ACTIVE IMPLANTABLE MEDICAL DEVICE WITH BIVENTRICULAR PACING AND AUTOMATIC OPTIMIZATION OF PACING CONFIGURATION

• US 20060293715A1
• Filed: 06/21/2006
• Published: 12/28/2006
• Est. Priority Date: 06/22/2005
• Status: Active Grant

• Current Assignee: Sorin CRM SAS (MicroPort Scientific Corp.)
• Original Assignee: Ela Medical SAS (MicroPort Scientific Corp.)
• Inventors: RENESTO, Fabrizio, MARCELLI, Emanuela, PLICCHI, Gianni
• Granted Patent: US 7,664,547 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: A61N 1/3682 with a variable atrioventricular delay
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/3688 configured for switching the pacing mode, e.g. from AAI to DDD

Abstract

An active implantable medical device with biventricular pacing and automatic optimization of pacing configuration. The device collects and analyzes an endocardial acceleration signal (EA), and searches for an optimal pacing configuration based upon a performance index derived from at least one value relating to one and/or the other of the two endocardial acceleration peaks (PEA 1, PEA 11) over a given heart cycle. Optimization search operates through a scanning of a parameter, e.g., atrio-ventricular delay, and calculation of the surface area underneath the characteristic of the peak amplitude as a function of the scanned parameter (atrioventricular delay).

Claims

1. An active implantable medical device with biventricular pacing, comprising:

means for collecting a signal of endocardial acceleration (EA), and means for analyzing the EA signal, able to determine at least one peak value that is function of one and/or the other of two peaks of endocardial acceleration over one given cycle, said two peaks comprising a first peak during the isovolumetric ventricular contraction phase (PEA I) and a second peak during the isovolumetric ventricular relaxation (PEA II), and

means for helping to search for an optimal pacing configuration, said means further comprising assessing means, able to determine, for each pacing configuration, a respective performance index, that is derived from the peak value(s).

2. The device of claim 1, wherein:

said means for helping to search for an optimal pacing configuration, further comprise scanning means, able to vary, in a controlled manner, a functional parameter of the device, and

said assessing means further comprises means able to derive the performance index, based upon the successive values of the at least one peak value throughout the variation of the functional parameter.

3. The device of claim 2, wherein the functional parameter is the atrio-ventricular delay (AV Delay) separating a ventricular event, spontaneous or paced, consecutive to an atrial pacing event.

4. The device of claim 2, wherein the assessing means further comprises means able to derive the performance index from the value of a surface area defined underneath a characteristic of the at least one peak value as a function of the functional parameter.

5. The device of claim 1, wherein the at least one peak value is a value selected from among the group consisting of:

the amplitude of first peak, the duration of first peak, the time interval between first peak to the consecutive second peak, the time interval between the second peak and consecutive first peak, and a combination of said values.

6. The device of claim 1, further comprising:

means for modifying the pacing configuration, to evaluate among a plurality of different configurations, the one leading to the highest performance index, and to parameter the device according to that said one configuration.

7. The device of claim 6 wherein the pacing configuration modifying means further comprises means for selecting different pacing sites.

8. The device of claim 6, wherein the pacing configuration modifying means further comprises means for modifying the sequence of delivery of the pacing pulses to the different pacing sites.

9. The device of claim 6, wherein the pacing configuration modifying means further comprises means for modifying the time interval(s) separating the delivery of pacing pulses between different pacing sites.

10. An active implantable medical device with biventricular pacing, comprising:

means for detecting an endocardial acceleration (EA) signal, including a first peak during the isovolumetric ventricular contraction phase (PEA 1) and a second peak during the isovolumetric ventricular relaxation (PEA II) of a given cardiac cycle;

means for analyzing the detected EA signal, able to determine at least one peak value that is function of one of said first peak and said second peak; and

means for determining a performance index derived from said determined peak value for a given pacing configuration, wherein said determined performance index may vary from one given pacing configuration to a different given pacing configuration.

11. The device of claim 10, wherein:

said performance index determining means further comprise scanning means, able to vary, in a controlled manner, a functional parameter of the device, and

means for deriving the performance index, based upon the successive values of the at least one peak value throughout the variation of the functional parameter.

12. The device of claim 11, wherein the functional parameter further comprises an atrio-ventricular delay (AV Delay) separating a ventricular event, spontaneous or paced, consecutive to an atrial pacing event.

14. The device of claim 10, wherein the at least one peak value is a value selected from among the group consisting of:

the amplitude of first peak, the duration of first peak, the time interval between first peak to the consecutive second peak, the time interval between the second peak and consecutive first peak, and a combination of said values.

15. The device of claim 10, further comprising means for modifying the pacing configuration, to evaluate among a plurality of different configurations, the one corresponding to a relatively highest performance index.

16. The device of claim 15 further comprising means for configuring said device according to said one different pacing configuration corresponding to said highest performance index.

17. The device of claim 15, wherein the pacing configuration modifying means further comprises means for selecting among a number of different pacing sites.

18. The device of claim 15, wherein the pacing configuration modifying means further comprises means for modifying the sequence of delivery of the pacing pulses to the different pacing sites.

19. The device of claim 15, wherein the pacing configuration modifying means further comprises means for modifying the time interval(s) separating the delivery of pacing pulses between different pacing sites.

13. The device of claim 13, wherein the means for deriving the performance index further comprises means able to derive the performance index from the value of a surface area defined underneath a characteristic of the at least one peak value as a function of the functional parameter.