Adaptive CRT Parameter Adjustment via Sensor Fusion
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Solution Overview
Problem
Current cardiac resynchronization therapy (CRT) systems face challenges in adjusting pacing parameters to optimize cardiac function due to variations in patient responses over time, influenced by factors like activity level, disease progression, and medication, leading to suboptimal therapy delivery.
Innovation Solution
An ambulatory medical device with a device parameter adjustment circuit that calculates sensitivity, variability, and covariability of physiologic signal metrics to determine optimal pacing parameters, using information fusion to adjust CRT settings dynamically, ensuring synchronized heart chamber contractions and improved cardiac output.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Adaptability or versatility
If fixed CRT parameters are used, then device simplicity is maintained, but patient response varies due to changes in activity level, disease progression, and medication
Solution Approach 1:
The patent implements dynamic adjustment of CRT parameters by continuously monitoring multiple physiologic signals (intracardiac electrograms, impedance, heart sounds, blood pressure) and automatically modifying pacing intervals based on detected changes in cardiac function, transforming the fixed-parameter system into an adaptive one that responds to patient condition changes
Solution Approach 2:
The system employs feedback mechanisms by sensing physiologic responses to delivered pacing pulses and using this information to adjust subsequent pacing parameters, creating a closed-loop control system that optimizes CRT delivery based on real-time cardiac function assessment
2Productivity
If manual adjustment of CRT parameters is performed, then some adaptability is achieved, but timely adjustment is difficult due to patient variation and clinical workload
Solution Approach 1:
The device performs self-adjustment of CRT parameters by automatically analyzing physiologic signals and modifying pacing intervals without requiring clinician intervention, enabling the system to adapt to patient condition changes in real-time and eliminating the burden of frequent manual reprogramming
3Measurement precision
If multiple sensor metrics are integrated, then measurement precision improves for determining optimal parameters, but device complexity increases
Solution Approach 1:
The patent combines multiple sensor metrics (electrograms, impedance, heart sounds, blood pressure) into a unified analysis framework that evaluates overall cardiac function, allowing the system to determine optimal pacing parameters through integrated assessment rather than relying on single-modality data
Data Source
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AI summary
Devices and methods for improving device therapy such as cardiac resynchronization therapy (CRT) by determining a desired value for a device parameter are described. An ambulatory medical device can receive one or more physiologic signals and generate multiple signal metrics from the physiologic signals. The ambulatory medical device can determine a desired value for a device parameter, such as a timing parameter used for controlling the delivery of CRT pacing to various heart chambers, using information fusion of signal metrics that are selected based on one or more of a signal metric sensitivity to perturbations to the device parameter in response to a stimulation, a signal metric variability in response to a stimulation, or a covariability between two or more signal metrics in response to a stimulation. The ambulatory medical device can program a stimulation using the desired device parameter value, and deliver the programmed stimulation to one or more target sites to achieve desired therapeutic effects.