New aspects in electrostimulation of the heart.
New aspects in electrostimulation of the heart.
复制标题
心脏电刺激的新方面。
DOI：
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发表时间：
1995
期刊：
影响因子：
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通讯作者：
M. Schaldach
中科院分区：
文献类型：
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作者：
M. Schaldach
自主神经系统（ANS）和心脏的相互作用的特点是一个新的跨学科领域称为神经心脏病学，提出了最新的策略，心电刺激。在这种情况下，最优先考虑的是用生理性闭环起搏重建变时性，以及通过ANS调制预防和治疗恶性心律失常。实现这一目标的主要目标包括适当的监测自主平衡和刺激，分别，使心脏传出神经的神经调节可以建立。电极作为传感器和致动器，其在细胞水平上的界面变得至关重要。电极-心肌界面由亥姆霍兹双层结构的物理、电化学和生理行为决定。电子穿过边界的传输以及决定界面生物相容性的电化学反应可以通过用氮化钛或铱形成分形表面涂层来改善固体组分的微结构。实验和临床结果已经证明，分形结构确保可忽略的极化以及改进的检测性能，因此，检测心肌细胞的诱发反应使得有可能监测心肌的神经反应作为叠加的变时性干扰的结果。刺激电极还监测从心内阻抗测量中提取的交感神经活动，从而提供了一种新的频率适应原理，其中起搏器是ANS的组成部分，重建正常的变时性。改进的电极接口性能的进一步优点在快速性心律失常的治疗和预防中以及在移植心脏的随访中为预防排斥过程开辟了新的方面。
The interaction of the autonomic nervous system (ANS) and the heart is characterized by a new interdisciplinary field known as neurocardiology which presents the newest strategy for electro-cardiostimulation. In this context, the reestablishment of chronotropy with physiological, closed-loop pacing, as well as the prevention and treatment of a malignant arrhythmia by ANS modulation, is of the highest priority. The main objective toward this goal consists of appropriate monitoring of the autonomic balance and stimulation, respectively, so that neuromodulation of the cardiac efferents can be established. The electrode, as a sensor and an actuator, with its interface on the cellular level becomes of essential importance. The electrode-myocardium interface is determined by the structure of the Helmholtz double layer with regard to its physical, electrochemical, and physiological behavior. The transportation of electrons across the boundary, as well as the electro-chemical reactions determining the biocompatibility of the interface, can be improved by the microstructure of the solid component by creating a fractal surface coating with titanium-nitride or iridium. Experimental and clinical results have demonstrated that the fractal structure ensures negligible polarization as well as improved detection performance, thus, detecting the evoked response of the myocardial cells makes it possible to monitor the neural response of the myocardium as a consequence of a superimposed chronotropic disturbance. The stimulation electrode also monitors the sympathetic activity extracted from intracardiac impedance measurements, thereby providing a new principle of rate adaptation in which the pacemaker is an integral part of the ANS, reestablishing normal chronotropy. Further advantages of the improved electrode interface performance open new aspects in the treatment and prevention of tachyarrhythmia, and in the follow-up of transplanted hearts for the prevention of the rejection processes.