Key result
Increasing exponential and ramp-like pacing waveforms reduce cardiac threshold energy by up to ~21%.
Why the study?
Optimization of cardiac pacemaker pulse shape to reduce energy threshold and tissue damage was investigated experimentally in vivo.
Does pulse shape modification reduce cardiac threshold energy in a canine heart model?
Does pulse shape modification reduce cardiac threshold energy in a canine heart model?
Effect estimate: up to 21% reduction
Modifying pacemaker pulse shapes to increasing exponential and ramp-like waveforms significantly reduces pacing energy thresholds in a canine model, potentially extending pacemaker battery life and reducing tissue damage.
Does not support clinical waveform changes; leaves open translation of lower-energy pacing to human devices.
This paper is an experimental extension of theoretical work previously published by one of the authors. Results of pacing a canine heart using four different increasing exponential and ramp-like waveforms are presented. It is shown that these waveforms reduce the cardiac threshold energy by as much as 14 percent when compared with a pure rectangular pulse shape and by about 21 percent when compared with a standard cardiac pacer pulse. It is also found that above threshold energy is reduced by 50-60 percent. These results offer promise of increasing the life of certain new pacer power sources currently being tested. In addition, it may now be possible to pace at lower energy levels, thereby reducing tissue damage near the stimulating electrode, without running as much of a risk of exit block as with a comparable rectangular pulse pacer.
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Klafter et al. (1976) studied Cardiac pacing. Increasing exponential and ramp-like waveforms vs. Pure rectangular pulse shape and standard cardiac pacer pulse was evaluated on Cardiac threshold energy (up to 21% reduction). Pacing a canine heart with increasing exponential and ramp-like waveforms reduced cardiac threshold energy by up to 14% compared to a pure rectangular pulse and 21% compared to a standard pacer pulse.
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