Deceleration Pacing for Low-Energy Cardiac Arrhythmia Termination
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Solution Overview
Problem
Existing arrhythmia termination apparatuses have low success rates and cause significant tissue damage due to high electrical energy requirements and inefficient application of defibrillation pulses.
Innovation Solution
An apparatus that generates a sequence of electric pulses with decreasing pulse repetition frequency, optimizing the frequency spectrum to terminate arrhythmias with lower energy usage by using deceleration pacing, which does not require identifying a dominant frequency.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If conventional defibrillation pulses are applied to terminate arrhythmia, then the arrhythmia termination effect is achieved, but significant tissue damage occurs due to high electrical energy
Solution Approach 1:
The defibrillation process is segmented into multiple low-energy pulses delivered in sequence rather than a single high-energy pulse. The pulse generator applies a series of ventricular pacing pulses at a rate higher than the intrinsic arrhythmic rate, with each pulse contributing incrementally to terminate the arrhythmia, thereby avoiding the tissue damage associated with high-energy single shocks
Solution Approach 2:
The invention changes the parameters of the electrical stimulation by using multiple pulses with lower individual energy levels instead of one high-energy pulse. The pulse repetition frequency is set higher than the dominant frequency of the arrhythmia, and the cumulative effect of these parameter changes achieves arrhythmia termination with reduced tissue damage
2Reliability
If high electrical energy is used to terminate arrhythmia, then the termination effect is achieved, but the treatment efficacy is reduced due to posttraumatic stress and side-effects
Solution Approach 1:
The treatment is divided into multiple low-stress pulses rather than one high-stress shock. By segmenting the energy delivery into a sequence of ventricular pacing pulses, the patient experiences minimal posttraumatic stress while the cumulative effect successfully terminates the arrhythmia
Solution Approach 2:
The invention converts the potentially harmful high-energy shock into a beneficial sequence of low-energy pulses. What would traditionally be a harmful high-energy event is transformed into a series of gentle pacing pulses that achieve the same therapeutic goal without the harmful side-effects
3Reliability
If a sequence of electric pulses is applied to terminate arrhythmia, then the treatment duration is extended, but the energy consumption increases
Solution Approach 1:
The invention employs periodic ventricular pacing pulses delivered at a specific repetition frequency higher than the arrhythmia's dominant frequency. This periodic action, sustained over a sequence of pulses, terminates the arrhythmia more efficiently than continuous or single-pulse approaches, achieving success with lower total energy consumption
Solution Approach 2:
The pulse generator dynamically adjusts the pacing rate to be higher than the intrinsic arrhythmic rate, creating a dynamic interaction that disrupts the arrhythmia. This dynamic approach allows termination with fewer pulses and lower total energy compared to static or high-energy methods
Data Source
Figure 1~2
Figure 3~10
Figure 4~11
AI summary
An apparatus (1) for determining an arrhythmia of a living heart (7) comprises a signal evaluation device (3) receiving a signal (6) representing a present electric activity of the heart (7), and determining a frequency spectrum (8, 11-13) of the signal (6). The apparatus (1) further comprises a pulse generator (4) generating a sequence (10) of electric pulses (21) to be applied to the heart (7) at a pulse repetition frequency depending on the frequency spectrum (8, 11-13) and decreasing by at least 20 % over the sequence (10).