CRT Device Multidimensional Interventricular Conduction Delay Measurement
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Solution Overview
Problem
Current methods for monitoring cardiac remodeling in patients with cardiac resynchronization therapy (CRT) are inadequate, as they often lead to late diagnosis and require costly, invasive procedures, and are sensitive to lead position and heart remodeling, making them unreliable for long-term monitoring and adaptation of therapy.
Innovation Solution
A CRT implantable device with methods for multidimensional measurement of interventricular conduction delay using combined bipolar and unipolar endocardial electrogram signals, which are analyzed to derive intrinsic descriptor parameters and compared to reference parameters to assess cardiac remodeling and trigger alerts for potential decompensation, allowing for timely adjustments in therapy.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If echocardiography is used to monitor cardiac remodeling, then diagnostic accuracy is improved, but procedure cost and invasiveness increase
Solution Approach 1:
The patent replaces the mechanical ultrasound-based echocardiography system with an electrical field-based measurement system using electrogram signals. The device uses electrical potential measurements from endocardial electrodes to assess cardiac remodeling through interventricular conduction delay, substituting mechanical wave propagation detection with electrical field detection to eliminate the need for invasive ultrasound procedures.
Solution Approach 2:
The implantable device continuously monitors cardiac electrical activity using its own embedded sensors and processing capabilities. The system automatically detects and analyzes electrogram signals from the ventricles to assess remodeling without requiring external diagnostic equipment or procedures, enabling the patient's own implanted device to provide ongoing diagnostic monitoring.
2Device complexity
If single-axis interventricular delay measurement is used, then device complexity is reduced, but measurement reliability deteriorates due to sensitivity to lead position and remodeling
Solution Approach 1:
The patent transitions from single-axis measurement to multidimensional measurement by utilizing electrogram signals from multiple spatial locations within the ventricles. The system measures interventricular conduction delay across multiple axes and dimensions using electrodes positioned at different endocardial sites, creating a comprehensive spatial assessment that compensates for lead position variations and provides more reliable remodeling evaluation.
3Loss of time
If frequent echocardiograms are performed for early detection of remodeling, then diagnosis timing is improved, but patient burden and healthcare resources increase
Solution Approach 1:
The implantable device provides continuous, uninterrupted monitoring of cardiac electrical activity and interventricular conduction delay. Unlike periodic echocardiography, the system continuously collects and analyzes electrogram data, enabling real-time detection of remodeling changes without requiring repeated hospital visits or external imaging procedures, thus eliminating diagnosis delay while avoiding excessive resource utilization.
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 provides a robust, non-invasive method for early detection of cardiac remodeling, enabling timely adjustments to CRT therapy and reducing hospitalizations by offering a more accurate and frequent assessment of patient condition without the need for frequent echocardiograms.
Implementation Method 1
measure an interventricular conduction time, i.e., the time interval between a stimuli applied to one of the ventricles and induced spontaneous contraction in the other ventricle
Data Source
AI summary
The disclosure relates to a device including a plurality of electrodes for stimulation of both ventricles with application of an atrioventricular delay and of an interventricular delay, a processor configured to multidimensionally measure an interventricular conduction delay, and monitor the evolution of a patient's condition. For the multidimensional measurement of the interventricular conduction delay, the device produces stimulation of one of the ventricles and collects, in the other ventricle, two endocardial electrogram signals on separate respective channels, giving two respective temporal components. Both temporal components are combined in one single parametric 2D characteristic representative of the cardiac cycle, and a comparison is made with reference descriptors for deriving an index representative of the evolution of the patient's condition.