Tiered Antitachycardia Pacing with Pre-Pulse Therapy
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Solution Overview
Problem
Conventional antitachycardia pacing (ATP) therapies for ventricular tachycardia are not always successful in converting the heart to normal sinus rhythm, often causing pain and accelerating the rhythm to ventricular fibrillation, necessitating the development of more effective and less painful treatment methods.
Innovation Solution
An implantable system employing tiered antitachycardia pacing with progressive pacing vectors and pre-pulsing therapy, starting with small electrodes inside the heart and escalating to larger electrodes outside, with pre-pulses applied to reduce pain and discomfort, ultimately culminating in cardioversion if necessary.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If conventional ATP is used to convert ventricular tachycardia to normal sinus rhythm, then the heart rhythm may be converted, but the treatment is often painful and sometimes accelerates the rhythm to ventricular fibrillation
Solution Approach 1:
The patent divides ATP therapy into multiple tiers with progressively different pacing vectors and configurations. Instead of using a single ATP approach, the system segments the treatment into hierarchical levels (first-tier, second-tier, third-tier pacing vectors) with increasing electrode distances and surface areas, allowing selection of the minimum effective therapy while avoiding excessive stimulation that causes pain or rhythm acceleration
Solution Approach 2:
The patent applies pre-pulsing therapy by delivering a preliminary pacing pulse before the main ATP pulse. This preliminary action modifies the tissue excitability state in advance, reducing the sensation of pain and discomfort associated with the subsequent ATP pulse while maintaining therapeutic effectiveness
2Reliability
If high voltage shock (cardioversion) is used to treat recalcitrant ventricular tachycardia, then the tachycardia can be terminated, but the shock is painful to the patient
Solution Approach 1:
The patent segments the electrotherapy into a hierarchical tiered system where cardioversion is only the final resort (third-tier). The system first attempts less invasive first-tier and second-tier pacing vectors, escalating to cardioversion only if lower tiers fail, thereby minimizing pain exposure while maintaining high termination success rates
Solution Approach 2:
The patent applies pre-pulsing therapy with preliminary pacing pulses before delivering cardioversion shocks. This preliminary action reduces the pain sensation associated with the high-voltage shock by modifying tissue excitability and neural response in advance, making the necessary painful intervention more tolerable
3Device complexity
If conventional ATP is used, then the treatment is simple, but the conversion time from ventricular tachycardia to normal sinus rhythm is prolonged
Solution Approach 1:
The patent implements a dynamic tiered ATP system that adapts the pacing vector configuration based on treatment response. The system dynamically progresses through tiers (first-tier to third-tier pacing vectors) with different electrode distances and surface areas, adjusting the therapy in real-time to achieve faster conversion while maintaining operational simplicity through automated escalation protocols
Data Source
AI summary
An implantable system applies tiered antitachycardia pacing (ATP) that may be combined with pre-pulsing therapy in order to reduce pain. In one implementation, an exemplary system applies a progression of increasingly potent pacing vectors, progressing in an initial tier from small electrodes inside the heart to later tiers that increasingly use a large electrode surface outside the heart. In the latter tiers, a pre-pulse may be added prior to each ATP pulse to reduce the sensation of pain.