Systems, Devices and Methods for Monitoring Efficiency of Pacing

• US 20080319501A1
• Filed: 06/26/2008
• Published: 12/25/2008
• Est. Priority Date: 12/20/2004
• Status: Active Grant

• Current Assignee: Newstim, Inc.
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Zhu, Qingsheng, Ortega, Daniel Felipe
• Granted Patent: US 8,010,191 B2
• Time in Patent Office: Days
• US Class Current: 607/28
• 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 1/36592 controlled by the heart rate variability

Abstract

Various systems, methods, devices and arrangements are implemented for use in pacing of the heart. One implementation is directed to methods and systems for determining a pacing location in the right ventricle of a heart and near the His bundle. A pacing signal is delivered to the location in the right ventricle. The pacing signal produces a capture of a left ventricle. Properties of the capture are monitored. Results of the monitored capture are used to assess the effectiveness of the delivered pacing signal as a function of heart function. The heart function can be, for example, at least one of a QRS width, fractionation and a timing of electrical stimulation of a late activation site of a left ventricle relative to the QRS.

Claims

1. A method for assessing a pacing location in a right ventricle of a heart and near a His bundle, the method comprising:

delivering a pacing signal to the location in the right ventricle;

monitoring a capture of a left ventricle of heart, the capture produced by the pacing signal, and

assessing, using the monitored capture, the effectiveness of the delivered pacing signal as a function of at least one of a QRS width, fractionation and a timing of electrical stimulation of a late activation site of a left ventricle relative to the QRS.

2. The method of claim 1, further including the step of providing an indication of an assessment from the processor arrangement to a user.

3. The method of claim 1, further including the steps of comparing relative heart function between two or more monitored captures of the left ventricle of the heart, each capture representing pacing signals applied to respective and different locations in the right ventricle, and providing an output that indicates improved heart function in at least one of the monitored captures.

4. The method of claim 1, wherein the step of monitoring includes the use of one or more sensors external to the patient, the sensors providing data indicative of the effectiveness of the delivered pacing signal.

5. The method of claim 1, wherein the step of the monitoring includes generating one or more electrocardiograph waveforms.

6. The method of claim 1, wherein the step of the monitoring includes use of a vectocardiogram input.

7. The method of claim 1, wherein the step of monitoring includes the use of Doppler imaging.

8. The method of claim 1, further including the steps of

adjusting, in response to the step of assessing showing improved effectiveness, a pacing profile;

delivering the pacing profile to a location in the right ventricle that corresponds to the improved effectiveness; and

assessing the effectiveness of the pacing profile.

9. The method of claim 1, wherein QRS width associated with the monitored capture is less than about 130 milliseconds.

10. A system for assessing a pacing location in a right ventricle of a heart of a patient, the system comprising:

a lead for delivering a pacing signal to a pacing location in the right ventricle to produce a capture of a left ventricle of the heart;

a monitoring arrangement for monitoring the capture, and

a processor arrangement for assessing, using results from the monitoring of the capture, the effectiveness of the delivered pacing signal as a function of at least one of a QRS width, fractionation, pressure generated by the heart, and a timing, relative to the QRS, of electrical stimulation of a late activation site of a left ventricle.

11. The system of claim 10, further including a display for providing, to a user of the system, a representation of an assessment from the processor arrangement.

12. The system of claim 10, wherein the processor arrangement compares relative heart function between two or more monitored captures of the left ventricle of the heart and provides an output that indicates improved heart function, relative to another capture, in at least one of the monitored captures.

13. The system of claim 10 wherein, the monitoring arrangement includes one or more sensors external to the patient, the sensors providing data indicative of the effectiveness of the delivered pacing signal.

14. The system of claim 10 wherein, the monitoring arrangement includes one or more sensors for generating one or more electrocardiograph waveforms.

15. The system of claim 10 wherein, the monitoring arrangement includes one or more sensors for determining timing of a late activation site when placed in the coronary sinus.