Biophysical modeling to simulate the response to multisite left ventricular stimulation using a quadripolar pacing lead.
Biophysical modeling to simulate the response to multisite left ventricular stimulation using a quadripolar pacing lead.
复制标题
使用四极起搏导线模拟对多部位左心室刺激的反应的生物物理模型。
DOI：
10.1111/j.1540-8159.2011.03243.x
复制
发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Rinaldi,CA
中科院分区：
文献类型：
--
作者：
Niederer,StevenA;Shetty,AK;Plank,G;Bostock,J;Razavi,R;Smith,NP;Rinaldi,CA
背景：后外侧瘢痕患者对心脏起搏治疗（CRT）的反应降低。多极起搏电极导线能够选择理想的起搏部位和/或使用单个电极导线位置同时从多个起搏部位进行刺激。尽管有这种潜力，临床评价和识别指标优化的多部位CRT（MCRT）尚未performed.Methods：通过四极导线与两个左心室（LV）起搏部位结合右心室起搏的MCRT的有效性进行了比较，单部位LV起搏使用耦合机电生物物理模型的人类心脏LV后外侧壁无，轻度，或严重的疤痕。结果：最大dP/dtmax改善从基线为21%，23%，和21%，标准CRT与22%，24%，和25%的MCRT无，轻度，和严重的疤痕，分别。在存在严重瘢痕的情况下，多部位CRT与标准CRT相比的获益增加（25% vs 21%，19%的反应相对改善）。最小化总激动时间（类似于QRS持续时间）或最小化心脏短轴切片的激动时间与CRT反应无关。LV中的峰值电激活波面积与CRT反应相对应，R2值在0.42和0.75之间。结论：生物物理模型预测，在存在后外侧疤痕的情况下，MCRT比传统CRT提供了更好的反应。最大化LV中的激活波面积与CRT反应具有最一致的相关性，与起搏方案、瘢痕大小或电极导线位置无关。(PACE 2012; 35：204-214）
Background:Response to cardiac resynchronization therapy (CRT) is reduced in patients with posterolateral scar. Multipolar pacing leads offer the ability to select desirable pacing sites and/or stimulate from multiple pacing sites concurrently using a single lead position. Despite this potential, the clinical evaluation and identification of metrics for optimization of multisite CRT (MCRT) has not been performed.Methods:The efficacy of MCRT via a quadripolar lead with two left ventricular (LV) pacing sites in conjunction with right ventricular pacing was compared with single‐site LV pacing using a coupled electromechanical biophysical model of the human heart with no, mild, or severe scar in the LV posterolateral wall.Result:The maximum dP/dtmaximprovement from baseline was 21%, 23%, and 21% for standard CRT versus 22%, 24%, and 25% for MCRT for no, mild, and severe scar, respectively. In the presence of severe scar, there was an incremental benefit of multisite versus standard CRT (25% vs 21%, 19% relative improvement in response). Minimizing total activation time (analogous to QRS duration) or minimizing the activation time of short‐axis slices of the heart did not correlate with CRT response. The peak electrical activation wave area in the LV corresponded with CRT response with an R2value between 0.42 and 0.75.Conclusion:Biophysical modeling predicts that in the presence of posterolateral scar MCRT offers an improved response over conventional CRT. Maximizing the activation wave area in the LV had the most consistent correlation with CRT response, independent of pacing protocol, scar size, or lead location. (PACE 2012; 35:204–214)