Skin-like, stretchable, and wearable sensors for monitoring QT interval and hemodynamic variables in Atrial Fibrillation

项目摘要 心房颤动（AF）是成人中最常见的持续性心律失常，终生风险为25- 33%， 每年花费美国医疗系统超过60亿美元。AF的发病率包括充血性心力衰竭， 痴呆，心输出量减少引起的症状，最重要的是血栓性卒中风险升高 由于血液淤滞。可穿戴技术的最新进展提高了AF的容量和准确性 通过在门诊环境中监测心率变异性进行诊断。然而，仍然没有 现有的流动技术，允许连续评估血液动力学影响的 AF也不测量心脏复极，以确定预防作用 抗抑郁药AF的一些治疗方面仍然存在争议，因为 心律控制干预，包括心脏消融和药物治疗，两者都有显着的 风险使用III类抗心律失常药的药物干预尤其危险，因为 对心室复极的影响，可导致危及生命的室性快速性心律失常， 尖端扭转型室性心动过速由于这些问题，仔细评估心室复极，如所代表的 通过心电图（ECG）上的QT间期，在药物启动期间需要。这需要很长的时间， 在药物负荷期间昂贵的住院监测和维持狭窄的治疗窗口的困难， 放电有一种可靠的方法来量化血液动力学不稳定的测量，导致一些AF- 相关症状，以及持续监测QT间期和其他临床重要参数 在流动环境中，将允许临床医生为个体定制他们的护理。该提案旨在完善 一个灵活的、非侵入性的可穿戴系统，可持续监测这些关键临床参数， 预测心律并发症，并规范心律控制和 AF的速率控制。一种传感器套件，由一个小型、无线和灵活的胸戴式贴片组成， 基于ECG和加速度计的心震描记术（SCG）和无线时间同步的柔性肢体 将使用能够监测光电体积描记（PPG）信号的装置。目标1将定量定义 QT间期监测的最佳位置在胸部表面。目标2将联合收割机结合ECG、SCG和 PPG数据流，并从已知的信号流中提取唯一的和时间相关的参数。 与心脏功能和血液动力学相关，使用机器学习来获得血液动力学的预测 这些复杂关系的不稳定性。Aim 3将解决这种可穿戴系统的使用和合规性问题 在III类抗肿瘤药物负荷和药理学期间， 心脏复律这项研究的结果将提供AF症状的第一个动态测量， 对治疗的反应，通知未来的研究和临床护理团队的主要生物电和 生物力学参数，这是最重要的护理不断增长，老龄化人口与AF。

Project Summary Atrial Fibrillation (AF) is the most common sustained arrhythmia in adults, carries a lifetime risk of 25-33%, and cost the US healthcare system > 6 Billion dollars a year. Morbidities from AF include congestive heart failure, dementia, symptoms due to decreased cardiac output, and most importantly an elevated thrombotic stroke risk due to blood stasis. Recent advances in wearable technology have increased the capacity and accuracy of AF diagnosis through monitoring heart rate variability in an ambulatory setting. However, there remains no available ambulatory technologies that permit continuous assessment of the hemodynamic effects of AF nor measurements of cardiac repolarization that determine the proarrhythmic effects of antiarrhythmic drugs. Some treatment aspects of AF have remained controversial due to limited efficacy of rhythm control interventions including cardiac ablation and pharmacologic therapy, both of which have significant risks. Pharmacologic interventions using Class III antiarrhythmics are especially risky due to the proarrhythmic effects on ventricular repolarization which can lead to life-threatening ventricular tachyarrhythmias such as torsades de pointes. As a result of these issues, careful assessment of ventricular repolarization, as represented by the QT interval on the electrocardiogram (ECG), is required during drug initiation. This requires lengthy and costly inpatient monitoring during drug loading and difficulties in maintaining the narrow therapeutic window after discharge. Having a reliable method to quantify measures of hemodynamic instability that leads to some AF- related symptoms, as well as continuously monitoring the QT interval and other clinically important parameters in an ambulatory setting would allow clinicians to tailor their care to the individual. This proposal aims to refine a flexible, non-obtrusive wearable system to continuously monitor these key clinical parameters, help in predicting heart rhythm complications and regulate medication intervention for both rhythm control and rate control of AF. A sensor suite consisting of a small, wireless and flexible chest-worn patch that measures both ECG and accelerometer based seismocardiography (SCG) and a wirelessly time synchronized flexible limb unit capable of monitoring photoplethysmographic (PPG) signals will be used. Aim 1 will quantitatively define the optimal location for QT interval monitoring on the surface of the chest. Aim 2 will combine the ECG, SCG, and PPG data streams and extract both unique and time-relational parameters from the signal streams known to be related to cardiac function and hemodynamics, using machine learning to obtain predictions of hemodynamic instability from these complex relationships. Aim 3 will address the use and compliance of this wearable system in a clinical setting against the standard of care during Class III antiarrhythmic drug loading and pharmacologic cardioversion. The results from this study will provide the first ambulatory measures of AF symptoms and responses to treatment, informing future studies and clinical care teams of the dominant bioelectrical and biomechanical parameters that are the most important in the care of the growing, aging population with AF.