Leadless Pacemaker Q-to-LV Activation Timing
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Solution Overview
Problem
Current cardiac resynchronization therapy (CRT) systems using transvenous leads face challenges such as morbidities and conductor/insulator failures, limiting their usage, and leadless cardiac pacemakers (LCPs) lack visibility to cardiac electrical activity in other chambers, necessitating alternative methods for optimizing left ventricular pacing.
Innovation Solution
A method and system for implanting a leadless cardiac pacemaker (LCP) using a delivery system with electrodes to sense cardiac signals during implantation, allowing for intraoperative monitoring of Q-wave and LV activation to identify optimal implant locations, and postoperative monitoring to adjust LV pace timing for improved atrioventricular delay.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If transvenous lead systems are used for CRT, then sensing of atrial and ventricular events is facilitated, but the system introduces morbidities and is prone to conductor and insulator failure
Solution Approach 1:
The patent removes the transvenous lead component from the CRT system by implanting the pacemaker generator directly in the left ventricular apex. This extraction eliminates the lead that causes morbidities and failures, while maintaining CRT functionality through direct LV pacing and alternative sensing methods.
Solution Approach 2:
The patent introduces an intermediary approach by using the pacemaker generator itself as both the pacing and sensing element. The device senses cardiac events directly through its housing and electrodes in the LV apex, eliminating the need for separate transvenous leads while maintaining sensing capability.
2Object-affected harmful factors
If leadless cardiac pacemaker is used, then lead-related morbidities are eliminated, but the device lacks visibility to cardiac electrical activity in other chambers
Solution Approach 1:
The leadless pacemaker performs self-service by using its own housing and integrated electrodes to sense cardiac electrical events directly at the LV apex. This eliminates dependency on external leads or other chambers for sensing, allowing the device to independently detect and respond to cardiac events.
Solution Approach 2:
The patent shifts the sensing dimension from relying on transvenous lead placement in other chambers to direct sensing at the LV apex. By changing the spatial dimension of sensing to the apex location, the device gains direct access to LV electrical activity while maintaining visibility to other chambers through alternative methods.
3Ease of operation
If LCP is placed in LV, then LV pacing is achieved, but the device cannot sense electrical activity in other chambers
Solution Approach 1:
The pacemaker generator is designed with multi-functionality to serve as both the pacing electrode for LV stimulation and the sensing element for detecting cardiac events. This universal design eliminates the need for separate sensing leads while maintaining the ability to detect electrical activity relevant to CRT timing.
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
Enables effective optimization of LV pacing therapy by identifying suitable implant locations and adjusting pacing timing, enhancing cardiac resynchronization without the limitations of traditional transvenous lead systems.
Implementation Method 1
the distal region and/or LCP containment housing comprise a plurality of electrodes adapted to sense cardiac signals during implantation of the LCP
Data Source
AI summary
Methods and systems for use of the Q-wave to R-wave interval to guide placement of a leadless cardiac pacemaker are disclosed. An implant delivery device is equipped with sensing electrodes to sense R-wave onset in a ventricle of a patient's heart to allow placement at a location of last or latest onset of the R-wave. Guidance tools are provided to assist in determination of the Q-wave to R-wave interval during implantation. For a chronic system, a cooperative approach is disclosed in which an implantable medical device and a leadless cardiac pacemaker exchange data to determine Q-wave to R-wave intervals and enhance cardiac resynchronization therapy delivery by the leadless cardiac pacemaker.