information in electrical signals from the heart using electrocardiograms (ECGs). They also frequently use electroencephalograms (EEGs) to capture electrical activity in the brain.

DeMazumder’s innovative leap is to look at these heart and brain signals jointly, as well as in new ways, during sleep. According to the physician-scientist, sleep is a good time to search for SCA signatures in the electrical crosstalk between the heart and the brain because many other aspects of brain activity quiet down. He also thinks it’s important to pay special attention to what happens to the body’s electrical signals during sleep because most sudden cardiac deaths happen early in the waking hours, for reasons that aren’t well understood.

He has promising preliminary evidence from both animal models and humans suggesting that signatures within heart and brain signals are unique predictors of sudden death, even in people who appear healthy [1]. DeMazumder has already begun developing a set of artificial intelligence algorithms for jointly deciphering waveform signals from the heart, brain, and other body signals [2,3]. These new algorithms associate the waveform signals with a wealth of information available in electronic health records to improve upon the algorithm’s ability to predict catastrophic illness.

DeMazumder credits his curiosity about what he calls the “art and science of healing” to his early childhood experiences and his family’s dedication to community service in India. It taught him to appreciate the human condition, and he has integrated this life-long awareness into his Western medical training and his growing interest in computer science.

For centuries, humans have talked about how true flourishing needs both head and heart. In DeMazumder’s view, science is just beginning to understand the central role of heart-brain conversations in our health. As he continues to capture and interpret these conversations through his NIH-supported work, he hopes to find ways to identify individuals who don’t appear to have serious heart disease but may nevertheless be at high risk for SCA. In the meantime, he will continue to do all he can for the patients in his care.

References:

[1] Mitochondrial ROS drive sudden cardiac death and chronic proteome remodeling in heart failure. Dey S, DeMazumder D, Sidor A, Foster DB, O’Rourke B. Circ Res. 2018;123(3):356-371.

[2] Entropy of cardiac repolarization predicts ventricular arrhythmias and mortality in patients receiving an implantable cardioverter-defibrillator for primary prevention of sudden death. DeMazumder D, Limpitikul WB, Dorante M, et al. Europace. 2016;18(12):1818-1828.

[3] Dynamic analysis of cardiac rhythms for discriminating atrial fibrillation from lethal ventricular arrhythmias. DeMazumder D, Lake DE, Cheng A, et al. Circ Arrhythm Electrophysiol. 2013;6(3):555-561.

Links:

Sudden Cardiac Arrest (National Heart, Lung, and Blood Institute/NIH)

Deeptankar DeMazumder (University of Cincinnati College of Medicine)

DeMazumder Project Information (NIH RePORTER)

NIH Director’s New Innovator Award (Common Fund)

NIH Support: National Heart, Lung, and Blood Institute; Common Fund

7 Comments

  • Zuccheri Gianni says:

    Interesting article by dr. DeMazumder who proposes a concrete preventive therapy, to which potentially all the so-called healthy (who ignore that they have a certain susceptibility to this fearful event) could potentially one day say thanks. In fact, we read an example of what is reported by various Authors
    “Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited arrhythmia syndrome characterized by adrenergically induced ventricular arrhythmias in patients with structurally normal hearts. Initiating triggered arrhythmias, such as bidirectional ventricular tachycardia, often degenerate into reentrant arrhythmias, such as ventricular fibrillation (VF)”
    Heart Rhythm. 2014 Jan;11(1):58-66. doi: 10.1016/j.hrthm.2013.10.027. Epub 2013 Oct 11.
    Outcomes of defibrillator therapy in catecholaminergic polymorphic ventricular tachycardia
    Ferran Roses-Noguer 1, Julian W E Jarman 1, Jonathan R Clague 1, Jan Till

    If a storm of catecholamines occurs in sleep or in conjunction with awakening, they will surprise the individual like a hurricane overlooking a placid beach of an archipelago: if we have two islands, one of them the Encephalus and the other the Heart, what will be the first to be overwhelmed? On brain activity (EEG), this peak (except in cases where it may for some reason give rise to an epileptic discharge) could be the precursor signal of an incipient similar cardiac event (ECG). This is also induced in parallel by Catecholamines, but with other and much more dramatic consequences (SCA).
    Maybe heralded nightmares (a sign that the brain was already invaded by this endogenous cytotoxic wave):
    who hasn’t experienced a night with impaired sleep from an indigestible dinner? If the microbiota plays a decisive role in the processing of some precursors, catecholamines may come from excessive production or absorption at the gastrointestinal level (think of precursors, as an example some toxins, scombroid toxin etc.).
    Other overproduction conditions would derive from endocrine sites where these catecholamines are normally produced. (adrenal glands, etc.) or in conjunction with an inadequate metabolic breakdown.
    Finally, will we consider tomorrow the activity of the electromagnetic field produced, both at the brain level, Magnetoencephalography (MEG) and cardiac Magnetocardiography (MCG), with more importance?
    You have already seen the prodigious effect of electromagnetic stimulation. transcranial TMS, we will perhaps one day be surprised how long we have been ignoring today regarding some sort of electromagnetic stimulation. Transcardiac which occurs daily in our surrounding technological environment, with more or less favorable repercussions on our ECG, or as in exceptional cases.
    I cite an example
    Multicenter Study J Emerg Med
    . 2012 Dec;43(6):970-5. doi: 10.1016/j.jemermed.2012.03.022. Epub 2012 Jun 5.
    Transcardiac conducted electrical weapon (TASER) probe deployments: incidence and outcomes
    William P Bozeman 1, Eric Teacher, James E Winslow

    • Tiffany richardson says:

      I have never been speechless when reading or researching my conditions that no one can figure out and I’ve been lucky 4 times that i didn’t die, thanks to my son. This is exactly what happens to me – sleeping and wake up unable to breathe, if something scares me or anything that gets me worked up and it goes from my brain to my entire body. I’m in the hospital with “possibly heart attack or seizures or ms relapse or anything at this point and no one knows what is wrong and I’m 42 and have lost 12 years of my life with my son who’s 14 because all they say is irregular heart rhythm or heart arrhythmias, but they don’t even tell me about these i find out when i read my reports so basically I’m being untreated for A serious medical condition and basically ignored. I need help because my son needs me and i have MS and seizures along with other medical issues but they still can’t find out why i am losing my memory and I’m like an elderly patient at 42

      • Zuccheri Gianni says:

        Being speechless to give an answer to a request for help: this is what a doctor generally fears most during his work.

        Dear Tiffany,
        I suppose the doctors are following your case adequately
        Even though I can’t find a concrete solution to what is happening to you, I still want one thing: express the sincere hope that you are better, that the medical solution you need will soon be found.
        In my work as a doctor, I have often not considered the effects of words on the patient’s health as important as how they are received: in reality they can be good or bad in the true physical sense.
        The mind with its mechanisms, conscious and unconscious, acts on our Neuro-Vegetative System, where HEART AND BRAIN MEET OR COLLIDE. This is what sometimes affects the path of healing.
        I didn’t think so when as a young doctor I paid more attention to the technical and scientific aspects in dialogue with patients, detached and sometimes even grumpy.
        But even the doctor finds himself one day living as a patient: then it becomes clear that the tablet given to you is less bitter if it is accompanied by a small smile. … And a regret comes over me: for too many years I have neglected it!

        A sincere greeting to all of you, especially to those who are suffering

  • Zuccheri Gianni says:

    Thanks to Dr. Collins who highlighted Dr. DeMazumder’s study, which investigates the bond involving electrophysiologically, Brain and Heart.

    We are usually led to think that only the brain is the thinking seat of the person; in reality it can be indicated that each cell through the tissue of which it is a part, which in turn, with other components, is part of organs and systems; that nothing is disconnected but everything is a UNICUM, thus giving rise to a whole set of signals, bioelectrical and biochemical communications, through hormones and other messengers, more or less distant from the emission and destination site. A universe in the body of each living being, in which communications, only in a small part, are translated into language encoded in verbal form, such as the one with which I am now writing.
    If we know that we have the brain that orders the hand to write, each muscle has its own bioelectric activity, which we measure with electromyography (EMG). This is translated on paper, conventionally derived, from instrumental analysis. But Nature with its mechanisms was born before our being doctors and our knowledge.
    The body speaks, chats and sometimes shouts to itself and within itself, through numerous neurormons, to be heard by its own Thinking Consciousness: often, due to our living in an environment and social conventions, it is ignored. Thus psychosomatic diseases (with various shades) afflict our health.
    Finally, with surprise we learn that the heart is also an organ that produces hormones, including oxytocin, with multiple effects, including affective ones.

    Infinite thanks to Dr. DeMazumder, for highlighting these Heart-Brain synergisms

    • Peggie says:

      “A universe in the body of each living being…” “The body speaks, chats and sometimes shouts to itself and within itself…” You write so poetically. Lovely.

      • Allison M J Brooks says:

        Peggie -I thought the very same as I was reading the words he chose as his form of enlightenment for others to understand ~

  • Zuccheri Gianni says:

    The great experience of still being here,
    the strong energy you take when you see the sun in the morning and feel the pleasant warmth on your face, is the …melody.
    The organism that wakes up enters into synchrony, by keeping all the functions of the neuro-hormonal system in the right work.

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