Leadless His Bundle Pacing for Synchronized Ventricular Activation
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Solution Overview
Problem
Conventional His bundle pacing techniques face challenges such as precise lead placement, potential damage to the His bundle during implantation, and suboptimal pacing output, leading to inefficient left ventricular contraction and increased risk of heart failure.
Innovation Solution
The method employs bundle branch pacing by bypassing conduction blocks and using algorithms to adjust pacing timing and output, delivering synchronized stimulation to both left and right bundle branches, and utilizing a leadless pacing device for precise placement near the His bundle or bundle branches.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If conventional His bundle pacing techniques are used, then pacing can be delivered to the ventricles, but precise lead placement is difficult and may damage the His bundle
Solution Approach 1:
The pacing system is divided into separate functional components: a leadless pacing device implanted in the right ventricle and a transvenous leadless bundle branch pacing device. This segmentation allows each device to be optimized for its specific function without requiring precise placement of a single complex lead, thereby reducing placement difficulty while maintaining pacing reliability.
Solution Approach 2:
The patent introduces an intermediary sensing and pacing system that detects ventricular activation and delivers coordinated pacing pulses through multiple electrodes distributed in the right ventricle and bundle branches. This intermediary system compensates for imprecise lead placement by using multiple sensing and pacing sites to achieve reliable synchronized ventricular activation.
2Reliability
If conventional His bundle pacing is used, then pacing can be delivered, but pacing output may be suboptimal leading to inefficient ventricular contraction
Solution Approach 1:
The pacing system dynamically adjusts pacing output and timing based on real-time sensing of ventricular activation. The processor controls the electrical pulse generator to deliver coordinated pulses with optimized amplitude and duration, adapting to individual patient responses to maximize ventricular contraction efficiency while minimizing energy consumption.
Solution Approach 2:
The system incorporates feedback mechanisms where the sensing circuit continuously monitors ventricular activation and uses this information to adjust pacing parameters. This closed-loop control ensures optimal pacing output is delivered to achieve efficient synchronized ventricular contraction.
3Productivity
If conventional pacing techniques are used, then ventricular contraction can be achieved, but left ventricle synchronization is delayed and heart failure risk increases
Solution Approach 1:
The pacing system segments the ventricular activation process by independently pacing the right ventricle and bundle branches, then coordinating these activations to achieve synchronized left ventricular contraction. This segmentation allows precise control over activation timing to eliminate delays in left ventricular synchronization.
Solution Approach 2:
The system performs preliminary sensing and timing calculations to determine optimal pacing moments before delivering pulses. The processor calculates the precise timing window to deliver coordinated pacing pulses that will achieve synchronized ventricular activation, preventing delays in left ventricular contraction.
4Reliability
If bundle branch pacing is used to bypass conduction blocks, then pacing can be delivered, but complex algorithms are needed to adjust timing and output
Solution Approach 1:
The system performs self-diagnosis and self-adjustment by automatically detecting conduction blocks and bundle branch block patterns through sensing, then autonomously modifying pacing parameters without external intervention. The processor identifies the specific conduction abnormality and automatically selects appropriate pacing strategies, reducing the need for complex external control algorithms.
Solution Approach 2:
The system manages complexity by systematically varying key pacing parameters (amplitude, pulse width, timing intervals) in response to detected conduction blocks. Instead of using complex control algorithms, the system uses straightforward parameter adjustment rules that adapt pacing output to the specific conduction abnormality, simplifying the overall control approach.
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
This approach enhances ventricular synchronization, reduces the risk of heart failure, and provides stable pacing even in the presence of conduction block or lead damage, improving cardiac efficiency.
Implementation Method 1
an electrical pulse generator configured to generate and deliver electrical His-bundle or bundle-branch stimulation pulses (Vp) based on one or both of As and Vs
Implementation Method 2
a sensing circuit configured to sense one or both of an atrial event (As) and a ventricular event (Vs)
Data Source
Figure 1
Figure 2A
Figure 2B
AI summary
The present disclosure relates generally to pacing of cardiac tissue, and more particularly to adjusting delivery of His bundle or bundle branch pacing in a cardiac pacing system to achieve synchronized ventricular activation. A leadless pacing device (LPD) may include a plurality of electrodes comprising a bundle pacing electrode leadlessly connected to the housing, which may be implanted proximate to or in the His bundle or bundle branch of the patient's heart. An electrical pulse generator may generate and deliver electrical His-bundle or bundle-branch stimulation pulses using the bundle pacing electrode based on sensing one or both of an atrial event and a ventricular event. The LPD may receive communication from another implantable device, such as a subcutaneously implanted device, and deliver His-bundle or bundle-branch pacing in response to the communication.