Novel lead for selective His bundle sensing and low-threshold pacing

项目摘要 患者的结节功能障碍通常需要植入起搏器以维持生理上的 心率正常历史上，右心室尖部中的起搏器已经将起搏脉冲递送到心室。 心室在一些患者中，右心室中的慢性起搏可能导致心室不同步，起搏 诱发心肌病，增加充血性心力衰竭的发生率。双心室起搏已被 与右心室起搏相比，显示可改善性能，但高达1/3的患者没有 对双心室起搏有反应。永久性希氏束起搏最近已被证明会导致心脏 失败和改善同步性，与标准右心室相比， 心室或双心室电极导线置入。 减慢希氏束起搏采用的局限性包括：1）较高的起搏阈值， 与其他电极导线配置相比，这可能会缩短高血压患者植入器械的电池寿命。 起搏需求，以及2）在感知和起搏希氏束和相邻心室时缺乏选择性 心肌如果希律干扰，利用感知的抗心动过速起搏等治疗可能不太有效。 激动和局部心肌激动导致室性心动过速的计算不正确 周期长度。 提出了一种新型的经静脉多电极起搏电极导线， 希氏束和相邻心室心肌的感测和起搏。电极导线的细化 配置将在离体犬心脏中进行，新电极导线的确认将在 体内慢性狗模型。电极导线配置将可使用当前可用的工具进行部署， 技术，并将允许医生基于个体的响应来优化起搏治疗。 患者 该项目的完成将大大改善希氏束起搏的电极导线系统 应用.这一翻译项目可能对许多人的起搏器植入产生直接影响， 全世界每年有100万患者植入心脏起搏器。

Project Summary Nodal dysfunction in patients often requires the implantation of a pacemaker to maintain physiologically normal heart rates. Historically, a pacemaker in the right ventricular apex has delivered pacing pulses to the ventricles. In some patients, chronic pacing in the right ventricle may lead to ventricular dyssynchrony, pacing induced cardiomyopathy, and increased congestive heart failure incidence. Biventricular pacing has been shown to lead to improved performance compared to right ventricular pacing, but up to 1/3 of patients are non- responders to biventricular pacing. Permanent His bundle pacing has recently been shown to lead to less heart failure and improved synchronicity, with a trend towards a mortality benefit as compared to the standard right ventricular or biventricular lead placement. Limitations that have slowed the adoption of His bundle pacing include 1) higher pacing thresholds as compared to other lead configurations, which may reduce battery life in implanted devices for patients with high pacing demand, and 2) a lack of selectivity in sensing and pacing the His bundle and adjacent ventricular myocardium. Therapies such as anti-tachycardia pacing that utilize sensing may be less effective if the His activation and the local myocardial activations lead to inappropriate calculation of the ventricular tachycardia cycle length. A novel, transvenous, multielectrode pacing lead is proposed that will allow for low threshold, selective sensing and pacing of the His bundle and the adjacent ventricular myocardium. Refinement of the lead configuration will be performed in ex vivo canine hearts, and validation of the new lead will be demonstrated in an in vivo, chronic dog model. The lead configuration will be deployable with currently available tools and techniques and will allow the physician to optimize the pacing therapy based on the response of individual patients. Completion of this project will lead to a substantially improved lead system for His bundle pacing applications. This translational project may have an immediate impact on pacemaker implantation for many of the one million patients worldwide that are implanted with pacemakers each year.