Termination of atrial fibrillation using pulsed ...
Description
Citation
| Title | Termination of atrial fibrillation using pulsed low-energy far-field stimulation |
| Author(s) | F. Fenton, S. Luther, E. Cherry, N. Otani, V. Krinsky, A. Pumir, E. Bodenschatz, R. Gilmour |
| Journal | Circulation |
| Date | 2009 |
| Volume | 120 |
| Issue | 6 |
| Start page | 467 |
| End page | 476 |
| Abstract | BACKGROUND: Electrically based therapies for terminating atrial fibrillation (AF) currently fall into 2 categories: antitachycardia pacing and cardioversion. Antitachycardia pacing uses low-intensity pacing stimuli delivered via a single electrode and is effective for terminating slower tachycardias but is less effective for treating AF. In contrast, cardioversion uses a single high-voltage shock to terminate AF reliably, but the voltages required produce undesirable side effects, including tissue damage and pain. We propose a new method to terminate AF called far-field antifibrillation pacing, which delivers a short train of low-intensity electric pulses at the frequency of antitachycardia pacing but from field electrodes. Prior theoretical work has suggested that this approach can create a large number of activation sites ("virtual" electrodes) that emit propagating waves within the tissue without implanting physical electrodes and thereby may be more effective than point-source stimulation. METHODS AND RESULTS: Using optical mapping in isolated perfused canine atrial preparations, we show that a series of pulses at low field strength (0.9 to 1.4 V/cm) is sufficient to entrain and subsequently extinguish AF with a success rate of 93% (69 of 74 trials in 8 preparations). We further demonstrate that the mechanism behind far-field antifibrillation pacing success is the generation of wave emission sites within the tissue by the applied electric field, which entrains the tissue as the field is pulsed. CONCLUSIONS: AF in our model can be terminated by far-field antifibrillation pacing with only 13% of the energy required for cardioversion. Further studies are needed to determine whether this marked reduction in energy can increase the effectiveness and safety of terminating atrial tachyarrhythmias clinically. |
| DOI | 10.1161/CIRCULATIONAHA.108.825091 |
| Use/Reproduction | Contact Publisher |
| Text | http://www.islandscholar.ca/scholartest/download_ds/ir:3105/PDF |
Using APA 6th Edition citation style.
[Page generation failure. The bibliography processor requires a browser with Javascript enabled.]
Times viewed: 91