The dromotropic pacemaker: System analysis and design considerations
| LEADER | caa a22 4500 | ||
|---|---|---|---|
| 001 | 378919121 | ||
| 003 | CHVBK | ||
| 005 | 20180305123600.0 | ||
| 007 | cr unu---uuuuu | ||
| 008 | 161128e20041101xx s 000 0 ger | ||
| 024 | 7 | 0 | |a 10.1515/BMT.2004.056 |2 doi |
| 035 | |a (NATIONALLICENCE)gruyter-10.1515/BMT.2004.056 | ||
| 245 | 0 | 0 | |a The dromotropic pacemaker: System analysis and design considerations |h [Elektronische Daten] |c Der dromotrope Schrittmacher: Systemanlyse und Entwurfskriterien / [M Hexamer, M Meine, C Kloppe, A Kloppe, A Mügge, J Werner] |
| 520 | 3 | |a Patients suffering from chronotropic incompetence are generally treated with a rate-responsive pacemaker that stimulates the heart at a rate derived from a strain related sensor signal. The pacemaker concept described here uses a well-defined time interval in the electrogram as sensor parameter (AVCT: atrio-ventricular conduction time). AVCT is directly controlled by the autonomic nervous system. The design of the new algorithm was based on a thorough experimental analysis of AVCT subject to variations of the exercise rate and the pacing frequency. There it was demonstrated that AVCT is disturbed by the respiratory activity. The new rate-responsive algorithm which uses the internal model control principle explicitly takes into account the closed-loop nature of the underlying system. The major design objectives were: a) extended range of the individual heart rate, b) effective attenuation of the respiratory related disturbance and c) dynamic stability. Seven patients undergoing an incre-mental exercise test were paced with the new AVCT-based algorithm. When paced with this algorithm the paced heart rate was 126±12 min-1 whereas the peak intrinsic heart rate was only 100±20 min-1. The increase which was significant (26±13 min-1; 15..53 min-1) clearly demonstrated the potential of this concept to restore chronotropic competence. A reanalysis of the experiments was undertaken in order to facilitate the individual parameterization in clinical practice. It could be demonstrated that a rather simple screening test is sufficient to gain the knowledge necessary for the individual parameterisation. Chronotrop inkompetente Patienten werden in der Regel mit einem frequenzadaptiven Herz-schrittmachersystem therapiert. Dieses stimuliert das Herz mit einer Frequenz, die von einem belastungskorrelierten Sensorsignal abgeleitet wird. In diesem Beitrag wird ein neues Schrittmacherkonzept beschrieben, das ein definiertes Zeitintervall im Elektrokardiogramm als Sensorgröße nutzt (atrio-ventrikuläre Leitungszeit, AVCT). AVCT unterliegt der direkten Kontrolle durch das autonome Nervensystem. Zunächst erfolgte eine gründliche experimentelle Analyse der AVCT bei Variation der Arbeitsbelastung und der Stimulationsfrequenz. Dabei konnte auch gezeigt werden, dass AVCT stark von der Atmung beeinflusst wird. Der Algorithmus, der auf dem "internal model control principle" basiert, berücksichtigt explizit die zu Grunde liegende ge-schlossene Rückkopplung. Wesentliche Entwurfskriterien waren a) erweiterter Stimulationsfrequenz- bereich, b) effektive Dämpfung der atmungsgekoppelten Variabilität und c) dynamische Stabilität. Sieben Patienten wurden einem inkrementalen Belastungstest unterzogen und mit dem neuen Algorithmus stimuliert. Dabei betrug die maximal erreichte stimulierte Herzfrequenz 126±12 min-1. Im Vergleich zur intrinsischen Herzfrequenz bei gleichen Bedingungen (100±20 min-1) wurde ein signifikanter Anstieg (26±13 min-1; 15.53 min-1) erzielt. Dieses Ergebnis belegte das Potential dieses Verfahrens, chronotrope Kompetenz wiederherzustellen. Eine weitergehende Analyse wurde mit dem Ziel unternommen, ein vereinfachtes Verfahren für die Parametrisierung des Algorithmus zu erarbeiten. Es konnte gezeigt werden, dass nur ein einfacher Belastungstest notwendig ist, um das System individuell einzustellen. | |
| 540 | |a © Walter de Gruyter | ||
| 690 | 7 | |a rate-responsive pacing |2 nationallicence | |
| 690 | 7 | |a atrio-ventricular conduction time |2 nationallicence | |
| 690 | 7 | |a closed-loop pacing |2 nationallicence | |
| 690 | 7 | |a Frequenzadaptive Stimulation |2 nationallicence | |
| 690 | 7 | |a atrio-ventrikuläre Überleitungszeit |2 nationallicence | |
| 690 | 7 | |a Closed-loop Stimulation |2 nationallicence | |
| 700 | 1 | |a Hexamer |D M. |u Department of Biomedical Engineering, Medical Faculty, and University Center of Medical Engineering (UZMT), Ruhr-University Bochum, Germany. |4 aut | |
| 700 | 1 | |a Meine |D M. |u Department of Biomedical Engineering, Medical Faculty, and University Center of Medical Engineering (UZMT), Ruhr-University Bochum, Germany. |4 aut | |
| 700 | 1 | |a Kloppe |D C. |u Medical Clinic II (Cardiology), St. Josef Hospital, Medical Faculty, Ruhr-University Bochum, Germany. |4 aut | |
| 700 | 1 | |a Kloppe |D A. |u Department of Biomedical Engineering, Medical Faculty, and University Center of Medical Engineering (UZMT), Ruhr-University Bochum, Germany; Medical Clinic II (Cardiology), St. Josef Hospital, Medical Faculty, Ruhr-University Bochum, Germany. |4 aut | |
| 700 | 1 | |a Mügge |D A. |u Medical Clinic II (Cardiology), St. Josef Hospital, Medical Faculty, Ruhr-University Bochum, Germany. |4 aut | |
| 700 | 1 | |a Werner |D J. |u Department of Biomedical Engineering, Medical Faculty, and University Center of Medical Engineering (UZMT), Ruhr-University Bochum, Germany. |4 aut | |
| 773 | 0 | |t Biomedizinische Technik/Biomedical Engineering |d Walter de Gruyter |g 49/11(2004-11-01), 300-305 |x 0013-5585 |q 49:11<300 |1 2004 |2 49 |o bmte | |
| 856 | 4 | 0 | |u https://doi.org/10.1515/BMT.2004.056 |q text/html |z Onlinezugriff via DOI |
| 908 | |D 1 |a research article |2 jats | ||
| 950 | |B NATIONALLICENCE |P 856 |E 40 |u https://doi.org/10.1515/BMT.2004.056 |q text/html |z Onlinezugriff via DOI | ||
| 950 | |B NATIONALLICENCE |P 700 |E 1- |a Hexamer |D M. |u Department of Biomedical Engineering, Medical Faculty, and University Center of Medical Engineering (UZMT), Ruhr-University Bochum, Germany |4 aut | ||
| 950 | |B NATIONALLICENCE |P 700 |E 1- |a Meine |D M. |u Department of Biomedical Engineering, Medical Faculty, and University Center of Medical Engineering (UZMT), Ruhr-University Bochum, Germany |4 aut | ||
| 950 | |B NATIONALLICENCE |P 700 |E 1- |a Kloppe |D C. |u Medical Clinic II (Cardiology), St. Josef Hospital, Medical Faculty, Ruhr-University Bochum, Germany |4 aut | ||
| 950 | |B NATIONALLICENCE |P 700 |E 1- |a Kloppe |D A. |u Department of Biomedical Engineering, Medical Faculty, and University Center of Medical Engineering (UZMT), Ruhr-University Bochum, Germany; Medical Clinic II (Cardiology), St. Josef Hospital, Medical Faculty, Ruhr-University Bochum, Germany |4 aut | ||
| 950 | |B NATIONALLICENCE |P 700 |E 1- |a Mügge |D A. |u Medical Clinic II (Cardiology), St. Josef Hospital, Medical Faculty, Ruhr-University Bochum, Germany |4 aut | ||
| 950 | |B NATIONALLICENCE |P 700 |E 1- |a Werner |D J. |u Department of Biomedical Engineering, Medical Faculty, and University Center of Medical Engineering (UZMT), Ruhr-University Bochum, Germany |4 aut | ||
| 950 | |B NATIONALLICENCE |P 773 |E 0- |t Biomedizinische Technik/Biomedical Engineering |d Walter de Gruyter |g 49/11(2004-11-01), 300-305 |x 0013-5585 |q 49:11<300 |1 2004 |2 49 |o bmte | ||
| 900 | 7 | |b CC0 |u http://creativecommons.org/publicdomain/zero/1.0 |2 nationallicence | |
| 898 | |a BK010053 |b XK010053 |c XK010000 | ||
| 949 | |B NATIONALLICENCE |F NATIONALLICENCE |b NL-gruyter | ||