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Simultaneous double external DC shock techniques for atrial fibrillation: a simulation study
D Konakanchi1, A L de Jongh Curry
1Department of Biomedical Engineering at the University of Memphis, TN 38152, USA. dkonknch@memphis.edu
Summary
Using larger and more electrodes significantly improves direct current cardioversion success rates for atrial fibrillation. This computational study found lower energy requirements and more uniform electrical fields with quadruple electrodes, benefiting refractory patients.
Area of Science:
- Biomedical Engineering
- Computational Electrophysiology
- Cardiovascular Research
Background:
- Direct current cardioversion (DCC) is standard for converting atrial fibrillation (AF) to sinus rhythm (SR).
- DCC success is influenced by factors like AF duration, therapy, electrode parameters, and shock type.
- Refractory AF patients may benefit from advanced defibrillation strategies.
Purpose of the Study:
- To computationally model and compare double-shock defibrillation with conventional single-shock DCC.
- To evaluate the impact of electrode size and quantity on defibrillation threshold (DFT) and heterogeneity index (HI).
Main Methods:
- Computational modeling of electric field distributions in atrial myocardium.
- Simulation of over five thousand electrode placements (conventional and quadruple) with varying electrode sizes.
- Calculation of DFT (energy for 5 V/cm over 95% myocardium) and HI (measure of non-uniformity).
Main Results:
- Increased electrode size and quantity significantly decreased DFT (p<0.01).
- Larger and more electrodes led to a significant reduction in HI (p<0.01).
- Quadruple electrode configurations showed improved electrical field uniformity.
Conclusions:
- Larger and increased numbers of electrodes enhance DCC efficacy by lowering energy requirements and improving electrical field distribution.
- Computational modeling supports the use of quadruple electrodes for improved cardioversion in refractory AF.
- Findings suggest potential for optimizing DCC protocols through advanced electrode configurations.
