Extracardiovascular ICD Concomitant Implantation Mode
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Solution Overview
Problem
Extracardiovascular implantable cardioverter defibrillators (ICDs) face challenges in accurately detecting therapy signals from concomitantly implanted cardiac pacing devices during implantation, leading to potential inappropriate shock delivery and complicating the surgical procedure due to the distance and differing sensing vectors between extracardiovascular and intracardiac electrodes.
Innovation Solution
The extracardiovascular ICD is configured to enter a concomitant medical device implantation mode, suspending ventricular tachyarrhythmia detection and therapy, allowing it to detect test therapy signals from an intracardiac pacing device, providing confirmation of signal detection, and re-enabling normal operations upon successful positioning, thus avoiding inappropriate shocks and simplifying the implantation process.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If an extracardiovascular ICD is implanted to avoid surgical risks of intracardiac leads, then patient safety is improved, but the ability to accurately detect pacing therapy signals is worsened due to greater distance and differing sensing vectors
Solution Approach 1:
The ICD is programmed in advance with a repository of pacing signal templates and detection algorithms before the pacing device is implanted. During implantation, the system automatically compares sensed signals against these pre-stored templates to identify and exclude pacing signals from arrhythmia detection, eliminating the need for manual programming during the surgical procedure.
Solution Approach 2:
The system continuously monitors the electrical signals sensed by the ICD electrodes and provides real-time feedback by comparing them against stored pacing signal templates. When a pacing signal is detected, the system automatically adjusts its arrhythmia detection algorithm to exclude that signal, creating a closed-loop feedback mechanism that maintains detection accuracy throughout the implantation process.
2Reliability
If the ICD remains in normal operation mode during implantation of another medical device, then normal tachyarrhythmia detection and therapy are maintained, but inappropriate shock delivery may occur due to misinterpretation of test therapy signals
Solution Approach 1:
The system is pre-programmed with a repository of pacing signal templates and detection algorithms before the pacing device is implanted. During implantation, the system automatically compares sensed signals against these pre-stored templates to identify and exclude pacing signals from arrhythmia detection, eliminating the need for manual programming during the surgical procedure.
Solution Approach 2:
The system continuously monitors the electrical signals sensed by the ICD electrodes and provides real-time feedback by comparing them against stored pacing signal templates. When a pacing signal is detected, the system automatically adjusts its arrhythmia detection algorithm to exclude that signal, creating a closed-loop feedback mechanism that maintains detection accuracy throughout the implantation process.
3Measurement precision
If manual programming and extensive interaction with programming devices is required during implantation, then detection parameters can be adjusted, but the implantation procedure becomes more complex and time-consuming
Solution Approach 1:
The ICD system performs automatic self-programming during implantation by autonomously comparing sensed electrical signals against pre-stored pacing signal templates and automatically adjusting its detection parameters. The system independently identifies pacing signals and configures its arrhythmia detection algorithm without requiring manual intervention, thereby simplifying the implantation procedure while maintaining detection precision.
Solution Approach 2:
The system is pre-programmed with a repository of pacing signal templates and detection algorithms before the pacing device is implanted. During implantation, the system automatically compares sensed signals against these pre-stored templates to identify and exclude pacing signals from arrhythmia detection, eliminating the need for manual programming during the surgical procedure.
4Object-affected harmful factors
If the ICD suspends ventricular tachyarrhythmia detection and therapy during implantation mode, then inappropriate shock delivery is prevented, but normal protective function is temporarily lost
Solution Approach 1:
The system is pre-programmed with a repository of pacing signal templates and detection algorithms before the pacing device is implanted. During implantation, the system automatically compares sensed signals against these pre-stored templates to identify and exclude pacing signals from arrhythmia detection, eliminating the need for manual programming during the surgical procedure.
Solution Approach 2:
The system continuously monitors the electrical signals sensed by the ICD electrodes and provides real-time feedback by comparing them against stored pacing signal templates. When a pacing signal is detected, the system automatically adjusts its arrhythmia detection algorithm to exclude that signal, creating a closed-loop feedback mechanism that maintains detection accuracy throughout the implantation process.
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
This approach ensures accurate detection of therapy signals from the pacing device, preventing inappropriate shocks and streamlining the implantation procedure by reducing the need for extensive interaction with programming devices, ensuring correct positioning and functionality of both devices.
Implementation Method 1
sensing circuitry configured to receive, via a plurality of electrodes, one or more test therapy signals generated by an intracardiac pacing device
Data Source
AI summary
Techniques are disclosed for determining, by an extracardiovascular implantable cardioverter defibrillator (ICD) implanted in a patient, whether one or more test therapy signals generated by another medical device implanted in the patient is detected. In response to detecting the one or more test therapy signals, the extracardiovascular ICD provides an indication that the extracardiovascular ICD has detected the one or more test therapy signals. In some examples, the indication is an audible tone provided to a clinician. In some examples, the other medical device is an intracardiac cardiac pacing device, and the one or more test therapy signals comprises a plurality of anti-tachycardia pacing (ATP) pulses.