Four-chamber pacing system for optimizing cardiac output and determining heart condition
First Claim
1. A pacing system for providing pacing of a patient'"'"'s left heart, comprising:
- first means for obtaining indications of mechanical contractions of the right ventricle;
left ventricular pacing means for pacing the left ventricle; and
LV control means for controlling the timing of said left ventricular pacing relative to indicated right ventricular mechanical contractions;
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Abstract
A pacing system and method for providing multiple chamber pacing of a patient'"'"'s heart, and in particular, pacing programmed for treatment of various forms of heart failure. The system utilizes impedance sensing for determining optimum pacing parameters, e.g., for pacing the left ventricle so that left heart output is maximized. The impedance sensing also is used for determination of arrhythmias or progression of heart failure. Impedance sensing is provided for between selected pairs of the four chambers, to enable optimizing of information for control and diagnosis. In a preferred embodiment/of the invention, impedance measurements are obtained for determining the timing of right heart valve closure or right ventricular contractions, and the timing of delivery of left ventricular pace pulses is adjusted so as to optimally synchronize left ventricular pacing with the right ventricular contractions. Impedance sensing in the left heart also provides timing of mechanical contraction, and the pacemaker controls pacing to maintain bi-ventricular mechanical synchronization adjusted for maximum cardiac output.
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Citations
26 Claims
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1. A pacing system for providing pacing of a patient'"'"'s left heart, comprising:
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first means for obtaining indications of mechanical contractions of the right ventricle;
left ventricular pacing means for pacing the left ventricle; and
LV control means for controlling the timing of said left ventricular pacing relative to indicated right ventricular mechanical contractions;
- View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10)
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11. A four-chamber pacing system for providing pacing of a patient'"'"'s left heart to improve cardiac output, comprising:
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RV means for determining the timing of right ventricular mechanical contractions;
LV means for determining the timing of left ventricular mechanical contractions; and
pacing sync means for pacing the patient'"'"'s left ventricle; and
control means for controlling said pacing means so as to substantially synchronize said left and right mechanical contractions;
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13. A system for bi-ventricular pacing, comprising:
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RVP generating means for generating and delivering pacing pulses to the patient'"'"'s right ventricle;
LVP generating means for generating and delivering pacing pulses to the patient'"'"'s left ventricle;
atrial sense means for determining the cyclical time of excitation of the patient'"'"'s right and left atria;
RAVD control means for controlling said RVP generating means to deliver pace pulses at a predetermined RAVD delay following right atrial activation;
LAVD control means for controlling said LVP generating means to generate pace pulses at an LAVD delay following left atrial activation;
output means for determining a measure of cardiac output from the patient'"'"'s left ventricle;
adjusting means for adjusting said LAVD and RAVD delays and determining the optimum relationship of said LAVD and RAVD delays which results in maximized cardiac output; and
program means for programming said RAVD control means and said LAVD control means to control delivery of pacing pulses to the left and right ventricles with said optimum relation. - View Dependent Claims (12, 14, 15)
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16. A method of cardiac pacing, comprising:
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cyclically determining mechanical events indicative of left ventricular contraction and right ventricular contraction;
cyclically determining cardiac output from the patient'"'"'s left ventricle;
pacing said patient'"'"'s left ventricle with varying timing relative to said right ventricular contractions and determining the relative mechanical synchronization of left ventricular and right ventricular contractions which results in maximum cardiac output; and
maintaining said relative mechanical synchronization. - View Dependent Claims (17, 18, 19)
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20. A method of bi-ventricular pacing, comprising sensing sinus signals from the patient'"'"'s right atrium;
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cyclically generating and delivering left and right ventricular pace pulses for pacing the patient'"'"'s left and right ventricles respectively;
cyclically determining a measure of cardiac output from the patient'"'"'s left ventricle; and
adjusting the relative timing of said left and right ventricular pace pulses to correspond to maximum cardiac output. - View Dependent Claims (21, 22, 24, 25, 26)
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23. A four chamber pacing system, having electrodes positioned in each of a patient'"'"'s four heart chambers, comprising:
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impedance means for obtaining impedance measurements between a selected pair of said four chambers;
processing means for processing said impedance measurements, and determining changes in said measurements over a period of time; and
determining means for determining whether any said change occurs which indicates a physically abnormal heart condition.
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Specification