Apparatus and methods for cardiac resynchronization therapy and cardiac contractility modulation

• US 20070060962A1
• Filed: 06/29/2006
• Published: 03/15/2007
• Est. Priority Date: 07/26/2005
• Status: Abandoned Application

• Current Assignee: Carlo Pappone
• Original Assignee: Carlo Pappone
• Inventors: Pappone, Carlo
• Application Number:
  US11/478,442
• Publication Number:
  US 20070060962A1
• Time in Patent Office: Days
• US Class Current: 607/9
• 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 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 1/372 Arrangements in connection with the implantation of stimulators

Abstract

A method of placing and testing placement of a plurality of pacing and stimulation leads for cardiac resynchronization therapy (CRT) employs cardiac contractility modulation (CCM), using a plurality of cardiac contractility modulation leads placed at a plurality of sites.

Claims

1. A method of placing and testing placement of a plurality of pacing and stimulation leads for cardiac resynchronization therapy (CRT) employing cardiac contractility modulation (CCM), where a plurality of cardiac contractility modulation (CCM) leads are placed at a plurality of sites.

2. The method of claim 1 where a bipolar CCM stimulation lead is placed in the right atrium.

3. The method of claim 1 where a bipolar pacing/sensing lead is placed in the right ventricle.

4. The method of claim 1 where a bipolar CCM stimulation lead is placed on the high-mid right anterior ventricular septum.

8. The method of claim 4 where the high-mid right anterior ventricular septal bipolar CCM stimulation lead is a screw-in lead.

13. The method of claim 1, where at least one of the CCM leads is stimulated using a bi-phasic square wave pulse with a pulse duration of less than about 65 ms.

14. The method of claim 1, where at least one of the CCM leads is stimulated using a bi-phasic square wave pulse with a voltage amplitude of less than about 10 V.

16. The method of claim 1, where the stimulation with at least one of the CCM leads is delivered in the post-local activation refractory period at its placement site about 20-50 ms post-local activation.

5-7. -7. (canceled)

9-12. -12. (canceled)

15. (canceled)

17-19. -19. (canceled)

20. A programmable pulse generator device with analyzer that can stimulate a plurality of sites sequentially with a programmable delay for sequential stimulation during the local refractory period for evaluating a plurality of cardiac contractility modulation lead placement sites.

22. The pulse generator of claim 20, where the pulse output delivers between about 3 mA and about 20 mA of current.

23. The pulse generator of claim 20, where the pulse duration is less than about 60 ms.

24. The pulse generator of claim 20, where the pulse voltage amplitude is less than about 10 V.

25. The pulse generator of claim 20, where the pulse is delivered in the post-local activation refractory period.

26. The pulse generator of claim 20, where the pulse is delivered in the post-local activation refractory period about 20-50 ms post-local activation.

59. The programmable pulse generator of claim 20 further comprising one or more cardiac resynchronization therapy (CRT) leads and a plurality of bipolar cardiac contractility modulation (CCM) leads that are adapted to be positioned in a plurality of cardiac sites, wherein the pulse generator device is configured to stimulate one or more of the sites via the leads during a local refractory period.

60. The apparatus of claim 59, wherein the pulse generator device is configured to pace right atrium, right ventricle and left ventricle sites.

61. The apparatus of claim 59, wherein the pulse generator device is configured to evaluate CRT and CCM sites in the same evaluation.

21. (canceled)

27-55. -55. (canceled)

56. A method of stimulating sites in the heart of a patient, the method comprising:

placing CCM stimulation leads in the right atrium and right ventricle;

placing a CCM stimulation lead in the high-mid right anterior ventricular septum or in the anterior medial area of the left coronary venous system;

placing CCM stimulation leads in the posterior area of the left coronary venous system and lateral area of the left coronary venous system;

placing one or more CRT leads in the coronary sinus venous vasculature; and

selectively applying signals to the heart through the leads.

57. The method of claim 56, wherein one or more of the CCM leads are bipolar.

58. The method of claim 56, wherein placing a CCM stimulation lead in the high-mid right anterior ventricular septum or the anterior medial area of the left coronary venous system comprises screwing in the lead.

62. (canceled)