Ventricular Pacing Interval Determination for Dyssynchrony
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Solution Overview
Problem
Current implantable medical devices struggle to effectively synchronize the pacing of left and right ventricles in the heart, leading to inefficient mechanical activation and potential competition for space within the pericardium, particularly in patients with diastolic heart failure.
Innovation Solution
The method involves determining specific pacing intervals for the left and right ventricles based on intrinsic conduction time intervals, where the left-ventricular pacing interval is less than the intrinsic conduction time and the right-ventricular pacing interval is greater than the left-ventricular interval but less than the intrinsic conduction time, allowing for dyssynchronous activation and contraction of the ventricles.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If simultaneous pacing of left and right ventricles is used, then mechanical activation occurs, but the ventricles compete for space within the pericardium and mechanical efficiency decreases
Solution Approach 1:
The patent applies periodic action by delivering pacing pulses to the left and right ventricles at different time intervals rather than simultaneously. The left ventricle is paced at a first pacing interval while the right ventricle is paced at a second pacing interval that is longer than the first, creating a dyssynchronous periodic activation pattern that allows each ventricle to complete its contraction and relaxation cycle without competing for space during diastole.
Solution Approach 2:
The patent implements dynamics by making the pacing intervals adjustable and adaptive. The device determines intrinsic conduction time intervals and uses these to dynamically set optimal pacing intervals that are less than the intrinsic conduction time. This dynamic adjustment allows the system to optimize ventricular activation timing based on the patient's specific cardiac conduction characteristics, thereby improving mechanical efficiency and reducing pericardial space competition.
2Productivity
If pacing intervals are set to achieve dyssynchronous activation, then mechanical efficiency improves, but precise determination of intrinsic conduction time is required
Solution Approach 1:
The patent applies self-service by having the implantable device automatically determine the patient's intrinsic conduction time intervals without requiring external measurement or manual setting. The device senses intrinsic cardiac electrical activity, measures the conduction time from atrial to ventricular activation, and uses this self-determined value to automatically calculate and set the optimal pacing intervals. This eliminates the need for complex external measurements and allows the system to adapt to the patient's specific physiology.
Solution Approach 2:
The patent implements feedback by continuously monitoring intrinsic cardiac electrical events and using this information to adjust pacing intervals. The device senses atrial and ventricular electrical activity, measures the intrinsic conduction time, and feeds this information back to the pacing algorithm to determine optimal pacing intervals that are less than the measured intrinsic conduction time, thereby achieving dyssynchronous activation that maximizes mechanical efficiency.
Data Source
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AI summary
A left-ventricular pacing interval and a right-ventricular pacing interval for timing the delivery of pacing pulses to a left ventricle and a right ventricle of a heart, respectively, may be based an intrinsic conduction time interval between at least one of an atrial sensing event or an atrial pacing event of an atrial chamber of a heart and a ventricular sensing event of a ventricular chamber of the heart. In some examples, the left-ventricular pacing interval is based on the time interval, where the left-ventricular pacing interval is less than the time interval. In some examples, the right-ventricular pacing interval is based on the time interval, where the right-ventricular pacing interval is greater than the left-ventricular pacing interval and less than the time interval.