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Antitachycardia Pacing at the His Bundle is Safer than Conventional Right Ventricular Antitachycardia Pacing in a Canine Myocardial Ischemic Injury Model
  • +7
  • Annie Hirahara M,
  • Muhammad Khan S,
  • Omar Gharbia,
  • Matthias Lange,
  • Yuki Ishidoya,
  • Douglas Smego,
  • Ravi Ranjan,
  • Gregory Stoddard J,
  • Craig Selzman,
  • Derek Dosdall
Annie Hirahara M
The University Of Utah Department of Biomedical Engineering
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Muhammad Khan S
The University of Utah
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Omar Gharbia
The University of Utah
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Matthias Lange
The University of Utah
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Yuki Ishidoya
The University of Utah
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Douglas Smego
The University of Utah Department of Surgery
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Ravi Ranjan
The University Of Utah Department of Biomedical Engineering
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Gregory Stoddard J
The University of Utah School of Medicine Center for Clinical and Translational Science
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Craig Selzman
The University of Utah Department of Surgery
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Derek Dosdall
The University Of Utah Department of Biomedical Engineering

Corresponding Author:[email protected]

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Abstract

Introduction: Antitachycardia pacing (ATP) is used to terminate ventricular tachycardia (VT) by delivering rapid, low energy pacing to the right ventricle (RV). Unfortunately, ATP is not effective against all VT episodes and can result in adverse outcomes, such as VT acceleration and degeneration into ventricular fibrillation (VF). Improving ATP is therefore desirable. Our objective was to compare the efficacy and safety of ATP delivered at the His bundle to traditional ATP. Methods: Six dogs were anesthetized and pacing leads were implanted in the RV and His bundle. The lateral anterior descending artery (LAD) was occluded for 2 hours to create an ischemic injury. In a study 4-7 days later, a 128-electrode sock was placed snugly around the ventricles and VT was induced using rapid pacing. ATP was delivered from either the His bundle or RV lead, then attempted at the other location if unsuccessful. Success rates and instances of VT acceleration and degeneration into VF were calculated. Results: We induced 83 runs of VT and attempted ATP 128 times. RV ATP was successful in 36% of attempts; His ATP was successful in 38% of attempts. RV ATP resulted in significantly more adverse outcomes. RV and His ATP induced VT acceleration in 9% and 3% of trains respectively, and induced degeneration into VF in 5% and 1% of trains, respectively. Conclusion: His bundle ATP is safer, but not significantly more effective, than RV ATP.
30 Jan 2023Submitted to Journal of Cardiovascular Electrophysiology
30 Jan 2023Submission Checks Completed
30 Jan 2023Assigned to Editor
30 Jan 2023Review(s) Completed, Editorial Evaluation Pending
04 Feb 2023Reviewer(s) Assigned
20 Mar 2023Editorial Decision: Revise Minor
06 Apr 20231st Revision Received
06 Apr 2023Submission Checks Completed
06 Apr 2023Assigned to Editor
06 Apr 2023Review(s) Completed, Editorial Evaluation Pending
06 Apr 2023Reviewer(s) Assigned
18 Apr 2023Editorial Decision: Accept