MECHANICAL VENTRICULAR PACING CAPTURE DETECTION FOR A POST EXTRASYSTOLIC POTENTIATION (PESP) PACING THERAPY USING AT LEAST ONE LEAD-BASED ACCELEROMETER

• US 20080234771A1
• Filed: 03/20/2007
• Published: 09/25/2008
• Est. Priority Date: 03/20/2007
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Chinchoy, Edward, Hess, Michael F.
• Granted Patent: US 8,738,131 B2
• Time in Patent Office: Days
• US Class Current: 607/11
• 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 1/3712 Auto-capture, i.e. automatic adjustment of the stimulation threshold

Abstract

A system and method for monitoring at least one chamber of a heart (e.g., a left ventricular chamber) during delivery of extrasystolic stimulation to determine if the desired extra-systole (i.e., ventricular mechanical capture following refractory period expiration) occurs. The system includes an implantable or external cardiac stimulation device in association with a set of leads such as epicardial, endocardial, and/or coronary sinus leads equipped with motion sensor(s). The device receives and processes acceleration sensor signals to determine a signal characteristic indicative of chamber capture resulting from one or more pacing stimulus delivered closely following expiration of the refractory period. A threshold optimization method optionally evaluates capture and at least one of: runs an iterative routine to establish or re-establish chamber capture for the PESP therapy, sets a logical flag relating to chamber capture status and stores parameter(s) relating to successful chamber capture for one or more subsequent cardiac cycles.

Claims

1. A method for assessing ventricular chamber capture status following delivery of pacing stimulus in a device configured to deliver a post extrasystolic potentiation (PESP) pacing therapy, comprising:

sensing movement of a portion of a ventricular chamber of a heart with a deployed movement transducer and for measuring a signal from the transducer related to the sensed movement;

coupling said signal to a means for detecting the sensed movement for a period of time following delivery of an extrasystolic pacing stimulus pulse to the ventricular chamber, wherein the extrasystolic pacing stimulus is delivered at the expiration of extrasystolic stimulation (ESS) interval;

filtering the signal obtained during the period of time; and

one of determining, storing, and programming a logical flag relating to whether or not the ventricular chamber was captured by the ESS pacing stimulus.

2. A method for determining the sequence, waveform, polarity, duration, or timing for delivering left ventricular (LV) electrical pulses that results in augmented stroke volume for at least one subsequent cardiac cycle, comprising:

disposing a transducer that is adapted to directly sense movement of a portion of a LV chamber of a heart and providing a signal related to the movement;

coupling said signal to a means for detecting the movement for a period of time following delivery of an LV pacing stimulus pulse;

filtering the signal obtained during the period of time;

delivering one or more sequential pacing pulses

one of determining, storing, and programming a logical flag relating to whether or not the LV chamber contracted due to delivery of an extrasystolic stimulation (ESS) pulse.

3. A method according to claim 2, wherein said transducer is adapted to be disposed in a portion of one of the coronary sinus vessel and a blood vessel fluidly coupled to said coronary sinus.

4. A method according to claim 3, wherein said transducer comprises an accelerometer.

5. A method according to claim 4, wherein the accelerometer comprises a uniaxial accelerometer having a longitudinal sensing axis substantially aligned toward the left ventricular apex portion of the heart.

6. A method according to claim 3, wherein said transducer comprises a biaxial accelerometer.

7. A method according to claim 3, wherein said transducer comprises a triaxial accelerometer.

8. A method according to claim 2, wherein said transducer is adapted to be disposed adjacent to a portion of the epicardium of the left ventricle of the heart.

9. A method according to claim 8, wherein the portion of the epicardium is a portion of the lateral wall of the left ventricle.

10. A method according to claim 9, wherein the portion of the lateral wall is a basal portion of the lateral wall.

11. A method according to claim 10, wherein the portion of the lateral wall is a mid-basal portion of the lateral wall.

12. A method according to claim 2, wherein said transducer is adapted to be disposed within the pericardium of the heart.

13. A method according to claim 4, wherein the device comprises an implantable medical device.

14. A method according to claim 13, wherein the first pacing electrode or the second pacing electrode further comprises a sense electrode in electrical communication with a sensing circuit coupled to the device.

15. A computer readable medium programmed with instructions for performing a method for assessing ventricular chamber capture status following delivery of pacing stimulus in a device configured to deliver a post extrasystolic potentiation (PESP) pacing therapy, comprising:

instructions for sensing movement of a portion of a ventricular chamber of a heart with a deployed movement transducer and for measuring a signal from the transducer related to any of the sensed movement;

instructions for coupling said signal to a means for detecting the sensed movement for a period of time following delivery of an extrasystolic stimulus (ESS) pulse to the ventricular chamber, wherein the ESS is delivered at the expiration of ESS interval;

instructions for filtering the signal obtained during the period of time; and

instructions for one of determining, storing, and programming a logical flag relating to whether or not the ventricular chamber was captured by the ESS pulse.

16. A computer readable medium according to claim 15, wherein said transducer is adapted to be disposed in a portion of the coronary sinus vessel or a blood vessel fluidly coupled to said coronary sinus.

17. A computer readable medium according to claim 16, wherein said transducer comprises an accelerometer.

18. A computer readable medium according to claim 17, wherein the accelerometer comprises a uniaxial accelerometer having a longitudinal sensing axis substantially aligned toward the left ventricular apex portion of the heart.

19. An apparatus for confirming capture of a left ventricular (LV) chamber due to LV pacing stimulus delivery resulting in augmented stroke volume on subsequent cardiac cycles, comprising:

transducer means for measuring movement of a portion of the lateral wall of a LV and providing a movement signal related to such movement;

a movement measurement circuit operatively coupled to the transducer means;

a pulse generator coupled to the measurement circuit;

a left pacing electrode in electrical communication with a portion of the LV and electrically coupled to a post extrasystolic potentiation (PESP) pacing circuit of the pulse generator; and

an LV movement threshold circuit coupled to the movement signal and adapted to generate a signal relating to one of a successful post extrasystolic depolarization LV pacing parameter, a logical flag relating to LV PESP pacing-induced capture, a programmable circuit coupled to modify LV pacing parameters until a successful LV PESP capture signal is generated by the threshold circuit.

20. An apparatus according to claim 19, wherein the pulse generator comprises an implantable pulse generator.

21. An apparatus according to claim 19, wherein the pulse generator further comprises at least one defibrillation electrode in electrical communication with at least one chamber of a heart and high-voltage circuitry disposed within the pulse generator.

22. An apparatus according to claim 19, wherein the transducer means further comprises an accelerometer and said left pacing electrode is coupled to said accelerometer.

23. An apparatus according to claim 19, wherein the transducer means comprises an accelerometer.

24. An apparatus according to claim 19, wherein the portion of the lateral wall is a mid-basal portion of the lateral wall.

25. An apparatus according to claim 24, wherein the portion of the left ventricle is a one of:

an epicardial portion, an endocardial portion, a pericardial portion.