Cardiac pacing therapy parameter programming

• US 20040220636A1
• Filed: 04/29/2003
• Published: 11/04/2004
• Est. Priority Date: 04/29/2003
• Status: Abandoned Application

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Burnes, John E.
• Application Number:
  US10/426,645
• Publication Number:
  US 20040220636A1
• Time in Patent Office: Days
• US Class Current: 607/17
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/37254 Pacemaker or defibrillator security, e.g. to prevent or inhibit programming alterations by hackers or unauthorised individuals

Abstract

Accordingly, according to the present invention a programmable IMD provides a patient with an essentially customized cardiac pacing therapy resulting in enhanced hemodynamic function. In particular, the present invention provides for refined tuning of pacing parameters to cause the heart to pump blood and perfuse in an efficient manner. In general, the invention promotes good hemodynamic operation through programming of an implantable medical device (IMD) as a function of one or more hemodynamic data sensed by a device located external to the body of the patient relying on said data as gathered either by discrete internal measuring device or an external device. The ability to share data among and between an IMD, an IMD programming device and a hemodynamic monitoring or measuring device spaced from the IMD (i.e., either an implantable device or external to the patient) allows for improved selection of pacing parameters to optimize hemodynamic function.

Claims

1. A method, comprising:

receiving at least one data signal from a hemodynamic monitoring device external to a patient, wherein the at least one data signal relates to hemodynamic function or mechanical cardiac function of the patient; and

programming at least one pacing parameter in an implanted cardiac pacing therapy device as a function of the at least one signal.

2. A method of claim 1, wherein the at least one data signal comprises at least a one of:

a stroke volume, a cardiac output, a heart rate.

3. A method of claim 1, wherein programming the at least one pacing parameter comprises setting the at least one pacing parameter to a first setting, and wherein the at least one data signal comprises a first hemodynamic datum, the method further comprising:

receiving a second hemodynamic datum while the at least one pacing parameter is set to the first setting.

4. A method of claim 3, further comprising:

setting the at least one pacing parameter at a second setting as a function of the second hemodynamic datum; and

receiving a third hemodynamic datum while the pacing parameter is at the second setting.

5. A method of claim 1, wherein the at least one pacing parameter comprises a one of:

a pacing interval, an intrinsic interval, a combination pacing/intrinsic interval, a blanking period, a refractory period, a cardiac stimulation pulse duration, a cardiac pulse stimulation amplitude, a cardiac stimulation pulse waveform type, a pacing rate, a blanking time period, a refractory time period, an extra-systolic interval, a pacing threshold, a defibrillation threshold, a cardioversion threshold.

6. A method of claim 5, wherein the pacing interval comprises at least one of:

an A-V interval, a V-V interval, and an A-A interval.

7. A method comprising:

setting at least one pacing parameter in an implantable medical device to a first setting; and

receiving a hemodynamic datum from a second device external to the body of a patient while the at least one pacing parameter is set to the first setting.

8. A method of claim 7, wherein the hemodynamic datum comprises at least one of a stroke volume datum, a cardiac output datum, and a heart rate datum.

9. A method of claim 7, further comprising setting the at least one pacing parameter to a second setting as a function of the hemodynamic datum.

10. A method of claim 9, wherein the hemodynamic datum is a first hemodynamic datum, the method further comprising:

receiving a second hemodynamic datum from the second device while the pacing parameter is at the second setting.

11. A method of claim 7, wherein the pacing parameter comprises a pacing interval.

12. A method of claim 11, wherein the pacing interval comprises at least one of an A-V interval, a V-V interval, and an A-A interval.

13. A method of claim 7, wherein setting the pacing parameter in the implantable medical device to the first setting comprises transmitting the pacing parameter setting to the implantable medical device.

14. An apparatus comprising a processor that receives a hemodynamic datum from at least one of a first device implanted in the body of a patient and a second device external to the body of the patient, wherein said second device generates a pacing parameter setting for the first device as a function of the hemodynamic datum.

15. An apparatus according to claim 14, further comprising a receiver to receive the hemodynamic datum from the second device.

16. An apparatus according to claim 14, further comprising a transmitter to transmit the pacing parameter setting to the first device.

17. An apparatus according to claim 14, wherein the hemodynamic datum comprises at least one of a stroke volume, a cardiac output, a heart rate.

18. An apparatus according to claim 14, wherein the pacing parameter comprises a pacing interval.

19. An apparatus according to claim 18, wherein the pacing interval comprises at least one of an A-V interval, a V-V interval, and an A-A interval.

20. An apparatus according to claim 14, further comprising a wireless communication circuit among the first device and the second device and wherein said second device further comprises means for sending a data signal from the first device to the second device.

21. An apparatus according to claim 20, wherein the data signal comprises a physiologic data measurement time interval.

22. An apparatus according to claim 20, wherein the first device comprises an implantable cardiac pulse generator and the second device comprises a combination hemodynamic monitor and a programmer for said implantable cardiac pulse generator.

23. An apparatus comprising:

a sensor to measure a hemodynamic datum from a body of a patient;

a transmitter to transmit the hemodynamic datum to a programmer,

wherein the sensor is external to the body of the patient; and

an implantable cardiac pulse generator to provide timed electrical stimulation therapy to the patient based at least in part on the hemodynamic datum.

24. An apparatus according to claim 23, wherein the programmer is internal to the body of the patient.

25. An apparatus according to claim 23, wherein the hemodynamic datum comprises at least one of a stroke volume, a cardiac output, a heart rate.

26. An apparatus according to claim 23, wherein the sensor comprises at least two electrodes to measure at least one transthoracic impedance vector of the patient.

27. A system comprising:

a sensing device external to the body of the patient to measure a hemodynamic datum;

a programmer to generate a pacing parameter setting as a function of the hemodynamic datum; and

an implantable medical device to apply pacing stimuli to a heart according to the pacing parameter setting.

28. A system according to claim 27, wherein the programmer is external to the body of the patient.

29. A system according to claim 27, wherein the hemodynamic datum comprises at least one of a stroke volume datum, a cardiac output datum, a heart rate datum.

30. A system according to claim 27, wherein the pacing parameter comprises a pacing interval.

31. A system according to claim 30, wherein the pacing interval comprises at least one of an A-V interval, a V-V interval, an A-A interval.

32. A system according to claim 27, the sensing device comprising at least one electrode to measure an impedance of the patient.

33. A computer-readable medium comprising instructions for causing a programmable processor to:

receive a hemodynamic datum from a first device external to the body of a patient; and

set a pacing parameter in a second device implanted in the patient as a function of the hemodynamic datum.

34. A medium according to claim 33, wherein the hemodynamic datum comprises at least one of stroke volume, cardiac output, and heart rate.

35. A medium according to claim 33,

wherein the instructions causing the processor to set the pacing parameter in the second device comprise instructions causing the processor to set the pacing parameter at a first setting, and wherein the hemodynamic datum is a first hemodynamic datum, the instructions further causing the processor to receive a second hemodynamic datum while the pacing parameter is at the first setting.

36. A medium according to claim 35, the instructions further causing the processor to:

set the pacing parameter in the second device at a second setting as a function of the second hemodynamic datum; and

receive a third hemodynamic datum while the pacing parameter is at the second setting.

37. A medium according to claim 33, wherein the pacing parameter comprises a pacing interval.

38. A medium according to claim 37, wherein the pacing interval comprises at least one of an A-V interval, a V-V interval, and an A-A interval.

39. A computer-readable medium comprising instructions for causing a programmable processor to:

set a pacing parameter in an implantable medical device to a first setting; and

receive a hemodynamic datum from a second device external to the body of a patient while the pacing parameter is at the first setting.

40. A medium according to claim 39, wherein the hemodynamic datum comprises at least one of a stroke volume, a cardiac output, a heart rate.

41. A medium according to claim 39, the instructions further causing the processor to set the pacing parameter to a second setting as a function of the hemodynamic datum.

42. A medium according to claim 41, wherein the hemodynamic datum is a first hemodynamic datum, the instructions further causing the processor to receive a second hemodynamic datum from the second device while the pacing parameter is at the second setting.

43. A medium according to claim 39, wherein the pacing parameter comprises a pacing interval.

44. A medium according to claim 43, wherein the pacing interval comprises at least one of an A-V interval, a V-V interval, and an A-A interval.

45. A medium according to claim 39, wherein the instructions causing the processor to set the pacing parameter in the implantable medical device to the first setting comprise instructions causing the processor to transmit the pacing parameter setting to the implantable medical device.

46. A system comprising:

means for measuring at least one hemodynamic datum of a patient with a first external device;

means for programming at least one pacing parameter as a function of the at least one hemodynamic datum with a second external device; and

means for applying cardiac pacing therapy according to the at least one pacing parameter.

47. A system according to claim 46, wherein the means for applying cardiac pacing therapy comprises an implantable medical device.

48. A system according to claim 47, wherein the means for programming comprises wirelessly acquiring data from the means for measuring.

49. A system according to claim 48, wherein the means for measuring further comprises means for receiving at least one timing signal from the implantable medical device so that the means for measuring extracts a measurement during a predetermined period of time.

50. A system according to claim 46, wherein said at least one hemodynamic datum comprises at least a one of:

a stroke volume datum, a cardiac output datum, a heart rate datum, an ECG/EGM recording datum, a heart sound datum, a blood pressure datum, a blood flow datum, a temperature datum, a tissue impedance datum, a trans-thoracic impedance datum, a body fluid datum, a tissue fluid saturation datum, a circulation delay time datum, a cardiac tissue contractility index datum, a cardiac mechanical restitution datum, a recirculation fraction datum, an ejection fraction datum, an acceleration datum for a moving part of a heart, a volumetric datum.

51. A system according to claim 46, wherein said at least one pacing parameter comprises at least a one of:

a timed, device-related cardiac pacing interval;

a sensed, intrinsic cardiac interval;

a combination pacing/intrinsic interval;

a blanking period;

a refractory period;

a pacing threshold;

a defibrillation threshold;

a cardioversion threshold.