20.500.12556/RUL-178472 Tok poškodbe v znotrajsrčnem elektrogramu ob vsaditvi elektrod srčnega spodbujevalnika za spodbujanje prevodnega sistema Current of injury in intracardiac electrogram during cardiac pacemaker lead implantation for conduction system pacing Pri aktivni pritrditvi elektrod trajnega srčnega spodbujevalnika se pojav toka poškodbe (ang. current of injury, COI) na znotrajsrčnem elektrogramu že dolgo uporablja kot pokazatelj ustreznega mehanskega stika elektrode z miokardom. Kljub klinični uporabi pa je vrednotenje COI v praksi pretežno subjektivno in temelji na vizualni presoji izvajalca posega, medtem ko kvantitativni parametri in njihova napovedna vrednost za dolgoročno stabilnost elektrode še niso standardizirani. Namen zaključnega dela je bil izvedba prospektivne longitudinalne raziskave, v kateri smo analizirali dinamiko COI pri postavitvi elektrode v področje levega kraka prevodnega sistema (ang. left bundle branch area pacing, LBBAP) ter ovrednotili povezavo med akutnimi spremembami COI in dolgoročno stabilnostjo parametrov spodbujanja. V raziskavo smo vključili deset bolnikov z ohranjenim iztisnim deležem levega prekata in brez znakov kardiomiopatije. Med implantacijo smo iz znotrajsrčnih elektrogramov pridobili signale ob času postavitve elektrode ter 5 in 10 minut po njej. Za kvantifikacijo COI smo uporabili različne parametre, ki odražajo intenziteto in časovni potek pojava. Rezultati so pokazali, da se parametri COI po postavitvi elektrode statistično značilno spreminjajo, kar odraža akutno elektrofiziološko prilagoditev stika elektrode z miokardom. Ključna ugotovitev raziskave je, da je hitrost upadanja COI povezana z dolgoročnim pragom spodbujanja: počasnejše zmanjšanje COI je koreliralo z nižjim in bolj stabilnim pragom spodbujanja po treh mesecih, medtem ko je hitro izginjanje COI nakazovalo manj optimalno stabilnost elektrode. Ugotovitve potrjujejo, da lahko kvantitativna analiza COI dopolni klinično presojo med vsaditvijo LBBAP in služi kot zgodnji pokazatelj kakovosti postavitve elektrode. Rezultati predstavljajo korak k bolj objektivnemu vrednotenju in potencialni standardizaciji merjenja pojava COI, pri čemer bodo potrebne raziskave na večjih skupinah bolnikov. During active fixation of permanent pacemaker leads, the appearance of current of injury (COI) on intracardiac electrogram signals has long been used as an indicator of adequate mechanical contact between the lead and the myocardium. Despite its clinical relevance, COI assessment in practice remains largely subjective and relies on visual interpretation by the operator, while quantitative parameters and their predictive value for long-term lead stability have not yet been standardized. The aim of this study was to conduct a prospective longitudinal study to analyse the dynamics of COI during implantation of the pacing lead for left bundle branch area pacing (LBBAP) and to evaluate the association between acute COI changes and long-term stability of pacing parameters. Ten patients with preserved left ventricular ejection fraction and no evidence of cardiomyopathy were included. Intracardiac electrograms were recorded at the time of lead fixation, and again at 5 and 10 minutes after fixation. Several quantitative parameters representing the intensity and time course of COI were used. The results demonstrated that COI parameters were changing significantly after lead fixation, reflecting acute electrophysiological adaptation at the lead–myocardium contact. A key finding was that the rate of COI decline was associated with the long-term pacing threshold: a slower reduction in COI correlated with lower and more stable pacing thresholds at three months, whereas faster disappearance of COI was associated with less favourable stability. These findings suggest that quantitative analysis of COI may complement clinical judgement during LBBAP implantation and serve as an early indicator of the quality of lead fixation. The results represent a step toward more objective evaluation and potential standardization of COI measurement, although larger studies will be required to validate these observations. obdelava signalov znotrajsrčni elektrogram (iEGM) elektrofiziologija srca srčni spodbujevalnik tok poškodbe (COI) spodbujanje področja levega kraka prevodnega sistema (LBBAP) signal processing intracardiac electrogram (iEGM) cardiac electrophysiology cardiac pacemaker current of injury (COI) left bundle branch area pacing (LBBAP) true false false Slovenski jezik Angleški jezik Magistrsko delo/naloga 2026-01-28 12:45:02 2026-01-28 12:45:15 2026-02-03 14:39:03 0000-00-00 00:00:00 2026 0 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 63194 267185923 Franic_Kristian_-_Tok_poskodbe_v_znotrajsrcnem_elektrogramu_ob_vsaditvi_elektrod_srcnega_spodbuj.pdf Franic_Kristian_-_Tok_poskodbe_v_znotrajsrcnem_elektrogramu_ob_vsaditvi_elektrod_srcnega_spodbuj.pdf 1 A0A052A72AF173D931864B0A7ADBE87E 6b90531215a64ccbf5cd903c49eac073e15deae9efddb9f3af453b98052c1d37 cb33cb09-fc3e-11f0-a1ba-0050569b8976 https://repozitorij.uni-lj.si/Dokument.php?lang=slv&id=226363 Fakulteta za elektrotehniko 0 0 0