Active implantable medical device, in particular a pacemaker, defibrillator and/or cardiovertor of the multisite type providing resynchronization of the ventricles

• US 20010012953A1
• Filed: 12/18/2000
• Published: 08/09/2001
• Est. Priority Date: 12/17/1999
• Status: Active Grant

• Current Assignee: Sorin CRM USA (MicroPort Scientific Corp.)
• Original Assignee: Ela Medical S.A. (LivaNova Plc)
• Inventors: Ripart, Alain, Molin, Renzo Dal
• Granted Patent: US 6,556,866 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• 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 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation

Abstract

An active implantable medical device, in particular a pacemaker, defibrillator and/or cardiovertor of the multisite type providing resynchronization of the ventricles electrodes are placed in at least two sites, right and left, and are connected to a circuit for the collection of cardiac signals, to detect a depolarization potential. Electrodes also are connected to a stimulation circuit, to apply stimulation pulses to at least some of the sites. The device provides resynchronization of the ventricular contraction, by establishing a delay between the times of application of the respective stimulation pulses on the right ventricle (RV) and left ventricle (LV), determining a parameter (z) representative of the degree of synchronization between ventricles, and varying the delay in the direction of the improvement of the aforesaid representative parameter. The parameter is a bio-impedance measurement.

Claims

1. An active implantable medical device, in particular a pacemaker, defibrillator and/or cardiovertor, of the multisite type to be connected to electrodes placed in at least one left cardiac site and at least one right cardiac site, said device having a cardiac signal collection circuit for connection to at least one of said electrodes to detect a depolarization potential, and a stimulation circuit to apply stimulation pulses to at least two of said sites through corresponding electrodes, said device comprising means for resynchronization of ventricular contractions, including means for establishing a delay between a time of application of a stimulation pulse to a right ventricle (RV) and a stimulation pulse to a left ventricle (LV);

and means for determining a parameter representative of a degree of desynchronization between said left and right ventricles for a cardiac cycle, and varying the delay in a direction of a reduction of the parameter representative of the degree of desynchronization.

2. The device of

claim 1

, wherein the means for determining the representative parameter further comprises a hemodynamic sensor.

3. The device of

claim 2

, wherein the hemodynamic sensor is a sensor of a dynamic intracardiac bio-impedance between a left side and a right side.

4. The device of

claim 3

, wherein the hemodynamic sensor is a sensor of a dynamic intracardiac bio-impedance between a right ventricular site (RV+, RA−

)and a left ventricular site (LV+, LV−

).

5. The device of

claim 3

, wherein the hemodynamic sensor is a sensor of dynamic intracardiac bio-impedance (z) between a right atrial site (RA+, RA−

) and a left ventricular site (LV+, LV−

).

6. The device of

claim 3

, wherein the means for determining said parameter further comprises means for injecting a current between a right site and a left site, and collecting a differential potential between two sites selected from among the group consisting of a right site and a left site, two right sites, and two left sites.

7. The device of

claim 6

, wherein the hemodynamic sensor is configured for obtaining the bio-impedance measurement in a tripolar lead configuration, with one site common to the injection of current and the collection of the differential potential.

8. The device of

claim 7

, in which one site common to the injection and the collection is a left ventricular distal site (RV−

), the other site of injection is a distal right ventricular site (LV−

) and the other site of collection is a proximal right ventricular site (RV+).

9. The device of

claim 6

, wherein the hemodynamic sensor is configured for obtaining the measurement in a quadripolar lead configuration, without a site common to the injection and the collection.