A novel approach for model-based design of gastric pacemakers

Wang, Luman; Malik, Avinash; Roop, Partha S.; Cheng, Leo K.; Paskaranandavadivel, Niranchan; Ai, Weiwei

doi:10.1016/j.compbiomed.2019.103576

Cited by 10 publications

(4 citation statements)

References 36 publications

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“…In addition, the role played by small intestine pacing on motility functions can be explored by mapping the contractile response. Closed-loop pacing strategies which minimize battery consumption can also improve the efficacy of this promising technique 63 , 64 .…”

Section: Discussionmentioning

confidence: 99%

Optimization of pacing parameters to entrain slow wave activity in the pig jejunum

Nagahawatte,

Avci,

Paskaranandavadivel

et al. 2024

Sci Rep

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Pacing has been proposed as a therapy to restore function in motility disorders associated with electrical dysrhythmias. The spatial response of bioelectrical activity in the small intestine to pacing is poorly understood due to a lack of high-resolution investigations. This study systematically varied pacing parameters to determine the optimal settings for the spatial entrainment of slow wave activity in the jejunum. An electrode array was developed to allow simultaneous pacing and high-resolution mapping of the small intestine. Pacing parameters including pulse-width (50, 100 ms), pulse-amplitude (2, 4, 8 mA) and pacing electrode orientation (antegrade, retrograde, circumferential) were systematically varied and applied to the jejunum (n = 15 pigs). Pulse-amplitudes of 4 mA (p = 0.012) and 8 mA (p = 0.002) were more effective than 2 mA in achieving spatial entrainment while pulse-widths of 50 ms and 100 ms had comparable effects (p = 0.125). A pulse-width of 100 ms and a pulse-amplitude of 4 mA were determined to be most effective for slow wave entrainment when paced in the antegrade or circumferential direction with a success rate of greater than 75%. These settings can be applied in chronic studies to evaluate the long-term efficacy of pacing, a critical aspect in determining its therapeutic potential.

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Section: Discussionmentioning

confidence: 99%

Optimization of pacing parameters to entrain slow wave activity in the pig jejunum

Nagahawatte,

Avci,

Paskaranandavadivel

et al. 2024

Sci Rep

Self Cite

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“…78 To proceed with clinical translation, it is important to demonstrate that the pacing does not cause tissue trauma, and therefore, where the extrinsic pacing pulses are synchronized with the intrinsic activity. [88][89][90] It is hypothesized that multi-point pacing will require less overall energy and enable the slow waves to be entrained over an extended length of the bowel. There are no studies to date on multi-site intestinal pacing with simultaneous bio-electrical recording, which could be a useful strategy as this field continues to develop.…”

Section: Discussionmentioning

confidence: 99%

“…To proceed with clinical translation, it is important to demonstrate that the pacing does not cause tissue trauma, and therefore, histological studies of the pacing sites are required. Furthermore, an emerging research area is the potential of “closed‐loop” pacing, where the extrinsic pacing pulses are synchronized with the intrinsic activity 88–90 . It is hypothesized that multi‐point pacing will require less overall energy and enable the slow waves to be entrained over an extended length of the bowel.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of small intestine pacing parameters for modulation of gut function

Nagahawatte

Cheng

Avci

et al. 2022

Neurogastroenterology Motil

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Background and Purpose:The efficacy of conventional treatments for severe and chronic functional motility disorders remains limited. High-energy pacing is a promising alternative therapy for patients that fail conventional treatment. Pacing primarily regulates gut motility by modulating rhythmic bio-electrical events called slow waves.While the efficacy of this technique has been widely investigated on the stomach, its application in the small intestine is less developed. This systematic review was undertaken to summarize the status of small intestinal pacing and evaluate its efficacy in modulating bowel function through preclinical research studies. Methods:The literature was searched using Scopus, PubMed, Ovid, Cochrane, CINAHL, and Google Scholar. Studies investigating electrophysiological, motility, and/or nutrient absorption responses to pacing were included. A critical review of all included studies was conducted comparing study outcomes against experimental protocols. Results:The inclusion criteria were met by 34 publications. A range of pacing parameters including amplitude, pulse width, pacing direction, and its application to broad regional small intestinal segments were identified and assessed. Out of the 34 studies surveyed, 20/23 studies successfully achieved slow-wave entrainment, 9/11 studies enhanced nutrient absorption and 21/27 studies modulated motility with pacing. Conclusion:Small intestine pacing shows therapeutic potential in treating disorders such as short bowel syndrome and obesity. This systematic review proposes standardized protocols to maximize research outcomes and thereby translate to human studies for clinical validation. The use of novel techniques such as high-resolution electrical, manometric, and optical mapping in future studies will enable a mechanistic understanding of pacing.

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“…A series of automata or rule-based models were also developed to investigate the effects of pacing or slow wave abnormalities in dogs, pigs, and rats (Familoni et al, 2005;Du et al, 2009b;Lammers et al, 2011). One of the key features of the rulebased models was the ability to impose precise definitions of the relative and absolute refractory periods so the expected propagations and their responses to stimulation could be simulated quickly and the system can be adopted to model a closed-loop operation (Wang et al, 2020a). However, a limitation of this approach is the plasticity of the response of the individual automata, which means frequency dependent responses to stimulation, such as frequency restitution cannot be easily modeled (Wang et al, 2017).…”

Section: Mathematical Modelsmentioning

confidence: 99%

Strategies to Refine Gastric Stimulation and Pacing Protocols: Experimental and Modeling Approaches

et al. 2021

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Gastric pacing and stimulation strategies were first proposed in the 1960s to treat motility disorders. However, there has been relatively limited clinical translation of these techniques. Experimental investigations have been critical in advancing our understanding of the control mechanisms that innervate gut function. In this review, we will discuss the use of pacing to modulate the rhythmic slow wave conduction patterns generated by interstitial cells of Cajal in the gastric musculature. In addition, the use of gastric high-frequency stimulation methods that target nerves in the stomach to either inhibit or enhance stomach function will be discussed. Pacing and stimulation protocols to modulate gastric activity, effective parameters and limitations in the existing studies are summarized. Mathematical models are useful to understand complex and dynamic systems. A review of existing mathematical models and techniques that aim to help refine pacing and stimulation protocols are provided. Finally, some future directions and challenges that should be investigated are discussed.

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A novel approach for model-based design of gastric pacemakers

Cited by 10 publications

References 36 publications

Optimization of pacing parameters to entrain slow wave activity in the pig jejunum

Optimization of pacing parameters to entrain slow wave activity in the pig jejunum

Systematic review of small intestine pacing parameters for modulation of gut function

Strategies to Refine Gastric Stimulation and Pacing Protocols: Experimental and Modeling Approaches

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