Intracardiac Electrogram Differentiation of CSP and Myocardial Pacing
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Solution Overview
Problem
Challenges exist in confirming successful conduction system pacing (CSP) during implantation and post-implantation of medical devices, leading to potential myocardial pacing, which can result in less efficacious left-ventricular septal pacing.
Innovation Solution
The system senses left-ventricular activations via electrodes to determine metrics such as timing and morphology, distinguishing between conduction system pacing and myocardial pacing, allowing for adjustments or transitioning to cardiac resynchronization therapy if CSP is not achieved.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If electrical stimulation is delivered to achieve conduction system pacing, then cardiac resynchronization is improved, but it is challenging to confirm successful CSP and distinguish from myocardial pacing
Solution Approach 1:
The system senses left-ventricular activations and determines activation metrics to provide feedback on whether CSP was successful. This feedback loop allows the system to distinguish between CSP and myocardial pacing by analyzing timing and morphology characteristics of the sensed activations, thereby confirming whether the electrical stimulation achieved the desired conduction system pacing.
2Ease of operation
If CSP is not successfully achieved, then the system defaults to myocardial pacing, but this results in less efficacious left-ventricular septal pacing
Solution Approach 1:
By implementing feedback through sensing and metric determination, the system can identify when CSP has been lost or failed to achieve. This allows the system to adjust the magnitude of electrical stimulation to regain capture of the conduction system, or transition to CRT if CSP cannot be achieved, rather than defaulting to less efficacious myocardial pacing.
Solution Approach 2:
The system dynamically adjusts pacing parameters based on sensed activation metrics. When CSP is not successfully achieved, the system can modify stimulation magnitude or transition to alternative therapies like CRT, making the pacing system adaptive rather than static, thereby maintaining optimal pacing efficacy under varying conditions.
3Reliability
If electrical stimulation magnitude is increased to ensure capture, then CSP capture is improved, but the risk of myocardial pacing increases
Solution Approach 1:
The sensing of left-ventricular activations with determination of activation metrics provides feedback that allows differentiation between CSP and myocardial pacing. This feedback mechanism enables the system to identify successful CSP at lower stimulation magnitudes, reducing the need to increase magnitude and thereby reducing the risk of unintended myocardial pacing while maintaining reliable conduction system capture.
Data Source
AI summary
In some examples, a method comprises sensing one or more left-ventricular activations via one or more electrodes of a left-ventricular lead, wherein each of the one or more left-ventricular activations are in response to delivery of an electrical stimulation to a heart of a patient; determining one or more left-ventricular activation metrics based on the sensed one or more left-ventricular activations; and determining whether the electrical stimulation provided conduction system pacing based on the one or more ventricular activation metrics.