Epicardial high-definition electrotherapy of AFib

Project Summary Paroxysmal atrial fibrillation (AF) is expected to affect 16 million Americans in 2050. AF is a heavy burden on the healthcare system. The current treatment strategies for AF include catheter ablation, transthoracic cardioversion, and drug therapy. Currently, no method exists for painless and rapid conversion of atrial fibrillation. This proposal features a novel epicardial high- resolution organ conformal electronics low-energy atrial defibrillator for painless AF conversion. In this project, a human-scale, fully implantable organ conformal device for high-definition detection and therapy of AF will be developed. It will be tested and optimized on a large animal model: a canine model of AF induced by high-rate atrial pacing. The endocardial coil-based multi- pulse therapy (MPT) system previously developed in the Efimov laboratory was tested in multicenter clinical trials for atrial fibrillation and ventricular tachycardia treatment. In this grant proposal, the current resolution limitations of MPT will be overcome by (1) incorporating a high- definition organ conformal array of electrodes to sense AF and delivery of MPT over a wide variety of configurations and vectors; (2) deploying MPT on fully implantable battery-free high-definition cardiac biointerface platform; (3) automatic detection of AF paroxysm; (4) machine learning optimized delivery of low energy high-definition MPT to terminate AF paroxysm without delay to prevent atrial pathological remodeling. In summary, rapid termination of AF paroxysm and conversion to normal sinus rhythm will be achieved at painless energy levels by applying state-of- the-art epicardial high-definition mapping and energy-efficient and optimized high-definition MPT delivery.