Low Energy Defibrillation

描述(申请人提供)：心律紊乱是发达国家发病率和死亡率的主要原因。尽管各种心律失常的生理机制、解剖和遗传决定因素以及病因有很大的不同，但只有两种主要的治疗方法：电疗法和消融疗法。药物治疗大多无效或受到副作用的阻碍。房性快速性心律失常的消融治疗被越来越多的人接受。然而，消融过程复杂、耗时，而且有许多副作用。在预防室性心动过速和室性颤动(VT/VF)引起的心脏性猝死(VT/VF)和阻止房性心动过速和房颤(AT/AF)方面，有几种方法是有效的。然而，目前的生物电治疗模式有许多局限性。抗心动过速起搏(ATP)能量需求低，是目前最理想的起搏方法，但其疗效有限。在过去的70年里，高压双相电击除颤已经发展成为治疗房颤和室颤的主要和高效的电疗法。然而，房颤的能量需求不是最理想的：高能电击是痛苦的，可能会导致心肌损伤。在我们的项目中，我们的目标是解决目前电疗的局限性，并提出一个新的假设：多阶段阶段性生物电治疗将使心房颤动的DFT显着减少。基于我们实验室以前由NIH资助的研究，我们开发了一种基于几种类型的低、阶段性(即递减)能量水平和频率的多脉冲电疗来终止房性快速性心律失常的方法：(1)远场低能量多次电击，(2)远场超低能量夹带刺激，和(3)近场夹带起搏。我们将探索两个技术平台来实施和进一步研究我们的新方法：(1)最先进的基于铅的植入型设备和(2)由伊利诺伊大学香槟分校罗杰斯实验室开发的柔性电子设备。该项目的成功完成将通过(1)减少高压电击引起的心肌损伤和继发于这种损伤的电击后传导异常，(2)减少与终止快速性心律失常相关的疼痛，以及(3)减少植入性设备的能量消耗，从而推动植入性心律失常的生物电治疗。将DFT降低到0.2J以下可能使数百万房颤患者的植入性心房除颤成为可能。由John A.Rogers开发的新型可伸展电子技术有望改变基于高解剖分辨率、局部感知和多阶段异常节律治疗的心律失常的电疗法。

DESCRIPTION (provided by applicant): Heart rhythm disorders are the leading cause of morbidity and mortality in the developed world. Despite a profound difference in physiological mechanisms, anatomic and genetic determinants, and etiology of various arrhythmias, there are only two predominant treatments: electric and ablative therapies. Pharmacological therapy has been mostly ineffective or hampered by side effects. Ablative therapy for atrial tachyarrhythmias is growing in acceptance. However, the ablation procedure is complex, time-consuming, and has a number of side effects. Several modalities of electrotherapy have been effective in preventing sudden cardiac death due to ventricular tachycardia and fibrillation (VT/VF), and in arresting atrial tachycardia and fibrillation (AT/AF). However, the current bioelectric therapy paradigm has a number of limitations. Antitachycardia pacing (ATP) is the most desirable approach due to its low energy requirement, but the efficacy of ATP is limited. High- voltage biphasic shock defibrillation has evolved over the last 70 years as the dominant and highly effective electrotherapy against both AF and VF. However, the energy requirements for AF are suboptimal: high-energy shocks are painful and could cause myocardial damage. In our project we aim to address the limitations of current electrotherapy and present a novel hypothesis: multi-stage phased bioelectric therapy will allow significant reduction in DFT for atrial fibrillaton. Based on previous NIH-funded research from our laboratory we have developed an approach that terminates atrial tachyarrhythmia based on several types of multiple pulse electrotherapies with low, phased (i.e. progressively reducing) energy levels and frequencies: (1) far-field low energy multiple shocks, (2) far-field ultra-low energy entrainment stimulation, and (3) near-field entrainment pacing. We will explore two technological platforms to implement and further investigate our novel method: (1) state-of-the-art lead-based implantable device and (2) flexible electronics developed by the Rogers laboratory at the University of Illinois, Urbana-Champagne. Successful completion of this project will advance implantable bioelectric therapy of cardiac arrhythmias by (1) reducing high-voltage shock induced myocardial damage and post-shock conduction abnormalities secondary to this damage, (2) reducing pain associated with termination of tachyarrhythmias, and (3) reducing energy consumption in the implantable devices. Reduction of the DFT below 0.2J is likely to make implantable atrial defibrillation possible for millions of AF patients. Novel stretchable electronic technology developed by John A. Rogers is likely to transform electrotherapy of cardiac arrhythmias based on high anatomic resolution local sensing and multi-stage therapy of aberrant rhythms.