Atrial Nerve Stimulation for Ventricular Dyssynchrony
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Solution Overview
Problem
Current cardiac stimulation therapies are inadequate for treating impaired diastolic filling in patients with diastolic heart failure, as they do not effectively address the competition between the right and left ventricles for pericardial volume during diastole, leading to reduced compliance and filling of the left ventricle.
Innovation Solution
A cardiac stimulation therapy that introduces dyssynchrony between the right and left ventricles by pacing one ventricle earlier than the other, using an implantable medical device with leads and electrodes to deliver AV nodal stimulation and ventricular pacing pulses, thereby prolonging the PR interval and allowing the left ventricle to fill earlier and more effectively.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If conventional cardiac stimulation therapy is used, then ventricular synchrony is maintained, but impaired diastolic filling in the left ventricle cannot be treated
Solution Approach 1:
The patent inverts the conventional approach by intentionally creating ventricular dyssynchrony rather than maintaining synchrony. By pacing one ventricle earlier than the other, the therapy reverses the normal simultaneous contraction pattern to achieve improved left ventricular filling, directly addressing the diastolic heart failure mechanism where the left ventricle competes with the right ventricle for pericardial volume.
Solution Approach 2:
The patent changes the temporal parameter of ventricular activation by introducing a programmed interval difference between right and left ventricular pacing. This parameter modification transforms the contraction timing from simultaneous to asymmetric, allowing the left ventricle to fill earlier and more effectively while reducing the competitive effect of right ventricular filling.
2Volume of stationary object
If the left ventricle fills later due to right ventricular competition, then pericardial volume distribution is maintained, but end-diastolic volume is reduced
Solution Approach 1:
The patent applies preliminary action by activating the left ventricle earlier than the right ventricle through asymmetric pacing. This temporal prioritization allows the left ventricle to complete its filling process before the right ventricle contracts, ensuring adequate end-diastolic volume is achieved while reducing the time loss caused by competitive filling dynamics.
3Strength
If ventricular hypertrophy increases chamber stiffness, then structural integrity is maintained, but diastolic compliance is impaired
Solution Approach 1:
The patent compensates for the reduced compliance caused by ventricular hypertrophy by implementing preliminary left ventricular filling through earlier pacing activation. This advance filling action overcomes the stiffness limitation, allowing the left ventricle to achieve adequate volume despite the increased chamber stiffness from hypertrophy.
Data Source
AI summary
A method and medical device for delivering an atrial pacing pulse to an atrial chamber to generate an evoked atrial depolarization, delivering a stimulation pulse to an atrioventricular node during a stimulation window to increase a PR interval of the heart, the stimulation window having a start time corresponding to the delivered atrial pacing pulse so that the stimulation pulse is delivered during a refractory period corresponding to the evoked atrial depolarization, and delivering a ventricular pacing pulse to a first ventricular chamber during the increased PR interval to cause a contraction of the first ventricular chamber to occur prior to a contraction of a second ventricular chamber to increase dyssynchrony between the contraction of the first ventricular chamber and the contraction of the second ventricular chamber.