METHOD AND SYSTEM FOR DETERMINING PACING SETTINGS

• US 20130053915A1
• Filed: 08/28/2012
• Published: 02/28/2013
• Est. Priority Date: 08/31/2011
• Status: Active Grant

• Current Assignee: St. Jude Medical AB (Abbott Laboratories)
• Original Assignee: St. Jude Medical AB (Abbott Laboratories)
• Inventors: Holmstrom, Nils, Karlsson, Andreas
• Granted Patent: US 9,138,583 B2
• Time in Patent Office: Days
• US Class Current: 607/18
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/3682 with a variable atrioventricular delay
• CPC Class Codes: A61N 1/3704 Circuits specially adapted therefor, e.g. for sensitivity control

Abstract

Systems and methods for optimizing the stimulation of a heart of a patient are disclosed herein. The method comprises delivering pacing therapy to the patient according to a pacing therapy setting schedule, using specific pacing intervals via specific electrode configurations. Further, sinus rate values are recorded over at least one cardiac cycle at each pacing therapy setting and it is determined whether a sinus rate value satisfies predetermined measurement conditions, wherein sinus rate values are used for trending the sinus rate over time if the measurement conditions are satisfied. The accepted sinus rate values, i.e. values that satisfy the measurement conditions, are trended over time, wherein each trended sinus rate value is created based on recordings from at least one cardiac cycle. A preferred pacing therapy setting is determined to be the pacing therapy setting that provides a lowest sinus rate.

Claims

1. A method for pacing therapy optimization of a cardiac stimulator implanted in a patient, the method comprising:

delivering pacing stimulation using specific pacing intervals via specific electrode configurations, over a range of pacing therapy settings;

recording sinus rate values over at least one cardiac cycle at each pacing therapy setting;

determining whether a sinus rate value satisfies predetermined measurement conditions;

trending the sinus rate over time using sinus rate values satisfying the measurement conditions; and

determining a preferred pacing therapy setting providing a lowest sinus rate based on a trend analysis of the sinus rate.

2. The method according to claim 1, further comprising:

delivering pacing therapy via at least two different electrode configurations and over a range of pacing intervals for each electrode configuration;

recording sinus rate values over at least one cardiac cycle for each pacing interval for each electrode configuration;

determining whether a sinus rate value satisfies predetermined measurement conditions;

trending the sinus rate over time using sinus rate values satisfying the measurement conditions; and

determining a preferred pacing therapy setting including a preferred electrode configuration and a preferred pacing interval providing a lowest sinus rate based on a trend analysis of the sinus rate values.

3. The method according to claim 1, wherein

said trend analysis comprises analyzing the trended sinus rate values to determine changes in the sinus rate, wherein a change is determined if an increased or decreased sinus rate persists at least a predetermined period of time and/or exceeds a first predetermined threshold or is below a second predetermined threshold, respectively;

and wherein said method further comprises;

selecting the pacing therapy setting that provides the lowest sinus rate for delivery of pacing therapy until next pacing therapy setting adjustment occurs according to said pacing therapy setting schedule.

4. The method according to claim 1, wherein said step of determining whether a sinus rate value satisfies predetermined measurement conditions comprises:

gathering measurement condition information of at least one measurement condition parameter; and

determining that a sinus rate value satisfies said predetermined measurement conditions if a value of said at least one measurement condition parameter indicates acceptable measurement conditions.

5. The method according to claim 4, wherein the step of analyzing comprises:

determining that a sinus rate value do not satisfy said predetermined measurement conditions if a value of said at least one measurement condition parameter indicates that the measurement conditions are not acceptable.

6. The method according to any one of preceding claims, wherein each sinus rate value is a median sinus rate value or an average sinus rate value over the sinus rate of each of a predetermined number of cardiac cycles.

7. The method according to claim 1, wherein said measurement condition parameters comprises:

an activity level of said patient; and

/or

a central body temperature of said patient; and

/or

an atmospheric pressure; and

/or

a body posture of said patient; and

/or

time point for measurement.

8. The method according to claim 7, wherein said measurement conditions parameters indicates acceptable measurement conditions if:

an activity level of said patient being below a predetermined level; and

/or

a central body temperature of said patient being within predetermined limits; and

/or

an atmospheric pressure being within predetermined limits; and

/or

a measurement was performed at specific body posture; and

/or

a measurement was performed during a specific period of time of a day.

9. The method according to claim 1, wherein said step of determining a preferred pacing therapy setting providing a lowest sinus rate based on a trend analysis of the sinus rate comprises:

comparing a value of the sinus rate determined over a predetermined period of time recorded at a previous pacing therapy setting with a value of the sinus rate determined over a predetermined period of time recorded at a present pacing therapy setting; and

selecting the pacing therapy setting providing the lowest value of the sinus rate as the preferred pacing therapy setting.

10. A system for pacing therapy optimization of a cardiac stimulator implanted in a patient, said system comprising:

a pacing delivery module configured to deliver pacing therapy stimulation using specific pacing intervals via a specific electrode configuration, over a range of pacing therapy settings;

a cardiac data recording module configured to record sinus rate values over at least one cardiac cycle for different pacing therapy settings;

an analyzing module configured to;

determine whether a sinus rate value satisfies predetermined measurement conditions;

trend the sinus rate over time using sinus rate values satisfying the predetermined measurement conditions; and

determine a preferred pacing therapy providing a lowest sinus rate based on a trend analysis of the sinus rate.

11. The system according to claim 10, wherein

said pacing delivery module is configured to deliver pacing therapy via at least two different electrode configurations and over a range of pacing intervals for each electrode configuration;

said cardiac data recording module is configured to record sinus rate values over at least one cardiac cycle for each pacing interval for each electrode configuration; and

wherein

said analyzing module is configured to;

determine whether a sinus rate value satisfies predetermined measurement conditions;

trend the sinus rate over time using sinus rate values satisfying the predetermined measurement conditions; and

determine a preferred pacing therapy setting including a preferred electrode configuration and a preferred pacing interval providing a lowest sinus rate based on a trend analysis of the sinus rate.

12. The system according to claim 10, wherein

said analyzing module is configured to:

analyze the trended sinus rate values to determine changes in the sinus rate, wherein a change is determined if an increased or decreased sinus rate persists at least a predetermined period of time and/or exceeds a first predetermined threshold or is below a second predetermined threshold, respectively; and

instruct said pacing delivery module to select the pacing therapy setting that has been determined to provide the lowest sinus rate for delivery of pacing therapy until next pacing therapy setting adjustment occurs according to said pacing therapy setting schedule.

13. The system according to claim 10, further comprising a data collecting module configured to gather measurement condition information of at least one measurement condition parameter;

and

wherein said analyzing module is configured to;

determine that a sinus rate value satisfies said predetermined measurement conditions if a value of said at least one measurement condition parameter indicates acceptable measurement conditions.

14. The system according to claim 13, wherein said analyzing module is configured to:

determine that a sinus rate value do not satisfy said predetermined measurement conditions if said at least one measurement condition parameters indicates that the measurement conditions are not acceptable.

15. The system according to claim 10, wherein said analyzing module is configured to determine at least one median or average sinus rate value over a predetermined number of cardiac cycles for each pacing therapy setting.

16. The system according to claim 10, wherein said measurement condition parameters comprises:

an activity level of said patient; and

/or

a central body temperature of said patient; and

/or

an atmospheric pressure; and

/or

a body posture of said patient; and

/or

time point for measurement.

17. The system according to claim 16, wherein said measurement conditions parameters indicates acceptable measurement conditions if:

an activity level of said patient being below a predetermined level; and

/or

a central body temperature of said patient being within predetermined limits; and

/or

an atmospheric pressure being within predetermined limits; and

/or

a measurement was performed at specific body posture; and

/or

a measurement was performed during a specific period of time of a day.

18. The system according to claim 10, wherein said analyzing module is further configured to:

compare a value of the sinus rate determined over a predetermined period of time recorded at a previous pacing therapy setting with a value of the sinus rate determined over a predetermined period of time recorded at a present pacing therapy setting; and

select the pacing therapy setting providing the lowest value of the sinus rate as the preferred pacing therapy setting.