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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Intramyocardial pacing and sensing for the enhancement of cardiac stimulation and sensing specificity.
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Intramyocardial pacing and sensing for the enhancement of cardiac stimulation and sensing specificity.

机译：心肌内起搏和感觉增强心脏刺激和感觉特异性。

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Background:Intracardiac electrodes create an "antenna" capable of unintentionally recording and stimulating tissue beyond the chamber in which they are positioned, resulting in far-field R wave oversensing in pacemakers and inappropriate detection in defibrillators. This feasibility study sought to determine whether a specially constructed lead with two distal totally intramyocardial electrodes could overcome these limitations. Methods:Two mongrel dogs were anesthetized and a median sternotomy performed. Epicardial intramyocardial pacing and sensing function was assessed and compared to standard active fixation pacing and sensing placed at the same atrial and ventricular sites. Right ventricular pacing was also assessed. Results:For the novel intramyocardial lead, the average R wave amplitude was 7.2 mV, compared to an average R wave of 8.4 mV for the standard active fixation lead placed at identical ventricular sites; P-waves were also similar. Cross-chamber sensing was present in the ventricle and atrium with the standard lead, and absent with the intramyocardial lead. The average pacing threshold was 0.7 mA at 0.2 ms for the novel lead compared to 1.1 mA for the standard lead. With the standard lead, phrenic stimulation was seen at threshold (cathode distal) and at 3 mA (cathode proximal electrode). No phrenic stimulation was seen with the novel intramyocardial lead despite outputs up to 20 mA at sites located 3-5 mm from the phrenic nerve. Conclusion:Totally intramyocardial pacing is feasible, and results in site-specific pacing and sensing function. This may eliminate far-field signal oversensing and phrenic stimulation in future devices.
机译：背景：心内电极产生一个“天线”，该天线能够无意间记录和刺激它们所位于的腔室以外的组织，从而导致起搏器中的远场R波感应过度以及除颤器中的不适当检测。这项可行性研究试图确定带有两个远端完全心肌内电极的特殊构造的导线是否可以克服这些限制。方法：对两只杂种犬进行麻醉，并进行正中胸骨切开术。评估了心外膜心肌内起搏和感觉功能，并将其与放置在相同心房和心室部位的标准主动固定起搏和感觉进行比较。还评估了右心室起搏。结果：对于新型心肌内导线，平均R波振幅为7.2 mV，相比之下，放置在相同心室部位的标准主动固定导线的平均R波为8.4 mV。纵波也相似。标准铅在心室和心房中存在跨室感应，而心肌内铅则不存在。新型引线的平均起搏阈值在0.2 ms时为0.7 mA，而标准引线的平均起搏阈值为1.1 mA。使用标准铅时，在阈值（阴极远端）和3 mA（阴极近端电极）处可见刺激。尽管在距nerve神经3-5 mm的部位输出高达20 mA的电流，但新型心肌内导线未见刺激。结论：完全心肌内起搏是可行的，并导致特定部位的起搏和感觉功能。这可以消除未来设备中的远场信号过度感应和刺激。

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