Antitachycardia pacing and improved lead for ventricular conduction system stimulation

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 生理上正常的心率。从历史上看，右室心尖部的起搏器 脑室的起搏脉搏。在一些患者中，右室慢性起搏可能会导致 心室不同步、起搏引起的心肌病和充血性心力衰竭加重 发病率。与右起搏相比，双室起搏的效果更好。 心室起搏，但多达三分之一的患者对双室起搏无反应。永久HIS 束和左束支(LBB)起搏最近被证明可以减少心力衰竭和 提高了同步性，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。 阻碍他的束起搏采用的局限性包括1)较高的起搏速度 与其他导线配置相比的阈值，这可能会缩短植入设备的电池寿命 对于有高起搏需求的患者，以及2)在感知和起搏希氏束时缺乏选择性 和邻近的室壁心肌。利用抗心动过速起搏(ATP)等疗法 如果His激活和局部心肌激活导致 室性心动过速(VT)周期长度计算不当。 ATP是一种终止室性心动过速而不提供高能量的有效技术， 痛苦的电击。然而，使用His束或LBB导联的ATP技术的有效性尚未得到证实 演示了。利用犬的缺血-再灌注性室性心动过速模型，这一假说将得到验证。 ATP将利用His-Purkinje网络终止室性心动过速，其效果比标准权限更大 室导联三磷酸腺苷治疗。 提出了一种新型的经静脉多电极起搏导线，它将允许低阈值， 选择性感知和起搏希氏束和邻近的心肌。精细化 导联构型将在体外犬心脏中进行，新导联的验证将是 在活体慢性狗模型中进行了演示。销售线索配置将可通过当前部署 可用的工具和技术，并将允许医生根据起搏治疗 个别患者的反应。 该项目的完成将大大改善HIS束起搏的导联系统 和LBB应用，并演示使用HIS束和LBB导联进行ATP治疗的有效性。 这一翻译项目可能会对其中许多人的起搏器植入产生直接影响 全球每年有100万名患者植入了起搏器。

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 and left bundle branch (LBB) 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 antitachycardia pacing (ATP) that utilize sensing may be less effective if the His activation and the local myocardial activations lead to inappropriate calculation of the ventricular tachycardia (VT) cycle length. ATP is an effective technique to terminate ventricular tachycardias without delivering high-energy, painful shocks. However, efficacy of ATP techniques with a His bundle or LBB lead has not been demonstrated. Using a canine model of ischemia-reperfusion induced VT, the hypothesis will be tested that ATP will utilize the His-Purkinje network to terminate VT with greater efficacy than standard right ventricular lead ATP therapy. 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 and LBB applications and demonstrate the effectiveness of ATP therapy with His bundle and LBB leads. 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.