His-bundle Capture Verification Using Electro-mechanical Delay
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Solution Overview
Problem
Current cardiac rhythm management devices face challenges in verifying cardiac capture at the His-bundle, particularly when multi-axis ECG data are not available, as they rely on attributes like QRS narrowing, which may not be accessible to implanted devices.
Innovation Solution
The system measures time intervals between paced and sensed cardiac events using a single sensor, comparing these intervals to a threshold to provide cardiac diagnostic information, including verification of cardiac capture, and discriminates between Purkinje fiber, cell-to-cell conduction, and intrinsic conduction cardiac contractions.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If QRS narrowing attributes are used to verify cardiac capture, then verification accuracy is improved, but device complexity increases due to requirement of multi-axis ECG data
Solution Approach 1:
The patent extracts the essential verification information (electro-mechanical delay interval) from the complex multi-axis ECG data requirement, using only a single sensor to measure the time interval between paced and sensed cardiac events. This extraction approach maintains verification accuracy while eliminating the need for complex multi-axis ECG acquisition systems.
Solution Approach 2:
The patent introduces an intermediary measurement approach by using the electro-mechanical delay interval as a mediator between the paced stimulus and the mechanical cardiac response. This intermediary time interval measurement serves as a reliable indicator of cardiac capture without requiring direct multi-axis ECG data, thus simplifying the device while maintaining verification accuracy.
2Reliability
If multiple sensors are used to detect cardiac activity, then measurement reliability is improved, but device complexity and cost increase
Solution Approach 1:
The patent makes the single sensor universal by designing it to perform multiple functions: detecting both the paced electrical stimulus and the sensed mechanical cardiac response. This multi-functional sensor approach achieves reliable cardiac capture verification without requiring separate specialized sensors for each detection task, thereby reducing device complexity while maintaining reliability.
Solution Approach 2:
The single sensor serves itself by simultaneously detecting both the input stimulus and the output response, eliminating the need for additional sensors. The sensor system is designed to self-monitor the electro-mechanical delay interval through its own measurements, reducing overall system complexity while maintaining detection reliability.
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 enables efficient verification of cardiac capture and discrimination between different conduction types without relying on multi-axis ECG data, providing accurate cardiac diagnostic information and potentially improving cardiac output by optimizing pacing techniques.
Implementation Method 1
stimulating a His-bundle at a first time... His-bundle stimulation
Implementation Method 2
measuring a time interval between the His-bundle pacing and a sensed mechanical cardiac activity
Data Source
AI summary
Stimulation energy can be provided to a His-bundle to activate natural cardiac contraction mechanisms. Interval information can be used to describe a cardiac response to His-bundle stimulation, and the interval information can provide cardiac stimulation diagnostic information. For example, interval information can be used to discriminate between intrinsic conduction cardiac contractions and contractions responsive to His-bundle pacing.