Adaptive Cardiac Resynchronization Therapy Pacing Site Selection
Find Innovative SolutionsGenerate Solutions
Solution Overview
Problem
Current cardiac resynchronization therapy (CRT) systems face challenges in selecting the most efficacious pacing electrode vectors for delivering therapy, particularly in the left ventricle, as the optimal vector for biventricular pacing may not be the same as for single ventricle pacing, affecting the therapeutic outcome.
Innovation Solution
A medical device and method that dynamically selects first and second pacing sites along the left ventricle based on activation time measurements, switching between biventricular and single ventricle pacing modes to optimize CRT delivery by using different pacing sites for each mode, ensuring optimal ventricular synchrony and adapting to changes in atrial-to-ventricular conduction.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Device complexity
If a single pacing site is used for both biventricular and single ventricle pacing modes, then device complexity is reduced, but therapeutic efficacy deteriorates because the optimal pacing vector differs between modes
Solution Approach 1:
The patent implements dynamic pacing site selection that automatically switches between different LV pacing electrodes based on the current ventricular pacing mode. The system transitions from a static single-site configuration to a dynamic multi-site configuration, optimizing the pacing vector for each specific mode (biventricular or single ventricle) while managing complexity through automated control algorithms.
2Reliability
If multiple pacing electrodes are used to optimize therapy for different modes, then therapeutic efficacy is improved, but device complexity increases due to the need for dynamic selection mechanisms
Solution Approach 1:
The patent makes the LV lead system universal by designing it to function effectively in both biventricular and single ventricle pacing modes. The same LV lead with multiple electrodes serves dual purposes, and the control system automatically configures the appropriate electrode combinations for each mode, eliminating the need for separate dedicated leads for each pacing mode.
Solution Approach 2:
The patent implements self-service through automated pacing site selection algorithms that independently determine the optimal pacing configuration based on real-time detection of ventricular pacing mode. The device self-adjusts without requiring manual reconfiguration by the clinician, automatically selecting the appropriate LV pacing electrodes for the current therapeutic mode.
3Ease of operation
If pacing sites are fixed during device implantation, then ease of operation is improved, but adaptability deteriorates when AV conduction changes require different pacing modes
Solution Approach 1:
The patent transforms the static pacing configuration established during implantation into a dynamic system that automatically adapts to changing physiological conditions. The device continuously monitors AV conduction and adjusts the pacing site selection in real-time, enabling transition between fixed and adaptive operation based on patient needs.
Solution Approach 2:
The patent implements feedback mechanisms where the device continuously monitors ventricular activation patterns and AV conduction status, then uses this information to automatically adjust pacing site selection. The system closes the control loop by detecting mode changes and responding with appropriate pacing configuration adjustments, maintaining optimal therapy as physiology evolves.
Data Source
Figure 1
Figure 2
Figure 3
AI summary
A medical device and associated method control the delivery of a cardiac pacing therapy by selecting first and second pacing sites along a first ventricle of a patient's heart and delivering the pacing therapy by pacing the first ventricle using the first pacing site during the periods of a first ventricular pacing mode and using the second pacing site during periods of a second ventricular pacing mode. In one embodiment, the device determines activation times at multiple sites along a ventricle in response to pacing pulses being delivered to the opposite ventricle. A first pacing site is selected in response to the activation time determination. The device delivers the pacing therapy by pacing the first ventricle using the first pacing site during periods of the first ventricular pacing mode.