CRT Parameter Optimization via Intracardiac Electrogram Sensing
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Solution Overview
Problem
Current cardiac resynchronization therapy (CRT) systems face challenges in optimizing atrio-ventricular and interventricular delay parameters, which are crucial for improving heart failure symptoms and disease progression, as existing methods rely heavily on clinical evaluations and echocardiography, and there is a need for more frequent and efficient optimization of these parameters over time.
Innovation Solution
The implementation of an exemplary method that involves delivering cardiac resynchronization therapy using measured atrio-ventricular and interventricular conduction delays to determine optimal delay parameter values, allowing for continuous monitoring and optimization of CRT performance, utilizing an implantable stimulation device with advanced sensing and pacing capabilities, and algorithms like QUICKOPT™ for efficient parameter determination.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If CRT parameter optimization relies on clinical evaluations and echocardiography, then measurement precision is improved, but loss of time increases due to infrequent optimization
Solution Approach 1:
The patent replaces the mechanical/clinical evaluation system (echocardiography and clinical assessments) with an electrical sensing system that uses intracardiac electrograms to automatically determine CRT parameter optimization. This substitution enables continuous monitoring without requiring repeated clinical visits or imaging procedures.
Solution Approach 2:
The implantable CRT device performs self-optimization by automatically analyzing its own intracardiac electrogram signals to determine optimal AV and VV delay parameters. This self-service capability eliminates the need for external clinical intervention for routine parameter optimization, allowing frequent adjustments without increasing clinic visit frequency.
2Adaptability or versatility
If frequent CRT optimization is implemented, then adaptability is improved, but device complexity increases
Solution Approach 1:
The system implements a feedback mechanism where intracardiac electrogram signals are continuously sensed and analyzed to provide information about ventricular activation timing. This feedback loop enables the device to automatically adjust AV and VV delay parameters based on real-time electrical activity, achieving frequent optimization without requiring complex external systems.
Solution Approach 2:
The implantable CRT device performs multiple functions using the same hardware infrastructure: it delivers biventricular pacing therapy, senses intracardiac electrograms for optimization, and monitors cardiac electrical activity. This multi-functionality allows frequent parameter optimization without adding separate dedicated hardware systems, thereby limiting the increase in device complexity.
3Measurement precision
If clinical evaluations are used for CRT optimization, then measurement precision is improved, but productivity decreases due to limited optimization frequency
Solution Approach 1:
The patent replaces the time-consuming clinical evaluation process with an automated electrical sensing and analysis system embedded in the implantable device. This substitution maintains measurement precision by using direct intracardiac electrogram measurements while dramatically increasing optimization frequency to occur automatically between clinical visits.
Solution Approach 2:
The system performs preliminary optimization actions continuously in the background using automatic analysis of intracardiac electrograms. This preliminary action maintains accurate parameter settings without requiring frequent clinical interventions, thereby increasing productivity (optimization frequency) while preserving measurement precision through the accuracy of electrogram-based timing measurements.
Data Source
AI summary
An exemplary method includes delivering a cardiac resynchronization therapy using an atrio-ventricular delay parameter and an interventricular delay parameter, measuring an atrio-ventricular conduction delay, measuring an interventricular conduction delay, assessing heart failure and/or cardiac resynchronization therapy performance based at least in part on the measured atrio-ventricular conduction delay and the measured interventricular conduction delay and determining at least one of an atrio-ventricular delay parameter value and an interventricular delay parameter value based at least in part on the measured atrio-ventricular conduction delay and the measured interventricular conduction delay. Other exemplary technologies are also disclosed.