IMPLANTABLE CARDIAC PROSTHETIC FOR RESYNCHRONIZATION BY BIVENTRICULAR PACING USING REVERSE REMODELING

摘要

An implantable prosthetic device for cardiac resynchronization by biventricular pacing including a cardiac reverse remodeling. The combination of the stimulation sites, the atrioventricular delay (AVD), and the interventricular delay (VVD) together define a common pacing configuration, temporarily switched from an original pacing configuration (a) to a modified pacing configuration (b) in a direction opposite to that of an optimization of the hemodynamic parameters, to cause an immediate change in the response to controlled stimulation of the myocardium. This response is assessed based on: the maximum value (P (b, a)) achieved by the peak-to-peak (PEA (i)) of the first peak of endocardial acceleration (PEA) after a pacing configuration change, the mean PEA value (A (b, a)) after stabilization, the PEA variability (V (b, a)) around this average value, and the duration (T (b, a)) of stabilization after the pacing configuration change. The analysis defines temporary, occasionally harmful stimulation sequences, forcing the myocardium to reverse remodeling, for, in the long term, improving its response in terms of pressure, ejected volume, and filling and ejection times.