Paired PESP Pacing for Contractility Disequilibrium

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Solution Overview

Problem

Current cardiac rhythm management devices struggle to effectively rebalance contractility between weakened and intact ventricles in patients with heart failure, leading to inefficiencies in cardiac output and potential worsening of heart failure symptoms.

Innovation Solution

Implementing a method for dual ventricular, independently timed, continuous paired post-extrasystolic potentiation (PESP) pacing, where different interpulse intervals are used for each ventricle to achieve minimal and maximum potentiation respectively, thereby reducing contractility disequilibrium and enhancing cardiac output.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Ease of operation

If a single interpulse interval is used for paired PESP pacing in both ventricles, then the pacing system is simple to operate, but contractility disequilibrium between weakened and intact ventricles cannot be effectively reduced

Engineering Contradiction:

Improvepacing system operationVSAvoidcontractility rebalancing effectiveness

Core Design Contradiction:

Ease of operationVSReliability

Solution Approach 1:

The patent applies different interpulse intervals to different ventricles based on their individual contractility states. The intact ventricle receives a first interpulse interval while the weakened ventricle receives a second interpulse interval, allowing each ventricle to be optimized locally for its specific functional state rather than applying a uniform pacing regimen to both

Inventive Principle:

Principle #3Local quality

Solution Approach 2:

The patent enables dynamic adjustment of pacing parameters by allowing independent modification of interpulse intervals for each ventricle. This dynamic control allows the pacing system to adapt to changing cardiac conditions and optimize contractility rebalancing as the patient's heart function evolves over time

Inventive Principle:

Principle #15Dynamics

2Reliability

If paired PESP pacing is applied to both ventricles with maximum potentiation, then contractility of weakened ventricle is improved, but overall cardiac efficiency decreases due to excessive potentiation in intact ventricle

Engineering Contradiction:

Improveweakened ventricle contractilityVSAvoidoverall cardiac efficiency

Core Design Contradiction:

ReliabilityVSProductivity

Solution Approach 1:

The patent delivers maximum potentiation only to the weakened ventricle while providing minimal or no potentiation to the intact ventricle through differentiated interpulse interval selection. This localized application of potentiation ensures that therapeutic benefit is concentrated where needed without wasting energy on the already functional ventricle

Inventive Principle:

Principle #3Local quality

Solution Approach 2:

The patent applies excessive potentiation (maximum level) selectively only to the weakened ventricle where it is therapeutic, while applying minimal or no potentiation to the intact ventricle where it would be harmful. This partial application of excessive action achieves optimal rebalancing without overall cardiac inefficiency

Inventive Principle:

Principle #16Partial or excessive action

3Productivity

If paired PESP pacing uses differentiated interpulse intervals for each ventricle, then contractility disequilibrium is reduced and cardiac output is enhanced, but device complexity increases

Engineering Contradiction:

Improvecardiac outputVSAvoidpacing control system

Core Design Contradiction:

ProductivityVSDevice complexity

Solution Approach 1:

The patent segments the pacing control into independent channels for each ventricle, allowing separate programming and control of interpulse intervals. This segmentation enables sophisticated differentiated pacing strategies while maintaining clear, organized control logic that can be implemented through standard programmable pacemaker functions

Inventive Principle:

Principle #1Segmentation

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 allows for improved cardiac output and reduced symptoms in patients with heart failure by rebalancing ventricular contractilities, making CRT more effective for previously non-responsive patients.

Implementation Method 1

Methodology Applied

Scientific EffectPost-extrasystolic potentiation (PESP):

Data Source

PatentUS8768461B2Systems and methods for controlling paired pacing interpulse intervals to reduce contractility disequilibrium using an implantable medical device

Publication Date: 2014.07.01 PACESETTER INC

AI summary

Techniques are provided for use with implantable medical devices equipped to deliver paired postextrasystolic potentiation (PESP) pacing within a patient having an intact ventricle and a weakened ventricle. A first interpulse interval is determined for use with paired PESP pacing of the intact ventricle sufficient to achieve only relatively minimal potentiation within the intact ventricle. A second interpulse interval is determined for use with paired PESP pacing of the weakened ventricle sufficient to achieve relatively more significant potentiation within the weakened ventricle. Then, paired PESP pacing is delivered to the intact ventricle using the first interpulse interval while paired PESP is also delivered to the weakened ventricle using the second interpulse interval to reduce contractility disequilibrium within the heart caused by the weakened ventricle to achieve a matching of natural contractilities. In this manner, dual ventricular, independently timed, continuous PESP is provided.