TY - JOUR
T1 - Clinical potential of beat-to-beat diastolic interval control in preventing cardiac arrhythmias
AU - Kulkarni, Kanchan
AU - Walton, Richard D.
AU - Armoundas, Antonis A.
AU - Tolkacheva, Elena G.
N1 - Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2021
Y1 - 2021
N2 - Life-threatening ventricular arrhythmias and sudden cardiac death are often preceded by cardiac alternans, a beat-to-beat oscillation in the T-wave morphology or duration. However, given the spatiotemporal and structural complexity of the human heart, designing algorithms to effectively suppress alternans and prevent fatal rhythms is challenging. Recently, an antiarrhythmic constant diastolic interval pacing protocol was proposed and shown to be effective in suppressing alternans in 0-, 1-, and 2-dimensional in silico studies as well as in ex vivo whole heart experiments. Herein, we provide a systematic review of the electrophysiological conditions and mechanisms that enable constant diastolic interval pacing to be an effective antiar-rhythmic pacing strategy. We also demonstrate a successful translation of the constant diastolic interval pacing protocol into an ECG-based real-time control system capable of modulating beat-to-beat cardiac electrical activity and preventing alter-nans. Furthermore, we present evidence of the clinical utility of real-time alternans suppression in reducing arrhythmia suscep-tibility in vivo. We provide a comprehensive overview of this promising pacing technique, which can potentially be translated into a clinically viable device that could radically improve the quality of life of patients experiencing abnormal cardiac rhythms.
AB - Life-threatening ventricular arrhythmias and sudden cardiac death are often preceded by cardiac alternans, a beat-to-beat oscillation in the T-wave morphology or duration. However, given the spatiotemporal and structural complexity of the human heart, designing algorithms to effectively suppress alternans and prevent fatal rhythms is challenging. Recently, an antiarrhythmic constant diastolic interval pacing protocol was proposed and shown to be effective in suppressing alternans in 0-, 1-, and 2-dimensional in silico studies as well as in ex vivo whole heart experiments. Herein, we provide a systematic review of the electrophysiological conditions and mechanisms that enable constant diastolic interval pacing to be an effective antiar-rhythmic pacing strategy. We also demonstrate a successful translation of the constant diastolic interval pacing protocol into an ECG-based real-time control system capable of modulating beat-to-beat cardiac electrical activity and preventing alter-nans. Furthermore, we present evidence of the clinical utility of real-time alternans suppression in reducing arrhythmia suscep-tibility in vivo. We provide a comprehensive overview of this promising pacing technique, which can potentially be translated into a clinically viable device that could radically improve the quality of life of patients experiencing abnormal cardiac rhythms.
KW - Alternans
KW - Arrhythmias
KW - Control
KW - Diastolic interval
KW - Pacing
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U2 - 10.1161/JAHA.121.020750
DO - 10.1161/JAHA.121.020750
M3 - Review article
C2 - 34027678
AN - SCOPUS:85107390782
SN - 2047-9980
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 11
M1 - e020750
ER -