Heart failure therapy adjustment based on ventricular pressures

• US 20080300643A1
• Filed: 08/01/2008
• Published: 12/04/2008
• Est. Priority Date: 01/04/2002
• Status: Active Grant

• Current Assignee: AT&T Intellectual Property I LP (AT&T, Inc.)
• Original Assignee: AT&T Intellectual Property I LP (AT&T, Inc.)
• Inventors: Salo, Rodney, Auricchio, Angelo
• Granted Patent: US 8,571,657 B2
• Time in Patent Office: Days
• US Class Current: 607/18
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• 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 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: A61N 2001/0585 Coronary sinus electrodes

Abstract

Pacing left and right ventricles of the heart for delivery of heart failure therapy involves measuring right ventricular (RV) pressure and a left ventricular (LV) pressure, and computing a parameter developed from one or both of the RV and LV pressure measurements. The parameter is indicative of a degree of left and right ventricular synchronization. At least one parameter of a heart failure pacing therapy is adjusted based on the parameter to improve synchronization of the right and left ventricles.

Claims

1. A method of pacing right and left ventricles of a heart for delivery of a heart failure pacing therapy, comprising:

measuring a right ventricular (RV) pressure;

measuring a coronary sinus (CS) pressure or a coronary vein (CV) pressure which is proportionally related to a left ventricular (LV) chamber pressure;

computing at least one parameter based at least in part on a comparison of the RV and LV pressure measurements, the parameter indicative of a degree of left and right ventricular synchronization; and

adjusting a parameter of the heart failure pacing therapy to improve synchronization of the right and left ventricles based on the at least one computed parameter.

2. The method of claim 1, comprising applying a scaling factor to the measured CS or CV pressure measurement to determine an actual LV chamber pressure value.

3. The method of claim 1, wherein the at least one parameter of the heart failure pacing therapy comprises an atrioventricular delay.

4. The method of claim 1, wherein the at least one parameter of the heart failure pacing therapy comprises an interventricular delay.

5. The method of claim 1, wherein the at least one parameter of the heart failure pacing therapy comprises an atrioventricular delay and an interventricular delay.

6. The method of claim 1, wherein the LV pressure measurement is indicative of hydrostatic pressure of the left ventricle.

7. The method of claim 1, comprising adjusting the at least one parameter of the heart failure pacing therapy to obtain a desired time or phase delay between RV and LV pressure signals from which the RV and LV pressure measurements are respectively developed.

8. The method of claim 1, comprising adjusting the at least one parameter of the heart failure pacing therapy to optimize synchronization of the right and left ventricles.

9. The method of claim 1, comprising adjusting the at least one parameter of the heart failure pacing therapy to reduce an area of a PP Loop developed from the comparison of the RV and LV pressure measurements.

10. The method of claim 1, wherein the method is repeated over time to correct for physiological changes which may occur in the course of disease progression or disease treatment.

11. An apparatus for pacing right and left ventricles of a heart for delivery of a heart failure pacing therapy, comprising:

a lead system comprising a right ventricular (RV) lead and a left ventricular (LV) lead;

a pressure sensor system comprising a left ventricular pressure (LVP) sensor catheter and a right ventricular pressure (RVP) sensor catheter, the RVP sensor catheter configured to take an RV pressure measurement and the LVP sensor catheter configured for placement in the coronary sinus or a coronary vein and to measure a coronary sinus pressure or a coronary vein pressure which is proportionally related to an LV chamber pressure;

an implantable housing;

a telemetry circuit disposed in the housing and configured to communicate with a patient-external device; and

a processor disposed in the implantable housing, the processor coupled to the telemetry circuit and to the lead and pressure sensor systems, the processor configured to execute program instructions stored in memory to compute at least one parameter based at least in part on a comparison of RVP and LVP sensor catheter pressure measurements wherein the parameter is indicative of a degree of left and right ventricular synchronization, the processor configured to adjust a parameter of the heart failure pacing therapy to improve synchronization of the right and left ventricles based on the at least one computed parameter.

12. The apparatus of claim 11, wherein the processor is configured to apply a scaling factor to the LVP sensor catheter pressure measurement to compute an actual LV chamber pressure value.

13. The apparatus of claim 11, wherein the at least one parameter of the heart failure pacing therapy comprises an atrioventricular delay.

14. The apparatus of claim 11, wherein the at least one parameter of the heart failure pacing therapy comprises an interventricular delay.

15. The apparatus of claim 11, wherein the at least one parameter of the heart failure pacing therapy comprises an atrioventricular delay and an interventricular delay.

16. The apparatus of claim 11, wherein the LVP sensor catheter is movably disposed within an open lumen of the LV lead, a distal tip of the LVP sensor catheter extendable beyond a distal tip of the LV lead, the LVP sensor catheter comprising at least one pressure transducer at a distal end of the LVP sensor catheter.

17. The apparatus of claim 11, wherein the lead system comprises an occlusion device at a distal end of the LVP sensor catheter, and the LVP sensor catheter senses hydrostatic pressure.

18. The apparatus of claim 11, wherein the processor is configured to adjust the at least one parameter of the heart failure pacing therapy to obtain a desired time or phase delay between signals produced by the RVL and LVP sensor catheters.

19. The apparatus of claim 11, wherein the processor is configured to adjust the at least one parameter of the heart failure pacing therapy to optimize synchronization of the right and left ventricles.

20. The apparatus of claim 11, wherein the processor is configured to adjust the at least one parameter of the heart failure pacing therapy to reduce an area of a PP Loop developed from the comparison of the RVP and LVP sensor catheter pressure measurements.