Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, UK.
Invicro, London, UK.
Europace. 2023 Feb 16;25(2):716-725. doi: 10.1093/europace/euac165.
Anti-tachycardia pacing (ATP) is a reliable electrotherapy to painlessly terminate ventricular tachycardia (VT). However, ATP is often ineffective, particularly for fast VTs. The efficacy may be enhanced by optimized delivery closer to the re-entrant circuit driving the VT. This study aims to compare ATP efficacy for different delivery locations with respect to the re-entrant circuit, and further optimize ATP by minimizing failure through re-initiation.
Seventy-three sustained VTs were induced in a cohort of seven infarcted porcine ventricular computational models, largely dominated by a single re-entrant pathway. The efficacy of burst ATP delivered from three locations proximal to the re-entrant circuit (septum) and three distal locations (lateral/posterior left ventricle) was compared. Re-initiation episodes were used to develop an algorithm utilizing correlations between successive sensed electrogram morphologies to automatically truncate ATP pulse delivery. Anti-tachycardia pacing was more efficacious at terminating slow compared with fast VTs (65 vs. 46%, P = 0.000039). A separate analysis of slow VTs showed that the efficacy was significantly higher when delivered from distal compared with proximal locations (distal 72%, proximal 59%), being reversed for fast VTs (distal 41%, proximal 51%). Application of our early termination detection algorithm (ETDA) accurately detected VT termination in 79% of re-initiated cases, improving the overall efficacy for proximal delivery with delivery inside the critical isthmus (CI) itself being overall most effective.
Anti-tachycardia pacing delivery proximal to the re-entrant circuit is more effective at terminating fast VTs, but less so slow VTs, due to frequent re-initiation. Attenuating re-initiation, through ETDA, increases the efficacy of delivery within the CI for all VTs.
抗心动过速起搏（ATP）是一种可靠的电疗法，可无痛终止室性心动过速（VT）。然而，ATP 通常无效，尤其是对于快速 VT。通过更接近驱动 VT 的折返环路来优化传递，可以增强疗效。本研究旨在比较不同传递位置相对于折返环路的 ATP 疗效，并通过重新启动最小化失败来进一步优化 ATP。
在 7 个梗死猪心室计算模型的队列中诱导了 73 个持续性 VT，这些模型主要由单个折返途径主导。比较了从折返环路附近的三个位置（间隔）和三个远端位置（左侧/后侧左心室）传递的突发 ATP 的疗效。使用重新启动发作来开发一种算法，该算法利用连续感知心电图形态之间的相关性自动截断 ATP 脉冲传递。与快速 VT 相比，ATP 更有效地终止缓慢 VT（65%比 46%，P=0.000039）。对缓慢 VT 的单独分析表明，当从远端传递时，疗效明显高于近端传递（远端 72%，近端 59%），而对于快速 VT 则相反（远端 41%，近端 51%）。我们的早期终止检测算法（ETDA）的应用可在 79%的重新启动病例中准确检测 VT 终止，从而提高近端传递的整体疗效，而在关键峡部（CI）内传递本身的疗效则是整体最佳。
由于频繁重新启动，靠近折返环路的抗心动过速起搏传递在终止快速 VT 时更有效，但在终止缓慢 VT 时效果较差。通过 ETDA 减轻重新启动可提高所有 VT 在 CI 内传递的疗效。
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