His Bundle IEGM Sensing Windows for Atrial Oversensing Avoidance

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Solution Overview

Problem

Existing implantable cardiac stimulation devices face challenges in accurately detecting and managing atrial oversensing during His bundle pacing, which can lead to inaccurate capture threshold measurements and impaired device functionality due to the proximity of the His bundle to the atrial and ventricular myocardium, complicating implant procedures and affecting the reliability of pacing algorithms.

Innovation Solution

The implementation of methods and systems for detecting atrial oversensing in His intracardiac electrograms (IEGMs) by using specified sense thresholds and windows, characterizing atrial oversensing, and employing subthreshold pacing pulses to determine atrial capture and AV node capture, thereby preventing atrial oversensing and optimizing pacing management.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Reliability

If His bundle pacing is performed, then ventricular activation is improved, but atrial oversensing occurs due to proximity of His bundle to atrial myocardium

Engineering Contradiction:

Improveventricular activationVSAvoidatrial oversensing

Core Design Contradiction:

ReliabilityVSObject-affected harmful factors

Solution Approach 1:

The patent segments the sensing task by creating separate sensing windows for different cardiac structures. The system divides the sensing period into distinct time windows: a first sensing window for detecting atrial signals, a second sensing window for detecting His bundle signals, and a third sensing window for detecting ventricular signals. This temporal segmentation allows the system to distinguish between overlapping signals from different structures and attribute them correctly, resolving the oversensing problem while maintaining the benefits of His bundle pacing.

Inventive Principle:

Principle #1Segmentation

Solution Approach 2:

The patent introduces an intermediary sensing window mechanism that acts as a buffer between the pacing stimulus and the sensing of subsequent signals. By implementing programmed sensing windows that are temporally separated from the pacing event, the system creates an intermediary time period where signals from the His bundle and ventricles can be reliably distinguished from atrial signals, enabling accurate capture threshold measurement without interference from atrial oversensing.

Inventive Principle:

Principle #24Intermediary (Mediator)

2Measurement precision

If capture threshold measurement is performed, then pacing accuracy is improved, but measurement inaccuracy occurs due to atrial signal interference

Engineering Contradiction:

Improvecapture threshold measurementVSAvoidsignal interference

Core Design Contradiction:

Measurement precisionVSLoss of information

Solution Approach 1:

The patent applies temporal segmentation by dividing the measurement process into distinct sensing windows. The first sensing window is positioned to detect atrial signals, while the second sensing window is positioned to detect His bundle signals during the capture threshold measurement. This segmentation prevents atrial signal interference with the capture threshold measurement by ensuring that atrial signals are sensed in a separate time window, thereby improving measurement precision.

Inventive Principle:

Principle #1Segmentation

Solution Approach 2:

The patent performs preliminary sensing of atrial signals in a first sensing window before the capture threshold measurement is completed. By preliminarily identifying and isolating atrial signal characteristics in advance, the system can then focus the second sensing window on detecting His bundle signals without contamination from atrial signals, ensuring accurate capture threshold measurement.

Inventive Principle:

Principle #10Preliminary action

3Adaptability or versatility

If multi-signal sensing is enabled, then comprehensive cardiac monitoring is improved, but device complexity increases

Engineering Contradiction:

Improvecardiac monitoring capabilityVSAvoidsensing system complexity

Core Design Contradiction:

Adaptability or versatilityVSDevice complexity

Solution Approach 1:

The patent manages device complexity by segmenting the sensing function into distinct, dedicated time windows for different cardiac structures. Rather than attempting to simultaneously process all signals with complex filtering, the system uses temporal segmentation to create separate sensing channels: a first sensing window for atrial signals, a second for His bundle signals, and a third for ventricular signals. This approach achieves comprehensive monitoring while keeping the sensing system relatively simple by avoiding the need for complex simultaneous signal separation algorithms.

Inventive Principle:

Principle #1Segmentation

Data Source

PatentUS20250360320A1Implantable medical systems and methods used to detect, characterize or avoid atrial oversensing within an iegm

Publication Date: 2025.11.27 PACESETTER INC

AI summary

Certain embodiments of the present technology described herein relate to detecting atrial oversensing, characterizing atrial oversensing, determining when atrial oversensing is likely to occur, and or reducing the chance of atrial oversensing occurring. Some such embodiments relate to specifying an atrial oversensing avoidance (AOA) period corresponding to when atrial oversensing may occur following one or more paced or sensed atrial events, and after specifying the AOA period selectively using an atrial oversensing avoidance technique during one or more instances of the AOA period that follow paced or sensed atrial events to thereby reduce a likelihood of atrial oversensing during the one or more instances of the AOA period.