Method and apparatus for determining excitation-physiologic response delays

• US 20070179541A1
• Filed: 01/31/2006
• Published: 08/02/2007
• Est. Priority Date: 01/31/2006
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Chinchoy, Edward, Mullen, Thomas, Prakash, Rajan
• Granted Patent: US 7,672,715 B2
• 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 1/36542 controlled by body motion, e.g. acceleration
• 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

Abstract

An implantable medical device system and associated method are provided for measuring an excitation-physiological response delay. The method includes sensing a first signal responsive to electrical activity in a first cardiac chamber, sensing a second signal responsive to a physiologic response to the electrical activity in the first cardiac chamber; and determining an excitation-physiologic response delay in response to the first signal and the second signal.

Claims

1. A method for use in an implantable medical device system, comprising:

sensing a first signal responsive to electrical activity in a first cardiac chamber;

sensing a second signal responsive to a physiologic response to the electrical activity in the first cardiac chamber; and

determining an excitation-physiologic response delay in response to the first signal and the second signal.

2. A method according to claim 1 wherein the first cardiac chamber is a first atrial chamber and wherein the second signal is a ventricular wall acceleration signal and wherein determining the excitation-physiologic response delay includes sensing an atrial electrical event in response to the first signal, sensing an atrial mechanical response to the atrial electrical event in response to the second signal, and determining a time interval between the atrial electrical event and the atrial mechanical response.

3. A method according to claim 2 wherein the atrial mechanical event occurs in a second atrial chamber.

4. A method according to claim 1 wherein the first cardiac chamber is a first ventricular chamber and wherein the second signal is a ventricular wall acceleration signal and wherein determining the excitation-physiologic response delay includes sensing a ventricular electrical event in response to the first signal, sensing a ventricular mechanical response to the ventricular electrical event in response to the second signal, and determining a time interval between the ventricular electrical event and the ventricular mechanical response.

5. A method according to claim 4 wherein the ventricular mechanical response to the electrical activity in the first ventricular chamber occurs in a second ventricular chamber.

6. A method according to claim 1 wherein sensing the first signal includes detecting one of an electrical depolarization signal feature and an electrical repolarization signal feature.

7. A method according to claim 1 wherein sensing the second signal includes sensing a signal responsive to one of a ventricular wall acceleration, a blood pressure, a blood chemistry, or an impedance.

8. A method according to claim 1 wherein determining the excitation-physiologic response delay includes averaging the second signal over a number of cardiac cycles.

9. A method according to claim 8 wherein determining the excitation-physiologic response delay includes determining a second signal template wherein determining the second signal template includes:

sensing the second signal during a plurality of atrial-ventricular (AV) delays, indexing the second signal sensed during the plurality of AV delays in time, and averaging the indexed second signal.

10. A method according to claim 9 wherein indexing the second signal includes aligning the second signal with a feature of the first signal.

11. A method according to claim 9 wherein determining the excitation-physiologic response delay includes subtracting the second signal template from the sensed second signal.

12. A method according to claim 1 further including determining an optimal atrial-ventricular (AV) delay in response to the excitation-physiologic response delay.

13. A method according to claim 12 wherein determining the optimal AV delay includes estimating an atrial contraction end time based on the determined excitation-physiological response delay.

14. A method according to claim 12 wherein determining an optimal AV delay includes determining a ventricular electromechanical delay.

15. A computer-readable medium for storing a set of instructions which when implemented in an implantable medical device cause the device to:

sense a first signal responsive to electrical activity in a first cardiac chamber;

sense a second signal responsive to a physiologic response to the electrical activity in the first cardiac chamber; and

determine an excitation-physiologic response delay in response to the first signal and the second signal.

16. An implantable medical device system, comprising:

a first sensor for sensing a first signal responsive to electrical activity in a first cardiac chamber;

a second sensor for sensing a second signal responsive to a physiologic response to the electrical activity in the first cardiac chamber; and

a processor for determining an excitation-physiologic response delay in response to the first sensor signal and the second sensor signal.

17. A system according to claim 16 wherein the first cardiac chamber is a first atrial chamber, the second signal is ventricular wall acceleration signal and wherein determining the excitation-physiologic response delay includes sensing an atrial electrical event in response to the first signal, sensing an atrial mechanical response to the atrial electrical event in response to the second signal, and determining a time interval between the atrial electrical event and the atrial mechanical response.

18. A system according to claim 17 wherein the atrial mechanical event occurs in a second atrial chamber.

19. A method according to claim 16 wherein the first cardiac chamber is a first ventricular chamber and wherein the second signal is a ventricular wall acceleration signal and wherein determining the excitation-physiologic response delay includes sensing a ventricular electrical event in response to the first signal, sensing a ventricular mechanical response to the ventricular electrical event in response to the second signal, and determining a time interval between the ventricular electrical event and the ventricular mechanical response.

20. A system according to claim 19 wherein the ventricular mechanical response to the electrical activity in the first ventricular chamber occurs in a second ventricular chamber.

21. A system according to claim 16 wherein sensing the first signal includes detecting one of an electrical depolarization signal feature and an electrical repolarization signal feature.

22. A system according to claim 16 wherein sensing the second signal includes sensing a signal responsive to one of a ventricular wall acceleration, a blood pressure, a blood chemistry, or an impedance.

23. A system according to claim 16 wherein determining the excitation-physiologic response delay includes averaging the second signal over a number of cardiac cycles.

24. A system according to claim 23 wherein determining the excitation-physiologic response delay includes determining a second signal template wherein determining the second signal template includes:

sensing the second signal during a plurality of atrial-ventricular (AV) delays, indexing the second signal sensed during the plurality of AV delays in time, and averaging the indexed second signal.

25. A system according to claim 24 wherein indexing the second signal includes aligning the second signal with a feature of the first signal.

26. A system according to claim 24 wherein determining the excitation-physiologic response delay includes subtracting the second signal template from the sensed second signal.

27. A system according to claim 16 wherein the processor further determines an optimal atrial-ventricular (AV) delay in response to the excitation-physiologic response delay.

28. A system according to claim 27 wherein determining the optimal AV delay includes estimating an atrial contraction end time based on the determined excitation-physiological response delay.

29. A system according to claim 27 wherein determining an optimal AV delay includes determining a ventricular electromechanical delay.

30. A method for use in an implantable medical device system, comprising:

sensing a first signal responsive to electrical activity in a first cardiac chamber;

sensing a second signal responsive to a physiologic response to the electrical activity in the first cardiac chamber during a plurality of atrial-ventricular (A-V) delays;

time-indexing the second signal during the plurality of AV delays to a selected feature of the first signal; and

determining a second signal template by averaging the time-indexed second signal.