VERY LOW ENERGY CARDIOVERSION FOR ATRIAL FIBRILLATION

极低能量心脏复律治疗心房颤动

• 批准号: 6619846
• 负责人: PATRICK D WOLF
• 金额: $ 26.95万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-08-01 至 2005-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6619846
• 关键词: atrial fibrillation; biomedical device power system; biomedical equipment development; electronic pacemaker; epicardial mapping; heart electrical activity; implantable defibrillators; medical implant science; sheep

Internal atrial defibrillation is a successful therapy for the treatment of atrial fibrillation(AF). Current internal atrial defibrillators(IAD) use conventional defibrillation technology to deliver high energy shocks with a high likelihood of success. The applied shock strength of 3-10 Joules is above a patient's pain threshold and this limits the broad application of IAD therapy. A technology is proposed that utilizes multiple very low energy (less than .5J) shocks(VLES) with a low probability of first shock success but a high cumulative probability of conversion. A telemetry system will be implanted in an ovine model of AF. The combined animal model and telemetry system will be used as a test bed for VLES atrial cardioversion. The telemetry unit transmits 4 electrograms a distance of 10 meters and delivers continuous and programmed pacing by remote control. This system will be enhanced by adding pressure monitoring and VLES circuitry. It will be used 1) to characterize electrical remodeling and to track changes in infra-atrial pressure induced by the rapid pacing protocol and 2) to measure the energy that corresponds to a 5 percent level of success, and 3) to test three strategies for increasing the VLES probability of success. The three strategies are: 1) pre-VLES overdrive pacing 2) pre-VLES non-linear dynamics based pacing, and 3) use of class III antiarrhythmic drugs with VLES. Epicardial mapping will be used to identify the mechanism of VLES defibrillation and to characterize the effects of the 3 enhancement strategies. The work proposed in this grant will advance the science of remote testing in unanesthetized animals, will characterize the development of electrical modeling and myocardial pathology produced by rapid pacing in sheep, and will test a total of four strategies for very low energy atrial defibrillation. These advances will increase our understanding of the progression of AF and allow a successful therapy for this debilitating disease to be more broadly applied.

心房内除颤是治疗心房颤动（AF）的一种成功疗法。 当前的内部心房除颤器（IAD）使用传统的除颤技术来递送具有高成功可能性的高能量电击。所施加的3-10焦耳的电击强度高于患者的疼痛阈值，这限制了IAD治疗的广泛应用。提出了一种利用多次极低能量（小于0.5J）冲击（VLES）的技术，其具有低的首次冲击成功概率但高的累积转换概率。 将遥测系统植入AF的绵羊模型中。组合的动物模型和遥测系统将用作VLES心房复律的试验床。 遥测装置在10米的距离内传输4个电描记图，并通过远程控制提供连续和程控起搏。 该系统将通过增加压力监测和VLES电路来增强。 它将用于1）表征电重构并跟踪快速起搏方案诱导的心房下压力变化，2）测量对应于5%成功水平的能量，3）测试增加VLES成功概率的三种策略。 这三项战略是：1）VLES前起搏，2）VLES前非线性动力学起搏，3）VLES使用III类抗心律失常药物。 心外膜标测将用于识别VLES除颤的机制并表征3种增强策略的效果。这项研究将推进在未麻醉动物中进行远程测试的科学，将描述绵羊快速起搏产生的电建模和心肌病理学的发展，并将测试四种极低能量心房除颤策略。 这些进展将增加我们对AF进展的理解，并使这种使人衰弱的疾病的成功治疗得到更广泛的应用。

项目成果

Minimum energy single-shock internal atrial defibrillation in sheep.

绵羊最小能量单次电击心房除颤。

• DOI: 10.1023/b:jice.0000019266.09648.f6
• 发表时间: 2004
• 期刊: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
• 作者: Goodman,AmyM;Clyde,MerliseA;Burdick,DonaldS;Idriss,SalimF;Wolf,PatrickD
• 通讯作者: Wolf,PatrickD