SELECTING CARDIAC PACING SITES

• US 20090125078A1
• Filed: 10/03/2008
• Published: 05/14/2009
• Est. Priority Date: 10/03/2007
• Status: Abandoned Application

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Neidert, Michael R., Shelton, Michael B., Gardeski, Kenneth G., Kaiser, Daniel R., Fischer, Trent M., Mulligan, Lawrence J., Kelley, James F., Skadsberg, Nicholas D.
• Application Number:
  US12/245,570
• Publication Number:
  US 20090125078A1
• Time in Patent Office: Days
• US Class Current: 607/27
• CPC Class Codes: A61B 5/062 using magnetic field
• CPC Class Codes: A61B 5/1104 induced by stimuli or drugs; A61B5/1102 takes precedence; investigating medicinal preparations G01N33/15
• CPC Class Codes: A61B 5/1107 Measuring contraction of parts of the body, e.g. organ, muscle apparatus for measuring work or force in general G01L
• CPC Class Codes: A61B 5/283 Invasive
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/6882 Anchoring means
• CPC Class Codes: A61N 1/0573 chacterised by means penetrating the heart tissue, e.g. helix needle or hook
• 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 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• 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 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence

Abstract

A method for selecting a cardiac pacing site includes steps of: securing first and second electromagnetic receiver coils at first and second positions, respectively, along a heart wall; collecting a set of non-paced heart wall motion data from each of the coils secured at the corresponding positions; applying cardiac pacing stimulation at at least one first pacing site; collecting a first set of paced heart wall motion data from each of the secured coils; comparing the non-paced heart wall motion data to the first set of paced heart wall motion data; and determining, based on the comparing, whether to maintain pacing at the at least one first cardiac pacing site or to apply pacing stimulation at a second pacing site for collection of a second set of paced heart wall motion data. The at least one first pacing site may include a right ventricular site and a left ventricular site.

Claims

1. A method for selecting at least one cardiac pacing site, the method comprising:

directing a first elongate lead to a position along a portion of a right ventricular heart wall, the first lead including an electromagnetic receiver coil;

securing the electromagnetic receiver coil of the first lead at the position along the right ventricular heart wall;

inducing a signal in the electromagnetic receiver coil of the first lead by generating a magnetic field, the signal facilitating creation of a virtual representation of a portion of the first lead to direct the first lead to the first position, and to track wall motion at the position along the right ventricular heart wall;

directing a second elongate lead to a position along a left ventricular heart wall, the second lead including an electromagnetic receiver coil;

securing the electromagnetic receiver coil of the second lead at the position along the left ventricular heart wall;

inducing a signal in the electromagnetic receiver coil of the second lead by generating a magnetic field, the signal facilitating creation of a virtual representation of a portion of the second lead, in order to direct the second lead to the second position, and to track wall motion at the position along the left ventricular heart wall;

collecting a set of non-paced heart wall motion data from the signal of each of the electromagnetic receiver coils secured at the corresponding position;

applying cardiac pacing stimulation at an at least one first cardiac pacing site;

collecting a first set of paced heart wall motion data from the signal of each of the electromagnetic receiver coils secured at the corresponding position;

comparing the set of non-paced heart wall motion data to the first set of paced heart wall motion data; and

determining, based on the comparing, whether to maintain pacing at the at least one first cardiac pacing site or to apply pacing stimulation at a second cardiac pacing site for collection of a second set of paced heart wall motion data.

2. The method of claim 1, wherein the portion of the right ventricular heart wall comprises a septal portion.

3. The method of claim 1, wherein the portion of the right ventricular heart wall comprises a portion located in proximity to an apex of the heart.

4. The method of claim 1, wherein the portion of the left ventricular heart wall comprises a portion in proximity to a base of the heart.

5. The method of claim 1, wherein directing the first elongate lead comprises directing, transvenously, to the position along the left ventricular heart wall, through a cardiac vein.

6. The method of claim 1, wherein directing the first elongate lead comprises directing, trans-thoracic, to the position along the left ventricular heart wall.

7. The method of claim 1, wherein securing at least one of the electromagnetic receiver coils comprises engaging a fixation element of the corresponding lead to the corresponding heart wall.

8. The method of claim 1, wherein securing the electromagnetic receiver coil of the second lead at the position along the left ventricular heart wall comprises lodging the at least one lead in a cardiac vein.

9. The method of claim 1, wherein comparing comprises a time domain analysis to determine a degree of synchrony between the wall motion at the position along the right ventricle and the wall motion at the position along the left ventricle.

10. The method of claim 1, wherein comparing comprises a torsional analysis to determine a relative rotation between the position along the right ventricular wall and the position along the left ventricular wall.

11. The method of claim 1, wherein the at least one first cardiac pacing site comprises a left ventricular pacing site and a right ventricular pacing site.

12. The method of claim 11, wherein the first elongate lead further includes an electrode, employed for applying the pacing stimulation to the right ventricular pacing site.

13. The method of claim 11, wherein the second elongate lead further includes an electrode, employed for applying the pacing stimulation to the left ventricular pacing site.

14. The method of claim 11, wherein the left ventricular pacing site comprises a site in proximity to a base of the heart.

15. The method of claim 11, wherein the right ventricular pacing site comprises a site located in proximity to an apex of the heart.

16. The method of claim 11, wherein the second cardiac pacing site comprises one of:

another left ventricular pacing site and another right ventricular pacing site.

17. The method of claim 1, further comprising:

applying cardiac pacing stimulation at an at least one second cardiac pacing site;

collecting a second set of paced heart wall motion data from the signal of each of the electromagnetic receiver coils secured at the corresponding position;

comparing the set of non-paced heart wall motion data to the second set of paced heart wall motion data; and

determining, based on the comparing, whether to maintain pacing at the at least one first pacing site, or at the at least one second pacing site, or to apply pacing stimulation at a third pacing site for collection of a third set of paced heart wall motion data.

18. A method for selecting at least one cardiac pacing site, the method comprising:

directing a first elongate lead to a first position along a heart wall, the first lead including an electromagnetic receiver coil and the first position being located in proximity to a base of the heart;

securing the electromagnetic receiver coil of the first lead at the first position, the electromagnetic receiver coil producing a signal in response to an externally induced magnetic field, the signal facilitating creation of a virtual representation of a portion of the first lead to direct the first lead to the first position, and to track wall motion at the first position;

directing a second elongate lead to a second position along the heart wall, the second lead including an electromagnetic receiver coil and the second position being located in proximity to an apex of the heart;

securing the at least one electromagnetic receiver coil of the second lead at the second position, the electromagnetic receiver coil producing a signal in response to an externally induced magnetic field, the signal facilitating creation of a virtual representation of a portion of the second lead to direct the second lead to the second position, and to track wall motion at the second position;

collecting a set of non-paced heart wall motion data from the signal of each of the electromagnetic receiver coils secured at the corresponding position;

applying cardiac pacing stimulation at an at least one first cardiac pacing site;

collecting a first set of paced heart wall motion data from the signal of each of the electromagnetic receiver coils secured at the corresponding position;

comparing the set of non-paced heart wall motion data to the first set of paced heart wall motion data; and

determining, based on the comparing, whether to maintain pacing at the at least one first cardiac pacing site or to apply pacing stimulation at a second cardiac pacing site for collection of a second set of paced heart wall motion data.

19. The method of claim 18, wherein securing at least one of the receiver coils comprises engaging a fixation element of the corresponding lead to the heart wall.

20. The method of claim 18, wherein comparing comprises a torsional analysis to determine a relative rotation between the first position and the second position.

21. The method of claim 18, wherein the at least one first cardiac pacing site comprises a left ventricular pacing site and a right ventricular pacing site.

22. The method of claim 21, wherein the second cardiac pacing site comprises one of:

another left ventricular pacing site and another right ventricular pacing site.

23. A method for selecting at least one cardiac pacing site, the method comprising:

securing a first electromagnetic receiver coil at a first position along a heart wall, the first electromagnetic receiver coil producing a signal in response to an externally induced magnetic field, the signal facilitating creation of a virtual representation of the first receiver coil to track wall motion at the first position;

securing a second electromagnetic receiver coil at a second position along the heart wall, the second electromagnetic receiver coil producing a signal in response to an externally induced magnetic field, the signal facilitating creation of a virtual representation of the second receiver coil to track wall motion at the second position along the heart wall;

collecting a set of non-paced heart wall motion data from the signal of each of the first and second electromagnetic receiver coils secured at the corresponding position;

applying cardiac pacing stimulation at an at least one first cardiac pacing site;

collecting a first set of paced heart wall motion data from the signal of each of the electromagnetic receiver coils secured at the corresponding position;

comparing the set of non-paced heart wall motion data to the first set of paced heart wall motion data; and

determining, based on the comparing, whether to maintain pacing at the at least one first cardiac pacing site or to apply pacing stimulation at an at least one second cardiac pacing site for collection of a second set of paced heart wall motion data.

24. The method of claim 23, wherein at least one of the first and second positions comprises a position located along a right ventricular septum.

25. The method of claim 23, wherein at least one of the first and second positions comprises a position located in proximity to an apex of the heart.

26. The method of claim 23, wherein at least one of the first and second positions comprises a positions located in proximity to a base of the heart.

27. The method of claim 23, wherein at least one of the first and second positions comprises a position located on a left ventricular wall.

28. The method of claim 23, wherein:

the first position comprises a position located along a right ventricular wall;

the second position comprises a position located along a left ventricular wall; and

the comparing comprises a time domain analysis to determine a degree of synchrony between the wall motion at the first position and the wall motion at the second position.

29. The method of claim 23, wherein:

the first position comprises a position located in proximity to an apex of the heart;

the second position comprises a position located in proximity to a base of the heart; and

the comparing comprises a torsional analysis to determine a relative rotation between the first position and the second position.

30. The method of claim 23, wherein the at least one first cardiac pacing site comprises a left ventricular pacing site and a right ventricular pacing site.

31. The method of claim 23, further comprising:

applying cardiac pacing stimulation at an at least one second cardiac pacing site;

collecting a second set of paced heart wall motion data from the signal of each of the first and second electromagnetic receiver coils secured at the corresponding position;

comparing the set of non-paced heart wall motion data to the second set of paced heart wall motion data; and

determining, based on the comparing, whether to maintain pacing at the at least one first pacing site, or at the at least one second pacing site, or to apply pacing stimulation at an at least one third pacing site for collection of a third set of paced heart wall motion data.

32. A method for selecting at least one cardiac pacing site, the method comprising:

introducing a first elongate lead to a position along a right ventricular heart wall, the first lead including a first electromagnetic receiver coil;

coupling the first electromagnetic receiver coil at a position along the right ventricular heart wall;

inducing a first signal in the first electromagnetic receiver coil by generating a magnetic field, the first signal facilitating creation of a first virtual representation of a portion of the first lead to direct the first lead to a first position, and to track wall motion at the position along the right ventricular heart wall;

introducing a second elongate lead to a position along a left ventricular heart wall, the second lead including a second electromagnetic receiver coil;

coupling the second electromagnetic receiver coil at the position along the left ventricular heart wall;

inducing a second signal in the second electromagnetic receiver coil by generating a magnetic field, the second signal facilitating creation of a second virtual representation of a portion of the second lead to direct the second lead to a second position, and to track wall motion at the position along the left ventricular heart wall;

storing a set of non-paced heart wall motion data from the signal of each of the electromagnetic receiver coils secured at the corresponding position;

applying cardiac pacing stimulation at an at least one first cardiac pacing site;

collecting a first set of paced heart wall motion data from the signal of each of the electromagnetic receiver coils secured at the corresponding position;

comparing the set of non-paced heart wall motion data to the first set of paced heart wall motion data;

determining, based on the comparing, whether to maintain pacing at the at least one first cardiac pacing site or to apply pacing stimulation at a second cardiac pacing site for collection of a second set of paced heart wall motion data;

generating notification data which indicates that the first cardiac pacing site being one of an optimal pacing site and a non-optimal pacing site.

33. A computer-readable medium having stored thereon at least one instruction that, when executed by a computer, causes the computer to perform:

introducing a first elongate lead to a position along a right ventricular heart wall, the first lead including a first electromagnetic receiver coil;

coupling the first electromagnetic receiver coil at a position along the right ventricular heart wall;

inducing a first signal in the first electromagnetic receiver coil by generating a magnetic field, the first signal facilitating creation of a first virtual representation of a portion of the first lead to direct the first lead to a first position, and to track wall motion at the position along the right ventricular heart wall;

introducing a second elongate lead to a position along a left ventricular heart wall, the second lead including a second electromagnetic receiver coil;

coupling the second electromagnetic receiver coil at the position along the left ventricular heart wall;

inducing a second signal in the second electromagnetic receiver coil by generating a magnetic field, the second signal facilitating creation of a second virtual representation of a portion of the second lead to direct the second lead to a second position, and to track wall motion at the position along the left ventricular heart wall;

storing a set of non-paced heart wall motion data from the signal of each of the electromagnetic receiver coils secured at the corresponding position;

applying cardiac pacing stimulation at an at least one first cardiac pacing site;

collecting a first set of paced heart wall motion data from the signal of each of the electromagnetic receiver coils secured at the corresponding position;

comparing the set of non-paced heart wall motion data to the first set of paced heart wall motion data;

determining, based on the comparing, whether to maintain pacing at the at least one first cardiac pacing site or to apply pacing stimulation at a second cardiac pacing site for collection of a second set of paced heart wall motion data; and

generating notification data which indicates that the first cardiac pacing site comprises one of;

an optimal pacing site and a non-optimal pacing site.

34. The computer readable medium of claim 33, wherein the optimal pacing site corresponds to a maximum difference in a voltage of the signal induced in the first and second electromagnetic receiver coils relative to a voltage reference.

35. The computer readable medium of claim 34, wherein the voltage reference comprises ground.