Cardiac Pacing Device AV Delay Adjustment
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Solution Overview
Problem
Current cardiac pacing therapies face challenges in optimizing pacing parameters, such as AV delay, to ensure effective synchronization and prevent pseudo-fusion or delayed activation, especially under ambulatory conditions, where mechanical responses may deviate from optimal electro-mechanical intervals.
Innovation Solution
A system combining an ECG belt and an implantable medical device that determines optimal pacing parameters based on electrical heterogeneity metrics during device placement, and continuously adjusts pacing settings, like AV delay, to maintain an optimal electro-mechanical response interval by sensing mechanical responses via an accelerometer, thereby ensuring synchronized pacing therapy.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If fixed pacing parameters are used during ambulatory pacing, then device operation is simple, but optimal synchronization is lost due to changes in electro-mechanical response interval
Solution Approach 1:
The pacing system dynamically adjusts the AV delay parameter based on real-time monitoring of the electro-mechanical response interval. The system transitions from fixed parameter operation to adaptive parameter modification, allowing the pacemaker to optimize synchronization effectiveness by changing pacing parameters in response to varying physiological conditions during ambulatory activity.
Solution Approach 2:
The system implements a feedback mechanism where the pacemaker monitors the electro-mechanical response interval (time from pacing stimulus to mechanical contraction) and uses this information to adjust the AV delay parameter. This closed-loop control ensures that pacing parameters remain optimized for effective synchronization even as physiological conditions change during ambulatory activity.
2Manufacturing precision
If AV delay is shortened to prevent pseudo-fusion, then mechanical response timing improves, but cell-to-cell conduction may be delayed
Solution Approach 1:
The system dynamically modifies the AV delay parameter based on monitored electro-mechanical response intervals. By adjusting this timing parameter in real-time, the system optimizes the balance between preventing pseudo-fusion (ensuring mechanical response occurs at appropriate time) and allowing sufficient cell-to-cell conduction time for effective cardiac activation.
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
This approach allows for real-time adjustment of pacing parameters to maintain optimal synchronization patterns, preventing pseudo-fusion and delayed activation, even under ambulatory conditions, by monitoring and adjusting AV delay settings to align with the optimal electro-mechanical response interval.
Implementation Method 1
sensing an EM signal from an EM sensor of the pacing device; The mechanical response may be measured at the peak of an accelerometer signal
Implementation Method 2
sensing electrical activity of tissue of a patient from a plurality of external electrodes during the delivered non-ambulatory pacing therapy
Data Source
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AI summary
A method and system for delivering cardiac pacing therapy that includes sensing electrical activity of tissue of a patient from a plurality of external electrodes during delivery of a non-ambulatory pacing therapy from a pacing device and determining an optimal electromechanical (EM) response time from an optimal electrical activation determined from electrical heterogeneity information obtained during non-ambulatory pacing therapy. During delivery of subsequent ambulatory pacing, the pacing sensing an EM signal from an EM sensor of the pacing device, determines a current EM response time in response to the sensed EM signal, and adjusting a pacing parameter setting of the ambulatory pacing therapy in response to comparing the current EM response time to the optimal EM response time.