Multimodal Transthoracic Cardioversion for Lower-Impedance Pacing
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Solution Overview
Problem
Current transthoracic cardioversion and pacing therapies for patients with perfusing rhythms are often ineffective, leading to significant failure rates and the need for sedation or emergency interventions due to inadequate current flow and resistance across the myocardium, despite efforts to improve electrical waveforms and electrode placement.
Innovation Solution
A multimodal device integrating mechanical, pneumatic, acoustic, and electrophysiologic capabilities with electrical countershock or pacing, utilizing enhanced contact pressure, synchronization with ventilation, multiple current paths, vibrational energy, vagal stimulation, and other mechanisms to optimize treatment efficacy.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If electrical therapy is delivered through the thorax to treat cardiac dysrhythmias, then the heart rhythm can be converted to a more organized rhythm, but the treatment often fails due to inadequate current flow and high resistance across the myocardium
Solution Approach 1:
The system delivers vibrational energy to the thorax before electrical cardioversion to pre-conditions the tissue by reducing impedance and improving electrode contact, thereby enhancing the effectiveness of the subsequent electrical shock
Solution Approach 2:
A vibrational energy source is applied to the thorax to mechanically vibrate the tissue, which reduces impedance to current flow and improves the penetration and distribution of electrical energy during cardioversion
2Reliability
If higher energy electrical shocks are delivered to ensure successful cardioversion, then the likelihood of converting the rhythm increases, but the need for sedation and risk of complications increases
Solution Approach 1:
Vibrational energy is applied before electrical therapy to reduce impedance and improve current flow, allowing effective cardioversion at lower energy levels and reducing the need for sedation
Solution Approach 2:
The system changes the physical state of the thoracic tissue through vibrational energy, reducing impedance and altering the electrical properties to allow more effective energy delivery at lower doses
3Reliability
If multiple electrode placements are attempted to improve current flow, then the effectiveness of electrical therapy may increase, but the complexity of the procedure and time required increases
Solution Approach 1:
Vibrational energy improves current flow through existing electrode placements by reducing tissue impedance, eliminating the need for multiple electrode positions or complex repositioning
Solution Approach 2:
The system replaces the mechanical approach of repositioning electrodes with a vibrational energy approach that modifies tissue properties to improve current flow through the existing electrode configuration
4Ease of operation
If electrical therapy is delivered during inspiration when lung volume is high, then the procedure is simpler to perform, but the resistance to current flow increases and efficacy decreases
Solution Approach 1:
Vibrational energy is applied to reduce impedance before electrical delivery, allowing effective treatment regardless of respiratory phase and eliminating the need to time delivery with expiration
Solution Approach 2:
Vibrational energy dynamically changes the impedance parameter of the thoracic tissue, counteracting the effect of lung volume changes during respiration and maintaining consistent current flow
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
Enhances the success rate of transthoracic cardioversion and pacing by reducing impedance, improving current flow, and minimizing the need for sedation, thereby providing safer and more effective treatment for cardiac dysrhythmias.
Implementation Method 1
application of vibrational or acoustic energy to place the myocardium in a state more amenable to cardioversion or pacing
Implementation Method 2
Both cardioversion and pacing can work by delivering an electric shock through the thorax of a patient
Implementation Method 3
integrating increased contact pressure... by means of adding one or more of: electromechanical and physiologic optimization... enhanced contact force pressure
Implementation Method 4
one or more exhalation bands that can be positioned around a torso of the patient and that can be constricted to decrease an air volume in the lungs
Data Source
AI summary
The invention disclosed here relates in general to the field of medical devices. In particular, to devices and methods for improving the clinical outcome of patients suffering from cardiac dysrhythmias without cardiac arrest. This method and/or device integrates mechanical, pneumatic, acoustic and/or electrophysiologic capabilities with electrical countershock or pacing capabilities such that the probability of successful cardioversion or pacing is increased. The sequence, forces, and electrical properties of the subsystems can be computer controlled and adjusted in response to biomarker inputs.