Novel lead for selective His bundle sensing and low-threshold pacing

用于选择性希束传感和低阈值起搏的新型导线

• 批准号: 10421275
• 负责人: Derek J Dosdall
• 金额: $ 22.88万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-07 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10421275
• 关键词: 3D Print; Address; Adoption; Apical; Canis familiaris; Cardiomyopathies; Catheters; Chronic; Clinical; Congestive Heart Failure; Detection; Development; Devices; Electrodes; Functional disorder; Goals; Heart; Heart Rate; Heart failure; Implant; Incidence; Lead; Length; Life; Location; Longevity; Modeling; Monitor; Myocardial; Myocardium; Nodal; Pacemakers; Patient-Focused Outcomes; Patients; Performance; Phase; Physicians; Physiologic pulse; Physiological; Procedures; Resolution; Right ventricular structure; Risk; System; Tachycardia; Techniques; Technology; Testing; Training; Utah; Validation; Ventricular; Ventricular Tachycardia; Ventricular septum; base; canine model; cardiogenesis; clinically relevant; cohort; design; experience; hemodynamics; implantable device; implantation; improved; in vivo; individual patient; individual response; mortality; novel; prototype; sample fixation; tool; trend

Project Summary Nodal dysfunction in patients often requires the implantation of a pacemaker to maintain physiologically normal heart rates. Historically, a pacemaker in the right ventricular apex has delivered pacing pulses to the ventricles. In some patients, chronic pacing in the right ventricle may lead to ventricular dyssynchrony, pacing induced cardiomyopathy, and increased congestive heart failure incidence. Biventricular pacing has been shown to lead to improved performance compared to right ventricular pacing, but up to 1/3 of patients are non- responders to biventricular pacing. Permanent His bundle pacing has recently been shown to lead to less heart failure and improved synchronicity, with a trend towards a mortality benefit as compared to the standard right ventricular or biventricular lead placement. Limitations that have slowed the adoption of His bundle pacing include 1) higher pacing thresholds as compared to other lead configurations, which may reduce battery life in implanted devices for patients with high pacing demand, and 2) a lack of selectivity in sensing and pacing the His bundle and adjacent ventricular myocardium. Therapies such as anti-tachycardia pacing that utilize sensing may be less effective if the His activation and the local myocardial activations lead to inappropriate calculation of the ventricular tachycardia cycle length. A novel, transvenous, multielectrode pacing lead is proposed that will allow for low threshold, selective sensing and pacing of the His bundle and the adjacent ventricular myocardium. Refinement of the lead configuration will be performed in ex vivo canine hearts, and validation of the new lead will be demonstrated in an in vivo, chronic dog model. The lead configuration will be deployable with currently available tools and techniques and will allow the physician to optimize the pacing therapy based on the response of individual patients. Completion of this project will lead to a substantially improved lead system for His bundle pacing applications. This translational project may have an immediate impact on pacemaker implantation for many of the one million patients worldwide that are implanted with pacemakers each year.

项目摘要 患者的淋巴结功能障碍通常需要植入起搏器才能维持生理 正常的心率。从历史上看，右心顶的起搏器已将起搏脉冲传递给 心室。在某些患者中，右心室中的慢性节奏可能导致心室不障碍，起搏 诱导心肌病，并增加充血性心力衰竭的发病率。双室起搏已经 与右心步调相比，证明可以提高性能，但多达1/3的患者是非 - 响应者对双室起搏。永久性他的捆绑起搏已被证明会导致心脏更少 与标准权相比 心室或双室铅放置。 减慢了捆绑起搏的限制包括1）较高的起搏阈值 与其他铅配置相比，这可能会降低植入设备的电池寿命 节奏需求，以及2）缺乏选择性的感觉和起搏 心肌。如果他的抗心痛节奏，例如使用感应的疗法，如果他的感觉 激活和局部心肌激活导致心室心动过速的计算不当 循环长度。 提出了一种新颖的，透性的，多电极起搏的铅，它将允许低阈值，选择性 他的束和相邻的心室心肌的感觉和起搏。铅的完善 配置将在离体犬心脏中进行，新铅的验证将在 体内，慢性狗模型。铅配置将使用当前可用的工具和 技术，将允许医生根据个人的反应来优化起搏疗法 患者。 该项目的完成将导致其捆绑起搏的铅系统大大改善 申请。这个翻译项目可能会对许多人的起搏器植入产生直接影响 每年在全球植入起搏器的一百万患者。

项目成果

Shorter distance between the esophagus and the left atrium is associated with higher rates of esophageal thermal injury after radiofrequency ablation.

• DOI: 10.1111/jce.15554
• 发表时间: 2022-07
• 期刊: JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
• 影响因子: 2.7
• 作者: Ishidoya, Yuki;Kwan, Eugene;Dosdall, Derek J.;Macleod, Rob S.;Navaravong, Leenhapong;Steinberg, Benjamin A.;Bunch, T. Jared;Ranjan, Ravi
• 通讯作者: Ranjan, Ravi

Atrial slow conduction develops and dynamically expands during premature stimulation in an animal model of persistent atrial fibrillation.

• DOI: 10.1371/journal.pone.0258285
• 发表时间: 2021
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Lange M;Hirahara AM;Ranjan R;Stoddard GJ;Dosdall DJ
• 通讯作者: Dosdall DJ

Short-term natural course of esophageal thermal injury after ablation for atrial fibrillation.

• DOI: 10.1111/jce.15553
• 发表时间: 2022-07
• 期刊: JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
• 影响因子: 2.7
• 作者: Ishidoya, Yuki;Kwan, Eugene;Dosdall, Derek J.;Macleod, Rob S.;Navaravong, Leenhapong;Steinberg, Benjamin A.;Bunch, T. Jared;Ranjan, Ravi
• 通讯作者: Ranjan, Ravi