GOALI: New Bioengineering Applications of Signal Analysis for Implantable Devices

可植入式抗心动过速装置（ICDs）通过为潜在致命性心律失常（即室性心动过速和室性颤动）提供即时电治疗，在挽救成千上万人的生命方面取得了巨大成功。这些节律被认为是造成80%以上心脏性猝死的原因，每年有40万人死于心脏性猝死。icd的植入数量非常多，迄今已超过10万，尽管它在医疗领域还处于起步阶段。ICD技术仍需解决的一个大问题是改进检测标准，使设备不再提供简单的暴力解决方案（如果有问题，电击）。这是一个三重问题：虚假电击会给病人带来不必要的痛苦；错误的电击会耗尽电池电量，使设备无法解决真正的紧急情况，并迫使过早拔出；假电击（或抗心动过速起搏）可引起先前不存在的室性心动过速（VT）或心室颤动（VF）。本提案的具体目标是：1)开发新的信号处理技术和模式识别方案，以准确检测心律失常，利用icd的技术现状；2)设计改进的室性心动过速和室性颤动的诊断区分，利用这些心律失常转换的独特治疗选择；3)完善双腔分析方法在ICD心律失常诊断中的应用。改进的检测方案包含一个工程问题，必须通过现代数字信号处理技术和采用超前场理论概念和新颖模式识别思想的富有想象力的工程解决方案来解决

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.***