Novel bipolar and transmural electrode configurations achieved higher ventricular tachycardia termination efficacy (93% and 85%, respectively) compared to conventional anti-tachycardia pacing (45%).
Do novel bipolar and transmural intra-cardiac electrode configurations improve the efficacy of terminating sustained ventricular tachycardia compared to traditional anti-tachycardia pacing in an in-silico model?
Novel bipolar and transmural electrode configurations demonstrated higher efficacy for terminating ventricular tachycardia compared to conventional anti-tachycardia pacing in an in-silico model.
Absolute Event Rate: 93% vs 45%
The implanted cardioverter defibrillator (ICD) is an effective direct therapy for the treatment of cardiac arrhythmias, including ventricular tachycardia (VT). Anti-tachycardia pacing (ATP) is often applied by the ICD as the first mode of therapy, but is often found to be ineffective, particularly for fast VTs. In such cases, strong, painful and damaging backup defibrillation shocks are applied by the device. Here, we propose two novel electrode configurations: "bipolar" and "transmural" which both combine the concept of targeted shock delivery with the advantage of reduced energy required for VT termination. We perform an in silico study to evaluate the efficacy of VT termination by applying one single (low-energy) monophasic shock from each novel configuration, comparing with conventional ATP therapy. Both bipolar and transmural configurations are able to achieve a higher efficacy (93% and 85%) than ATP (45%), with energy delivered similar to and two orders of magnitudes smaller than conventional ICD defibrillation shocks, respectively. Specifically, the transmural configuration (which applies the shock vector directly across the scar substrate sustaining the VT) is most efficient, requiring typically less than 1 J shock energy to achieve a high efficacy. The efficacy of both bipolar and transmural configurations are higher when applied to slow VTs (100% and 97%) compared to fast VTs (57% and 29%). Both novel electrode configurations introduced are able to improve electrotherapy efficacy while reducing the overall number of required therapies and need for strong backup shocks.
Qian et al. (Sat,) conducted a other in Ventricular tachycardia. Bipolar and transmural electrode configurations vs. Conventional anti-tachycardia pacing (ATP) was evaluated on Efficacy of VT termination. Novel bipolar and transmural electrode configurations achieved higher ventricular tachycardia termination efficacy (93% and 85%, respectively) compared to conventional anti-tachycardia pacing (45%).