CRT Electrode Site Selection via Timing Interval Measurement
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Solution Overview
Problem
Patients with heart conditions such as heart failure and arrhythmias often experience reduced cardiac output due to unsynchronized contractions of the heart chambers, which current cardiac resynchronization therapy (CRT) may not effectively address, as not all cardiac electrode sites respond equally well to CRT, leading to variability in treatment efficacy.
Innovation Solution
A system and method for selecting a pacing output configuration that includes multiple electrodes positioned within the left ventricle to sense cardiac electrical signals, measuring timing intervals between depolarization features, and determining the most responsive electrode sites to deliver CRT, thereby optimizing pacing output and improving patient responsiveness and hemodynamic status.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If cardiac resynchronization therapy is delivered to multiple left ventricular electrode sites, then the likelihood of finding a responsive site increases, but the device complexity and programming complexity increase
Solution Approach 1:
The patent segments the left ventricular pacing function by testing multiple discrete electrode sites independently. Each electrode site is evaluated separately through pacing tests that measure timing intervals and hemodynamic response, allowing the system to identify responsive sites without requiring a complex unified approach across all electrodes simultaneously.
Solution Approach 2:
The patent performs preliminary testing and identification of responsive electrode sites before final pacemaker implantation or before activating CRT. Through pacing tests conducted during the procedure, the system pre-identifies which electrode sites will respond to CRT, eliminating the need for complex post-implantation programming and reducing overall device complexity.
2Reliability
If pacing tests are conducted at multiple electrode sites to identify responsive sites, then treatment efficacy improves, but the time required for procedure increases
Solution Approach 1:
The patent applies partial action by conducting pacing tests at a selected subset of electrode sites rather than exhaustively testing all possible sites. The system identifies responsive sites through targeted testing of representative electrodes, achieving sufficient treatment efficacy without requiring complete evaluation of every potential electrode location.
Solution Approach 2:
The testing process is segmented into discrete, standardized pacing tests that can be performed efficiently at multiple sites. By breaking down the evaluation into separate, modular testing steps (measuring timing intervals, assessing hemodynamic response), the system reduces overall procedure time while maintaining comprehensive evaluation of responsive electrode sites.
3Reliability
If multiple electrodes are positioned within the left ventricle to enable CRT, then the ability to improve cardiac output increases, but the invasiveness and procedural complexity increase
Solution Approach 1:
The patent employs a single lead system that serves multiple functions: it contains multiple electrodes that can pace different left ventricular sites, sense cardiac electrical signals, and deliver CRT. This multi-functional approach eliminates the need for separate leads for each electrode site, reducing procedural complexity and invasiveness while maintaining the ability to improve cardiac output through targeted pacing.
Data Source
AI summary
Cardiac therapy systems include multiple electrodes respectively positionable at multiple left ventricular electrode sites. A pulse generator is coupled to the electrodes and configured to deliver a cardiac resynchronization therapy (CRT). A processor is configured to measure, for each left ventricular electrode site, a timing interval between first and second cardiac signal features associated with left ventricular depolarization. The timing interval is associated with a degree of responsiveness of each left ventricular electrode site to CRT. The processor is configured to determine a pacing output configuration that provides improved patient responsiveness to CRT based on the timing interval measurements and to select at least one left ventricular electrode site from the plurality of left ventricular electrode sites based on the timing interval measurements. The processor may be configured to monitor for a change in hemodynamic status of the patient based on a change in the timing interval.