Leadless Pacemaker and Defibrillator Coordination for Tachycardia Safety
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Solution Overview
Problem
Current cardiac rhythm management systems face challenges in preventing ATP-induced acceleration of ventricular tachycardia, particularly when the implantable cardioverter defibrillator is unable to provide shock therapy due to fault conditions or battery depletion, leading to potential worsening of arrhythmia.
Innovation Solution
An implantable system comprising an implantable leadless pacemaker and a non-transvenous cardioverter defibrillator that detects tachycardia and delivers anti-tachycardia pacing only when the defibrillator is available, enabling and disabling pacing based on defibrillation availability signals, and performing painless electrode impedance measurements to ensure safe therapy delivery.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If anti-tachycardia pacing is delivered to treat ventricular tachycardia, then the tachycardia can be terminated, but it may accelerate the tachycardia if defibrillation is not available
Solution Approach 1:
The system performs preliminary detection of defibrillator availability before initiating anti-tachycardia pacing therapy. The pacing device receives a signal from the defibrillator indicating whether shock therapy is available, and only enables ATP delivery when defibrillation backup is confirmed present, preventing harmful acceleration of tachycardia
Solution Approach 2:
The system implements a feedback mechanism where the pacing device continuously monitors the availability status of the defibrillator. Based on this feedback signal, the pacing device dynamically enables or disables ATP delivery, ensuring therapy safety conditions are met before and during treatment
2Adaptability or versatility
If the implantable system includes both pacing and defibrillation functions, then comprehensive arrhythmia treatment is available, but device complexity increases
Solution Approach 1:
The system combines pacing and defibrillation functions into a single integrated implantable system. The pacing device and defibrillator work together as coordinated components, sharing detection capabilities and communicating therapy availability, providing comprehensive arrhythmia treatment while reducing overall system complexity compared to separate devices
3Reliability
If the defibrillator is implanted to provide shock therapy, then ventricular fibrillation can be treated, but battery consumption increases
Solution Approach 1:
The system uses partial action by implementing impedance measurements at reduced power levels for therapy planning purposes, rather than full defibrillation shocks. This allows the system to assess treatment feasibility and monitor electrode conditions without depleting battery capacity through repeated high-energy shocks
Data Source
AI summary
An implantable system for providing anti-tachycardia and/or shock therapy, comprising an implantable pacing device, in particular an implantable leadless pacemaker, and an implantable cardioverter defibrillator, in particular a non-transvenous implantable cardioverter defibrillator, wherein the implantable pacing device is configured to detect a tachycardia and to provide anti-tachycardia pacing, wherein the implantable cardioverter defibrillator is further configured to signal an availability and/or unavailability of defibrillation to the implantable pacing device, and wherein the implantable pacing device is configured, in response to the signal of the implantable cardioverter defibrillator to enable and/or disable anti-tachycardia pacing. The invention further relates to a computer implemented method for providing anti-tachycardia and/or shock therapy, a computer program and a computer readable data carrier.