His-bundle pacing system with left-ventricular backup
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Solution Overview
Problem
Conventional cardiac pacing methods, such as long-term RV apex pacing, can lead to uncoordinated ventricular contractions and adverse hemodynamic effects due to bypassing the natural His-Purkinje conduction system, resulting in decreased cardiac efficiency and potential long-term structural changes.
Innovation Solution
The integration of left ventricular pacing (LVP) into a cardiac pacing system that generates His-bundle pacing (HBP) pulses, allowing for concurrent or sequential delivery of HBP and LVP pulses, with adjustments based on His-bundle capture status to enhance cardiac synchrony and reduce unintended activation of non-targeted myocardium.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Stability of the object's composition
If RV apex pacing is used to treat cardiac dyssynchrony, then ventricular contraction coordination is improved, but long-term structural changes and decreased cardiac efficiency occur due to bypassing the natural His-Purkinje system
Solution Approach 1:
The patent segments the ventricular pacing function into two independent pathways: His-bundle pacing through the natural conduction system and direct LV pacing. This segmentation allows the system to preserve the natural conduction pathway while providing backup LV pacing capability, thereby maintaining cardiac efficiency while achieving coordinated ventricular contraction.
Solution Approach 2:
The His-bundle acts as an intermediary structure that the pacing system targets to activate the natural His-Purkinje conduction system. By pacing through this intermediary rather than directly pacing the ventricles, the system restores physiological conduction patterns while maintaining the ability to provide coordinated ventricular activation.
2Stability of the object's composition
If His-bundle pacing is used to activate the natural conduction system, then cardiac synchrony is improved, but capture verification and classification of capture types becomes more complex
Solution Approach 1:
The patent uses distinct electrical signal characteristics (analogous to color changes) to differentiate between capture types. Each capture type (His-bundle capture, para-Hisian capture, non-capture) produces a distinct signal pattern that can be reliably detected and classified, simplifying the verification process despite the complexity of the conduction system.
Solution Approach 2:
The system changes detection parameters (such as signal amplitude, timing intervals, and waveform morphology) to identify different capture types. By monitoring specific parameter changes in the electrical signals, the system can reliably distinguish between successful His-bundle capture, para-Hisian capture, and non-capture events.
3Reliability
If LVP is delivered as backup when HBP fails, then ventricular pacing reliability is improved, but device complexity increases
Solution Approach 1:
The patent merges the HBP and LVP capabilities into a single integrated pacing device with a unified control system. The device combines His-bundle pacing, LV pacing, and capture verification functions in one unit, reducing overall system complexity compared to having separate devices while maintaining the backup pacing reliability.
Solution Approach 2:
The pacing device is designed with multi-functionality, capable of performing HBP, LVP, and capture verification classification. This universal design allows a single device to handle multiple pacing scenarios and backup requirements, reducing the need for additional specialized devices and simplifying the overall system architecture.
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 reduces harmful hemodynamic effects associated with RV apex pacing by utilizing the natural conduction system, providing a backup ventricular pacing option and potentially extending the longevity of implantable devices by minimizing unnecessary interventions.
Implementation Method 1
The artificial cardiac pacing system can deliver electrical stimulation to one or more portions of the heart such as to restore normal functioning of the heart
Data Source
AI summary
Systems and methods for cardiac pacing are described in this document. A medical system includes an electrostimulation circuit to generate His-bundle pacing (HBP) pulses to capture a His bundle, and LV pacing (LVP) pulses to capture a left ventricle. A sensing circuit may sense a cardiac activity, such as an atrial or an LV cardiac electrical activity. The system includes a control circuit controlling the delivery of HBP and LVP pulses. The HBP and LVP may be delivered concurrently or sequentially. In an example, the LVP pulses may be delivered based on a His-bundle capture status in response to the HBP pulse. The system may adjust one or more His-bundle stimulation parameters based on the His-bundle capture status.