Termination of Atrial Fibrillation Using Pulsed Low-Energy Far-Field Stimulation
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- Flavio H. Fenton
- From the Department of Biomedical Sciences (F.H.F., S.L., E.M.C., N.F.O., R.F.G.) and Laboratory of Solid State Physics and Department of Mechanical and Aerospace Engineering (E.B.), Cornell University, Ithaca, NY; Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany (S.L., E.B.); Institute Non Lineáire de Nice, Valbonne, France (V.K.); and Laboratoire de Physique, Ecole Normale Supérieure de Lyon, Lyon, France (A.P.).
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- Stefan Luther
- From the Department of Biomedical Sciences (F.H.F., S.L., E.M.C., N.F.O., R.F.G.) and Laboratory of Solid State Physics and Department of Mechanical and Aerospace Engineering (E.B.), Cornell University, Ithaca, NY; Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany (S.L., E.B.); Institute Non Lineáire de Nice, Valbonne, France (V.K.); and Laboratoire de Physique, Ecole Normale Supérieure de Lyon, Lyon, France (A.P.).
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- Elizabeth M. Cherry
- From the Department of Biomedical Sciences (F.H.F., S.L., E.M.C., N.F.O., R.F.G.) and Laboratory of Solid State Physics and Department of Mechanical and Aerospace Engineering (E.B.), Cornell University, Ithaca, NY; Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany (S.L., E.B.); Institute Non Lineáire de Nice, Valbonne, France (V.K.); and Laboratoire de Physique, Ecole Normale Supérieure de Lyon, Lyon, France (A.P.).
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- Niels F. Otani
- From the Department of Biomedical Sciences (F.H.F., S.L., E.M.C., N.F.O., R.F.G.) and Laboratory of Solid State Physics and Department of Mechanical and Aerospace Engineering (E.B.), Cornell University, Ithaca, NY; Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany (S.L., E.B.); Institute Non Lineáire de Nice, Valbonne, France (V.K.); and Laboratoire de Physique, Ecole Normale Supérieure de Lyon, Lyon, France (A.P.).
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- Valentin Krinsky
- From the Department of Biomedical Sciences (F.H.F., S.L., E.M.C., N.F.O., R.F.G.) and Laboratory of Solid State Physics and Department of Mechanical and Aerospace Engineering (E.B.), Cornell University, Ithaca, NY; Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany (S.L., E.B.); Institute Non Lineáire de Nice, Valbonne, France (V.K.); and Laboratoire de Physique, Ecole Normale Supérieure de Lyon, Lyon, France (A.P.).
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- Alain Pumir
- From the Department of Biomedical Sciences (F.H.F., S.L., E.M.C., N.F.O., R.F.G.) and Laboratory of Solid State Physics and Department of Mechanical and Aerospace Engineering (E.B.), Cornell University, Ithaca, NY; Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany (S.L., E.B.); Institute Non Lineáire de Nice, Valbonne, France (V.K.); and Laboratoire de Physique, Ecole Normale Supérieure de Lyon, Lyon, France (A.P.).
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- Eberhard Bodenschatz
- From the Department of Biomedical Sciences (F.H.F., S.L., E.M.C., N.F.O., R.F.G.) and Laboratory of Solid State Physics and Department of Mechanical and Aerospace Engineering (E.B.), Cornell University, Ithaca, NY; Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany (S.L., E.B.); Institute Non Lineáire de Nice, Valbonne, France (V.K.); and Laboratoire de Physique, Ecole Normale Supérieure de Lyon, Lyon, France (A.P.).
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- Robert F. Gilmour
- From the Department of Biomedical Sciences (F.H.F., S.L., E.M.C., N.F.O., R.F.G.) and Laboratory of Solid State Physics and Department of Mechanical and Aerospace Engineering (E.B.), Cornell University, Ithaca, NY; Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany (S.L., E.B.); Institute Non Lineáire de Nice, Valbonne, France (V.K.); and Laboratoire de Physique, Ecole Normale Supérieure de Lyon, Lyon, France (A.P.).
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説明
<jats:p> <jats:bold> <jats:italic>Background—</jats:italic> </jats:bold> 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 <jats:italic>far-field antifibrillation pacing</jats:italic> , 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. </jats:p> <jats:p> <jats:bold> <jats:italic>Methods and Results—</jats:italic> </jats:bold> 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. </jats:p> <jats:p> <jats:bold> <jats:italic>Conclusions—</jats:italic> </jats:bold> 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. </jats:p>
収録刊行物
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- Circulation
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Circulation 120 (6), 467-476, 2009-08-11
Ovid Technologies (Wolters Kluwer Health)
