Morphology-based optimization of cardiac resynchronization therapy
First Claim
1. A method for operating a cardiac rhythm management device in a patient, comprising:
- delivering paces to both right and left ventricles in accordance with a programmed biventricular pacing mode, such that the paces are delivered at a programmed biventricular offset interval and after a programmed AV delay interval with respect to an atrial event;
switching to LV-only pacing mode and recording an evoked response test electrogram during an LV-only pace with the programmed AV delay interval;
comparing the test electrogram to an evoked response template electrogram previously recorded during LV-only pacing when the programmed AV delay interval was known to be matched to the patient'"'"'s then existing intrinsic AV interval;
adjusting the programmed AV delay interval to match the patient'"'"'s current intrinsic AV interval based upon the comparison of the test and template electrograms;
returning to the biventricular pacing mode with the adjusted AV delay interval.
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Accused Products
Abstract
A method and apparatus for delivering cardiac resynchronization therapy (CRT) in which an evoked response electrogram is recorded during one or more cardiac cycles and used to aid in the selection of resynchronization pacing parameters and/or to monitor the effectiveness of resynchronization therapy. The morphology of an evoked response electrogram may be recorded and analyzed to determine if and when intrinsic activation of one ventricle is occurring in order to optimally adjust the programmed atrio-ventricular (AV) delay interval for ventricular resynchronization pacing of a patient with intact AV node conduction.
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Citations
21 Claims
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1. A method for operating a cardiac rhythm management device in a patient, comprising:
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delivering paces to both right and left ventricles in accordance with a programmed biventricular pacing mode, such that the paces are delivered at a programmed biventricular offset interval and after a programmed AV delay interval with respect to an atrial event;
switching to LV-only pacing mode and recording an evoked response test electrogram during an LV-only pace with the programmed AV delay interval;
comparing the test electrogram to an evoked response template electrogram previously recorded during LV-only pacing when the programmed AV delay interval was known to be matched to the patient'"'"'s then existing intrinsic AV interval;
adjusting the programmed AV delay interval to match the patient'"'"'s current intrinsic AV interval based upon the comparison of the test and template electrograms;
returning to the biventricular pacing mode with the adjusted AV delay interval. - View Dependent Claims (2, 3, 4, 5, 6, 7)
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8. A method for operating a cardiac rhythm management device in a patient, comprising:
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delivering paces to both right and left ventricles in accordance with a programmed biventricular pacing mode, such that the paces are delivered at a programmed biventricular offset interval and after a programmed AV delay interval with respect to an atrial event;
upon a change by a specified amount in a current pacing rate at which the right and left ventricular paces are delivered, adjusting the programmed AV delay interval according to a mapping function which maps a particular pacing rate to a particular AV delay interval;
switching to LV-only pacing mode and recording an evoked response test electrogram during an LV-only pace with the programmed AV delay interval;
comparing the test electrogram to an evoked response template electrogram previously recorded during LV-only pacing when the programmed AV delay interval was known to be matched to the patient'"'"'s then existing intrinsic AV interval;
if the test and template electrograms do not sufficiently correlate, adjusting the mapping function so that the programmed AV delay interval which is mapped to by the current pacing rate matches the patient'"'"'s current intrinsic AV interval based upon the comparison of the test and template electrograms; and
returning to the biventricular pacing mode with the adjusted mapping function. - View Dependent Claims (9, 10)
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11. A cardiac rhythm management device, comprising:
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pacing channels through which paces may be delivered to both right and left ventricles;
a controller programmed to deliver the paces in accordance with a programmed biventricular pacing mode at a programmed biventricular offset interval and after a programmed AV delay interval with respect to an atrial event;
wherein the controller is programmed to;
switch to an LV-only pacing mode and record an evoked response test electrogram during an LV-only pace;
compare the test electrogram to an evoked response template electrogram previously recorded during LV-only pacing when the programmed AV delay interval was known to be matched to the patient'"'"'s then existing intrinsic AV interval;
adjust the programmed AV delay interval to match the patient'"'"'s current intrinsic AV interval based upon the comparison of the test and template electrograms; and
,return to the biventricular pacing mode with the adjusted AV delay interval. - View Dependent Claims (12, 13, 14, 15, 16, 17)
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18. A cardiac rhythm management device, comprising:
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pacing channels through which paces may be delivered to both right and left ventricles;
a controller programmed to deliver the paces in accordance with a programmed biventricular pacing mode at a programmed biventricular offset interval and after a programmed AV delay interval with respect to an atrial event;
wherein the controller is programmed to;
upon a change by a specified amount in a current pacing rate at which the right and left ventricular paces are delivered, adjust the AV delay interval according to a mapping function which maps a particular pacing rate to a particular AV delay interval;
switch to LV-only pacing mode and recording an evoked response test electrogram during an LV-only pace;
compare the test electrogram to an evoked response template electrogram previously recorded during LV-only pacing when the programmed AV delay interval was known to be matched to the patient'"'"'s then existing intrinsic AV interval;
if the test and template electrograms do not sufficiently correlate, adjust the mapping function so that the programmed AV delay interval which is mapped to by the current pacing rate matches the patient'"'"'s current intrinsic AV interval based upon the comparison of the test and template electrograms; and
return to the biventricular pacing mode with the adjusted mapping function. - View Dependent Claims (19, 20)
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21. A method for setting pacing parameters of a cardiac rhythm management device implanted in a patient, comprising:
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setting a pacing parameter to a plurality of different values while assessing the patient'"'"'s hemodynamic performance in order to determine an optimum value which results in the best hemodynamic performance;
setting the pacing parameter to the optimum value, recording an evoked response electrogram during delivery of a pace, and storing the recorded electrogram as a template;
recording test evoked response electrograms during one or more cardiac cycles and comparing the morphologies of the test electrogram and the template; and
,adjusting the value of the pacing parameter so that the morphology of a subsequently recorded test electrogram will more nearly resemble the morphology of the template.
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Specification