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Related Experiment Videos

Adaptive pacing during ventricular fibrillation.

Philip L Johnson1, Jonathan C Newton, Dennis L Rollins

  • 1Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama, USA. plj@crml.uab.edu

Pacing and Clinical Electrophysiology : PACE
|August 22, 2003
PubMed
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Pacing during ventricular fibrillation (VF) in pigs captured epicardium, but adaptive algorithms did not improve capture area. Capture was asymmetrical, favoring the right ventricular side, influenced by myocardial fiber orientation and VF activation patterns.

Area of Science:

  • Cardiovascular Physiology
  • Electrophysiology
  • Medical Device Technology

Background:

  • Ventricular fibrillation (VF) is a life-threatening arrhythmia characterized by chaotic electrical activity.
  • Pacing during VF has shown potential for capturing portions of the epicardium, but characteristics of captured areas and adaptive pacing efficacy remain unclear.

Purpose of the Study:

  • To investigate the characteristics of epicardial area captured during ventricular fibrillation (VF) pacing.
  • To determine if adaptively changing pacing rate during VF increases the captured epicardial area.

Main Methods:

  • Pacing during VF was performed in open-chested pigs using a 504-electrode plaque on the anterior right ventricle.
  • Activation maps were constructed from simultaneous recordings to determine the area of epicardium captured by pacing.

Related Experiment Videos

  • Four pacing algorithms were tested: fixed-rate, two adaptive real-time algorithms, and a rate-increasing algorithm.

    • Main Results:

    • Regional capture was achieved in 71% of pacing episodes, with no significant difference between fixed-rate and adaptive algorithms (1-3).
    • Captured area was markedly asymmetrical, with 9.7 times more epicardium captured on the right ventricular side compared to the left.
    • Increasing pacing rate (algorithm 4) maintained capture but progressively decreased the area captured.

    Conclusions:

    • Epicardial capture during VF is repeatable and significantly asymmetrical, influenced by myofiber orientation and VF activation spread.
    • Adaptive pacing algorithms tested did not improve epicardial capture area compared to fixed-rate pacing.
    • While capture can be maintained with increased pacing rates, the captured area diminishes.