Synchronization as a mechanism for low-energy anti-fibrillation pacing
Synchronization as a mechanism for low-energy anti-fibrillation pacing
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DOI：
10.1016/j.hrthm.2017.05.021
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发表时间：
2017-08-01
期刊：
影响因子：
5.5
通讯作者：
Fenton, Flavio H.
中科院分区：
文献类型：
--
作者：
Claire, Yanyan;Uzelac, Ilija;Fenton, Flavio H.
低能量抗纤颤起搏（LEAP）已被建议作为症状性纤颤患者的替代治疗。目的探讨LEAP终止心律失常的机制，系统分析电击周期和电击时机对LEAP成功率的影响。方法在离体犬心脏上诱发心房颤动和心室颤动，应用LEAP和标准单次电击除颤终止心律失常。结果体外实验表明，LEAP成功地终止了心房纤颤和心室纤颤，平均能量减少分别为88%和81%。实验和仿真均证实了虚拟电极同步是改良仓本相LEAP终止心律失常的关键机制图和组织激发分数（FTE）图。我们还观察到，在模拟中，LEAP是更有效的，当冲击周期接近主导周期和第一次电击时，FTE是decreasing.CONCLUSIONS我们的研究结果支持同步的LEAP终止心律失常的机制，其有效性可以提高通过调整电击周期和时机。
BACKGROUND Low-energy anti-fibrillation pacing (LEAP) has been suggested as an alternative treatment in symptomatic fibrillation patients. It significantly lowers the energy required compared with standard 1-shock defibrillation.OBJECTIVE In this study, we investigated the mechanism of arrhythmia termination by LEAP and systematically analyzed the influence of shock period and timing on the success rate of LEAP.METHODS We induced atrial and ventricular fibrillation in isolated canine hearts and applied LEAP and standard 1-shock defibrillation to terminate the arrhythmia. We simulated the arrhythmia and LEAP using a 2-dimensional bidomain human atrial model.RESULTS The ex vivo experiments showed successful termination of atrial fibrillation and ventricular fibrillation using LEAP, with an average 88% and 81% energy reduction, respectively, and both experiments and simulations verified that synchronization from virtual electrodes is the key mechanism for termination of arrhythmia by LEAP using modified Kuramoto phase plots and fraction of tissue excited (FTE) plots. We also observed in simulations that LEAP is more effective when the shock period is close to the dominant period and the first shock is delivered when FTE is decreasing.CONCLUSIONS Our results support synchronization as the mechanism for arrhythmia termination by LEAP, and its effectiveness can be improved by adjusting shock period and timing.