Phrenic Nerve Stimulation Map for Cardiac Pacing

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Solution Overview

Problem

Cardiac pacing electrodes often inadvertently stimulate the phrenic nerve, causing undesired diaphragm movement and patient discomfort, as existing systems lack effective methods for precise location selection and navigation to avoid such stimulation.

Innovation Solution

A noninvasive system using imaging and computing apparatus to generate a phrenic nerve stimulation map, projected onto a graphical representation of the heart, aiding in the selection of pacing locations and navigation of electrodes to minimize phrenic nerve stimulation.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Reliability

If cardiac pacing electrodes are used to deliver therapy, then cardiac pacing function is achieved, but phrenic nerve stimulation occurs causing patient discomfort

Engineering Contradiction:

Improvecardiac pacing therapy deliveryVSAvoidphrenic nerve stimulation

Core Design Contradiction:

ReliabilityVSObject-affected harmful factors

Solution Approach 1:

The system performs preliminary detection of phrenic nerve stimulation susceptibility at multiple candidate pacing locations before final electrode placement. By assessing phrenic nerve stimulation risk in advance using sensing electrodes and threshold determination, the system allows clinicians to select optimal pacing locations that deliver effective cardiac therapy while avoiding phrenic nerve stimulation that would cause patient discomfort

Inventive Principle:

Principle #10Preliminary action

Solution Approach 2:

The system introduces sensing electrodes as intermediary elements that can detect electrical signals without delivering therapeutic pacing. These sensing electrodes allow preliminary assessment of phrenic nerve stimulation risk by measuring threshold voltages and detecting phrenic nerve responses, enabling indirect evaluation of pacing location safety before committing to final electrode placement

Inventive Principle:

Principle #24Intermediary (Mediator)

2Ease of operation

If traditional manual methods are used for electrode placement, then procedure simplicity is maintained, but precision in avoiding phrenic nerve stimulation is insufficient

Engineering Contradiction:

Improveelectrode placement procedureVSAvoidpacing location selection accuracy

Core Design Contradiction:

Ease of operationVSMeasurement precision

Solution Approach 1:

The system replaces manual visual inspection and tactile assessment with automated electrical sensing and computational analysis. By using sensing electrodes to detect phrenic nerve electrical responses and processing threshold data through a system, the method achieves precise objective measurement of phrenic nerve stimulation risk, far surpassing the accuracy of traditional manual placement methods while maintaining procedural simplicity

Inventive Principle:

Principle #28Mechanics substitution (Replace mechanical system)

Data Source

PatentEP3180081B1Systems, methods, and interfaces for configuring cardiac therapy

Publication Date: 2023.11.01 MEDTRONIC INC

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AI summary

Systems, methods, and interfaces are described herein for assisting in a user in configuring cardiac therapy. A projection of a phrenic nerve stimulation map may be projected on a graphical depiction of a portion of a patient's heart. The phrenic nerve stimulation map may indicate to a user the regions of the patient's heart that may have a likelihood of stimulating the patient's phrenic nerve.