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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Reduction of pacing output coupling capacitance for sensing the evoked response.
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Reduction of pacing output coupling capacitance for sensing the evoked response.

机译：减少起搏输出耦合电容，以感应诱发的反应。

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摘要

Sensing of the intracardiac evoked response (ER) after a pacing stimulus has been used in implantable pacemakers for automatic verification of capture. Reliable detection of ER is hampered by large residual afterpotentials associated with pacing stimuli. This led to the development of various technological solutions, like the use of triphasic pacing pulses and low polarizing electrode systems. This study investigated the effect of reducing the coupling capacitance (CC) in the pacemaker output circuitry on the magnitude of afterpotential, and the ability to automate detection of ventricular evoked response. A CC of 2.2 microF and four different blanking and recharge time settings were clinically tested to evaluate its impact on sensing of the ventricular ER and pacing threshold. Using an automatic step-down threshold algorithm, 54 consecutive patients, aged 70 +/- 10 years with acutely (n = 27) or chronically (n = 27) implanted ventricular pacing leads were enrolled for measurement testing. Routine measurements, using a standard pacing system analyzer (PSA), were (mean +/- SD) impedance 569 +/- 155 omega, R wave amplitude baseline to peak 9.8 +/- 3.7 mV and threshold 0.9 +/- 0.7 V at 0.4-ms pulse width. This new capture verification scheme, based on a CC of 2.2 microF and recharge/blanking timing setting of 10/12 ms, was successful in 52 patients which is equivalent to a success rate of 96%. In a subgroup of 26 patients implanted with bipolar ventricular leads (10 chronic, 16 acute), data were collected in unipolar (UP) and bipolar (BP) pace/sense configurations. Also, ER signals were recorded with two different band-pass filters: a wider band (WB) of 6-250 Hz and a conventional narrow band (NB) of 20-100 Hz. WB sensing from UP lead configuration yielded statistically significant larger signal to artifact ratios (SAR) than the other settings (P < 0.01). A dedicated unipolar ER sensing configuration using a small output capacitor and a wider band-pass filter enables adequate automatic capture verification, without any restrictions on pacing lead models or pacing/sensing configurations.
机译：起搏刺激后心内诱发反应（ER）的传感已用于植入式起搏器中，以自动验证捕获情况。与起搏刺激相关的大量残留后电位阻碍了ER的可靠检测。这导致了各种技术解决方案的发展，例如使用三相起搏脉冲和低极化电极系统。这项研究调查了减少起搏器输出电路中耦合电容（CC）对后电位幅度的影响，以及自动检测心室诱发反应的能力。临床测试了2.2 microF的CC和四个不同的消隐和充电时间设置，以评估其对心室ER和起搏阈值感知的影响。使用自动降低阈值算法，对54例年龄在70 +/- 10岁且有急性（n = 27）或慢性（n = 27）植入的心室起搏导线的连续患者进行了测量测试。使用标准起搏系统分析仪（PSA）进行的常规测量为（平均+/- SD）阻抗569 +/- 155Ω，R波幅度基线达到峰值9.8 +/- 3.7 mV和阈值0.9 +/- 0.7 V 0.4毫秒脉冲宽度。这种新的捕获验证方案基于2.2 microF的CC和10/12 ms的充电/消隐定时设置，在52位患者中获得了成功，相当于96％的成功率。在植入双极心室导线的26位患者的亚组（10例慢性，16例急性）中，以单极（UP）和双极（BP）步速/感觉配置收集数据。而且，ER信号是用两个不同的带通滤波器记录的：6-250 Hz的较宽频带（WB）和20-100 Hz的常规窄带（NB）。从UP引线配置进行的WB感应产生的统计信噪比（SAR）比其他设置大（P <0.01）。使用小输出电容器和更宽的带通滤波器的专用单极ER感应配置可实现足够的自动捕获验证，而对起搏引线模型或起搏/感应配置没有任何限制。

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