Multi-Site Anti-Tachycardia Pacing Site-to-Site Offset Calculation
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Solution Overview
Problem
Current anti-tachycardia pacing therapies, such as those used in cardiac resynchronization therapy devices, have limited effectiveness in terminating ventricular arrhythmias, particularly in ischemic cardiomyopathy patients, due to incomplete understanding of directional conduction times and site-to-site offsets, leading to inconsistent treatment outcomes.
Innovation Solution
The method involves determining directional conduction times between electrodes in the right and left ventricles and calculating a site-to-site offset to deliver multi-site anti-tachycardia pacing, optimizing energy delivery to disrupt arrhythmic wavefronts and increase the chances of terminating arrhythmias by depolarizing a larger portion of the ventricle.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If conventional anti-tachycardia pacing is used with fixed pacing regimens, then the device complexity is reduced, but the effectiveness in terminating arrhythmias deteriorates due to incomplete understanding of directional conduction times
Solution Approach 1:
The system performs preliminary measurement of directional conduction times between multiple ventricular sites by delivering test pacing stimuli and sensing responses. These conduction time data are stored and used to calculate site-to-site offsets in advance, which are then applied during actual arrhythmia termination pacing to optimize wavefront disruption effectiveness
Solution Approach 2:
The pacing system dynamically adjusts the timing of multi-site pacing stimuli based on measured directional conduction times. Instead of using fixed inter-beat intervals, the system calculates time-critical offsets between different ventricular sites (e.g., RV to LV offset, LV to RV offset) and applies these dynamic timing parameters to optimize arrhythmia termination while maintaining manageable system complexity through automated control
2Reliability
If multi-site anti-tachycardia pacing with calculated site-to-site offsets is implemented, then the probability of terminating arrhythmias is improved by depolarizing larger ventricular portions, but the measurement and calculation complexity increases
Solution Approach 1:
The measurement process is segmented into discrete, manageable components: (1) delivering a first pacing stimulus at a first ventricular site, (2) sensing the response at a second ventricular site to determine first directional conduction time, (3) delivering a second pacing stimulus at the second site, (4) sensing the response at the first site to determine second directional conduction time. This segmentation allows complex conduction timing to be measured through simple, repeatable steps using standard pacing electrodes
Solution Approach 2:
The system uses its own existing pacing and sensing capabilities to measure conduction times without requiring external equipment. The same electrodes used for normal cardiac resynchronization therapy pacing and sensing are utilized to measure directional conduction times and calculate site-to-site offsets, eliminating the need for additional measurement hardware or invasive procedures
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 enhances the probability of terminating arrhythmias by ensuring that energy is delivered based on calculated site-to-site offsets, improving the effectiveness of anti-tachycardia pacing therapies, especially in ischemic cardiomyopathy patients by targeting altered zones of electrical conduction.
Implementation Method 1
delivering a pace using an electrode positioned on the lateral wall of the left ventricle of a heart
Implementation Method 2
sensing the pace using an electrode positioned in the right ventricle of the heart
Implementation Method 3
deliver multi-site anti-tachycardia pacing using the site-to-site offset (VVATP) to enhance a probability of terminating arrhythmias
Data Source
AI summary
An exemplary method includes delivering a pace using an electrode positioned on the lateral wall of the left ventricle of a heart, sensing the pace using an electrode positioned in the right ventricle of the heart, determining a left to right directional conduction time (TLR), delivering a pace using an electrode positioned in the right ventricle of the heart, sensing the pace using an electrode positioned on the lateral wall of the left ventricle of the heart, determining a right to left directional conduction time (TRL), calculating a site-to-site offset (VVATP) for multi-site anti-tachycardia pacing based on the left to right directional conduction time and the right to left directional conduction time and instructing an implantable device to deliver multi-site anti-tachycardia pacing using the site-to-site offset (VVATP). Other exemplary methods, devices, systems, etc., are also disclosed.