Automated detection of effective left-ventricular pacing: going beyond percentage pacing counters
Automated detection of effective left-ventricular pacing: going beyond percentage pacing counters
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DOI：
10.1093/europace/euv062
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发表时间：
2015-10-01
期刊：
影响因子：
6.1
通讯作者：
Mittal, Suneet
中科院分区：
文献类型：
--
作者：
Ghosh, Subham;Stadler, RobertW.;Mittal, Suneet
目的心脏起搏治疗（CRT）器械报告起搏百分比作为诊断，但无法确定每次起搏搏动夺获左心室（LV）心肌的有效性。无效LV起搏的原因包括时机不当（即假融合）或起搏输出不足。基于设备的有效LV起搏的确定可能有助于优化CRT response.Methods和结果的LV阴极的有效捕获结果在单极电描记图（EGM）上的负偏转（QS或QS-R形态）。分析了左心室阴极-右心室线圈电描记图的形态特征，以开发一种基于器械的自动算法，该算法将每个起搏搏动分类为有效或无效的左心室起搏。使用28例CRT除颤器患者的急性数据对该算法进行了验证。通过在不同AV延迟下起搏模拟有效的LV起搏和假融合。通过仅RV起搏模拟LV夺获丧失。该算法始终将LV或双心室（BV）起搏与AV延迟分类
Aims Cardiac resynchronization therapy (CRT) devices report percentage pacing as a diagnostic but cannot determine the effectiveness of each paced beat in capturing left-ventricular (LV) myocardium. Reasons for ineffective LV pacing include improper timing (i.e. pseudofusion) or inadequate pacing output. Device-based determination of effective LV pacing may facilitate optimization of CRT response.Methods and results Effective capture at the LV cathode results in a negative deflection (QS or QS-r morphology) on a unipolar electrogram (EGM). Morphological features of LV cathode-RV coil EGMs were analysed to develop a device-based automatic algorithm, which classified each paced beat as effective or ineffective LV pacing. The algorithm was validated using acute data from 28 CRT-defibrillator patients. Effective LV pacing and pseudofusion was simulated by pacing at various AV delays. Loss of LV capture was simulated by RV-only pacing. The algorithm always classified LV or biventricular (BV) pacing with AV delays