Myocardial Ischemia Sensor for Implantable Pacemakers

描述(由申请人提供)： 在西方文明中，冠状动脉疾病(CAD)是主要的死亡原因。每年接受植入式起搏器的74.7万人代表了心肌梗死的高危人群。虽然这些患者拥有一个复杂的系统来获取和处理心内心电图，但当代起搏器并不能感觉到心肌缺血或新出现的梗塞。这促使我们进行了心肌缺血对心内心电图影响的第一阶段研究。我们开发了一种新的经静脉导线电极配置和时频窗口指数(TFWI)算法来展示起搏器检测新出现的梗塞的潜力。这些想法在猪的心肌梗死模型中得到了验证。我们现在建议扩展我们的研究，以调查短暂性缺血和分级狭窄对心内心电图的影响。我们的中心假设是，经静脉导联检测到的心电图将显示与缺血程度和时间进程相关的变化。我们将验证这一假设，然后利用结果进一步开发过滤和自适应阈值策略，以区分新出现的脑梗塞和短暂性脑缺血发作。综上所述，我们希望对缺血负荷对心内心电图的影响有更透彻的了解。我们的长期目标是将其发展成为新出现的心肌梗死的可靠传感器。这种技术可以与当今植入式心脏设备中常见的“患者警报”功能捆绑在一起，以最大限度地减少治疗时间，从而减少死亡率。

DESCRIPTION (provided by applicant): Coronary artery disease (CAD) is the leading cause of death in Western civilization. The 747,000 individuals per year who receive an implantable pacemaker represent a population who are at high-risk for myocardial infarction. While these patients have a sophisticated system to acquire and process the intracardiac ECG, current generation pacemakers do not sense myocardial ischemia or emerging infarctions. This motivated our Phase I study on the effect of myocardial ischemia on the intracardiac ECG. We have developed a novel transvenous lead-based electrode configuration and Time Frequency Window Index (TFWI) algorithm to demonstrate the potential for a pacemaker to detect emerging infarctions. These ideas were validated in a porcine model of myocardial infarction. We now propose to extend our studies to investigate the effect of transient ischemia and graded stenoses on the intracardiac ECG. Our central hypothesis is that the ECG sensed by a transvenous lead will demonstrate changes which are correlated with the extent and time course of ischemia. We will test this hypothesis and then use the results to further develop filtering and adaptive thresholding strategies to discriminate emerging infarctions from episodes of transient ischemia. In summary, we hope to develop a more thorough understanding of the effects of ischemic burden on the intracardiac ECG. It is our long-term goal to develop this into a reliable sensor for emerging myocardial infarctions. Such technology could be tied to "patient-alert" features, which are common in today's implantable cardiac devices, to minimize time-to-treatment and thus mortality.