His-Bundle Pacing for Ventricular Rate Regularization
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Solution Overview
Problem
Conventional cardiac pacing methods, such as long-term right ventricular apex pacing, lead to uncoordinated heart contractions and long-term adverse effects, while existing treatments for atrial tachyarrhythmias like atrial fibrillation often fail to improve quality of life and cardiac function due to side effects and inefficiencies.
Innovation Solution
The system employs His-bundle pacing (HBP) to stimulate the natural cardiac conduction pathways, using an electrostimulation circuit and arrhythmia detector to regulate ventricular rate during atrial tachyarrhythmias by determining and updating an HBP configuration on a beat-by-beat basis, thereby regularizing ventricular activation.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If right ventricular apex pacing is used to treat atrial tachyarrhythmia, then ventricular rate control is achieved, but cardiac synchrony deteriorates and long-term adverse effects occur
Solution Approach 1:
The patent introduces His-bundle pacing as an intermediary approach between atrial tachyarrhythmia detection and ventricular rate control. By pacing the His bundle (the natural conduction pathway), the invention mediates between the atrial arrhythmia and ventricular response, preserving cardiac synchrony while achieving rate control. The His bundle acts as an intermediary structure that maintains physiological conduction patterns.
Solution Approach 2:
The patent changes the pacing parameter from conventional RV apex pacing to His-bundle pacing. This parameter change involves targeting a specific anatomical location (His bundle) with distinct electrophysiological properties, thereby altering the activation pattern to preserve ventricular synchrony while controlling ventricular rate during atrial tachyarrhythmia.
2Object-affected harmful factors
If biventricular pacing is used to restore synchronized contraction, then cardiac synchrony is improved, but surgical complexity increases and ventricular function may still be adversely impacted
Solution Approach 1:
The patent extracts the essential function of synchronized ventricular contraction by pacing the His bundle, which naturally distributes activation to both ventricles through the conduction system. This eliminates the need for complex biventricular pacing with multiple leads, achieving synchrony restoration through a single pacing site that leverages the heart's inherent conduction architecture.
Solution Approach 2:
The His-bundle pacing approach allows the heart's natural conduction system to perform the work of distributing electrical activation to both ventricles. The paced impulse self-propagates through the AV node, His bundle, and bundle branches, automatically achieving synchronized ventricular contraction without requiring external coordination of multiple pacing sites.
3Reliability
If AV node ablation is performed for rate control, then ventricular rate regularization is achieved, but pacemaker dependency increases and sudden cardiac death risk rises
Solution Approach 1:
The patent applies partial pacing action by stimulating the His bundle rather than completely ablating the AV node. This partial approach provides sufficient ventricular rate control during atrial tachyarrhythmia while preserving enough native conduction function to avoid complete pacemaker dependency and reduce sudden cardiac death risk associated with AV node ablation.
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
HBP improves cardiac synchrony and performance by leveraging the heart's natural conduction mechanisms, reducing the harmful effects of conventional pacing and achieving more efficient ventricular rate control compared to traditional methods, potentially reducing the need for medications and medical interventions.
Implementation Method 1
The artificial cardiac pacing system may provide electrical stimulations 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 pacing cardiac conductive tissue are described. An exemplary system includes an electrostimulation circuit that may generate HBP pulses to stimulate patient physiologic conduction pathway, such as a His bundle or a bundle branch. The system includes an arrhythmia detector to detect an atrial tachyarrhythmia (AT) with intermittent ventricular conduction. A control circuit may sense ventricular activation and, in response to the detected AT indication, determine or update a His-bundle pacing (HBP) configuration. The HBP may be recursively updated on a beat-by-beat basis using the sensed ventricular activation. The electrostimulation circuit may deliver HBP according to the determined or adjusted HBP configuration to regularize ventricular rate during AT.