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迷走神经刺激参数对心力衰竭时变时性和变力性的影响。

Influence of Vagus Nerve Stimulation parameters on chronotropism and inotropism in heart failure.

作者信息

Rousselet Laure, Le Rolle Virginie, Ojeda David, Guiraud David, Hagége Albert, Bel Alain, Bonnet Jean-Luc, Mabo Philippe, Carrault Guy, Hernández Alfredo I

出版信息

Annu Int Conf IEEE Eng Med Biol Soc. 2014;2014:526-9. doi: 10.1109/EMBC.2014.6943644.

Abstract

Vagus Nerve Stimulation (VNS) has been shown to be useful in heart failure patients, including antiarrhythmic effects, improvement of cardiac function and reduction of the mortality. However, the optimal configuration of VNS can be a difficult task, since there are several adjustable parameters, such as current amplitude (mA), pulse width (ms), burst frequency (Hz), number of pulses and, in the case of cardiac-triggered VNS, the delay (ms) between the R-wave and the beginning of the stimulation. The objective of this paper is to analyse the effect of these parameters, and their interaction, on the chronotropic and inotropic responses to vagal stimulation. 306 VNS sequences were tested on 12 sheep with induced heart failure. Autonomic markers of the chronotropic (changes in RR interval) and inotropic (changes in dP/dtmax) effects were extracted from the observed data. In order to analyse the influence of stimulation parameters on these markers, a sensitivity analysis method was applied. Results illustrate the strong interaction between the delay and the others parameters. The number of pulses, the current and the frequency seem to be particularly influent on chronotropism and inotropism although the effect of the frequency is highly non-linear or it depends on other parameters.

摘要

迷走神经刺激(VNS)已被证明对心力衰竭患者有用,包括抗心律失常作用、改善心脏功能和降低死亡率。然而,VNS的最佳配置可能是一项艰巨的任务,因为有几个可调节参数,如电流幅度(mA)、脉冲宽度(ms)、爆发频率(Hz)、脉冲数量,以及在心脏触发VNS的情况下,R波与刺激开始之间的延迟(ms)。本文的目的是分析这些参数及其相互作用对迷走神经刺激的变时性和变力性反应的影响。在12只诱发心力衰竭的绵羊身上测试了306个VNS序列。从观察数据中提取变时性(RR间期变化)和变力性(dP/dtmax变化)效应的自主神经标志物。为了分析刺激参数对这些标志物的影响,应用了一种敏感性分析方法。结果表明延迟与其他参数之间存在强烈的相互作用。脉冲数量、电流和频率似乎对变时性和变力性有特别的影响,尽管频率的影响高度非线性或取决于其他参数。

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