Cardiac Electrogram-Guided Navigation for Left Atrial Appendage Closure
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Solution Overview
Problem
Current minimally invasive procedures for closing the left atrial appendage are cumbersome, require large incisions, and pose risks due to the need for thoracotomy or transseptal penetration, and lack effective navigation and visualization methods, especially in the slippery and fluid-filled pericardial space, leading to potential trauma and incomplete closure.
Innovation Solution
A navigation and tissue capture system that utilizes the innate electrical activity of cardiac tissues to guide devices to the left atrial appendage, employing electrodes to distinguish between different cardiac signals and facilitate minimally invasive access through a sub-xiphoid approach, allowing for precise closure without the need for thoracotomy or transseptal penetration.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Illumination intensity
If a thoracotomy is performed to access the left atrial appendage, then direct visualization and surgical access are improved, but patient trauma and procedural risk are significantly increased
Solution Approach 1:
The patent replaces the mechanical thoracotomy approach with a percutaneous needle-based system that uses electrical field detection (electrograms) to navigate and identify the left atrial appendage, eliminating the need for large incisions and chest opening while maintaining access capability
Solution Approach 2:
The patent introduces electrogram monitoring as an intermediary detection method that allows indirect identification and navigation to the left atrial appendage through electrical signal detection, replacing direct visual inspection that would require thoracotomy
2Ease of operation
If a transseptal penetration is performed to access the left atrial appendage, then minimally invasive access is achieved, but risks of clot dislodgement and endocardial injury are increased
Solution Approach 1:
The patent uses electrogram monitoring as an intermediary to guide needle placement externally through the pericardium, avoiding the need for transseptal penetration and intracardiac navigation that could dislodge clots or injure the endocardium
Solution Approach 2:
The patent extracts the navigation and detection function from the intracardiac space to the pericardial space, performing all detection and guidance maneuvers outside the heart chambers to eliminate risks associated with intracardiac manipulation
3Object-affected harmful factors
If thoracoscopic approach is used to close the left atrial appendage, then chest opening is avoided, but lung deflation and full anesthesia are still required
Solution Approach 1:
The patent replaces the thoracoscopic mechanical visualization system with an electrical field-based detection system using electrograms, enabling navigation and identification without lung deflation or full anesthesia, reducing procedural complexity and patient risk
4Object-affected harmful factors
If percutaneous approach is used to access the left atrial appendage, then patient trauma is reduced, but navigation and visualization in the pericardial space become difficult
Solution Approach 1:
The patent introduces electrogram monitoring as an intermediary detection system that provides real-time electrical signal feedback from the pericardial space, enabling accurate navigation and identification of the left atrial appendage without requiring visual inspection or complex imaging
Solution Approach 2:
The patent implements continuous electrogram signal feedback to guide needle advancement and positioning in the pericardial space, allowing real-time adjustment of the approach based on detected electrical signals from cardiac structures
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 precise and stable closure of the left atrial appendage with reduced risk and trauma, allowing for procedures under local or general anesthesia without deflating the lungs, using a percutaneous approach that improves visualization and navigation within the pericardial space.
Implementation Method 1
monitoring electrograms in tissue proximate the internal body location using the capture shaft electrode and the first electrode
Data Source
AI summary
Navigation and tissue capture systems and methods for navigation to and/or capture of selected tissue using the innate electrical activity of the selected tissue and/or other tissue are described. In the context of left atrial appendage closure, the systems and methods can be used to navigate to the left atrial appendage and capture/control the appendage while a closure instrument (suture, clip, ring) is placed over the appendage and tightened down or a closure method (ablation, cryogenic procedures, stapling, etc.) is performed to close the left atrial appendage. The use of innate electrical activity for navigating devices may be used in connection with other tissues and/or areas of the body.