Quantification of Electromechanical Coupling to Prevent Inappropriate Implantable Cardioverter-Defibrillator Shocks

Keene, Daniel; Shun-Shin, Matthew; Arnold, Ahran; Howard, James P.; Lefroy, David; Davies, D. Wyn; Lim, Phang Boon; Ng, Fu Siong; Koa‐Wing, Michael; Qureshi, Norman; Linton, Nick; Shah, Jaymin; Peters, Nicholas S.; Kanagaratnam, Prapa; Francis, Dárrel P.; Whinnett, Zachary I.

doi:10.1016/j.jacep.2019.01.025

Cited by 7 publications

(12 citation statements)

References 19 publications

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“…Implantation of this technology may also assist devices to make a physiologically based decision on whether to deliver therapy in suspected tachycardias. We have previously found that the addition of perfusion data successfully improves discrimination of when therapy is appropriate 20 …”

Section: Discussionmentioning

confidence: 99%

“…Further research is still required before laser Doppler can be incorporated into a device. Chronic safety and signal fidelity of laser Doppler implantation needs to be assessed, expanding on pilot recordings using a miniaturized laser Doppler prototype 20,34,35 …”

Section: Discussionmentioning

confidence: 99%

“…Laser Doppler has been validated in patients with burns, for assessment of viability of skin grafts and guiding therapy in various rheumatological and dermatological conditions 18,19 . We have previously found that it is sensitive to the hemodynamic changes associated with ventricular arrhythmias 20 …”

Section: Introductionmentioning

confidence: 99%

“…18,19 We have previously found that it is sensitive to the hemodynamic changes associated with ventricular arrhythmias. 20 A key necessity for any automated optimization technique is a good method for automatically detecting data that has been disrupted by noise, so that it is not used by the device to apply an incorrect setting.…”

Section: Introductionmentioning

confidence: 99%

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Optimizing atrio‐ventricular delay in pacemakers using potentially implantable physiological biomarkers

Keene

Miyazawa

Johal

et al. 2022

Pacing Clinical Electrophis

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Background: Hemodynamically optimal atrioventricular (AV) delay can be derived by echocardiography or beat-by-beat blood pressure (BP) measurements, but analysis is labor intensive. Laser Doppler perfusion monitoring measures blood flow and can be incorporated into future implantable cardiac devices.We assess whether laser Doppler can be used instead of BP to optimize AV delay.Methods: Fifty eight patients underwent 94 AV delay optimizations with biventricular or His-bundle pacing using laser Doppler and simultaneous noninvasive beat-by-beat BP. Optimal AV delay was defined using a curve of hemodynamic response to switching from AAI (reference state) to DDD (test state) at several AV delays (40-320 ms), with automatic quality control checking precision of the optimum.Five subsequent patients underwent an extended protocol to test the impact of greater numbers of alternations on optimization quality.Results: 55/94 optimizations passed quality control resulting in an optimal AV delay on laser Doppler similar to that derived by BP (median absolute deviation 12 ms).An extended protocol with increasing number of replicates consistently improved quality and reduced disagreement between laser Doppler and BP optima. With only five replicates, no optimization passed quality control, and the median absolute deviation would be 29 ms. These improved progressively until at 50 replicates, all optimizations passed quality control and the median absolute deviation was only 13 ms.Conclusions: Laser Doppler perfusion produces hemodynamic optima equivalent to BP. Quality control can be automatic. Adding more replicates, consistently improves quality. Future implantable devices could use such methods to dynamically and reliably optimize AV delays.Abbreviations: AV, atrioventricular; BP, blood pressure; CRT, cardiac resynchronization therapy; SE OPT , Standard error of the optimum.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optimizing atrio‐ventricular delay in pacemakers using potentially implantable physiological biomarkers

Keene

Miyazawa

Johal

et al. 2022

Pacing Clinical Electrophis

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“…ICD shocks) as a reference, and it focused on PPG features. Electromechanical coupling analysis has been recently used with success [14] to discriminate ventricular fibrillation from sinus rhythm or artefacts using used two laser doppler flowmetry light probes, one at the heart and the other at the finger. Compared to PPG, this laser doppler is a complex and expensive technology that uses coherent light to measure perfusion, which limits the application to in-clinic use.…”

Section: Discussionmentioning

confidence: 99%

Real Time Non-Invasive Hemodynamic Assessment of Ventricular Tachycardia

et al. 2020

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Hemodynamically unstable ventricular tachycardia (VT) is a critical cardiac arrhythmia associated with hemodynamic compromise that requires immediate cardioversion to prevent sudden cardiac death. Since unnecessary cardioverter defibrillators shocks damage the heart and increase the risk of mortality, the discrimination between unstable (i.e. requiring cardioversion) and stable (i.e. not requiring cardioversion) VT is of paramount importance. The aim of this study was to propose and assess non-invasive identification of hemodynamically unstable VT using photoplethysmography (PPG). Seventy-five (n=75) episodes of VT were recorded in 14 patients undergoing invasive electrophysiological studies for VT catheter ablation. Invasive continuous arterial blood pressure (ABP), PPG and electrocardiogram (ECG) were simultaneously recorded. VTs were classified as unstable if during the first 10 seconds from onset, the mean ABP (PVT) was PVT<60 mmHg or if PVT dropped more than 30% with respect to a 10 seconds baseline (i.e. ratio RABP<0.70). Five PPG morphological features were derived and compared to the heart rate from the ECG. PPG markers detected hemodynamically unstable VT with accuracy as high as 86% and were more accurate than the heart rate. The mean absolute slope was the best PPG parameter for classification of PVT<60 mmHg (AUC=0.85, Sensitivity=72%, Specificity=86%) and RABP<0.70 (AUC=0.90, Sensitivity=83%, Specificity=89%) and it was automatically selected in the best two-variables logistic regression, for which AUC=0.94. In conclusion, PPG analysis can accurately identify haemodynamically unstable VTs and has potential to enable optimization of VT therapy and reduce unnecessary and harmful cardioversion shocks.

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Therapeutic potential of conduction system pacing as a method for improving cardiac output during ventricular tachycardia

Keene,

Miyazawa,

Arnold

et al. 2024

J Interv Card Electrophysiol

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Background Ventricular tachycardia (VT) reduces cardiac output through high heart rates, loss of atrioventricular synchrony, and loss of ventricular synchrony. We studied the contribution of each mechanism and explored the potential therapeutic utility of His bundle pacing to improve cardiac output during VT. Methods Study 1 aimed to improve the understanding of mechanisms of harm during VT (using pacing simulated VT). In 23 patients with left ventricular impairment, we recorded continuous ECG and beat-by-beat blood pressure measurements. We assessed the hemodynamic impact of heart rate and restoration of atrial and biventricular synchrony. Study 2 investigated novel pacing interventions during clinical VT by evaluating the hemodynamic effects of His bundle pacing at 5 bpm above the VT rate in 10 patients. Results In Study 1, at progressively higher rates of simulated VT, systolic blood pressure declined: at rates of 125, 160, and 190 bpm, -22.2%, -42.0%, and -58.7%, respectively (ANOVA p < 0.0001). Restoring atrial synchrony alone had only a modest beneficial effect on systolic blood pressure (+ 3.6% at 160 bpm, p = 0.2117), restoring biventricular synchrony alone had a greater effect (+ 9.1% at 160 bpm, p = 0.242), and simultaneously restoring both significantly increased systolic blood pressure (+ 31.6% at 160 bpm, p = 0.0003). In Study 2, the mean rate of clinical VT was 143 ± 21 bpm. His bundle pacing increased systolic blood pressure by + 14.2% (p = 0.0023). In 6 of 10 patients, VT terminated with His bundle pacing. Conclusions Restoring atrial and biventricular synchrony improved hemodynamic function in simulated and clinical VT. Conduction system pacing could improve VT tolerability and treatment. Graphical Abstract

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Quantification of Electromechanical Coupling to Prevent Inappropriate Implantable Cardioverter-Defibrillator Shocks

Cited by 7 publications

References 19 publications

Optimizing atrio‐ventricular delay in pacemakers using potentially implantable physiological biomarkers

Optimizing atrio‐ventricular delay in pacemakers using potentially implantable physiological biomarkers

Real Time Non-Invasive Hemodynamic Assessment of Ventricular Tachycardia

Therapeutic potential of conduction system pacing as a method for improving cardiac output during ventricular tachycardia

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