Cardiac resynchronization therapy parameter optimization

• US 20100023078A1
• Filed: 01/25/2006
• Published: 01/28/2010
• Est. Priority Date: 01/25/2006
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Stucky, Michael John, Wei, Xuan, Meyer, Scott A., Dong, Yanting, Yu, Yinghong, Ding, Jiang
• Granted Patent: US 8,175,703 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• 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 1/36585 controlled by two or more physical parameters
• 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

Abstract

Systems and methods involve determination of CRT parameters using a number of CRT optimization processes. Each CRT optimization process attempts to return recommended parameters. The CRT parameters are determined based on the recommended parameters returned by one or more of the CRT optimization processes. The CRT optimization processes may be sequentially implemented and the CRT parameters may be determined based on the recommended parameters returned by a first CRT optimization process to return recommended parameters. The CRT parameters may be determined based on a combination of the recommended parameters returned. The CRT optimization processes implemented may be selected from available CRT optimization processes based on patient conditions.

Claims

1. A method for operating a cardiac device to algorithmically determine a value of a parameter for use in delivery of cardiac resynchronization therapy (CRT), the method comprising:

implementing a first cardiac resynchronization therapy (CRT) optimization process including analyzing a first set of physiological signals and returning a first recommended value for a CRT parameter based on the first set of physiological signals;

adjusting a CRT parameter search range of at least one additional CRT optimization process based on the first recommended value;

implementing the at least one additional CRT optimization process including analyzing a second set of physiological signals and using the adjusted search range to return an additional recommended value for the CRT parameter; and

determining the value of the CRT parameter for use in delivery of CRT by the cardiac device based on the additional recommended value.

2. The method of claim 1, wherein:

implementing the at least one additional CRT optimization process comprises sequentially implementing a plurality of additional CRT optimization processes; and

determining the value of the CRT parameter comprises determining the value of the CRT parameter based on a recommended value returned first-in-time by one of the plurality of additional CRT optimization processes

3. The method of claim 2, wherein sequentially implementing the plurality of additional CRT optimization processes comprises sequentially implementing the plurality of additional CRT optimization processes according to a predetermined order indicated by a physician.

5. The method of claim 1, wherein determining the value of the CRT parameter comprises combining the recommended values returned by two or more of the at least one additional CRT optimization process.

6. The method of claim 1, wherein implementing the at least one additional CRT optimization process comprises:

implementing a plurality of additional CRT optimization processes, including implementing a first group of the plurality of CRT optimization processes and implementing a second group of the plurality of additional CRT optimization processes if the recommended values returned by the first group produce an ambiguity in selection of the value of the CRT parameter.

7. The method of claim 1, wherein implementing the at least one additional CRT optimization process comprises selectively implementing the at least one additional CRT optimization process based on information acquired from at least one of an implantable or patient-external device.

8. The method of claim 7, wherein the information comprises patient conditions.

9. The method of claim 1, wherein determining the value of the CRT parameter comprises determining the value of the CRT parameter based at least in part on physician input.

10. The method of claim 1, wherein the CRT parameter comprises at least one of a pacing energy, a pacing waveform, a pacing site, a pacing mode, a pacing rate, an atrioventricular delay, an interventricular delay, and an interatrial delay.

11. The method of claim 1, further comprising implementing CRT using the value of the CRT parameter.

4. (canceled)

12. A medical system, comprising:

sensor circuitry configured to sense physiological signals;

a first cardiac resynchronization therapy (CRT) optimization module configured to analyze one or more of the sensed physiological signals and to return a first recommended value for a CRT parameter used to implement CRT;

one or more additional CRT optimization modules, each additional CRT optimization module configured to analyze one or more of the sensed physiological signals and to use a CRT parameter value search range adjusted using the first recommended value to return an additional recommended value for the CRT parameter;

a processor configured to determine a value of the CRT parameter for use in implementing CRT based on the additional recommended parameters returned by the one or more additional CRT optimization modules

13. The medical system of claim 12, wherein the first CRT optimization module is configured to analyze a first one or more physiological signals and the one or more additional CRT optimization modules is configured to analyze a second one or more physiological signals

14. The medical system of claim 12, further comprising a control module configured to automatically determine an order of implementation of the one or more additional CRT optimization modules.

15. The medical system of claim 12, further comprising a user interface, wherein determination of the value of the CRT parameter is performed based at least in part on information acquired via the user interface.

16. The medical system of claim 12, further comprising a user interface, wherein an order of implementation of the one or more additional CRT optimization modules is determined at least in part based on input acquired from a patient-external device.

17. The medical system of claim 12, wherein the processor is configured to combine the first recommended value and at least one additional recommended value returned by the one or more additional CRT optimization modules and to determine the value of the CRT parameter based on the combined recommended values.

18. The medical system of claim 12, wherein at least one component of the medical system is disposed within a housing of an implantable cardiac rhythm management system.

19. The medical system of claim 12, wherein at least one component of the medical system is disposed within a patient-external device.

20. The medical system of claim 12, wherein the processor is configured to automatically select one recommended value returned by the one or more additional CRT optimization modules as the value of the CRT parameter.

21. The medical system of claim 12, wherein at least one of the CRT optimization modules is selected for implementation based on patient conditions.

22. The medical system of claim 12, wherein the CRT parameter comprises one or more pacing parameters.

23. The medical system of claim 12, further comprising a CRT delivery module configured to deliver the CRT using the value of the CRT parameter.

24. A system for determining a value of at least one cardiac resynchronization therapy (CRT) parameter, the system comprising:

means for implementing a first cardiac resynchronization therapy (CRT) optimization process the first CRT optimization process analyzing one or more physiological signals and returning a first recommended value for at least one CRT parameter;

means for implementing one or more additional CRT optimization processes each additional CRT optimization process analyzing one or more physiological signals to return an additional recommended value for the at least one CRT parameter using a search range that is adjusted based on the first recommended value; and

means for determining the value of the at least one CRT parameter for use in delivery of CRT based on the additional recommended parameters returned by the one or more additional CRT optimization processes

25. The system of claim 24, further comprising:

means for acquiring information related to CRT optimization; and

means for selectively implementing at least one of the first and the one or more additional CRT optimization processes based at least in part on the acquired information.

26. The system of claim 24, wherein the means for determining further comprises means for combining the recommended parameters of returned by the one or more additional CRT optimization processes.

27. The system of claim 24, further comprising means for sequentially implementing the one or more additional CRT optimization processes.