Method and apparatus for measuring left ventricular pressure

• US 6,666,826 B2
• Filed: 01/04/2002
• Issued: 12/23/2003
• Est. Priority Date: 01/04/2002
• Status: Expired due to Fees

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Salo, Rodney, Auricchio, Angelo
• Primary Examiner(s): Hindenburg, Max F.
• Assistant Examiner(s): Natnithithadha, Navin
• Application Number:
  US10/038,936
• Publication Number:
  US 20030130581A1
• Time in Patent Office: 718 Days
• Field of Search: 600/485, 600/481, 600/486, 600/488, 600/508, 600/509, 607/9, 607/17, 607/23, 607/2, 607/1
• US Class Current: 600/485
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• 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 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: A61N 2001/0585 Coronary sinus electrodes

Abstract

A body implantable system employs a lead system having at least one electrode and at least one pressure transducer at a distal end. The lead system is implanted within a patient'"'"'s heart in a coronary vein of the left ventricle. The lead system includes an occlusion device at a distal end to occlude flow in the coronary vein. The pressure transducer is attached to a catheter that is disposed within an open lumen of the lead system. The pressure transducer senses a coronary vein pressure, the coronary vein pressure being proportional to the left ventricular pressure. The sensed coronary vein pressure gives indications of hemodynamic state of the left ventricle, and measured coronary vein pressure can be used to change a signal sent to the electrode to adaptively pace the patient'"'"'s heart. The body implantable system can further utilize a right ventricular pressure measurement in concert with the left ventricular pressure measurement to modify pacing therapy parameters.

Claims

1. A body implantable system, comprising:

a lead system comprising an open lumen, at least one electrode, and an occlusion device at a distal end of the lead system;

a sensing catheter movably disposed within the open lumen of the lead system, a distal tip of the sensing catheter extendable beyond a distal tip of the lead system, the sensing catheter comprising at least one pressure transducer at a distal end of the sensing catheter; and

a detection/energy delivery system coupled to the lead system, the detection/energy delivery system sensing ventricular rhythms from the at least one electrode, sensing hydrostatic pressure from the at least one pressure transducer, and delivering an electrical signal to the at least one electrode.

2. The system of claim 1, wherein the pressure transducer comprises a capacitive pressure sensor.

3. The system of claim 1, wherein the pressure transducer comprises a piezoresistive pressure sensor.

4. The system of claim 1, wherein the pressure transducer comprises a MEMS pressure sensor.

5. The system of claim 1, wherein the pressure transducer comprises a resistive pressure sensor.

6. The system of claim 1, wherein the detection/energy system delivers a synchronized electrical signal to the at least one electrode for resynchronization therapy.

7. The system of claim 1, wherein the detection/energy system uses a measured pressure from the at least one pressure transducer to adaptively modify the electrical signal sent to the at least one electrode.

8. The system of claim 1, wherein the occlusion device comprises an increased diameter of the lead system at the distal end of the lead system.

9. The system of claim 1, wherein the occlusion device comprises an inflatable member at the distal end of the lead system.

10. The system of claim 9, wherein the inflatable member comprises an absorbable material, the absorbable material inflating upon contact with a fluid.

11. The system of claim 9, wherein the inflatable member inflates by injection of a fluid into the lead system.

12. A method of pacing a patient'"'"'s heart, comprising:

providing a lead system disposed within a coronary vein of the patient'"'"'s heart, the lead system comprising;

an open lumen;

at least one electrode; and

an occlusion device at a distal end of the lead system;

introducing a sensing catheter within the open lumen of the lead system until a distal tip of the sensing catheter extends beyond a distal tip of the lead system, the sensing catheter comprising at least one pressure transducer at a distal end of the sensing catheter;

measuring ventricular electrical rhythms from the at least one electrode to deliver a synchronized electrical signal to the at least one electrode; and

measuring, while occluding blood flow in the vein using the occlusion device, a coronary vein pressure from the pressure transducer to adaptively modify the synchronized electrical signal.

13. The method of claim 12, further comprising measuring a right ventricular pressure prior to adaptively modifying the synchronized electrical signal, and wherein adaptively modifying the synchronized electrical signals further comprises adaptively modifying the synchronized electrical signals to minimize an area of a PP loop derived from the measured right ventricular pressure and the measured coronary vein pressure.

14. The method of claim 12, wherein modifying the synchronized electrical signal further comprises measuring a timing between the measured coronary vein pressure and the measured ventricular electrical rhythms.

15. The method of claim 14, wherein modifying the synchronized electrical signal further comprises modifying the synchronized electrical signal to minimize the pre-ejection period.

16. The method of claim 12, wherein the pressure transducer comprises a MEMS pressure sensor.

17. The method of claim 12, wherein the pressure transducer comprises a resistive pressure sensor.

18. The method of claim 12, wherein the pressure transducer comprises a capacitive pressure sensor.

19. The method of claim 12, wherein the pressure transducer comprises a piezoresistive pressure sensor.

20. The method of claim 12, wherein the occlusion device comprises an increased diameter at the distal end of the lead system.

21. The method of claim 12, wherein the occlusion device comprises an inflatable member at the distal end of the lead system.

22. The method of claim 21, wherein the inflatable member comprises an absorbable material, the absorbable material inflating upon contact with a fluid.

23. The method of claim 21, wherein the inflatable member inflates by injection of a fluid into the lead system.

24. The method of claim 12, further comprising calculating a scaling factor based on a measured coronary vein pressure and a left ventricular pressure after introducing the sensing catheter, and wherein adaptively modifying the rate of the synchronized electrical signal further comprises applying the scaling factor to the measured coronary vein pressure.

25. A method of pacing a patient'"'"'s heart, comprising:

implanting a first lead system into a coronary vein of the patient'"'"'s heart and a second lead system into a chamber of the patient'"'"'s heart, the first and second lead systems each comprising;

at least one electrode; and

at least one pressure transducer at a distal end of the lead system;

measuring ventricular electrical rhythms from the respective electrodes of the first and second lead systems to deliver synchronized electrical signals to the respective electrodes of the first and second lead systems; and

measuring a coronary vein pressure from the at least one pressure transducer of the first lead system and measuring a heart chamber pressure from the at least one pressure transducer of the second lead system to adaptively modify the synchronized electrical signals.

26. The method of claim 25, wherein the second lead system is implanted in the right ventricle, and wherein adaptively modifying the synchronized electrical signals further comprises measuring a right ventricular pressure from the at least one pressure transducer of the second lead system.

27. The method of claim 26, wherein adaptively modifying the synchronized electrical signals further comprises adaptively modifying the synchronized electrical signals to minimize an area of a PP loop derived from the measured right ventricular pressure and the measured coronary vein pressure.

28. The method of claim 25, wherein modifying the synchronized electrical signals further comprises measuring a timing between the measured coronary vein pressure and the measured ventricular electrical rhythms.

29. The method of claim 28, wherein modifying the synchronized electrical signal further comprises modifying the synchronized electrical signal to minimize the pre-ejection period.

30. The method of claim 25, wherein modifying the synchronized electrical signals further comprises measuring a timing between the measured heart chamber pressure and the measured ventricular electrical rhythms.

31. The method of claim 30, wherein modifying the synchronized electrical signal further comprises modifying the synchronized electrical signal to optimize an electromechanical timing period.

32. The method of claim 25, wherein the pressure transducer comprises a MEMS pressure sensor.

33. The method of claim 25, wherein the pressure transducer comprises a resistive pressure sensor.

34. The method of claim 25, wherein the pressure transducer comprises a capacitive pressure sensor.

35. The method of claim 25, wherein the pressure transducer comprises a piezoresistive pressure sensor.

36. The method of claim 25, further comprising calculating a scaling factor based on a measured coronary vein pressure and a left ventricular pressure after implanting a first lead system, and wherein adaptively modifying the rate of the synchronized electrical signals further comprises applying the scaling factor to the measured coronary vein pressure.