Supraventricular Stimulation for Ventricular Rate Control

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Solution Overview

Problem

Current medical devices for delivering therapeutic electrical signals to the heart often fail to effectively manage ventricular rate and blood pressure, as they lack a precise method to control cardiac electrical activity during the cardiac cycle, leading to potential arrhythmias and suboptimal therapeutic outcomes.

Innovation Solution

The implementation of atrial pacing and cardiac electrical-window therapy (CEWT), which involves delivering pacing signals to cause atrial depolarization followed by stimulation to the supraventricular portion of the heart during specific refractory periods, allowing for controlled reduction of ventricular rate and blood pressure without triggering ventricular contractions.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Reliability

If conventional pacemakers deliver therapeutic electrical signals to the heart, then cardiac rhythm can be maintained, but ventricular rate and blood pressure cannot be effectively controlled

Engineering Contradiction:

Improvecardiac rhythm maintenanceVSAvoidventricular rate control

Core Design Contradiction:

ReliabilityVSAdaptability or versatility

Solution Approach 1:

The invention segments the cardiac electrical activity into distinct phases (atrial refractory period, ventricular refractory period) and applies different stimulation strategies to each phase. By delivering supraventricular stimulation during the ventricular refractory period, the system can independently control ventricular rate without compromising atrial pacing reliability.

Inventive Principle:

Principle #1Segmentation

Solution Approach 2:

The system dynamically adjusts the timing and parameters of supraventricular stimulation based on real-time detection of refractory periods. The processor modifies stimulation delivery timing according to the detected cardiac cycle phase, enabling adaptive control of ventricular rate while maintaining stable atrial pacing.

Inventive Principle:

Principle #15Dynamics

2Productivity

If supraventricular stimulation is delivered during ventricular refractory period, then ventricular rate can be reduced, but arrhythmias may be triggered

Engineering Contradiction:

Improveventricular rate reductionVSAvoidarrhythmia risk

Core Design Contradiction:

ProductivityVSObject-affected harmful factors

Solution Approach 1:

The system performs preliminary detection of the ventricular refractory period timing before delivering supraventricular stimulation. By anticipating the refractory period window and preparing the stimulation delivery timing accordingly, the system can reduce ventricular rate while avoiding premature or inappropriate stimulation that would trigger arrhythmias.

Inventive Principle:

Principle #10Preliminary action

Solution Approach 2:

The system continuously monitors cardiac electrical activity to detect refractory period timing and uses this feedback information to control supraventricular stimulation delivery. The processor adjusts stimulation timing based on real-time detection, creating a closed-loop system that reduces ventricular rate while minimizing arrhythmia risk through adaptive response to actual cardiac conditions.

Inventive Principle:

Principle #23Feedback

3Power

If atrial pacing is used to control ventricular rate, then cardiac efficiency can be improved, but precise control during refractory periods is difficult

Engineering Contradiction:

Improvecardiac efficiencyVSAvoidrefractory period timing control

Core Design Contradiction:

PowerVSMeasurement precision

Solution Approach 1:

The system replaces purely time-based pacing mechanisms with an electrical signal-based detection and control system. By using electrical sensing to detect refractory period timing and automatically adjusting stimulation delivery accordingly, the system achieves precise control of atrial pacing timing and refractory period synchronization, improving both cardiac efficiency and timing precision.

Inventive Principle:

Principle #28Mechanics substitution (Replace mechanical system)

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 effectively reduces ventricular rate by up to 50% and lowers blood pressure, providing a targeted therapeutic effect that can be titrated to achieve desired cardiac parameters such as ventricular rate, stroke volume, cardiac efficiency, and cardiac output, while minimizing the risk of arrhythmias.

Implementation Method 1

delivering a pacing signal configured to cause an atrial depolarization to a heart of a patient

Methodology Applied

Scientific EffectElectrical depolarization: Electric Field

Implementation Method 2

delivering a signal to a supraventricular portion of the heart of the patient subsequent to the atrial refractory period and during a ventricular refractory period

Methodology Applied

Scientific EffectElectrical stimulation: Electric Field

Data Source

PatentUS8509893B2Supraventricular stimulation to control ventricular rate

Publication Date: 2013.08.13 MEDTRONIC INC

AI summary

Various techniques for delivering atrial pacing and supraventricular stimulation to achieve a desired ventricular rate and/or cardiac output are described. One example method described includes delivering a pacing signal configured to cause an atrial depolarization to a heart of a patient, wherein the atrial depolarization results in an associated refractory period during the cardiac cycle, and delivering a signal to a supraventricular portion of the heart of the patient subsequent to the atrial refractory period and during a ventricular refractory period of the cardiac cycle.