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功能 心率正常。历史上，右室心尖部的起搏器将起搏脉冲发送到 脑室。在一些患者中，右室的慢性起搏可能会导致心室不同步， 诱发心肌病，增加充血性心力衰竭的发生率。双室起搏已经被 与右室起搏相比，显示出改善的效果，但多达三分之一的患者没有 双室起搏的应答者。最近有研究表明，永久性希氏束起搏可导致心脏收缩 失败和改善的同步性，与标准权利相比，有提高死亡率的趋势 脑室或双室导联置入。 阻碍采用HIS束起搏的限制包括：1)较高的起搏阈值 与其他导线配置相比，其他导线配置可能会缩短高电压患者植入设备的电池寿命 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。抗心动过速起搏等利用感知的疗法可能不太有效，如果 激活和局部心肌激活导致对室性心动过速的错误计算 周期长度。 提出了一种新的经静脉多电极起搏导线，它将允许低阈值、选择性地起搏 感知和起搏希氏束和邻近的心肌。提炼销售线索 配置将在体外犬心脏中进行，新导线的验证将在 一种活体、慢性的狗模型。销售线索配置将可使用当前可用的工具和 技术，并将允许医生根据个体的反应来优化起搏治疗 病人。 该项目的完成将大大改善HIS束起搏的导联系统 申请。这一翻译项目可能会对许多患者的起搏器植入产生直接影响 全球每年有100万名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.