Automatic Pre-Excitation Interval Adjustment for Fusion Pacing
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Solution Overview
Problem
Existing cardiac resynchronization therapy (CRT) systems face challenges in efficiently delivering fusion-based therapy to patients with cardiac conduction abnormalities like left or right bundle branch block, due to varying conduction delays and electrode placement issues, leading to ineffective ventricular resynchronization.
Innovation Solution
The system automatically adjusts the AV interval to deliver a single ventricular pacing stimulus based on prior cardiac events, using a pre-excitation interval (PEI) calculated from intrinsic AV intervals, allowing for ventricular fusion and synchronization with minimal pacing energy, and can be adjusted dynamically based on patient physiologic state.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If a single ventricular pacing stimulus is delivered to pre-excite the conduction-delayed ventricle, then ventricular resynchronization and stroke volume are enhanced, but the timing must be precisely optimized to fuse with intrinsic depolarization
Solution Approach 1:
The system calculates and prepares the optimal AV interval in advance based on prior cardiac events (A p/s -RVs and A p/s -LVs intervals), allowing the pacing stimulus to be delivered at the precise moment needed for fusion without requiring real-time complex calculations during each beat
Solution Approach 2:
The system uses feedback from sensed ventricular events (RVs, LVs) and prior cardiac cycles to continuously refine and adjust the AV interval, ensuring the pacing stimulus is delivered at the optimal moment for fusion while adapting to changing physiological conditions
2Ease of operation
If the AV interval is automatically adjusted based on prior cardiac events, then the need for manual echocardiographic evaluations is reduced, but the system complexity increases
Solution Approach 1:
The system performs self-optimization by automatically measuring prior cardiac intervals (A p/s -RVs, A p/s -LVs) and calculating the optimal AV interval without requiring external manual echocardiographic evaluations or clinical intervention
Solution Approach 2:
The patent replaces manual mechanical echocardiographic evaluation with an automated electronic system that uses electrical sensing and computational algorithms to determine the optimal pacing timing, substituting physical examination tools with digital signal processing
3Use of energy by moving object
If fusion-based CRT is delivered using intrinsic depolarization, then pacing energy is minimized, but the system must accurately distinguish between paced and intrinsic events
Solution Approach 1:
The system uses feedback from ventricular sensing (RVs, LVs) to determine whether a ventricular event is paced or intrinsic, allowing the pacemaker to distinguish between the two and adjust timing accordingly to minimize energy consumption while maintaining accurate event differentiation
Data Source
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AI summary
Automated adjustment of a pre-excitation interval (PEI) used to deliver hemodynamically efficient fusion pacing therapy.