HIS Bundle Pacing Timing With Adaptive Backup Switching
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Solution Overview
Problem
Existing cardiac stimulation devices struggle to efficiently identify and configure settings for HIS bundle pacing, particularly in patients with intact AV node and HIS bundle conduction, leading to delayed ventricular conduction and reduced hemodynamic efficiency in heart failure patients.
Innovation Solution
A cardiac stimulation system that includes a pulse generator, stimulating and sensing electrodes, and a processor to measure conduction times and response characteristics, allowing for automatic identification and configuration of pacing settings to induce HIS bundle capture and ventricular depolarization, including backup pacing mechanisms to optimize efficiency and operational life.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If conventional ventricular pacing is used, then the device can provide backup pacing functionality, but delayed ventricular conduction and reduced hemodynamic efficiency occur in patients with intact AV node and HIS bundle
Solution Approach 1:
The patent segments the pacing function into two distinct modes: HIS bundle pacing mode (for optimal hemodynamic efficiency when conduction is intact) and conventional ventricular pacing mode (for backup reliability when conduction fails). The device automatically switches between these segmented modes based on real-time conduction assessment, allowing each mode to operate independently to optimize its specific function.
Solution Approach 2:
The patent implements dynamic switching between pacing modes based on real-time assessment of AV node and HIS bundle conduction. The device continuously monitors conduction parameters and dynamically adjusts the pacing strategy, transitioning from HIS bundle pacing to conventional ventricular pacing when conduction deterioration is detected, and vice versa when conduction recovers.
2Measurement precision
If manual configuration of pacing settings is performed, then the device can be programmed for specific patients, but the process is time-consuming and requires expert intervention
Solution Approach 1:
The patent enables the device to automatically configure its own pacing settings by assessing the patient's conduction characteristics and self-programming the appropriate parameters for HIS bundle pacing or conventional ventricular pacing. The device performs automated threshold searches, determines optimal pacing vectors, and configures switching criteria without requiring external programmer intervention, thereby achieving both precision and speed.
Solution Approach 2:
The patent performs preliminary assessment of conduction parameters during initial device implantation or during scheduled checks, storing the results for later use. This preliminary action allows the device to pre-configure pacing settings based on the assessed conduction status, reducing the need for time-consuming manual reconfiguration during subsequent operations.
3Productivity
If HIS bundle pacing is implemented, then hemodynamic efficiency is improved, but the device requires automatic identification and configuration capabilities
Solution Approach 1:
The patent designs the device with multi-functional capabilities that allow it to perform conduction assessment, automatic mode selection, parameter optimization, and switching control using a integrated control system. This universal approach consolidates multiple functions into a single coordinated system, reducing overall device complexity while achieving the benefits of automated HIS bundle pacing configuration.
Solution Approach 2:
The patent implements feedback mechanisms where the device continuously monitors conduction parameters, compares them against predefined criteria, and automatically adjusts pacing settings based on the feedback. This closed-loop control system simplifies the identification and configuration process by using real-time physiological feedback to guide automatic parameter optimization and mode selection.
4Reliability
If the device continuously monitors conduction parameters, then switching between pacing modes can be optimized, but energy consumption increases
Solution Approach 1:
The patent implements periodic monitoring of conduction parameters at scheduled intervals rather than continuous monitoring. The device performs conduction assessments at predefined time points (e.g., during routine follow-ups or at scheduled intervals) and maintains the last known good pacing mode configuration between assessments, thereby reducing energy consumption while maintaining reliable mode switching capability when needed.
Solution Approach 2:
The patent applies partial monitoring by selectively monitoring only the critical conduction parameters necessary for mode switching decisions, rather than continuously monitoring all possible parameters. The device focuses on key indicators such as PR interval and His-ventricular conduction time, performing measurements only when switching decisions are anticipated, thus reducing overall energy consumption while maintaining switching accuracy.
Data Source
AI summary
Methods and systems for dynamically modifying pacing timing and backup pacing delivery in cardiac stimulation devices include applying pacing impulses, measuring corresponding responses, and, based on such responses, automatically modifying timing or operational settings of the stimulation device to improve pacing functionality. Among other things, the approaches described herein reduce unnecessary backup pacing impulses in HIS bundle pacing applications, facilitate fusion in bundle branch block applications, and automatically enable or disable backup pacing in response to achieving QRS complex correction.