Non-invasive method and apparatus for cardiac pacemaker pacing parameter optimization and monitoring of cardiac dysfunction
First Claim
1. An external programmer device for programming pacing parameters of an implanted cardiac pacing device for providing pacing to the heart of a patient in which the pacing device is implanted, comprising:
- (a) a transmitter for transmitting programming instructions from the programmer device to the implanted cardiac pacing device to program pacing parameters of the implanted cardiac pacing device;
(b) a finger plethysmogram signal detector for providing a finger plethysmogram signal when attached to a finger of the patient in which the cardiac pacing device is implanted; and
(c) a programmer processor coupled to the transmitter and the finger detector and programmed to process the finger plethysmogram signal, to generate programming instructions for programming the pacing parameters of the implanted cardiac pacing device, and to control the transmitter for transmitting the programming instructions to the implanted cardiac pacing device.
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Abstract
Non-invasive method and apparatus for monitoring the condition of a heart failure patient and for optimizing the pacing parameters of a cardiac device implanted in a patient. A plethysmogram signal, e.g., a finger photoplethysmogram, is obtained from a patient and provided to a programmer device. The plethysmogram signal is analyzed by the programmer device to obtain a cardiac performance parameter, e.g., a pulse amplitude response, a degree of pulsus alternans, or irregularity in the pressure pulses detected in an atrial fibrillation patient. The effect on the cardiac performance parameter derived from the plethysmogram is determined for various pacing parameter values in a manner so as to reject noncardiogenic effects and artifacts. Pacing parameters resulting in the best cardiac performance parameter may be selected as the optimum pacing parameters. The programmer device may monitor a Valsalva maneuver performed by a patient. Optimum pacing parameters may be derived by analysis of the plethysmogram signals obtained during performance of the Valsalva maneuver using different pacing parameters.
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Citations
51 Claims
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1. An external programmer device for programming pacing parameters of an implanted cardiac pacing device for providing pacing to the heart of a patient in which the pacing device is implanted, comprising:
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(a) a transmitter for transmitting programming instructions from the programmer device to the implanted cardiac pacing device to program pacing parameters of the implanted cardiac pacing device;
(b) a finger plethysmogram signal detector for providing a finger plethysmogram signal when attached to a finger of the patient in which the cardiac pacing device is implanted; and
(c) a programmer processor coupled to the transmitter and the finger detector and programmed to process the finger plethysmogram signal, to generate programming instructions for programming the pacing parameters of the implanted cardiac pacing device, and to control the transmitter for transmitting the programming instructions to the implanted cardiac pacing device. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
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14. An external programmer device for programming pacing parameters of an implanted cardiac pacing device for providing pacing to the heart of a patient in which the pacing device is implanted, comprising:
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(a) a transmitter for transmitting programming instructions from the programmer device to the implanted cardiac pacing device to program pacing parameters of the implanted cardiac pacing device;
(b) a finger plethysmogram signal detector for providing a finger plethysmogram signal when attached to a finger of the patient in which the cardiac pacing device is implanted;
(c) a mouthpiece adapted for performance of a Valsalva maneuver by the patient;
(d) a pressure sensor coupled to the mouthpiece to provide a pressure signal relative to pressure in the mouthpiece during performance of the Valsalva maneuver by the patient; and
(e) a programmer processor coupled to the transmitter and the finger detector and the pressure sensor and programmed to monitor performance of the Valsalva maneuver from the pressure signal, to process the finger plethysmogram signal during performance of the Valsalva maneuver, to generate programming instructions for programming the pacing parameters of the implanted cardiac pacing device, and to control the transmitter for transmitting the programming instructions to the implanted cardiac pacing device. - View Dependent Claims (15, 16, 17, 18, 19, 20, 21, 22, 23)
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24. A non-invasive method of optimizing pacing parameters of a cardiac device implanted in a patient, comprising the steps of:
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(a) detecting a finger plethysmogram signal from a patient during pacing with a selected pacing parameter value;
(b) analyzing the finger plethysmogram signal to obtain a cardiac performance parameter indicative of cardiac performance therefrom;
(c) adjusting the selected pacing parameter value of the implanted cardiac device; and
(d) obtaining an improvement in the cardiac performance parameter by repeating steps (a)-(c) to obtain a selected pacing parameter value which results in an improved cardiac performance parameter. - View Dependent Claims (25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38)
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39. A non-invasive method of optimizing pacing parameters of a cardiac device implanted in a patient, comprising the steps of:
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(a) detecting a photoplethysmogram signal from a patient during a plurality of pacing series intervals separated by non-paced intervals;
(b) adjusting a pacing parameter value used during the pacing series intervals to a different value for different pacing series intervals;
(c) using characteristics of the photoplethysmogram signal during paced beats in the pacing series intervals and during non-paced intervals before and after the series of paced beats to reduce noncardiogenic effects on the photoplethysmogram signal;
(d) analyzing the photoplethysmogram signal to obtain a cardiac performance parameter indicative of cardiac performance therefrom; and
(e) selecting the pacing parameter values resulting in an improved cardiac performance parameter. - View Dependent Claims (40, 41)
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42. A non-invasive method of optimizing pacing parameters of a cardiac device implanted in a patient, comprising the steps of:
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(a) non-invasively detecting a signal related to cardiac pulse amplitude during a plurality of pacing series intervals;
(b) adjusting a pacing parameter value used during the pacing series intervals to a different value for different pacing series intervals; and
(c) selecting the pacing parameter value resulting in the greatest non-invasively detected pulse amplitude response to pacing. - View Dependent Claims (43)
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44. A non-invasive method of optimizing pacing parameters of a cardiac device implanted in a patient, comprising the steps of:
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(a) non-invasively detecting a signal related to cardiac pulse amplitude during a plurality of pacing series intervals;
(b) adjusting a pacing parameter value used during the pacing series intervals to a different value for different pacing series intervals; and
(c) selecting the pacing parameter value resulting in most reduced pulsus alternans in the non-invasively detected signal. - View Dependent Claims (45, 46)
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47. A non-invasive method of optimizing pacing parameters of a cardiac device implanted in a patient;
- comprising the steps of;
(a) non-invasively detecting a signal related to cardiac pulse amplitude during a plurality of pacing series intervals during performance of a Valsalva maneuver by the patient;
(b) adjusting a pacing parameter value used during the pacing series intervals to a different value for different pacing series intervals; and
(c) selecting the pacing parameter value resulting in the most normal cardiac pulse amplitude response detected during performance of the Valsalva maneuver. - View Dependent Claims (48, 49)
- comprising the steps of;
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50. A non-invasive method of optimizing pacing parameters of a cardiac device implanted in a patient, comprising the steps of:
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(a) non-invasively detecting a signal related to cardiac pulse amplitude during a plurality of pacing series intervals;
(b) adjusting a pacing parameter value used during the pacing series intervals to a different value for different pacing series intervals; and
(c) selecting the pacing parameter value resulting in the most even pulse amplitude in the non-invasively detected signal. - View Dependent Claims (51)
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Specification