Implantable cardiac stimulation device for and method of monitoring progression or regression of heart disease by monitoring evoked response features

• US 6,473,647 B1
• Filed: 10/18/2000
• Issued: 10/29/2002
• Est. Priority Date: 10/18/2000
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Bradley, Kerry
• Primary Examiner(s): Schaetzle, Kennedy
• Assistant Examiner(s): DROESCH, KRISTEN L
• Application Number:
  US09/691,689
• Time in Patent Office: 741 Days
• Field of Search: 600/508-510, 600/516, 600/517, 600/521, 607/4-6, 607/9, 607/17, 607/26-28
• US Class Current: 607/27
• 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 1/3684 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

Abstract

An implantable cardiac stimulation device has a system and method that monitors progression or regression in a patient'"'"'s heart disease. A pulse generator delivers pacing pulses to the heart to cause evoked responses of the heart. A sensing circuit senses the evoked responses of the heart and generates evoked response signals. A processor is programmed to analyze the evoked response signals, to isolate a given characteristic of the evoked response signals and to quantify the isolated characteristics to provide corresponding quantized values. Relative changes in the quantized values over time are indicative of the progression or regression in the patient'"'"'s heart disease. A memory stores the quantized values and a telemetry circuit transmits the stored quantized values to an external receiver for analysis.

Claims

1. An implantable cardiac stimulation device comprising:

a pulse generator that generates pacing pulses for delivery to a heart;

a sensing circuit that senses electrical evoked responses of the heart and generates evoked response signals; and

circuitry connected to the pulse generator and the sensing circuit and that is operative to quantify at least one characteristic of the evoked response signals to provide corresponding quantized values, wherein the circuitry is further operative to process the quantized values to determine if progression or regression of the heart disease exists, and wherein the circuitry is operative to adjust at least one pacing parameter when progression or regression of the heart disease exists.

2. The system of claim 1 wherein the processor is programmed to isolate a positive slope in the evoked response signals, to quantify the positive slopes to provide quantized slope values, and to store the quantized slope values in the memory over time, relative changes in the quantized slope values over time being indicative of changes in conduction velocity of myocardial tissue of the heart.

3. The system of claim 1 wherein the processor is programmed to isolate continuity in the evoked response signals, to quantify the continuity of the evoked response signals to provide quantized continuity values, and to store the quantized continuity values in the memory over time, relative changes in the quantized continuity values over time being indicative of progression or regression in myocardial state.

4. The system of claim 1 wherein the processor is programmed to isolate maximum amplitudes in the evoked response signals, to quantify the maximum amplitudes to provide quantized amplitude values, and to store the quantized amplitude values in the memory over time, relative changes in the quantized amplitude values over time being indicative of changes in wall thickness and conduction velocity of the heart.

5. The system of claim 1 wherein the processor is programmed to isolate T-wave slew rate in the evoked response signals, to quantify the T-wave slew rates to provide quantized slew rates, and to store the quantized slew rates in the memory over time, relative changes in the quantized slow rates over time being indicative of changes in repolarization heterogeneity.

6. The system of claim 1 wherein the processor is programmed to isolate T-wave amplitude in the evoked response signals, to quantify the T-wave amplitude to provide quantized T-wave amplitude, and to store the quantized T-wave amplitude in the memory over time, relative changes in the quantized T-wave amplitudes over time being indicative of changes in repolarization heterogeneity.

7. The system of claim 1 wherein the pulse generator delivers pacing pulses to the right ventricle of the heart.

8. In an implantable cardiac stimulation device, a method comprising:

applying stimulation pulses to a heart according to a set of pacing parameters;

sensing electrical evoked responses and providing corresponding evoked response signals;

monitoring at least one feature of the evoked response signals to provide corresponding quantized values;

processing the quantized values to determine if progression or regression of the heart disease exists; and

adjusting at least one of the pacing parameter when progression or regression of the heart disease exists.

9. The method of claim 8 wherein monitoring comprises quantifying a positive slope in the evoked responses signals.

10. The method of claim 8 wherein monitoring comprises quantifying continuity in the evoked response signals.

11. The method of claim 8 wherein monitoring comprises quantifying maximum amplitudes in the evoked response signal.

12. The method of claim 8 wherein monitoring comprises quantifying T-wave slew rate in the evoked response signals.

13. The method of claim 8 wherein monitoring comprises quantifying T-wave amplitude in the evoked response signals.

14. The method of claim 8 wherein applying comprises applying stimulation pulses to the right ventricle of the heart.

15. In an implantable cardiac stimulation device, a method of monitoring progression or regression of a patient'"'"'s heart disease, the method including the steps of:

applying stimulation pulses to the heart to cause electrical evoked responses of the heart;

sensing the electrical evoked responses to provide evoked response signals;

quantifying at least one isolated feature of the evoked response signals to provide corresponding quantified values, the quantified values over time being indicative of the progression or regression of the patient'"'"'s heart disease;

storing the quantified values in a memory;

conveying the stored quantified values to an external receiver for analysis;

processing the quantified values to determine if progression or regression of the heart disease exists; and

adjusting at least one pacing parameter when progression or regression of the heart disease exists.

16. The method of claim 15 wherein the quantifying step includes quantifying a positive slope in the evoked responses signals, and wherein the storing step includes storing the quantified slope values over time, relative changes in the quantified slope values over time being indicative of changes in conduction velocity of myocardial tissue of the heart.

17. The method of claim 15 wherein the applying step includes applying stimulation pulses to the right ventricle of the heart.

18. The method of claim 15 wherein the applying step includes applying stimulation pulses to the left ventricle of the heart.

19. The method of claim 15 wherein the applying step includes applying stimulation pulses to the right atrium of the heart.

20. The method of claim 15 wherein the applying step includes applying stimulation pulses to the left atrium of the heart.

21. The method of claim 15 wherein the applying step is carried out in accordance with programmed parameters and wherein the method further includes the step of adjusting the programmed parameters responsive to the quantified values.

22. In an implantable cardiac stimulation device, a system for monitoring progression or regression of a patients heart disease, comprising;

stimulation means for applying stimulation pulses to the heart and causing electrical evoked responses of the heart;

analyzing means for analyzing the electrical evoked responses for quantifying at least one isolated feature of the electrical evoked responses to provide corresponding quantified values, the quantified values over time being indicative of the progression or regression of the patient'"'"'s heart disease;

memory means for storing the quantified values;

telemetry means for conveying the stored quantified values to a nonimplanted receiver for analysis;

means for determining if progression or regression of the heart disease exists from the quantified values; and

means for adjusting at least one pacing parameter when progression or regression of the heart disease exists.

23. The system of claim 22 wherein the analyzing means includes means for quantifying a positive slope in the evoked responses, and wherein the memory means stores the quantified slope values over time, relative changes in the quantified slope values over time being indicative of changes in conduction velocity of myocardial tissue of the heart.

24. The system of claim 22 wherein the stimulation means is adapted for applying stimulation pulses to the right ventricle of the heart.

25. The system of claim 22 wherein the stimulation means is adapted for applying stimulation pulses to the left ventricle of the heart.

26. The system of claim 22 wherein the stimulation means is adapted for applying stimulation pulses to the right atrium of the heart.

27. The system of claim 22 wherein the stimulation means is adapted for applying stimulation pulses to the left atrium of the heart.

28. The system of claim 22 wherein the stimulation means applies the stimulation pulses to the heart in accordance with programmed parameters and wherein the system further includes control means for adjusting the programmed parameters responsive to the quantified values.

29. In an implantable cardiac stimulation device, a system that monitors progression or regression in a patients heart disease, the system comprising:

a pulse generator that delivers pacing pulses to the heart to cause electrical evoked responses of the heart;

a sensing circuit that senses the electrical evoked responses of the heart to generate evoked response signals;

a processor programmed to analyze the evoked response signals, to isolate a given characteristic of the evoked response signals and to quantify the isolated characteristics to provide corresponding quantized values, relative changes in the quantized values over time being indicative of the progression or regression in the patient'"'"'s heart disease;

a memory that stores the quantized values;

a telemetry circuit that transmits the stored quantized values to an external receiver for analysis; and

circuitry that is operative to process the quantized values to determine if progression or regression of the heart disease exists, wherein the circuitry is operative to adjust at least one pacing parameter when progression or regression of the heart disease exists.

30. The system of claim 29 wherein the processor is programmed to isolate a positive slope in the evoked response signals, to quantify the positive slopes to provide quantized slope values, and to store the quantized slope values in the memory over time, relative changes in the quantized slope values over time being indicative of changes in conduction velocity of myocardial tissue of the heart.

31. The system of claim 29 wherein the pulse generator delivers pacing pulses to the right ventricle of the heart.

32. The system of claim 29 wherein the pulse generator delivers pacing pulses to the left ventricle of the heart.

33. The system of claim 29 wherein the pulse generator delivers pacing pulses to the right atrium of the heart.

34. The system of claim 29 wherein the pulse generator delivers pacing pulses to the left atrium of the heart.

35. The system of claim 29 wherein the pulse generator delivers the pacing pulses to the heart in accordance with pacing parameters and wherein the processor is further programmed to adjust the pacing parameters responsive to the quantized values.