ATP Therapy Coordination in Implantable Cardiac Devices

Resolve Bottlenecks,
Find Innovative SolutionsGenerate Solutions

Solution Overview

Problem

Subcutaneous implantable cardioverter defibrillators (ICDs) have limited capabilities to provide anti-tachyarrhythmia pacing (ATP) therapies, necessitating additional devices for effective tachyarrhythmia management, and there is a need to ensure that ATP therapy is delivered only when another device capable of anti-tachyarrhythmia shock is available to prevent overlapping therapies.

Innovation Solution

An implantable medical device system that includes an extracardiovascular ICD and an intracardiac pacing device, capable of detecting enable and disable events to enable or disable ATP therapy based on the availability of another device for anti-tachyarrhythmia shock, using signal generation and processing circuitry to coordinate therapy delivery.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Adaptability or versatility

If an additional pacing device is used to provide ATP therapy when subcutaneous ICD has limited capabilities, then anti-tachyarrhythmia pacing capability is improved, but device complexity increases

Engineering Contradiction:

Improveanti-tachyarrhythmia pacing capabilityVSAvoiddevice complexity

Core Design Contradiction:

Adaptability or versatilityVSDevice complexity

Solution Approach 1:

The patent combines multiple functions into a single intracardiac pacing device that can detect tachyarrhythmias, deliver ATP therapy, and communicate with external devices to receive enable/disable commands. This integration provides comprehensive anti-tachyarrhythmia capability while managing system complexity through unified device architecture.

Inventive Principle:

Principle #5Merging (Combining)

Solution Approach 2:

The intracardiac pacing device is designed with multi-functionality, serving as both a pacing device and an ATP delivery device with arrhythmia detection capabilities. The device can operate in different modes (pacing, ATP delivery, shock detection) depending on received commands, providing versatile anti-tachyarrhythmia management.

Inventive Principle:

Principle #6Universality (Multi-functionality)

2Reliability

If ATP therapy is enabled in the pacing device, then anti-tachyarrhythmia pacing is provided, but risk of overlapping therapies increases when another device is unavailable

Engineering Contradiction:

Improveanti-tachyarrhythmia pacing deliveryVSAvoidpro-arrhythmic effects from overlapping therapies

Core Design Contradiction:

ReliabilityVSObject-affected harmful factors

Solution Approach 1:

The system implements feedback through bidirectional communication between the pacing device and external devices (subcutaneous ICD or programmer). The pacing device receives enable/disable commands based on the availability of shock-capable devices, and can detect shocks delivered by other devices. This feedback mechanism ensures ATP therapy is only delivered when appropriate, preventing harmful overlapping therapies.

Inventive Principle:

Principle #23Feedback

Solution Approach 2:

The system performs preliminary checks by detecting the availability of shock-capable devices before enabling ATP therapy. The pacing device monitors for the presence and operational status of other devices that can deliver anti-tachyarrhythmia shocks, and only enables ATP delivery when such backup capability is confirmed, preventing situations where ATP might be the sole therapy available.

Inventive Principle:

Principle #10Preliminary action

3Reliability

If the pacing device monitors for enable and disable events, then coordinated therapy delivery is achieved, but device complexity and power consumption increase

Engineering Contradiction:

Improvecoordinated therapy deliveryVSAvoidpower consumption

Core Design Contradiction:

ReliabilityVSUse of energy by moving object

Solution Approach 1:

The pacing device employs periodic monitoring rather than continuous operation for detecting enable/disable events and shock detection. The device checks for arrhythmias and communicates with external devices at scheduled intervals, enabling coordinated therapy delivery while minimizing power consumption by keeping monitoring functions dormant between periodic checks.

Inventive Principle:

Principle #19Periodic action

4Speed

If ATP therapy is delivered without verifying availability of shock device, then treatment speed is improved, but patient safety is compromised

Engineering Contradiction:

Improvetreatment speedVSAvoidpatient safety risks

Core Design Contradiction:

SpeedVSObject-affected harmful factors

Solution Approach 1:

The system performs preliminary verification by detecting the presence and operational status of shock-capable devices before enabling ATP therapy delivery. This advance checking ensures that appropriate backup therapy is available, preventing situations where ATP delivery alone could be harmful, while maintaining rapid response capability once verification is complete.

Inventive Principle:

Principle #10Preliminary action

Data Source

PatentEP3448509B1Enabling and disabling Anti-tachyarrhythmia pacing in a concomitant medical device system

Publication Date: 2021.06.16 MEDTRONIC INC

Figure 1
Figure 2A
Figure 2B

AI summary

An implantable medical device comprising a signal generator configured to generate and deliver anti-tachyarrhythmia pacing (ATP) to a heart of a patient and processing circuitry. The processing circuitry is configured to detect an enable event, responsive to detecting the enable event, enable the delivery of ATP by the signal generator, detect a disable event indicating that another implantable medical device cannot be relied upon to deliver an anti-tachyarrhythmia shock, and responsive to detecting the disable event, disable delivery of ATP.