Method and System for Configuration of a Pacemaker and For Placement of Pacemaker Electrodes

• US 20080146928A1
• Filed: 12/14/2006
• Published: 06/19/2008
• Est. Priority Date: 12/14/2006
• Status: Active Grant

• Current Assignee: St. Jude Medical, Atrial Fibrillation Division, Inc. (Abbott Laboratories)
• Original Assignee: Ep Medsystems Incorporated (Abbott Laboratories)
• Inventors: Dala-Krishna, Praveen
• Granted Patent: US 8,187,190 B2
• Time in Patent Office: Days
• US Class Current: 600/443
• CPC Class Codes: A61B 8/06 Measuring blood flow measuring volume flow in general G01F, e.g. G01F1/66, G01F1/72; measuring speed of fluids in general G01P5/00
• CPC Class Codes: A61B 8/0883 for diagnosis of the heart
• CPC Class Codes: A61B 8/12 in body cavities or body tracts, e.g. by using catheters catheters per se A61M25/00
• 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 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 1/37264 Changing the program; Upgrading firmware

Abstract

Ultrasound imaging methods and systems for assisting a clinician in configuring the operation of a pacemaker and for determining an optimal site for the pacemaker electrode are presented. The methods and systems provide a toolbox for analyzing and optimizing the effectiveness of the pacemaker and proposed electrode sites. The method includes a function which evaluates one or more electrode sites and pacemaker configurations. The function may be based, for example, on the activation voltage of the pacemaker, on an estimate of the volume of blood ejected from the heart and/or on the cardiac dysynchrony. The ejection volume and the dysynchrony may be estimated using an imaging cardiac catheter ultrasound transducer array and ultrasound unit.

Claims

1. A cardiac ultrasound imaging system for helping a clinician select a pacemaker electrode site and configure a pacemaker, the system comprising:

an intracardiac ultrasound imaging system configured to image a patient'"'"'s heart; and

a computer configured to;

process images generated by the ultrasound system in order to compute a measurement of cardiac ejection volume for a given pacemaker configuration and electrode site;

save at least one combination of the corresponding pacemaker configuration, the corresponding electrode site, and the ejection volume measurement; and

retrieve the ejection volume measurement, the pacemaker configuration, and the electrode site of any of the saved combinations.

2. The system of claim 1, wherein the computer saves a cardiac dysynchrony measurement with at least one of the saved combinations.

3. The system of claim 1, wherein the cardiac ejection volume is represented as an ejection fraction which is relative to the maximum cardiac volume.

4. The system of claim 1, wherein the pacemaker configuration comprises an activation voltage.

5. The system of claim 1, wherein the computer is configured to display at least one of the saved combinations.

6. The system of claim 1, wherein the computer is configured to rank the saved combinations according to a specified criterion.

7. The system of claim 6, wherein the criterion is activation voltage and the combinations are ranked in order from lowest voltage to highest voltage.

8. The system of claim 6, wherein the criterion is ejection volume and the combinations are ranked in order from most volume to least volume.

9. The system of claim 6, wherein the criterion is dysynchrony timing delay and the combinations are ranked in order from least delay to most delay.

10. The system of claim 6, wherein the computer is configured to accept the criterion as an input provided by a user of the system.

11. The system of claim 1, wherein the computer is configured to associate the electrode site of a saved combination with a site on an image of the heart.

12. The system of claim 1, wherein the computer is configured to apply a function to each saved combination, wherein the function returns a figure-of-merit value for the combination.

13. The system of claim 12, wherein the computer is configured to rank the saved combinations in order according to the figure-of-merit value.

14. The system of claim 12, wherein the computer is configured to accept the function from a user of the system.

15. A method for helping a clinician to select a pacemaker electrode site and to configure a pacemaker, the method comprising:

positioning a pacemaker electrode at a site on a patient'"'"'s heart;

configuring the pacemaker with operational parameters;

imaging the patient'"'"'s heart with an intracardiac ultrasound imaging system;

computing a measure of cardiac ejection volume;

saving in a computer memory a combination of the measure of cardiac ejection volume, the corresponding pacemaker operational parameters, and the corresponding electrode site;

performing the positioning, configuring, imaging, computing, and saving steps for two or more different combinations of electrode site and pacemaker operational parameters; and

retrieving from the computer memory the saved measure of cardiac ejection volume, the pacemaker operational parameters, and electrode site of at least one of the saved combinations. 16. The method of claim 15, wherein saving the combination further comprises saving a dysynchrony measurement.

17. The method of claim 15, wherein saving the cardiac ejection volume is performed by saving an ejection fraction which is relative to the maximum cardiac volume.

18. The method of claim 15, wherein the pacemaker operational parameters comprises an activation voltage.

19. The method of claim 15, further comprising displaying at least one of the saved combinations.

20. The method of claim 15, further comprising ranking the saved combinations according to a criterion.

21. The method of claim 20, wherein the criterion is activation voltage and the saved combinations are ranked in order from lowest voltage to highest voltage.

22. The method of claim 20, wherein the criterion is ejection volume and the saved combinations are ranked in order from most volume to least volume.

23. The method of claim 20, wherein the criterion is dysynchrony timing delay and the saved combinations are ranked in order from least delay to most delay.

24. The method of claim 20, further comprising a user of the method specifing the criterion.

25. The method of claim 15, further comprising associating the electrode site of a saved combination with a site on an image of the heart.

26. The method of claim 15, further comprising applying a function to each saved combination, wherein the function returns a figure-of-merit value for the combination.

27. The method of claim 26, wherein the ranking is performed according to the figure-of-merit value.

28. The method of claim 26, further comprising saving a baseline combination of the ejection volume measured without stimulation of the patient'"'"'s heart.

29. The method of claim 15, further comprising saving notes, markers, and annotations with the saved site, configuration, and measurements.