A novel pacing method to suppress repolarization alternans in vivo: Implications for arrhythmia prevention
A novel pacing method to suppress repolarization alternans in vivo: Implications for arrhythmia prevention
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DOI：
10.1016/j.hrthm.2012.12.026
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发表时间：
2013-04-01
期刊：
影响因子：
5.5
通讯作者：
Merchant, Faisal M.
中科院分区：
文献类型：
--
作者：
Armoundas, Antonis A.;Weiss, Eric H.;Merchant, Faisal M.
背景复极交替（RA），心室复极的模式，每隔一拍的基础上重复，已密切联系在一起的基板与室性心动过速/心室fibrillation.Objective评估一种新的方法来抑制RA.METHODS我们已经开发出一种新的方法，动态（R波检测）触发起搏脉冲在绝对不应期。我们已经测试了这种方法的能力，以控制RA在结构正常的猪heartinvivo.Results触发起搏引起的RA可以从心内和体表导联测量和R波触发起搏引起的电交替的幅度可以通过改变起搏脉冲的幅度和宽度进行局部调制。我们估计，要在体表、冠状窦和左心室电极导线上引起1 μ V的交替电压变化，需要在右心室中分别输送0.04 +/- 0.02、0.05 +/- 0.025和0.06 +/- 0.033 μ C的触发起搏脉冲。类似地，为了引起K-分数（交替峰与噪声的比率）的1个单位的变化，分别需要0.93 +/- 0.73、0.32 +/- 0.29和0.33 +/- 0.37 μ C的起搏刺激。我们已经能够证明，RA可以抑制R波触发的起搏从一个网站是在心室内或跨心室。最后，我们已经证明，所提出的方法可以用来抑制自发发生的交替在患病的heart.Conclusion我们已经开发了一种新的方法来抑制RA在体内。
BACKGROUND Repolarization alternans (RA), a pattern of ventricular repolarization that repeats on an every other beat basis, has been closely linked with the substrate associated with ventricular tachycardia/ventricular fibrillation.OBJECTIVE To evaluate a novel method to suppress RA.METHODS We have developed a novel method to dynamically (on R-wave detection) trigger pacing pulses during the absolute refractory period. We have tested the ability of this method to control RA in a structurally normal swine heart in vivo.RESULTS RA induced by triggered pacing can be measured from both intracardiac and body surface leads and the amplitude of R-wave triggered pacing-induced alternans can be locally modulated by varying the amplitude and width of the pacing pulse. We have estimated that to induce a 1 mu V change in alternans voltage on the body surface, coronary sinus, and left ventricle leads, a triggered pacing pulse delivered in the right ventricle of 0.04 +/- 0.02, 0.05 +/- 0.025, and 0.06 +/- 0.033 mu C, respectively, is required. Similarly, to induce a 1 unit change in K-score (ratio of alternans peak to noise), a pacing stimulus of 0.93 +/- 0.73, 0.32 +/- 0.29, and 0.33 +/- 0.37 mu C, respectively, is required. We have been able to demonstrate that RA can be suppressed by R-wave triggered pacing from a site that is within or across ventricles. lastly, we have demonstrated that the proposed method can be used to suppress spontaneously occurring alternans in the diseased heart.CONCLUSION We have developed a novel method to suppress RA in vivo.