Non-invasive cardiac pacing with image-guided focused ultrasound.
Currently, no non-invasive cardiac pacing device acceptable for prolonged use in conscious patients exists. High Intensity Focused Ultrasound (HIFU) can be used to perform remote pacing using reversibility of electromechanical coupling of cardiomyocytes. Here we described an extracorporeal cardiac stimulation device and study its efficacy and safety. We conducted experiments ex vivo and in vivo in a large animal model (pig) to evaluate clinical potential of such a technique. The stimulation threshold was determined in 10 different ex vivo hearts and different clinically relevant electrical effects such as consecutive stimulations of different heart chambers with a single ultrasonic probe, continuous pacing or the inducibility of ventricular tachycardia were shown. Using ultrasonic contrast agent, consistent cardiac stimulation was achievable in vivo for up to 1 hour sessions in 4 different animals. No damage was observed in inversion-recovery MR sequences performed in vivo in the 4 animals. Histological analysis revealed no differences between stimulated and control regions, for all ex vivo and in vivo cases.
IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France.|Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France.|INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France.
Fabrice
F
Marquet
IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France.|Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France.|INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France.|Image-Guided Therapy SA, F-33600 Pessac, France.
Pierre
P
Bour
IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France.|Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France.|INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France.
Fanny
F
Vaillant
IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France.|Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France.|INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France.|Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F-33600 Pessac, France.
Sana
S
Amraoui
IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France.|Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France.|INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France.
Rémi
R
Dubois
IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France.|Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France.|INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France.|Bordeaux University Hospital (CHU), Electrophysiology and Cardiac Stimulation Unit, F-33600 Pessac, France.
Philippe
P
Ritter
IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France.|Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France.|INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France.|Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F-33600 Pessac, France.
Michel
M
Haïssaguerre
IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France.|Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France.|INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France.|Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F-33600 Pessac, France.
Mélèze
M
Hocini
IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France.|Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France.|INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France.
Olivier
O
Bernus
IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France.|Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France.|INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France.
Bruno
B
Quesson
D000818:Animals; D002304:Cardiac Pacing, Artificial; D005240:Feasibility Studies; D006321:Heart / Q000502:physiology*; D023421:Models, Animal; D013552:Swine; D014463:Ultrasonography