Key result
In a biophysical model of atrial fibrillation, the number of stimulation electrodes on a septal ring had a lesser impact on AF capture than the AF substrate, suggesting 3-4 electrodes are sufficient.
Why the study?
Does the number of stimulation electrodes in a septal ring impact atrial fibrillation capture in computational models of different AF substrates?
Does the number of stimulation electrodes in a septal ring impact atrial fibrillation capture in computational models of different AF substrates?
Computational modeling suggests that a septal pacing ring with 3-4 electrodes is sufficient for capturing most atrial fibrillation dynamics.
AF substrate alters septal pacing capture in models; leaves open patient-specific clinical translation.
AIMS: Atrial fibrillation (AF) septal pacing consists of rapid pacing from a ring of electrodes around the atrial septum, leading to local capture of both atria during AF. The present model-based study evaluated the impact of the number of stimulation electrodes in the septal ring on AF capture for different types of sustained AF dynamics. METHODS AND RESULTS: Using a biophysical model of AF based on CT scans from an AF patient, models with different AF substrates (Cholinergic AF and Meandering Wavelets) were created by varying the atrial membrane kinetics. Rapid pacing was applied from the septum area with a ring of 1, 2, 3, 4, 6, 8, or 12 electrodes during 20 seconds at a pacing cycle lengths (PCLs) in the range 60-100% of AF cycle length (AFCL), in 4% steps. Percentage of captured tissue during rapid pacing was determined using 24 sensing electrode pairs evenly distributed on the atrial surface. Results were averaged over 10 AF simulations. For Cholinergic AF, the number of stimulation electrodes on the septal ring had no significant impact on AF capture independently of AF dynamics. For Meandering Wavelets, more electrodes were needed to achieve AF capture in the presence of complex AF. CONCLUSION: Changes in AF substrate significantly impacted septal pacing outcomes and response to rapid AF pacing may similarly vary patient-to-patient. The number of stimulation electrodes had a lesser impact, suggesting that the design of a ring with 3-4 electrodes around the septum would be sufficient for most AF dynamics.
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Luca et al. (2016) studied Atrial fibrillation. Rapid pacing from the septum area with a ring of 1 to 12 electrodes vs. Different number of electrodes and AF substrates was evaluated on Percentage of captured tissue during rapid pacing. In a biophysical model of atrial fibrillation, the number of stimulation electrodes on a septal ring had a lesser impact on AF capture than the AF substrate, suggesting 3-4 electrodes are sufficient.
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