Dynamic AV Delay Optimization for Cardiac Pacing
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Solution Overview
Problem
Current cardiac pacing therapies for heart failure face challenges in providing individualized and dynamic adjustments to account for inter-patient differences and intra-patient variations over time, often requiring frequent reconfiguration of pacing electrodes and suspension of ventricular pacing, which increases complexity and reduces therapy efficacy.
Innovation Solution
A system and method for dynamically updating stimulation parameters, such as atrioventricular delay (AVD) values, based on real-time atrioventricular conduction characteristics and patient conditions, allowing for personalized cardiac pacing therapy tailored to specific heart rates, postures, and activities, reducing the need for frequent electrode reconfiguration and pacing suspension.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Adaptability or versatility
If frequent reconfiguration of pacing electrodes is performed to account for inter-patient differences and intra-patient variations, then therapy individualization is improved, but device complexity and operational burden increase
Solution Approach 1:
The system automatically determines AV conduction characteristics and dynamically adjusts AVD parameters without requiring manual reconfiguration by clinicians. The IMD self-monitors physiological signals, processes AV conduction data, and autonomously updates pacing parameters, eliminating the need for frequent manual electrode reconfiguration while maintaining personalized therapy
Solution Approach 2:
The system dynamically changes the AVD stimulation parameter based on real-time or periodically updated AV conduction characteristics. By adjusting the AVD parameter in response to measured physiological variations, the system achieves individualized therapy adaptation without physical reconfiguration of the device or electrodes
2Adaptability or versatility
If frequent reconfiguration of pacing electrodes is performed to account for inter-patient differences and intra-patient variations, then therapy individualization is improved, but the frequency of pacing suspension increases
Solution Approach 1:
The system performs preliminary determination of AV conduction characteristics and pre-calculates optimal AVD parameters before they are needed for therapy delivery. By having parameters ready in advance based on predicted or measured physiological states, the system avoids last-minute adjustments that would require pacing suspension
Solution Approach 2:
The IMD autonomously monitors AV conduction and dynamically adjusts parameters without requiring clinician intervention or device reconfiguration events. This self-adjusting capability eliminates the need to suspend pacing for parameter updates, as changes occur seamlessly in the background
3Reliability
If dynamic updating of stimulation parameters is implemented based on real-time AV conduction characteristics, then therapy efficacy is improved, but energy consumption increases
Solution Approach 1:
The system updates AV conduction characteristics and adjusts AVD parameters periodically rather than continuously, balancing therapy efficacy with energy conservation. By sampling physiological signals at appropriate intervals and updating parameters based on significant changes in AV conduction, the system maintains effective therapy while minimizing unnecessary energy expenditure on continuous monitoring and adjustment
Solution Approach 2:
The system dynamically changes stimulation parameters only when AV conduction characteristics warrant adjustment, rather than continuously varying parameters. This event-driven parameter update approach ensures therapy efficacy is maintained during periods of physiological change while conserving energy during stable conditions
Data Source
AI summary
Systems and methods for monitoring and treating patients with heart failure are discussed. The system may receive patient atrioventricular (AV) conduction characteristic under different heart rates or patient conditions. Stimulation parameters including stimulation timing parameters may be stored in a memory. The system may include a stimulation control circuit configured to determine a parameter update schedule indicating a timing at which to update stimulation parameter using patient AV conduction characteristic, and dynamically update at least a portion of the stored set of stimulation parameters at the determined parameter update schedule. For a specified heart rate or heart rate range, a stimulation parameter may be selected from the set of the stimulation parameters for use during cardiac stimulation.