Leadless Pacemaker Respiration-Phase Modulation
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Solution Overview
Problem
Current pacing therapies for heart conditions do not effectively modulate heart pacing rates based on a patient's respiration phase, which can lead to inefficient heart contractions and reduced blood delivery.
Innovation Solution
A method and system that determine a patient's posture and respiration phase using accelerometers, transthoracic impedance, intracardiac impedance, flow sensors, or pressure sensors to adjust the pacing rate, particularly by delivering electrical stimulation pulses at different rates during inhalation and exhalation periods, using a leadless cardiac pacemaker.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If pacing therapy is delivered without modulation based on respiration phase, then the pacing system operates with fixed control logic, but heart contraction efficiency decreases and blood delivery is reduced
Solution Approach 1:
The pacing system dynamically adjusts the pacing rate based on the detected respiration phase. The controller modifies pacing parameters in real-time according to whether the patient is in inhalation or exhalation phase, transforming a static pacing system into an adaptive one that responds to physiological variations, thereby improving heart contraction efficiency without requiring overly complex external monitoring equipment
Solution Approach 2:
The system incorporates feedback mechanisms by detecting respiration phase through impedance changes or accelerometer signals and using this information to modulate the pacing rate. This closed-loop control allows the pacemaker to automatically adjust therapy based on the patient's respiratory state, improving cardiac output while maintaining manageable device complexity through integrated sensing capabilities
2Measurement precision
If multiple sensors (accelerometer, impedance sensors, flow sensors, pressure sensors) are used to determine respiration phase, then respiration detection accuracy improves, but device complexity and power consumption increase
Solution Approach 1:
The pacemaker device performs multiple functions using integrated components: it provides cardiac pacing, detects respiration phase through impedance measurements (which are already part of the pacing function), and can utilize accelerometer data for activity detection. This multi-functionality approach allows the system to gather respiration information without adding dedicated separate sensing systems, thereby improving measurement precision while controlling device complexity
Solution Approach 2:
The system uses existing device components for respiration detection. The impedance sensors already present for pacing lead monitoring are repurposed to detect respiration phase by measuring impedance variations during breathing. This self-service approach allows the device to extract additional physiological information without requiring external or additional specialized sensors, balancing accuracy with complexity
3Productivity
If pacing rate is modulated based on respiration phase during sleep posture, then cardiac output and blood delivery improve, but energy consumption increases due to continuous monitoring
Solution Approach 1:
The system implements periodic monitoring of respiration phase rather than continuous monitoring. The pacemaker checks respiration phase at relevant intervals in the cardiac cycle and modulates pacing accordingly. This periodic approach maintains the therapeutic benefit of respiration-synchronized pacing while significantly reducing power consumption compared to continuous monitoring, which is critical for battery-operated implantable devices
Solution Approach 2:
The system detects posture changes in advance using accelerometer data and determines whether the patient is in a sleep posture before initiating respiration-phase-based pacing modulation. This preliminary action allows the device to switch between different pacing algorithms appropriately, ensuring optimal cardiac output during sleep while conserving energy by not continuously processing respiration data when pacing modulation is not needed
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 heart pacing efficiency by synchronizing pacing rates with respiration phases, improving blood delivery and cardiac output, especially during sleep postures.
Implementation Method 1
determining a posture of the patient and determining if the sensed posture corresponds to a predetermined sleep posture... the posture of the patient may be determined at least in part using an accelerometer... the respiration phase of the patient may be determined based at least in part on a signal generated by an accelerometer
Implementation Method 2
the respiration phase of the patient may be determined based at least in part on a measure related to a transthoracic impedance of the patient
Data Source
AI summary
Systems, devices, and methods for pacing a heart of a patient are disclosed. In some embodiments, a method for pacing a patient's heart may include determining a posture of the patient and determining if the determined posture corresponds to a predetermined sleep posture. If the determined posture correspond to the predetermined sleep posture, the method may further comprise determining a respiration phase of the patient and pacing the patient's heart at a pacing rate that is modulated based on the determined respiration phase of the patient. If the determined posture does not correspond to the predetermined sleep posture, the method may pace the patient's heart at a pacing rate that is not dependent on the respiration phase of the patient.