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A novel method to estimate safety factor of capture by a fetal micropacemaker

机译：一种估算胎儿微心脏起搏器捕获安全系数的新方法

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We have developed a rechargeable fetal micropacemaker in order to treat severe fetal bradycardia with comorbid hydrops fetalis, a life-threatening condition in pre-term non-viable fetuses for which there are no effective treatment options. The small size and minimally invasive form factor of our design limit the volume available for circuitry and a power source. The device employs a fixed-rate and fixed-amplitude relaxation oscillator and a tiny, rechargeable lithium ion power cell. For both research and clinical applications, it is valuable to monitor the electrode-myocardium interface in order to determine that adequate pacemaker output is being provided. This is typically accomplished by observing the minimal stimulus strength that achieves threshold for pacing capture. The output of our simple micropacemaker cannot be programmatically altered to determine this minimal capture threshold, but a safety factor can be inferred by determining the refractory period for ventricular capture at a given stimulus strength. This is done by measuring the minimal timing between naturally occurring QRS complexes and pacing stimuli that successfully generate a premature ventricular contraction. The method was tested in a pilot study in four fetal sheep and the data demonstrate that a relative measure of threshold is obtainable. This method provides valuable real-time information about the electrode-tissue interface.
机译：我们已经开发出一种可充电的胎儿微心脏起搏器，以治疗合并胎儿水肿的严重胎儿心动过缓，这对没有生命的早产胎儿会造成生命危险，目前尚无有效的治疗选择。我们设计的小尺寸和微创外形限制了电路和电源的可用体积。该器件采用了固定速率和固定振幅的张弛振荡器和一个小型可充电锂离子动力电池。对于研究和临床应用而言，监视电极-心肌界面以确定提供足够的起搏器输出是很有价值的。这通常是通过观察达到起搏捕获阈值的最小刺激强度来完成的。不能通过程序更改简单的微型起搏器的输出来确定此最小捕获阈值，但是可以通过确定在给定刺激强度下进行心室捕获的不应期来推断安全系数。通过测量自然产生的QRS复合体和成功产生心室早搏的起搏刺激之间的最短时间来完成。该方法在四只胎羊中进行了一项初步研究，并进行了试验，数据表明可以相对阈值进行测量。该方法提供了有关电极组织界面的有价值的实时信息。

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