Endocardial lead
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BACKGROUND: Endocardial fibroelastosis (EFE) is a diffuse thickening of the ventricular endocardium, causing myocardial dysfunction and presenting as unexplained heart failure in infants and children. One of the postulated causes is persistent and increased wall tension in the ventricles. RESULTS: To examine whether reduced ventricular pressure in a chick model of hypoplastic left heart syndrome (HLHS) induced by left atrial ligation (LAL) at embryonic day (ED) 4 is associated with EFE at later stages, myocardial fibrosis was evaluated by histology and immunoconfocal microscopy and mass spectrometry (MS) at ED12. Immunohistochemistry with collagen I antibody clearly showed a significant thickening of the layer of subendocardial fibrous tissue in LAL hearts, and MS proved this significant increase of collagen I. To provide further insight into pathogenesis of this increased fibroproduction, hypoxyprobe staining revealed an increased extent of hypoxic regions, normally limited to the interventricular septum, in the ventricular myocardium of LAL hearts at ED8. CONCLUSIONS: Abnormal hemodynamic loading during heart development leads to myocardial hypoxia, stimulating collagen production in the subendocardium. Therefore, EFE in this chick embryonic model of HLHS appears to be a secondary effect of abnormal hemodynamics. Developmental Dynamics 247:509-520, 2018. © 2017 Wiley Periodicals, Inc.
- MeSH
- endokard metabolismus MeSH
- endokardiální fibroelastóza etiologie MeSH
- hemodynamika * MeSH
- kolagen biosyntéza MeSH
- kuřecí embryo MeSH
- srdce embryologie růst a vývoj MeSH
- syndrom hypoplazie levého srdce etiologie MeSH
- zvířata MeSH
- Check Tag
- kuřecí embryo MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: A total of 30% to 40% of patients with congestive heart failure eligible for cardiac resynchronization therapy (CRT) either do not respond to conventional CRT or remain untreated due to an inability or impediment to coronary sinus (CS) lead implantation. The WiSE-CRT system (EBR Systems, Sunnyvale, California) was developed to address this at-risk patient population by performing biventricular pacing via a wireless left ventricular (LV) endocardial pacing electrode. OBJECTIVES: The SELECT-LV (Safety and Performance of Electrodes implanted in the Left Ventricle) study is a prospective multicenter non-randomized trial assessing the safety and performance of the WiSE-CRT system. METHODS: A total of 35 patients indicated for CRT who had "failed" conventional CRT underwent implantation of an LV endocardial pacing electrode and a subcutaneous pulse generator. System performance, clinical efficacy, and safety events were assessed out to 6 months post-implant. RESULTS: The procedure was successful in 97.1% (n = 34) of attempted implants. The most common indications for endocardial LV pacing were difficult CS anatomy (n =12), failure to respond to conventional CRT (n = 10), and a high CS pacing threshold or phrenic nerve capture (n = 5). The primary performance endpoint, biventricular pacing on the 12-lead electrocardiogram at 1 month, was achieved in 33 of 34 patients. A total of 28 patients (84.8%) had improvement in the clinical composite score at 6 months, and 21 (66%) demonstrated a positive echocardiographic CRT response (≥5% absolute increase in LV ejection fraction). There were no pericardial effusions, but serious procedure/device-related events occurred in 3 patients (8.6%) within 24 h, and 8 patients (22.9%) between 24 h and 1 month. CONCLUSIONS: The SELECT-LV study demonstrates the clinical feasibility for the WiSE-CRT system, and provided clinical benefits to a majority of patients within an otherwise "failed" CRT population. (Safety and Performance of Electrodes Implanted in the Left Ventricle [SELECT-LV]; NCT01905670).
- MeSH
- lidé středního věku MeSH
- lidé MeSH
- neúspěšná terapie MeSH
- prospektivní studie MeSH
- prostředky srdeční resynchronizační terapie škodlivé účinky statistika a číselné údaje MeSH
- senioři MeSH
- srdeční resynchronizační terapie škodlivé účinky statistika a číselné údaje MeSH
- srdeční selhání terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- multicentrická studie MeSH
BACKGROUND: The benefit of biventricular pacing (BiV) may be substantially affected by optimal lead placement. AIM: To evaluate the importance of right ventricular (RV) lead positioning on clinical outcome of BiV. METHODS AND RESULTS: A total of 99 patients with symptomatic heart failure and implantation of BiV system were included. Position of the left-ventricular (LV) lead was selected based on timing of local endocardial signal within the terminal portion of the QRS complex. RV lead was preferably positioned at the midseptum (n=74, RVS group) where the earliest RV endocardial signal was recorded. A subgroup of patients had RV lead placed in the apex (n=25, RVA group). NYHA class, maximum oxygen-uptake (VO(2)max), LV end-diastolic diameter (LVEDD, mm) and ejection fraction were assessed every third month. A trend towards greater improvement in NYHA class and significant increase in VO(2)max was present in the RVS group. Moreover, a significant decrease in LVEDD (DeltaLVEDD) was observed in the RVS group only (-3.4+/-6.5 mm versus +1.7+/-6.4 mm in RVA group at 12 months, p=0.004). No significant correlation between the degree of DeltaLVEDD and QRS narrowing induced by BiV was found. LVEDD reduction was predominantly present in dilated cardiomyopathy. CONCLUSIONS: Midseptal positioning of the RV lead appears to promote reverse LV remodelling during cardiac resynchronisation therapy.
Measures from the theory of nonlinear dynamics were applied on complex fractionated atrial electrograms (CFAEs) in order to characterize their physiological dynamic behavior. The results were obtained considering 113 short term atrial electrograms (A-EGMs) which were annotated by three experts into four classes of fractionation according to A-EGMs signal regularity. The following measures were applied on A-EGM signals: General Correlation Dimension, Approximate Entropy, Detrended Fluctuation Analysis, Lempel-Ziv Complexity, and Katz-Sevcik, Variance and Box Counting Fractal Dimension. Assessment of disorganization was evaluated by a Kruskal Wallis statistical test. Except Detrended Fluctuation Analysis and Variance Fractal Dimension, the CFAE disorganization was found statistically significant even for low significant level alpha = 0.001. Moreover, the increasing complexity of A-EGM signals was reflected by higher values of General Correlation Dimension of order 1 and Approximate Entropy.
Cardiac resynchronization therapy (CRT) has proven efficacious in the treatment of patients with heart failure and dyssynchronous activation. Currently, we select suitable CRT candidates based on the QRS complex duration (QRSd) and morphology with left bundle branch block being the optimal substrate for resynchronization. To improve CRT response rates, recommendations emphasize attention to electrical parameters both before implant and after it. Therefore, we decided to study activation times before and after CRT on the body surface potential maps (BSPM) and to compare thus obtained results with data from electroanatomical mapping using the CARTO system. Total of 21 CRT recipients with symptomatic heart failure (NYHA II-IV), sinus rhythm, and QRSd >/=150 ms and 7 healthy controls were studied. The maximum QRSd and the longest and shortest activation times (ATmax and ATmin) were set in the BSPM maps and their locations on the chest were compared with CARTO derived time interval and site of the latest (LATmax) and earliest (LATmin) ventricular activation. In CRT patients, all these parameters were measured during both spontaneous rhythm and biventricular pacing (BVP) and compared with the findings during the spontaneous sinus rhythm in the healthy controls. QRSd was 169.7+/-12.1 ms during spontaneous rhythm in the CRT group and 104.3+/-10.2 ms after CRT (p<0.01). In the control group the QRSd was significantly shorter: 95.1+/-5.6 ms (p<0.01). There was a good correlation between LATmin(CARTO) and ATmin(BSPM). Both LATmin and ATmin were shorter in the control group (LATmin(CARTO) 24.8+/-7.1 ms and ATmin(BSPM) 29.6+/-11.3 ms, NS) than in CRT group (LATmin(CARTO) was 48.1+/-6.8 ms and ATmin(BSPM) 51.6+/-10.1 ms, NS). BVP produced shortening compared to the spontaneous rhythm of CRT recipients (LATmin(CARTO) 31.6+/-5.3 ms and ATmin(BSPM) 35.2+/-12.6 ms; p<0.01 spontaneous rhythm versus BVP). ATmax exhibited greater differences between both methods with higher values in BSPM: in the control group LATmax(CARTO) was 72.0+/-4.1 ms and ATmax (BSPM) 92.5+/-9.4 ms (p<0.01), in the CRT candidates LATmax(CARTO) reached only 106.1+/-6.8 ms whereas ATmax(BSPM) 146.0+/-12.1 ms (p<0.05), and BVP paced rhythm in CRT group produced improvement with LATmax(CARTO) 92.2+/-7.1 ms and ATmax(BSPM) 130.9+/-11.0 ms (p<0.01 before and during BVP). With regard to the propagation of ATmin and ATmax on the body surface, earliest activation projected most often frontally in all 3 groups, whereas projection of ATmax on the body surface was more variable. Our results suggest that compared to invasive electroanatomical mapping BSPM reflects well time of the earliest activation, however provides longer time-intervals for sites of late activation. Projection of both early and late activated regions of the heart on the body surface is more variable than expected, very likely due to changed LV geometry and interposed tissues between the heart and superficial ECG electrode.
- MeSH
- blokáda Tawarova raménka diagnóza patofyziologie terapie MeSH
- dospělí MeSH
- elektrofyziologické jevy fyziologie MeSH
- elektrokardiografie metody trendy MeSH
- lidé středního věku MeSH
- lidé MeSH
- mapování potenciálů tělesného povrchu metody trendy MeSH
- převodní systém srdeční patofyziologie MeSH
- senioři MeSH
- srdeční resynchronizační terapie metody trendy MeSH
- srdeční selhání diagnóza patofyziologie terapie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Complex fractionated atrial electrograms (CFAEs) may represent the electrophysiological substrate for atrial fibrillation (AF). Progress in signal processing algorithms to identify CFAEs sites is crucial for the development of AF ablation strategies. A novel algorithm for automated description of atrial electrograms (A-EGMs) fractionation based on wavelet transform and several statistical pattern recognition methods was proposed and new methodology of A-EGM processing was designed and tested. The algorithms for A-EGM classification were developed using normal density based classifiers, linear and high degree polynomial classifiers, nearest mean scaled classifiers, nonlinear classifiers, neural networks and j48. All classifiers were compared and tested using a representative set of 1.5 s A-EGMs (n = 68) ranked by 3 independent experts 100% coincidentialy into 4 classes of fractionation: 1 - organized atrial activity; 2 - mild; 3 - intermediate; 4 - high degree of fractionation. Feature extraction and well performing classification algorithms tested here showed maximal error of 15% and mean classification error across all implemented classifiers 9%, and the best mean classification error 5.9% (nearest mean classifier), and classification error of highly fractionated A-EGMs of approximately 9%.
- MeSH
- algoritmy MeSH
- automatizace MeSH
- elektrofyziologie metody MeSH
- elektrokardiografie metody MeSH
- endokard patofyziologie MeSH
- fibrilace síní diagnóza patofyziologie MeSH
- lidé MeSH
- neuronové sítě MeSH
- neurony patologie MeSH
- normální rozdělení MeSH
- počítačové zpracování signálu MeSH
- statistické modely MeSH
- výpočetní biologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- MeSH
- elektrokardiografie MeSH
- fibrilace síní přenos MeSH
- katetrizační ablace MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
Complex fractionated atrial electrograms (CFAEs) may represent the electrophysiological substrate for atrial fibrillation (AF). Progress in signal processing algorithms to identify sites of CFAEs is crucial for the development of AF ablation strategies. A novel algorithm for automated description of fractionation of atrial electrograms (A-EGMs) based on the wavelet transform has been proposed. The algorithm was developed and validated using a representative set of 1.5 s A-EGM (n = 113) ranked by three experts into four categories: 1-organized atrial activity; 2-mild; 3-intermediate; 4-high degree of fractionation. A tight relationship between a fractionation index and expert classification of A-EGMs (Spearman correlation rho = 0.87) was documented with a sensitivity of 82% and specificity of 90% for the identification of highly fractionated A-EGMs. This operator-independent description of A-EGM complexity may be easily incorporated into mapping systems to facilitate CFAE identification and to guide AF substrate ablation.
- MeSH
- algoritmy MeSH
- automatizace MeSH
- elektrokardiografie statistika a číselné údaje MeSH
- fibrilace síní patofyziologie MeSH
- interpretace statistických dat MeSH
- katetrizační ablace MeSH
- lidé středního věku MeSH
- lidé MeSH
- pilotní projekty MeSH
- počítačové zpracování signálu MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
