Implantable automatic and haemodynamically responsive cardioverting/defibrillating pacemaker
First Claim
1. An apparatus for the treatment of the heart, comprising:
- a) means for obtaining an electrogram from the heart;
b) means for acquiring a signal indicative of ventricular pressure;
c) processing means for processing said signal to produce a signal representative of at least one of filtered peak-to-peak ventricular pressure amplitude and ventricular peak pressure function, the latter comprising the integral of a filtered and rectified ventricular pressure waveform signal;
d) comparison means responsive to said representative signal for determining whether at least one of said filtered peak-to-peak ventricular pressure amplitude and said ventricular peak pressure function is below a predetermined level;
e) examining means for examining said electrogram to determine whether an arrhythmia is present;
f) therapy selection means responsive to said comparison means and said examining means for selecting therapy to apply to the heart if at least one of said filtered peak-to-peak ventricular pressure amplitude and said ventricular peak pressure function is below said predetermined level and an arrhythmia is present; and
g) therapy application means for applying a therapy to the heart.
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Accused Products
Abstract
A cardioverting/defibrillating pacemaker with the ability to sense and respond to haemodynamic compromise. The ventricular pressure (VP) and electrical activity of the heart are sensed via one or more transvenous or epicardial devices. The filtered peak-to-peak amplitude (VFPPA) or a peak pressure function (VPPF) based upon the right and/or left VP waveform(s) are derived. In one embodiment the VP and the electrical activity of the heart are sensed and processed continuously, and the VFPPA or the VPPF continuously derived. The VFPPA or the VPPF, and the ECG are used to initiate bradycardia pacing, antitachycardia pacing and cardioversion/defibrillation therapies. In another embodiment the VP and electrical activity of the heart are continuously sensed. The electrical activity is processed continuously and used to determine whether or not some irregularity exists. If so, one of the VPPF or VFPPA is derived and used to decide which of the therapies are to be used. One of the VPPF or VFPPA is also periodically determined to ensure optimal haemodynamic function. In both emobidments the degree of haemodynamic compromise is determined by comparing the derived VFPPA or VPPF with programmed values. An algorithm maximizes the effectiveness of support pacing. Preferably an ECG transvenous sensor in the right atrium and a combined ECG/VP sensor in the right ventricle are used.
173 Citations
28 Claims
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1. An apparatus for the treatment of the heart, comprising:
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a) means for obtaining an electrogram from the heart; b) means for acquiring a signal indicative of ventricular pressure; c) processing means for processing said signal to produce a signal representative of at least one of filtered peak-to-peak ventricular pressure amplitude and ventricular peak pressure function, the latter comprising the integral of a filtered and rectified ventricular pressure waveform signal; d) comparison means responsive to said representative signal for determining whether at least one of said filtered peak-to-peak ventricular pressure amplitude and said ventricular peak pressure function is below a predetermined level; e) examining means for examining said electrogram to determine whether an arrhythmia is present; f) therapy selection means responsive to said comparison means and said examining means for selecting therapy to apply to the heart if at least one of said filtered peak-to-peak ventricular pressure amplitude and said ventricular peak pressure function is below said predetermined level and an arrhythmia is present; and g) therapy application means for applying a therapy to the heart. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14)
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15. An apparatus for the treatment of a malfunctioning heart comprising:
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a programmable device capable of sensing malfunction of the heart and the successful treatment of malfunction based on electrical and haemodynamic function of the heart; means for calculating a filtered peak-to-peak amplitude and a filtered and rectified integration of a pressure waveform of the right ventricle; means for determining haemodynamic compromise based upon the calculations; first therapy means for initiating anti-tachycardia pacing and cardioversion/defibrillation based on the electrical and haemodynamic function of the heart; and second therapy means for implementing a method of bradycardia support pacing optimization based on both the electrical and the haemodynamic function of the heart. - View Dependent Claims (16, 17, 18, 19)
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20. A method of determining an index of the hemodynamic function of the heart by monitoring right ventricular pressure to obtain a pressure waveform comprising the steps of:
- high-pass filtering the pressure waveform and determining the peak-to-peak amplitude from the filtered pressure waveform to determine an index of hemodynamic function;
or, filtering and rectifying said pressure waveform and then integrating the filtered and rectified waveform to produce a peak pressure function representative of said hemodynamic index. - View Dependent Claims (21, 22, 23)
- high-pass filtering the pressure waveform and determining the peak-to-peak amplitude from the filtered pressure waveform to determine an index of hemodynamic function;
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24. A method of automatically optimizing bradycardia support pacing by monitoring the haemodynamic performance of the heart comprising the steps of:
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sensing the haemodynamic state of the heart by monitoring right ventricular pressure, wherein said step of sensing the haemodynamic state further comprises processing the right ventricular pressure waveform by either high-pass filtering said pressure waveform and determining the peak-to-peak amplitude of said filtered pressure waveform;
or, filtering and rectifying said pressure waveform and then integrating the filtered and rectified waveform to produce a peak pressure functiondetermining that the sensed haemodynamic state is outside programmed performance limits, that there is a relatively steady cardiac state present, and that there is not a tachyarrhythmia present; sweeping through programmed pacing parameter values including at least one of A-V delay and pacing rate in a step wise pattern; reassessing the heart'"'"'s haemodynamic state and electrical activity after each change in pacing parameters; and choosing, out of those pacing parameters tested, ones that produce the best haemodynamic state. - View Dependent Claims (25, 26, 27, 28)
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Specification