title: Atrial septal pacing for the termination of atrial fibrillation: study in a biophysical model of human atria.
abstract: OBJECTIVE
  While successful termination by pacing of organized atrial tachycardias has been observed in patients, single site rapid pacing has not yet led to conclusive results for the termination of atrial fibrillation (AF). The purpose of this study was to evaluate a novel atrial septal pacing algorithm for the termination of AF in a biophysical model of the human atria.
  
  
  RESULTS
  Sustained AF was generated in a model based on human magnetic resonance images and membrane kinetics. Rapid pacing was applied from the septal area following a dual-stage scheme: (i) rapid pacing for 10-30 s at pacing intervals 62-70% of AF cycle length (AFCL), (ii) slow pacing for 1.5 s at 180% AFCL, initiated by a single stimulus at 130% AFCL. Atrial fibrillation termination success rates were computed. A mean success rate for AF termination of 10.2% was obtained for rapid septal pacing only. The addition of the slow pacing phase increased this rate to 20.2%. At an optimal pacing cycle length (64% AFCL) up to 29% of AF termination was observed.
  
  
  CONCLUSIONS
  The proposed septal pacing algorithm could suppress AF reentries in a more robust way than classical single site rapid pacing. Experimental studies are now needed to determine whether similar termination mechanisms and rates can be observed in animals or humans, and in which types of AF this pacing strategy might be most effective.
authors.affiliation: Applied Signal Processing Group,  Swiss Federal Institute of Technology, Lausanne,  Switzerland.
authors.forename: Laurent
authors.initials: L
authors.lastname: Uldry
authors.forename: Nathalie
authors.initials: N
authors.lastname: Virag
authors.forename: Fred
authors.initials: F
authors.lastname: Lindemans
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Vesin
authors.forename: Lukas
authors.initials: L
authors.lastname: Kappenberger
mesh_terms: D000465:Algorithms; D000818:Animals; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000517:prevention & control*; D054087:Atrial Septum / Q000503:physiopathology*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003198:Computer Simulation; D006325:Heart Atria / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008955:Models, Cardiovascular; D013813:Therapy, Computer-Assisted / Q000379:methods