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Hirahara AM, Khan MS, Gharbia O, Lange M, Ishidoya Y, Smego D, Ranjan R, Stoddard GJ, Selzman C, Dosdall DJ. Antitachycardia pacing at the His bundle is safer than conventional right ventricular antitachycardia pacing in a canine myocardial ischemic injury model. J Cardiovasc Electrophysiol 2023; 34:1249-1256. [PMID: 37125623 PMCID: PMC10259204 DOI: 10.1111/jce.15916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/04/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Antitachycardia pacing (ATP) is used to terminate ventricular tachycardia (VT) by delivering rapid, low energy pacing to the right ventricle (RV). Unfortunately, ATP is not effective against all VT episodes and can result in adverse outcomes, such as VT acceleration and degeneration into ventricular fibrillation (VF). Improving ATP is therefore desirable. Our objective was to compare the efficacy and safety of ATP delivered at the His bundle to traditional ATP. METHODS Six dogs were anesthetized and pacing leads were implanted in the RV and His bundle. The left anterior descending artery was occluded for 2 h to create an ischemic injury. In a study 4-7 days later, a 128-electrode sock was placed snugly around the ventricles and VT was induced using rapid pacing. ATP was delivered from either the His bundle or RV lead, then attempted at the other location if unsuccessful. Success rates and instances of VT acceleration and degeneration into VF were calculated. RESULTS We induced 83 runs of VT and attempted ATP 128 times. RV ATP was successful in 36% of attempts; His ATP was successful in 38% of attempts. RV ATP resulted in significantly more adverse outcomes. RV and His ATP induced VT acceleration in 9% and 3% of trains, respectively, and induced degeneration into VF in 5% and 1% of trains, respectively. CONCLUSION His bundle ATP is safer, but not significantly more effective, than RV ATP.
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Affiliation(s)
- Annie M Hirahara
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Drive Salt Lake City, Utah, 84112 USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
| | - Muhammad S Khan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
| | - Omar Gharbia
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
| | - Matthias Lange
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
| | - Yuki Ishidoya
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
| | - Douglas Smego
- Department of Surgery, Division of Cardiothoracic Surgery, 30 N 1900 E Salt Lake City, Utah, 84132 USA
| | - Ravi Ranjan
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Drive Salt Lake City, Utah, 84112 USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
- Department of Internal Medicine, Division of Cardiothoracic Surgery, 30 N 1900 E Salt Lake City, Utah 84132 USA
| | - Gregory J Stoddard
- Clinical and Translational Science Institute, University of Utah, 375 Chipeta Way A, Salt Lake City, Utah, 84108 USA
| | - Craig Selzman
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
- Department of Surgery, Division of Cardiothoracic Surgery, 30 N 1900 E Salt Lake City, Utah, 84132 USA
| | - Derek J Dosdall
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Drive Salt Lake City, Utah, 84112 USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
- Department of Surgery, Division of Cardiothoracic Surgery, 30 N 1900 E Salt Lake City, Utah, 84132 USA
- Department of Internal Medicine, Division of Cardiothoracic Surgery, 30 N 1900 E Salt Lake City, Utah 84132 USA
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Sunwoo SH, Cha MJ, Han SI, Kang H, Cho YS, Yeom DH, Park CS, Park NK, Choi SW, Kim SJ, Cha GD, Jung D, Choi S, Oh S, Nam GB, Hyeon T, Kim DH, Lee SP. Ventricular tachyarrhythmia treatment and prevention by subthreshold stimulation with stretchable epicardial multichannel electrode array. SCIENCE ADVANCES 2023; 9:eadf6856. [PMID: 37000879 PMCID: PMC10065438 DOI: 10.1126/sciadv.adf6856] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/28/2023] [Indexed: 05/24/2023]
Abstract
The implantable cardioverter-defibrillator (ICD) is an effective method to prevent sudden cardiac death in high-risk patients. However, the transvenous lead is incompatible with large-area electrophysiological mapping and cannot accommodate selective multichannel precision stimulations. Moreover, it involves high-energy shocks, resulting in pain, myocardial damage, and recurrences of ventricular tachyarrhythmia (VTA). We present a method for VTA treatment based on subthreshold electrical stimulations using a stretchable epicardial multichannel electrode array, which does not disturb the normal contraction or electrical propagation of the ventricle. In rabbit models with myocardial infarction, the infarction was detected by mapping intracardiac electrograms with the stretchable epicardial multichannel electrode array. Then, VTAs could be terminated by sequential electrical stimuli from the epicardial multichannel electrode array beginning with low-energy subthreshold stimulations. Last, we used these subthreshold stimulations to prevent the occurrence of additional VTAs. The proposed protocol using the stretchable epicardial multichannel electrode array provides opportunities toward the development of innovative methods for painless ICD therapy.
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MESH Headings
- Rabbits
- Animals
- Tachycardia, Ventricular/therapy
- Tachycardia, Ventricular/epidemiology
- Tachycardia, Ventricular/etiology
- Defibrillators, Implantable/adverse effects
- Heart Ventricles
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/epidemiology
- Myocardial Infarction/therapy
- Myocardial Infarction/etiology
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Affiliation(s)
- Sung-Hyuk Sunwoo
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
| | - Myung-Jin Cha
- Departments of Cardiology and Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Sang Ihn Han
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Hyejeong Kang
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Ye Seul Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Da-Hae Yeom
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Chan Soon Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Na Kyeong Park
- Department of Physiology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Seong Woo Choi
- Department of Physiology, Dongguk University College of Medicine, Gyeongju 38066, Republic of Korea
| | - Sung Joon Kim
- Department of Physiology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Gi Doo Cha
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Dongjun Jung
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Suji Choi
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Seil Oh
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Gi-Byoung Nam
- Departments of Cardiology and Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Taeghwan Hyeon
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Dae-Hyeong Kim
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
- Department of Materials Science and Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Seung-Pyo Lee
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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Tsukahara K, Oginosawa Y, Fujino Y, Honda T, Kikuchi K, Nozoe M, Uchida T, Minamiguchi H, Sonoda K, Ogawa M, Ideguchi T, Kizaki Y, Nakamura T, Oba K, Higa S, Yoshida K, Yagyu K, Miyamoto T, Yamagishi Y, Ohe H, Kohno R, Kataoka M, Otsuji Y, Abe H. RR interval variability in the evaluation of ventricular tachycardia and effects of implantable cardioverter defibrillator therapy. J Arrhythm 2021; 37:1052-1060. [PMID: 34386132 PMCID: PMC8339111 DOI: 10.1002/joa3.12551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND An implantable cardioverter defibrillator (ICD) is the most reliable therapeutic device for preventing sudden cardiac death in patients with sustained ventricular tachycardia (VT). Regarding its effectiveness, targeted VT is defined based on the tachyarrhythmia cycle length. However, variations in RR interval variability of VTs may occur. Few studies have reported on VT characteristics and effects of ICD therapy according to the RR interval variability. We aimed to identify the clinical characteristics of VTs and ICD therapy effects according to the RR interval variability. METHODS We analyzed 821 VT episodes in 69 patients with ICDs or cardiac resynchronization therapy defibrillators. VTs were classified as irregular when the difference between two successive beats was >20 ms in at least one of 10 RR intervals; otherwise, they were classified as regular. We evaluated successful termination using anti-tachycardia pacing (ATP)/shock therapy, spontaneous termination, and acceleration between regular and irregular VTs. The RR interval variability reproducibility rates were evaluated. RESULTS Regular VT was significantly more successfully terminated than irregular VT by ATP. No significant difference was found in shock therapy or VT acceleration between the regular and irregular VTs. Spontaneous termination occurred significantly more often in irregular than in regular VT cases. The reproducibility rates of RR interval variability in each episode and in all episodes were 89% and 73%, respectively. CONCLUSIONS ATP therapy showed greater effectiveness for regular than for irregular VT. Spontaneous termination was more common in irregular than in regular VT. RR interval variability of VTs seems to be reproducible.
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Affiliation(s)
- Keita Tsukahara
- The Second Department of Internal MedicineUniversity of Occupational and Environment HealthKitakyushuJapan
| | - Yasushi Oginosawa
- The Second Department of Internal MedicineUniversity of Occupational and Environment HealthKitakyushuJapan
| | - Yoshihisa Fujino
- The Department of Environmental Epidemiology Institute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Toshihiro Honda
- Division of CardiologyKumamoto Junkankika HospitalKumamotoJapan
| | - Kan Kikuchi
- Division of CardiologyJapan Community Healthcare OrganizationKyushu HospitalKitakyusyuJapan
| | - Masatsugu Nozoe
- Division of CardiologySaiseikai Fukuoka General HospitalFukuokaJapan
| | - Takayuki Uchida
- Department of Cardiovascular SurgeryIizuka HospitalIizukaJapan
| | | | - Koichiro Sonoda
- Department of CardiologySasebo City General HospitalSaseboJapan
| | - Masahiro Ogawa
- Department of CardiologyFukuoka University School of MedicineFukuokaJapan
| | - Takeshi Ideguchi
- Department of Internal Medicine, Circulatory and Body Fluid RegulationFaculty of MedicineUniversity of MiyazakiMiyazakiJapan
| | | | - Toshihiro Nakamura
- Department of CardiologyNational Hospital Organization Kyushu Medical CenterFukuokaJapan
| | - Kageyuki Oba
- Department of CardiologyYuai Medical CenterOkinawaJapan
| | - Satoshi Higa
- Cardiac Electrophysiology and Pacing LaboratoryDivision of Cardiovascular MedicineMakiminato Central HospitalOkinawaJapan
| | - Keiki Yoshida
- Department of CardiologySaga‐ken Medical Centre KoseikanSagaJapan
| | - Keishiro Yagyu
- The Second Department of Internal MedicineUniversity of Occupational and Environment HealthKitakyushuJapan
| | - Taro Miyamoto
- The Second Department of Internal MedicineUniversity of Occupational and Environment HealthKitakyushuJapan
| | - Yasunobu Yamagishi
- The Second Department of Internal MedicineUniversity of Occupational and Environment HealthKitakyushuJapan
| | - Hisaharu Ohe
- The Second Department of Internal MedicineUniversity of Occupational and Environment HealthKitakyushuJapan
| | - Ritsuko Kohno
- Department of Heart Rhythm ManagementUniversity of Occupational and Environment HealthKitakyusyuJapan
| | - Masaharu Kataoka
- The Second Department of Internal MedicineUniversity of Occupational and Environment HealthKitakyushuJapan
| | - Yutaka Otsuji
- The Second Department of Internal MedicineUniversity of Occupational and Environment HealthKitakyushuJapan
| | - Haruhiko Abe
- Department of Heart Rhythm ManagementUniversity of Occupational and Environment HealthKitakyusyuJapan
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Holden AV, Begg GA, Bounford K, Stegemann B, Tayebjee MH. Phase Entrainment of Induced Ventricular Fibrillation: A Human Feasibility and Proof of Concept Study. J Atr Fibrillation 2019; 12:2217. [PMID: 32435345 DOI: 10.4022/jafib.2217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/19/2019] [Accepted: 09/21/2019] [Indexed: 11/10/2022]
Abstract
Cardioversion and defibrillation by a single high energy shock applied by myocardial or body surface electrodes is painful, causes long term tissue damage, and is associated with worsening long term outcomes, but is almost always required for treatment of ventricular fibrillation . As a initial step towards developing methods that can terminate ventricular arrhythmias painlessly, we aim to determine if pacing stimuli at a rate of 5/s applied via an implantable cardiac defibrillator (ICD) can modify human ventricular fibrillation. In 8 patients undergoing defibrillation testing of a new/exchanged intracardiac defibrillator, five seconds of pacing at five stimuli per second was applied during the 10-20 seconds of induced ventricular fibrillation before the defibrillation shock was automatically applied, and the cardiac electrograms recorded and analyzed. The high frequency pacing did not entrain the ventricular fibrillation, but altered the dominant frequency in all 8 patients, and modulated the phase computed via the Hilbert Transform, in four of the patients. In this pilot study we demonstrate that high frequency pacing applied via ICD electrodes during VF can alter the dominant frequency and modulate the probability density of the phase of the electrogram of the ventricular fibrillation.
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Affiliation(s)
- Arun V Holden
- School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT; UK
| | - Gordon A Begg
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Katrina Bounford
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Berthold Stegemann
- Medtronic Plc, Bakken Research Center, Endepolsdomein 5, 6229 GW Maastricht, The Netherlands
| | - Muzahir H Tayebjee
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
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Hohmann S, Duncker D, König T, Horke A, Westhoff-Bleck M, Veltmann C. Implantable cardioverter defibrillator therapy in grown-up patients with transposition of the great arteries-role of anti-tachycardia pacing. J Thorac Dis 2018; 10:S1769-S1776. [PMID: 30034851 DOI: 10.21037/jtd.2018.01.159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Grown-up patients with surgically corrected dextro-transposition of the great arteries (dTGA) as well as patients with congenitally corrected transposition of the great arteries (ccTGA) carry a high risk of ventricular arrhythmias. Data regarding implantable cardioverter defibrillator (ICD) therapy and efficacy of anti-tachycardia pacing in these patients is limited. Methods Clinical data from a contemporary cohort of ICD carriers with atrial switch-corrected dTGA and burdened right ventricle or with ccTGA were obtained retrospectively from hospital records and patients were followed for additional 25 months prospectively. Clinical characteristics and ICD episode data were analyzed. Results Fourteen ICD carriers (8 male) with dTGA or ccTGA were included in the analysis. Four patients received the ICD for primary prevention based on severely reduced systemic ventricular function. The remaining patients had an ICD indication for secondary prevention. Cumulative follow-up added up to 113.5 patient-years. One patient died suddenly due to massive pulmonary embolism. One patient received a ventricular assist device. There were no arrhythmic deaths during the prospective follow-up period. Nine patients (64%) experienced a total of 177 ventricular tachyarrhythmias. Anti-tachycardia pacing was highly effective with 80% success rate in termination of arrhythmias. Five patients (36%) suffered from a total of 28 inappropriate ICD shocks for supraventricular tachycardia. Conclusions In a contemporary cohort of ICD carriers with dTGA and ccTGA we observed a high proportion of appropriate ICD therapies for ventricular tachyarrhythmias. Over a period of up to 15 years almost two thirds of the patients received appropriate therapies. ATP was highly effective in our cohort and should therefore be programmed whenever possible.
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Affiliation(s)
- Stephan Hohmann
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - David Duncker
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Thorben König
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Christian Veltmann
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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