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Cardiac Pacing for Heart Failure Patients

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George Yanulis
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A Novel Cardiac Pacing Paradigm for Atrial Fibrillation and Heart Failure Patients George Emanuel Yanulis, D. Eng
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Outline
Atrial Fibrillation ,[object Object],[object Object],[object Object],[object Object]
Clinical Correlates of AF ,[object Object],[object Object],[object Object],[object Object]
Heart Failure ,[object Object],[object Object],[object Object],[object Object],AHA 2007 Statistics Update
Anatomical/Physiological Considerations ,[object Object],[object Object],[object Object]
1 st Pacing Paradigm ,[object Object],[object Object],[object Object],[object Object]
Schematic Representation of Cardiac Conduction Pathways in the Human Heart http://images.main.uab.edu/
Concept of Coupled Pacing during AF (Electrically Activating the Ventricles after a Specific Delay) Atrium Ventricle AVN                       Atrium Ventricle AVN
AF can Lead to Ventricular Tachycardia ,[object Object],[object Object],[object Object],[object Object]
Coupled Pacing vs. Paired Stimulation
Prior Coupled Pacing Studies ,[object Object],[object Object],[object Object],Yamada H et al. Am J Physiol 287: H2016-H2022, 2004.
My Studies on Chronic Coupled Pacing ,[object Object],[object Object],[object Object]
Placement of the Leads, Adapters, and Pacemakers for the AF Model Cingoz et al (2007). The Annals of Thoracic Surgery , 83 (5), 1858-1862.
Effects of Chronic AF ,[object Object],[object Object],[object Object],Yanulis et al (2008). The Annals of Thoracic Surgery, 86(3), 984-987
ECG Tracings The top panel shows when the animal was in sinus rhythm. The number indicates the intrinsic electrical activations. The middle panel show when the animal was in persistent AF. The bottom panel shows coupled pacing.
Yanulis et al (2008). The Annals of Thoracic Surgery, 86(3), 984-987
Results of Sustained CP on LV Volumes- Reversed Remodeling ,[object Object],[object Object],Yanulis et al (2008). The Annals of Thoracic Surgery, 86(3), 984-987
Hemodynamic Tracings Marks above the left ventricular (LV) pressure tracings illustrate VRMC, and marks above the aortic flow tracings illustrate VREJ.
My studies on Chronic Coupled Pacing ,[object Object],[object Object],[object Object],[object Object]
The 2 nd Pacing Paradigm (CRT+CP Pacing) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Atrial Fibrillation (AF) in Heart Failure (HF) Patients ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Eur Heart J. 2002 Nov; 23(21): 1692-8.
Electrical Activations of the Normal Heart www.physiome.org
RV Apex Pacing Left Bundle Branch Block Prinzen et al, 2000
Clinical Significance of CRT ,[object Object],[object Object]
Current Pacing Therapies ,[object Object],[object Object],[object Object],[object Object],[object Object],Circulation. 2005 Sep 27;112(13):e236-7.
AF in HF Patients with Left Bundle Branch Block (LBBB) ,[object Object],[object Object],[object Object],[object Object]
The CRT+CP Pacing Paradigm ,[object Object],[object Object],[object Object],[object Object]
Animal preparation RA electrode RV electrode Epicardial Echocardiography LV electrode Vagal electrode
 
RV pacing HR=178bpm Step 2 QRS=120ms SD=16% CRT+CP HR=110bpm Step 4 QRS=90ms SD=5% CRT-VS HR=110bpm Step 5 QRS=90ms SD=3% -12% -7% -14% Baseline HR=103bpm Step 1 QRS=80ms SD=5% Atrial Fibrillation Sinus rhythm Dog #176 CRT HR=197bpm Step 3 QRS=90ms SD=5% -3% -19%
Use of CRT+CP on CRT Non-responders ,[object Object],[object Object]
Sensors to Control Pacing ,[object Object],[object Object]
Simulation of Flow in the Great Cardiac Vein ,[object Object],[object Object],[object Object]
Pressure Recording (Millar Sensors) Mock II Circulatory Circuit (Results) Photograph of the Mock II Circulatory Circuit
Conclusions of My Simulation Studies ,[object Object],[object Object],[object Object]
Acknowledgements ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Cardiac Pacing for Heart Failure Patients

  • 1. A Novel Cardiac Pacing Paradigm for Atrial Fibrillation and Heart Failure Patients George Emanuel Yanulis, D. Eng
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8. Schematic Representation of Cardiac Conduction Pathways in the Human Heart http://images.main.uab.edu/
  • 9. Concept of Coupled Pacing during AF (Electrically Activating the Ventricles after a Specific Delay) Atrium Ventricle AVN                       Atrium Ventricle AVN
  • 10.
  • 11. Coupled Pacing vs. Paired Stimulation
  • 12.
  • 13.
  • 14. Placement of the Leads, Adapters, and Pacemakers for the AF Model Cingoz et al (2007). The Annals of Thoracic Surgery , 83 (5), 1858-1862.
  • 15.
  • 16. ECG Tracings The top panel shows when the animal was in sinus rhythm. The number indicates the intrinsic electrical activations. The middle panel show when the animal was in persistent AF. The bottom panel shows coupled pacing.
  • 17. Yanulis et al (2008). The Annals of Thoracic Surgery, 86(3), 984-987
  • 18.
  • 19. Hemodynamic Tracings Marks above the left ventricular (LV) pressure tracings illustrate VRMC, and marks above the aortic flow tracings illustrate VREJ.
  • 20.
  • 21.
  • 22.
  • 23. Electrical Activations of the Normal Heart www.physiome.org
  • 24. RV Apex Pacing Left Bundle Branch Block Prinzen et al, 2000
  • 25.
  • 26.
  • 27.
  • 28.
  • 29. Animal preparation RA electrode RV electrode Epicardial Echocardiography LV electrode Vagal electrode
  • 30.  
  • 31. RV pacing HR=178bpm Step 2 QRS=120ms SD=16% CRT+CP HR=110bpm Step 4 QRS=90ms SD=5% CRT-VS HR=110bpm Step 5 QRS=90ms SD=3% -12% -7% -14% Baseline HR=103bpm Step 1 QRS=80ms SD=5% Atrial Fibrillation Sinus rhythm Dog #176 CRT HR=197bpm Step 3 QRS=90ms SD=5% -3% -19%
  • 32.
  • 33.
  • 34.
  • 35. Pressure Recording (Millar Sensors) Mock II Circulatory Circuit (Results) Photograph of the Mock II Circulatory Circuit
  • 36.
  • 37.

Editor's Notes

  1. This schema shows the concept of bigeminal pacing. 1