Antitachycardia pacing and improved lead for ventricular conduction system stimulation

抗心动过速起搏和改善心室传导系统刺激的导联

• 批准号: 10478220
• 负责人: Derek J Dosdall
• 金额: $ 61.18万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10478220
• 关键词: Acute; Adoption; Apical; Arrhythmia; Canis familiaris; Cardiac pacemaker; Cardiomyopathies; Chronic; Clinical; Clinical Trials; Congestive Heart Failure; Development; Effectiveness; Electrodes; Functional disorder; Funding; Goals; Heart; Heart Rate; Heart failure; Implant; Incidence; Infarction; Ischemia; Lead; Left; Length; Life; Modeling; Myocardial; Myocardium; Nodal; Pacemakers; Pain; Patients; Performance; Physicians; Physiologic pulse; Physiological; Preparation; Reperfusion Therapy; Right ventricular structure; Role; Safety; Science; Shock; Sinus; Site; System; Techniques; Testing; Validation; Ventricular; Ventricular Tachycardia; Work; base; canine model; epicardial mapping; evidence base; hemodynamics; implantable device; implantation; improved; in vivo; individual patient; individual response; mortality; novel; optimal treatments; relating to nervous system; 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 and left bundle branch (LBB) 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 antitachycardia pacing (ATP) that utilize sensing may be less effective if the His activation and the local myocardial activations lead to inappropriate calculation of the ventricular tachycardia (VT) cycle length. ATP is an effective technique to terminate ventricular tachycardias without delivering high-energy, painful shocks. However, efficacy of ATP techniques with a His bundle or LBB lead has not been demonstrated. Using a canine model of ischemia-reperfusion induced VT, the hypothesis will be tested that ATP will utilize the His-Purkinje network to terminate VT with greater efficacy than standard right ventricular lead ATP therapy. 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 and LBB applications and demonstrate the effectiveness of ATP therapy with His bundle and LBB leads. 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 生理上正常的心率。从历史上看，右心顶的起搏器已经交付 脉搏到心室。在某些患者中，右心室中的慢性节奏可能导致 心室异位障碍，起搏引起的心肌病和充血性心力衰竭增加 发病率。与右侧相比 心室起搏，但多达1/3的患者是双室起搏的无反应者。永久性他 束和左捆分支（LBB）起搏最近已显示导致心力衰竭和 提高同步性，与标准权利相比，具有死亡率益处的趋势 心室或双室铅放置。 减慢了捆绑起搏的限制包括1）更高的起搏 与其他铅配置相比，阈值可能会降低植入设备的电池寿命 适用于高速起搏需求的患者，以及2）在感应和起搏时缺乏选择性 和邻近的心肌心肌。使用抗心动心脏步调（ATP）等疗法 如果他的激活和局部心肌激活导致他的感应可能不太有效 心室心动过速（VT）周期长度的不当计算。 ATP是一种有效的技术，可以终止心室心动过速，而无需提供高能量， 痛苦的冲击。但是，ATP技术与他的束或LBB铅的功效尚未 证明。使用缺血 - 再灌注诱导的VT的犬模型，将检验该假设 该ATP将利用His-Purkinje网络以比标准权更大的效力终止VT 心室铅ATP治疗。 提出了一种新颖的，透性的，多电极起搏的铅，将允许低阈值， 他的束和相邻的心肌心肌的选择性感测和起搏。改进 铅配置将在离体犬心脏中执行，新铅的验证将是 在体内慢性狗模型中展示。铅配置将在当前部署 可用的工具和技术，将允许医生根据 个别患者的反应。 该项目的完成将导致其捆绑起搏的铅系统大大改善 和LBB的应用，并通过其捆绑包和LBB铅来证明ATP治疗的有效性。 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百万名患者。