Atrioventricular Interval Optimization Algorithm for CRT Devices
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Solution Overview
Problem
Current cardiac therapy techniques have limited ability to optimize atrioventricular (A-V) and ventricular-ventricular (V-V) intervals, leading to suboptimal cardiac resynchronization therapy (CRT) delivery, particularly in patients with uncoordinated myocardial motion, which affects heart function and requires costly and delayed echocardiographic optimizations.
Innovation Solution
An algorithmic approach that uses inter-atrial delay and left ventricular volume measurements to predict and adjust A-V intervals, allowing for personalized programming of CRT devices to enhance cardiac resynchronization and synchronization therapy, including iterative and dynamic adjustments based on real-time data.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If traditional CRT delivery methods are used with fixed A-V intervals, then device simplicity is maintained, but therapeutic effectiveness is reduced due to inability to optimize for individual patient physiology
Solution Approach 1:
The patent applies parameter changes by dynamically adjusting the A-V interval based on measured physiological parameters (inter-atrial mechanical delay and LV volume). The system calculates an optimized A-V interval using the formula: optimized A-V interval = measured inter-atrial delay + time constant (k) × ln(LV volume threshold / LV volume), allowing customization of pacing parameters to individual patient physiology rather than using fixed intervals.
Solution Approach 2:
The patent implements feedback by continuously measuring inter-atrial mechanical delay and LV volume using echocardiographic equipment, then using these measurements to automatically adjust and optimize the A-V interval. This closed-loop system monitors physiological response and adjusts pacing parameters in real-time to maintain optimal therapeutic effect.
2Reliability
If post-implant echocardiographic optimization procedures are performed, then CRT delivery is optimized, but cost and time delays increase
Solution Approach 1:
The patent applies preliminary action by performing echocardiographic measurements and calculating the optimized A-V interval immediately during or shortly after device implantation. This allows the system to establish personalized pacing parameters before the patient leaves the clinic, eliminating the need for delayed follow-up optimization procedures and reducing both time loss and associated costs.
3Adaptability or versatility
If generic A-V interval programming is used, then ease of operation is maintained, but adaptability to individual patient physiology is reduced
Solution Approach 1:
The patent applies self-service by enabling the pacing system to automatically measure inter-atrial mechanical delay and LV volume, then autonomously calculate and program the optimized A-V interval without requiring complex manual programming by the clinician. The device performs the optimization process itself based on measured physiological parameters, making personalized therapy accessible while maintaining operational simplicity.
Data Source
AI summary
Determining an optimal atrioventricular interval is of interest for proper delivery of cardiac resynchronization therapy. Although device optimization is gradually and more frequently being performed through a referral process with which the patient undergoes an echocardiographic optimization, the decision of whether to optimize or not is still generally reserved for the implanting physician. Recent abstracts have suggested a formulaic approach for setting A-V interval based on intrinsic electrical sensing, that may possess considerable appeal to clinicians versus a patient average nominal A-V setting of 100 ms. The present invention presents a methods of setting nominal device settings based on entering patient cardiac demographics to determine what A-V setting may be appropriate. The data is based on retrospective analysis of the MIRACLE trial to determine what major factors determined baseline A-V settings.