3D Cardiac Activation Map for CRT Lead Positioning
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Solution Overview
Problem
Current methods for cardiac resynchronization therapy (CRT) lack the ability to determine the optimal positioning of pacemaker leads in patients, leading to suboptimal results and failure in approximately 30% of patients due to asynchronous and insufficient heart contractions caused by conduction disorders like Left Bundle Branch Block (LBBB) or Right Bundle Branch Block (RBBB).
Innovation Solution
Generating a three-dimensional (3D) cardiac activation map to identify the location of conduction delays, such as LBBB or RBBB, and using this map to precisely position pacing devices, including direct His bundle pacing and left ventricular stimulation downstream of the conduction block to restore ventricular synchrony.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If conventional CRT methods are used with simultaneous pacing of RV and LV, then the basic goal of improving LV mechanical functioning is achieved, but the positioning of pacemaker leads involves guesswork and does not allow determination of optimal location
Solution Approach 1:
The patent applies preliminary action by generating a 3D activation map before lead implantation to identify the optimal pacing site. The map is created using electroanatomic mapping technology that reconstructs the heart's electrical activation sequence, allowing the physician to plan the precise lead position in advance rather than relying on guesswork during the procedure.
Solution Approach 2:
The patent employs feedback by using the 3D activation map to provide real-time information about electrical activation patterns during the procedure. The map updates as electrodes are positioned, allowing the physician to see the effect of each placement and adjust accordingly to achieve optimal resynchronization.
2Reliability
If conventional CRT methods are used, then biventricular pacing is provided, but real time determination of whether leads have been properly positioned is not allowed
Solution Approach 1:
The patent uses feedback by continuously updating the 3D activation map during the procedure to provide real-time verification of lead positioning. The system compares the measured electrical signals from positioned electrodes against the predicted activation pattern, allowing immediate assessment of whether leads are properly positioned for effective resynchronization therapy.
Solution Approach 2:
The patent replaces mechanical trial-and-error lead positioning with an electrical mapping system. Instead of relying on anatomical landmarks and physical probe manipulation, the system uses electrical signal analysis and 3D reconstruction to objectively determine optimal lead positions and verify proper placement.
3Reliability
If conventional CRT positioning methods are used, then pacemaker leads are implanted, but 30% of patients fail to respond to CRT due to suboptimal lead positioning
Solution Approach 1:
The patent applies preliminary action by performing electroanatomic mapping and generating a 3D activation map before lead implantation. This pre-planning step identifies the optimal pacing site based on the patient's specific electrical activation patterns, ensuring that leads are positioned to maximize resynchronization effectiveness and reduce the 30% failure rate associated with conventional methods.
Data Source
AI summary
Various embodiments include methods of cardiac resynchronization therapy (CRT). Various embodiments may include: generating, using a processing unit, a cardiac activation map including a three-dimensional (3D) heart model of the heart that shows coronary vessels of a patient and shows the propagation of electrical signals through the 3D heart model; determining the location of a left bundle branch block (LBBB) based on the cardiac activation map; implanting a first pacing device and a second pacing device into the patient; stimulating the His Bundle of the heart using the first pacing device; and stimulating the left ventricle (LV) of the heart at a position downstream of the LBBB with respect to a direction of electrical conduction through the LV using the second pacing device after stimulating the His bundle.