Impact of anatomical reverse remodelling in the design of optimal quadripolar pacing leads: A computational study.
Impact of anatomical reverse remodelling in the design of optimal quadripolar pacing leads: A computational study.
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DOI：
10.1016/j.compbiomed.2021.105073
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发表时间：
2022-01
影响因子：
7.7
通讯作者：
Niederer SA
中科院分区：
文献类型：
--
作者：
Rodero C;Strocchi M;Lee AWC;Rinaldi CA;Vigmond EJ;Plank G;Lamata P;Niederer SA
导联位置是决定非同步心衰（HF）患者对心脏再同步化治疗（CRT）反应的重要因素。多点起搏（MPP）可以在同一导联内实现多个电极起搏，从而改善患者的潜在预后。虚拟四极导联设计通过模拟HF （n = 24）和模拟反向重构（RR, n = 20）患者中每个虚拟患者的1和2电极沿导联的所有组合的起搏来评估。以90%心室心肌激活（AT090）的时间来评估电同步性。将AT090的最佳1电极和2电极起搏配置结合起来，确定4电极导联设计，使所有患者的获益最大化。在所有可能的单电极和双电极位置，心衰组左室起搏使AT090降低14.48±5.01 ms（11.92±3.51%）。激活时间减少的主要决定因素是患者的解剖结构。在HF组中，单导联起搏降低AT090的效果优于RR组（12.68±3.29% vs 10.81±2.34%）。采用单一的HF和RR人群优化引线设计的起搏实现了电再同步，在HF和RR解剖结构中几乎等同于个性化引线设计。这些发现表明，虽然导联配置必须针对每个患者量身定制，但单个最佳导联设计足以在大多数患者中获得接近最佳的结果。这项研究显示了虚拟临床试验作为比较现有和探索新的先导设计的工具的潜力。与个性化引线设计相比，常见的最佳多极引线设计可以减少CRT的激活时间。随着心脏的重塑，CRT在减少激活时间上的益处降低。这项研究显示了虚拟临床试验作为探索新型起搏导联设计工具的潜力。
Lead position is an important factor in determining response to Cardiac Resynchronization Therapy (CRT) in dyssynchronous heart failure (HF) patients. Multipoint pacing (MPP) enables pacing from multiple electrodes within the same lead, improving the potential outcome for patients. Virtual quadripolar lead designs were evaluated by simulating pacing from all combinations of 1 and 2 electrodes along the lead in each virtual patient from cohorts of HF (n = 24) and simulated reverse remodelled (RR, n = 20) patients. Electrical synchrony was assessed by the time 90% of the ventricular myocardium is activated (AT090). Optimal 1 and 2 electrode pacing configurations for AT090 were combined to identify the 4-electrode lead design that maximised benefits across all patients. LV pacing in the HF cohort in all possible single and double electrode locations reduced AT090 by 14.48 ± 5.01 ms (11.92 ± 3.51%). The major determinant of reduction in activation time was patient anatomy. Pacing with a single optimal lead design reduced AT090 more in the HF cohort than the RR cohort (12.68 ± 3.29% vs 10.81 ± 2.34%). Pacing with a single combined HF and RR population-optimised lead design achieves electrical resynchronization with near equivalence to personalised lead designs both in HF and RR anatomies. These findings suggest that although lead configurations have to be tailored to each patient, a single optimal lead design is sufficient to obtain near-optimal results across most patients. This study shows the potential of virtual clinical trials as tools to compare existing and explore new lead designs. A common optimal multi-pole lead design delivers a similar reduction in activation times with CRT compared to personalised lead designs. As the heart remodels the benefit of CRT on the reduction in activation time decreases. This study shows the potential of virtual clinical trials as tools to explore new pacing lead designs.
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