Ventricular Pacing In Cardiac-Related Applications

• US 20150257670A1
• Filed: 10/02/2013
• Published: 09/17/2015
• Est. Priority Date: 10/02/2012
• Status: Active Grant

• Current Assignee: Newstim, Inc.
• Original Assignee: XSynchro, Inc.
• Inventors: Ortega, Daniel Felipe, Spinelli, Julio Csar, Bonomini, Maria Paula, Barja, Luis Dante
• Granted Patent: US 9,392,949 B2
• Time in Patent Office: Days
• US Class Current: 1/1
• CPC Class Codes: A61B 5/283 Invasive
• CPC Class Codes: A61B 5/30 Input circuits therefor
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• CPC Class Codes: A61B 5/341 Vectorcardiography [VCG]
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/366 Detecting abnormal QRS complex, e.g. widening
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• 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 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• 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 1/3684 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 1/3688 configured for switching the pacing mode, e.g. from AAI to DDD
• CPC Class Codes: A61N 1/37254 Pacemaker or defibrillator security, e.g. to prevent or inhibit programming alterations by hackers or unauthorised individuals
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment

Abstract

Various aspects of the present disclosure are directed toward an asynchrony index that is related to data of a subject'"'"'s heart. The asynchrony index includes intra-ventricular or inter-ventricular electrical asynchrony data. The intra-ventricular or inter-ventricular electrical asynchrony data can be specific to a certain subject, and indicative of a different conditions specific to that subject.

Claims

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11. An apparatus comprising:

an acquisition circuit configured and arranged to collect a first signal at a first location of a subject'"'"'s heart and a second signal at a second location of the subject'"'"'s heart, the first signal being indicative of at least one of a first heart surface electrocardiography (ECG) and a first intracardiac electrogram (EG), and the second signal being indicative of at least one of a second heart surface ECG and a second intracardiac electrogram (EG);

preprocessing circuitry configured and arranged to perform detection and filtering of QRS complexes of the first signal and the second signal collected by the acquisition circuit;

analysis circuitry configured and arranged to;

from the first signal and the second signal, extract signal information comprising one or more of parameters and data points,

segment the QRS complexes of the first signal and the second signal using the extracted information,

cross-correlate the QRS complex segments of the first signal and the second signal to produce a correlation signal, and

provide an asynchrony index that at least one of is based on and corresponds to the correlation signal and that indicates a level of electrical asynchrony between the first location and the second location.

12. An apparatus according to claim 11, further comprising intracardiac electrodes, coupled to the acquisition circuit, configured and arranged to collect the first signal and the second signal, and to stimulate the subject'"'"'s heart.

13. An apparatus according to claim 11, wherein the analysis circuitry is further configured and arranged to determine whether the asynchrony index is conclusive, and in response to the asynchrony index being inconclusive, measure the QRS width by performing one of the following:

bandpass filter the first signal and the second signal at 5-15 Hz to enhance the QRS complex; and

locate the peak of the complex via determining a maximum for R waves and minimum for Q-S waves.

14. An apparatus according to claim 11, wherein the extracted information comprises timing of the QRS complex by detection of R or S waves, the correlation signal comprises at least one of Tshift, which comprises a delay between peak obtained from the correlation signal, or Xcorrwidth, which comprises a width of the correlation signal, and the analysis circuitry is further configured and arranged to extract the parameter Tshift from the correlation signal as a measure of time displacement between an activation of the two surfaces of the heart collect from the first signal and the second signal.

15. An apparatus according to claim 11, wherein the analysis circuitry is further configured and arranged to extract Xcorrwidth, which comprises a width of the correlation signal, from the correlation signal as a measure of difference in shape between the first signal and the second signal.

16. An apparatus according to claim 11, wherein the analysis circuitry is further configured and arranged to calculate a Fourier Transform or a fast Fourier Transform of the correlation signal between the first signal and the second signal.

17. An apparatus according to claim 11, wherein the analysis circuitry is further configured and arranged to calculate an energy ratio of a low frequency band of the cross-correlation signal relative to a total energy of the correlation signal energy spectrum.

18. An apparatus according to claim 11, wherein the extracted information comprises information regarding vectocardigraphical data, and wherein the asynchrony index is zero if the vectocardigraphical data is normal, and the asynchrony index is maximal when the vectocardigraphical data is maximally abnormal.

19. An apparatus according to claim 11, wherein the analysis circuitry is further configured and arranged to increase the asynchrony index by a first predetermined factor when both signals have opposite to normal polarities, to increase the asynchrony index by a second predetermined factor, that is less than the first predetermined factor, when the first and second signals have different respective polarities in that one is normal and the other is abnormal.

20. An apparatus according to claim 11, wherein the extracted information comprises at least one of amplitudes of the QRS complexes, and a mean or average of peak-to-peak amplitudes of the QRS complexes.

22. An apparatus according to claim 11, wherein the acquisition circuit is further configured and arranged to collect the first signal and the second signal as corresponding to the first EG and the second EG.

23. An apparatus of claim according to claim 11, wherein the acquisition circuit is further configured and arranged to collect the first signal and the second signal as corresponding to the first ECG and the second ECG.

33. An apparatus according to claim 11, further comprising:

an implantable device configured and arranged to cycle through interventricular delay (VV) intervals or atrio-ventricular (AV) intervals inside a pre-determined safety range and to calculate electrograms obtained by the device during implantation; and

the analysis circuitry further configured and arranged to determine the asynchrony index of the subject based on the electrograms.

40. An apparatus according to claim 11, further comprising circuitry that is communicatively coupled with the asynchrony index and that is used to provide a pacing change of a device configured and arranged to be implanted in the subject.

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