Implantable His Bundle Pacing IEGM Detection for Atrial Oversensing
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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 myocardium and AV node.
Innovation Solution
Implementing methods and systems to detect atrial oversensing by analyzing His intracardiac electrograms (IEGMs) using specified sense thresholds and windows, and employing subthreshold pacing pulses to identify atrial oversensing, thereby preventing improper capture management and ensuring accurate capture threshold determination.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If His bundle pacing is performed using implantable cardiac stimulation devices, then hemodynamic improvement and effective ventricular activation are achieved, but atrial oversensing occurs due to the proximity of the His bundle to the atrial myocardium and AV node
Solution Approach 1:
The system performs preliminary detection of atrial oversensing by analyzing the IEGM signal before conducting capture threshold measurements. This preliminary action identifies the presence of atrial signals that could interfere with accurate threshold determination, allowing the system to prevent inaccurate measurements from occurring in the first place
Solution Approach 2:
The patent introduces an intermediary detection mechanism that analyzes the IEGM signal to distinguish between genuine His bundle capture and atrial oversensing. This intermediary analysis layer acts as a mediator between the pacing stimulus and the capture determination, filtering out false positives caused by atrial signals
2Measurement precision
If capture threshold measurements are performed without detecting atrial oversensing, then device functionality is simplified, but inaccurate capture threshold measurements result leading to improper capture management
Solution Approach 1:
The system implements feedback by continuously monitoring the IEGM signal during pacing and using this information to adjust capture threshold determination. The feedback loop analyzes whether atrial oversensing is present and modifies the measurement process accordingly, ensuring accurate thresholds are obtained while managing device complexity through automated decision-making
Solution Approach 2:
The detection process is segmented into distinct phases: IEGM signal acquisition, atrial oversensing detection, and capture threshold measurement. This segmentation allows each function to be performed independently and systematically, making the overall complex process more manageable and reliable
3Productivity
If the His bundle is paced at locations close to the AV node and atrial myocardium, then effective ventricular activation is achieved, but atrial signal components appear on the IEGM causing oversensing
Solution Approach 1:
The system performs preliminary characterization of the IEGM signal to identify the presence and magnitude of atrial signal components before relying on the signal for capture determination. This preliminary characterization prevents loss of information by identifying degraded signal quality in advance
Solution Approach 2:
The patent replaces reliance on pure mechanical/electrical signal amplitude thresholds with a more sophisticated analysis method that characterizes the temporal and morphological features of the IEGM signal. This substitution allows the system to distinguish between atrial and ventricular signals even when they overlap in amplitude
Data Source
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 characterize and/or avoid atrial oversensing.