Dynamic AV Delay Adjustment for Cardiac Output Optimization
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Solution Overview
Problem
Cardiac conduction defects, such as bundle branch blocks, lead to irregular heart function due to uncoordinated ventricular activation, which existing cardiac rhythm management systems struggle to address effectively across varying heart rates.
Innovation Solution
A cardiac rhythm management system that dynamically adjusts pacemaker atrioventricular (AV) delay using intrinsic and heart-rate-dependent AV delays to optimize fusion of paced and native ventricular activations, enhancing cardiac output by coordinating ventricular contractions through a therapy control circuit and physiologic parameter sensing circuit.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Device complexity
If a fixed AV delay is used in pacing therapy, then the device complexity is reduced, but the adaptability to varying heart rates and physiological conditions deteriorates
Solution Approach 1:
The patent implements dynamic adjustment of the AV delay parameter based on detected heart rate. The device transitions from a fixed, static AV delay to a dynamic, variable AV delay that automatically adapts to the subject's physiological state. This resolves the contradiction by making the pacing therapy flexible and adaptive without requiring complex manual programming or multiple fixed modes.
Solution Approach 2:
The system employs feedback mechanisms by continuously monitoring the subject's heart rate and using this information to adjust the AV delay parameter. The detected heart rate serves as feedback that drives the adjustment of pacing parameters, enabling the device to optimize pacing fusion automatically in response to varying physiological conditions while maintaining relatively simple device architecture.
2Productivity
If the AV delay is optimized for rest, then cardiac output at rest is enhanced, but cardiac output during physical activity deteriorates
Solution Approach 1:
The patent changes the AV delay parameter dynamically based on heart rate. Instead of using a single fixed AV delay optimized for rest, the device adjusts the AV delay parameter according to the detected heart rate, thereby optimizing cardiac output across the entire range of heart rates from rest to physical activity. This resolves the contradiction by making the parameter adaptive rather than fixed.
3Ease of operation
If heart rate independent AV delay is used, then the ease of operation is improved, but the precision of pacing fusion optimization deteriorates
Solution Approach 1:
The device performs self-adjustment of the AV delay parameter by automatically detecting the subject's heart rate and computing the appropriate AV delay based on stored relationships. This eliminates the need for complex manual programming or frequent clinical adjustments, maintaining ease of operation while achieving precise optimization of pacing fusion through automatic adaptation to varying heart rates.
Data Source
AI summary
In an example, a pacing therapy can be optimized using information indicative of an offset duration between an intrinsic first atrioventricular delay of a subject at rest and a second atrioventricular delay specified to enhance a cardiac output of the subject heart when the subject is at rest. Optimizing the therapy can include receiving information about a heart rate of the subject and receiving information about an intrinsic, heart rate dependent atrioventricular delay. In an example, a therapy parameter, such as a therapy atrioventricular delay, can be adjusted using information about the received heart rate of the subject, the heart-rate-dependent third AV delay, or the offset duration.