His bundle has shorter chronaxie than adjacent ventricular myocardium: Implications for pacemaker programming
His bundle has shorter chronaxie than adjacent ventricular myocardium: Implications for pacemaker programming
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他的束具有比相邻心室心肌更短的时间：对起搏器编程的影响
DOI：
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
D. Czarnecka
中科院分区：
文献类型：
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作者：
M. Jastrzębski;P. Moskal;A. Bednarek;G. Kiełbasa;P. Vijayaraman;D. Czarnecka
背景永久性希氏束（HB）起搏的强度-持续时间曲线对于起搏器程控可能很重要。目的计算希氏束（HB）及邻近右心室（RV）工作心肌的强度-时间曲线和时值，分析不同脉冲持续时间（PD）起搏时HB选择性夺获区和电池电流消耗区。方法连续性心脏起搏患者。在几个PD评估RV和HB夺获阈值。测定了PD为0.1、0.2、0.4和1.0 ms时的电池电流消耗和选择性HB夺获区。结果全组（n =127）HB时值均短于RV时值。这种差异是由选择性HB起搏的患者造成的（HB时值为0.47 vs RV时值为0.79 ms）。HB的强度-持续时间曲线具有较低的基强度，其陡峭部分在较短PD时开始，因此在较短PD时在HB和RV强度-持续时间曲线之间产生较宽的距离-可编程选择性HB起搏区。PD为0.1 - 0.4 ms时起搏的电池电流消耗低于1.0 ms时起搏的电池电流消耗。Chronaxie调整后的PD提供了最低的电流消耗。结论首次测定了选择性和非选择性心脏起搏的强度-时间曲线。选择性HB夺获和电池寿命可以通过更短的PD（0.2 ms）来提高。更长的PD（1.0 ms）为RV夺获提供了更大的安全裕度，如果需要在HB起搏期间同时进行RV夺获，则可能更可取。
Background Strength-duration curves for permanent His bundle (HB) pacing are potentially important for pacemaker programming. Objective We aimed to calculate strength-duration curve and chronaxie of the His bundle (HB) and of the adjacent right ventricular (RV) working myocardium and to analyze zones of selective HB capture and battery current drain when pacing at different pulse durations (PDs). Methods Consecutive patients with permanent HB pacing were studied. The RV and HB capture thresholds were assessed at several PDs. Battery current drain and zones of selective HB capture at PDs of 0.1, 0.2, 0.4 and 1.0 ms were determined. Results In the whole group (n =127) the HB chronaxie was shorter than the RV chronaxie. This difference was driven by patients with selective HB pacing (HB chronaxie of 0.47 vs RV chronaxie of 0.79 ms). Strength-duration curve for HB had lower rheobase and its steep portion started at shorter PDs thus creating wider distance - zone of programmable selective HB pacing - between the HB and RV strength-duration curves at shorter PDs. The battery current drain was lower with pacing at PDs of 0.1 - 0.4 ms vs 1.0 ms. Chronaxie adjusted PDs offered lowest current drain. Conclusion For the first time the strength-duration curves for permanent selective and non-selective HB pacing were determined. Selective HB capture and battery longevity can be promoted by shorter PDs (0.2 ms). Longer PDs (1.0 ms) offer bigger safety margin for RV capture and may be preferable if simultaneous RV capture during HB pacing is desired.