Optimization of Gastric Pacing Parameters Using High-Resolution Mapping

Objective:
Abnormal slow-wave activity has been associated with functional motility disorders. Gastric pacing has been investigated to correct slow-wave abnormalities, but clinical therapies are yet to be established. This study aimed to define optimal parameters to advance the application of gastric pacing.
Methods:
High-resolution gastric mapping was utilized to evaluate four pacing parameters in in-vivo pig studies: (i) orientation of the pacing electrodes (longitudinal vs circumferential), (ii) pacing energy (900 vs 10,000 ms mA
²
), (iii) the pacing location (corpus vs antrum), and (iv) pacing period (between 12 and 36 s).
Results:
The probability of slow-wave initiation and entrainment with the pacing electrodes oriented longitudinally was significantly higher than with electrodes orientated circumferentially (86 vs 10%). High-energy pacing accelerated entrainment over the entire mapped field compared to low-energy pacing (3.1±1.5 vs 7.3±2.4 impulses, p < 0.001). Regardless of the location of the pacing site, the new site of slow-wave initiation was always located 4–12 mm away from the pacing site, between the greater curvature and negative pacing electrode. A pacing period between 14–30 s resulted in stable slow-wave initiation and entrainment.
Conclusion:
These data will now inform effective application of gastric pacing in future studies, including human translation.