Tissue characterization and treatment using pacing

• US 5,954,661 A
• Filed: 03/31/1997
• Issued: 09/21/1999
• Est. Priority Date: 03/31/1997
• Status: Expired due to Term

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation), Thomas Jefferson University (Main Line Health System)
• Original Assignee: Boston Scientific Corporation, Thomas Jefferson University (Main Line Health System)
• Inventors: Hsu, Steve S., Panescu, Dorin, Swanson, David K., Whayne, James G., Greenspon, Arnold J.
• Primary Examiner(s): Jastrzab, Jeffrey R.
• Application Number:
  US08/831,489
• Time in Patent Office: 904 Days
• Field of Search: 607/9, 607/510, 607/515, 607/518
• US Class Current: 600/510
• CPC Class Codes: A61B 2562/043 in a linear array
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/6858 with a distal basket, e.g. expandable basket
• CPC Class Codes: A61B 5/7217 of noise originating from a therapeutic or surgical apparatus, e.g. from a pacemaker
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate

Abstract

Heart tissue is characterized by using pacing without inducing ventricular tachycardia (VT). With the tissue characterization, a patient'"'"'s risk of developing VT can be determined and a slow conduction zone in the patient'"'"'s heart can be determined. The characterization involves applying pacing signals with varying pacing cycle intervals to a chamber of the patient'"'"'s heart to pace the patient'"'"'s heart. The response signals generated by the paced heart are received and used as the basis for characterizing the patient'"'"'s heart tissue.

Claims

1. A method for characterizing heart tissue, comprising:

(a) applying pacing signals with varying pacing cycle intervals to a chamber of a heart of a patient to pace the patient'"'"'s heart without inducing ventricular tachycardia;

(b) receiving response signals generated by the paced heart; and

(c) characterizing the patient'"'"'s heart tissue based on the response signals.

2. The method of claim 1 wherein step (a) comprises applying the pacing signals which have at least a first pacing cycle interval and a second pacing cycle interval wherein the first pacing cycle interval is shorter in time than the second pacing cycle interval.

3. The method of claim 2 wherein step (c) comprises identifying the patient'"'"'s risk of developing ventricular tachycardia based on the response signals.

4. The method of claim 3 wherein the identifying step comprises:

determining durations of the response signals; and

assessing the patient'"'"'s risk of developing ventricular tachycardia based on the durations of the response signals.

5. The method of claim 2 wherein step (c) comprises identifying a slow conduction zone in the patient'"'"'s heart based on the response signals.

6. The method of claim 5 wherein the identifying step comprises:

determining durations of the response signals; and

identifying the slow conduction zone based on the durations of the response signals.

7. The method of claim 5 further comprising:

treating the slow conduction zone to inhibit electrical conduction by the slow conduction zone.

8. The method of claim 7 wherein treating the slow conduction zone is by ablating the slow conduction zone.

9. The method of claim 2 wherein step (a) comprises applying the pacing signals in which each of the first and second pacing cycle intervals is at least 20% shorter than a pacing cycle interval corresponding to a normal sinus rhythm.

10. The method of claim 2 wherein step (a) comprises applying the pacing signals in which each of the first and second pacing cycle intervals is in the range of about 260 milliseconds to about 800 milliseconds.

11. The method of claim 2 wherein step (a) comprises applying the pacing signals in which one of the first and second pacing cycle intervals is in the range of about 260 milliseconds to about 320 milliseconds.

12. The method of claim 2 wherein step (c) comprises:

determining durations of the response signals resulting from the pacing signals of the first pacing cycle interval and the pacing signals of the second pacing cycle interval;

forming a ratio using the duration of at least one of the response signals resulting from the pacing signals of the first pacing cycle interval and the duration of at least one of the response signals resulting from the pacing signals of the second pacing cycle interval; and

identifying the patient'"'"'s risk of developing ventricular tachycardia based on the ratio.

13. The method of claim 2 wherein step (c) comprises:

determining durations of the response signals resulting from the pacing signals of the first pacing cycle interval and the pacing signals of the second pacing cycle interval;

forming a ratio using the duration of at least one of the response signals resulting from the pacing signals of the first pacing cycle interval and the duration of at least one of the response signals resulting from the pacing signals of the second pacing cycle interval; and

identifying a slow conduction zone in the patient'"'"'s heart based on the ratio.

14. The method of claim 2 wherein step (c) comprises:

determining durations of the response signals resulting from the pacing signals of the first pacing cycle interval and the pacing signals of the second pacing cycle interval;

forming a difference using the duration of at least one of the response signals resulting from the pacing signals of the first pacing cycle interval and the duration of at least one of the response signals resulting from the pacing signals of the second pacing cycle interval; and

identifying the patient'"'"'s risk of developing ventricular tachycardia based on the difference.

15. The method of claim 2 wherein step (c) comprises:

determining durations of the response signals resulting from the pacing signals of the first pacing cycle interval and the pacing signals of the second pacing cycle interval;

forming a difference using the duration of at least one of the response signals resulting from the pacing signals of the first pacing cycle interval and the duration of at least one of the response signals resulting from the pacing signals of the second pacing cycle interval; and

identifying a slow conduction zone in the patient'"'"'s heart based on the difference.

16. A method for characterizing heart tissue, comprising:

(a) placing at least two electrodes in a chamber of a heart of a patient;

(b) using at least one of the electrodes to apply sequentially pacing signals with predetermined varying pacing cycle intervals at multiple sites within the chamber to pace the heart without inducing ventricular tachycardia;

(c) using at least one of the electrodes to receive response signals produced by the paced heart; and

(d) characterizing the patient'"'"'s heart tissue based on the response signals.

17. The method of claim 16 wherein step (b) comprises applying the pacing signals which have at least a first pacing cycle interval and a second pacing cycle interval wherein the first pacing cycle interval is shorter in time than the second pacing cycle interval.

18. The method of claim 17 wherein step (d) comprises identifying the patient'"'"'s risk of developing ventricular tachycardia based on the response signals.

19. The method of claim 18 wherein the identifying step comprises:

determining durations of the response signals; and

assessing the patient'"'"'s risk of developing ventricular tachycardia based on the durations of the response signals.

20. The method of claim 17 wherein step (d) comprises identifying a slow conduction zone in the patient'"'"'s heart based on the response signals.

21. The method of claim 20 wherein the identifying step comprises:

determining durations of the response signals; and

identifying the slow conduction zone based on the durations of the response signals.

22. The method of claim 20 further comprising:

treating the slow conduction zone to inhibit electrical conduction by the slow conduction zone.

23. A system for characterizing heart tissue, comprising:

a signal generator for use with a plurality of electrodes adapted for applying pacing signals to a chamber of a heart of a patient to pace the patient'"'"'s heart, the signal generator also for generating and delivering to the heart via at least some of the electrodes pacing signals with varying pacing cycle intervals without inducing ventricular tachycardia in the patient'"'"'s heart; and

a recorder system for use with the plurality of electrodes and for receiving response signals generated by a paced heart and characterizing the patient'"'"'s heart tissue based on the response signals.

24. The system of claim 23 further comprising a basket catheter comprising a plurality of circumferentially spaced splines for contacting circumferentially spaced endocardial region in the chamber of the heart, each of the splines including at least one of the plurality of electrodes.

25. The system of claim 23 wherein the signal generator includes a computer controller for controlling pacing signal parameters, pacing cycle intervals, and a sequence that the pacing signals are applied via the at least some of the electrodes.

26. The system of claim 23 wherein the recorder system comprises a signal processor for analyzing the response signals to assess the patient'"'"'s risk of developing ventricular tachycardia.

27. The system of claim 23 wherein the recorder system comprises a signal processor for analyzing the response signals to identify a slow conduction zone in the patient'"'"'s heart to produce an identification signal.

28. The system of claim 29 further comprising an ablation catheter and an ablation energy source, the ablation catheter being in electrical communication with the ablation energy source and the ablation catheter being adapted to treat an identified slow conduction zone to inhibit electrical conduction by the slow conduction zone in response to the identification signal.