His-Purkinje Pacing for Low Energy Implantable Cardioverter Defibrillators

用于低能量植入式心脏复律除颤器的希氏浦肯野起搏

• 批准号: 8944632
• 负责人: Derek J Dosdall
• 金额: $ 48.72万
• 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 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8944632
• 关键词: Algorithms; American; Animal Model; Animals; Anxiety; Arrhythmia; Atrial Fibrillation; Canis familiaris; Cardiac; Cardiac conduction system; Catheters; Cause of Death; Cessation of life; Chronic; Clinical; Conscious; Dilated Cardiomyopathy; Effectiveness; Electric Countershock; Electrodes; Electroporation; Failure; Goals; Heart; Heart failure; Implant; Implantable Defibrillators; Lead; Legal patent; Length; Maintenance; Maps; Measures; Microelectrodes; Modeling; Morbidity - disease rate; Myocardial; Myocardial Ischemia; Myocardium; Optics; Oryctolagus cuniculus; Pain; Patients; Physiologic pulse; Play; Quality of life; Risk; Role; Series; Shock; Sinus; Structure of purkinje fibers; System; Techniques; Technology; Testing; Time; Tissues; Training; Ventricular; Ventricular Fibrillation; Work; clinically relevant; effective therapy; high risk; implantable device; implantation; improved; mortality; public health relevance; simulation; sudden cardiac death; theories; virtual

 DESCRIPTION (provided by applicant): Ventricular fibrillation (VF) is a leading cause of death in the industrialized world. The only effective treatment for VF is electrical defibrillation. In te US alone, approximately 150,000 patients at high risk of VF receive implantable cardioverter defibrillators (ICDs) each year. The large shocks delivered by ICDs may lead to cardiac damage and anxiety in patients. Significant reductions in defibrillation shock energy may lead to reduced mortality and improved quality of life for ICD patients. The overall goal of this proposal is to develop a clinically relevant defibrillation strategy that significantly lowers the shock energy below the pain and damage thresholds of conventional defibrillation shocks. The main hypothesis of this proposal is that critically timed pacing-level pulses delivered directly to the Purkinje system will capture a critical mass of cardiac tissue and terminate VF. This work builds on recent understanding that the Purkinje system plays and active role in the maintenance of VF, a recent resurgence of work in low-energy defibrillation techniques, and the emergence of clinically available lead systems that directly interface the His-Purkinje system. The specific aims of this proposal are to: 1) demonstrate that there is an excitable gap in the His-Purkinje system in VF during which pacing pulses capture large regions of fibrillating tissue, 2) determine which low-energy defibrillation algorithm terminates VF with the least amount of energy, and 3) demonstrate the implementation of these techniques in a clinically relevant model that may be integrated into current ICD technology. Completion of these aims will lead to further understanding of the role and importance of the Purkinje system in cardiac arrhythmias. It will demonstrate that low energy defibrillation techniques which have only been demonstrated to be effective in small animal hearts and simulations are effective in larger hearts if the specialized conduction system is used to distribute pacing pulses throughout the working myocardium. The techniques will be developed and tested in normal and heart failure animal models. The end result of this project will be a clinically translatable technique and algorithm for terminating VF with pulse so small that damage and pain from defibrillation therapy with ICDs will be eliminated entirely.

 描述（由适用提供）：心室纤颤（VF）是工业化世界中死亡的主要原因。 VF的唯一有效治疗方法是电除颤。仅在我们的情况下，每年大约有15万名VF风险高风险的患者接受植入的心脏逆转除颤器（ICD）。 ICD带来的大量冲击可能导致患者的心脏损伤和焦虑。除颤冲击能量的显着减少可能导致ICD患者的死亡率降低和生活质量改善。该提案的总体目标是制定与临床相关的定义策略，该策略可显着降低冲击能量低于常规除颤冲击的疼痛和损害阈值。该提案的主要假设是，直接传递到珀肯吉系统的临时定时起搏级脉冲将捕获临界的心脏组织和终止VF。工作以最近的理解为基础，即Purkinje系统在维持VF，最新的低能量定义技术中的工作以及直接连接His-Purkinje系统的临床可用铅系统的出现中发挥着积极作用。该提案的具体目的是：1）证明，His-Purkinje在VF中存在一个令人兴奋的差距，在此过程中，起搏脉冲捕获了大的颤振组织的大区域，2）确定以最少的能量终止VF的VF终止哪些能量，并且可以在临床上终止这些技术的实施，并演示其在临床上相关的模型。这些目标的完成将进一步了解浦肯野系统在心律不齐中的作用和重要性。它将证明，如果专门的传导系统用于在整个工作心肌中分发起搏脉冲，那么仅被证明仅在小动物心脏中有效的低能量定义技术在更大的心脏中有效。这些技术将在正常和心力衰竭动物模型中开发和测试。该项目的最终结果将是一种临床翻译技术和用于终止VF的算法 随着脉搏的较小，将完全消除对ICD定义治疗的损害和疼痛。