Contact Information:

Principal Investigator: Henry R. Halperin, MD, MA

Laboratory Manager: Sarah Fink, MS

Laboratory Location:

Traylor 901-905
The Johns Hopkins Hospital

Research Focus:

One focus in on the applications of advanced imaging techniques for arrhythmia management. The primary limitation of current fluoroscopy guided techniques for ablation of cardiac arrhythmia is the inability to visualize soft tissues and complex 3-dimensional anatomic relationships, which is likely a major reason for the 30-50% recurrence of arrhythmia after many complex ablations. Implementation of alternative advanced modalities has the potential to improve complex ablation procedures by guiding catheter placement, visualizing abnormal scar tissue, determining what tissues is completely ablated, reducing procedural time devoted to mapping, and eliminating patient and operator exposure to radiation.  

A second focus in on studying the pathophysiology and therapy of cardiac arrest. There are over 500,000 cardiac arrests in the United States each year, and the current survival rate for out of hospital cardiac arrest is around 10%.                

Active Projects:

• Successful ablation sites in ischemic ventricular tachycardia in a porcine model and the correlation to Magnetic Resonance Imaging
• Imaging of ablation lesions to determine if the tissue that has received ablated energy is necrotic or still potentially viable
• Magnetic resonance imaging guided radiofrequency ablation of canine atrial fibrillation
• MR-guided diagnosis and intervention for arrhythmias
• Physiological and metabolic effects of interruptions in chest compressions during cardiopulmonary resuscitation
• Pathophysiology and therapy of pulseless electrical activity

Engineers

• Eric Meyer, MS
• Hassan Elahi, MSEE

Laboratory Collaborators:

• Dr. Ronald D. Berger
• Dr. Gordon F. Tomaselli
• Dr. Hugh Calkins

Selected Bibliography:

1. Halperin H, Tsitlik J, Guerci A, Mellits ED, Levin H, Shi AY, Chandra N, Weisfeldt ML: The determinants of blood flow to vital organs during cardiopulmonary resuscitation in dogs. Circulation 73 (3): 539 550, 1986

2. Halperin H, Weiss JL, Guerci A, Chandra N, Tsitlik J, Brower R, Beattie C, Wurmb E, Weisfeldt ML: Cyclic elevation of intrathoracic pressure can close the mitral valve during cardiac arrest. Circulation 78(3): 754 760, 1988

3. Halperin H, Brower R, Weisfeldt ML, Tsitlik J, Chandra N, Cristiano L, Fessler H, Beyar R, Wurmb E, Guerci A: Air trapping in the lungs during cardiopulmonary resuscitation in dogs: A mechanism for generating changes in intrathoracic pressure. Circulation Research 65(4): 946 954, 1989

4. Beyar R, Halperin H, Chandra N, Guerci A, Sideman S, Dinar U, Tsitlik J: Manipulation of external pressure as a method to assist the failing heart. IEEE Trans Biomed Eng. 37(2): 197 203, 1990

5. Chandra N, Beyar R, Halperin H, Tsitlik J, Wurmb E, Rayburn B, Guerci A, Weisfeldt ML: Vital organ perfusion during non invasive assisted circulation with intrathoracic pressure. Circulation. 84(1): 279-286, 1991

6. Halperin H, Tsitlik J, Gelfand M, Weisfeldt M, Gruben K, Levin H, Rayburn B, Chandra N, Scott C, Kreps B, Siu C, Guerci A: A preliminary study of cardiopulmonary resuscitation by circumferential compression of the chest with the use of a pneumatic vest. NEJM. 329(11): 762-768, 1993 (Abstracted in Year Book of Anesthesia and Pain Management. Mosby-Year Book, Chicago, Ill, 1994)

7. Chandra N, Halperin H, Gruben K, Tsitlik J: Observations of ventilation during  resuscitation in a canine model. Circulation. 90: 3070-3075, 1994

8. Leng C, Paradis N, Calkins H, Berger R, Halperin H. Resusitation after prolonged ventricular fibrillation with monophasic versus biphasic waveform external defibrillation. Circulation. 2000; 101(25): 2968-74

9. Lardo A, McVeigh E, Yeung C, Jumrussirikul P, Atalar E, Berger R, Calkins H, Halperin H: Magnetic resonance guided radiofrequency ablation: Visualization and temporal characterization of thermal lesions. (Young Investigator Award Finalist, NASPE Scientific Sessions, 1999). Circulation. 2000; 102(6): 698-705

10. Susil R, Yeung C, Lardo A, Halperin H, Atalar E: Multifunctional interventional devices for MRI: A combined electrophysiologic/ MR imaging catheter. Magnetic Resonance in Medicine. 2002; 47(3):584-600.

11. Kato R, Lickfett L, Meininger G, Dickfeld T, Wu R, Juang G, Angkeow P, LaCorte J, Bluemke D, Berger R, Halperin HR, Calkins H: Pulmonary vein anatomy in patients undergoing catheter ablation of atrial fibrillation: lessons learned by use of magnetic resonance imaging. Circulation 2003 Apr 22;107(15):2004-10

12. Roguin A, Bomma CS, Nasir K, Tandri H, Tichnell C, James C, Rutberg J, Crosson J, Spevak PJ, Berger RD, Halperin HR, Calkins H. Implantable cardioverter-defibrillators in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy. J Am Coll Cardiol. 2004 May 19;43(10):1843-52.

13. Roguin A, Zviman M, Meininger G, Rodriguez ER, Dickfeld T, Bluemke D, Lardo A, Berger R, Calkins H, Halperin H: Modern pacemaker and implantable cardioverter-defibrillator systems can be MRI safe: In-vitro and in-vivo assessment of safety and function at 1.5-Tesla. Circulation. 2004 Aug 3;110(5):475-82.

14. Dickfeld T, Calkins H, Zviman M, Meininger G, Lickfett L, Roguin A, Lardo AC, Berger R, Halperin H, Solomon SB. Stereotactic magnetic resonance guidance for anatomically targeted ablations of the fossa ovalis and the left atrium. J Interv Card Electrophysiol. 2004 Oct;11(2):105-15.

15. Zviman M, Roguin A, Jacobs A, Rent K, Lardo A, Halperin H: A new method for inducing hypothermia during cardiac arrest. Crit Care Med. 2004 32(9): S369-S373

16. Halperin H, Paradis N, Ornato J, Zviman M, LaCorte J, Lardo A, Kern K: Cardiopulmonary resuscitation with a novel chest compression device in a porcine model of cardiac arrest: Improved hemodynamics and mechanisms. J Am Coll Cardiol. 2004 Dec 7;44(11):2214-20.

17. Nazarian S, Bluemke DA, Lardo AC, Zviman MM, Watkins SP, Dickfeld TL, Meininger GR, Roguin A, Calkins H, Tomaselli GF, Weiss RG, Berger RD, Lima JA, Halperin HR. Magnetic resonance assessment of the substrate for inducible ventricular tachycardia in nonischemic cardiomyopathy. Circulation. 2005;112:2821-5.

18. Nazarian S, Knight BP, Dickfeld TL, Zviman MM, Jayanti VB, Amundson D, Hanlin J, Castleberry J, Smith MF, Blankenship L, Halperin HR, Ferguson TB, Jr., Berger RD. Direct visualization of coronary sinus ostium and branches with a flexible steerable fiberoptic infrared endoscope. Heart Rhythm. 2005;2:844-8.

19. Roguin A, Zviman MM, Halperin HR. Re.: Complete loss of ICD programmability after magnetic resonance imaging. Pacing Clin Electrophysiol. 2005;28:354; author reply 354-5.

20. Dickfeld T, Kato R, Zviman M, Lai S, Meininger G, Lardo AC, Roguin A, Blumke D, Berger R, Calkins H, Halperin H. Characterization of radiofrequency ablation lesions with gadolinium-enhanced cardiovascular magnetic resonance imaging. J Am Coll Cardiol. 2006;47:370-8.

21. Lardo AC, Cordeiro MA, Silva C, Amado LC, George RT, Saliaris AP, Schuleri KH, Fernandes VR, Zviman M, Nazarian S, Halperin HR, Wu KC, Hare JM, Lima JA. Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction: characterization of myocyte death, microvascular obstruction, and chronic scar. Circulation. 2006;113:394-404

22. Nazarian S, Roguin A, Zviman M, Lardo A, Dickfeld T, Calkins H , Berger R,  Bluemke D, Halperin H: Clinical Utility and Safety of a Protocol for Non-Cardiac and Cardiac Magnetic Resonance Imaging of Patients with Permanent Pacemakers and Implantable Cardioverter Defibrillators at 1.5 Tesla. Circulation. 2006;114(12):1277-84. Epub 2006

23. Dickfeld T, Kato R, Zviman M, Nazarian S, Dong J, Ashikaga H, Lardo AC, Berger RD, Calkins H, Halperin H. Characterization of acute and subacute radiofrequency ablation lesions with nonenhanced magnetic resonance imaging. Heart Rhythm. 2007 Feb;4(2):208-14. Epub 2006 Nov 1.

24. Ashikaga H, Sasano T, Dong J, Zviman MM, Evers R, Hopenfeld B, Castro V, Helm RH, Dickfeld T, Nazarian S, Donahue JK, Berger RD, Calkins H, Abraham MR, Marban E, Lardo AC, McVeigh ER, Halperin HR:  Magnetic Resonance Based Anatomical Analysis of Scar-Related Ventricular Tachycardia. Implications for Catheter Ablation. Circ Res. 2007; Oct 26;101(9):939-47. Epub 2007 Oct 4.

25. Berger RD, Palazzolo J, Halperin H. Rhythm discrimination during uninterrupted CPR using motion artifact reduction system. Resuscitation. 2007 Oct;75(1):145-52. Epub 2007 Apr 30.

26. Tandri H, Zviman MM, Wedan SR, Lloyd T, Berger RD, Halperin H. Determinants of gradient field-induced current in a pacemaker lead system in a magnetic resonance imaging environment. Heart Rhythm. 2008 Mar;5(3):462-8. Epub 2007 Dec 27.

27. Nazarian S, Kolandaivelu A, Zviman MM, Meininger G, Kato R, Susil R, Roguin A, Dickfeld T, Ashikaga H, Calkins H, Berger RD, Bluemke D, Lardo A, Halperin HR: Feasibility of real-time magnetic resonance imaging for catheter guidance in electrophysiology studies. Circulation. 2008 Jul 15;118(3):223-9. Epub 2008 Jun 23.

28. Nazarian S, Kantsevoy SV, Zviman MM, Matsen FA 3rd, Calkins H, Berger RD, Halperin HR: Feasibility of endoscopic guidance for nonsurgical transthoracic atrial and ventricular epicardial ablation. Heart Rhythm. 2008 Aug;5(8):1115-9. Epub 2008 May 9.

29. Yannopoulos D, Zviman M, Castro V, Kolandaivelu A, Ranjan R, Wilson RF, Halperin HR: Intra-cardiopulmonary resuscitation hypothermia with and without volume loading in an ischemic model of cardiac arrest. Circulation. 2009 Oct 6;120(14):1426-35. Epub 2009 Sep 21.

30. Halperin HR, Lee K, Zviman M, Illindala U, Lardo A, Kolandaivelu A, Paradis NA: Outcomes from low versus high-flow cardiopulmonary resuscitation in a swine model of cardiac arrest. Am J Emerg Med. 2010 Feb;28(2):195-202.

31. Nazarian S, Bluemke DA, Wagner KR, Zviman MM, Turkbey E, Caffo BS, Shehata M, Edwards D, Butcher B, Calkins H, Berger RD, Halperin HR, Tomaselli GF. QRS prolongation in myotonic muscular dystrophy and diffuse fibrosis on cardiac magnetic resonance. Magn Reson Med. 2010;64(1):107-114.

32. Kolandaivelu A, Zviman MM, Castro V, Lardo AC, Berger RD, Halperin HR. Noninvasive assessment of tissue heating during cardiac radiofrequency ablation using MRI thermography. Circ Arrhythm Electrophysiol. 2010;3(5):521-529

33. Yannopoulos D, Matsuura T, Schultz J, Rudser K, Halperin HR, Lurie KG. Sodium nitroprusside enhanced cardiopulmonary resuscitation improves survival with good neurological function in a porcine model of prolonged cardiac arrest. Crit Care Med. 2011;39(6):1269-1274.

34. Ranjan R, Kato R, Zviman MM, Dickfeld TM, Roguin A, Berger RD, Tomaselli GF, Halperin HR. Gaps in the ablation line as a potential cause of recovery from electrical isolation and their visualization using MRI. Circ Arrhythm Electrophysiol. 2011;4(3):279-286.

35. Estner HL, Zviman MM, Herzka D, Miller F, Castro V, Nazarian S, Ashikaga H, Dori Y, Berger RD, Calkins H, Lardo AC, Halperin HR. The Critical Isthmus Sites of Ischemic Ventricular Tachycardia are in Zones of Tissue Heterogeneity, Visualized by Magnetic Resonance Imaging. Heart Rhythm. 2011. Dec;8(12):1942-9. Epub 2011 Jul 26.

36. Nazarian S, Hansford R, Roguin A, Goldsher D, Zviman MM, Lardo AC, Caffo BS, Frick KD, Kraut MA, Kamel IR, Calkins H, Berger RD, Bluemke DA, Halperin HR. A prospective evaluation of a protocol for Magnetic Resonance Imaging of patients with implanted cardiac devices. Ann Intern Med. 2011;155(7):415-424.

37. Kolandaivelu A, Jayanti V, Halperin H, Berger R: Switchable Faraday Shielding with Application to Reducing the Pain of Internal Cardiac Defibrillation while Permitting External Defibrillation. IEEE Trans Biomed Eng. 2012;59(2):409-16. Epub 2011 Oct 26

38. Paradis NA, Halperin H, Zviman M, Barash D, Quan W, Freeman G: Coronary perfusion pressure during external chest compression in pseudo-EMD, comparison of systolic versus diastolic synchronization. Resuscitation. 2012;83(10):1287-91. Epub 2012 Feb 23. (PMID: 22366351)

39. Ashikaga H, Arevalo H, Vadakkumpadan F, Blake RC, 3rd, Bayer JD, Nazarian S, Muz Zviman M, Tandri H, Berger RD, Calkins H, Herzka DA, Trayanova NA, Halperin HR. Feasibility of image-based simulation to estimate ablation target in human ventricular arrhythmia. Heart rhythm : the official journal of the Heart Rhythm Society. 2013  Aug;10(8):1109-16. Epub 2013 Apr 19. (PMID: 23608593)

40. Arevalo H, Plank G, Helm P, Halperin H, Trayanova N: Tachycardia in post-infarction hearts: insights from 3D image-based ventricular models. PLoS One. 2013; 2;8(7): e68872. (PMID: 23844245)

41. Ashikaga H, Estner HL, Herzka DA, McVeigh ER, Halperin HR. Quantitative assessment of single-image super-resolution in myocardial scar imaging. IEEE Journal of Translational Engineering in Health and Medicine. 2014; 2 (PMID: 25699223)

42. Yannopoulos D, Aufderheide TP, Abella BS, Duval S, Frascone RJ, Goodloe JM, Mahoney BD, Nadkarni VM, Halperin HR, O'Connor R, Idris AH, Becker LB, Pepe PE. Quality of CPR: An important effect modifier in cardiac arrest clinical outcomes and intervention effectiveness trials. Resuscitation. 2015;94:106-113

43. Hunter DW, Tandri H, Halperin H, Tung L, Berger RD: Tetanizing prepulse: A novel strategy to mitigate implantable cardioverter-defibrillator shock-related pain. Heart Rhythm. 2016 Jan 6. pii: S1547-5271(15)01682-3