Systems, methods, and interfaces for identifying optimal electrical vectors

• US 10,064,567 B2
• Filed: 03/27/2014
• Issued: 09/04/2018
• Est. Priority Date: 04/30/2013
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Ghosh, Subham, Gillberg, Jeffrey, Justen, Manfred, Schilling, Eric
• Primary Examiner(s): D ABREU, MICHAEL JOSEPH
• Application Number:
  US14/227,919
• Publication Number:
  US 20140323882A1
• Time in Patent Office: 1,622 Days
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/339 Displays specially adapted therefor
• CPC Class Codes: A61B 5/4029 for evaluating the peripheral nervous systems A61B5/24 takes precedence
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/371 Capture, i.e. successful stimulation
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means

Abstract

Systems, methods, and graphical user interfaces are described herein for identification of optimal electrical vectors for use in assisting a user in implantation of implantable electrodes to be used in cardiac therapy. Cardiac improvement information may be generated for each pacing configuration, and one or more pacing configuration may be selected based on the cardiac improvement information. Optimal electrical vectors using the selected pacing configurations may be identified using longevity information generated for each electrical vector. Electrodes may then be implanted for use in cardiac therapy to form the optimal electrical vector.

Claims

1. A system for use in cardiac therapy comprising:

electrode apparatus comprising a plurality of electrodes configured to be located proximate tissue of a patient for pacing;

display apparatus comprising a graphical user interface, wherein the graphical user interface is configured to present information for use in assisting a user in at least one of assessing a patient'"'"'s cardiac health, evaluating and adjusting cardiac therapy delivered to a patient, and navigating at least one implantable electrode to a region of the patient'"'"'s heart; and

computing apparatus coupled to the electrode apparatus and display apparatus and configured to;

deliver pacing therapy to the patient using each pacing configuration of a plurality of different pacing configurations, wherein each pacing configuration uses one or more electrodes of the plurality of electrodes to deliver electrical pacing stimulation,

generate cardiac improvement information for each pacing configuration, wherein the cardiac improvement information is representative of a change in mechanical and/or electrical cardiac functionality resulting from pacing delivered using each pacing configuration,

select one or more pacing configurations of the plurality of different pacing configurations that each used one or more electrodes of the plurality of electrodes to deliver pacing stimulation based on the cardiac improvement information, wherein each of the one or more selected pacing configurations that used one or more electrodes of the plurality of electrodes to deliver pacing stimulation are usable with one or more other electrodes to define a plurality of electrical vectors, wherein each of the plurality of electrical vectors are defined by at least one of the one or more electrodes used by the one or more selected pacing configurations to deliver pacing stimulation and at least one of the one or more other electrodes,

generate longevity information for each electrical vector of the plurality of electrical vectors, wherein the longevity information comprises at least energy expenditure expressed in actual or predicted battery longevity,

identify one or more optimal electrical vectors of the plurality of electrical vectors based on the longevity information, and

display, on the graphical user interface, information for use in assisting a user in at least one of assessing a patient'"'"'s cardiac health, evaluating and adjusting cardiac therapy delivered to a patient, and navigating at least one implantable electrode to a region of the patient'"'"'s heart, wherein the information comprises the identified one or more optimal electrical vectors.

2. The system of claim 1, wherein generating cardiac improvement information for each pacing configuration comprises generating dyssynchrony information for each pacing configuration by monitoring heart function using at least one of a plurality of surface electrodes during pacing and cardiac imaging apparatus during pacing.

3. The system of claim 2, wherein the dyssynchrony information comprises a dyssynchrony improvement value for each pacing configuration, wherein the dyssynchrony improvement value is generated by comparing baseline dyssynchrony to paced dyssynchrony during pacing using each pacing configuration.

4. The system of claim 3, wherein selecting one or more pacing configurations based on the cardiac improvement information comprises:

defining a threshold value based on the dyssynchrony information; and

selecting one or more pacing configurations having a dyssynchrony improvement value greater than the threshold value.

5. The system of claim 1, wherein the electrode apparatus further comprises at least one lead, wherein the plurality of electrodes are coupled to the at least one lead.

6. The system of claim 1, wherein a common anode is used when delivering pacing therapy using each pacing configuration of the plurality of different pacing configurations to be used to generate cardiac improvement information.

7. The system of claim 1, wherein the control module is further configured to deliver pacing therapy using at least one pacing configuration that uses two or more electrodes of the plurality of electrodes per cardiac cycle if the cardiac improvement information generated for each pacing configuration that uses one electrode of the plurality of electrodes does not meet a threshold criteria.

8. The system of claim 1, wherein generating longevity information for each electrical vector of the plurality of electrical vectors comprises determining at least one of a capture threshold for each electrical vector and an impedance value for each electrical vector.

9. The system of claim 1, wherein the control module is further configured to:

determine whether each electrical vector stimulates the phrenic nerve; and

identify the one or more optimal electrical vectors of the plurality of electrical vectors based on an absence of phrenic nerve stimulation.

10. The system of claim 1, wherein identifying the one or more optimal electrical vectors of the plurality of electrical vectors based on the longevity information comprises identifying the electrical vector having at least one of the greatest longevity, lowest capture threshold, and smallest impedance.

11. The system of claim 1, wherein the computing apparatus is further configured to identify, on the graphical user interface, the identified one or more optimal electrical vectors on a graphical depiction of at least a portion of anatomy of the patient'"'"'s heart.

12. The system of claim 1, wherein the computing apparatus is further configured to:

determine one or more candidate regions proximate the patient'"'"'s heart for implantation of an implantable electrode based on the identified one or more optimal electrical vectors; and

identify, on the graphical user interface, the one or more candidate site regions on a graphical depiction of at least a portion of anatomy of the patient'"'"'s heart for implantation of the implantable electrode.

13. A method for use in cardiac therapy comprising:

delivering pacing therapy using each pacing configuration of a plurality of different pacing configurations, wherein each pacing configuration uses one or more electrodes of a plurality of electrodes to deliver electrical pacing stimulation;

generating cardiac improvement information for each pacing configuration, wherein the cardiac improvement information is representative of a change in mechanical and/or electrical cardiac functionality resulting from pacing delivered using each pacing configuration;

selecting one or more pacing configurations of the plurality of different pacing configurations that each used one or more electrodes of the plurality of electrodes to deliver pacing stimulation based on the cardiac improvement information, wherein each of the one or more selected pacing configurations that used one or more electrodes of the plurality of electrodes to deliver pacing stimulation are usable with one or more other electrodes to define a plurality of electrical vectors, wherein each of the plurality of electrical vectors are defined by at least one of the one or more electrodes used by the one or more selected pacing configurations to deliver pacing stimulation and at least one of the one or more other electrodes;

generating longevity information for each electrical vector of the plurality of electrical vectors, wherein the longevity information comprises at least energy expenditure expressed in actual or predicted battery longevity;

identifying one or more optimal electrical vectors of the plurality of electrical vectors based on the longevity information; and

displaying, on the graphical user interface, information for use in assisting a user in at least one of assessing a patient'"'"'s cardiac health, evaluating and adjusting cardiac therapy delivered to a patient, and navigating at least one implantable electrode to a region of the patient'"'"'s heart, wherein the information comprises the identified one or more optimal electrical vectors.

14. The method of claim 13, wherein generating cardiac improvement information for each pacing configuration comprises generating dyssynchrony information for each pacing configuration by monitoring heart function using at least one of a plurality of surface electrodes during pacing and cardiac imaging apparatus during pacing.

15. The method of claim 14, wherein the dyssynchrony information comprises a dyssynchrony improvement value for each pacing configuration, wherein the dyssynchrony improvement value is generated by comparing baseline dyssynchrony to paced dyssynchrony during pacing using each pacing configuration.

16. The method of claim 14, wherein selecting one or more pacing configurations based on the cardiac improvement information comprises:

defining a threshold value based on the dyssynchrony information; and

selecting one or more pacing configurations having a dyssynchrony improvement value greater than the threshold value.

17. The method of claim 13, wherein the electrode apparatus further comprises at least one lead, wherein the plurality of electrodes are coupled to the at least one lead.

18. The method of claim 13, wherein a common anode is used when delivering pacing therapy using each pacing configuration of the plurality of different pacing configurations to be used to generate cardiac improvement information.

19. The method of claim 13, wherein the method further comprises delivering pacing therapy using at least one pacing configuration that uses two or more electrodes of the plurality of electrodes per cardiac cycle if the cardiac improvement information generated for each pacing configuration that uses one electrode of the plurality of electrodes does not meet a threshold criteria.

20. The method of claim 13, wherein generating longevity information for each electrical vector of the plurality of electrical vectors comprises determining at least one of a capture threshold for each electrical vector and an impedance value for each electrical vector.

21. The method of claim 13, wherein the method further comprises:

determining whether each electrical vector stimulates the phrenic nerve; and

identifying the one or more optimal electrical vectors of the plurality of electrical vectors based on an absence of phrenic nerve stimulation.

22. The method of claim 13, wherein identifying the one or more optimal electrical vectors of the plurality of electrical vectors based on the longevity information comprises identifying the electrical vector having at least one of the greatest longevity, lowest capture threshold, and smallest impedance.

23. The method of claim 13, wherein the method further comprises identifying, on the graphical user interface, the identified one or more optimal electrical vectors on a graphical depiction of at least a portion of anatomy of the patient'"'"'s heart.

24. The method of claim 13, wherein the method further comprises:

determining one or more candidate regions proximate the patient'"'"'s heart for implantation of an implantable electrode based on the identified one or more optimal electrical vectors; and

identifying, on the graphical user interface, the one or more candidate site regions on a graphical depiction of at least a portion of anatomy of the patient'"'"'s heart for implantation of the implantable electrode.

25. A system for use in cardiac therapy comprising:

means for deliver pacing therapy using each pacing configuration of a plurality of different pacing configurations, wherein each pacing configuration uses one or more electrodes of a plurality of electrodes to deliver electrical pacing stimulation;

computing means for generating cardiac improvement information for each pacing configuration, wherein the cardiac improvement information is representative of a change in mechanical and/or electrical cardiac functionality resulting from pacing delivered using each pacing configuration, for selecting one or more pacing configurations of the plurality of different pacing configurations that each used one or more electrodes of the plurality of electrodes to deliver pacing stimulation based on the cardiac improvement information, wherein each of the one or more selected pacing configurations that used one or more electrodes of the plurality of electrodes to deliver pacing stimulation are usable with one or more other electrodes to define a plurality of electrical vectors, wherein each of the plurality of electrical vectors are defined by at least one of the one or more electrodes used by the one or more selected pacing configurations to deliver pacing stimulation and at least one of the one or more other electrodes, for generating longevity information for each electrical vector of the plurality of electrical vectors, wherein the longevity information comprises at least energy expenditure expressed in actual or predicted battery longevity, and for identifying one or more optimal electrical vectors of the plurality of electrical vectors based on the longevity information; and

display means for providing a graphical user interface information for use in assisting a user in at least one of assessing a patient'"'"'s cardiac health, evaluating and adjusting cardiac therapy delivered to a patient, and navigating at least one implantable electrode to a region of the patient'"'"'s heart, wherein the information comprises the identified one or more optimal electrical vectors.