His Bundle Pacing Timing for Hypertension Without AV Delay
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Solution Overview
Problem
Existing cardiac stimulation therapies for hypertension often result in non-physiological ventricular stimulation, particularly in patients with intact AV conduction, leading to unwanted effects and are not recommended for long-term use.
Innovation Solution
An implantable device that stimulates the His bundle or left bundle branch immediately before or after atrial activity detection, without using an AV time delay, to prematurely terminate ventricular filling and reduce blood pressure, with optional suspension of stimulation based on predefined cycles or parameters.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Stress or pressure
If ventricular stimulation is delivered with time delay after atrial activity to lower blood pressure, then blood pressure reduction is achieved, but non-physiological spread of excitation occurs leading to unwanted effects
Solution Approach 1:
The patent introduces the His bundle as an intermediary structure between the atrium and ventricles. By stimulating the His bundle instead of directly stimulating the ventricles, the excitation spreads through the natural conduction pathway, achieving blood pressure reduction without the harmful non-physiological spread of excitation that occurs with direct ventricular stimulation.
Solution Approach 2:
The patent copies the natural electrical conduction pathway by stimulating the His bundle, which is the actual conduit through which electrical impulses travel from the atrium to the ventricles. This copying of the physiological pathway allows for effective blood pressure control while maintaining normal excitation spread patterns.
2Stress or pressure
If atrial stimulation is used to lower blood pressure in patients with intact AV conduction, then blood pressure reduction is achieved, but unnecessary right ventricular stimulation occurs
Solution Approach 1:
The His bundle serves as a selective intermediary that allows electrical stimulation to reach the ventricles through the normal conduction system without causing unnecessary right ventricular activation. This intermediary approach enables blood pressure control while avoiding the harmful effect of unnecessary right ventricular stimulation that occurs with direct atrial pacing in patients with intact AV conduction.
3Stress or pressure
If direct ventricular stimulation is applied to reduce blood pressure, then blood pressure reduction is achieved, but the therapy is not recommended for long-term use due to non-physiological effects
Solution Approach 1:
The patent copies the natural physiological pathway by stimulating the His bundle, which is the actual electrical conduction pathway in the heart. This approach makes the therapy suitable for long-term use because it replicates normal cardiac electrical activity, unlike direct ventricular stimulation which creates non-physiological effects that are not recommended for long-term therapy.
Data Source
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AI summary
The present invention relates to an implantable device (200) for stimulating a heart (H) and lowering blood pressure, comprising: a stimulation unit (201) configured to stimulate the His bundle (HIS) or the left-bundle branch (LBB) of the heart (H), and a sensing unit (202) for detecting atrial activity of the heart (H). According to the present invention the stimulation unit is configured to stimulate the His bundle (HIS) or the left bundle branch (LBB) immediately before or immediately after detection of an atrial activity.