Bongiorni M G, Soldati E, Arena G, Quirino G, Vernazza F, Bernasconi A, Garberoglio B
CNR-CREAS Clinical Physiology Institute, Pisa, Italy.
Pacing Clin Electrophysiol. 1996 Nov;19(11 Pt 2):1682-8. doi: 10.1111/j.1540-8159.1996.tb03206.x.
The availability of sensors monitoring cardiac function parameters may offer many interesting new applications in cardiac pacing. A microaccelerometer sensor (BEST, Biomechanical Endocardial Sorin Transducer) located at the tip of a pacing lead (PL) has been developed by Sorin Biomedica. The signal detected by the accelerometer, peak endocardial acceleration (PEA), was shown to reflect cardiac contractility and to be related to the dP/dt signal. Whether the PEA detected by the BEST sensor in different cardiac locations is the expression of local acceleration forces or reflects the whole heart contractility has not yet been demonstrated in humans. Endocardial acceleration and PEA were evaluated in five patients (4 males, 1 female, mean age 68 years) who underwent cardiac catheterization. Sinus rhythm was present in four patients and chronic atrial fibrillation was present in one. The BEST PL was introduced through the left subclavian vein and PEA signals were recorded: (1) at the apex of the right ventricle (RV), (2) within the coronary sinus (CS), (3) at the right atrial appendage (RAA), and (4) floating in the right atrium. The PEA signals were recorded simultaneously with surface ECG, intracardiac electrograms, and RV pressure. At each recording site, PEA signals with significant amplitude were always recorded during the preejection period, during the isovolumic contraction phase, independently of the recording site and cardiac rhythm. The PEA amplitude was higher in the RV (mean value 1.32 g) and it decreased in the RAA and CS (0.75 and 0.45 g, respectively). The same behavior of PEA was observed during sinus rhythm or atrial fibrillation. The amplitude and the timing of the PEA signals detected by the BEST accelerometer were independent of the recording site and atrial rhythm; they appeared to be strictly related to the global ventricular contractility. These results suggest that the BEST could be used either as an effective sensor in closed loop pacing systems, or primarily as a diagnostic hemodynamic sensor.
监测心脏功能参数的传感器的可用性可能会在心脏起搏方面带来许多有趣的新应用。索林生物医学公司开发了一种位于起搏导线（PL）尖端的微加速度计传感器（BEST，生物力学心内膜索林换能器）。加速度计检测到的信号，即心内膜峰值加速度（PEA），已被证明可反映心脏收缩力并与dP/dt信号相关。BEST传感器在不同心脏位置检测到的PEA是局部加速力的表现还是反映全心收缩力，在人类中尚未得到证实。对5例接受心导管检查的患者（4例男性，1例女性，平均年龄68岁）的心内膜加速度和PEA进行了评估。4例患者为窦性心律，1例为慢性心房颤动。通过左锁骨下静脉插入BEST PL并记录PEA信号：（1）在右心室（RV）心尖处，（2）在冠状窦（CS）内，（3）在右心耳（RAA）处，以及（4）漂浮在右心房中。PEA信号与体表心电图、心内心电图和RV压力同时记录。在每个记录部位，在射血前期、等容收缩期总是能记录到具有显著幅度的PEA信号，与记录部位和心律无关。RV处的PEA幅度更高（平均值1.32 g），在RAA和CS处降低（分别为0.75和0.45 g）。在窦性心律或心房颤动期间观察到PEA的相同行为。BEST加速度计检测到的PEA信号的幅度和时间与记录部位和心房节律无关；它们似乎与整体心室收缩力密切相关。这些结果表明，BEST既可以用作闭环起搏系统中的有效传感器，也可以主要用作诊断性血流动力学传感器。
