1. A Novel Cardiac Pacing Paradigm for Atrial Fibrillation and Heart Failure Patients George Emanuel Yanulis, PhD

8. Schematic Representation of Cardiac Conduction Pathways in the Human Heart http://images.main.uab.edu/

9. Concept of Coupled Pacing during AF (Electrically Activating the Ventricles after a Specific Delay) Atrium Ventricle AVN                       Atrium Ventricle AVN

11. Coupled Pacing vs. Paired Stimulation

14. Placement of the Leads, Adapters, and Pacemakers for the AF Model Cingoz et al (2007). The Annals of Thoracic Surgery , 83 (5), 1858-1862.

16. ECG Tracings The top panel shows when the animal was in sinus rhythm. The number indicates the intrinsic electrical activations. The middle panel show when the animal was in persistent AF. The bottom panel shows coupled pacing.

17. Yanulis et al (2008). The Annals of Thoracic Surgery, 86(3), 984-987

19. Hemodynamic Tracings Marks above the left ventricular (LV) pressure tracings illustrate VRMC, and marks above the aortic flow tracings illustrate VREJ.

23. Electrical Activations of the Normal Heart www.physiome.org

24. RV Apex Pacing Left Bundle Branch Block Prinzen et al, 2000

29. Animal preparation RA electrode RV electrode Epicardial Echocardiography LV electrode Vagal electrode

31. RV pacing HR=178bpm Step 2 QRS=120ms SD=16% CRT+CP HR=110bpm Step 4 QRS=90ms SD=5% CRT-VS HR=110bpm Step 5 QRS=90ms SD=3% -12% -7% -14% Baseline HR=103bpm Step 1 QRS=80ms SD=5% Atrial Fibrillation Sinus rhythm Dog #176 CRT HR=197bpm Step 3 QRS=90ms SD=5% -3% -19%

35. Pressure Recording (Millar Sensors) Mock II Circulatory Circuit (Results) Photograph of the Mock II Circulatory Circuit