Cardiac pacing for optimal intra-left ventricular resynchronization

• US 20040215252A1
• Filed: 04/25/2003
• Published: 10/28/2004
• Est. Priority Date: 04/25/2003
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Prinzen, Frits W., Verbeek, Alexander Adrianus Martinus
• Granted Patent: US 7,079,895 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence

Abstract

Cardiac pacing to treat ventricle dysynchrony for improved cardiac function is performed as follows. Early paced inter-ventricular asynchrony is determined during ventricular pacing. Baseline inter-ventricular asynchrony is determined without pacing. Average inter-ventricular asynchrony is calculated by averaging the early paced inter-ventricular asynchrony and the baseline inter-ventricular asynchrony. Atrio-ventricular delay and ventricular-ventricular delay are adjusted during ventricular pacing to yield the average inter-ventricular asynchrony for optimal intra-left ventricular resynchronization and maximal cardiac function. The elements above can be configured in software contained in an implantable medical device or embodied as a computer software product that includes a medium readable by a processor.

Claims

1. A method of cardiac pacing for optimal intra-left ventricular resynchronization, comprising:

determining an early paced inter-ventricular asynchrony during ventricular pacing;

determining a baseline inter-ventricular asynchrony without pacing;

calculating an average inter-ventricular asynchrony by averaging the early paced inter-ventricular asynchrony and the baseline inter-ventricular asynchrony; and

,

adjusting atrio-ventricular delay and ventricular-ventricular delay during ventricular pacing to yield the average inter-ventricular asynchrony for intra-left ventricular resynchronization.

2. The method as in claim 1, wherein the average inter-ventricular asynchrony optimizes cardiac function by minimizing intra-left ventricular asynchrony.

3. The method as in claim 1, wherein the early paced inter-ventricular asynchrony is determined by applying a short atrio-ventricular delay and then measuring an activation delay between the left-ventricle and the right-ventricle.

4. The method as in claim 3, wherein the short atrio-ventricular delay is less than 50 ms.

5. The method as in claim 1, wherein the baseline inter-ventricular asynchrony is determined by measuring an activation delay between a left-ventricle and a right-ventricle.

6. The method as in claim 1, wherein intra-left ventricular resynchronization is optimized automatically by the implantable cardiac device.

7. The method as in claim 1, wherein paced inter-ventricular asynchrony is determined during ventricular pacing using left ventricular pacing with a short atrio-ventricular delay.

8. The method as in claim 1, wherein atrio-ventricular delay and ventricular-ventricular delay are adjusted by

adjusting atrio-ventricular delay by an atrio-ventricular delay increment and increasing ventricular-ventricular delay by a ventricular-ventricular delay increment,

measuring an inter-ventricular asynchrony,

comparing the inter-ventricular asynchrony to the average inter-ventricular asynchrony,

adjusting atrio-ventricular delay by an atrio-ventricular delay increment and increasing or decreasing ventricular-ventricular delay by a ventricular-ventricular delay increment, and,

setting the atrio-ventricular delay and ventricular-ventricular delay once the average inter-ventricular asynchrony is reached.

9. The method as in claim 8, wherein the atrio-ventricular delay increment and the ventricular-ventricular delay increment are less than about 30 ms.

10. The method as in claim 8, wherein the inter-ventricular asynchrony is sensed using a left-ventricular pacing lead and a right-ventricular pacing lead.

11. The method as in claim 8, wherein comparing the inter-ventricular asynchrony to the average inter-ventricular asynchrony is performed by minimizing the absolute difference between the inter-ventricular asynchrony and the average inter-ventricular asynchrony.

12. A cardiac pacemaker configured for optimizing intra-left ventricular resynchronization, comprising:

means for determining an early paced inter-ventricular asynchrony during ventricular pacing;

means for determining a baseline inter-ventricular asynchrony without pacing;

means for calculating average inter-ventricular asynchrony by averaging the paced inter-ventricular asynchrony and the baseline inter-ventricular asynchrony;

means for adjusting atrio-ventricular delay and ventricle-ventricle delay during ventricular pacing to yield the average inter-ventricular asynchrony for intra-left ventricular resynchronization.

13. A cardiac pacemaker for optimal intra-left ventricular resynchronization, comprising:

a housing having a power supply carried in the housing and a feedthrough;

a controller carried in the housing coupled to the power supply;

memory coupled to the controller;

pacing electronics coupled to the controller and the feedthrough;

sensing electronics coupled to the controller and the feedthrough;

a first electrical lead coupled to the feedthrough and configured for positioning in the right ventricle;

a second electrical lead coupled to the feedthrough and configured for positioning in the left ventricle;

software stored in memory containing instructions including,

a first sequence of instructions when executed by the controller, causes the controller receive an early paced inter-ventricular asynchrony data during ventricular pacing through the first electrical lead and sensing electronics,

a second sequence of instruction when executed by the controller, causes the controller to receive a baseline inter-ventricular asynchrony without pacing data through the first electrical lead, the second electrical lead, and sensing electronics,

a third sequence of instruction when executed by the controller, causes the controller to calculate average inter-ventricular asynchrony by averaging the early paced inter-ventricular asynchrony data and the baseline inter-ventricular asynchrony data, and,

a forth sequence of instruction when executed by the controller, causes the controller to adjust atrio-ventricular delay and ventricular-ventricular delay during ventricular pacing to yield the average inter-ventricular asynchrony for optimal intra-left ventricular resynchronization.

14. A cardiac pacemaker for optimal intra-left ventricular resynchronization, comprising:

a housing having a power supply carried in the housing and a feedthrough;

a controller carried in the housing coupled to the power supply;

memory coupled to the controller;

pacing electronics coupled to the controller and the feedthrough;

sensing electronics coupled to the controller and the feedthrough;

a first electrical lead coupled to the feedthrough and configured for positioning in the right ventricle;

a second electrical lead coupled to the feedthrough and configured for positioning in the left ventricle;

means for determining an early paced inter-ventricular asynchrony during ventricular pacing;

means for determining a baseline inter-ventricular asynchrony without pacing;

means for calculating average inter-ventricular asynchrony by averaging the paced inter-ventricular asynchrony and the baseline inter-ventricular asynchrony; and

,

means for adjusting atrio-ventricular delay and ventricle-ventricle delay during ventricular pacing to yield the average inter-ventricular asynchrony for intra-left ventricular resynchronization.

15. A computer software product that includes a medium readable by a processor, the medium having stored thereon instructions for cardiac pacing for optimal intra-left ventricular resynchronization in an implantable cardiac, comprising:

a first sequence of instructions when executed by the controller, causes the controller receive an early paced inter-ventricular asynchrony data during ventricular pacing;

a second sequence of instruction when executed by the controller, causes the controller to receive a baseline inter-ventricular asynchrony without pacing data;

a third sequence of instruction when executed by the controller, causes the controller to calculate average inter-ventricular asynchrony by averaging the early paced inter-ventricular asynchrony data and the baseline inter-ventricular asynchrony data; and

,

a forth sequence of instruction when executed by the controller, causes the controller to adjust atrio-ventricular delay and ventricular-ventricular delay during ventricular pacing to yield the average inter-ventricular asynchrony for intra-left ventricular resynchronization.