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Novel Low-Voltage MultiPulse Therapy to Terminate Atrial Fibrillation

FS. Ng, O. Toman, J. Petru, P. Peichl, RA. Winkle, VY. Reddy, P. Neuzil, RH. Mead, NA. Qureshi, ZI. Whinnett, DW. Bourn, MB. Shelton, J. Kautzner, AD. Sharma, M. Hocini, M. Haïssaguerre, NS. Peters, IR. Efimov

. 2021 ; 7 (8) : 988-999. [pub] 20210331

Jazyk angličtina Země Spojené státy americké

Typ dokumentu časopisecké články, Research Support, N.I.H., Extramural, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/bmc22004022

Grantová podpora
R43 HL107055 NHLBI NIH HHS - United States
R01 HL115415 NHLBI NIH HHS - United States
R01 HL141470 NHLBI NIH HHS - United States
RG/16/3/32175 British Heart Foundation - United Kingdom
R41 HL114329 NHLBI NIH HHS - United States
Department of Health - United Kingdom
R44 HL107055 NHLBI NIH HHS - United States

OBJECTIVES: This first-in-human feasibility study was undertaken to translate the novel low-voltage MultiPulse Therapy (MPT) (Cardialen, Inc., Minneapolis, Minnesota), which was previously been shown to be effective in preclinical studies in terminating atrial fibrillation (AF), into clinical use. BACKGROUND: Current treatment options for AF, the most common arrhythmia in clinical practice, have limited success. Previous attempts at treating AF by using implantable devices have been limited by the painful nature of high-voltage shocks. METHODS: Forty-two patients undergoing AF ablation were recruited at 6 investigational centers worldwide. Before ablation, electrode catheters were placed in the coronary sinus, right and/or left atrium, for recording and stimulation. After the induction of AF, MPT, which consists of up to a 3-stage sequence of far- and near-field stimulation pulses of varied amplitude, duration, and interpulse timing, was delivered via temporary intracardiac leads. MPT parameters and delivery methods were iteratively optimized. RESULTS: In the 14 patients from the efficacy phase, MPT terminated 37 of 52 (71%) of AF episodes, with the lowest median energy of 0.36 J (interquartile range [IQR]: 0.14 to 1.21 J) and voltage of 42.5 V (IQR: 25 to 75 V). Overall, 38% of AF terminations occurred within 2 seconds of MPT delivery (p < 0.0001). Shorter time between AF induction and MPT predicted success of MPT in terminating AF (p < 0.001). CONCLUSIONS: MPT effectively terminated AF at voltages and energies known to be well tolerated or painless in some patients. Our results support further studies of the concept of implanted devices for early AF conversion to reduce AF burden, symptoms, and progression.

Citace poskytuje Crossref.org

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