Rate-responsive pacing regulated by cardiac haemodynamics

Gasparini, G.; Curnis, Antonio; Gulizia, Michele Massimo; Occhetta, Eraldo; Corrado, Andrea; Bontempi, Luca; Mascioli, Giosuè; Francese, Giuseppina Maura; Bortnik, Miriam; Magnani, Andrea; Gregorio, F. Di; Barbetta, A.; Raviele, Antonio

doi:10.1016/j.eupc.2005.02.115

Cited by 22 publications

(10 citation statements)

References 31 publications

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“…Moreover, previous experience demonstrated that the assessment of ventricular volume inferred from TVI data provided reliable information on acute changes in the adrenergic tone, allowing a physiological regulation of the pacing rate. 13–15 …”

Section: Discussionmentioning

confidence: 99%

Left ventricular mechanical activity detected by impedance recording

et al. 2010

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AimsRecording and analysing impedance fluctuation along the cardiac cycle in the right (RV) and left ventricles (LV).Methods and resultsDuring a biventricular (BiV) implantation procedure, impedance was sequentially derived between the atrial ring electrode and either electrode (tip or ring) of the RV lead [transvalvular impedance (TVI)], and between the atrial ring and either the tip or ring electrode of a coronary sinus lead, positioned in a cardiac vein [left ventricle impedance (LVI)]. The LVI signal was also recorded by the implanted pacemaker at the 1 day and 3 months follow-ups. With intrinsic conduction, TVI showed an average increase of 53 ± 29 Ω during ventricular systole, whereas at the same time, LVI decreased by 45 ± 21 Ω (25 and 23 patients, respectively, out of 28 tested cases). Transvalvular impedance and LVI displayed a similar time course, which appeared to be related to the systolic timing in the RV and LV. Both LVI amplitude and duration decreased as a function of the cardiac rate. The LVI deflection started immediately after LV stimulation, and often anticipated the R-wave sensing after contralateral pacing. At the 3-month follow-up, LVI amplitude was decreased in 70% of cases and increased in the remainder, with a non-significant average change of −5 ± 85% with respect to the acute recordings.ConclusionTransvalvular impedance properties are consistent with the assumption of an inverse relationship with RV volume. Though LVI requires a different physical interpretation, the waveform duration might reflect the timing of LV myocardial contraction. In this hypothesis, the relationship between TVI and LVI could provide insight into the effects of BiV pacing on mechanical synchronization.

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Section: Discussionmentioning

confidence: 99%

Left ventricular mechanical activity detected by impedance recording

et al. 2010

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“…On the other hand, Biotronik and Medico are using impedance measurements on standard leads; however, the extension of their utility in the clinical practice is very limited. [26][27][28] The major advantage of our system in comparison to the existing systems is that any standard bipolar cardiac lead may be the cardiac contraction sensor without any special device mounted on its body. Furthermore, the sensor does not seem to be affected by factors that influence measurements in impedance sensors such as changes in thoracic anatomy and fluid status, although the signal can be modulated by respiration ( Fig.…”

Section: Advantages Of the Cardiomechanic Sensormentioning

confidence: 99%

New Cardiomechanic Pacing Lead Sensor Based on High Frequency Parameters: Experimental Studies in Sheep

Brusich

Tomasic²,

Sovilj

et al. 2013

Cardiovasc electrophysiol

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“…When inotropic index was used to drive a rate-responsive stimulator (SOPHÒS by Medico, Padova, Italy), the TVI-indicated pacing rate proved a precise replication of the individual sinus rate in patients with physiological chronotropic competence [35]. …”

Section: Rate Responsiveness Haemodynamic Sensorsmentioning

confidence: 99%

Usefulness of Hemodynamic Sensors for Physiologic Cardiac Pacing in Heart Failure Patients

Occhetta

Bortnik

Marino

2011

Cardiology Research and Practice

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The rate adaptive sensors applied to cardiac pacing should respond as promptly as the normal sinus node with an highly specific and sensitive detection of the need of increasing heart rate. Sensors operating alone may not provide optimal heart responsiveness: central venous pH sensing, variations in the oxygen content of mixed venous blood, QT interval, breathing rate and pulmonary minute ventilation monitored by thoracic impedance variations, activity sensors. Using sensors that have different attributes but that work in a complementary manners offers distinct advantages. However, complicated sensors interactions may occur. Hemodynamic sensors detect changes in the hemodynamic performances of the heart, which partially depends on the autonomic nervous system-induced inotropic regulation of myocardial fibers. Specific hemodynamic sensors have been designed to measure different expression of the cardiac contraction strength: Peak Endocardial Acceleration (PEA), Closed Loop Stimulation (CLS) and TransValvular Impedance (TVI), guided by intraventricular impedance variations. Rate-responsive pacing is just one of the potential applications of hemodynamic sensors in implantable pacemakers. Other issues discussed in the paper include: hemodynamic monitoring for the optimal programmation and follow up of patients with cardiac resynchronization therapy; hemodynamic deterioration impact of tachyarrhythmias; hemodynamic upper rate limit control; monitoring and prevention of vasovagal malignant syncopes.

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Rate-responsive pacing regulated by cardiac haemodynamics

Abstract: The study confirms the reliability of the haemodynamic information derived from TVI and supports its application in the regulation of rate-responsive pacing.

Cited by 22 publications

References 31 publications

Left ventricular mechanical activity detected by impedance recording

Left ventricular mechanical activity detected by impedance recording

New Cardiomechanic Pacing Lead Sensor Based on High Frequency Parameters: Experimental Studies in Sheep

Usefulness of Hemodynamic Sensors for Physiologic Cardiac Pacing in Heart Failure Patients

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