Rodero Cristobal, Strocchi Marina, Lee Angela W C, Rinaldi Christopher A, Vigmond Edward J, Plank Gernot, Lamata Pablo, Niederer Steven A
Cardiac Electro-Mechanics Research Group, Biomedical Engineering Department, King ́s College London, London, United Kingdom.
Cardiac Electro-Mechanics Research Group, Biomedical Engineering Department, King ́s College London, London, United Kingdom.
Comput Biol Med. 2022 Jan;140:105073. doi: 10.1016/j.compbiomed.2021.105073. Epub 2021 Nov 25.
Lead position is an important factor in determining response to Cardiac Resynchronization Therapy (CRT) in dyssynchronous heart failure (HF) patients. Multipoint pacing (MPP) enables pacing from multiple electrodes within the same lead, improving the potential outcome for patients. Virtual quadripolar lead designs were evaluated by simulating pacing from all combinations of 1 and 2 electrodes along the lead in each virtual patient from cohorts of HF (n = 24) and simulated reverse remodelled (RR, n = 20) patients. Electrical synchrony was assessed by the time 90% of the ventricular myocardium is activated (AT090). Optimal 1 and 2 electrode pacing configurations for AT090 were combined to identify the 4-electrode lead design that maximised benefits across all patients. LV pacing in the HF cohort in all possible single and double electrode locations reduced AT090 by 14.48 ± 5.01 ms (11.92 ± 3.51%). The major determinant of reduction in activation time was patient anatomy. Pacing with a single optimal lead design reduced AT090 more in the HF cohort than the RR cohort (12.68 ± 3.29% vs 10.81 ± 2.34%). Pacing with a single combined HF and RR population-optimised lead design achieves electrical resynchronization with near equivalence to personalised lead designs both in HF and RR anatomies. These findings suggest that although lead configurations have to be tailored to each patient, a single optimal lead design is sufficient to obtain near-optimal results across most patients. This study shows the potential of virtual clinical trials as tools to compare existing and explore new lead designs.
在不同步心力衰竭（HF）患者中，起搏部位是决定心脏再同步治疗（CRT）反应的重要因素。多点起搏（MPP）可实现同一根电极导线内多个电极的起搏，改善患者的潜在治疗效果。通过模拟来自HF队列（n = 24）和模拟逆向重构（RR，n = 20）患者队列中每个虚拟患者沿导线的1个和2个电极的所有组合进行起搏，对虚拟四极导线设计进行了评估。通过90%心室心肌被激活的时间（AT090）评估电同步性。将AT090的最佳1电极和2电极起搏配置相结合，以确定能使所有患者获益最大化的4电极导线设计。在HF队列中，在所有可能的单电极和双电极位置进行左心室起搏可使AT090缩短14.48±5.01毫秒（11.92±3.51%）。激活时间缩短的主要决定因素是患者的解剖结构。在HF队列中，采用单一最佳导线设计起搏比RR队列能更多地缩短AT090（12.68±3.29%对10.81±2.34%）。采用单一的HF和RR人群优化导线设计进行起搏，在HF和RR解剖结构中均可实现电再同步，且与个性化导线设计几乎等效。这些发现表明，尽管导线配置必须针对每个患者进行定制，但单一最佳导线设计足以在大多数患者中获得接近最佳的结果。这项研究显示了虚拟临床试验作为比较现有导线设计和探索新导线设计工具的潜力。
