Implantable Device Detects Cardiac Stress via PAC Induction
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Solution Overview
Problem
Current cardiac stress tests often fail to detect reduced tolerance to cardiac stress associated with pathological changes in the cardiac substrate until adverse symptoms appear, leading to potential myocardial infarction or life-threatening arrhythmias.
Innovation Solution
An implantable medical device system that monitors the ventricular response to premature atrial contractions (PACs) to assess cardiac stress by sensing cardiac signals, including EGM and pressure signals, and delivers pacing pulses to induce PACs for stress assessment, allowing for early detection of changes in the cardiac substrate.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If traditional cardiac stress tests are performed only after symptoms appear, then diagnostic simplicity is maintained, but detection of early cardiac substrate changes is delayed until adverse events occur
Solution Approach 1:
The device performs preliminary cardiac stress assessment by inducing premature atrial contractions and measuring ventricular responses before adverse cardiac events occur. This proactive approach detects early changes in cardiac substrate, allowing intervention before myocardial infarction or life-threatening arrhythmias develop, thus resolving the contradiction between maintaining diagnostic simplicity and achieving early detection.
2Reliability
If device-based PAC induction and monitoring is implemented, then early detection of cardiac substrate changes is enabled, but device complexity increases
Solution Approach 1:
The implantable medical device performs multiple functions using the same hardware infrastructure: it senses cardiac electrical signals, delivers pacing pulses to induce premature atrial contractions, measures ventricular responses, and stores assessment data. This multi-functionality enables early detection of cardiac substrate changes without proportionally increasing device complexity, as the same components serve multiple purposes in the stress assessment protocol.
Solution Approach 2:
The device autonomously induces premature atrial contractions by delivering pacing pulses and automatically measures ventricular responses using its own sensing capabilities. The system self-manages the entire stress assessment process including PAC induction, signal acquisition, and data storage without requiring external intervention, thereby enabling early detection capability while minimizing the complexity burden on the clinical workflow.
3Measurement precision
If multiple cardiac parameters are monitored during PAC induction, then measurement precision of cardiac stress response is improved, but device complexity and energy consumption increase
Solution Approach 1:
The device uses its existing pacing and sensing functions to simultaneously achieve multiple measurement objectives. The same electrodes and circuits used for routine pacing and sensing are leveraged to measure ventricular responses to premature atrial contractions, eliminating the need for separate dedicated measurement hardware and reducing overall energy consumption while maintaining measurement precision.
Data Source
AI summary
A medical device and associated method establish an occurrence of a premature atrial contraction. The device senses a ventricular signal. A control unit is configured to determine a metric of the ventricular signal during an interval following the premature atrial contraction and detect a change in cardiac stress tolerance in response to the determined metric.