Reducing the Pain of Cardiac Electrical Therapies

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Since the discovery that electrical currents were important for cardiac function there has been intense interest in the development of cardiac electrical therapies. The most common cardiac electrical therapies today are pacing and defibrillation, which act to restore mechanical function and blood flow by correcting pathological electrical dysrhythmias. Each year over 100,000 implantable cardioverter defibrillators (ICDs) are implanted in the US alone, and despite significant research, both ICDs and noninvasive pacing therapies are limited by the common issue of pain. The pain of electrical therapies is a well-studied yet poorly-understood limitation that has created underserved clinical populations. My work to reduce pain uses biophysically detailed computational models, isolated muscle and heart preparations, and large animal in vivo experiments. A novel method to quantify pain in animals was developed based on extensive evidence suggesting that aberrant skeletal muscle contraction underlies shock-induced pain. This measurement, the rate of force development (RoFD), was then used to develop a novel waveform to reduce pain caused by defibrillation. I will discuss this prior work, other studies to reduce the pain of external cardiac pacing, and ongoing work to translate our findings to human clinical application.

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