Low Energy Defibrillation in Human Cardiac Tissue: A Simulation Study
Low Energy Defibrillation in Human Cardiac Tissue: A Simulation Study
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DOI：
10.1016/j.bpj.2008.11.031
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发表时间：
2009-02-18
影响因子：
3.4
通讯作者：
Biktashev, Vadim N.
中科院分区：
文献类型：
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作者：
Morgan, Stuart W.;Plank, Gernot;Biktashev, Vadim N.
我们旨在评估反馈控制共振漂移起搏作为低能量除颤方法的有效性。抗心动过速起搏是唯一获得临床意义的低能量除颤方法，但它仍然是次优的。低能量除颤将避免与高压电击相关联的不良副作用，并且允许在目前不耐受植入式心律转复除颤器（ICD）治疗的情况下应用这种治疗。我们提出了一个bidomain模型的心脏组织与人类心房离子动力学的计算机模拟结果。启动再入并在与再入相同的时间段施加低能量冲击，使用反馈来维持共振。我们证明，这样的刺激可以移动的核心折返模式，在方向上，取决于电极的位置和反馈的时间延迟。终止再入是实现冲击强度一个数量级弱于传统的单次电击除颤。我们的结论是，共振漂移起搏可以终止折返在目前用于除颤的冲击强度的一小部分，并可能在抗心动过速起搏失败，由于反馈机制。成功取决于这些数值模拟所揭示的许多细节。
We aim to assess the effectiveness of feedback-controlled resonant drift pacing as a method for low energy defibrillation. Antitachycardia pacing is the only low energy defibrillation approach to have gained clinical significance, but it is still suboptimal. Low energy defibrillation would avoid adverse side effects associated with high voltage shocks and allow the application of implantable cardioverter defibrillator (ICD) therapy, in cases where such therapy is not tolerated today. We present results of computer simulations of a bidomain model of cardiac tissue with human atrial ionic kinetics. Reentry was initiated and low energy shocks were applied with the same period as the reentry, using feedback to maintain resonance. We demonstrate that such stimulation can move the core of reentrant patterns, in the direction that depends on the location of the electrodes and the time delay in the feedback. Termination of reentry is achieved with shockstrength one-order-of-magnitude weaker than in conventional single-shock defibrillation. We conclude that resonant drift pacing can terminate reentry at a fraction of the shock strength currently used for defibrillation and can potentially work where antitachycardia pacing fails, due to the feedback mechanisms. Success depends on a number of details that these numerical simulations have uncovered.