Bilateral Bundle Branch Pacing Capture for Ventricular Synchrony
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Solution Overview
Problem
Existing cardiac pacing methods, particularly ventricular pacing via the right ventricular apex, are associated with increased risks of atrial fibrillation and heart failure, and alternative pacing sites like the His bundle or left bundle branch are sought to promote more physiologically normal cardiac electrical activation.
Innovation Solution
A medical device system is used to guide the implantation of cardiac pacing electrodes for delivering ventricular pacing pulses along the His-Purkinje system, determining anodal and cathodal capture during bipolar pacing to achieve simultaneous capture of both the left and right bundle branches, and adjusting pacing pulse output based on capture thresholds to improve ventricular electrical synchrony.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If ventricular pacing is performed via electrodes at the right ventricular apex, then ventricular pacing can be achieved, but the risk of atrial fibrillation and heart failure increases
Solution Approach 1:
The invention segments the ventricular pacing function by targeting specific bundle branches (right bundle branch and left bundle branch) rather than using a single apex pacing site. This allows independent pacing of each ventricle through its native conduction system, achieving effective ventricular pacing while reducing harmful effects associated with apex pacing
Solution Approach 2:
The invention applies local quality by placing electrodes at specific locations along the bundle branches (septal and lateral walls) rather than at the ventricular apex. This localized approach enables physiological pacing through the His-Purkinje system, improving pacing effectiveness while minimizing the risk of atrial fibrillation and heart failure
2Reliability
If pacing is performed through the His bundle or left bundle branch, then more physiologically normal cardiac electrical activation is achieved, but the complexity of electrode placement and capture verification increases
Solution Approach 1:
The invention divides the bundle branch pacing into separate target sites (right bundle branch and left bundle branch) with dedicated electrodes for each. This segmentation simplifies the verification process by allowing independent assessment of capture at each site through specific sensing channels, reducing the overall complexity compared to His bundle pacing
Solution Approach 2:
The invention implements feedback mechanisms through sensing channels that monitor electrical signals from each electrode. The system verifies capture by detecting evoked responses and adjusting pacing parameters accordingly, automating the complex verification process and reducing manual intervention requirements
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
The system enables effective and synchronized ventricular pacing by simultaneously capturing both bundle branches, reducing the risks associated with traditional pacing methods and promoting a more natural heart rhythm.
Implementation Method 1
bilateral bundle branch pacing delivered from a bipolar electrode pair comprising an anode positioned along a first bundle branch and a cathode positioned along a second bundle branch
Implementation Method 2
receive at least one cardiac electrical signal that is sensed during bilateral bundle branch pacing
Data Source
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AI summary
A medical device processor is configured to receive at least one cardiac electrical signal that is sensed during bilateral bundle branch pacing delivered from a bipolar electrode pair comprising an anode positioned along a first bundle branch and a cathode positioned along a second bundle branch opposite the first bundle branch, determine at least one feature from the first cardiac electrical signal, determine that the at least one feature meets first bundle branch capture criteria; and determine anodal bundle branch capture in response to the first bundle branch capture criteria being met.