Dynamic Atrioventricular Delay Optimization in Cardiac Resynchronization
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Solution Overview
Problem
Current cardiac resynchronization therapy systems do not efficiently and accurately optimize atrioventricular delay, particularly at different sensing and pacing rates and during mode switches, leading to suboptimal heart performance and reduced oxygen-rich blood pumping efficiency.
Innovation Solution
A cardiac resynchronization device with a therapy module, sensing module, timer module, and controller that measures and calculates atrioventricular intervals at various rates, stores these delays in a memory, and adjusts pacing accordingly to optimize atrioventricular delay for both sensed and paced atrial and ventricular activities across different pacing modes and rates.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Device complexity
If a fixed atrioventricular delay is used in current cardiac resynchronization therapy systems, then the device complexity is reduced, but the hemodynamic efficiency and oxygen-rich blood pumping efficiency deteriorate
Solution Approach 1:
The patent implements dynamic adjustment of atrioventricular delay based on real-time sensing of atrial and ventricular events. The system automatically modifies the AV delay parameter according to the detected heart rate and rhythm conditions, transitioning from a fixed to a dynamic control strategy that optimizes hemodynamic efficiency across varying physiological states
Solution Approach 2:
The system employs feedback mechanisms by sensing actual atrial and ventricular electrical events and using this information to adjust the atrioventricular delay. The controller continuously monitors heart rhythm and modifies pacing parameters based on the sensed events, creating a closed-loop control system that enhances pumping efficiency while adapting to changing cardiac conditions
2Productivity
If the system optimizes atrioventricular delay at multiple pacing rates and modes, then the hemodynamic efficiency is improved, but the device complexity and measurement requirements increase
Solution Approach 1:
The patent creates a universal optimization framework that handles multiple pacing modes (atrial pacing, ventricular pacing, dual chamber pacing) and multiple heart rates within a single integrated system. The same controller and sensing mechanisms serve all pacing modes, eliminating the need for separate optimization systems for each mode while maintaining hemodynamic efficiency across all operating conditions
Solution Approach 2:
The system systematically varies pacing rate and mode parameters to establish optimal atrioventricular delays for each condition. By methodically testing and storing optimization data across different pacing rates and modes, the system builds a comprehensive parameter set that enables efficient operation under any prescribed pacing condition without requiring complex real-time calculations
3Measurement precision
If atrioventricular intervals are measured and calculated at various rates, then the optimization precision is improved, but the loss of time for measurement and calculation increases
Solution Approach 1:
The system performs preliminary measurements and calculations during routine pacing operations, accumulating optimization data over time rather than conducting separate dedicated measurement sessions. By continuously sensing atrial and ventricular events during normal therapy delivery, the system builds an accurate profile of optimal AV delays for different pacing conditions without adding significant measurement time
Solution Approach 2:
The optimization process operates continuously alongside therapy delivery, with the controller constantly monitoring sensed events and adjusting parameters in real-time. This continuous operation eliminates interruptions for separate measurement phases, maintaining both high measurement precision and continuous therapeutic benefit without time loss
Data Source
AI summary
Systems and methods to optimize atrioventricular delay during sensing or pacing of the atrium and for a plurality of sensed rates or pacing rates. In one example, a paced atrioventricular delay is calculated using a sensed atrioventricular interval and a paced atrioventricular interval. In another example, a plurality of paced atrioventricular delays for different pacing rates can be calculated. In another example embodiment, a plurality of sensed atrioventricular delays for different sensing rates can be calculated. Combinations of the various systems and methods are also possible.