AV Delay Measurement for Autonomic Tone Assessment
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Solution Overview
Problem
Current methods for assessing autonomic nervous system balance, particularly sympathetic/parasympathetic balance, are inadequate as they often require exercise tests, which can be invasive, time-consuming, and costly, and do not effectively measure responses to artificial atrial pacing in subjects with autonomic imbalances.
Innovation Solution
A system and method using a cardiac rhythm management device to measure atrioventricular (AV) delays during and after atrial pacing at rest, determining autonomic status indicators by analyzing the duration of recovery periods and the relationship between AV delays and pacing rates, allowing for the adjustment of therapies such as neurostimulation.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If exercise tests are used to assess autonomic nervous system balance, then measurement accuracy is improved, but device complexity, time consumption, and cost increase
Solution Approach 1:
The patent extracts the essential measurement component (AV delay) from the complex exercise test protocol. By measuring AV delay during simple atrial pacing at rest, the system obtains autonomic balance information without requiring full exercise testing infrastructure, thereby reducing device complexity while maintaining measurement capability
Solution Approach 2:
The patent creates a simplified model of autonomic assessment by copying only the critical measurement element (AV delay response to pacing) rather than implementing the entire exercise test. This copied measurement provides sufficient information about sympathetic/parasympathetic balance without requiring the full complexity of exercise testing
2Measurement precision
If exercise tests are used to assess autonomic nervous system balance, then measurement accuracy is improved, but time consumption increases
Solution Approach 1:
The patent applies partial action by measuring only the specific parameter (AV delay) that provides autonomic balance information, rather than conducting a complete exercise test. This partial measurement approach achieves sufficient diagnostic accuracy in a fraction of the time required for full exercise testing
Solution Approach 2:
The system performs preliminary measurement of AV delay during routine atrial pacing before clinical decisions are made. This preliminary assessment provides immediate autonomic balance information without requiring time-consuming exercise tests, enabling faster clinical workflow
3Measurement precision
If exercise tests are used to assess autonomic nervous system balance, then measurement accuracy is improved, but cost increases
Solution Approach 1:
The patent employs a cost-effective measurement approach using standard pacemaker components (atrial pacing circuit and AV delay measurement) rather than expensive exercise testing equipment. This disposable-like simplicity in measurement methodology reduces overall system cost while maintaining diagnostic accuracy
4Ease of operation
If AV delay is measured during recovery from atrial pacing at rest, then ease of operation is improved, but measurement precision may worsen
Solution Approach 1:
The system uses feedback by measuring AV delay during the recovery phase after atrial pacing. The recovery-phase AV delay provides feedback about parasympathetic reactivation, which is a sensitive indicator of autonomic balance. This feedback mechanism maintains measurement precision while simplifying the testing procedure to just atrial pacing at rest
Data Source
AI summary
An autonomic status indicator representative of a sympathetic/parasympathetic balance of a subject can use atrioventricular (AV) delays measured during recovery from (or in response to) elevated atrial pacing while the subject is at rest.