Journal
CIRCULATION
Volume 120, Issue 6, Pages 467-4Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCULATIONAHA.108.825091
Keywords
arrhythmia; atrium; cardioversion; fibrillation; mapping
Funding
- National Institutes of Health [HL075515-S03, HL075515-S04, HL075515, HL073644]
- Indo-French Centre for the Promotion of Advanced Research [3404-4]
- National Science Foundation [0800793, BES-0503336]
- Max Planck Society
- Kavli Institute for Theoretical Physics under National Science Foundation [PHY05-51164]
- Div Of Civil, Mechanical, & Manufact Inn
- Directorate For Engineering [0800793] Funding Source: National Science Foundation
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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. (Circulation. 2009;120:467-476.)
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