Novel Real-time Pacing Strategy for Cardiac-Diastolic-Interval-Control to Prevent Lethal Heart Rhythm Disorders – CarDICo

Sudden cardiac death (SCD), instigated by cardiac arrhythmias forms a significant healthcare burden in Europe with over 350,000 fatalities reported annually. Implantable cardioverter defibrillators (ICDs), are the mainstay treatment for lethal ventricular tachyarrhythmias (VT/VF), however, they suffer from significant limitations. Failure or false detection of VT/VF, cumulative damage to the heart due to frequent and painful ICD shocks, loss of consciousness on arrhythmia onset and extreme psychological stress due to unwarranted electrical discharges are some of the major drawbacks of the ICD technology. We aim to address these current shortcomings by developing a novel, preventive, beat-to-beat cardiac pacing technique, based on an innovative, real-time diastolic interval control technology. Our pacing modality offers to prevent the onset of VT/VF by employing precise control of the diastolic interval on a beat-by-beat basis. In-silico and ex-vivo studies have demonstrated that maintaining a fixed diastolic interval on an every beat basis can inhibit the onset of VT/VF by eliminating the dependence of the diastolic interval on the preceding action potential duration. Hence, electrical disturbances originating at the cellular level are prevented from propagating further and transitioning in to global VT/VF episodes. This preventive electrical interventional therapy can help to reduce the morbidity and mortality resulting from VT/VF, reduce the pain and complications associated with ICDs, reduce the frequency of the high-energy painful ICD discharges and reduce collateral damage to the myocardium during high output electrical shocks. Hence, our promising pacing methodology holds potential to translate into a clinically viable device that can radically improve the quality-of-life of patients suffering from SCD.