Defibrillator Conduction System Pacing for Lower-Energy Shocks
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Solution Overview
Problem
Existing medical devices for treating cardiac arrhythmias, such as implantable cardiac defibrillators (ICDs), often cause significant discomfort due to high-voltage shocks and require large mechanical packages, while relying on ventricular myocyte propagation for pacing, which may not effectively capture the ventricular myocardium.
Innovation Solution
A medical system that delivers pacing signals to the heart's conduction system, like the Bundle of His or Purkinje fibers, to capture the ventricle effectively, followed by a low-energy shock if necessary, reducing discomfort and system size.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If high-voltage shocks are delivered to treat cardiac arrhythmias, then the arrhythmia is effectively treated, but patient discomfort increases significantly
Solution Approach 1:
The system performs preliminary conduction system pacing at a high rate (e.g., 180-200 bpm) for a predetermined period (e.g., 5-10 seconds) before delivering the defibrillation shock. This preliminary pacing action suppresses the arrhythmia and prepares the myocardium, allowing the subsequent shock to be delivered at lower energy levels while maintaining treatment efficacy.
Solution Approach 2:
The system changes the pacing parameters by delivering high-rate pacing signals to the conduction system (Bundle of His or Purkinje fibers) before the shock, and then delivers the defibrillation shock at reduced voltage levels. This parameter change sequence transforms the treatment approach from direct high-voltage shock to a two-stage process with lower overall energy requirements.
2Reliability
If high-rate pacing is delivered to the conduction system to capture the ventricle, then ventricular capture effectiveness is improved, but the complexity of the device increases
Solution Approach 1:
The system uses an intermediary approach by pacing the conduction system (Bundle of His or Purkinje fibers) rather than directly pacing the ventricular myocardium. This intermediary conduction system pacing serves as a more effective mediator for achieving ventricular capture, particularly during arrhythmias when direct myocardial pacing may fail.
3Device complexity
If conventional ventricular myocyte propagation pacing is used, then the device structure can be simpler, but the ventricular capture may not be effective during arrhythmias
Solution Approach 1:
The system uses an intermediary approach by pacing the conduction system (Bundle of His or Purkinje fibers) rather than directly pacing the ventricular myocardium. This intermediary conduction system pacing serves as a more effective mediator for achieving ventricular capture, particularly during arrhythmias when direct myocardial pacing may fail.
Data Source
AI summary
A medical system configured to monitor physiological symptoms of a patient to detect a current or imminent arrhythmia in a heart of a patient. The medical system is configured to deliver pacing signals to the conduction system of the heart in response to the current or imminent arrhythmia. In examples, the pacing signals are configured to cause high-rate conduction system pacing of the heart. In examples, if the arrhythmia continues or another arrhythmia is detected, the medical system is configured to cause a defibrillation element to deliver a shock to the heart of the patient. In examples, the medical system is configured to deliver a relatively low energy shock following the conduction system pacing.