Abstract
We devise a methodology to determine an optimal pattern of inputs to synchronize firing patterns of cardiac cells which only requires the ability to measure action potential durations in individual cells. In numerical bidomain simulations, the resulting synchronizing inputs are shown to terminate spiral waves with a higher probability than comparable inputs that do not synchronize the cells as strongly. These results suggest that designing stimuli which promote synchronization in cardiac tissue could improve the success rate of defibrillation, and point towards novel strategies for optimizing antifibrillation pacing.
Highlights
While cardiac arrest continues to be a leading cause of death in the industrialized world, for the past century, the only clinically reliable method of defibrillation has been the application of a high voltage shock across the myocardium, typically with a voltage gradient of at least 5V/cm [1]
We have proposed a methodology which can be used to find an efficacious series of pulsed inputs to synchronize the activity of myocardial tissue, which increases the likelihood of preventing spiral wave reentry
These results suggest that fixed time pulsatile stimulation as currently implemented by low energy strategies may be far from optimal and that the development of strategies to synchronize cardiac cell activity could offer significant room for improvement
Summary
While cardiac arrest continues to be a leading cause of death in the industrialized world, for the past century, the only clinically reliable method of defibrillation has been the application of a high voltage shock across the myocardium, typically with a voltage gradient of at least 5V/cm [1]. Patients who survive an initial cardiac arrest are at a higher risk for subsequent cardiac arrests and often require implantable cardioverter defibrillators (ICDs) in order to improve long term survival rates [2, 3] This chronic treatment is not without side effects, as defibrillating shocks from ICDs cause intense pain, which puts patients at a severe risk of secondary effects including depression and anxiety [4,5,6,7], adversely affecting their quality of life. These shocks can lead to long term damage, including fibrosis [8], as well as other short-term side-effects [9]. Others have developed pacing strategies which can terminate single spiral waves responsible for tachycardia [12] [13], but these strategies are not effective when multiple spirals are present, as is the case during cardiac arrest
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