Cardiac Pacing Configuration for Reverse Remodeling
Find Innovative SolutionsGenerate Solutions
Solution Overview
Problem
Cardiac resynchronization therapy (CRT) devices do not effectively reverse the adverse effects of cardiac remodeling, which leads to increased left ventricle size, worsened ejection fraction, and reduced cardiac output, despite optimizing hemodynamic parameters and contraction/relaxation cycles.
Innovation Solution
Implement a temporary alteration in pacing configuration to induce a non-optimal hemodynamic response, using endocardial acceleration sensors to select pacing configurations that promote reverse remodeling by applying controlled, short-term pacing sequences that force the heart to adapt, potentially harming it in the short term but improving its response over time.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If CRT devices optimize hemodynamic parameters and contraction/relaxation cycles, then cardiac output and ejection fraction are improved, but adverse effects of cardiac remodeling (increased left ventricle size, worsened ejection fraction) are not reversed
Solution Approach 1:
The patent applies inversion by deliberately applying suboptimal or harmful pacing configurations temporarily to achieve the opposite long-term effect. Instead of continuously optimizing hemodynamics, the device intentionally creates controlled harmful conditions (increased wall stress, altered contraction patterns) that trigger reverse remodeling, thereby reducing ventricle size and improving long-term cardiac function
Solution Approach 2:
The patent implements periodic action by alternating between optimal pacing configurations (for immediate hemodynamic improvement) and suboptimal/harmful pacing configurations (for long-term reverse remodeling). The device cycles through different pacing modes including harmful configurations that increase wall stress, followed by recovery periods with optimal pacing, creating periodic stress-recovery patterns that drive remodeling reversal
2Shape
If temporary harmful pacing configurations are applied to induce reverse remodeling, then long-term heart morphology and function improve, but short-term hemodynamic response deteriorates
Solution Approach 1:
The patent applies preliminary action by first assessing the patient's response to harmful pacing configurations through monitored parameters (endocardial acceleration, wall stress indicators) before committing to extended periods of suboptimal pacing. This preliminary testing phase allows the device to identify which harmful configurations will effectively trigger reverse remodeling while minimizing excessive short-term damage
Solution Approach 2:
The patent implements feedback by continuously monitoring hemodynamic parameters and endocardial acceleration during harmful pacing configurations. The device uses this real-time feedback to determine when to terminate the harmful pacing sequence and return to optimal configurations, ensuring that short-term hemodynamic deterioration remains within safe limits while still achieving long-term remodeling benefits
3Reliability
If continuous optimal pacing is applied, then immediate hemodynamic parameters are maintained, but reverse remodeling does not occur
Solution Approach 1:
The patent applies dynamics by transitioning from static continuous optimal pacing to a dynamic pacing strategy that adapts over time. The device alternates between optimal and harmful configurations in predetermined sequences, creating temporal dynamics that expose the myocardium to varying stress patterns. This dynamic approach enables both immediate hemodynamic stability during optimal phases and long-term morphological improvement through cumulative effects of controlled harmful phases
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 leads to long-term improvements in heart morphology and function, with beneficial effects on contractility, pressure, filling, and ejection timings, often seen within days, weeks, or months, without causing lasting harm.
Implementation Method 1
The endocardial acceleration is for example measured by an accelerometer integrated into an endocardial lead
Data Source
AI summary
Improving cardiac response in terms of pressure, ejected volume, and filling and ejection times by cardiac reverse remodelling, including temporary, occasionally harmful stimulation sequences. An original pacing configuration (a) is switched to a modified pacing configuration (b) in a direction opposite to that of an optimization of the hemodynamic parameters, to cause an immediate change in the response to controlled stimulation of the myocardium. This response is assessed based on: the maximum value (P (b, a)) achieved by the peak-to-peak (PEA (i)) of the first peak of endocardial acceleration (PEA) after a pacing configuration change, the mean PEA value (A (b, a)) after stabilization, the PEA variability (V (b, a)) around this average value, and the duration (T (b, a)) of stabilization after the pacing configuration change.