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A real-time system for selectively sensing and pacing the His-bundle during sinus rhythm and ventricular fibrillation.
BioMedical Engineering OnLine ( IF 3.9 ) Pub Date : 2020-04-10 , DOI: 10.1186/s12938-020-00763-6
Ankur R Shah 1, 2 , Muhammad S Khan 2 , Annie M Hirahara 1, 2 , Matthias Lange 2 , Ravi Ranjan 1, 2, 3 , Derek J Dosdall 1, 2, 3, 4
Affiliation  

BACKGROUND The His-Purkinje (HP) system provides a pathway for the time-synchronous contraction of the heart. His bundle (HB) of the HP system is gaining relevance as a pacing site for treating non-reversible bradyarrhythmia despite limited availability of tools to identify the HB. In this paper, we describe a real-time stimulation and recording system (rt-SRS) to investigate using multi-electrode techniques to identify and selectively pace the HB. The rt-SRS can not only be used in sinus rhythm, but also during ventricular fibrillation (VF). The rt-SRS will also help investigate the so far unknown causal effects of selectively pacing the HB during VF. METHODS The rt-SRS consists of preamplifiers, data acquisition cards interfaced with a real-time controller, a current source, and current routing switches on a remote computer, which may be interrupted to stimulate using a host machine. The remote computer hosts a series of algorithms designed to aid in identifying electrodes directly over the HB, to accurately detect activation rates without over-picking, and to deliver stimulation pulses. The performance of the rt-SRS was demonstrated in seven isolated, perfused rabbit hearts. RESULTS The rt-SRS can visualize up to 96 channels of raw data, and spatial derivative data at 6.25-kHz sampling rate with an input-referred noise of 100 µV. The rt-SRS can send up to ± 150 V of stimuli pulses to any of the 96 channels. In the rabbit experiments, HB activations were detected in 18 ± 6.8% of the 64 electrodes used during VF. CONCLUSIONS The rt-SRS is capable of measuring and responding to cardiac electrophysiological phenomena in real-time with precisely timed and placed electrical stimuli. This rt-SRS was shown to be an effective research tool by successfully detecting and quantifying HB activations and delivering stimulation pulses to selected electrodes in real-time.

中文翻译:

一个实时系统,可在窦性心律和心室纤颤期间选择性地感应和调节His束。

背景技术His-Purkinje(HP)系统为心脏的时间同步收缩提供了一条途径。尽管用于诊断HB的工具有限,但他在HP系统中的捆绑(HB)正在作为治疗不可逆性缓慢性心律失常的起搏点而获得关注。在本文中,我们描述了一种实时刺激和记录系统(rt-SRS),以研究使用多电极技术来识别和选择性调节HB。rt-SRS不仅可以用于窦性心律,还可以用于心室纤颤(VF)。rt-SRS也将有助于调查迄今为止在VF期间选择性起搏HB的未知因果关系。方法rt-SRS由前置放大器,与实时控制器接口的数据采集卡,远程计算机上的电流源和电流路由开关组成,可能会被中断以刺激使用主机。远程计算机包含一系列算法,这些算法旨在帮助在HB上方直接识别电极,准确检测激活率而不会过度拾取以及传递刺激脉冲。rt-SRS的性能在七个离体的灌注兔心脏中得到证实。结果rt-SRS可以以6.25 kHz的采样率可视化多达96个通道的原始数据和空间导数数据,并具有100 µV的输入参考噪声。rt-SRS可以向96个通道中的任何一个发送高达±150 V的刺激脉冲。在兔实验中,在VF期间使用的64个电极中的18±6.8%中检测到HB激活。结论rt-SRS能够实时测量并响应心脏电生理现象,并具有精确定时和放置的电刺激。通过成功检测和量化HB激活并将刺激脉冲实时传递到选定的电极,该rt-SRS被证明是一种有效的研究工具。
更新日期:2020-04-22
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