METHOD AND APPARATUS FOR PREDICTING ACUTE RESPONSE TO CARDIAC RESYNCHRONIZATION THERAPY

• US 20080097542A1
• Filed: 12/21/2007
• Published: 04/24/2008
• Est. Priority Date: 03/30/2001
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Auricchio, Angelo, Yu, Yinghong, Ding, Jiang, Spinelli, Julio
• Granted Patent: US 8,170,652 B2
• Time in Patent Office: Days
• US Class Current: 607/25
• 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 1/3682 with a variable atrioventricular delay

Abstract

A method and apparatus for predicting acute response to cardiac resynchronization therapy is disclosed. The method can comprise measuring a first interval during an intrinsic systolic cycle and measuring a second interval during a stimulated systolic cycle. The acute response can be predicted by comparing the percent change in duration between the first interval and the second interval against a pre-determined threshold value. The first and second time intervals can be measured using, for example, a surface ECG or, alternatively, an intracardiac electrogram. In one embodiment, the first interval can be the duration of an intrinsic QRS complex measured during a non-stimulated systolic cycle. Similarly, the second interval can be the duration of a stimulated QRS complex measured during a stimulated systolic cycle.

Claims

1. A method for predicting acute response to cardiac resynchronization therapy, comprising:

delivering ventricular pacing to a selected stimulation site at a specified AV delay with respect to an atrial sense or pace;

varying the specified AV delay used to deliver the ventricular pacing over a plurality of cardiac cycles;

measuring the duration of ventricular depolarization for different specified AV delays; and

,

classifying the stimulation site as non-responsive to cardiac resynchronization therapy if the variation in the duration of ventricular depolarization for the different specified AV delays exceeds a specified threshold.

2. The method of claim 1 wherein the duration of ventricular depolarization is measured as the QRS width in a surface electrocardiogram.

3. The method of claim 1 wherein the duration of ventricular depolarization is measured from an intra-cardiac electrogram.

4. The method of claim 1 further comprising delivering ventricular pacing to a plurality of stimulation sites at the specified AV delay during a cardiac cycle and classifying the plurality of stimulation sites as non-responsive to cardiac resynchronization therapy if the variation in the duration of ventricular depolarization for the different specified AV delays exceeds a specified threshold.

5. The method of claim 1 further comprising predicting the acute response to cardiac resynchronization therapy of a plurality of stimulation sites and selecting the stimulation site that exhibits the least variation in the duration of ventricular depolarization for the different specified AV delays for delivering cardiac resynchronization therapy.

6. A system for predicting a patient'"'"'s acute response to cardiac resynchronization therapy, comprising:

an implantable cardiac device configured to deliver ventricular pacing at a specified AV delay with respect to an atrial sense or pace;

an external programmer in communication with the implantable cardiac device;

wherein the external programmer is configured to;

transmit commands to the implantable cardiac device that vary the specified AV delay used to deliver the ventricular pacing over a plurality of cardiac cycles;

measure the duration of ventricular depolarization for different specified AV delays; and

,

classify the patient as a non-responder to cardiac resynchronization therapy if the variation in the duration of ventricular depolarization for the different specified AV delays exceeds a specified threshold.

7. The system of claim 6 further comprising a surface electrocardiogram apparatus and wherein the duration of ventricular depolarization is measured as the QRS width in a surface electrocardiogram.

8. The system of claim 6 wherein the duration of ventricular depolarization is measured from an intra-cardiac electrogram detected by the implantable cardiac device.

9. The system of claim 6 wherein the implantable cardiac device is configured to deliver ventricular pacing to a plurality of stimulation sites at the specified AV delay during a cardiac cycle and wherein the external programmer is configured to classify the plurality of stimulation sites as non-responsive to cardiac resynchronization therapy if the variation in the duration of ventricular depolarization for the different specified AV delays exceeds a specified threshold.

10. The system of claim 6 wherein the external programmer is configured to predict the acute response to cardiac resynchronization therapy of a plurality of stimulation sites and select the stimulation site that exhibits the least variation in the duration of ventricular depolarization for the different specified AV delays for delivering cardiac resynchronization therapy.

11. A device for delivering cardiac resynchronization therapy, comprising:

circuitry for detecting cardiac electrical activity;

circuitry for delivering ventricular pacing at a specified AV delay with respect to an atrial sense or pace;

circuitry for varying the specified AV delay used to deliver the ventricular pacing over a plurality of cardiac cycles;

circuitry for measuring the duration of ventricular depolarization for different specified AV delays; and

,

circuitry for classifying the patient as a non-responder to cardiac resynchronization therapy if the variation in the duration of ventricular depolarization for the different specified AV delays exceeds a specified threshold.

12. The device of claim 11 wherein the duration of ventricular depolarization is measured from an intra-cardiac electrogram detected by the implantable cardiac device.

13. The device of claim 11 wherein the device is configured to deliver ventricular pacing to a plurality of stimulation sites at the specified AV delay during a cardiac cycle and configured to classify the plurality of stimulation sites as non-responsive to cardiac resynchronization therapy if the variation in the duration of ventricular depolarization for the different specified AV delays exceeds a specified threshold.

14. The device of claim 11 wherein the device is configured to predict the acute response to cardiac resynchronization therapy of a plurality of stimulation sites and select the stimulation site that exhibits the least variation in the duration of ventricular depolarization for the different specified AV delays for delivering cardiac resynchronization therapy.