IMD Atrioventricular Synchrony Assessment via Far-Field Ventricular Signals
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Solution Overview
Problem
Existing medical devices face challenges in determining atrioventricular (AV) synchrony, particularly in patients with conduction abnormalities, where ventricular pacing without an atrial lead makes it difficult to sense and track atrial events, affecting the maintenance of AV synchrony.
Innovation Solution
An implantable medical device (IMD) is configured to sense cardiac signals, including far-field ventricular event signals, to determine a ventricular activity metric and calculate an AV synchrony metric, which indicates the performance of a ventricular pacemaker in maintaining AV synchrony, allowing for adjustments in atrial pacing parameters or transmission of signals indicating AV asynchrony.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Ease of manufacture
If a ventricular intracardiac pacemaker is implanted without an atrial lead, then the device can provide ventricular rate support, but sensing and tracking of atrial events to maintain AV synchrony becomes challenging
Solution Approach 1:
The patent uses far-field ventricular event signals as an intermediary to indirectly assess AV synchrony. Instead of directly sensing atrial events, the device detects ventricular events and uses them as a proxy to determine whether atrial contraction is properly synchronized with ventricular contraction, thereby resolving the contradiction between simplified implantation and maintained sensing capability
Solution Approach 2:
The patent replaces the electrical sensing system (atrial lead) with a mechanical/motion-based approach using accelerometer signals to detect atrial contraction. This substitution allows the device to maintain AV synchrony monitoring without requiring an atrial lead, achieving both implantation simplicity and measurement capability
2Adaptability or versatility
If far-field ventricular event signals are used to determine AV synchrony, then atrial event tracking is enabled without an atrial lead, but signal discrimination becomes more difficult
Solution Approach 1:
The patent applies preliminary filtering and signal processing to the accelerometer signal to isolate the QRS complex before using it for AV synchrony determination. By pre-processing the signal to enhance the ventricular event detection, the device reduces the difficulty of discriminating far-field signals from other mechanical artifacts
Solution Approach 2:
The patent transitions from electrical signal detection (traditional ECG approach) to mechanical signal detection (accelerometer approach). This dimensional change from electrical to mechanical sensing space allows the device to detect ventricular events without electrical leads, though it introduces new signal discrimination challenges that are addressed through signal processing
Data Source
AI summary
A medical device is configured to sense a cardiac signal that includes far field ventricular event signals and determine a ventricular activity metric from the sensed cardiac signal. The ventricular activity metric may be representative of a ventricular rate or an atrioventricular time interval. The medical device is configured to determine an atrioventricular synchrony metric based on the ventricular activity metric and generate an output based on the atrioventricular synchrony metric. The device may include a memory configured to store data corresponding to the atrioventricular synchrony metric.