A conceptual basis for pacing waveforms

Three-dimensional static parametric modelling of phasic colonic contractions for the purpose of microprocessor-controlled functional stimulation

The study aimed at creating an integrated electromechanical model of invoked phasic contractions in canine colon during direct high frequency voltage stimulation. The model utilized data obtained from two large anaesthetized dogs that underwent laparotomy and serosal implantation of two circumferential electrode pairs into a distal segment of the left colon. The strength distribution of the stimulating electric field was analysed over a cylindrical mesh-surface grid modelling the interrogated colonic segment. Recordings of the stimulating current were utilized to model smooth muscle depolarization using linearized macroscopic tissue conductivity. The invoked contractile stress was related to the stimulating electric field strength using an exponential sigmoid function. Artificially produced occlusion of the lumen was derived for a pair of 5mm electrodes positioned on a cylindrical mesh-surface of 2 cm diameter and 15 cm length. The model simulated contractions invoked by stimuli of different amplitude (up to 12 V) with 98.6% accuracy of approximation. Macroscopic tissue conductivity was modelled as a combination of two first-order exponential terms involving a 3ms time constant. Real-time simulation of the current drawn by the smooth muscle during 10 V/50Hz bipolar voltage stimulation was performed. The integrated electromechanical model facilitates the quantification of microprocessor-controlled phasic colonic contractions.

Predicting the relative efficacy of shock waveforms for transthoracic defibrillation in dogs

STUDY OBJECTIVE

Previous work has shown that a passive membrane model using a parallel resistor-capacitor circuit is capable of predicting optimal waveforms for transvenous defibrillation. This study tested the ability of that model to predict optimal waveforms for transthoracic defibrillation.

METHODS

This study was divided into 3 parts, each of which determined transthoracic defibrillation thresholds (DFTs) in 6 dogs for several different waveform shapes and durations. For each part, strength-duration relationships were determined from both experimental and model data and then compared with test model predictions. Part 1 DFTs were determined at various durations for 3 different monophasic waveforms-the ascending ramp, descending ramp, and square waveform. Part 2 DFTs were determined for 3 biphasic waveforms. Phase 1 was a 30-ms ascending ramp, and phase 2 was an ascending ramp, a descending ramp, or a square waveform. Part 3 DFTs were determined for 3 biphasic waveforms with very short second-phase durations. Phase 1 was a 30-ms ascending ramp, and phase 2 was a descending ramp.

RESULTS

For part 1, the model was able to predict the relative defibrillation efficacy of the 3 monophasic waveforms ( P < .05). For parts 2 and 3, the model was able to predict the biphasic waveforms with the lowest DFTs. These predictions were based on the criterion that the model response at the end of the second phase should return to or slightly pass the model response value at the beginning of the first phase.

CONCLUSION

The resistor-capacitor model successfully predicted the relative defibrillation efficacy of several different waveforms delivered transthoracically.

Application of models of defibrillation to human defibrillation data: implications for optimizing implantable defibrillator capacitance

BACKGROUND

Theoretical models predict that optimal capacitance for implantable cardioverter-defibrillators (ICDs) is proportional to the time-dependent parameter of the strength-duration relationship. The hyperbolic model gives this relationship for average current in terms of the chronaxie (t(c)). The exponential model gives the relationship for leading-edge current in terms of the membrane time constant (tau(m)). We hypothesized that these models predict results of clinical studies of ICD capacitance if human time constants are used.

METHODS AND RESULTS

We studied 12 patients with epicardial ICDs and 15 patients with transvenous ICDs. Defibrillation threshold (DFT) was determined for 120-microF monophasic capacitive-discharge pulses at pulse widths of 1.5, 3.0, 7.5, and 15 ms. To compare the predictions of the average-current versus leading-edge-current methods, we derived a new exponential average-current model. We then calculated individual patient time parameters for each model. Model predictions were validated by retrospective comparison with clinical crossover studies of small-capacitor and standard-capacitor waveforms. All three models provided a good fit to the data (r2=.88 to .97, P<.001). Time constants were lower for transvenous pathways (53+/-7 omega) than epicardial pathways (36+/-6 omega) (t(c), P<.001; average-current tau(m), P=.002; leading-edge-current tau(m), P<.06). For epicardial pathways, optimal capacitance was greater for either average-current model than for the leading-edge-current model (P<.001). For transvenous pathways, optimal capacitance differed for all three models (P<.001). All models provided a good correlation with the effect of capacitance on DFT in previous clinical studies: r2=.75 to .84, P<.003. For 90-microF, 120-microF, and 150-microF capacitors, predicted stored-energy DFTs were 3% to 8%, 8% to 16%, and 14% to 26% above that for the optimal capacitance.

CONCLUSIONS

Model predictions based on measured human cardiac-muscle time parameter have a good correlation with clinical studies of ICD capacitance. Most of the predicted reduction in DFT can be achieved with approximately 90-microF capacitors.