Dynamic AV Delay Programming to Reduce Ventricular Pacing
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Solution Overview
Problem
Implantable cardiac rhythm management devices face challenges in minimizing unnecessary ventricular pacing, which can advance the progression of congestive heart failure due to complex programming requirements and interrelated control parameters.
Innovation Solution
The method involves measuring and extrapolating intrinsic conducted AV intervals at different heart rates to automatically suggest or program a dynamic AV delay interval that is longer than the predicted intrinsic conducted AV interval, incorporating patient-specific factors like age and health status, and using a safety margin to reduce ventricular pacing, along with dynamic adjustment of PVARP and AVSH to optimize pacing.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If a fixed AV delay interval is programmed to ensure adequate ventricular filling, then heart failure progression is avoided, but unnecessary ventricular pacing occurs when intrinsic conduction is sufficient
Solution Approach 1:
The patent implements dynamic AV delay programming where the AV delay interval is automatically adjusted based on measured intrinsic conducted AV intervals at different heart rates. The system transitions from a fixed AV delay to a dynamic AV delay that adapts to patient-specific conduction characteristics, allowing the device to optimize the balance between avoiding unnecessary pacing and ensuring adequate ventricular filling.
Solution Approach 2:
The patent changes the AV delay parameter from a fixed value to a dynamically calculated value based on intrinsic conducted AV intervals. By measuring AV intervals at multiple heart rates and using these measurements to program the AV delay, the system optimizes the parameter to prevent unnecessary ventricular pacing while maintaining reliable cardiac output.
2Reliability
If the AV delay interval is extended to avoid ventricular pacing, then heart failure progression is delayed, but ventricular filling may be compromised
Solution Approach 1:
The patent employs feedback mechanisms where the device measures intrinsic conducted AV intervals and uses these measurements to adjust the AV delay programming. This feedback loop allows the system to continuously optimize the AV delay to balance ventricular filling requirements with the need to avoid unnecessary pacing, thereby improving both reliability and productivity.
Solution Approach 2:
The patent performs preliminary measurement of intrinsic conducted AV intervals at different heart rates before finalizing the AV delay programming. This preliminary action allows the system to predict optimal AV delay values that will prevent unnecessary pacing while ensuring adequate ventricular filling, avoiding the need for trial-and-error adjustment.
3Ease of operation
If automatic AV delay programming is implemented to reduce ventricular pacing, then programming complexity is reduced for clinicians, but measurement and extrapolation accuracy becomes critical
Solution Approach 1:
The patent implements self-service programming where the device automatically measures intrinsic conducted AV intervals and programs the AV delay without requiring clinician intervention for manual programming. The system performs the measurements and calculations autonomously, reducing the complexity of operation for clinicians while relying on accurate measurement algorithms.
Solution Approach 2:
The patent performs preliminary measurements of AV intervals at multiple heart rates as part of the automatic programming process. These preliminary measurements are used to calculate and program optimal AV delay values, ensuring that the system has accurate data before making programming decisions, thereby maintaining measurement precision while simplifying the overall operation.
Data Source
AI summary
A cardiac interface device helps program an implantable cardiac rhythm or function management device, such as to reduce unnecessary ventricular pacing to avoid contributing to the advancement of heart failure disease progression. An intrinsic conducted AV interval is measured for at least one heart rate, and is predicted or measured for other heart rates. One or more of an age-predicted upper rate limit, a measured sensed AV offset, a PVARP based on measured retrograde conduction time can be used to determine an AV search hysteresis control parameter, and a resulting ventricular interval is graphically displayed relative to the intrinsic conducted AV interval at various heart rates. Confidence intervals or percentage ventricular pacing can also be displayed. Separate graphs for sense and pace initiated AV intervals can be provided.