Ventricular Defibrillation Combining DC Electrical Field and Electrical Pacing: An Optical Mapping Study

Sai Shruthi Musunuri, Liang Tang, Boyoung Joung, Edward J. Berbari, Shien Fong Lin

Research output: Contribution to journalConference article

1 Citation (Scopus)

Abstract

Although high voltage direct current (DC) shock is a standard technique to terminate ventricular fibrillation (VF), it can cause severe pain and tissue damage. The exact effect of the DC electric field, which can depolarize the heart during VF is still unknown. We hypothesized that low-energy DC field in combination with pacing (pacing+DC) could terminate VF by affecting the ventricular propagation pattern. In six Langendorff-perfused isolated rabbit hearts with the ablated sinoatrial (SA) node, the DC field was delivered to the left ventricle (cathode) and right ventricle (anode). We designed a timed protocol using LabVIEW programming that delivers pacing, DC and pacing+DC stimuli for two seconds time intervals each. The pacing pulse (with varying pacing cycle length: 300ms-30ms) was delivered to the apex. Transmembrane voltage was recorded with optical mapping technique for 16 seconds at a sampling rate of 2ms/frame. We crushed the sinoatrial node to reduce the heart rate. The baseline activation appeared to have endocardial origins with a mean escape ventricular rate of 60 ± 5bpm at baseline. The DC field (30mA-60mA) alone increased the mean heart rate to 120±5bpm. Although DC alone terminated VF in a few cases, the rate of termination was very low (6.2%). However, when pacing+DC was applied, it was possible to terminate VF in 34 of 130 episodes in six rabbits. The rate of successful defibrillation of VF with pacing+DC was significantly higher than that with DC alone (20% vs 6.2%, p<0.01). Pacing alone never terminated the VF. In conclusion, DC field may affect the conduction velocity in normal condition. Pacing+DC intervention could lead to regularization of VF propagation and eventually to termination. Further improvement of this approach may offer a higher success rate of defibrillation with lower energy requirements.

Original languageEnglish
Article number718214
JournalProgress in Biomedical Optics and Imaging - Proceedings of SPIE
Volume7182
DOIs
Publication statusPublished - 2009 Jun 1
EventImaging, Manipulation, and Analysis of Biomolecules, Cells, and Tissues VII - San Jose, CA, United States
Duration: 2009 Jan 262009 Jan 28

Fingerprint

Defibrillation
Ventricular Fibrillation
fibrillation
direct current
Sinoatrial Node
Electric potential
Heart Ventricles
Terminate
Anodes
Electrodes
Cathodes
Heart Rate
Chemical activation
Electric fields
heart rate
Tissue
Sampling
Rabbits
Nociceptive Pain
rabbits

All Science Journal Classification (ASJC) codes

  • Electronic, Optical and Magnetic Materials
  • Biomaterials
  • Atomic and Molecular Physics, and Optics
  • Radiology Nuclear Medicine and imaging

Cite this

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title = "Ventricular Defibrillation Combining DC Electrical Field and Electrical Pacing: An Optical Mapping Study",
abstract = "Although high voltage direct current (DC) shock is a standard technique to terminate ventricular fibrillation (VF), it can cause severe pain and tissue damage. The exact effect of the DC electric field, which can depolarize the heart during VF is still unknown. We hypothesized that low-energy DC field in combination with pacing (pacing+DC) could terminate VF by affecting the ventricular propagation pattern. In six Langendorff-perfused isolated rabbit hearts with the ablated sinoatrial (SA) node, the DC field was delivered to the left ventricle (cathode) and right ventricle (anode). We designed a timed protocol using LabVIEW programming that delivers pacing, DC and pacing+DC stimuli for two seconds time intervals each. The pacing pulse (with varying pacing cycle length: 300ms-30ms) was delivered to the apex. Transmembrane voltage was recorded with optical mapping technique for 16 seconds at a sampling rate of 2ms/frame. We crushed the sinoatrial node to reduce the heart rate. The baseline activation appeared to have endocardial origins with a mean escape ventricular rate of 60 ± 5bpm at baseline. The DC field (30mA-60mA) alone increased the mean heart rate to 120±5bpm. Although DC alone terminated VF in a few cases, the rate of termination was very low (6.2{\%}). However, when pacing+DC was applied, it was possible to terminate VF in 34 of 130 episodes in six rabbits. The rate of successful defibrillation of VF with pacing+DC was significantly higher than that with DC alone (20{\%} vs 6.2{\%}, p<0.01). Pacing alone never terminated the VF. In conclusion, DC field may affect the conduction velocity in normal condition. Pacing+DC intervention could lead to regularization of VF propagation and eventually to termination. Further improvement of this approach may offer a higher success rate of defibrillation with lower energy requirements.",
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Ventricular Defibrillation Combining DC Electrical Field and Electrical Pacing : An Optical Mapping Study. / Musunuri, Sai Shruthi; Tang, Liang; Joung, Boyoung; Berbari, Edward J.; Lin, Shien Fong.

In: Progress in Biomedical Optics and Imaging - Proceedings of SPIE, Vol. 7182, 718214, 01.06.2009.

Research output: Contribution to journalConference article

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T1 - Ventricular Defibrillation Combining DC Electrical Field and Electrical Pacing

T2 - An Optical Mapping Study

AU - Musunuri, Sai Shruthi

AU - Tang, Liang

AU - Joung, Boyoung

AU - Berbari, Edward J.

AU - Lin, Shien Fong

PY - 2009/6/1

Y1 - 2009/6/1

N2 - Although high voltage direct current (DC) shock is a standard technique to terminate ventricular fibrillation (VF), it can cause severe pain and tissue damage. The exact effect of the DC electric field, which can depolarize the heart during VF is still unknown. We hypothesized that low-energy DC field in combination with pacing (pacing+DC) could terminate VF by affecting the ventricular propagation pattern. In six Langendorff-perfused isolated rabbit hearts with the ablated sinoatrial (SA) node, the DC field was delivered to the left ventricle (cathode) and right ventricle (anode). We designed a timed protocol using LabVIEW programming that delivers pacing, DC and pacing+DC stimuli for two seconds time intervals each. The pacing pulse (with varying pacing cycle length: 300ms-30ms) was delivered to the apex. Transmembrane voltage was recorded with optical mapping technique for 16 seconds at a sampling rate of 2ms/frame. We crushed the sinoatrial node to reduce the heart rate. The baseline activation appeared to have endocardial origins with a mean escape ventricular rate of 60 ± 5bpm at baseline. The DC field (30mA-60mA) alone increased the mean heart rate to 120±5bpm. Although DC alone terminated VF in a few cases, the rate of termination was very low (6.2%). However, when pacing+DC was applied, it was possible to terminate VF in 34 of 130 episodes in six rabbits. The rate of successful defibrillation of VF with pacing+DC was significantly higher than that with DC alone (20% vs 6.2%, p<0.01). Pacing alone never terminated the VF. In conclusion, DC field may affect the conduction velocity in normal condition. Pacing+DC intervention could lead to regularization of VF propagation and eventually to termination. Further improvement of this approach may offer a higher success rate of defibrillation with lower energy requirements.

AB - Although high voltage direct current (DC) shock is a standard technique to terminate ventricular fibrillation (VF), it can cause severe pain and tissue damage. The exact effect of the DC electric field, which can depolarize the heart during VF is still unknown. We hypothesized that low-energy DC field in combination with pacing (pacing+DC) could terminate VF by affecting the ventricular propagation pattern. In six Langendorff-perfused isolated rabbit hearts with the ablated sinoatrial (SA) node, the DC field was delivered to the left ventricle (cathode) and right ventricle (anode). We designed a timed protocol using LabVIEW programming that delivers pacing, DC and pacing+DC stimuli for two seconds time intervals each. The pacing pulse (with varying pacing cycle length: 300ms-30ms) was delivered to the apex. Transmembrane voltage was recorded with optical mapping technique for 16 seconds at a sampling rate of 2ms/frame. We crushed the sinoatrial node to reduce the heart rate. The baseline activation appeared to have endocardial origins with a mean escape ventricular rate of 60 ± 5bpm at baseline. The DC field (30mA-60mA) alone increased the mean heart rate to 120±5bpm. Although DC alone terminated VF in a few cases, the rate of termination was very low (6.2%). However, when pacing+DC was applied, it was possible to terminate VF in 34 of 130 episodes in six rabbits. The rate of successful defibrillation of VF with pacing+DC was significantly higher than that with DC alone (20% vs 6.2%, p<0.01). Pacing alone never terminated the VF. In conclusion, DC field may affect the conduction velocity in normal condition. Pacing+DC intervention could lead to regularization of VF propagation and eventually to termination. Further improvement of this approach may offer a higher success rate of defibrillation with lower energy requirements.

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