Heart Stimulator Beat-to-Beat A-V Delay Optimization
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Solution Overview
Problem
Current pacemaker A-V delay optimization methods are limited by requiring external measurements, are not dynamic, and do not account for inter-atrial conduction time, AV nodal recovery time, and autonomic status, leading to suboptimal cardiac performance, especially in ambulatory conditions.
Innovation Solution
An implantable heart stimulator that evaluates electric signals to determine P-wave duration and calculates atrio-ventricular delay on a beat-to-beat basis, incorporating inter-atrial conduction time, AV nodal recovery time, and autonomic status to adjust the delay dynamically.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Adaptability or versatility
If external measurements and manual optimization methods are used, then A-V delay can be adjusted, but the optimization is not dynamic and does not account for inter-atrial conduction time, AV nodal recovery time, and autonomic status
Solution Approach 1:
The pacemaker automatically determines P-wave duration from sensed atrial events and calculates optimal A-V delay using built-in algorithms that incorporate inter-atrial conduction time, AV nodal recovery time, and autonomic status detection, eliminating the need for external measurements and manual optimization
Solution Approach 2:
The system continuously monitors atrial events, measures P-wave duration, detects autonomic status changes, and dynamically adjusts A-V delay in real-time based on feedback from the patient's actual cardiac physiology, creating a closed-loop optimization system
2Productivity
If fixed A-V delay is used, then device operation is simple, but cardiac performance is suboptimal under varying physiological conditions
Solution Approach 1:
The A-V delay is transformed from a fixed value to a dynamic parameter that changes beat-to-beat based on detected P-wave duration, AV nodal recovery time, and autonomic status, allowing optimization across varying physiological conditions while maintaining manageable device complexity through algorithmic approaches
3Reliability
If traditional A-V delay optimization is used, then device structure is simple, but it leads to diastolic regurgitation and decreased preload in ambulatory conditions
Solution Approach 1:
The system performs preliminary assessment of P-wave duration and AV nodal recovery time before determining the optimal A-V delay, proactively preventing diastolic regurgitation and decreased preload by selecting appropriate delay values in advance for each heart cycle
Solution Approach 2:
The system changes the A-V delay parameter dynamically based on detected physiological parameters including P-wave duration, AV nodal recovery time, and autonomic status, adapting to prevent harmful effects like diastolic regurgitation under varying ambulatory conditions
Data Source
AI summary
Exemplary methods and apparatuses are disclosed that provide for determination of an atrio-ventricular delay on a beat-to-beat basis by determining a P-wave duration from electric signals corresponding to electric potentials in a heart, and determining the atrio-ventricular delay on a beat-to-beat basis such that the atrio-ventricular delay for an individual heart cycle depends on the P-wave duration of a same or an immediately preceding heart cycle.