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Strength-Duration Characterisation of Subcutaneous Pacing: A Preclinical Study.

Peter Bennett^1,2, Stephen J Hahn¹, Stephen Daniels³

¹Cardiac Rhythm Management R&D, Boston Scientific, Clonmel, Ireland.

Pacing and Clinical Electrophysiology : PACE

|April 19, 2026

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Subcutaneous pacing excitability was characterized in swine, revealing predictable responses to pulse width and waveform. These findings support optimizing energy delivery for extended battery life in new pacing systems.

Area of Science:

Cardiovascular physiology
Biomedical engineering
Electrophysiology

Background:

Subcutaneous and extravascular pacing systems are emerging cardiac rhythm management devices.
Their clinical potential is high, but excitability characteristics are not well defined.

Purpose of the Study:

To define the excitability characteristics of subcutaneous stimulation.
To generate strength-duration curves and derive Lapicque's model parameters (rheobase and chronaxie).

Main Methods:

Acute preclinical studies in swine (n=4) using a coil-to-can subcutaneous pacing configuration.
Delivery of monophasic and biphasic pulses with varying amplitude and duration.
Confirmation of myocardial capture via intra-aortic pressure measurements.

Keywords:

biphasic waveform cardiac electrophysiology cardiac stimulation chronaxie monophasic waveform preclinical model strength‐duration subcutaneous pacing

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Main Results:

A hyperbolic strength-duration profile was observed in all subjects.
Rheobase ranged from 19.54 to 77.58 mA; chronaxie varied from 0.70 to 2.94 ms.
An inverse relationship between rheobase and chronaxie was noted, influenced by factors like electrode geometry and tissue impedance.

Conclusions:

Subcutaneous pacing exhibits excitability consistent with Lapicque's theory.
Stimulus thresholds depend predictably on pulse width and waveform, allowing for optimization of energy delivery.
Data support programming strategies and device designs for lower energy use and extended battery life in subcutaneous and extravascular pacing systems.