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 生理上正常的心率历史上，右心室心尖部的起搏器 心室起搏脉冲在某些患者中，右心室长期起搏可能导致 心室不同步、起搏诱发心肌病和充血性心力衰竭增加 发病率。与右心室起搏相比，双心室起搏可改善性能 心室起搏，但高达1/3的患者对双心室起搏无应答。永久His 束支和左束支分支（LBB）起搏最近已显示导致较少的心力衰竭， 提高同步性，与标准权利相比， 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）更高的起搏 与其他电极导线配置相比，阈值可能会缩短植入器械的电池寿命 对于具有高起搏需求的患者，以及2）在感测和起搏希氏束时缺乏选择性 和邻近的心室心肌。抗心动过速起搏（ATP）等疗法利用 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是一种有效的终止室性心动过速的技术， 痛苦的冲击然而，使用His束或LBB导联的ATP技术的有效性尚未得到证实。 演示。使用缺血-再灌注诱导的室性心动过速的犬模型，将检验该假设 ATP将利用His-Purkinje网络终止VT，其有效性高于标准右心室 心室导联ATP治疗。 提出了一种新型的经静脉多电极起搏导线， 希氏束和相邻心室心肌的选择性感知和起搏。细化 电极导线配置将在离体犬心脏中进行，新电极导线的确认将 在体内慢性狗模型中证实。电极导线配置将可部署， 可用的工具和技术，并将允许医生根据 个别患者的反应。 该项目的完成将大大改善希氏束起搏的电极导线系统 和LBB应用，并证明了使用His束和LBB导线的ATP治疗的有效性。 这个翻译项目可能会对许多人的起搏器植入产生直接影响。 全球每年有数百万患者植入起搏器。

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.