Implantable Cardiac Pacing Delay Adjustment for Hemodynamic Optimization
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Solution Overview
Problem
Current implantable medical devices (IMDs) face challenges in automatically determining optimal pacing related parameters such as AV delay, RV to LV delay, and LV to LV delay, which can lead to suboptimal hemodynamic performance in patients.
Innovation Solution
The system and method involve pacing at multiple sites in the heart with adjustable inter-electrode delays to avoid sensed events and ensure paced events, using a process that adjusts these delays based on capture confirmation and intrinsic activity detection to optimize cardiac timing.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Ease of operation
If clinician programmed settings are used for pacing parameters, then device operation is simple, but desired hemodynamic performance is not achieved in all patients
Solution Approach 1:
The device performs automatic detection of intrinsic cardiac events and self-adjustment of pacing parameters based on sensed physiological data, eliminating the need for complex manual programming while optimizing hemodynamic performance for each individual patient
Solution Approach 2:
The system continuously monitors intrinsic cardiac events and uses this feedback information to dynamically adjust pacing delays, creating a closed-loop control system that adapts to patient-specific physiology and achieves reliable hemodynamic outcomes
2Reliability
If automatic search for pacing parameters is implemented, then hemodynamic performance is optimized, but device complexity increases
Solution Approach 1:
The device performs preliminary detection of intrinsic events and pre-determination of optimal pacing parameters during device initialization or clinical programming, eliminating the need for complex real-time adjustments while achieving optimized hemodynamic performance
Solution Approach 2:
The system automatically determines optimal pacing parameters by analyzing intrinsic cardiac events and adjusting delay intervals based on detected physiological characteristics, achieving personalized optimization without requiring complex manual intervention
Data Source
AI summary
Pacing related timing is determined for an implantable medical device (IMD) by pacing at an RV pacing site, a first LV pacing site and a second LV pacing site in accordance with a first site, a second site and a third site pacing order, and further in accordance with a first inter-electrode pacing delay between pacing at the first site and pacing at the second site and a second inter-electrode pacing delay between pacing at the second site and pacing at the third site. At least one of a sensed event or a paced event is detected for at each of the second site and the third site. The first inter-electrode pacing delay and the second inter-electrode pacing delay are adjusted to avoid sensed events in favor of paced events at each of the second site and the third site. An atrio-ventricular delay may also be adjusted to avoid sensed events or lack of capture due to possible fusion at the first site, in favor of paced events at the first site.