His-bundle pacing threshold detection for selective capture
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Solution Overview
Problem
Conventional cardiac pacing methods, such as long-term RV apex pacing, can lead to uncoordinated heart contractions and adverse hemodynamic effects due to inefficient activation of the ventricles, while His-bundle pacing aims to restore synchrony but often fails to selectively activate the His bundle without activating adjacent para-Hisian myocardium, leading to energy inefficiency and potential loss of capture.
Innovation Solution
A system that determines and adjusts individualized stimulation thresholds for selective and non-selective His-bundle pacing, allowing for precise delivery of pulses to activate only the His bundle, thereby improving cardiac synchrony and reducing energy consumption.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Stability of the object's composition
If His-bundle pacing is used to restore cardiac synchrony, then cardiac coordination is improved, but selective activation of the His bundle without adjacent para-Hisian myocardium is difficult to achieve
Solution Approach 1:
The system dynamically adjusts the stimulation threshold based on real-time detection of capture status. The threshold is not fixed but adapts to changing physiological conditions, allowing the system to maintain selective His bundle activation while preserving cardiac synchrony. The control circuit continuously monitors and modifies stimulation parameters to optimize the balance between selective activation and coordinated contraction.
Solution Approach 2:
The system changes stimulation parameters (amplitude, pulse width, frequency) to achieve selective His bundle activation. By adjusting these parameters and detecting the resulting capture status, the system identifies optimal settings that activate only the His bundle without involving adjacent para-Hisian myocardium, thereby maintaining both selectivity and cardiac synchrony.
2Ease of operation
If conventional RV apex pacing is used to provide cardiac stimulation, then ease of implementation is improved, but uncoordinated heart contractions and adverse hemodynamic effects occur
Solution Approach 1:
The system extracts the harmful effect of uncoordinated contractions by selectively activating only the His bundle through precise threshold control, rather than stimulating the broader RV apex region. This extraction of selective activation from general stimulation eliminates the adverse hemodynamic effects while maintaining the ease of RV apex access.
Solution Approach 2:
The system employs feedback mechanisms where the control circuit detects capture status and adjusts stimulation parameters accordingly. This closed-loop feedback ensures coordinated heart contractions by continuously monitoring and correcting the stimulation delivery, thereby eliminating adverse hemodynamic effects while maintaining operational simplicity.
3Use of energy by moving object
If stimulation threshold is reduced to activate only the His bundle, then energy consumption is reduced, but capture reliability may be compromised
Solution Approach 1:
The stimulation threshold is made dynamic rather than fixed. The control circuit continuously adjusts the threshold based on detected capture status, allowing the system to operate at the minimum effective threshold for reliable His bundle capture. This dynamic adjustment optimizes energy consumption while maintaining capture reliability by adapting to physiological variations in real-time.
Solution Approach 2:
The system uses feedback from capture detection to adjust stimulation parameters. When capture is detected, the system can reduce the threshold to minimize energy consumption. When capture is not detected, the threshold is increased to ensure reliable activation. This feedback-driven adjustment balances energy efficiency with capture reliability.
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
The system enhances cardiac pacing efficiency by selectively activating the His bundle, reducing long-term harmful effects of conventional pacing, and potentially extending device battery life through energy-saving benefits and minimizing unnecessary medical interventions.
Implementation Method 1
An electrostimulation circuit may be configured to deliver His-bundle pacing (HBP) pulses
Data Source
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AI summary
Systems and methods for pacing cardiac conductive tissue are described. A medical system includes an electrostimulation circuit to generate His-bundle pacing (HBP) pulses. A sensing circuit senses a physiologic signal, and detect a local His-bundie activation discrete from a pacing artifact of the HBP pulse. A control circuit verifies capture status in response to the HBP pulses. Based on the capture status, the control circuit determines one or more pacing thresholds including a selective HBP threshold representing a threshold strength to capture only the His bundle but not the local myocardium, and a non-selective HBP threshold representing a threshold strength to capture both the His bundle and the local myocardium. The electrostimulation circuit may deliver HBP pulses based on the selective and non-selective HBP thresholds.