Cardiac arrhythmia management by application of adnodal stimulation for

Abstract

An anodal stimulation method and apparatus for the prevention or treatment of tachyarrhythmias using anodal stimulation (AS) energy for effecting hyperpolarization of myocardial cells of a heart chamber to enhance the relaxation thereof in the diastolic phase and to enhance cardiac function, reverse or inhibit cell activation, and thereby treat or prevent tachyarrhythmias. In a preemptive mode with a recognizable ventricular rhythm, the AS pulse is optimally timed to be delivered in an AS delivery interval following an AS delay interval timed from a preceding ventricular depolarization to effect maximal cardiac relaxation and suppress aberrant electrical activity. In a reactive mode responsive to a detected tachyarrhythmia requiring delivery of an anti-tachyarrhythmia therapy, e.g. a cardioversion shock therapy, the AS pulse is delivered during charging of high voltage output capacitors providing the cardioversion shock energy. The sub-threshold AS pulse or train of pulses is increased in energy (amplitude) and/or decreased in energy to and from a peak energy level gradually rather than abruptly. The AS pulses are delivered through a plurality of discrete AS electrodes distributed about the heart chamber or through or large surface area epicardial patch or endocardial AS electrodes.