Cardiac resynchronization therapy optimization using cardiac activation sequence information

• US 20080119903A1
• Filed: 11/17/2006
• Published: 05/22/2008
• Est. Priority Date: 11/17/2006
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Zhang, Yi, Dong, Yanting, Yu, Yinghong, Ding, Jiang, Arcot-Krishnamurthy, Shantha
• Granted Patent: US 8,725,255 B2
• Time in Patent Office: Days
• US Class Current: 607/17
• CPC Class Codes: A61B 5/341 Vectorcardiography [VCG]
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/353 Detecting P-waves
• CPC Class Codes: A61B 5/358 Detecting ST segments
• 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 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/36535 controlled by body position or posture
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration

Abstract

Systems and methods provide for pacing a heart to improve pumping efficiency of the heart, such as by producing a cardiac fusion response for patient'"'"'s subject to cardiac resynchronization therapy. A pacing parameter, such as an A-V delay, V-V delay, lead/electrode configuration or vector, is adjusted and a cardiac signal vector representative of all or a portion of one or more cardiac activation sequences is monitored during pacing parameter adjustment. A change in a characteristic of the cardiac signal vector is detected in response to an adjusted pacing parameter, the change indicative of a cardiac fusion response. A pacing therapy may be delivered to produce the cardiac fusion response using the adjusted pacing parameter.

Claims

1. A method of pacing a heart to produce a fusion response, comprising:

obtaining a cardiac signal vector associated with all or a portion of one or more cardiac activation sequences;

adjusting one or more pacing parameters and monitoring the cardiac signal vector during pacing parameter adjustment;

detecting a change in a characteristic of the cardiac signal vector in response to the one or more adjusted pacing parameters, the change indicative of a cardiac fusion response; and

delivering a pacing therapy to produce the cardiac fusion response using the one or more adjusted pacing parameters.

2. The method of claim 1, wherein the one or more pacing parameters comprises at least an A-V delay parameter.

3. The method of claim 1, wherein the one or more pacing parameter comprises at least a V-V delay parameter.

4. The method of claim 1, wherein the one or more pacing parameter comprises at least one of a pacing lead configuration, a pacing electrode configuration, or a pacing vector.

5. The method of claim 1, wherein detecting the change in the cardiac signal vector characteristic comprises a change in an angle of the cardiac signal vector.

6. The method of claim 1, wherein detecting the change in the cardiac signal vector characteristic comprises a change in a magnitude of the cardiac signal vector.

7. The method of claim 1, wherein the change in the cardiac signal vector characteristic indicative of the cardiac fusion response is detected for a range of pacing parameter values or a set of pacing parameters, and the pacing therapy is delivered using the adjusted pacing parameter falling within the range of pacing parameter values or selected from the set of pacing parameters.

8. The method of claim 1, wherein detecting the change in cardiac signal vector characteristic comprises detecting a change in one or both of intrinsic cardiac activation and therapy-initiated cardiac activation.

9. The method of claim 1, further comprising:

detecting a change in a cardiac signal vector indicative of intrinsic cardiac activation relative to a baseline;

repeating the obtaining, adjusting, and detecting processes in response to the detected change from baseline; and

storing the adjusted pacing parameter for subsequent pacing therapy delivery.

10. The method of claim 9, wherein the repeating and storing processes are initiated in response to local or remote user input.

11. The method of claim 9, wherein the repeating and storing processes are initiated automatically.

12. The method of claim 1, further comprising:

detecting a change in a cardiac signal vector indicative of therapy-initiated cardiac activation relative to a first baseline and absence of change in a cardiac signal vector indicative of intrinsic cardiac activation relative to a second baseline; and

in response to the detected change, adjusting the pacing parameter to produce the cardiac fusion response for subsequent pacing therapy delivery.

13. The method of claim 12, further comprising accessing a look-up table of pacing parameters established by prior implementation of the obtaining, adjusting, and detecting processes, the adjusted pacing parameter selected from the look-up table.

14. The method of claim 1, wherein the pacing therapy comprises a cardiac resynchronization therapy.

15. A system, comprising:

a plurality of electrodes configured for at least sensing cardiac electrical activity and energy delivery;

a signal processor coupled to the electrodes and configured to produce a cardiac signal vector associated with all or a portion of one or more cardiac activation sequences; and

a controller coupled to the electrodes and the signal processor, the controller configured to adjust a pacing parameter and detect a change in a characteristic of the cardiac signal vector in response to an adjusted pacing parameter, the change indicative of a cardiac fusion response.

16. The system of claim 15, wherein the controller is configured to deliver a pacing therapy to produce the cardiac fusion response using the adjusted pacing parameter.

17. The system of claim 15, wherein the controller is disposed within an implantable housing, a patient-external housing, or distributed in both the implantable and patient-external housing.

18. The system of claim 15, wherein the signal processor is disposed within an implantable housing, a patient-external housing, or distributed in both the implantable and patient-external housing.

19. The system of claim 15, wherein the plurality of electrodes comprise implantable electrodes, cutaneous electrodes, or a combination of implantable and cutaneous electrodes.

20. The system of claim 15, further comprising an implantable housing, wherein the controller and the signal processor are provided in the housing, and the electrodes comprise implantable electrodes coupled to, or provided on, the housing.

21. The system of claim 15, further comprising a patient-external housing, wherein the controller and the signal processor are provided in the housing, and the electrodes comprise cutaneous electrodes coupled to the housing.

22. The system of claim 15, wherein the change in characteristic of the cardiac signal vector indicates a change between therapy-initiated cardiac activation, fusion, and intrinsic cardiac activation.

23. The system of claim 15, wherein the controller is coupled to memory, the memory configured to store a look-up table comprising pacing parameters associated with one or both of heart rate and patient condition, the pacing parameters established to produce a cardiac fusion response.

24. The system of claim 23, wherein the controller is configured to update the look-up table with updated pacing parameters in response to a change in the cardiac signal vector characteristic indicative of therapy-initiated or intrinsic cardiac activation, the updated pacing parameters established to produce a cardiac fusion response for the patient.

25. The system of claim 23, wherein the controller, in response to a change in the cardiac signal vector characteristic indicative of a change in intrinsic cardiac activation, is configured to update the look-up table with updated baselines characterizing each of the patient'"'"'s intrinsic cardiac activation and therapy-initiated cardiac activation.