CRT Settings Determination via Parametric Wave Width Modeling
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Solution Overview
Problem
Conventional cardiac resynchronization therapy (CRT) systems face inefficiencies in determining optimal interchamber delays when multiple pacing sites are available, leading to complex and time-consuming procedures that are impractical for real-world applications.
Innovation Solution
A system comprising an electrode connector, pulse generator, and processor that applies defined interchamber delays to determine candidate delays minimizing the width of R or P waves through an nth order parametric model, allowing for efficient CRT setting determination without exhaustive search times.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If multiple pacing sites are used in cardiac resynchronization therapy, then the clinical outcome and hemodynamic response are improved, but the number of possible electrode combinations and delay settings increases dramatically, making optimization procedures impractical
Solution Approach 1:
The patent segments the optimization process into two independent stages: first optimizing AV delays for each electrode independently, then optimizing VV delays between electrodes. This segmentation reduces the combinatorial complexity from testing all AV-VV combinations simultaneously to separate, manageable optimization steps.
Solution Approach 2:
The patent performs preliminary optimization of AV delays before optimizing VV delays. By first determining optimal AV delays for each electrode independently, the system establishes a foundation that simplifies the subsequent VV delay optimization, avoiding the need to test all combinations simultaneously.
2Measurement precision
If all possible electrode and delay combinations are tested to find optimal VV and intraventricular delays, then the most optimal settings are found, but the procedure becomes impossible to complete in real applications due to time constraints
Solution Approach 1:
The patent divides the exhaustive search into separate optimization stages for AV and VV delays. This segmentation allows the system to find near-optimal settings efficiently without testing all 32,000 combinations, significantly reducing optimization time while maintaining adequate precision.
Solution Approach 2:
The patent performs preliminary optimization of AV delays before VV delays. This preliminary action establishes optimal AV settings that serve as a foundation for subsequent VV optimization, enabling the system to achieve good results without exhaustive searching.
3Measurement precision
If a large number of electrode combinations are tested, then the optimal CRT settings are determined with high precision, but the battery drain and procedural complexity become unacceptable for clinical use
Solution Approach 1:
The patent segments the CRT optimization into independent AV and VV delay optimization stages. This segmentation dramatically reduces the number of pacing pulses and ECG measurements required compared to exhaustive searching, thereby reducing battery drain while maintaining sufficient optimization accuracy.
Solution Approach 2:
The patent performs preliminary AV delay optimization before VV delay optimization. This preliminary action reduces the overall computational and energetic burden by establishing optimal AV settings first, which simplifies and reduces the subsequent VV optimization requirements.
Data Source
AI summary
CRT settings for an implantable medical device are determined by applying pacing pulses to heart chambers of a scheme of different combinations of interchamber delays. A respective width parameter value representing an R or P wave width is determined for each such delay combination based on an ECG representing signal and the width parameter values are employed to estimate a parametric model defining the width parameter as a function of interchamber delays. Candidate interchamber delays that minimize the width parameter are determined from the parametric model and employed to determine optimal CRT settings. The technique provides an efficient way of finding optimal CRT settings when multiple pacing sites are available in a heart chamber.