Cardiac Pacing AV Delay Correction
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Solution Overview
Problem
Current pacing methods can result in long atrial-ventricular (AV) delays, leading to compromised atrial function, ventricular filling, and ventricular systolic performance due to atrial contraction against a closed valve, which existing technologies fail to adequately address.
Innovation Solution
A method and apparatus that determine if the current AV delay is inappropriate and induce an additional atrial contraction within the same ventricular cycle by analyzing AV and VA intervals, providing an additional atrial pace if the AV interval is too long and the VA interval is too short, with safety checks to ensure the pace is tolerated by the patient.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If pacing methods such as Search AV and Managed Ventricular Pacing are used to promote intrinsic conduction, then ventricular pacing support is maintained, but long atrial-ventricular delays occur causing atrial contraction against closed valves
Solution Approach 1:
The patent applies preliminary action by detecting the AV delay duration before the harmful effect occurs and preemptively delivering an additional atrial pace to reset the AV node. The system calculates the AV delay from the atrial paced event to the ventricular sensed event, and when this exceeds a threshold, it delivers a corrective atrial pace before the atrial contraction would occur against a closed valve, thereby preventing the harmful effect while maintaining the beneficial ventricular pacing support
Solution Approach 2:
The patent implements feedback by continuously monitoring the AV delay duration and using this information to control the delivery of additional atrial paces. The system senses ventricular events, calculates the AV interval, compares it against programmed thresholds, and adjusts pacing therapy accordingly. This closed-loop feedback mechanism allows the device to adaptively prevent long AV delays while maintaining appropriate ventricular pacing support
2Device complexity
If long AV delays are permitted to maintain intrinsic conduction promotion, then pacing simplicity is preserved, but ventricular-atrial mechanical coupling is compromised
Solution Approach 1:
The patent applies self-service by enabling the pacing system to automatically detect and correct its own long AV delay problems without external intervention. The device monitors its own pacing output and sensed events, calculates AV delays, and autonomously delivers corrective atrial paces when needed. This self-correcting mechanism maintains simple programming while ensuring proper mechanical coupling, as the device manages its own optimization without requiring complex external programming or adjustment
3Reliability
If additional atrial paces are delivered to correct long AV delays, then mechanical coupling is improved, but risk of inducing arrhythmias increases
Solution Approach 1:
The patent applies preliminary anti-action by implementing safety checks that detect and prevent potentially harmful effects before they occur. The system monitors for signs of arrhythmia induction such as consecutive 1:1 conduction, Wenckebach block, premature atrial contractions, or atrial tachycardia/fibrillation following the corrective atrial pace. When these harmful patterns are detected, the system preemptively withholds further corrective paces, thereby preventing the escalation of arrhythmias while still providing the beneficial mechanical coupling improvement when safe
Data Source
AI summary
A method and apparatus is provided for determining whether a current atrial-ventricular (AV) delay during cardiac pacing is appropriate for proper mechanical coupling of the atrium and ventricle. If proper mechanical coupling is determined to not exist, an additional atrial contraction is induced within the same ventricular cycle to maintain atrial-ventricular mechanical coupling.