Implantable Pacing Mode Selection via RV-LV Conduction Time Analysis
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Solution Overview
Problem
Current methods for selecting between biventricular (BiV) and left ventricular (LV) only pacing in cardiac resynchronization therapy (CRT) devices are inadequate, as they do not accurately determine which chamber(s) to pace, leading to suboptimal patient responses and increased costs, with LV only pacing being effective in non-responders to BiV pacing and reducing battery life.
Innovation Solution
A system with implantable leads and a processor that determines conduction times between RV and LV electrodes to set the pacing mode to either BiV or LV only pacing based on calculated relations and thresholds, using RV-LV and LV-RV conduction times to decide between the two modes.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If biventricular pacing is implemented, then cardiac resynchronization is improved, but battery life is reduced and costs increase
Solution Approach 1:
The system dynamically selects between biventricular pacing and left ventricular only pacing based on real-time conduction time measurements. The processor continuously monitors RV-LV and LV-RV conduction times and adjusts the pacing mode accordingly, allowing the device to adapt to changing cardiac conditions and optimize battery consumption while maintaining resynchronization benefits when needed.
Solution Approach 2:
The invention changes the parameter of conduction time measurement to determine pacing mode. By measuring and comparing RV-LV and LV-RV conduction times against thresholds, the system objectively determines when biventricular pacing is necessary versus when left ventricular only pacing suffices, thereby reducing unnecessary RV pacing and extending battery life.
2Productivity
If biventricular pacing is implemented, then cardiac output is enhanced, but procedure time and costs increase
Solution Approach 1:
The system performs preliminary conduction time measurements during a characterization phase to determine the patient's optimal pacing mode before actual therapy begins. By pre-measuring RV-LV and LV-RV conduction times and establishing thresholds, the system prepares pacing recommendations in advance, reducing the need for time-consuming trial-and-error adjustments during treatment.
Solution Approach 2:
The implantable medical device autonomously measures conduction times and selects pacing modes without requiring continuous external intervention. The processor automatically monitors conduction times, compares them against stored thresholds, and adjusts pacing parameters independently, reducing the time clinicians would otherwise need to spend on manual adjustments and monitoring.
3Stability of the object's composition
If RV pacing is performed, then ventricular synchrony is achieved, but harmful effects are increased and battery life is reduced
Solution Approach 1:
The system extracts and eliminates unnecessary RV pacing from the treatment protocol. By measuring conduction times and determining when LV-only pacing suffices, the system removes RV pacing interventions that do not provide additional benefit, thereby avoiding their associated harmful effects while preserving ventricular synchrony through optimized LV pacing alone.
Solution Approach 2:
The invention converts the potential harm of RV pacing into a benefit by using conduction time measurements to identify when RV pacing is actually beneficial versus when it is harmful. The system measures RV-LV and LV-RV conduction times to objectively determine the optimal pacing strategy, transforming the potentially harmful practice of routine RV pacing into a targeted intervention that only occurs when truly necessary.
Data Source
AI summary
A system and method have at least one implantable lead comprising a right ventricular (RV) electrode and one or more left ventricular (LV) electrodes, at least one processor, and a memory coupled to the at least one processor. The memory stores program instructions. The program instructions are executable by the at least one processor to determine a right ventricular to left ventricular (RV-LV) conduction time representative of a conduction time between a right ventricular (RV) paced event and one or more responsive left ventricular (LV) sensed events, determine a left ventricular to right ventricular (LV-RV) conduction time representative of a conduction time between one or more LV paced event and an RV sensed events, calculate a relation between the RV-LV conduction time and the LV-RV conduction time, and set a pacing mode of an implantable medical device to one of i) a biventricular (BiV) pacing mode and ii) an LV only pacing mode based on the relation between the RV-LV conduction time and the LV-RV conduction time.