Implantable Pacing Protocol for Intrinsic Ventricular Conduction
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Solution Overview
Problem
Traditional dual chamber pacing modes often result in ventricular pacing due to prolonged intrinsic AV delay, which is undesirable, and existing protocols struggle to minimize ventricular pacing while maintaining AV synchrony and responsiveness to physiological needs.
Innovation Solution
The implementation of a Ventricular Pacing Protocol (VPP) in an implantable medical device that operates in an atrial-based pacing mode, senses for intrinsic ventricular activity, and adjusts pacing modes based on the nature of sensed events, including properly conducted beats and premature ventricular contractions, to minimize ventricular pacing and promote intrinsic conduction.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If traditional dual chamber pacing mode (DDD) is used, then AV synchrony is maintained, but ventricular pacing occurs frequently due to prolonged intrinsic AV delay
Solution Approach 1:
The patent implements dynamic adjustment of the AV delay interval based on sensed ventricular activity. The system transitions from a fixed DDD mode to a dynamic mode where the AV delay is continuously optimized to promote intrinsic conduction while maintaining AV synchrony. This resolves the contradiction by making the pacing system adaptive rather than static.
Solution Approach 2:
The patent changes the timing parameter (AV delay interval) to promote intrinsic ventricular conduction. By extending the AV delay beyond traditional limits and using sensed ventricular events to trigger mode changes, the system reduces ventricular pacing while preserving AV synchrony through parameter optimization.
2Object-generated harmful factors
If atrial based pacing mode is used to minimize ventricular pacing, then intrinsic conduction is promoted, but AV synchrony and rate responsiveness may be compromised
Solution Approach 1:
The patent creates a multi-functional pacing system that can operate in multiple modes (DDD, AAI, and intermediate modes) depending on the patient's physiological state. This universal system provides both ventricular pacing capability and atrial-based intrinsic conduction promotion, resolving the contradiction by offering both functions contextually rather than choosing one exclusively.
Solution Approach 2:
The system uses feedback from sensed ventricular events to dynamically adjust pacing mode and AV delay settings. By continuously monitoring intrinsic conduction and adjusting parameters accordingly, the system maintains AV synchrony while minimizing ventricular pacing through real-time feedback control.
3Productivity
If rate responsive pacing is implemented, then cardiac output increases with activity level, but AV delay timing becomes more complex to maintain synchrony
Solution Approach 1:
The patent implements dynamic AV delay adjustment that automatically adapts to changing heart rates during rate-responsive pacing. As the pacing rate increases with activity level, the system dynamically optimizes the AV delay to promote intrinsic conduction, simplifying timing control while maintaining synchrony across different activity states.
Data Source
AI summary
An implantable medical device operates to promote intrinsic ventricular depolarization according to a pacing protocol. The medical device determines a course of action based upon the presence or absence of sensed ventricular activity. The device further determines whether that activity is properly conducted or the result of a PVC or nodal rhythm.