Left Univentricular Pacing Control via Conduction Difference
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Solution Overview
Problem
Conventional cardiac pacing systems often require right ventricular pacing, which may not be necessary for all patients, as left ventricular pacing can be effective without right ventricular pacing in certain conditions, leading to suboptimal cardiac performance due to varying atrio-ventricular and interventricular conduction delays.
Innovation Solution
An implantable medical device (IMD) system that determines and adjusts left univentricular pacing therapy by measuring atrial-ventricular conduction delays between atrial and left/right ventricular sites, using a correction term based on intrinsic inter-ventricular conduction delay, and sets an LV atrial-ventricular pacing delay to optimize pacing without right ventricular pacing, utilizing electrodes at atrial, left, and right ventricular sites.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If conventional pacing algorithms are used that call for right ventricular pacing, then cardiac performance can be maintained in most patients, but unnecessary right ventricular pacing may be delivered to patients who would benefit from left univentricular pacing alone, leading to suboptimal cardiac performance
Solution Approach 1:
The patent applies local quality by customizing the pacing therapy to match the specific conduction characteristics of each patient's heart. By measuring individual conduction delays (ARRV, ARLV, IVCD) and calculating a patient-specific conduction difference Δ, the system delivers pacing only to the left ventricle when appropriate, rather than applying a universal right ventricular pacing approach to all patients.
Solution Approach 2:
The patent implements dynamics by making the pacing algorithm adaptive and responsive to measured physiological parameters. The system dynamically determines whether left univentricular pacing is appropriate based on real-time measurements of conduction delays, and adjusts pacing strategy accordingly, transitioning from static conventional algorithms to dynamic patient-specific control.
2Ease of operation
If right ventricular pacing is delivered to all patients, then a simple universal pacing strategy can be applied, but cardiac performance deteriorates in patients who would benefit from left univentricular pacing due to varying atrio-ventricular and interventricular conduction delays
Solution Approach 1:
The patent applies feedback by measuring conduction delays (ARRV, ARLV, IVCD) and using these measurements to determine the appropriate pacing strategy. The system incorporates feedback loops that continuously monitor cardiac conduction characteristics and adjust pacing delivery accordingly, ensuring that patients receiving left univentricular pacing have the appropriate conduction delay profiles for this therapy.
Solution Approach 2:
The patent implements self-service by enabling the pacing system to automatically determine the appropriate pacing strategy without requiring manual intervention. The algorithm autonomously measures conduction delays, calculates the conduction difference Δ, and decides whether to deliver left univentricular pacing or conventional right ventricular pacing based on the measured parameters.
3Reliability
If left univentricular pacing is used without right ventricular pacing, then unnecessary right ventricular pacing is eliminated, but the complexity of determining optimal LV atrial-ventricular pacing delays increases due to varying conduction delays
Solution Approach 1:
The patent applies preliminary action by pre-calculating the conduction difference Δ based on measured conduction delays before initiating left univentricular pacing. The system performs preliminary measurements of ARRV, ARLV, and IVCD, and uses these to establish the appropriate AVLV delay setting, rather than attempting to adjust delays in real-time during pacing delivery.
Solution Approach 2:
The patent uses the conduction difference Δ as an intermediary parameter that simplifies the control problem. Rather than directly managing multiple conduction delay parameters (ARRV, ARLV, IVCD), the system calculates Δ as an intermediate value that captures the essential relationship between these parameters and uses it to determine optimal pacing delays.
4Reliability
If optimal atrio-ventricular pacing delay and interventricular pacing delay are set, then cardiac performance is improved, but the delays may become suboptimal over time due to changes in device and cardiac function
Solution Approach 1:
The patent implements dynamics by making the pacing system adaptive to changes in conduction characteristics over time. Rather than using fixed pacing delays, the system can re-measure conduction delays and recalculate the conduction difference Δ to update pacing parameters, allowing the therapy to adapt to temporal changes in cardiac function.
Solution Approach 2:
The patent applies feedback by using measured conduction delays to continuously inform pacing parameter selection. The system incorporates feedback mechanisms that monitor changes in ARRV, ARLV, and IVCD, and adjust pacing delays accordingly to maintain optimality despite temporal variations in cardiac function.
Data Source
AI summary
Methods, devices and program products are provided for controlling a left univentricular (LUV) pacing therapy using an implantable medical device. Electrodes are configured to be located proximate to an atrial (A) site, left ventricular (LV) site and right ventricular (RV) site of the heart. A conduction different Δ is determined based on i) an atrial-ventricular conduction delay (ARRV) between the A site and the RV site, and ii) an atrial-ventricular conduction delay (ARLV) between the A site and the LV site. A correction term ε is based on intrinsic inter-ventricular conduction delay (IVCD) between the LV and RV. An LV atrial-ventricular pacing (AVLV) delay is set based on the conduction difference Δ, a pacing latency PL and the correction term ε and manages the LUV pacing therapy based on the AVLV delay, wherein the LUV pacing therapy lacks pacing in the RV.