Activity-Sensing Rate Responsive Pacing for HFpEF Chronotropic Incompetence
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Solution Overview
Problem
Heart failure with preserved ejection fraction (HFpEF) patients experience chronotropic incompetence, leading to decreased heart rate response during activities, resulting in reduced cardiac output and increased risk of atrial fibrillation and pulmonary hypertension.
Innovation Solution
A method and device for delivering rate responsive pacing (RRP) using an implantable medical device that monitors patient activity levels and adjusts pacing rates based on sensed activity information, utilizing a sensing apparatus, control apparatus, and electrode apparatus to deliver pacing therapy.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If rate responsive pacing is delivered at a fixed pacing rate, then the device structure is simple, but the cardiac output cannot be increased during activities requiring higher metabolic demand
Solution Approach 1:
The patent applies dynamics by transitioning from a fixed pacing rate to a variable pacing rate that adapts to patient activity levels. The IMD includes activity sensors that detect patient movement and automatically adjust the pacing rate accordingly, allowing the heart rate to increase during activities requiring higher cardiac output while maintaining simplicity through automated control algorithms
Solution Approach 2:
The patent implements feedback mechanisms where the IMD continuously monitors activity information from sensors and uses this feedback to adjust the pacing rate. The control apparatus processes sensor data and modifies pacing parameters in real-time, creating a closed-loop system that responds to changing metabolic demands without requiring complex manual intervention
2Productivity
If the pacing rate is increased to meet metabolic demand during exercise, then cardiac output is improved, but the risk of atrial fibrillation and pulmonary hypertension increases in HFpEF patients
Solution Approach 1:
The system dynamically adjusts pacing rates based on actual patient activity levels rather than using fixed high rates. By matching pacing rate to genuine metabolic demand through sensor feedback, the system increases cardiac output during appropriate activities while avoiding unnecessary tachycardia that could trigger arrhythmias or pulmonary hypertension in HFpEF patients
Solution Approach 2:
The patent changes the pacing rate parameter dynamically based on activity level detection. The control apparatus modifies pacing parameters such as rate and timing intervals according to sensed activity, allowing physiological adaptation without exceeding safe thresholds that would increase arrhythmia risk in vulnerable HFpEF patients
Data Source
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AI summary
Some aspects relate to systems, devices, and methods of delivering rate responsive pacing therapy. The method includes monitoring activity information related to an activity level of a patient and delivering rate responsive pacing (RRP) to the patient at a pacing rate corresponding to a RRP profile. The RRP profile may be used to generate the pacing rate based on the activity information and may be adjusted based on the monitored activity information. The implantable medical device comprises a sensing apparatus comprising a sensor to sense activity information of a patient; a control apparatus comprising processing circuitry to select a rate responsive pacing (RRP) profile based on the sensed activity information received from the sensing apparatus; and an electrode apparatus comprising a plurality of pacing electrodes, the electrode apparatus operably coupled to the control apparatus, the electrode apparatus to deliver rate responsive pacing to the patient at a pacing rate corresponding to the RRP profile, wherein the control apparatus is configured to adjust the RRP profile based on the sensed activity information.