Pacing system analyzer having three sensing and pacing channels

• US 20060253155A1
• Filed: 05/09/2005
• Published: 11/09/2006
• Est. Priority Date: 05/09/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Mass, William R., Dingman, Phillip, Axelrod, Jay, Krishnan, Radhakrishnan, Childs, Jeff, Kovtun, Vladimir
• Granted Patent: US 7,590,447 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• CPC Class Codes: A61N 1/37 Monitoring; Protecting
• CPC Class Codes: A61N 1/372 Arrangements in connection with the implantation of stimulators
• CPC Class Codes: G16H 40/63 for local operation

Abstract

A pacing system analyzer (PSA) having three or more individually controllable sensing and pacing channels provides for testing and measurement during an operation for implanting a pacemaker having three or more sensing and pacing channels. The PSA allows control and adjustment of pacing parameters including cross-channel pacing parameters relating activities between any two of the three or more channels, such as atrioventricular and interventricular pacing delays. The PSA is also capable of, among other things, displaying real-time cardiac signals, measuring amplitude and slew rate of cardiac depolarizations, and measuring lead impedance for each of the sensing and pacing channels, as well as measuring time intervals between cardiac depolarizations in two different sensing and pacing channels. In one embodiment, the PSA includes individually controllable atrial, right ventricular (RV), and left ventricular (LV) sensing and pacing channels.

Claims

1. A pacing system analyzer, comprising:

a first sensing and pacing channel including a first sensing circuit to sense a first cardiac signal indicative of first cardiac events and a first pacing circuit to deliver first pacing pulses;

a second sensing and pacing channel including a second sensing circuit to sense a second cardiac signal indicative of second cardiac events and a second pacing circuit to deliver second pacing pulses;

a third sensing and pacing channel including a third sensing circuit to sense a third cardiac signal indicative of third cardiac events and a third pacing circuit to deliver third pacing pulses;

a pacing control circuit coupled to the first, second, and third sensing and pacing circuit, the pacing control circuit adapted to control the delivery of one or more of the first, second and third pacing pulses using a plurality of pacing parameters including user-programmable pacing parameters;

a housing adapted to enclose the first, second, and third sensing and pacing channels and the pacing control circuit; and

a user interface electrically connected to the pacing control circuit, the user interface including;

a pacing parameter input adapted to allow programming of the user-programmable pacing parameters; and

a presentation device including a display screen adapted to display the first, second, and third cardiac signals in real time.

2. The pacing system analyzer of claim 1, further comprising a conduction interval measurement circuit, coupled to the first, second and third sensing and pacing channels and enclosed in the housing, to measure one or more conduction intervals each being a time interval between two cardiac events selected from the first, second, and third cardiac events.

3. The pacing system analyzer of claim 2, wherein the conduction interval measurement circuit comprises at least two of:

a first conduction interval measurement circuit to measure a first conduction interval being a time interval between one of the first cardiac events and one of the second cardiac events;

a second conduction interval measurement circuit to measure a second conduction interval being a time interval between one of the first cardiac events and one of the third cardiac events; and

a third conduction interval measurement circuit to measure a third conduction interval being a time interval between one of the second cardiac events and one of the third cardiac events.

4. The pacing system analyzer of claim 3, wherein the display screen is adapted to display one or more intervals of the first, second, and third conduction intervals in addition to the first, second, and third cardiac signals.

5. The pacing system analyzer of claim 3, wherein the pacing parameter input comprises at least two of:

a first cross-channel pacing delay input adapted to allow adjustment of a first cross-channel pacing delay being a pacing delay interval between the first sensing and pacing channel and the second sensing and pacing channel;

a second cross-channel pacing delay input adapted to allow adjustment of a second cross-channel pacing delay being a pacing delay interval between the first sensing and pacing channel and the third sensing and pacing channel; and

a third cross-channel pacing delay input adapted to allow adjustment of a third cross-channel pacing delay being a pacing delay interval between the second sensing and pacing channel and the third sensing and pacing channel.

6. The pacing system analyzer of claim 1, further comprising a lead impedance measurement circuit, coupled to the first, second and third sensing and pacing channels, to measure one or more lead impedance values each associated with one of the first, second and third sensing and pacing channels.

7. The pacing system analyzer of claim 6, wherein the display screen is adapted to display the one or more lead impedance values in addition to the first, second, and third cardiac signals.

8. The pacing system analyzer of claim 1, further comprising a cardiac event measurement circuit, coupled to the first, second and third sensing and pacing channels and enclosed in the housing, to measure one or more event parameters each associated with one of the first, second, and third cardiac events.

9. The pacing system analyzer of claim 8, wherein the cardiac event measurement circuit comprises an amplitude measurement circuit to measure one or more amplitudes each associated with the one of the first, second, and third cardiac events.

10. The pacing system analyzer of claim 9, wherein the cardiac event measurement circuit further comprises a slew rate measurement circuit to measure one or more slew rates each associated with the one of the first, second, and third cardiac events.

11. The pacing system analyzer of claim 10, wherein the display screen is adapted to display one or more of the one or more amplitudes and the one or more slew rates in addition to the first, second, and third cardiac signals.

12. The pacing system analyzer of claim 1, further comprising:

a cardiac event detection circuit, coupled to the first, second and third sensing and pacing channels and enclosed in the housing, to detect the first, second, and third cardiac events; and

an event marker generator, coupled to the cardiac event detection circuit and the pacing control circuit, to produce sense markers each indicative of a detection of one cardiac event of the first, second, and third cardiac events and pace markers each indicative of a delivery of one pacing pulse of the first, second, and third pacing pulses,

and wherein the display screen is adapted to display the sense markers and the pace markers along with the first, second, and third cardiac signals.

13. The pacing system analyzer of claim 12, wherein the presentation devices further comprises a plurality of light-emitting diodes indicative of the first, second, and third cardiac events and the first, second, and third pacing pulses

14. The pacing system analyzer of claim 1, further comprising a surface electrocardiogram (ECG) sensing circuit to sense one or more surface ECG signals, and wherein the display screen is adapted to display the one or more surface ECG signals with the first, second, and third cardiac signals.

15. A pacing system analyzer, comprising:

an atrial sensing and pacing channel including an atrial sensing circuit to sense an atrial electrogram indicative of atrial depolarizations and an atrial pacing circuit to deliver atrial pacing pulses;

a right ventricular (RV) sensing and pacing channel including an RV sensing circuit to sense an RV electrogram indicative of RV depolarizations and an RV pacing circuit to deliver RV pacing pulses;

a left ventricular (LV) sensing and pacing channel including an LV sensing circuit to sense an LV electrogram indicative of LV depolarizations and an LV pacing circuit to deliver LV pacing pulses;

a pacing control circuit to control the atrial pacing circuit, the RV pacing circuit, and LV pacing circuit using a plurality of pacing parameters including user-programmable pacing parameters, the pacing control circuit including a pacing algorithm execution module to control the delivery of one or more of the atrial, RV and LV pacing pulses by executing a predetermined biventricular pacing algorithm;

a housing adapted to enclose the atrial, RV, and LV sensing and pacing channels and the pacing control circuit; and

a user interface electrically connected to the pacing control circuit, the user interface including a pacing parameter input adapted to allow adjustment of the user-programmable pacing parameters, the pacing parameter input adapted to allow programming of an interventricular delay being an offset interval between a delivery of one of the RV pacing pulses and a delivery of one of the LV pacing pulses.

16. The pacing system analyzer of claim 15, wherein the pacing algorithm execution module comprises a cardiac resynchronization therapy pacing algorithm execution module to executing a cardiac resynchronization therapy pacing algorithm.

17. The pacing system analyzer of claim 16, wherein the pacing parameter input comprises an atrioventricular delay input adapted to allow adjustment of an atrioventricular delay for timing the delivery of the RV or LV pacing pulses and an interventricular delay input adapted to allow adjustment of the interventricular delay.

18. The pacing system analyzer of claim 16, wherein the pacing parameter input comprises a first atrioventricular delay input adapted to allow adjustment of a first atrioventricular delay for timing a delivery of one of the RV pacing pulses after one of the atrial depolarizations and a second atrioventricular delay input adapted to allow adjustment of a second atrioventricular delay a second atrioventricular delay for timing a delivery of one of the LV pacing pulses after one of the atrial depolarizations.

19. The pacing system analyzer of claim 16, further comprising a conduction interval measurement circuit, coupled to the atrial, RV, and LV sensing and pacing channels and enclosed in the housing, to measure conduction intervals each being a time interval between two cardiac events selected from the atrial depolarizations, the RV depolarizations, and the LV depolarizations.

20. The pacing system analyzer of claim 19, wherein the conduction interval measurement circuit comprises:

a first atrioventricular interval measurement circuit to measure a first atrioventricular interval being a time interval between one of the atrial depolarizations and one of the RV depolarizations;

a second atrioventricular interval measurement circuit to measure a second atrioventricular interval being a time interval between one of the atrial depolarizations and one of the LV depolarizations; and

an interventricular interval measurement circuit to measure an interventricular interval being a time interval between one of the RV depolarizations and one of the LV R-values.

21. The pacing system analyzer of claim 20, further comprising:

a depolarization detection circuit, coupled to the atrial, RV, and LV sensing and pacing channels and enclosed in the housing, to detect the atrial, RV, an LV depolarizations; and

an event marker generator to produce sense markers each indicative of a detection of one the atrial events, RV events, and LV events and pace markers each indicative of a delivery of a pacing pulse of the atrial, RV, and LV pacing pulses,

and wherein the user interface comprises a display screen to display the atrial, RV, and LV electrograms in real time, along with the sense markers and the pace markers.

22. The pacing system analyzer of claim 21, further comprising a lead impedance measurement circuit, coupled to the atrial, RV, and LV sensing and pacing channels and enclosed in the housing, to measure lead impedance values each associated with one of the atrial, RV, and LV sensing and pacing channels.

23. The pacing system analyzer of claim 22, further comprising a depolarization parameter measurement circuit, coupled to the atrial, RV, and LV sensing and pacing channels and enclosed in the housing, to measure one or more depolarization parameters each associated with one of the atrial depolarizations, the RV depolarizations, and the LV depolarizations.

24. The pacing system analyzer of claim 23, wherein the user interface comprises a display screen adapted to display one or more of the atrial electrogram, the RV electrogram, the LV electrogram, the sense markers, the pace markers, the conduction intervals, the lead impedance values, and the one or more depolarization parameters.

25. The pacing system analyzer of claim 24, further comprising a surface electrocardiogram (ECG) sensing circuit to sense one or more surface ECG signals, and wherein the display screen is adapted to display one or more of the one or more surface ECG signals, the atrial electrogram, the RV electrogram, the LV electrogram, the sense markers, the pace markers, the conduction intervals, the lead impedance values, and the one or more depolarization parameters.

26. A method for operating a pacing system analyzer (PSA), the method comprising:

sensing cardiac signals including a first cardiac signal indicative of first cardiac events using a first sensing and pacing channel of the PSA, a second cardiac signal indicative of second cardiac events using a second sensing and pacing channel of the PSA, and a third cardiac signal indicative of third cardiac events using a third sensing and pacing channel of the PSA;

controlling a delivery of pacing pulses by executing a predetermined pacing algorithm using a plurality of pacing parameters including user-programmable pacing parameters, the delivery of pacing pulses including one or more of a delivery of first pacing pulses using the first sensing and pacing channel of the PSA, a delivery of second pacing pulses using the second sensing and pacing channel of the PSA, and a delivery of third pacing pulses using the third sensing and pacing channel of the PSA; and

measuring a plurality of lead impedance values each associated with one of the first, second, and third sensing and pacing channels, a plurality of event parameters each associated with one of the first, second, and third cardiac events, and a plurality of conduction intervals using the PSA, the conduction intervals each being a time interval between two cardiac events selected from two of the first, second, and third cardiac events.

27. The method of claim 26, further comprising:

detecting the first, second, and third cardiac events;

producing sense markers each indicative of a detection of one cardiac event of the first, second, and third cardiac events and pace markers each indicative of a delivery of one pacing pulse of the first, second, and third pacing pulses;

displaying the first, second, and third cardiac signals in real time using a display screen of the PSA; and

displaying the sense markers and pace markers along with the first, second, and third cardiac signals using the display screen.

28. The method of claim 27, further comprising controlling a plurality of light-emitting diodes (LEDs) mounted on the PSA, the LEDs each corresponding to one of the sense markers and pace markers.

29. The method of claim 26, wherein measuring the plurality of event parameters comprises measuring one or more amplitudes each associated with one the first cardiac events, the second cardiac events, and the third cardiac events and one or more slew rates each associated with one of the first cardiac events, the second cardiac events, and the third cardiac events.

30. The method of claim 29, wherein measuring the plurality of lead impedance values comprises measuring lead impedance values associated with the first, second, and third sensing and pacing channels concurrently.

31. The method of claim 26, wherein measuring the plurality of conduction intervals comprises two or more of:

measuring a first conduction interval being a time interval between one of the first cardiac events and one of the second cardiac events;

measuring a second conduction interval being a time interval between one of the first cardiac events and one of the third cardiac events; and

measuring a third conduction interval being a time interval between one of the second cardiac events and one of the third cardiac events.

32. The method of claim 31, furthering comprising receiving the user-programmable pacing parameters including two or more of:

a first cross-channel pacing delay being a pacing delay interval between the first sensing and pacing channel and the second sensing and pacing channel;

a second cross-channel pacing delay being a pacing delay interval between the first sensing and pacing channel and the third sensing and pacing channel; and

a third cross-channel pacing delay being a pacing delay interval between the second sensing and pacing channel and the third sensing and pacing channel.

33. A method for operating a pacing system analyzer (PSA), the method comprising:

sensing an atrial electrogram indicative of atrial depolarizations using an atrial sensing and pacing channel of the PSA, a right ventricular (RV) electrogram indicative of RV depolarizations using an RV sensing and pacing channel of the PSA, and a left ventricular (LV) electrogram indicative of LV depolarizations using an LV sensing and pacing channel of the PSA;

controlling a delivery of pacing pulses using a plurality of pacing parameters including user-programmable pacing parameters, the delivery of pacing pulses including one or more of a delivery of atrial pacing pulses using the atrial sensing and pacing channel of the PSA, a delivery of RV pacing pulses using the RV sensing and pacing channel of the PSA, and a delivery of LV pacing pulses using the LV sensing and pacing channel of the PSA;

measuring a plurality of conduction intervals using the PSA, the conduction intervals each being a time interval between two depolarizations selected from two of the atrial depolarizations, the RV depolarizations, and LV depolarizations; and

displaying the atrial electrogram, the RV electrogram, the LV electrogram, and the measured conduction intervals using a display screen of the PSA.

34. The method of claim 33, wherein measuring the plurality of conduction intervals comprises two or more of:

measuring a first conduction interval being a time interval between one of the atrial depolarizations and one of the RV depolarizations;

measuring a second conduction interval being a time interval between one of the atrial depolarizations and one of the LV depolarizations;

measuring a third conduction interval being a time interval between one of the RV depolarizations and one of the LV depolarizations.

35. The method of claim 34, wherein controlling the delivery of pacing pulses comprises executing a cardiac resynchronization therapy pacing algorithm.

36. The method of claim 35, further comprising receiving and storing values of the user-programmable pacing parameters including atrioventricular and interventricular pacing delays.

37. The method of claim 33, further comprising measuring a plurality of lead impedance values using the PSA, the lead impedance values each associated with one of the atrial, RV, and LV sensing and pacing channels.

38. The method of claim 37, further comprising measuring a plurality of event parameters using the PSA, the event parameters each associated with one of the atrial depolarizations, the RV depolarizations, and LV depolarizations.

39. The method of claim 38, wherein measuring the plurality of event parameters comprises:

measuring a plurality of amplitudes each associated with one the atrial depolarizations, the RV depolarizations, and LV depolarizations; and

measuring a plurality of slew rates each associated with one of the atrial depolarizations, the RV depolarizations, and LV depolarizations.

40. The method of claim 38, further comprising displaying one or more of the measured lead impedance values and the measured event parameters using the display screen of the PSA.