Left-Ventricular Electrogram Analysis for CSP Confirmation

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Solution Overview

Problem

Confirming successful conduction system pacing (CSP) during implantation and post-implantation is challenging, often resulting in less efficacious myocardial pacing, such as left-ventricular septal pacing (LVSP), which can be difficult to differentiate from CSP.

Innovation Solution

Sensing left-ventricular activations via electrodes to determine metrics such as timing and morphology, allowing differentiation between CSP and myocardial pacing through techniques that include determining left-ventricular activation metrics and adjusting electrical stimulation parameters to achieve CSP.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Reliability

If electrical stimulation is delivered to achieve conduction system pacing, then cardiac resynchronization is provided, but it is difficult to confirm successful CSP and differentiate from myocardial pacing

Engineering Contradiction:

ImproveCSP achievement confirmationVSAvoidDifferentiation between CSP and myocardial pacing

Core Design Contradiction:

ReliabilityVSDifficulty of detecting and measuring

Solution Approach 1:

The system senses left-ventricular activations and determines activation metrics (timing, morphology) to provide feedback on whether CSP was successfully achieved. This feedback loop allows real-time verification of pacing effectiveness and differentiation from myocardial pacing by analyzing the characteristics of the sensed activations.

Inventive Principle:

Principle #23Feedback

Solution Approach 2:

The patent replaces mechanical/visual confirmation methods with electrical sensing and signal analysis. By sensing electrical activations and analyzing their metrics, the system substitutes traditional mechanical assessment with electrical field-based detection, enabling objective differentiation between CSP and myocardial pacing.

Inventive Principle:

Principle #28Mechanics substitution (Replace mechanical system)

2Manufacturing precision

If electrical stimulation parameters are adjusted to achieve CSP, then conduction system capture is improved, but stimulation magnitude must be precisely controlled

Engineering Contradiction:

ImproveElectrode placement precisionVSAvoidElectrode placement and stimulation adjustment

Core Design Contradiction:

Manufacturing precisionVSEase of operation

Solution Approach 1:

The system provides real-time feedback on CSP achievement by analyzing left-ventricular activation metrics. This feedback guides electrode placement and stimulation parameter adjustment, making the process more operator-friendly by indicating whether CSP is being achieved without requiring expert visual assessment.

Inventive Principle:

Principle #23Feedback

Solution Approach 2:

The system performs preliminary sensing and analysis of left-ventricular activations to determine whether CSP is achieved before finalizing electrode placement. This preliminary assessment allows operators to adjust placement or parameters proactively rather than discovering failure after implantation.

Inventive Principle:

Principle #10Preliminary action

3Reliability

If loss of CSP is not detected, then continued myocardial pacing occurs, but timely adjustment of stimulation parameters is required to regain capture

Engineering Contradiction:

ImproveCSP maintenanceVSAvoidTime to detect and correct CSP loss

Core Design Contradiction:

ReliabilityVSLoss of time

Solution Approach 1:

The system continuously senses left-ventricular activations and monitors activation metrics to maintain continuous detection of CSP status. This continuous monitoring ensures timely detection of CSP loss and enables immediate parameter adjustment to regain capture, eliminating gaps in monitoring.

Inventive Principle:

Principle #20Continuity of useful action

Solution Approach 2:

The continuous feedback mechanism monitors CSP achievement status in real-time and triggers alerts or automatic adjustments when CSP is lost. This feedback loop reduces the time to detect and correct CSP loss by providing immediate information on pacing effectiveness.

Inventive Principle:

Principle #23Feedback

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 identification of loss of CSP and adjustment of stimulation parameters to regain capture of the conduction system, providing feedback for electrode placement and transitioning to CRT if CSP cannot be achieved.

Implementation Method 1

sensing one or more left-ventricular activations via one or more electrodes of a left-ventricular lead

Methodology Applied

Scientific EffectElectrical conduction: Conduction (electrical)

Data Source

PatentEP4392131B1Intracardiac electrogram-based differentiation of conduction system and myocardial pacing

Publication Date: 2025.09.24 MEDTRONIC INC

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AI summary

In some examples, a method comprises sensing one or more left-ventricular activations via one or more electrodes of a left-ventricular lead, wherein each of the one or more left-ventricular activations are in response to delivery of an electrical stimulation to a heart of a patient; determining one or more left-ventricular activation metrics based on the sensed one or more left-ventricular activations; and determining whether the electrical stimulation provided conduction system pacing based on the one or more ventricular activation metrics.