Cardiac Device Adjusting AV and VV Delays via Hemodynamic Feedback
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Solution Overview
Problem
Existing methods for optimizing cardiac resynchronization therapy (CRT) focus on individual hemodynamic parameters, neglecting the interrelationship between cardiac phases, which can lead to suboptimal adjustments of atrioventricular and interventricular delays, affecting the overall hemodynamic status of patients.
Innovation Solution
A device that dynamically monitors and adjusts atrioventricular and interventricular delays based on multiple hemodynamic parameters, such as left ventricular pre-ejection interval, ejection time, and filling time, to ensure optimal synchronization of cardiac phases across the entire cardiac cycle.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Manufacturing precision
If optimization is focused on a single cardiac phase (e.g., systole or filling), then that specific phase is improved, but other phases of the cardiac cycle are compromised
Solution Approach 1:
The cardiac cycle is segmented into distinct phases (systole, diastole, filling, ejection) with specific hemodynamic parameters identified for each phase. The device separately monitors and optimizes each phase independently rather than treating the cardiac cycle as a single unit, allowing precise control of each segment while maintaining overall cycle integrity
Solution Approach 2:
The device dynamically adjusts atrioventricular (AV) and ventriculoventricular (VV) delays in real-time based on continuously monitored hemodynamic parameters. This dynamic adaptation allows the system to respond to changing cardiac conditions and optimize each phase without compromising others, as the adjustments are made based on actual physiological feedback rather than fixed settings
2Ease of operation
If AV delay and VV delay are adjusted based on single hemodynamic parameter, then adjustment simplicity is maintained, but comprehensive optimization of cardiac hemodynamics is achieved
Solution Approach 1:
The device incorporates continuous feedback from multiple hemodynamic sensors that monitor parameters such as ventricular pressure, volume, and flow. This feedback is processed to determine the optimal AV and VV delays, with the system automatically adjusting delays based on the composite information from all sensors. This multi-parameter feedback loop enables comprehensive optimization while maintaining operational simplicity through automated control
Solution Approach 2:
Multiple hemodynamic parameters from different cardiac phases are merged and integrated into a unified control algorithm. The device combines information from various sensors monitoring different aspects of cardiac function into a single decision-making process for delay adjustment, achieving comprehensive optimization through the synergistic integration of multiple data streams rather than separate adjustments for each parameter
Data Source
AI summary
An active implantable medical device such as a cardiac prosthesis for the treatment of a heart failure by controlled adjustment of the atrioventricular and interventricular delays. The device provides atrioventricular and/or biventricular stimulation, a sensor delivering at least one hemodynamic parameter correlated with time intervals representative of the succession of the systolic and diastolic phases, and circuits to adjust the AV delay and/or VV delay. The device determines (12) during one cardiac cycle several parameters such as the left ventricular pre-ejection interval LPEI, the left ventricular ejection time LVET, the diastolic filling time FT and the conduction time PR. The device compares (14, 18) these parameters with at least one predetermined criterion. If a condition is met, the device readjusts (16) the AV delay and/or VV delay to maximize the ventricular filling and ejection.