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Biophysical Modeling to Simulate the Response to Multisite Left Ventricular Stimulation Using a Quadripolar Pacing Lead

机译:用四极起搏导线模拟对多部位左心室刺激的反应的生物物理模型。

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摘要

Background: Response to cardiac resynchronization therapy (CRT) is reduced in patients with posterolateral scar. Multipolar pacing leads offer the ability to select desirable pacing sites and/or stimulate from multiple pacing sites concurrently using a single lead position. Despite this potential, the clinical evaluation and identification of metrics for optimization of multisite CRT (MCRT) has not been performed. Methods: The efficacy of MCRT via a quadripolar lead with two left ventricular (LV) pacing sites in conjunction with right ventricular pacing was compared with single-site LV pacing using a coupled electromechanical biophysical model of the human heart with no, mild, or severe scar in the LV posterolateral wall. Result: The maximum dP/dt(max) improvement from baseline was 21%, 23%, and 21% for standard CRT versus 22%, 24%, and 25% for MCRT for no, mild, and severe scar, respectively. In the presence of severe scar, there was an incremental benefit of multisite versus standard CRT (25% vs 21%, 19% relative improvement in response). Minimizing total activation time (analogous to QRS duration) or minimizing the activation time of short-axis slices of the heart did not correlate with CRT response. The peak electrical activation wave area in the LV corresponded with CRT response with an R-2 value between 0.42 and 0.75. Conclusion: Biophysical modeling predicts that in the presence of posterolateral scar MCRT offers an improved response over conventional CRT. Maximizing the activation wave area in the LV had the most consistent correlation with CRT response, independent of pacing protocol, scar size, or lead location. (PACE 2012; 35:204-214)
机译:背景:后外侧瘢痕患者对心脏再同步治疗(CRT)的反应降低。多极起搏导线提供了使用单个导线位置同时选择所需起搏部位和/或从多个起搏部位刺激的能力。尽管有这种潜力,但尚未进行用于优化多站点CRT(MCRT)的临床评估和指标确定。方法:使用无人,轻度或重度人心脏的耦合生物电生理模型,将四极导线与两个左心室起搏点结合右心室起搏的MCRT疗效与单点LV起搏进行比较左后外侧壁瘢痕。结果:对于标准CRT,无,轻度和重度瘢痕的最大dP / dt(max)改善相对于基线分别为21%,23%和21%,而MCRT分别为22%,24%和25%。在存在严重疤痕的情况下,与标准CRT相比,多部位治疗有增加的获益(25%vs 21%,相对改善19%)。最小化总激活时间(类似于QRS持续时间)或最小化心脏短轴切片的激活时间与CRT反应无关。 LV中的峰值电激活波面积与CRT响应相对应,R-2值在0.42和0.75之间。结论:生物物理模型预测,在存在后外侧瘢痕的情况下,MCRT可提供比常规CRT更好的反应。左心室中激活波面积的最大化与CRT响应具有最一致的相关性,而与起搏协议,疤痕大小或导线位置无关。 (PACE 2012; 35:204-214)

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