Cardiac Resynchronization Device Pacing Vector Selection

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Solution Overview

Problem

Selecting the most efficacious pacing electrode vectors for cardiac resynchronization therapy (CRT) in the left ventricle remains a challenge due to the variability in pacing site location and the need for optimizing ventricular synchrony.

Innovation Solution

An implantable medical device (IMD) system with programmable pacing pulse timing parameters and vectors, utilizing a method to select the optimal LV pacing site by measuring RV activation times and analyzing EGM signals to determine the best electrode configuration for CRT delivery.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Adaptability or versatility

If multiple pacing electrode vectors are available in the left ventricle, then the possibility of finding an optimal pacing site increases, but the complexity of selecting the most efficacious vector remains unresolved

Engineering Contradiction:

Improvepacing electrode vector optionsVSAvoidvector selection complexity

Core Design Contradiction:

Adaptability or versatilityVSDevice complexity

Solution Approach 1:

The system performs preliminary testing of multiple LV pacing electrodes by delivering test pacing pulses and measuring RV activation times before final selection. This preliminary action allows the system to evaluate candidate vectors and identify the optimal pacing site in advance, resolving the selection complexity when multiple vectors are available.

Inventive Principle:

Principle #10Preliminary action

Solution Approach 2:

The system uses feedback from measured RV activation times to evaluate the effectiveness of each LV pacing electrode vector. By measuring the activation time at the RV in response to LV pacing at different candidate sites, the system receives feedback that guides the selection of the optimal vector, transforming the complex selection problem into a measurable optimization task.

Inventive Principle:

Principle #23Feedback

2Reliability

If RV activation time measurement is used to identify optimal LV pacing sites, then ventricular synchrony optimization improves, but the measurement and selection process time increases

Engineering Contradiction:

Improveventricular synchrony optimizationVSAvoidpacing site selection time

Core Design Contradiction:

ReliabilityVSLoss of time

Solution Approach 1:

The system measures RV activation times for a selected number of candidate LV pacing electrodes rather than exhaustively testing all possible vectors. By applying partial action to a representative subset of candidates, the system achieves sufficient optimization of ventricular synchrony while limiting the time required for the selection process.

Inventive Principle:

Principle #16Partial or excessive action

Data Source

PatentUS9199087B2Apparatus and method for selecting a preferred pacing vector in a cardiac resynchronization device

Publication Date: 2015.12.01 MEDTRONIC INC

AI summary

A medical device and associated method control the delivery of a cardiac pacing therapy including selecting left ventricular pacing sites for delivering the therapy. The left ventricular pacing sites are selected by delivering pacing pulses to a patient's left ventricle at multiple pacing sites one at a time and determining right ventricular activation times in response to the pacing pulses being delivered at each of the pacing sites. A left ventricular pacing site is selected in response to the determined right ventricular activation times.