Method, apparatus, and system to optimize cardiac preload based on measured pulmonary artery pressure

• US 20090054945A1
• Filed: 08/20/2007
• Published: 02/26/2009
• Est. Priority Date: 08/20/2007
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Patangay, Abhilash, Maskara, Barun, Yu, Yinghong, Ding, Jiang, Kwok, Jonathan T.
• Granted Patent: US 7,957,802 B2
• Time in Patent Office: Days
• US Class Current: 607/23
• 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 1/3682 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

Abstract

Optimizing cardiac preload based on measured pulmonary artery pressure involves varying, for each repetition of an acute burst protocol, a parameter of pacing applied to a patient'"'"'s heart during the acute burst protocol. Pulmonary artery pressure is measured during the repetitions of the acute burst protocol. An optimum ventricular preload is determined based on the measured pulmonary artery pressure. Pacing therapy is provided using a value of the parameter that is selected based on the determination of optimum ventricular preload.

Claims

1. A method, comprising:

varying, for each repetition of an acute burst protocol, a parameter of pacing applied to a patient'"'"'s heart during the acute burst protocol;

measuring pulmonary artery pressure during the repetitions of the acute burst protocol;

determining an optimum ventricular preload based on the measured pulmonary artery pressure; and

providing pacing therapy using a value of the parameter of pacing that is selected based on the determination of optimum ventricular preload.

2. The method of claim 1, wherein the parameter of pacing comprises a pacing delay.

3. The method of claim 2, wherein the pacing delay comprises an atrioventricular pacing delay.

4. The method of claim 2, wherein the pacing delay comprises a biventricular delay.

5. The method of claim 2, wherein the pacing delay comprises an interatrial delay.

6. The method of claim 1, wherein the parameter of pacing comprises a pacing site of an implantable cardiac lead in the patient'"'"'s heart.

7. The method of claim 1, further comprising choosing a length of the repetitions of the acute burst protocol so that the patient'"'"'s baroreflex system does not adjust to the varied parameter of pacing during the repetitions of the acute burst protocol.

8. The method of claim 1, further comprising measuring the pulmonary artery pressure between repetitions of the acute burst protocol to determine a baseline pulmonary artery pressure, and wherein determining the optimum ventricular preload comprises comparing the baseline pulmonary artery pressure with the pulmonary artery pressure measured during the repetitions of the acute burst protocol.

9. The method of claim 1, wherein measuring pulmonary artery pressure during the repetitions of the acute burst protocol comprises measuring pulmonary artery diastolic pressure.

10. The method of claim 9, wherein determining the optimum ventricular preload based on the measured pulmonary artery diastolic pressure comprises determining the optimum ventricular preload based on a maximum value of the pulmonary artery diastolic pressure.

11. The method of claim 1, wherein determining the optimum ventricular preload based on the measured pulmonary artery pressure comprises determining the optimum ventricular preload based on a maximum value of the pulmonary artery pressure.

12. The method of claim 1, wherein providing the pacing therapy comprises performing ambulatory optimization of a pacing interval applied to the patient'"'"'s heart.

13. The method of claim 1, further comprising varying patient posture during selected ones of the repetitions of the acute burst protocols.

14. A medical system, comprising:

one or more electrodes for delivering pacing pulses to a patient'"'"'s heart;

an energy delivery and sensing unit coupled to the one or more electrodes;

a pulmonary artery pressure sensor capable of making pulmonary artery pressure measurements;

a memory configured to store at least the pulmonary artery pressure measurements; and

a controller coupled to the memory, pulmonary artery pressure sensor, and the energy delivery and sensing unit, the controller configured to,

vary, for each repetition of an acute burst protocol, a parameter of pacing applied to the patient'"'"'s heart via the energy delivery and sensing unit during the acute burst protocol;

store the pulmonary artery pressure measurements made during the repetitions of the acute burst protocol; and

providing pacing therapy using a value of the parameter that is selected based on an optimum ventricular preload that is determined via the stored pulmonary artery pressure measurements.

15. The medical system of claim 14, the parameter of the pacing comprises a pacing delay.

16. The medical system of claim 14, the parameter of the pacing comprises a pacing site of the electrodes.

17. The medical system of claim 14, wherein the controller is further configured to store the pulmonary artery pressure measurements between repetitions of the acute burst protocol to determine a baseline pulmonary artery pressure, and where the optimum ventricular preload is determined by comparing the baseline pulmonary artery pressure with the pulmonary artery pressure measurements stored during the repetitions of the acute burst protocol.

18. The medical system of claim 14, wherein the pulmonary artery pressure measurements comprise pulmonary artery diastolic pressure measurements.

19. The medical system of claim 14, wherein the controller is further configured to determine the optimum ventricular preload based on a maximum pressure measurement made during the repetitions of the acute burst protocol.

20. The medical system of claim 14, wherein the controller is further configured to provide the pacing therapy during ambulatory optimization of a pacing interval applied to the patient'"'"'s heart.

21. A medical system, comprising:

means for applying pacing to a patient'"'"'s heart for multiple repetitions of an acute burst protocol, wherein a parameter of the pacing is varied for each repetition of the acute burst protocol;

means for measuring pulmonary artery pressure during the repetitions of the acute burst protocol;

means for determining an optimum ventricular preload based on the measured pulmonary artery pressure; and

means for providing pacing therapy using a value of the parameter of pacing that is selected based on the determination of optimum ventricular preload.

22. The medical system of claim 21, further comprising means for measuring the pulmonary artery pressure between repetitions of the acute burst protocol to determine a baseline pulmonary artery pressure, and wherein the means for determining the optimum ventricular preload further comprises means for comparing the baseline pulmonary artery pressure with the pulmonary artery pressure measured during the repetitions of the acute burst protocol.