Document Detail

A Novel Pacing Method to Suppress Repolarization Alternans in Vivo: Implications for Arrhythmia Prevention.
MedLine Citation:
PMID:  23274372     Owner:  NLM     Status:  Publisher    
BACKGROUND: Repolarization alternans (RA), a pattern of ventricular repolarization which repeats on an every other beat basis, has been closely linked with the substrate associated with ventricular tachycardia/ventricular fibrillation (VT/VF). OBJECTIVE: To evaluate a novel method to suppress RA. METHODS: We have developed a novel method to dynamically (upon R-wave detection) trigger pacing pulses during the absolute refractory period. We have tested the ability of this method to control RA in a structurally normal swine heart in vivo. RESULTS: RA induced by triggered pacing can be measured from both intra-cardiac and body surface leads and the amplitude of R-wave triggered-pacing induced alternans can be locally modulated by varying the amplitude and width of the pacing pulse. We have estimated that to induce a one μV change in alternans voltage on the body surface, coronary sinus (CS) and left ventricle (LV) leads requires a triggered pacing pulse delivered in the right ventricle (RV) of 0.04 ± 0.02, 0.05 ± 0.025 and 0.06 ± 0.033 μC, respectively. Similarly, to induce a one unit change in K(score) (ratio of alternans peak to noise) requires a pacing stimulus of 0.93 ± 0.73, 0.32 ± 0.29 and 0.33 ± 0.37 μC, respectively. We have been able to demonstrate that RA can be suppressed by R-wave triggered pacing from a site that is within or across ventricles. Lastly, we have demonstrated that the proposed method can be used to suppress spontaneously occurring alternans in the diseased heart. CONCLUSIONS: We have developed a novel method to suppress RA in-vivo.
Antonis A Armoundas; Eric H Weiss; Omid Sayadi; Shawna Laferriere; Naveen Sajja; Theofanie Mela; Jagmeet P Singh; Conor D Barrett; E Kevin Heist; Faisal M Merchant
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-27
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Inc.
the Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA; the Massachusetts General Hospital, Division of Cardiology, Harvard Medical School, Boston, MA. Electronic address:
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