System and method for pacing parameter optimization using heart sounds

• US 10,391,316 B2
• Filed: 05/08/2017
• Issued: 08/27/2019
• Est. Priority Date: 07/29/2011
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Zhang, Xusheng, Gillberg, Jeffrey M, Mullen, Thomas J
• Primary Examiner(s): Lee, Erica S
• Application Number:
  US15/589,868
• Publication Number:
  US 20170239472A1
• Time in Patent Office: 841 Days
• Field of Search: None
• CPC Class Codes: A61B 7/00 Instruments for auscultation
• CPC Class Codes: A61B 7/04 Electric stethoscopes microphones, acoustic transducers therefor H04R
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/3682 with a variable atrioventricular delay
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/37264 Changing the program; Upgrading firmware

Abstract

A medical device system and associated method predict a patient response to a cardiac therapy. The system includes for delivering cardiac pacing pulses to a patient'"'"'s heart coupled to a cardiac sensing module and a cardiac pacing module for generating cardiac pacing pulses and controlling delivery of the pacing pulses at multiple pace parameter settings. An acoustical sensor obtains heart sound signals. A processor is enabled to receive the heart sound signals, derive a plurality of heart sound signal parameters from the heart sound signals, and determine a trend of each of the plurality of heart sound signal parameters with respect to the plurality of pace parameter settings. An external display is configured to present the trend of at least one heart sound parameter with respect to the plurality of pace parameter settings.

Claims

1. A method comprising

delivering, by a medical device system, pacing pulses at varying pacing settings;

obtaining, by the medical device system, heart sound signals from an acoustical sensor;

determining, by the medical device system and based on the heart sound signals, a plurality of heart sound signal parameters;

determining, by the medical device system and based on the heart sound signal parameters, a relative change of a V-S2 interval, wherein the V-S2 interval is a time interval between a ventricular electrical event and an S2 heart sound, and wherein the relative change of the V-S2 interval is responsive to the varying pacing settings;

identifying, by the medical device system and based on the relative change of the V-S2 interval, a target pacing parameter; and

delivering, by the medical device system, pacing pulses according to the target pacing parameter.

2. The method of claim 1, wherein determining the relative change of the V-S2 interval includes:

determining a generally bell-shaped trend in values of the V-S2 interval, wherein the generally bell-shaped trend has a peak.

3. The method of claim 1, wherein determining the relative change of the V-S2 interval includes:

determining an inflection point in values of the V-S2 interval.

4. The method of claim 1, wherein determining the relative change of the V-S2 interval includes:

identifying a sudden slope change in values of the V-S2 interval.

5. The method of claim 1, wherein determining the relative change of the V-S2 interval includes:

identifying a first trend in values of the V-S2 interval; and

identifying a second trend in values of the V-S2 interval.

6. The method of claim 1, further comprising:

determining, by the medical device system and based on the heart sound signal parameters, a relative change of an S1 heart sound amplitude, wherein the relative change of the S1 heart sound amplitude is responsive to the varying pacing settings.

7. The method of claim 1, further comprising:

determining, by the medical device system and based on the heart sound signal parameters, a relative change of an S1-52 interval, wherein the S1-52 interval is a time interval between an S1 heart sound and an S2 heart sound, and wherein the relative change of the S1-S2 interval is responsive to the varying pacing settings.

8. A medical device system comprising:

therapy delivery circuitry;

an acoustical sensor; and

processing circuitry configured to;

control delivery of pacing pulses by the therapy delivery circuitry at varying pacing settings,

obtain heart sound signals from the acoustical sensor,

determine, based on the heart sound signals, a plurality of heart sound signal parameters,

determine, based on the heart sound signal parameters, a relative change of a V-S2 interval, wherein the V-S2 interval is a time interval between a ventricular electrical event and an S2 heart sound, and wherein the relative change of the V-S2 interval is responsive to the varying pacing settings,

identify, based on the relative change of the V-S2 interval, a target pacing parameter, and

control delivery of pacing pulses at the target pacing parameter.

9. The medical device system of claim 8, wherein the processing circuitry configured to determine the relative change of the V-S2 interval is further configured to:

determine a generally bell-shaped trend in values of the V-S2 interval, wherein the generally bell-shaped trend has a peak.

10. The medical device system of claim 8, wherein the processing circuitry configured to determine the relative change of the V-S2 interval is further configured to:

determine an inflection point in values of the V-S2 interval.

11. The medical device system of claim 8, wherein the processing circuitry configured to determine the relative change of the V-S2 interval is further configured to:

identify a sudden slope change in values of the V-S2 interval.

12. The medical device system of claim 8, wherein the processing circuitry configured to determine the relative change of the V-S2 interval is further configured to:

identify a first trend in values of the V-S2 interval; and

identify a second trend in values of the V-S2 interval.

13. The medical device system of claim 8, wherein the processing circuitry is configured to:

determine, based on the heart sound signal parameters, a relative change of an S1 heart sound amplitude, wherein the relative change of the S1 heart sound amplitude is responsive to the varying pacing settings.

14. The medical device system of claim 8, wherein the processing circuitry is configured to:

determine, based on the heart sound signal parameters, a relative change of an S1-52 interval, wherein the S1-52 interval is a time interval between an S1 heart sound and an S2 heart sound, and wherein the relative change of the S1-S2 interval is responsive to the varying pacing settings.

15. A non-transitory computer-readable storage medium comprising instructions that, when executed, configure processing circuitry of a medical device system to:

control delivery of pacing pulses at varying pacing settings;

obtain heart sound signals from an acoustical sensor;

determine, based on the heart sound signals, a plurality of heart sound signal parameters;

determine, based on the heart sound signal parameters, a relative change of a V-S2 interval, wherein the V-S2 interval is a time interval between a ventricular electrical event and an S2 heart sound, and wherein the relative change of the V-S2 interval is responsive to the varying pacing settings;

identify, based on the relative change of the V-S2 interval, a target pacing parameter; and

deliver pacing pulses according to the target pacing parameter.

16. The non-transitory computer-readable storage medium of claim 15, wherein the instructions that configure the processing circuitry to determine the relative change of the V-S2 interval include instructions that, when executed, configure the processing circuitry to:

determine a generally bell-shaped trend in values of the V-S2 interval, wherein the generally bell-shaped trend has a peak.

17. The non-transitory computer-readable storage medium of claim 15, wherein the instructions that configure the processing circuitry to determine the relative change of the V-S2 interval include instructions that, when executed, configure the processing circuitry to:

determine an inflection point in values of the V-S2 interval.

18. The non-transitory computer-readable storage medium of claim 15, wherein the instructions that configure the processing circuitry to determine the relative change of the V-S2 interval include instructions that, when executed, configure the processing circuitry to:

identify a sudden slope change in values of the V-S2 interval.

19. The non-transitory computer-readable storage medium of claim 15, wherein the instructions that configure the processing circuitry to determine the relative change of the V-S2 interval include instructions that, when executed, configure the processing circuitry to:

identify a first trend in values of the V-S2 interval; and

identify a second trend in values of the V-S2 interval.

20. The non-transitory computer-readable storage medium of claim 15, wherein the instructions, when executed, further configure the processing circuitry to:

determine, based on the heart sound signal parameters, a relative change of an S1 heart sound amplitude, wherein the relative change of the S1 heart sound amplitude is responsive to the varying pacing settings.

21. The non-transitory computer-readable storage medium of claim 15, wherein the instructions, when executed, further configure the processing circuitry to:

determine, based on the heart sound signal parameters, a relative change of an S1-S2 interval, wherein the S1-S2 interval is a time interval between an S1 heart sound and an S2 heart sound, and wherein the relative change of the S1-S2 interval is responsive to the varying pacing settings.