Cardiac Resynchronization Device Optimizing AV and VV Delays

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Solution Overview

Problem

Current cardiac resynchronization therapy (CRT) devices face challenges in efficiently optimizing atrioventricular (AV) and interventricular (VV) delays due to the complexity and time-consuming nature of existing assessment methods, which often require multiple tests and echocardiographic procedures, leading to suboptimal results for approximately 30% of patients.

Innovation Solution

The technique involves analyzing endocardial acceleration (EA) signals during a single cardiac cycle to optimize AV and VV delays by combining temporal and non-temporal parameters, specifically optimizing the moment of onset for the EA4 component and the magnitude of the EA1 component, allowing for simultaneous and precise adjustment of these delays to maximize stroke volume and hemodynamic efficiency.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Measurement precision

If echocardiographic assessment is used to optimize AV and VV delays, then measurement precision is improved, but loss of time and device complexity increase significantly

Engineering Contradiction:

Improveoptimization precisionVSAvoidoptimization time

Core Design Contradiction:

Measurement precisionVSLoss of time

Solution Approach 1:

The patent replaces the mechanical echocardiographic assessment system with an electrical signal-based optimization system. The device uses intracardiac electrogram signals and endocardial acceleration signals to automatically determine optimal AV and VV delays, eliminating the need for external echocardiographic equipment and manual assessment procedures.

Inventive Principle:

Principle #28Mechanics substitution (Replace mechanical system)

Solution Approach 2:

The optimization system is integrated directly into the CRT device, allowing it to perform self-optimization without external intervention. The device automatically analyzes intracardiac signals, processes the data, and adjusts pacing parameters autonomously, making the system self-sufficient for parameter optimization.

Inventive Principle:

Principle #25Self-service

2Measurement precision

If multiple tests and echocardiographic procedures are performed to optimize delays, then optimization precision is improved, but device complexity and ease of operation deteriorate

Engineering Contradiction:

Improvedelay optimization precisionVSAvoidoptimization procedure complexity

Core Design Contradiction:

Measurement precisionVSDevice complexity

Solution Approach 1:

The patent combines multiple assessment functions into a single integrated system. The device simultaneously analyzes intracardiac electrograms, endocardial acceleration signals, and ventricular contraction timing to determine optimal delays, merging what would otherwise require separate tests into one unified automated process.

Inventive Principle:

Principle #5Merging (Combining)

Solution Approach 2:

The CRT device is designed with multi-functionality, serving both as a pacemaker and as an optimization system. The same device that delivers cardiac resynchronization therapy also performs the optimization assessment and adjustment, eliminating the need for separate optimization procedures and equipment.

Inventive Principle:

Principle #6Universality (Multi-functionality)

3Ease of operation

If traditional stimulation is used, then ease of operation is maintained, but productivity and treatment effectiveness deteriorate for 30% of patients

Engineering Contradiction:

Improvedevice operation simplicityVSAvoidtreatment effectiveness

Core Design Contradiction:

Ease of operationVSProductivity

Solution Approach 1:

The patent introduces dynamic adaptation to the otherwise static traditional stimulation approach. The device automatically adjusts pacing parameters based on real-time analysis of intracardiac signals and endocardial acceleration, enabling it to adapt to individual patient characteristics and physiological variations without requiring manual reprogramming.

Inventive Principle:

Principle #15Dynamics

Solution Approach 2:

The system automatically optimizes critical pacing parameters including AV delay and VV delay by analyzing physiological signals. By dynamically changing these parameters based on measured endocardial acceleration and electrogram characteristics, the system improves treatment effectiveness while maintaining ease of operation through automation.

Inventive Principle:

Principle #35Parameter changes

Data Source

PatentUS8219193B2Active implantable medical device for cardiac resynchronization with automatic optimization of atrioventricular and interventricular delays

Publication Date: 2012.07.10 SORIN CRM

AI summary

An active implantable medical device for cardiac resynchronization with automatic optimization of atrioventricular and interventricular delays is disclosed. The device collects an endocardial acceleration signal EA and calculates the atrioventricular delay AVD and the interventricular delay VVD. The device isolate in the EA signal a component EA4 corresponding to the fourth EA peak and measure a temporal parameter related to a time interval between the detection of an atrial event (P/A) and the occurrence of the EA4 component. The device isolates an EA1 component corresponding to the first EA peak and measures a non-temporal parameter (APEA1) related to the peak amplitude or a signal energy of the EA1 component. The optimal AVD (AVDO) is determined by the temporal parameter related to the EA4 component, and is calculated for a plurality of different values of VVD to obtain a plurality of pairs of optimal values {AVDO, VVD}. The device selects one of these pairs of values based on the non-temporal parameter related to the EA1 component.