His-Bundle Pacing Control for Intermittent AV Block
Find Innovative SolutionsGenerate Solutions
Solution Overview
Problem
Conventional cardiac pacing methods, such as right ventricular apical pacing, can cause ventricular dyssynchrony and adverse long-term effects, while biventricular pacing may still suffer from potential adverse impacts on ventricular function, and His-bundle pacing may not adequately restore cardiac synchrony or result in undesirable outcomes like para-Hisian capture or loss of capture.
Innovation Solution
A medical system with an AV conduction monitor that detects intermittent or rate-related AV conduction disturbances, controlling the delivery of His-bundle pacing pulses based on the presence or absence of these disturbances to promote intrinsic ventricular conduction and activation, thereby adapting pacing therapy to the patient's needs.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If His-bundle pacing is delivered continuously to treat AV block, then cardiac synchrony and hemodynamic performance are improved, but device battery power is depleted faster and unnecessary therapy is administered
Solution Approach 1:
The system transitions from continuous pacing to intermittent demand pacing, delivering His-bundle pacing pulses only when AV conduction disturbance is detected. The controller monitors AV conduction status and activates pacing only when blocks are present, allowing the device to remain inactive during normal conduction periods, thereby extending battery life while maintaining therapeutic effectiveness.
Solution Approach 2:
The system incorporates continuous monitoring of AV conduction status through physiological signals (PR interval, QRS width, heart rate) that provide feedback to the controller. This feedback mechanism enables the controller to dynamically adjust pacing delivery based on real-time conduction state, ensuring therapy is administered only when needed and optimizing both therapeutic outcome and energy consumption.
2Reliability
If His-bundle pacing is delivered continuously to ensure adequate treatment coverage, then cardiac synchrony is maintained, but unnecessary therapy and potential side effects increase
Solution Approach 1:
The system dynamically adapts pacing delivery based on real-time detection of AV conduction disturbances. The controller adjusts the pacing strategy from continuous to intermittent mode according to the patient's instantaneous conduction status, ensuring therapy is provided only when pathologically needed and avoiding unnecessary treatment during normal conduction periods.
Solution Approach 2:
Continuous monitoring of AV conduction parameters provides feedback that triggers pacing only when conduction disturbance is detected. This feedback-based demand pacing ensures therapeutic coverage is matched precisely to clinical need, eliminating unnecessary therapy and its associated side effects while maintaining adequate treatment when blocks occur.
3Power
If conventional RV apical pacing is used to treat ventricular dyssynchrony, then immediate cardiac output improvement is achieved, but adverse ventricular changes and heart failure develop over time
Solution Approach 1:
The system uses His-bundle pacing as an intermediary approach that activates the natural His-Purkinje conduction system rather than directly stimulating ventricular muscle. By pacing at the His bundle level, the system restores physiological ventricular activation sequences through the conduction system, avoiding the harmful effects of direct muscle-muscle contraction while maintaining cardiac output improvement.
Solution Approach 2:
The system replaces the mechanical muscle-muscle contraction mechanism of RV apical pacing with an electrical conduction-based mechanism. By delivering pulses to the His bundle, the system utilizes the heart's natural electrical conduction pathways to propagate activation throughout the ventricles, substituting the harmful mechanical stimulation with a physiological electrical mechanism that preserves ventricular function.
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 improves cardiac synchrony and hemodynamic performance by leveraging the natural conduction mechanisms of the heart, reducing unnecessary therapy and potential side effects, and extending device longevity with efficient use of battery power.
Implementation Method 1
His-bundle pacing pulses may be delivered to a His bundle or a bundle branch to stimulate a physiologic conduction pathway of the heart
Data Source
AI summary
Systems and methods for dynamically controlling His-bundle pacing (HBP) according to an indication of a rate-related or intermittent atrioventricular (AV) block in a subject are disclosed. An exemplary medical system includes an AV conduction monitor to detect an indication of either a presence or an absence of intermittent or rate-related AV conduction disturbance using physiologic information of the subject. In the event that an intermittent or rate-related AV conduction disturbance is present, a control circuit provides a control signal to an electrostimulation circuit to deliver HBP pulses. If there is no indication of intermittent or rate-related AV conduction disturbance, or a previously detected intermittent or rate-related AV conduction disturbance has been terminated, the control circuit withholds or discontinues delivery of the HBP pulses to promote intrinsic ventricular conduction and activation.