Optimal Left Ventricular Electrode Selection via Electrical Dyssynchrony
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Solution Overview
Problem
Current methods for selecting optimal left ventricular electrodes for cardiac resynchronization therapy (CRT) are limited in optimizing fusion pacing, as they primarily rely on conduction velocities and activation times, lacking comprehensive approaches to improve CRT response in patients with stable intrinsic A-V conduction and intraventricular conduction disorders.
Innovation Solution
The development of methods and systems that use criteria to automatically select optimized electrode locations and parameters for delivering CRT through fusion pacing, including determining weighted electrical dyssynchrony to identify the optimal left ventricular electrode and optimizing atrioventricular delay for maximal cardiac resynchronization, thereby improving CRT response.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If conventional electrode selection methods based on conduction velocities and activation times are used, then the selection process is simple, but the CRT response optimization is insufficient
Solution Approach 1:
The system performs preliminary assessment of electrical dyssynchrony metrics before final electrode selection. Activation times, conduction velocities, and electrical dyssynchrony are measured and analyzed in advance to pre-identify optimal electrode candidates, making the actual selection process more reliable without excessive complexity
Solution Approach 2:
The invention introduces electrical dyssynchrony as an additional parameter beyond traditional conduction velocity and activation time measurements. By changing the selection criteria to include multiple parameters (conduction velocity, activation time, and electrical dyssynchrony), the system achieves better CRT response optimization while managing complexity through systematic evaluation
2Reliability
If multiple electrodes are evaluated to find the optimal left ventricular electrode, then the CRT effectiveness improves, but the time required for electrode selection increases
Solution Approach 1:
The system replaces manual electrode selection with an automated computer-based analysis system. The processor automatically calculates conduction velocities, activation times, and electrical dyssynchrony metrics, and identifies the optimal electrode without requiring time-consuming manual evaluation of multiple electrodes
Solution Approach 2:
The system performs self-assessment by automatically measuring electrical signals from multiple electrodes, calculating dyssynchrony metrics, and selecting the optimal electrode without external intervention. This automation reduces the time loss associated with manual evaluation while maintaining high CRT effectiveness
3Use of energy by moving object
If fusion pacing is implemented to reduce power consumption, then energy efficiency improves, but the requirements for precise electrode selection and parameter optimization increase
Solution Approach 1:
The system optimizes fusion pacing parameters by precisely determining electrical dyssynchrony and selecting the optimal LV electrode based on multiple metrics. This parameter optimization enables effective fusion pacing that reduces power consumption while managing the increased complexity through systematic analysis
Solution Approach 2:
The system uses measured electrical signals and calculated dyssynchrony metrics as feedback to automatically adjust and optimize pacing parameters. This feedback mechanism enables the device to achieve energy-efficient fusion pacing by continuously monitoring and adjusting based on measured physiological parameters
Data Source
AI summary
Generally, the disclosure is directed one or more methods or systems of cardiac pacing employing a plurality of left ventricular electrodes. Pacing using a first one of the left ventricular electrodes and measuring activation times at other ones of the left and right ventricular electrodes. Pacing using a second one of the ventricular electrodes and measuring activation times at other ones of the left ventricular electrodes. Employing weighted sums of the measured activation times to measure a fusion index and select one of the left ventricular electrodes for delivery of subsequent pacing pulses based on comparing fusion indices during pacing from different LV electrodes. One or more embodiments use the same fusion index to select an optimal A-V delay by comparing fusion indices during pacing with different A-V delays at resting atrial rates as well as rates above the resting rate.