Mélissa Dali1, Chloé Picq2, Olivier Rossel3, Pawel Maciejasz4, Charles-Henri Malbert5, David Guiraud6. 1. INRIA, University of Montpellier, Montpellier, France. Electronic address: Melissa.DALI@cnrs.fr. 2. Axonic, Sophia Antipolis, France. 3. University Hospital of Montpellier, Montpellier, France. 4. Otto Bock HealthCare GmbH, Duderstadt, Germany. 5. INRA, Rennes, France. 6. INRIA, University of Montpellier, Montpellier, France.
Abstract
BACKGROUND: In the context of morbid obesity, vagus nerve stimulation could be used to control gastric function targeting the small afferent B-fibers and C-fibers. Compared to large A-fibers, activation thresholds of these small efferent fibers are 10 to 100 times greater, inducing technical constraints and possible nerve damages. Although rectangular waveform is commonly used in nerve stimulation, recent modeling and experimental studies suggest that non-rectangular waveforms could reduced the charge injected by the stimulator. NEW METHOD: The objective of the present study is to evaluate the charge injection of complex waveforms such as the ramp, quarter sine and chopped pulses in the context of vagus nerve stimulation. We performed in-vivo study on the porcine abdominal vagus nerves and evaluated charge injection at activation thresholds. A modeling study was performed to further extent the results obtained in-vivo. COMPARISON WITH EXISTING METHOD: Compared to the rectangular pulse, the ramp and quarter sine waveforms activated gastric fibers with the lowest charge injection: -23.2% and -30.1% respectively. The efficacy of chopped pulses is questioned through the consideration of the strength-duration curve. CONCLUSION: Continuous ramp and quarter sine waveforms effectively activate small diameter fibers. These pulse shapes may be considered for long-term vagus nerve stimulation. The results predicted by computational models were qualitatively consistent with experiments. This suggested the relevance of using modeling in the context of complex waveforms prior to future in-vivo tests.
BACKGROUND: In the context of morbid obesity, vagus nerve stimulation could be used to control gastric function targeting the small afferent B-fibers and C-fibers. Compared to large A-fibers, activation thresholds of these small efferent fibers are 10 to 100 times greater, inducing technical constraints and possible nerve damages. Although rectangular waveform is commonly used in nerve stimulation, recent modeling and experimental studies suggest that non-rectangular waveforms could reduced the charge injected by the stimulator. NEW METHOD: The objective of the present study is to evaluate the charge injection of complex waveforms such as the ramp, quarter sine and chopped pulses in the context of vagus nerve stimulation. We performed in-vivo study on the porcine abdominal vagus nerves and evaluated charge injection at activation thresholds. A modeling study was performed to further extent the results obtained in-vivo. COMPARISON WITH EXISTING METHOD: Compared to the rectangular pulse, the ramp and quarter sine waveforms activated gastric fibers with the lowest charge injection: -23.2% and -30.1% respectively. The efficacy of chopped pulses is questioned through the consideration of the strength-duration curve. CONCLUSION: Continuous ramp and quarter sine waveforms effectively activate small diameter fibers. These pulse shapes may be considered for long-term vagus nerve stimulation. The results predicted by computational models were qualitatively consistent with experiments. This suggested the relevance of using modeling in the context of complex waveforms prior to future in-vivo tests.
Authors: Jason P Wright; Ibrahim T Mughrabi; Jason Wong; Jose Mathew; Naveen Jayaprakash; Christine Crosfield; Eric H Chang; Sangeeta S Chavan; Kevin J Tracey; Valentin A Pavlov; Yousef Al-Abed; Theodoros P Zanos; Stavros Zanos; Timir Datta-Chaudhuri Journal: Biosens Bioelectron Date: 2021-12-11 Impact factor: 12.545