Multi-site Cardiac Pacing Site Selection via Activation Timing
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Solution Overview
Problem
Current cardiac resynchronization therapy (CRT) systems face challenges in identifying optimal pacing sites for multi-site cardiac stimulation, which can be complex due to anatomical and pathophysiological factors, leading to increased energy requirements and system complexity, as well as difficulties in selecting suitable sites for patients with congestive heart failure.
Innovation Solution
A system comprising an electrostimulation circuit, a physiologic sensor circuit, and a stimulation site selector circuit that determines activation timings at multiple candidate sites within the heart, allowing for simultaneous or temporally offset electrostimulation at selected sites to improve cardiac hemodynamics, including the use of electrodes positioned in the left ventricle and communication with external systems for programming and data transmission.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If multi-site pacing is implemented to improve cardiac hemodynamic outcomes, then cardiac performance is improved, but energy consumption increases
Solution Approach 1:
The system changes stimulation parameters (timing, duration, intensity) to optimize cardiac performance while managing energy consumption. By adjusting these parameters based on sensed physiologic signals, the system achieves improved hemodynamic outcomes without excessive energy use.
Solution Approach 2:
The system performs preliminary sensing of physiologic signals and determination of activation timings before delivering multi-site pacing stimuli. This preliminary action allows the system to plan stimulation sequences that maximize cardiac performance while minimizing energy consumption through optimized timing.
2Reliability
If multi-site pacing is implemented to recruit more excitable cardiac tissues, then cardiac performance is improved, but system complexity increases
Solution Approach 1:
The system segments the cardiac stimulation task into distinct functional modules: sensing physiologic signals, determining activation timings at multiple candidate sites, selecting optimal stimulation sites, and delivering paced stimuli. This segmentation manages system complexity by organizing functions into manageable, independent components.
Solution Approach 2:
The system uses feedback from sensed physiologic signals to dynamically adjust stimulation timing and site selection. This feedback mechanism allows the system to adapt to varying cardiac conditions, improving performance while maintaining manageable complexity through rule-based decision making.
3Reliability
If multi-site pacing is implemented to improve therapy effectiveness, then cardiac hemodynamic outcome is improved, but difficulty in identifying optimal pacing sites increases
Solution Approach 1:
The system replaces manual clinical assessment of optimal pacing sites with an automated electronic system that senses physiologic signals and computationally determines activation timings. This substitution of mechanical/clinical judgment with electronic measurement and algorithmic processing reduces the difficulty of identifying optimal sites.
Solution Approach 2:
The system performs self-assessment by sensing its own physiologic impact through implanted electrodes and automatically determining which sites provide optimal activation timing. This self-service capability eliminates the need for external clinical intervention in site identification.
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
This approach enables more effective recruitment of excitable cardiac tissues, improving cardiac hemodynamic outcomes by identifying and confirming optimal pacing sites based on physiologic signals, thereby enhancing the therapy's effectiveness and reducing complexity.
Implementation Method 1
The electrodes can be electrically coupled to an electronics unit such as a pulse generator, such as via a lead, and can be used to deliver one or more electrostimulations to the heart
Implementation Method 2
The system can sense a physiologic signal during the electrostimulation of the heart
Data Source
AI summary
Systems and methods for determining multiple sites for multi-site cardiac stimulation are disclosed. The system can comprise an electrostimulation circuit that can deliver electrostimulation to one or more candidate sites in at least one chamber of the heart, such as a left ventricle of the heart, within the same cardiac cycle. The system can sense a physiologic signal during the electrostimulation of the heart, determine activation timings from first and second sets of physiologic signals respectively sensed at the plurality of candidate sites when the heart undergoes specified intrinsic activities or stimulation, and determine at least first and second selected sites, among a plurality of candidate sites, using the respective activation timings. The system can deliver multi-site stimulation such as to the first and second selected sites during a same cardiac cycle, simultaneously or separated by a specified temporal offset.