Termination of atrial fibrillation using pulsed low-energy far-field stimulation.
Termination of atrial fibrillation using pulsed low-energy far-field stimulation.
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DOI：
10.1161/circulationaha.108.825091
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发表时间：
2009-08-11
期刊：
影响因子：
37.8
通讯作者：
Gilmour RF Jr
中科院分区：
文献类型：
--
作者：
Fenton FH;Luther S;Cherry EM;Otani NF;Krinsky V;Pumir A;Bodenschatz E;Gilmour RF Jr
Electrically-based therapies for terminating atrial fibrillation (AF) currently fall into two categories: anti-tachycardia pacing (ATP) and cardioversion. ATP utilizes 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 anti-fibrillation pacing (FF-AFP), which delivers a short train of low-intensity electrical pulses at the frequency of ATP, 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. Using optical mapping in isolated perfused canine atrial preparations, we show that a series of pulses at low field strength (0.9-1.4 V/cm) is sufficient to entrain and subsequently extinguish AF with a success rate of 93 percent (69/74 trials in 8 preparations). We further demonstrate that the mechanism behind FFAFP 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. AF in our model can be terminated by FF-AFP using 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.
