Cardiac Pacing Using Local and Non-Local Signal Sensing
Solution Overview
Problem
Current cardiac pacing therapies face challenges in determining optimal timing intervals for pacing pulses, particularly in patients with irregular heart rhythms or those requiring cardiac resynchronization, as existing methods often rely on fixed atrioventricular delays that may not account for individual patient conduction times, leading to suboptimal hemodynamic synchronization.
Innovation Solution
The method involves sensing both local and non-local cardiac signals to determine pacing timing intervals, specifically using the temporal relationship between local and non-local P-waves or QRS complexes to dynamically adjust atrioventricular delays on a beat-by-beat basis, allowing for patient-specific optimization of pacing therapy.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Device complexity
If fixed atrioventricular delays are used in cardiac pacing, then device complexity is reduced, but pacing timing precision deteriorates leading to suboptimal hemodynamic synchronization
Solution Approach 1:
The patent implements dynamic adjustment of atrioventricular delays by sensing both local and non-local cardiac signals and using the temporal relationship between these signals to vary pacing timing intervals on a beat-by-beat basis, replacing fixed delays with adaptive timing that responds to actual cardiac conduction variations
Solution Approach 2:
The system uses feedback from dual sensing (local and non-local signals) to continuously monitor cardiac activation timing and adjust pacing intervals accordingly, creating a closed-loop control system that optimizes hemodynamic synchronization based on real-time physiological conditions
2Measurement precision
If non-local sensing is implemented to detect left atrial activation, then measurement capability is improved, but device complexity increases
Solution Approach 1:
The patent makes existing electrodes serve multiple functions by using both local and non-local sensing capabilities simultaneously, where the same implantable device and electrodes provide both traditional local cardiac signal sensing and additional non-local activation detection without requiring separate dedicated sensors
Solution Approach 2:
The system uses non-local cardiac signals as an intermediary to indirectly detect left atrial activation timing, allowing the pacemaker to obtain information about distant cardiac events through signal propagation patterns without requiring direct local electrode contact with all cardiac chambers
Data Source
AI summary
Systems and methods for determining pacing timing intervals based on the temporal relationship between the timing of local and non-local cardiac signal features are described. A device includes a plurality of implantable electrodes electrically coupled to the heart and configured to sense local and non-local cardiac signals. Sense circuitry coupled to first and second electrode pairs senses a local cardiac signal via a first electrode pair and a non-local cardiac signal via a second electrode pair. Detection circuitry is used to detect a feature of the local signal associated with activation of a heart chamber and to detect a feature of the non-local signal associated with activation of the heart chamber. A control processor times delivery of one or more pacing pulses based on a temporal relationship between timing of the local signal feature and timing of the non-local signal feature.