Intracardiac Electrogram Differentiation of CSP and Myocardial Pacing
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Solution Overview
Problem
Confirming successful conduction system pacing (CSP) during implantation and post-implantation of medical devices such as cardiac pacemakers is challenging, often resulting in less efficacious myocardial pacing.
Innovation Solution
Sensing left-ventricular activations via electrodes to determine metrics such as timing and morphology, allowing differentiation between CSP and myocardial pacing through techniques that include using implantable medical devices to adjust electrical stimulation parameters.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If electrical stimulation is delivered to achieve conduction system pacing, then cardiac resynchronization is provided, but it is challenging to confirm successful pacing and may result in less efficacious 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 device to detect successful conduction system pacing by analyzing the timing and morphology of sensed activations, and to adjust stimulation parameters if myocardial pacing is detected instead of successful CSP.
2Reliability
If electrical stimulation parameters are adjusted to regain capture of the conduction system, then CSP is restored, but device complexity increases
Solution Approach 1:
The device automatically senses left-ventricular activations, determines activation metrics, and adjusts electrical stimulation parameters to regain capture of the conduction system without requiring manual intervention. The system self-corrects by detecting loss of CSP and autonomously modifying stimulation delivery based on sensed activation characteristics.
3Measurement precision
If left-ventricular activations are sensed and metrics are determined to differentiate CSP from myocardial pacing, then successful pacing is confirmed, but measurement precision requirements increase
Solution Approach 1:
The system analyzes specific local characteristics of left-ventricular activations, such as timing relative to stimulation and waveform morphology, to differentiate CSP from myocardial pacing. By focusing on localized features of the activation signal rather than requiring comprehensive analysis, the system achieves reliable differentiation with manageable measurement requirements.
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
Enables identification of loss of CSP and adjustment of electrical stimulation to regain capture of the conduction system, providing feedback for electrode placement and transitioning to CRT if CSP cannot be achieved.
Implementation Method 1
sensing one or more left-ventricular activations via one or more electrodes of a left-ventricular lead
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.