His Bundle Pacing Sensing During AF/AT Without Atrial Over-Sensing
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Solution Overview
Problem
Existing HIS bundle pacing systems struggle to avoid atrial over-sensing during atrial arrhythmias like AF or AT, particularly when switched to a non-tracking mode, leading to potential inhibition of HIS pacing when it is desired.
Innovation Solution
A system and method that utilize a HIS electrode to define a sensing vector and adjust sensing configurations to detect ventricular events accurately during arrhythmias by analyzing cardiac activity signals, determining V-A feature of interest relations, and selecting a resultant sensing configuration to manage HIS bundle pacing.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Adaptability or versatility
If the AOA process is disabled during non-tracking mode, then the device can operate without atrial tracking, but atrial over-sensing may occur leading to inhibition of HIS pacing
Solution Approach 1:
The system performs preliminary characterization of ventricular and atrial signals during tracking mode before switching to non-tracking mode. By pre-establishing signal templates and thresholds, the system enables reliable ventricular event detection during non-tracking mode without requiring real-time atrial tracking, thus preventing atrial over-sensing while maintaining mode switching flexibility
Solution Approach 2:
The system creates a copy of the AOA process functionality that operates independently during non-tracking mode. Instead of requiring the original AOA process to function, a simplified version uses pre-characterized signal templates to detect ventricular events, allowing the device to maintain reliability without the original atrial tracking dependency
2Device complexity
If the device switches to non-tracking mode, then atrial arrhythmia detection is simplified, but ventricular event detection accuracy may be compromised
Solution Approach 1:
The system performs preliminary signal characterization during tracking mode, establishing templates for both ventricular and atrial signals. This preliminary action enables the system to accurately distinguish ventricular events from atrial over-sensing signals during non-tracking mode, maintaining detection precision while reducing operational complexity
Solution Approach 2:
The system introduces an intermediary signal processing layer that uses pre-characterized templates as mediators between the raw signals and the detection algorithm. This intermediary template-matching approach enables accurate ventricular event detection during non-tracking mode by filtering out atrial over-sensing artifacts
Data Source
AI summary
System and methods are provided herein and include a HIS electrode configured to be located proximate to a HIS bundle and to at least partially define a HIS sensing vector. They system includes memory to store program instructions and cardiac activity (CA) signals for a series of beats utilizing a candidate sensing configuration. The candidate sensing configuration is defined by i) the HIS sensing vector and ii) a sensing channel that utilizes sensing circuitry configured to operate based on one or more sensing settings to detect near field and far field activity. The system includes one or more processors that, when executing the program instructions, are configured to analyze the CA signals to obtain an atrial (A) feature of interest (FOI) and a ventricular (V) FOI for the corresponding beats within the series of beats and identify a V-A FOI relation between the A FOIs and the V FOIs across the series of beats. The system adjusts the candidate sensing configuration and repeat the obtain, analyze and identify operations to obtain a collection of V-A FOI relations for a corresponding collection of candidate sensing configurations and selects a resultant sensing configuration from the collection of candidate sensing configurations based on one or more criteria, the resultant sensing configuration to be utilized to manage HIS bundle pacing during an atrial arrhythmia.