Left Ventricular Electrode Selection for Conduction Non-Uniformity
Find Innovative SolutionsGenerate Solutions
Solution Overview
Problem
Current pacemaker systems face challenges in addressing non-uniform electrical conduction in the left ventricle, which affects the efficacy of multi-point pacing therapy and cardiac resynchronization therapy, as they lack effective methods to identify optimal pacing configurations that account for local dyssynchrony and electrical heterogeneity.
Innovation Solution
The method involves sensing LV activation events at multiple sites, measuring arrival times, calculating site-to-site relative delays, and identifying an LV electrode combination with significant non-uniformity to designate a preferred pacing site for delivering pacing pulses, thereby optimizing the multi-electrode pacing configuration to enhance synchrony and hemodynamic response.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If multi-point pacing configuration is selected based on traditional criteria (reducing capture thresholds, avoiding nerve capture, maximizing anatomical distance), then device reliability and safety are improved, but the non-uniformity of electrical conduction at LV electrodes is not addressed, limiting therapeutic efficacy
Solution Approach 1:
The patent applies local quality by making different LV electrodes have different functions based on their local electrical conduction characteristics. Each electrode is evaluated for its local conduction velocity and dyssynchrony patterns, and pacing configurations are optimized to provide different pacing strategies at different locations. This allows the system to address local non-uniformity in electrical conduction while maintaining overall system reliability.
Solution Approach 2:
The system dynamically adapts pacing configurations based on measured electrical conduction properties. The IMD measures arrival times and calculates conduction velocities, then uses this information to select optimal pacing configurations that account for local dyssynchrony. This dynamic adaptation allows the system to optimize therapeutic efficacy while maintaining safety margins.
2Ease of operation
If single LV pacing site is used to simplify device operation, then ease of operation is improved, but non-uniform electrical conduction cannot be addressed, reducing productivity of pacing therapy
Solution Approach 1:
The IMD performs self-service by automatically measuring electrical conduction properties, calculating arrival times, determining conduction velocities, and selecting optimal pacing configurations without requiring manual programming or complex clinician intervention. The device autonomously adapts pacing parameters based on real-time measurements, simplifying operation while maximizing therapeutic efficacy.
Solution Approach 2:
The system performs preliminary measurements of electrical conduction characteristics during device implantation or initial programming. These measurements establish a baseline understanding of local conduction velocities and dyssynchrony patterns, enabling subsequent automated optimization of pacing configurations without requiring repeated manual adjustments.
3Device complexity
If traditional MPP configuration methods are used, then device complexity is minimized, but measurement precision of electrical conduction non-uniformity is insufficient
Solution Approach 1:
The system implements feedback by continuously measuring arrival times at multiple LV electrodes, calculating conduction velocities, and using this information to refine pacing configuration selections. The measured electrical conduction properties feed back into the decision-making process, enabling precise identification and targeting of regions with non-uniform conduction while maintaining manageable device complexity through automated algorithms.
Data Source
AI summary
Methods, devices and systems are provided for selecting one or more left ventricular multi-electrode pacing site(s). The methods, devices and systems measure arrival times of LV activation events for corresponding LV sensing sites, where the arrival times each correspond to a conduction time from an intrinsic ventricular event or delivery of a pacing pulse until sensing of the corresponding LV activation event. Site-to-site (STS) relative delays are calculated as differences between the arrival times associated with adjacent LV sensing sites. The STS relative delays represent STS arrival delays for corresponding combinations of the adjacent LV sensing sites. An LV electrode combination is identified that is associated with at least one of the STS relative delays that satisfy selection criteria, where the LV electrode combination corresponds to a target tissue region exhibiting a select degree of non-uniformity. The LV electrode combination is designated as a first LVEC pacing site from which to deliver LV pacing pulses.