A model for multi-site pacing of fibrillation using nonlinear dynamics feedback

During Early VF in Rabbit Hearts, His Bundle Pacing is Less Effective Than Working Myocardial Pacing in Modulating Left Ventricular Activation Rates

PURPOSE

The potential of pacing and capturing the His-Purkinje system (HPS) to synchronize VF wavefronts is not known even though the HPS is thought to be electrically linked during VF. In this study the effect of selective His Bundle (HB) pacing was compared with nearby working myocardial (WM) pacing on the left ventricular (LV) endocardial activation rates.

METHODS

Rabbit hearts (n = 9) were explanted and Langendorff perfused. Electrodes directly on the HB were identified and paced subsequently using an electrode array. The WM was paced through a silver wire inserted in the right ventricular septal wall. After VF was induced, the HB was paced at rates faster than the intrinsic HB activation rate (n = 18 episodes) and also at rates faster than the LV activation rate (n = 16). A basket array inserted in the LV was used to record electrograms before and during each pacing episode. Activation rates at five LV electrodes each from the earliest and latest activating sinus rhythm regions were analyzed before and during pacing.

RESULTS

Both HB and WM pacing reduced LV activation rates during pacing, but WM pacing was more effective (p < 0.005). WM pacing events were more effective (p < 0.05) in reducing LV activation rates than HB pacing in episodes which were faster than LV activation rates.

CONCLUSION

This study provides evidence that during early VF in rabbit hearts, the HPS cannot be driven to effectively modulate the LV activation rates.

Follow the Light - From Low-Energy Defibrillation to Multi-Site Photostimulation

One major cause of death in the industrialized world is sudden cardiac death, which so far can be reliably treated only by applying strong electrical shocks. Developing improved methods, aiming at lowering shock intensity and associated side effects potentially has significant clinical implications. Thus, optogenetic stimulation using structured illumination has been introduced as a promising experimental tool to investigate mechanisms underlying multi-site pacing and to optimize potential low-energy approaches. Furthermore, an objective of this work is to strengthen the application of optogenetic tools for cardiac arrhythmia research, which in turn is expected to improve applicable technologies towards tissue-protective defibrillation.

Spherical topology in cardiac simulations

Computational simulations of the electrodynamics of cardiac fibrillation yield a great deal of useful data and provide a framework for theoretical explanations of heart behavior. Extending the application of these mathematical models to defibrillation studies requires that a simulation should sustain fibrillation without defibrillation intervention. In accordance with the critical mass hypothesis, the simulated tissue should be of a large enough size. The choice of biperiodic boundary conditions sustains fibrillation for a longer duration than no-flux boundary conditions for a given area, and so is commonly invoked. Here, we show how this leads to a boundary condition artifact that may complicate the analysis of defibrillation efficacy; we implement an alternative coordinate scheme that utilizes spherical shell topology and mitigates singularities in the Laplacian found with the usual spherical curvilinear coordinate system.

Optimization of feedback pacing for defibrillation

A mathematical model of multisite feedback pacing for defibrillation is optimized for electrode spacing and stimulus period. For four electrodes, the defibrillation success rate is highest at 88% when the electrodes are spaced as far apart as possible. For a single electrode, the optimum success rate was 26%.