Adaptive Conduction System Pacing for Ventricular Synchrony
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Solution Overview
Problem
Conventional pacing techniques often lead to delayed electrical conduction between the ventricles, causing inefficiency in the left ventricle's blood pumping and increased risk of heart failure, especially in patients with atrial fibrillation or long P-wave-to-R-wave intervals, due to suboptimal pacing locations and desynchronization of ventricular contraction.
Innovation Solution
Adaptive cardiac conduction system pacing therapy for dual-chamber and triple-chamber devices that periodically check conduction disorders and switch between pacing modes to maintain atrioventricular and ventricular synchrony, using a computing apparatus with implantable electrodes to deliver cardiac conduction system pacing based on intrinsic electrical activity metrics.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Speed
If conventional pacing techniques are used to treat bradycardia by delivering electrical pulses to the right ventricle, then the heart rate can be increased, but the electrical conduction between ventricles becomes delayed and the left ventricle cannot maintain synchrony with the right ventricle
Solution Approach 1:
The patent introduces the cardiac conduction system (specifically the His bundle or bundle branches) as an intermediary pathway to deliver electrical pulses. Instead of pacing the ventricular myocardium directly, the system uses the specialized conduction system fibers as a mediator to transmit impulses rapidly to both ventricles, thereby maintaining synchrony while treating bradycardia
Solution Approach 2:
The patent replaces the slow myocyte-to-myocyte conduction mechanism with the faster cardiac conduction system pathway. By substituting the direct myocardial pacing approach with conduction system pacing, the system achieves faster electrical propagation while maintaining ventricular synchrony
2Speed
If pacing is delivered to myocardial tissue to treat bradycardia, then the heart rate can be increased, but the electrical pulse conduction is slow and causes delayed ventricular contraction
Solution Approach 1:
The cardiac conduction system serves as a specialized intermediary pathway that accelerates electrical pulse transmission. By using the His bundle or bundle branches as intermediaries, the system achieves faster conduction times compared to direct myocardial pacing, thereby reducing the delay in ventricular contraction
3Speed
If conventional ventricular pacing is used, then bradycardia can be treated, but the left ventricle becomes inefficient at pumping blood and heart failure may develop
Solution Approach 1:
By using the cardiac conduction system as an intermediary, the system achieves faster and more synchronized ventricular activation, which improves left ventricular pumping efficiency and reduces the risk of heart failure compared to conventional direct ventricular pacing
4Adaptability or versatility
If the device monitors intrinsic electrical activity to select pacing mode, then adaptive pacing can be provided, but the device complexity increases
Solution Approach 1:
The system uses feedback from monitoring intrinsic electrical activity (P-wave and QRS complex detection) to automatically select the appropriate pacing mode. This feedback mechanism enables adaptive pacing that responds to changing conduction disorders without requiring manual intervention, balancing adaptability with manageable complexity through automated decision-making
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
The adaptive pacing therapy effectively maintains cardiac synchrony by correcting conduction abnormalities without introducing dyssynchrony, improving heart function and reducing the risk of heart failure.
Implementation Method 1
monitoring intrinsic electrical activity of the patient's heart during intrinsic cardiac activation
Implementation Method 2
The bundle of His, or His bundle, 13 is located in the membranous atrioventricular septum near the annulus of the tricuspid valve. The His bundle 13 splits into the left and right bundle branches 8a, 8b and are formed of specialized fibers called 'Purkinje fibers'9. The Purkinje fibers 9 may be described as being capable of rapidly conducting an action potential down the ventricular septum (VS), spreading the depolarization wavefront quickly through the remaining ventricular myocardium
Data Source
AI summary
Adaptive cardiac conduction system pacing therapy for multi-chamber devices may monitor electrical activity of a patient's heart and select a cardiac conduction system pacing therapy pacing mode based on the monitored electrical activity. For instance, one or more metrics such as P-wave-to-R-wave interval and QRS complex width may be determined based on the monitored electrical activity, and one of an inhibited pacing mode, a ventricular fusion pacing mode, an atrioventricular synchronous pacing mode, and an atrial fibrillation pacing mode may be selected based on the determined one or more metrics.