Automated Optimization of Multi-Electrode Pacing for Cardiac Resynchronization

• US 20080294218A1
• Filed: 03/31/2006
• Published: 11/27/2008
• Est. Priority Date: 03/31/2005
• Status: Active Grant

• Current Assignee: Proteus Digital Health, Inc. (Otsuka Holdings Company Limited)
• Original Assignee: Proteus Biomedical, Inc. (Otsuka Holdings Company Limited)
• Inventors: Zdeblick, Mark J., Thompson, Todd, Colliou, Olivier, Arne, Lawrence W., Savage, George M., Costello, Benedict James, Omidvar, Fataneh A.
• Granted Patent: US 8,036,743 B2
• Time in Patent Office: Days
• US Class Current: 607/30
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• 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 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/36571 controlled by blood flow rate, e.g. blood velocity or cardiac output
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means

Abstract

One embodiment of the present invention provides a system for automatically optimizing CRT procedures using a multi-electrode pacing lead. During operation, the system performs a first set of iterations to select one or more satellites on one or more pacing leads inserted in a patient. A pacing lead includes a plurality of pacing satellites, and a pacing satellite includes a plurality of electrodes that can be individually addressed and used for transmitting or detecting electric signals. The system then performs a second set of iterations to select one or more electrodes on the selected satellites. The system further performs a third set of iterations to select one or more timing configurations for pacing signals transmitted through one or more of the selected electrodes.

Claims

1. A method for performing automatic optimization of cardiac resynchronization therapy (CRT), the method comprising:

performing a first set of iterations to select one or more satellites on one or more pacing leads inserted in a patient, wherein a pacing lead includes a plurality of pacing satellites, and wherein a pacing satellite includes a plurality of electrodes that can be individually addressed and used for transmitting or detecting electric signals;

performing a second set of iterations to select one or more electrodes on the selected satellites; and

performing a third set of iterations to select one or more timing configurations for pacing signals transmitted through one or more of the selected electrodes.

2. The method of claim 1, wherein the pacing lead further includes one or more sensors.

3. The method of claim 2, wherein the sensor can be an accelerometer, a strain gauge, an angle gauge, a pressure sensor, a temperature sensor, or an electrode configured to detect a signal induced by an electric field.

4. The method of claim 1, wherein performing the first set of iterations involves:

iteratively transmitting a pacing signal through the pacing satellites, wherein each iteration involves at least one different satellite from the previous iteration; and

selecting the one or more satellites based on a cardiac response resulting from the pacing signal transmitted through such satellites.

5. The method of claim 4, wherein transmitting the pacing signal through the satellites involves using at least one satellite or a can as a signal source, and using at least one satellite or the can as a signal sink.

6. The method of claim 4, wherein transmitting the pacing signal through the satellite involves using all the electrodes on the satellite for transmission.

7. The method of claim 4, wherein selecting the one or more satellites based on the cardiac response involves determining whether the pacing signal results in a cardiac contraction.

8. The method of claim 1, wherein performing the second set of iterations involves:

iteratively transmitting a pacing signal through the electrodes on the selected satellites, wherein each iteration involves a different electrode from the previous iteration; and

selecting the one or more electrodes based on a cardiac response resulting from the pacing signal transmitted through such electrodes.

9. The method of claim 8, wherein transmitting the pacing signal through the electrodes involves using at least one electrode on one of the selected satellites or a can as a signal source, and using at least one electrode on one of the selected satellites or the can as a signal sink.

10. The method of claim 8, wherein selecting one or more electrodes based on the cardiac response involves selecting the electrodes through which the pacing signal resulting in a cardiac contraction is transmitted.

11. The method of claim 1, wherein performing the third set of iteration involves:

iteratively transmitting pacing signals through at least one selected electrode, wherein each iteration involves a different timing configuration of the pacing signal from the previous iteration; and

selecting one or more pacing-signal timing configurations based on a cardiac response resulting from the pacing signal.

12. The method of claim 11,

wherein transmitting the pacing signal through the selected electrodes involves:

transmitting a first pulse through a first selected electrode at a first location, and

transmitting a second pulse through a second selected electrode at a second location; and

wherein the timing configuration of the pacing signal includes a time delay between the first pulse and the second pulse.

13. The method of claim 11, wherein iteratively transmitting pacing signals through the selected electrodes involves performing a set of coarse-granularity iterations and a set of fine-granularity iterations;

and

wherein the timing-configuration difference between the coarse-granularity iterations is larger than that between the fine-granularity iterations.

14. The method of claim 13, wherein the timing-configuration difference between the coarse-granularity iterations is approximately 5 to 10 times of that between the fine-granularity iterations.

15. The method of claim 14, wherein the timing-configuration difference between the coarse-granularity iterations is at least twice that between the fine-granularity iterations.

16. The method of claim 15, wherein the timing-configuration difference between the coarse-granularity iterations is approximately 5 to 10 times of that between the fine-granularity iterations.

17. The method of claim 16, wherein the timing-configuration difference between the coarse-granularity iterations is approximately 5 to 10 ms;

and

wherein the timing-configuration difference between the fine-granularity iterations is approximately 1 ms.

18. The method of claim 13, wherein selecting the pacing-signal timing configurations based on the cardiac response involves measuring a synchrony corresponding to the pacing-signal timing configuration;

and

wherein after the coarse-granularity iterations, selecting the pacing-signal timing configurations further involves determining a collection of timing configurations that produce better synchrony than other timing configurations; and

wherein the fine-granularity iterations are performed based on the collection of timing configurations determined after the coarse-granularity iterations.

19. The method of claim 18, wherein determining the collection of timing configurations involves identifying a broad peak based on a synchrony-versus-timing plot.

20. The method of claim 18, wherein determining the collection of timing configurations involves grouping the timing configurations based on predetermined threshold.

21. The method of claim 18, wherein measuring the synchrony involves measuring a time difference between two response signals indicating cardiac contraction at two corresponding locations.

22. The method of claim 21, wherein measuring the time difference between the two response signals involves comparing corresponding highest-slew-rate points of the two signals, thereby allowing relative values of the two signals to be used.

23. The method of claim 18, wherein measuring the synchrony involves computing a cross-correlation of two response signals indicating cardiac contraction at two corresponding locations.

24. The method of claim 18, wherein measuring the synchrony involves comparing electromechanical delays of two response signals indicating cardiac contraction at two corresponding locations.

25. The method of claim 24, wherein the electromechanical delay of a signal is a time delay between a characteristic point of an electrocardiogram (ECG) and a characteristic point of the signal.

26. The method of claim 25, wherein the characteristic point of the ECG is the start of the QRS complex;

and

wherein the characteristic point of the signal is the corresponding peak of the signal.

27. The method of claim 18, wherein selecting the pacing-signal timing configurations involves displaying an illustration of the synchrony corresponding to the timing configuration which is viewable to a physician.

28. The method of claim 27,

wherein displaying the illustration of the synchrony involves, tracing a point in real time on an X-Y coordinate plane;

wherein the X coordinate of the point indicates a value corresponding to the amplitude of a first response signal indicating cardiac contraction at a first location; and

wherein the Y coordinate of the point indicates a value corresponding to the amplitude of a second response signal indicating cardiac contraction at a second location.

29. The method of claim 27, wherein displaying the illustration of the synchrony involves:

tracing a first point on a polar coordinate plane, wherein the radial coordinate of the first point indicates a value corresponding to the amplitude of a first signal indicating cardiac contraction at a first location, and wherein the angular coordinate of the first point is configured to change at a constant rate;

tracing a second point on the same polar coordinate plane, wherein the radial coordinate of the second point indicates a value corresponding to the amplitude of the second signal indicating cardiac contraction at a second location, and wherein the angular coordinate of the second point is configured to change at the same constant rate; and

highlighting the area enclosed by both traces of the first point and the second point.

30. The method of claim 1, further comprising using scripting language to automatically perform the three sets of iterations.

31. The method of claim 30, further comprising saving values for response signals during each set of iteration using scripting language.

32. The method of claim 30, further comprising loading the saved values using scripting language.

33. The method of claim 30, further comprising saving satellite, electrode, and timing configurations using scripting language.

34. The method of claim 33, further comprising loading the saved satellite, electrode, and timing configurations using scripting language.

35. The method of claim 30, further comprising allowing a physician to create pacing procedures by specifying satellite, electrode, and timing configurations.

36. The method of claim 35, wherein allowing the physician to create pacing procedures involves generating scripts that automatically perform the pacing procedures.

37. A graphic user interface (GUI) for configuring a cardiac pacing lead that accommodates a plurality of pacing satellites, the GUI comprising:

an illustration of the pacing lead, which indicates the status of a plurality of electrodes on each pacing satellite; and

a selection field that allows a user to configure a polarity, rate, amplitude, and pulse width of a pacing signal that is to be transmitted to the pacing lead.

38. The GUI of claim 37, wherein the illustration of the pacing lead is configured to allow the user to configure a connection state and a polarity of each electrode.

39. The GUI of claim 38, wherein the illustration of the pacing lead is configured to allow the user to toggle the status of each electrode by clicking on the image of the electrode.

40. The GUI of claim 37, further comprising a field that indicates a battery voltage for a can to which the pacing lead is coupled.

41. The GUI of claim 37, further comprising a field that indicates an impedance of the pacing lead.

42. The GUI of claim 37, further comprising a field that indicates a temperature of a temperature sensor included with the pacing lead.

43. The GUI of claim 37, further comprising a field that allows the user to specify a script file to run.

44. The GUI of claim 37, further comprising an area for displaying in real time a signal detected by the pacing lead.

45. The GUI of claim 37, wherein the area is configured to display an illustration of cardiac synchrony.

46. The GUI of claim 45,

wherein the illustration of cardiac synchrony is configured to trace a point in real time on an X-Y coordinate plane;

wherein the X coordinate of the point indicates a value corresponding to the amplitude of a first response signal indicating cardiac contraction at a first location; and

wherein the Y coordinate of the point indicates a value corresponding to the amplitude of a second response signal indicating cardiac contraction at a second location.

47. The GUI of claim 45, wherein the illustration of cardiac synchrony is configured to:

trace a first point on a polar coordinate plane, wherein the radial coordinate of the first point indicates a value corresponding to the amplitude of a first signal indicating cardiac contraction at a first location, and wherein the angular coordinate of the first point is configured to change at a constant rate;

trace a second point on the same polar coordinate plane, wherein the radial coordinate of the second point indicates a value corresponding to the amplitude of the second signal indicating cardiac contraction at a second location, and wherein the angular coordinate of the second point is configured to change at the same constant rate; and

to highlight the area enclosed by both traces of the first point and the second point.