System and Method for Estimating Cardiac Pressure Based on Cardiac Electrical Conduction Delays Using an Implantable Medical Device

• US 20090018597A1
• Filed: 07/18/2007
• Published: 01/15/2009
• Est. Priority Date: 04/04/2007
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Inventors: Siou, Jeffery, Panescu, Dorin, Min, Xiaoyi, Wenzel, Brian Jeffrey, Bjorling, Anders, Naware, Mihir, Gutfinger, Dan E.
• Granted Patent: US 8,504,152 B2
• Time in Patent Office: Days
• US Class Current: 607/23
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/02156 Calibration means
• CPC Class Codes: A61B 5/72 Signal processing specially adapted for physiological signals or for diagnostic purposes character recognition, recognising digital ink, document-oriented image-based pattern recognition G06V30/00; recognition or understanding of postal images G06V30/424
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• 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 1/3682 with a variable atrioventricular delay
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 1/37258 Alerting the patient

Abstract

Techniques are provided for estimating left atrial pressure (LAP) or other cardiac performance parameters based on measured conduction delays. In particular, LAP is estimated based interventricular conduction delays. Predetermined conversion factors stored within the device are used to convert the various the conduction delays into LAP values or other appropriate cardiac performance parameters. The conversion factors may be, for example, slope and baseline values derived during an initial calibration procedure performed by an external system, such as an external programmer. In some examples, the slope and baseline values may be periodically re-calibrated by the implantable device itself. Techniques are also described for adaptively adjusting pacing parameters based on estimated LAP or other cardiac performance parameters. Still further, techniques are described for estimating conduction delays based on impedance or admittance values and for tracking heart failure therefrom.

Claims

1. A method for controlling a therapy delivered to a patient using an implantable medical device, the method comprising:

measuring an electrical conduction delay in the heart of the patient that is affected by cardiac pressure;

estimating cardiac pressure within the patient from the electrical conduction delay; and

controlling a therapy for the patient based on estimated cardiac pressure.

2. The method of claim 1 wherein the implantable device is equipped with an implantable drug pump and wherein drug therapy is controlled based on estimated cardiac pressure.

3. The method of claim 1 wherein therapy is controlled in an effort to maintain the estimated cardiac pressure within a predetermined range representative of healthy pressure values.

4. The method of claim 3 wherein, so long as the estimated cardiac pressure is within the predetermined range representative of healthy pressure values, no therapy adjustments are performed.

5. The method of claim 3 wherein, if the estimated cardiac pressure is within a first predetermined range above healthy pressure values, cardiac pacing parameters are adjusted in an effort to lower the cardiac pressure.

6. The method of claim 5 wherein, if the estimated cardiac pressure is within a second predetermined range above the first range, one or more of the following actions are performed:

warning signals are generated indicative of high pressure values;

appropriate medications are directly delivered to the patient;

instruction signals are generated to instruct the patient to take appropriate medications;

instruction signals are generated to instruct the patient to visit a physician.

7. The method of claim 1 wherein the step of adjusting a therapy includes adjusting one or more pacing timing parameters of the implantable medical device to reduce cardiac pressure.

8. The method of claim 7 wherein therapy is adjusted by adjusting an atrioventricular (AV) timing parameter.

9. The method of claim 7 wherein therapy is adjusted by adjusting an interventricular (LV-RV) timing parameter.

10. The method of claim 7 wherein therapy is adjusted by adjusting an intraventricular (LV₁-LV₂, RV₁-RV₂) timing parameter.

11. The method of claim 7 wherein therapy is adjusted based on pressure values estimated only during particular patient activity levels as determined in conjunction with an activity sensor.

12. The method of claim 7 wherein therapy is adjusted based on pressure values estimated only while the patient is in a particular posture as determined in conjunction with a position sensor.

13. The method of claim 7 wherein therapy is adjusted based on pressure values estimated only while the patient has a particular blood oxygen saturation level as determined in conjunction with a blood oxygen saturation sensor.

14. The method of claim 7 wherein therapy is adjusted on a beat-by-beat basis.

15. The method of claim 7 wherein the device is equipped to selectively deliver pacing at any of a plurality of pacing sites and wherein the step of adjusting therapy is performed to select particular pacing sites based on the conduction delays.

16. A system for controlling therapy delivered to a patient using an implantable medical device, the system comprising:

an electrical conduction delay measurement unit operative to measure conduction delays within the heart of the patient that are affected by cardiac pressure;

a cardiac pressure estimation unit operative to estimate cardiac pressure within the patient based on the electrical conduction delay; and

a therapy controller operative to control therapy based on estimated cardiac pressure.

17. The system of claim 16 wherein the therapy controller is operative to control therapy in an effort to maintain the estimated cardiac pressure within a predetermined range representative of healthy pressure values.

18. The system of claim 17 wherein, so long as the estimated cardiac pressure is within the predetermined range representative of healthy pressure values, the therapy controller makes no therapy adjustments based on the estimated cardiac pressure.

19. The system of claim 18 wherein, if the estimated cardiac pressure is within a first predetermined range above healthy pressure values, the therapy controller is operative to adjust cardiac pacing parameters in an effort to lower the cardiac pressure.

20. The system of claim 19 wherein, if the estimated cardiac pressure is within a second predetermined range above the first range, the therapy controller is operative to perform one or more of the following actions:

generate warning signals indicative of high pressure values;

deliver appropriate medications directly to the patient via an implantable drug pump;

generate instruction signals for transmitting to an external device for instructing the patient to take appropriate medications;

generate instruction signals for transmitting to an external device for instructing the patient to visit a physician.

21. A method for detecting a heart failure condition within a patient using an implantable medical device, the method comprising:

measuring an electrical conduction delay in the heart of the patient that is affected by cardiac pressure;

estimating cardiac pressure within the patient from the electrical conduction delay; and

detecting a heart failure condition based on estimated cardiac pressure.

22. The method of claim 21 wherein the implantable device is equipped with a warning device and wherein a warning is generated upon detection of heart failure.

23. The method of claim 22 wherein the implantable device is equipped to transmit signals to an external display device and wherein the warning is transmitted to the external device.

24. A method for estimating cardiac pressure within a patient using an implantable medical device, the method comprising:

measuring an electrical conduction delay in the heart of the patient;

estimating cardiac pressure within the patient from the electrical conduction delay; and

transmitting estimated cardiac pressure values to an external device.

25. The method of claim 24 wherein the external device is equipped to store estimated cardiac pressure values within a database.

26. The method of claim 24 wherein the implantable device is equipped to receive signals from the external device and wherein adjusted pacing parameters are received from the external device.

27. The method of claim 25 wherein the adjusted pacing parameters include cardiac resynchronization (CRT) parameters.