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European Heart Journal 1992 13(Supplement E):104-112; doi:10.1093/eurheartj/13.suppl_E.104
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Right ventricular conductance to establish closed-loop pacing

M. Schaldach*, E. Ebner{dagger}, H. Hutten{ddagger}, G. H. von Knorre§, W. Niederlag||, W. Rentsch, H. Volkmann**, D. Weber{dagger}{dagger} and E. Wunderlich{ddagger}{ddagger}

* Zentralinstitut für Biomedizinische Technik, Universität Erlangen-Nürnberg Erlangen, Germany
{dagger} Hufeland Klinik GmbH, Innere Klinik, Weimar Germany
{ddagger} lnstitut für Elektro- und Biomedizinische Technik, Universität Graz Graz, Austria
§ Klinik und Poliklinik füir Innere Medizin, Universität Rostock Rostock 1, Germany
|| Krankenhaus Dresden-Friedrichstadt, Abteilung Biomedizintechnik und Physik Dresden, Germany
Laboratorium für biomedizinische Elektronik Pirna, Germany
** Klinikum der Friedrich-Schiller Universität, Klinik für Innere Medizin, Kardiologie/Angiologie Jena-Lobeda Germany
{dagger}{dagger} Städtische Kliniken Chemnitz, Medizinische Klinik, Abteilung Kardiologie, Chemnitz Germany
{ddagger}{ddagger} Krankenhaus Dresden-Friedrichstadt, Abteilung Innere Medizin, Dresden Germany

Correspondence Prot Dr M. Schaldach, Zentralinstitut für Biomedizinische Technik der Friedrich-Alexander-Universität Erlangen-Nümberg, Tumstraβe 5, D-8520 Erlangen, Germany

Innovations in pacing technology, which include the addition of rate-responsive features to programmable pacemakers, can improve the quality of life of patients suffering from sick sinus syndrome. Among the strategies providing rate-adaptive cardiac pacing, the most attractive is the physiological restoration of closed-loop chronotropic control. This paper describes how autonomic nervous system (ANS) control information is extracted from dynamic measures of myocardial contractile performance obtained from unipolar conductance measurements using the stimulation electrode in the right ventricular cavity. The pacemaker uses the ANS information to modulate pacing rate and restore normal physiological control of heart rate. A new algorithm, regional effective slope quantity (RQ), for isolating the ANS signal was developed. The resulting signal, ventricular inotropic parameter (VIP), is a normalized parameter proportional to the strength of the ANS inotropic signals to the myocardium. '1 he efficacy of the ANS control concept was evaluated in multi-centre studies. Patients with AV block and VIP-controlled pulse generators performed defined exercise protocols. The ANS-controlled pacing rate and the spontaneous sinus rate were closely correlated. Blood pressure and subjective patient reports further indicated that good control of the cardiovascular circulation was achieved.

Key Words: Bio-sensors • intracardiac impedance • intracardiac conductance • autonomic nervous system • rate-adaptive pacemaker • cardiovascular control


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