Devices and methods for accelerometer-based characterization of cardiac synchrony and dyssynchrony
First Claim
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1. A device for measuring cardiac dyssynchrony, comprising:
- a. a catheter having a tubular polymeric outer lumen configured for accessing the coronary sinus, the lumen having a proximal end and a distal end, such that when installed in a patient the distal end resides in the coronary sinus;
b. a second tubular polymeric lumen for receiving a guide wire;
c. an acceleration sensor disposed at the distal end of the outer lumen; and
d. at least one decoupling capacitor adjacent to said acceleration sensor.
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Abstract
Systems and methods according to the invention employ an acceleration sensor to characterize the synchrony or dyssynchrony of the left ventricle. Patterns of acceleration related to myocardial contraction can be used to assess synchrony or dyssynchrony. Time-frequency transforms and coherence are derived from the acceleration. Information and numerical indices determined from the acceleration time frequency transforms and coherence can be used to find the optimal pacing location for cardiac resynchronization therapy. Similarly, the information can be used to optimize timing intervals including V to V and A to V timing.
226 Citations
37 Claims
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1. A device for measuring cardiac dyssynchrony, comprising:
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a. a catheter having a tubular polymeric outer lumen configured for accessing the coronary sinus, the lumen having a proximal end and a distal end, such that when installed in a patient the distal end resides in the coronary sinus;
b. a second tubular polymeric lumen for receiving a guide wire;
c. an acceleration sensor disposed at the distal end of the outer lumen; and
d. at least one decoupling capacitor adjacent to said acceleration sensor. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10)
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11. A system for measuring dyssynchrony, comprising:
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a. a catheter with an acceleration sensor mounted in the distal region of the catheter;
b. a pacing device;
c. a microprocessor, said microprocessor programmed to convert acceleration patterns into one or more dyssynchrony indices; and
d. a display for showing acceleration patterns or dyssynchrony indices. - View Dependent Claims (12, 13, 14, 15, 16, 17, 18, 19)
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20. A method for measuring cardiac dyssynchrony, comprising:
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a. placing one 3-axis acceleration sensor for disposition within a patient'"'"'s coronary sinus;
b. wherein said sensor measures the global acceleration of the left ventricle;
c. and wherein said measured acceleration forms a pattern indicative of global dyssynchrony of the left ventricle. - View Dependent Claims (21, 22)
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23. A method for identifying an optimal pacing location, comprising:
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a. introducing an acceleration-measuring catheter into the coronary sinus of a patient;
b. measuring a baseline pattern of left ventricular myocardial acceleration;
c. placing a right ventricular pacing device in the right ventricle;
d. placing a left ventricular pacing device in or on the left ventricle;
e. moving the left ventricular pacing device to a plurality of locations in or on the left ventricle;
f. performing biventricular or left ventricular pacing at the plurality of locations with the left ventricular pacing device;
g. measuring the acceleration pattern with biventricular or left ventricular pacing;
h. determining a location of the left ventricle with a less dyssynchronous acceleration pattern; and
i. selecting the less dyssynchronous location to implant a CRT pacing lead. - View Dependent Claims (24, 25, 26, 27)
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28. A method for optimizing the V to V and A to V timing intervals, comprising:
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a. introducing an acceleration-measuring catheter into the coronary sinus of a patient;
b. measuring a baseline pattern of left ventricular myocardial acceleration;
c. placing a right ventricular pacing device in the right ventricle;
d. placing a left ventricular pacing device in or on the left ventricle;
e. moving the left ventricular pacing to a plurality of locations in or on the left ventricle;
f. performing biventricular pacing at the plurality of locations of the left ventricular pacing catheter;
g. measuring the acceleration pattern with biventricular pacing;
h. determining the location of pacing in or on the left ventricle with a less dyssynchronous acceleration pattern;
i. selecting the less dyssynchronous location to implant a CRT pacing lead;
j. varying the V to V timing intervals between a range of millisecond delays and selecting the timing that produces a less dyssynchronous acceleration pattern. - View Dependent Claims (29, 30, 33)
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31. A method for improving the outcome of CRT, comprising:
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a. placing a catheter with an acceleration sensor in the coronary sinus;
b. diagnosing the presence of dyssynchrony by measuring an acceleration pattern that characterizes dyssynchrony;
c. inserting a pacing guide wire;
d. test pacing with said pacing guide wire a plurality of locations in or on the left ventricle;
e. identifying locations with a less dyssynchronous acceleration pattern than that found in step b; and
f. implanting a left ventricular lead in said identified location. - View Dependent Claims (32, 34, 35)
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36. A method for measuring cardiac dyssynchrony, comprising:
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g. placing a 3-axis acceleration sensor for disposition within a patient'"'"'s coronary sinus;
h. measuring the global acceleration of the left ventricle with the sensor;
i. creating a time-frequency transform; and
j. using frequency or frequency energy data from said time-frequency transform to characterize dyssynchrony.
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37. A method for measuring cardiac dyssynchrony, comprising:
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k. placing a 3-axis acceleration sensor for disposition within a patient'"'"'s coronary sinus l. measuring the global acceleration of the left ventricle with the sensor;
m. using the acceleration data to create a measure of coherence; and
n. characterizing dyssynchony using the coherence.
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Specification