Cardiac Stimulation Site Selection Using Physiologic Signal Analysis
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Solution Overview
Problem
Current cardiac stimulation therapies, such as single site and multisite pacing, often fail to achieve desired therapeutic outcomes due to ineffective recruitment of excitable cardiac tissues, particularly when pacing sites are near myocardial infarction or scar tissue with slow electrical conductivity, leading to inadequate propagation of electrical activation.
Innovation Solution
A system that senses physiologic signals at multiple candidate stimulation sites, determines activation timing indicators, and detects myocardial infarction indicators to select optimal pacing sites, automatically or based on user input, for improved cardiac stimulation, including the use of a stimulation site selector circuit to generate candidate electrostimulation vectors and deliver targeted therapy.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Ease of operation
If pacing is performed at a site within or near myocardial infarction tissue, scar or fibrous tissue, then the stimulation may be delivered to accessible locations, but the electrical activation propagation to other parts of cardiac tissue is blocked and therapeutic outcome is not achieved
Solution Approach 1:
The system performs preliminary assessment of candidate pacing sites by sensing physiologic signals and determining activation timing indicators before selecting the final pacing site. This preliminary action identifies sites with appropriate electrical conductivity and avoids areas with propagation blocks, ensuring both accessibility and therapeutic effectiveness before actual pacing begins
Solution Approach 2:
The system uses feedback from sensed physiologic signals at multiple candidate sites to evaluate activation timing indicators and select the optimal pacing site. The feedback mechanism compares electrical propagation characteristics across different sites and selects sites that demonstrate adequate activation propagation to other cardiac tissue portions, thereby ensuring therapeutic outcome while maintaining accessibility
2Reliability
If multiple candidate pacing sites are assessed to ensure effective electrical activation propagation, then therapeutic outcome is improved, but the complexity of site selection process increases
Solution Approach 1:
The system replaces complex manual assessment procedures with automated electronic sensing and analysis. The processor automatically evaluates activation timing indicators from sensed physiologic signals at multiple candidate sites, using computational algorithms to identify optimal pacing sites without requiring complex manual testing procedures, thereby maintaining high reliability while reducing operational complexity
Solution Approach 2:
The system performs self-assessment of candidate pacing sites by automatically sensing physiologic signals and determining activation timing indicators without external intervention. The device independently evaluates multiple sites and selects the optimal pacing site based on predefined criteria, reducing the burden on operators while ensuring reliable therapeutic outcomes
Data Source
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AI summary
Systems and methods for selecting one or more sites at or within at least one heart chamber for cardiac stimulation are disclosed. The system can include a physiologic sensor circuit to sense physiologic signals at two or more candidate stimulation sites. The system can generate respective activation timing indicators corresponding to the two or more candidate stimulation sites, and detect MI indicators indicating the presence of, or spatial proximity of each of the two or more candidate stimulation sites to a MI tissue. The system can use the activation timing indicators and the MI indicators to select at least one target stimulation site or to determine an electrostimulation vector. The system can display the selected target stimulation site to a user, or deliver electrostimulation to the patient at the target stimulation site or according to the determined electrostimulation vector.