Multi-site LV Pacing Delay Optimization via Conduction Measurement
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Solution Overview
Problem
Implantable cardiac stimulation devices equipped with multi-pole left ventricular leads face challenges in determining optimal interelectrode pacing delays and pacing vector permutations for effective multi-site left ventricular pacing, which is crucial for improving cardiac hemodynamics and reducing tachyarrhythmias.
Innovation Solution
The method involves determining and setting optimal MSLV interelectrode pacing delays and identifying preferred pacing vectors by measuring conduction delays during single-site LV and RV pacing, sinus rhythm, and evaluating parameters like QRS durations and hemodynamic responses to select the most effective pacing combinations while avoiding adverse cardiac effects.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If multi-site LV pacing is implemented using multi-pole LV leads, then cardiac hemodynamics are improved and tachyarrhythmia susceptibility is reduced, but determining optimal interelectrode pacing delays becomes complex and challenging
Solution Approach 1:
The patent applies preliminary action by measuring interelectrode conduction delays during single-site LV pacing, single-site RV pacing, and sinus rhythm before implementing multi-site LV pacing. These pre-measured conduction delays are then used to calculate and set optimal interelectrode pacing delays, avoiding the need to determine optimal delays in real-time during complex multi-site pacing operations.
Solution Approach 2:
The patent uses an intermediary approach by introducing a calculation methodology that translates measured conduction delays into optimal pacing delays. The system uses measured conduction delays as intermediate data to compute pacing delays through specific formulas (e.g., pacing delay = conduction delay × scaling factor), serving as a bridge between measurement and optimal pacing configuration.
2Productivity
If multiple pacing vectors and permutations are evaluated to optimize MSLV pacing, then pacing efficiency is improved, but the time and computational resources required increase
Solution Approach 1:
The system performs preliminary measurements of conduction delays during single-site pacing and sinus rhythm before optimizing multi-site pacing. This preliminary data collection enables subsequent rapid calculation of optimal pacing delays without requiring extensive real-time evaluation of all possible pacing vector permutations.
Solution Approach 2:
The patent applies parameter changes by using scaling factors (e.g., 0.5-2.0) to transform measured conduction delays into optimal pacing delays. This mathematical transformation allows the system to efficiently determine optimal pacing parameters without exhaustively testing all possible pacing configurations, significantly reducing optimization time.
3Object-affected harmful factors
If interelectrode pacing delays are set based on measured conduction delays, then adverse cardiac effects are minimized, but the range of acceptable delay values must be precisely controlled
Solution Approach 1:
The patent uses parameter changes by applying scaling factors to conduction delays to generate pacing delays within safe ranges. The scaling factors (e.g., 0.5-2.0) transform the measured conduction delay values into pacing delay values that are guaranteed to be within acceptable limits, preventing adverse cardiac effects while maintaining precision.
Solution Approach 2:
The system incorporates feedback by measuring conduction delays during single-site pacing and sinus rhythm, then using these measurements to calculate and set pacing delays. This feedback loop ensures that pacing delays are continuously adjusted based on actual cardiac conduction characteristics, minimizing adverse effects while maintaining precise control.
Data Source
AI summary
Techniques are provided for use with an implantable cardiac stimulation device equipped for multi-site left ventricular (MSLV) pacing using a multi-pole LV lead. In one example, MSLV interelectrode conduction delays are determined among the electrodes of the multi-pole LV lead. MSLV interelectrode pacing delays are then set based on the MSLV interelectrode conduction delays for use in delivering MSLV pacing. To this end, various criteria are exploited for determining optimal values for the pacing delays based on the interelectrode conduction delays. MSLV pacing is then controlled using the specified MSLV interelectrode pacing delays. In some examples, the optimization procedure is performed by the implantable device itself. In other examples, the procedure is performed by an external programmer device. In such an embodiment, the external device determines optimal MSLV interelectrode pacing delays and then transmits programming commands to the implantable device to program the device to use the pacing delays.