Method and apparatus for automatic determination of hemodynamically optimal cardiac pacing parameter values
First Claim
1. Method of automatic determination of a multi-chamber cardiac pacemaker'"'"'s programmable pacing parameter values providing hemodynamically optimal pacing therapy, comprising defining one or more pacing parameters, such as atrioventricular delays, inter-atrial delay, inter-ventricular delay, or heart rate, which are subject to variation during an optimization cycle, defining a variation range for values of each pacing parameter and a variation step width for stepping through the variation range during the optimization cycle, with the number of pacing parameters subject to variation and the number of applicable variation steps for each parameter defining the number of permutations of pacing parameter values and, thus, the sequence of the optimization cycle, within an optimization cycle sequentially programming the pacemaker with one permutation of pacing parameter values after the other and taking, with each permutation applied, hemodynamic measurements of the stroke volume (SV), cardiac output (CO) or ejection fraction (EF) and other indices of ventricular performance for a predefined time period, and recording each of the measurements taken, determining the hemodynamically optimal permutation of pacing parameter values from all recordings, and programming the pacemaker with this hemodynamically optimal permutation of pacing parameter values for pacing therapy.
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Abstract
For cardiac rhythm management a combination of cardiac pacing and a noninvasive heart monitoring is proposed for the determination of a set of programmable pacing parameters hemodynamically most beneficial to the patient. The apparatus incorporates a cardiac pacemaker (130) and a thoracic electrical bioimpedance (TEB) heart monitor (120). This combination allows the creation of a closed-loop system that conveniently and effectively obtains pacing parameter settings providing hemodynamically optimal pacing therapy to the patient as determined by measuring and recording of stroke volume (SV), cardiac output (GO), and other indices of ventricular performance by the heart monitor during an optimization cycle automatically employing different permutations of values of pacing parameters such as atrioventricular delays, inter-atrial delay, inter-ventricular delay, or heart rate, that are sequentially programmed to the pacemaker. The hemodynamically optimal permutation of pacing parameter values is determined from all recordings and programmed to the pacemaker for permanent or temporary pacing therapy.
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Citations
11 Claims
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1. Method of automatic determination of a multi-chamber cardiac pacemaker'"'"'s programmable pacing parameter values providing hemodynamically optimal pacing therapy, comprising
defining one or more pacing parameters, such as atrioventricular delays, inter-atrial delay, inter-ventricular delay, or heart rate, which are subject to variation during an optimization cycle, defining a variation range for values of each pacing parameter and a variation step width for stepping through the variation range during the optimization cycle, with the number of pacing parameters subject to variation and the number of applicable variation steps for each parameter defining the number of permutations of pacing parameter values and, thus, the sequence of the optimization cycle, within an optimization cycle sequentially programming the pacemaker with one permutation of pacing parameter values after the other and taking, with each permutation applied, hemodynamic measurements of the stroke volume (SV), cardiac output (CO) or ejection fraction (EF) and other indices of ventricular performance for a predefined time period, and recording each of the measurements taken, determining the hemodynamically optimal permutation of pacing parameter values from all recordings, and programming the pacemaker with this hemodynamically optimal permutation of pacing parameter values for pacing therapy.
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6. Apparatus for automatic determination of a multi-chamber cardiac pacemaker'"'"'s pacing parameter values providing optimal pacing therapy (optimization apparatus), comprising
a programmable processing unit (110) for storing an operator defined set of one or more programmable pacing parameters subject to variation and operator defined parameter specific variation ranges and step widths of values for pacing parameters, such as atrioventricular delays, inter-atrial delay, inter-ventricular delay, or heart rate, thus defining the number of permutations of pacing parameter values and the sequence of the optimization cycle, means for programming one permutation of pacing parameter values at a time to a pacemaker (130, 170) in accordance with the defined sequence of the optimization cycle, a heart monitor (120) for communication with the pacemaker for taking hemodynamic measurements of the stroke volume (SV), cardiac output (GO) or ejection fraction (EF) and other indices of ventricular performance in accordance with the defined sequence of the optimization cycle, means (110) for recording the measurements for each permutation of applied pacing parameter values, means (110) for determining the optimal permutation of pacing parameter values from all recordings, and means (110) for permanently programming the pacemaker with the so found optimal pacing parameter values.
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9. Any communicate with the cardiac pacemaker (170) through which the pacemaker is programmable by the processing unit (110).
Specification