His Bundle Pacing Atrial Oversensing Detection
Find Innovative SolutionsGenerate Solutions
Solution Overview
Problem
Implantable cardiac stimulation devices face challenges in accurately detecting and managing atrial oversensing during His bundle pacing, which can lead to inaccurate capture threshold measurements and unreliable sensing of evoked responses, affecting the functionality of the devices.
Innovation Solution
The implementation of methods and systems that use electrodes implanted near the His bundle to sense and pace the heart, employing specific windows and pacing pulses to detect atrial oversensing, characterize its occurrence, and adjust sensing thresholds to prevent interference, thereby ensuring accurate capture management and device functionality.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If His bundle pacing is performed to achieve hemodynamic improvement and physiological ventricular activation, then cardiac function is improved, but atrial oversensing may occur which disrupts device logic and impairs normal functionality
Solution Approach 1:
The patent performs atrial oversensing detection before relying on automated His capture threshold detection algorithms. By proactively identifying atrial signal contamination in the His IEGM, the system prevents inaccurate threshold measurements and inappropriate pacing adjustments, thereby maintaining reliable cardiac function without the harmful effects of atrial oversensing disrupting device operation
Solution Approach 2:
The patent introduces an intermediary detection mechanism that analyzes the His IEGM for atrial signal components. This intermediary step acts as a filter between the His bundle pacing delivery and the capture threshold measurement, identifying when atrial oversensing is present and preventing it from corrupting the capture management algorithm's decision-making process
2Ease of operation
If automated His capture threshold detection is performed to simplify device operation, then ease of operation is improved, but measurement accuracy deteriorates when atrial oversensing is present
Solution Approach 1:
The patent performs atrial oversensing detection as a preliminary step before executing automated His capture threshold detection. By checking for atrial signal contamination in advance, the system ensures that the subsequent automated threshold measurement is not corrupted, thereby maintaining both ease of operation and measurement precision
Solution Approach 2:
The patent implements a feedback mechanism where the detection of atrial oversensing signals adjusts the operation of the automated threshold detection algorithm. When atrial signals are detected in the His IEGM, the system modifies its measurement approach or alerts the operator, ensuring that inaccurate measurements do not compromise the ease of operation while preserving measurement precision
3Productivity
If His bundle pacing electrodes are implanted to provide physiological activation, then cardiac efficiency is improved, but sensing reliability deteriorates due to unreliable evoked response detection
Solution Approach 1:
The patent performs atrial oversensing detection before attempting to sense evoked responses following His bundle pacing. By identifying atrial signal contamination in advance, the system prevents false or unreliable evoked response detection, thereby maintaining both the cardiac efficiency benefits of His bundle pacing and the reliability of evoked response sensing for capture confirmation
Data Source
AI summary
Certain embodiments of the present technology described herein relate to detecting atrial oversensing in a His intracardiac electrogram (His IEGM), characterizing atrial oversensing, determining when atrial oversensing is likely to occur, and or reducing the chance of atrial oversensing occurring. Some such embodiments characterize and/or avoid atrial oversensing within a His IEGM. Other embodiments of the present technology described herein relate to determining whether atrial capture occurs in response to His bundle pacing (HBP). Still other embodiments of the present technology described herein relate to determining whether AV node capture occurs in response to HBP.