GOALI: New Bioengineering Applications of Signal Analysis for Implantable Devices

植入式抗心动过速装置(ICD)通过为潜在的致命性心律失常，即室性心动过速和室颤提供即时的电治疗，在挽救数千人的生命方面取得了压倒性的成功。这些节律被认为是超过80%的心脏性猝死病例的原因，每年有40万人死亡。ICD的植入物数量是例外的，迄今已超过100,000个植入物，尽管它在医疗领域相对处于起步阶段。ICD技术需要解决的一个大问题是检测标准的改进，使该设备不再提供简单的暴力解决方案(如果有问题，则是电击)。这是一个三重问题：假电击是一种不必要的患者痛苦；假电击会耗尽电池电量，使设备处理真正紧急情况的能力降低，并迫使患者过早植入；假电击(或抗心动过速起搏)可在以前不存在的情况下引发室性心动过速(VT)或室颤(VF)。这项建议的具体目标是：1)开发新的信号处理技术和模式识别方案，以利用ICD的技术现状进行准确的心律失常检测；2)设计改进的室性心动过速和室颤之间的诊断鉴别，利用这些心律失常的独特治疗选择；以及3)改进双腔分析方法，用于ICD心律失常的诊断。改进的检测方案包括必须由现代数字信号处理技术解决的工程问题和使用铅场理论和新的模式识别思想的富有想象力的工程解决方案。

9812525JenkinsImplantable antitachycardia devices (ICDs) have achieved overwhelming success in salvaging thousands of lives by providing immediate electrical therapy for the treatment of potentially lethal arrhythmias, i.e., ventricular tachycardia and ventricular fibrillation. These rhythms are believed responsible for over 80% of cases of sudden cardiac death, which claims 400,000 victims per year. The number of implants of ICDs is exceptional, over 100,000 implants to date, despite its relative infancy in the medical field. A large remaining problem to be solved in ICD technology is refinement of detection criteria such that the device no longer offers a simple brute force solution (if in question, shock). This is a three-fold problem: false shocks are an unnecessary patient distress; false shocks deplete battery power rendering the device less capable of addressing true urgencies and forcing premature explantation; and false shocks (or antitachycardia pacing) can initiate ventricular tachycardia (VT) or ventricular fibrillation (VF) when none previously existed. The specific aims of this proposal are: 1) to develop new signal processing techniques and pattern recognition schemes for accurate arrhythmia detection which exploit the present state of technology in ICDs; 2) to design improved diagnostic distinction between ventricular tachycardia and ventricular fibrillation which capitalize on the unique therapeutic choices for conversion of these arrhythmias; and 3) to refine methods of dual-chamber analysis for application to ICD arrhythmia diagnosis. Improved detection schemes comprise an engineering problem which must be addressed by modern digital signal processing techniques and imaginative engineering solutions employing concepts of lead-field theory and novel pattern recognition ideas.***