Cardiac Resynchronization Therapy with Nested Endocardial-Epicardial Electrodes
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Solution Overview
Problem
Current cardiac resynchronization therapy (CRT) methods do not effectively mimic the natural physiology of the heart, particularly in coordinating left ventricular endocardial and epicardial depolarization, which is crucial for efficient heart contraction and synchronization.
Innovation Solution
An implantable medical device with a lead connector system that includes both epicardial and endocardial electrodes, allowing for coordinated pacing between the two layers, utilizing intrinsic and paced time intervals to synchronize depolarization and activation patterns to mimic natural heart activation sequences.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If epicardial left ventricular electrodes are used for CRT, then the therapy can be delivered to reduce ventricular wall stress, but the pacing activation sequence is very different from normal physiology
Solution Approach 1:
The patent places endocardial electrodes inside a lumen of the epicardial lead assembly, creating a nested configuration where endocardial pacing capability is integrated within the epicardial lead structure. This allows simultaneous or coordinated activation of both endocardial and epicardial layers, mimicking the natural endocardial-to-epicardial activation sequence while maintaining the benefits of epicardial access.
Solution Approach 2:
The patent transitions from single-layer (epicardial only) pacing to dual-layer (endocardial and epicardial) pacing by adding the endocardial electrode dimension. This enables three-dimensional coordination of activation across the ventricular wall thickness, creating a more physiologically appropriate activation pattern that progresses from endocardium through myocardium to epicardium.
2Productivity
If total synchronization pacing is applied, then ventricular contraction is synchronized, but it does not achieve physiologically suitable heart contraction
Solution Approach 1:
The patent applies preliminary action by delivering pacing impulses to the endocardial electrodes first, before the epicardial electrodes. This creates a time-delayed activation sequence where endocardial depolarization precedes epicardial depolarization, mimicking the natural propagation direction of electrical activation through the ventricular wall and achieving more physiological contraction patterns.
3Device complexity
If a single epicardial lead is used, then the device complexity is reduced, but the ability to coordinate endocardial and epicardial depolarization is limited
Solution Approach 1:
The patent integrates endocardial electrodes within the lumen of the epicardial lead, creating a nested configuration that combines both endocardial and epicardial pacing capabilities in a single lead assembly. This maintains relatively simple device structure while enabling coordinated dual-layer depolarization through the integrated electrode system.
Solution Approach 2:
The single epicardial lead assembly serves multiple functions: it provides epicardial pacing through epicardial electrodes, endocardial pacing through endocardial electrodes in its lumen, and can deliver both activation sequences through a unified lead structure. This multi-functionality allows coordinated dual-layer depolarization without requiring separate leads for each function.
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 cardiac contraction efficiency by closely mimicking the natural activation sequence of a healthy heart, promoting effective left ventricular rotation and contraction during systole, thereby improving cardiac function.
Implementation Method 1
A ventricular pulse generator arranged in the IMD and connected to the lead connector is configured to apply pacing pulses to coordinate endocardial and epicardial depolarization
Data Source
AI summary
An implantable medical device is connectable to an epicardial left ventricular lead having at least one epicardial electrode and a myocardium penetrating catheter with at least one endocardial electrode and present in a lumen of the lead. The device comprises a pulse generator controller that controls a ventricular pulse generator to generate pulses to be applied to the epicardial and endocardial electrodes. The controller uses an endocardial-to-epicardial time interval or epicardial-to-endocardial time interval to coordinate endocardial and epicardial activation of the left ventricle to thereby achieve cardiac pacing that closely mimics the natural electrical activation pattern of a healthy heart.