His-Purkinje Capture Detection for Adaptive Cardiac Pacing

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Solution Overview

Problem

Existing cardiac pacing technologies struggle to determine the type of capture achieved by pacing pulses delivered to the His-Purkinje system, leading to potential inefficiencies and risks such as atrial fibrillation or heart failure.

Innovation Solution

A medical device is developed to detect the type of cardiac capture by analyzing cardiac electrical signals, distinguishing between selective His-Purkinje system capture, non-selective His-Purkinje system capture, ventricular myocardial capture, and loss of capture, using sensing and therapy delivery circuits to adjust pacing pulse parameters accordingly.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Reliability

If conventional ventricular pacing via right ventricular apex electrodes is used, then ventricular rate maintenance is achieved, but the risk of atrial fibrillation and heart failure increases

Engineering Contradiction:

Improveventricular rate maintenanceVSAvoidrisk of atrial fibrillation and heart failure

Core Design Contradiction:

ReliabilityVSObject-affected harmful factors

Solution Approach 1:

The patent introduces the His bundle as an intermediary structure between the pacing electrode and the ventricular myocardium. By pacing the His bundle rather than directly stimulating the ventricular apex, the electrical activation propagates through the natural His-Purkinje conduction system, achieving more physiological ventricular activation and reducing harmful effects on cardiac function

Inventive Principle:

Principle #24Intermediary (Mediator)

Solution Approach 2:

The patent replaces the mechanical/electrical direct stimulation of ventricular myocardium with electrical stimulation of the His bundle conduction system. This substitution allows activation to propagate through the heart's natural electrical pathways rather than directly depolarizing ventricular muscle, thereby reducing the risk of arrhythmias and heart failure

Inventive Principle:

Principle #28Mechanics substitution (Replace mechanical system)

2Reliability

If His-Purkinje system pacing is performed, then more physiologically normal cardiac activation is achieved, but the ability to determine capture type becomes difficult

Engineering Contradiction:

Improvephysiologically normal cardiac activationVSAvoidcapture type determination

Core Design Contradiction:

ReliabilityVSDifficulty of detecting and measuring

Solution Approach 1:

The patent segments the cardiac electrical signal into distinct components for analysis: the His bundle evoked response and the ventricular depolarization signal. By separating and independently analyzing these signal components, the system can determine whether His bundle capture, ventricular capture, or both have occurred, solving the detection difficulty

Inventive Principle:

Principle #1Segmentation

Solution Approach 2:

The patent implements a feedback mechanism where the pacing system delivers test pulses at varying amplitudes and analyzes the resulting cardiac electrical signals to determine capture type. Based on this feedback information, the system automatically adjusts the pacing pulse amplitude to achieve and maintain desired His bundle capture, thereby resolving the detection and control challenge

Inventive Principle:

Principle #23Feedback

3Reliability

If pacing pulse amplitude is increased to ensure capture, then capture reliability improves, but energy consumption increases

Engineering Contradiction:

Improvecapture reliabilityVSAvoidpacing pulse energy consumption

Core Design Contradiction:

ReliabilityVSUse of energy by moving object

Solution Approach 1:

The patent employs dynamic adjustment of pacing pulse amplitude based on real-time detection of capture type. Rather than using a fixed high amplitude to ensure capture, the system continuously monitors cardiac electrical signals and adjusts the pulse amplitude dynamically - increasing when capture is lost and decreasing when capture is confirmed - thereby optimizing energy consumption while maintaining capture reliability

Inventive Principle:

Principle #15Dynamics

Solution Approach 2:

The patent changes the pacing pulse parameters (amplitude, width) based on detected capture status. By adjusting these parameters dynamically according to the determined capture type and threshold, the system achieves reliable capture at the minimum necessary energy level, avoiding excessive energy consumption associated with fixed high-amplitude pacing

Inventive Principle:

Principle #35Parameter changes

Data Source

PatentUS20250345613A1His-purkinje system capture detection

Publication Date: 2025.11.13 MEDTRONIC INC

AI summary

A medical device is configured to sense a cardiac electrical signal and determine from the cardiac electrical signal at least one of a maximum peak amplitude of a positive slope of the cardiac electrical signal and a maximum peak time interval from a pacing pulse to the maximum peak amplitude. The device is configured to determine a capture type of the pacing pulse based on at least one or both of the maximum peak amplitude and the maximum peak time interval.