Cardiac rhythm management devices provide therapies for both @entity943 and resynchronisation but not @entity712 , which affects millions of @entity1 worldwide. This paper reviews recent advances in biophysics and mathematical engineering that provide a novel technological platform for addressing @entity299 and enabling beat-to-beat adaptation of cardiac pacing in response to physiological feedback. The technology consists of @entity6619 hardware central pattern generators (hCPGs) that may be trained to emulate accurately the dynamical response of biological central pattern generators (bCPGs). We discuss the limitations of present CPGs and appraise the advantages of analog over digital circuits for application in bioelectronic medicine. To test the system, we have focused on the @entity1576 in the medulla oblongata that modulate heart rate in phase with respiration to induce @entity13610 ( @entity13610 ). We describe here a novel, scalable hCPG comprising physiologically realistic (Hodgkin-Huxley type) neurones and synapses. Our hCPG comprises two neurones that antagonise each other to provide rhythmic motor drive to the vagus nerve to slow the heart. We show how recent advances in modelling allow the motor output to adapt to physiological feedback such as respiration. In @entity35 , we report on the restoration of @entity13610 using an hCPG that receives diaphragmatic electromyography input and use it to stimulate the vagus nerve at specific time points of the respiratory cycle to slow the heart rate. We have validated the adaptation of stimulation to alterations in respiratory rate. We demonstrate that the hCPG is tuneable in terms of the depth and timing of the @entity13610 relative to respiratory phase. These pioneering studies will now permit an analysis of the physiological role of @entity13610 as well as its any potential therapeutic use in @entity299 .

XXXX central pattern generators for @entity299 .

@entity1 :: ('9606', 'Species') :: ['patients'] @entity712 :: ('MESH:D006333', 'Disease') :: ['heart failure'] @entity13610 :: ('MESH:D001146', 'Disease') :: ['RSA', 'respiratory sinus arrhythmia'] @entity1576 :: ('MESH:D012131', 'Disease') :: ['cardio-respiratory oscillators'] @entity299 :: ('MESH:D006331', 'Disease') :: ['cardiac disease', 'heart disease'] @entity35 :: ('10116', 'Species') :: ['rats'] @entity943 :: ('MESH:D001145', 'Disease') :: ['arrhythmias'] @entity6619 :: ('MESH:D012825', 'Chemical') :: ['silicon']
@entity6619 :: (MESH:D012825,Chemical) :: ['Silicon']
