Multi-Pole LV Lead Pacing Delay Optimization
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Solution Overview
Problem
The use of multi-pole left ventricular leads in cardiac stimulation devices requires numerous tests to optimize pacing delays, making the process time-consuming and inefficient, leading to increased costs and inconvenience for patients and clinicians.
Innovation Solution
A method is introduced to reduce the number of tests by performing a single V sense test and a single RV pace test to determine interventricular conduction time delays, allowing for more efficient determination of optimal VV pacing delays using a multi-pole lead, which involves detecting ventricular depolarization at multiple electrodes and calculating interventricular conduction time delays based on these events.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If separate V sense tests are performed for each LV electrode to determine optimal pacing delays, then measurement precision is improved, but loss of time increases
Solution Approach 1:
The patent combines multiple V sense tests into a single test by simultaneously sensing ventricular depolarization at multiple LV electrodes during one test event. This merging approach maintains the precision of measuring intrinsic interventricular conduction delays for each electrode while eliminating the need to perform separate tests for each electrode, thereby significantly reducing total test time.
Solution Approach 2:
The patent makes the V sense test multi-functional by using a single test to determine intrinsic interventricular conduction delays for all LV electrodes simultaneously. The single test serves multiple purposes: it measures conduction delays from RV to each LV electrode, identifies the earliest activating electrode, and provides data for optimizing VV pacing delays for all electrodes, replacing what would traditionally require multiple separate tests.
2Measurement precision
If separate RV pace tests are performed for each LV electrode to determine paced interventricular conduction delays, then measurement precision is improved, but device complexity increases
Solution Approach 1:
The patent merges multiple RV pace tests into a single test by delivering one RV pacing pulse and simultaneously recording the resulting ventricular depolarization at all LV electrodes. This approach maintains measurement precision for determining paced interventricular conduction delays while reducing the number of tests from multiple separate tests to just one, thereby simplifying the overall testing procedure.
3Reliability
If multiple separate tests are performed for each LV electrode, then reliability of pacing delay optimization is improved, but ease of operation deteriorates
Solution Approach 1:
The patent performs preliminary sensing of ventricular depolarization at all LV electrodes during a single V sense test and a single RV pace test, collecting all necessary data before final analysis. This preliminary collection of conduction delay measurements for all electrodes in one testing session maintains the reliability of optimization results while making the procedure easier to perform by eliminating the need to conduct multiple separate tests.
Data Source
AI summary
Techniques are provided for use by implantable medical devices for controlling ventricular pacing using a multi-pole left ventricular (LV) lead. In one example, a single “V sense” test is performed to determine intrinsic interventricular conduction time delays (Δn) between the RV electrode and each of the LV electrodes of the multi-pole lead. Likewise, a single “RV pace” test is performed to determine paced interventricular conduction time delays (IVCD_RLn) between the RV electrode and each of the LV electrodes. A set of “LV pace” tests is then performed to determine paced interventricular conduction time delays (IVCD_LRn) between individual LV electrodes and the RV electrode. Optimal or preferred interventricular pacing delays are determined using the intrinsic interventricular conduction delay (Δn) values and a set of interventricular correction terms (εn) determined from the results of the RV pace test and the set of LV pace tests. With these techniques, overall test time can be reduced.