Antitachycardia Pacing Routines for Ventricular Tachycardia Termination
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Solution Overview
Problem
Current antitachycardia pacing (ATP) methods for terminating ventricular tachycardia in implantable cardioverter defibrillators often require multiple attempts with varying cycle lengths, leading to inefficient energy use and discomfort for patients, as they rely on series of evenly spaced pulses without consideration for optimal pulse rates and patterns to effectively stop the arrhythmia.
Innovation Solution
A method and apparatus that initiate a first antitachycardia pulse routine with pulses spaced by a first cycle length, followed by additional routines with decreasing final cycle lengths, and utilize a processor to determine and adjust the cycle lengths based on return cycle lengths to achieve orthodromic block in the ventricular tachycardia circuit, ensuring effective termination of the arrhythmia.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If multiple ATP attempts with different cycle lengths are used to terminate ventricular tachycardia, then the probability of successful termination increases, but the energy consumption increases and treatment time increases
Solution Approach 1:
The patent applies preliminary action by pre-calculating and storing optimal ATP cycle lengths in a lookup table based on detected VT cycle lengths. When VT is detected, the device immediately retrieves the pre-determined optimal cycle length from the table and applies it without requiring multiple trial attempts, thereby ensuring high termination success while minimizing energy consumption.
Solution Approach 2:
The patent implements feedback by using the detected VT cycle length as input to select the appropriate ATP cycle length from the lookup table. The system continuously monitors the heart rhythm, detects VT characteristics, and adjusts the ATP parameters based on the detected cycle length, creating a closed-loop control system that optimizes treatment efficacy and energy efficiency.
2Reliability
If multiple ATP attempts with different cycle lengths are used to terminate ventricular tachycardia, then the probability of successful termination increases, but the treatment time increases
Solution Approach 1:
The patent applies preliminary action by pre-calculating and storing optimal ATP cycle lengths in a lookup table based on detected VT cycle lengths. When VT is detected, the device immediately retrieves the pre-determined optimal cycle length from the table and applies it without requiring multiple trial attempts, thereby ensuring high termination success while minimizing treatment time.
Solution Approach 2:
The patent implements feedback by using the detected VT cycle length as input to select the appropriate ATP cycle length from the lookup table. The system continuously monitors the heart rhythm, detects VT characteristics, and adjusts the ATP parameters based on the detected cycle length, creating a closed-loop control system that optimizes treatment efficacy and speed.
3Reliability
If cardioversion or defibrillation shocks are used to terminate ventricular tachycardia, then the effectiveness of stopping VT increases, but patient discomfort increases and energy consumption increases
Solution Approach 1:
The patent applies parameter changes by dynamically adjusting the ATP cycle length parameter based on the detected VT cycle length. By optimizing this temporal parameter, the system achieves effective VT termination using low-energy pacing pulses instead of high-energy shocks, thereby maintaining therapeutic effectiveness while eliminating patient discomfort and reducing energy consumption.
Solution Approach 2:
The patent applies partial action by using antitachycardia pacing with optimized parameters to achieve VT termination before resorting to full cardioversion or defibrillation shocks. The lookup table provides pre-calculated optimal pacing parameters that can partially terminate VT in many cases, avoiding the need for excessive high-energy intervention while still achieving the therapeutic goal.
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
This approach reduces the number of ATP attempts required to terminate ventricular tachycardia, conserves energy in the implantable device, and minimizes patient discomfort by using a more aggressive and targeted pacing strategy that effectively entrains and terminates the arrhythmia.
Implementation Method 1
the ventricular tachycardia wave within the ventricular tachycardia circuit is entrained by delivering a plurality of evenly spaced pulses at a first cycle length
Implementation Method 2
the ventricular tachycardia wave is terminated by a last pulse at a second cycle length that is less than the first cycle length by producing an orthodromic block in an inhomogeneous region of the ventricular tachycardia circuit
Data Source
AI summary
An implantable device for terminating ventricular tachycardia is disclosed. The device includes a processor configured to determine a first antitachycardia pulse routine of N pulses. In the routine the first N−1 pulses are separated by a first cycle length and the Nth pulse is separated by a second cycle length that is shorter than the first cycle length. The device also comprises a lead coupled to the processor. The lead comprises an electrode configured to sense a tachycardia and further configured, under control of the processor, to administer the antitachycardia pulse routine.