Title Uporaba endovenske elektrode za elektrostimulaciju srca kao hemodinamskog senzora : doktorski rad
Title (english) New hemodynamic pacing lead sensor based on high frequency parameters
Author Sandro Brusich
Mentor Žarko Mavrić (mentor)
Committee member Žarko Mavrić (predsjednik povjerenstva)
Granter University of Rijeka Faculty of Medicine (Department of Internal Medicine) Rijeka
Defense date and country 2012-01-01, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Internal Medicine
Universal decimal classification (UDC ) 616 - Pathology. Clinical medicine
Abstract CILJ ISTRAŽIVANJA. Ovim istraživanjem želi se dokazati mogućnost upotrebe srčane elektrode za elektrostimulaciju kao novog, jedinstvenog senzora za monitoriranje kontraktilnosti srca. Senzor se temelji na mjerenju koeficijenta refleksije visokofrekventnog (HF) električnog signala primijenjenog na srčanu elektrodu kojeg smo nazvali LBS (engl. Lead bending signal). ISPITANICI I METODE.Istraživanje je provedeno na skupini od deset odraslih ovaca križanih pasmina (42 ± 6 kg) u kojima su implantirane tri vrste elektroda. Izvršena je istovremena akvizicija LBS, EKG i tlaka u lijevoj klijetki (LVP), prilikom implantacije i nakon četiri mjeseca od implantacija elektroda, u bazalnim uvjetima i pri hemodinamskim intervencijama koje su se sastojale od infuzije dobutamina, esmolola te indukcije tahikardije brzom ventrikularnom stimulacijom frekvencije do 200/min. REZULTATI. Stabilni, reproducibilni i konzistentni signali dobiveni su u svih životinja, u oba dijela istraživanja, te u svim eksperimentalnim uvjetima i tijekom hemodinamskih intervencija. Dobutamin je uzrokovao signifikantni porast frekvencije srca, krvnoga tlaka, LV dP/dt i akceleracije savijanja elektrode (LBA). Korelacija između LBAmax i LVdp/dtmax pokazala se kao statistički značajna, s visokim Pearsonovim koeficijentom korelacije (r = 0.855, p << 0,001), što dokazuje mogućnost korištenja LBS signala kao hemodinamskog, kardiomehaničkog senzora. Prilikom brze ventrikularne stimulacije mogli smo zamijetiti hemodinamsku deterioraciju životinja koja je dovela do sniženja LVP, LV dP/dt, LBS i LBA, te oporavka hemodinamskih parametara nakon ponovne uspostave sinusnog ritma. ZAKLJUČAK. Ovo je prvo istraživanje koje je istražilo mogućnost upotrebe HF parametara srčanih elektroda za monitoriranje kontraktilnosti srca. Visoki koeficijent korelacije između akceleracije savijanja elektrode i kontraktilnosti miokarda dokazuje Vmogućnost njegove uporabe kao hemodinamskog, kardiomehaničkog senzora. U budućim istraživanjima bit će potrebno potvrditi mogućnost korištenja LBS senzora uporabom bilo koje standardne bipolarne elektrode.
Abstract (english) OBJECTIVES.In this study, we propose a new hemodynamic (cardiomechanic) sensor based upon high frequency (HF) parameters of bipolar cardiac pacing leads. By measuring the lead HF impedance variation, or any related parameter such as HF reflection coefficient, we can quantify the lead bending due to the myocardial contraction. Therefore, the signal obtained by measuring the HF reflection coefficient on an implanted cardiac lead is named the lead bending signal (LBS). The purpose of this pilot study was to investigate the possibility of detecting the ventricular contraction in sheep utilizing LBS measurements on endovenous pacemaker and defibrillator leads. We also compared the cardiomechanic parameter - maximum rate of rise of the lead bending signal (dLBS/dtmax), i.e. the maximum lead bending acceleration (LBAmax), with the hemodynamic parameter - positive peak LV dP/dt, universally accepted as a good and highly sensitive index for contractility assessment in an individual patient. MATERIAL AND METHODS.The study was a single-centre, experimental animal feasibility study. The study was designed to evaluate the following hypotheses: (1) measuring and recording LBS in implanted bipolar or multipolar cardiac leads at the time of implantation procedure and after four months is feasible, (2) there is a correlation between LBS, LBAmax and LV dp/dtmax acquired four months after the implantation procedure. We implanted three different pacing leads and tested the measurement system in ten sheep (42 ± 6 kg) at baseline and during acute hemodynamic intervention with dobutamine infusion, esmolol infusion and tachycardia induced by fast ventricular pacing at rate up to 200 bpm. VIIRESULTS.A stable, consistent, and reproducible LBS was obtained in all sheep during the implantation procedure and four months after the implant during different experimental conditions that included hemodynamic interventions. Dobutamine infusion significantly increases heart rate (HR), left ventricular pressure (LVP), maximum rate of rise of left ventricular pressure (LV dP/dtmax) and maximum rate of rise of the lead bending signal (dLBS/dtmax) being the maximum lead bending acceleration (LBAmax). The dependence between LBAmax and LV dP/dtmax was found to be statistically significant and with high Pearson’s correlation coefficient (r = 0.855, p < 10-9). We could observe the hemodynamic deterioration caused by RV pacing. Pacing at 200 ppm decreased the LVP, LV dp/dt, LBS and LBA compared with the sinus rhythm. The return to sinus rhythm was associated with restoration of normal hemodynamics. CONCLUSION. To my knowledge, the present study is the first to evaluate and confirm the feasibility and efficacy of the hemodynamic sensor based upon HF lead parameters. Moreover, it was demonstrated that the maximum lead bending acceleration is highly correlated to the ventricular contractility and, therefore, can be efficiently used as a hemodynamic and cardiomechanic sensor. Our ongoing studies should reveal that the high-frequency system functions with every standard cardiac lead having at least two conductors. To establish fully the advantages and limits of this new method, comparison with LV pressure-volume loops in humans and multicentre study data are needed
Keywords
Elektrode
implantirane
Hemodinamika
Kontraktilnost
srce
Srčani elektrostimulator.
Keywords (english)
Contractility
heart
hemodynamic
pacemaker
pacing lead
implanted.
Language croatian
URN:NBN urn:nbn:hr:188:671484
Promotion 2012
Study programme Title: Biomedicine Postgraduate (doctoral) study programme Study programme type: university Study level: postgraduate Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
Catalog URL https://libraries.uniri.hr/cgi-bin/ucat/unilib.cgi?form=D1130106051
Type of resource Text
Extent 93 str; 30 cm
File origin Born digital
Access conditions Closed access
Terms of use
Created on 2017-01-19 20:05:34